Fibromyalgia syndrome is a musculoskeletal pain and fatigue disorder manifested by diffuse myalgia [muscle aches and pain], localized areas of tenderness, fatigue, lowered pain thresholds, and nonrestorative sleep.
This description comes from a paper titled: Fibromyalgia and the serotonin pathway
The paper discusses how low serotonin is often a contributing factor with fibromyalgia and how beneficial tryptophan and/or 5-HTP can be for the anxiety, depression, pain and insomnia we often see in those with classic fibromyalgia:
Evidence from multiple sources support the concept of decreased flux through the serotonin pathway in fibromyalgia patients.
Serotonin substrate supplementation, via L-tryptophan or 5-hydroxytryptophan (5-HTP), has been shown to improve symptoms of depression, anxiety, insomnia and somatic pains in a variety of patient cohorts.
I recently blogged about the effectiveness of 5-HTP being a clinically-effective serotonin precursor and how it improves many of these same symptoms:
Therapeutic administration of 5-HTP has been shown to be effective in treating a wide variety of conditions, including depression, fibromyalgia, binge eating associated with obesity, chronic headaches, and insomnia.
5-HTP improves symptoms of fibromyalgia but can also cause agitation when cortisol is high
An open 90-day study in 50 patients affected by fibromyalgia found benefits with the use of 5-HTP:
When all the clinical variables studied throughout the trial (number of tender points, anxiety, pain intensity, quality of sleep, fatigue) were compared with baseline results, they all showed a significant improvement.
It is concluded that 5-HTP is effective in improving the symptoms of primary fibromyalgia syndrome and that it maintains its efficacy throughout the 90-day period of treatment.
UPDATES March 25, 2022:
Despite the fact that 5-HTP is beneficial for many individuals there is no one-size fits all.
I don’t recommend 5-HTP when a client has elevated cortisol levels because we know that it can raise cortisol levels in certain individuals. This can leave you feeling agitated, cranky, as well as “wired and tired” at the same time. You may be able to relate to this if you’ve ever used 5-HTP to help with anxiety and insomnia and ended up feeling more anxious and more wide-awake despite your exhaustion and need for sleep. You can read more about this here: Does 5-HTP make you “wired-tired” and affect your sleep when cortisol is high?
A tryptophan-enriched diet and a combination tryptophan product for fibromyalgia symptoms
As you can see below, a tryptophan-enriched diet and a combination tryptophan product improved some fibromyalgia symptoms and for some individuals, but we still need to customize protocols.
In this study, Psychological and Sleep Effects of Tryptophan and Magnesium-Enriched Mediterranean Diet in Women with Fibromyalgia, “the intervention group received a Mediterranean diet enriched with high doses of tryptophan and magnesium.” Interestingly, the source of extra tryptophan (60 mg) and magnesium (60 mg) was eating walnuts at breakfast and dinner!
This study concludes that tryptophan and magnesium-enriched Mediterranean diet reduced anxiety symptoms, mood disturbance, eating disorders, and dissatisfaction with body image but did not improve sleep quality in women with fibromyalgia.
The addition of additional tryptophan as a supplement would be the next thing I’d recommend for improving sleep. This would be dosed according to each person’s unique needs and after doing a trial and adjusting as needed.
In another study, Comparison between Acupuncture and Nutraceutical Treatment with Migratens® in Patients with Fibromyalgia Syndrome: A Prospective Randomized Clinical Trial, the treatment group used product called Migratens®, a powdered blend of coenzyme Q10, vitamin D, alpha-lipoic acid, magnesium, tryptophan (300mg), niacin, and riboflavin.
It was used twice a day on an empty stomach and dissolved in a glass of water, spaced about 10 hours apart.
The authors report that “Migratens® treatment shows a statistically significant reduction of pain 1 month after the start of therapy, strengthened after 3 months with maintenance of treatment.” They also noted improvement in quality of life.
Unfortunately, gastrointestinal side-effects (diarrhea, nausea, dyspepsia, constipation, and lack of appetite) were reported by 11% of participants in the treatment group. I’d suspect these side-effects were caused by the ingredients used to make the product slow release.
It’s not surprising that the authors also confirmed “the validity of acupuncture in these patients, as stated by the most recent literature.”
If we suspect low serotonin may be a factor, I have my clients do the following (whether or not they have a fibromyalgia diagnosis):
- complete the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and check off their symptoms on the low serotonin section. The rating uses scale of 1-10 with 10 being worst.
- review the Amino Acids Precautions and figure out if we can do a trial of 5-HTP or tryptophan
- do a trial of the amino acid 5-HTP or tryptophan and observe for improvements in anxiety, depression, pain, insomnia and the other low serotonin symptoms
We are all unique and some people do better on 5-HTP and some do better on tryptophan. I typically start with a tryptophan trial since I’ve seen such great benefits with this amino acid. If that’s not working, we’ll do a 5-HTP trial, always watching for high cortisol as 5-HTP can raise cortisol if it’s already high. In this instance 5-HTP may be too stimulating.
Quality is an important issue when it comes to the amino acids and this is especially the case with tryptophan. I find that the Lidtke brand is the most superior. You can see my amino acid product recommendations here.
If you suspect low levels of serotonin and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the team you or your loved one is working with. Blog posts like this are intended to add value to the chapter on amino acids, which contains detailed information on doses and time of the day for dosing.
If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. It’s an opportunity to interact with me and other practitioners who are also using the amino acids.
Do you have a diagnosis of fibromyalgia and have you found benefits with 5-HTP or tryptophan? For your pain? For your sleep? For your anxiety and/or depression?
I’d love to also hear what else has helped with your symptoms?
Feel free to ask your questions here too.
Hi Trudy; I find that I do much better with 5HTP than with tryptophan but how do you know if you have high cortisol as a result. I take about 200-300 mg a day. Also can you explain what “theraupetic administration of 5HTP” means? Does this signify dose levels or manner of dosing (intravenous, injections, etc.) or something else. Thank you!
Ann
A saliva test that measures cortisol throughout the day (morning, noon, 5pm and 10pm) will show cortisol levels. Most people with high cortisol feel wired when they take 5-HTP. If it’s helping that’s a good sign but I still like to see cortisol levels to be safe.
I’m pleased to hear it’s helping! May I ask how it’s helping? anxiety and pain and insomnia? and when do you take it?
In medicine “theraupetic” means treating or curing of disease. In this study they are referring to depression, fibromyalgia, binge eating associated with obesity, chronic headaches, and insomnia. As a nutritionist I don’t treat or cure but help my clients discover nutritional deficiencies or imbalances and find ways to address them.
Hi Trudy, I am taking 5HTP along with Gaba at night. My symptoms before taking these were anxiety but it was heightened only in the mornings. I feel ok in the evenings. Should I take these in the morning? Also, where would we get what we need to test the cortisol levels? I had a huge life changing event last year and I think my levels have been up ever since…
Mnay thanks,
yolande
Yolande
Some people do fine with GABA and 5-HTP in the morning, some people feel sleepy on them in the morning.
Cortisol tested via saliva is best. I like Diagnostechs. A functional medicine practitioner can order this for you.
Hi Trudy, Some people (like myself unfortunately) don’t tolerate 5-HTP over the long term. It can exacerbate gastritis and stomach ulcers in people who have sensitive stomachs, even if they take the capsules with plenty of food. Would it be worth mentioning this caution on your blog?
Kat
Thanks for mentioning this. This is covered in general in the Amino Precautions link I provide in the blog – to use caution or avoid if you “Have an ulcer (amino acids are slightly acidic)” https://www.everywomanover29.com/blog/amino-acid-precautions/
But you are correct, 5-HTP is specifically known to cause digestive distress, more so than any of the other amino acids. It often passes in a few days but for some people it continues and they have to quit taking it.
Are you able to better tolerate tryptophan? If not, what do you do for serotonin support instead of 5-HTP? exercise? light therapy? St. Johns Wort?
Thanks Trudy, I got sore eyes from St John’s Wort after a few weeks and got nervous about permanent damage. I looked up online and saw others found they got sore, dry eyes and there is some research on this: http://www.ncbi.nlm.nih.gov/pubmed/15623347
My eyes came right once I stopped the SJW luckily.
Most of the aminos I’ve tried haven’t had a noticeable effect so maybe I don’t need them or the brands I have used are not good (there are some restrictions here on what we can buy from overseas).
The problems with my stomach too a while to resolve so I won’t be trying 5-HTP again.
The search continues for what will help. I am open-minded and hopeful 🙂
Kat
Thanks for sharing. Have you tried tryptophan (and what brand?) or full spectrum light therapy or niacin? I’m assuming you have pain, anxiety and insomnia? any other issues?
Hi Trudy,
Thanks you for all you to help others! Have you ever used SAM-E for treatment of Fibromyalgia?
Staci
I have not but it is well known for helping with pain (and mood) and there is promising research “magnesium, l-carnitine, and S-adenosylmethionine are nonpharmacological supplements with the most potential for further research” http://www.ncbi.nlm.nih.gov/pubmed/20192908
I’d love to hear if you use it and how it helps?
Hi Trudy,
Just “discovered” you and it’s given me HOPE! Things have felt pretty bleak. I started yesterday with both GABA and L-tryptophan. Woke, as usual, around 2:30, stayed awake for an hour and finally took .5 xanex, which I truly hate to do! Should I start with one aminoacid, not two? I have almost all the symptoms for low GABA as well as low serotonin.I have Hashi’s, very low adrenal function and am homo for MTHFR A1298C, which might be the really complicating factor. Do you advise just one amino at a time, until I notice a change? Anything I should know about the MTHFR complication? I take methyl folate and b12.
i
Wonderful Lucinda! I have my clients trial one amino acid at a time https://www.everywomanover29.com/blog/how-to-do-an-amino-acid-trial-for-anxiety/.
A benzodiazepine like Xanax can complicate things so do read my blogs the topic (there are many – simply use the search box)
Here is one of many useful blog posts on MTHFR https://www.everywomanover29.com/blog/anxiety-summit-methylfolate-anxiety/
Hi Trudy, been following along. Have a very long complex medical history. So i ll just get to the point. Why do you prefer tryptophan over 5 htp?
My research on tryptophan finds that it needs other things in the gut to convert to 5htp or otherwise its useless. Is it vit b6 and a carbohydrate? Something like that, dont have it in front of me. So how does adding trypto supps in diet get to making seratonin? Im just about to order your recommended Gaba but i want to up my seratonin as ive finally suceeded in getting off SSRI after 20 years of torture on them and the many times of trying to come off and going through discontinuation syndrome. I am elated to say the least that i finally succeeded and i am feeling physically better every day, but i want to support my neurotransmitters because im never going back on meds again. Thanks
Jodie
Over the years I have found better results with clients using tryptophan (and only the Lidtke brand – quality is key). But some do better on 5-HTP so it’s a matter of doing a trial. Lidtke now has Tryptophan Complete with all the cofactors https://www.everywomanover29.com/blog/tryptophan-500mg-or-tryptophan-complete-lidtke/
I interview Ron Sturtz from Lidtke on tryptophan in the upcoming Anxiety Summit http://www.theanxietysummit.com – join us!
Glad you’re doing better every day!
Hi Jodie. I have been trying to come off my SSRI for several years. I have gotten down to just less than half but have a tough time going lower. Insomnia comes right back. I have tried all the animo’s but no luck. Do you have any suggestions on doing it. By the way, I eat a very good paleo diet! Thanks sue
Hi sue, since posting this comment things have gone very downhill im sorry to say. I was going really well for the first month. I did go cold turkey because my psychiatrist and myself had moved me off cymbalta, which has a short half life, to Lovan (Prozac in US)
Because it has a very long half life and is therefore suppose to be easier to taper. Unfortunately the prozac itself made me extremely ill, physically and emotionally. Back to suicidal thoughts. I went to hospital for a day and while waiting i didnt have my dose of prozac and by the evening i had started to feel slightly better. The hospital just wanted to change me back to Paxil, my very first SSRI , i had taken for 18 years. And it stopped working, hence the Cymbalta. But i always knew these meds were making me sicker and i wanted to come off but never could get through a taper.
Anyhow, the day after hospital my GP wrote the script for Paxil. But said it was a 4/7 day wash out period before i could start. In that 7 days i just started feeling better and better, although my pyschiatrist said to use a small dose of Valium as well, so i did and i started weaning them down over the next month also.
Then after my last dose of valium within two days everything turned to mud.
Sad to say im really struggling. I tried the Gaba from source naturals and it didnt help. So im still on Valium which im having breakthrough anxiety because becoming tolerant, but have resisted putting it up. Ive ordered Trudys recommended Lidtke Trypto Complete and have just seen a new intergrative naturopath. I live in Australia so im desperately waiting for the trypto to arrive. My new naturopath agrees with the trypto plan and has added SAMe and a host of other supplements. I was lucky as my Gp had done alot of recent testing which i had copies of so there were clues in the blood results that the naturopath could use to make a plan.
I am too acid so addressing alkalizing and she believes im not methylating properly and the list goes on. Im sorry its not great news, i know how frustrating and frightening it all is. I hope you get to see my reply, i will flag it in my phone, and update as i go along, hopefully with good news.
Hi Trudy,
I watched the anxiety summit and learned so much. I am currently going through a very rough time. I did you test and discovered I am low in serotonin – difficulty falling asleep, staying asleep, adrenal function completely out of sync,anxiety, panic, worrying, stress – low cortisol in the morning and flat the whole day, total fatigue. Unfortunately, I was put on clonzepam 2 mg and I also take 1 zolpidem for sleep, although I was so unrelaxed I couldn’t sleep. I am now trying to gradually reduce the clonazepam and eventually the zolpidem. My question is whether I can introduce the tryptophan you recommended before I come off the above or slowly start introducing it while I taper? Also, do you do private consultations via skype/phone as I live abroad.
Thanks for your advice
Yael
I have been really struggling with depression and anxiety over the past several weeks. My practitioner already had me on 150mg of 5HTP per day and several hundred mgs of Mucuna Pruriens. As some events came up and the depression and anxiety became more acute she pulled the MP, but told me to increase the 5HTP. I took 100mg with lunch two days ago after a fairly low key morning and within an hour I could feel myself becoming agitated and very anxious. After reading your material above I’m convinced that I’m sensitive to 5HTP and I’ve probably been on too much all along. I have MAO SNPs as well. I’ve typically had a low/normal cortisol pattern when we’ve looked at saliva (it’s been a while) but this feels like the high cortisol issue that you describe. So I’m safe in taking l-tryptophan instead? I’m desperate to sleep past 4AM without taking loads of Benadryl or Seroquel (which I’ve been using sparingly lately out of desperation).
Thanks.
Jason
Jason
Some people find 5-HTP too stimulating and do better with tryptophan. I’d talk to your practitioner about doing a trial of tryptophan (assuming you have low serotonin anxiety and depression https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/)
The starting dose of tryptophan is 500mg but for sensitive folks that may even be too much as we start lower and build up. I also like to do amino at a time so we know what is working. I prefer a tryptophan-only product but some people find the Lidtke Tryptophan Complete works better for them (some don’t so it’s trial and error) https://www.everywomanover29.com/blog/tryptophan-500mg-or-tryptophan-complete-lidtke/
I only use stimulating amino acids (I use tyrosine and not mucuna) once sleep is good and we’ve calmed things down.
May I ask if your practitioner is trained in the Dr. Marty Hinz method?
Thanks for responding Trudy. I bought the Lidtke tryptophan 500mg and started it over the weekend before bed, one capsule. I also take 25mg of Benadryl before bed and, so far, my insomnia is still breaking through, most notably between 4 and 4:30AM. I use things like Valerian, Skull Cap and l-theanine when I wake up early and can’t fall back to sleep. My mood is pretty poor alternating between pretty deep depression and anxiety. Should I dump out half the contents of the capsule to lower the dose? I’ve been on the 500mg for 3 days so far.
Thanks.
Jason
I can’t give you specific advice via the blog but as I mentioned I do a trial increasing to see added benefits, I also try the Tryptophan Complete. Taking tryptophan on waking in the early hours often helps too.
I also consider melatonin timed-release and GABA if there is physical tension and low GABA symptoms.
I’d also look into SIBO, remove all gluten and all caffeine (even decaf), and parasites, plus sleep apnea.
A history of benzodiazepine use or SSRIs can also be a factor.
I have similar issues to Jason and I can confirm that breathing and apnea are an issue – I do Buteyko breathing before bed to get my controlled pause score up and that does help. Also, if I have a heavy gluten dinner, etc. it definitely affects my breathing.
Jill
Hearing “heavy gluten dinner affects my breathing” is a big red flag to me. I’d investigate a 100% gluten free diet
I forgot to answer your question – my practitioner has not mentioned the Dr. Marty Hinz method.
I’d love to hear back from you about this the next time you see him
I spoke to her yesterday. Unfortunately, I forgot to mention the Hinx protocol but I’m rather obsessed with how I’m feeling. I told her that I had tried switching to l-tryptophan from 5htp because I was suspicious that 5htp was causing me to be agitated and anxious. She said that she’s had worse luck with that with her clients using l-tryptophan. I can’t say that I’ve had any relief from the anxiety and air hunger symptoms since switching to l-tryptophan several days ago so we agreed that I would discontinue and focus more on GABA to try to get some help with the anxiety. I’m using PharmaGABA at night for that. She prefers Phenotropic but I am afraid of becoming addicted to it and having to wean off. She said that if PharmaGABA works it’s only because I have a leaky BBB and that I’ll need to wean off of that too. Her concern is getting the anxiety under control and to worry about weaning off of supps later, if necessary.
Thanks.
Trudy,
I have been dealing with some very odd symptoms the past couple of years. Until recently we believe I might be dealing with some sort of autoimmune disease. I get a very distinct rash similar to lupus. I have problems after eating, I get extremely high blood pressure, I get seizure like when my blood pressure is too high, I have extremely tight muscles in my face, neck, and back. My breasts are constantly lumpy feeling and sometimes burn. Recently my blood test have shown ANA in my body and very low serotonin levels ( <25). I started slowly taking L-tryptophan with B6. I was wondering if it might be better for me to try 5- HTP. I did produce anxiety over the past couple of years after dealing with all this. The symptoms and the factor of not know what is going on put me into a state of panic at times. Sometimes I am strong and can handle when I am having a flare up or bad episode but other times I cannot. I know 5-HTP can cause high cortisol levels? I am wondering what would be best for me to do considering I need to get my serotonin levels up a lot! How fast can serotonin levels rise on these supplements?
Jessica
If someone has low serotonin symptoms (I use the questionnaire) tryptophan and 5-HTP have an immediate impact.
With what you describe I’d also consider looking into a histamine (Yasmina covers some of this here https://www.everywomanover29.com/blog/anxiety-summit-histamine-anxiety-depression-schizophrenia/) and possibly salicylate reaction.
HOW TO SWITCH FROM PROZAC 20 MB TO TRYPTOPHAN? and how to replace xanax….for something healthy……..I AM RECOVERING FROM PTSD AND BRAIN TRAUMA COGNITIVE LOSSES AND FIBROMYALGIA AND VISION LOSS AFTER LEAVING AN ABUSIVE AND VIOLENT HUSBAND. i am tired of traditional chemical medications that just take away so much from me. I ENDED UP DISABLED AND HOMELESS AND NEED TO GO BACK TO THE HEALTHY FOOD AND SUPLEMENTS THAT I WAS ABLE TO AFFORD BEFORE SEPARATED. I WANT TO HEAL AND THRIVE! THANKS, isa
Isa
I’m sorry to hear this. have my clients get the ok from their doctor with adding tryptophan. We spend a month or two supporting them nutritionally – real food, no gluten, no sugar, no caffeine and add tryptophan 6 hours from SSRI. Once they are feeling better they begin the taper until their doc’s supervision. After this the benzo could be tapered (using the very slow Ashton method)
With PTSD these are often very helpful too: adrenal support, addressing low omega-3s, low vitamin D and doing EMDR.
Isa,
As Trudy suggests EMDR is great but you usually have to pay someone else to do it with you. EFT which is “emotional freedom technique”, is a simple tapping method on the meridians as you say various statements and can be learned in a few minutes and done daily. It has clinically proven results and scientific studies using it effectively for especially PTSD but all kinds of emotions , beliefs, and health conditions. Check out Nick Ortner’s work with http://www.thetappingsolution.com who offers lots of free education, tools and research.
I agree, tapping is wonderful! e.g. even veterans who were so traumatized they could barely speak – nothing else helped…they tried tapping and within a short time, it made a massive difference in their life functionality!
Once again, Trudy, you have insights that others don’t write about. I recently switched to 5-HTP because the store was out of tryptophan and I would take it 30 minutes before bed and my heart would race and pound out of my chest!
I am in a high stress anxiety period so my cortisol was already excessive and as soon as I switched back to tryptophan this side effect stopped of elevated heart rate and increased anxiety. I also couldn’t get to sleep sometimes because I felt so over stimulated, so thanks for the distinction!
All the amino acids work wonders for me and my clients- I take tryptophan, tyrosine, gaba and theanine almost daily for fibromyalgia, sleep and overall balance of my emotions and mood.
Sophia
Thanks for sharing how 5-HTP affected you and so glad to hear the amino acids work wonders for you and your clients
Trudy, I’ve followed your work for a while (thank you!)…first being pyroluria and the protocol for that made a huge difference for me! I have had depression historically (runs in the family) and found that 5 HTP upon waking and with lunch helps, followed by GABA with dinner and bedtime. I was technically diagnosed with fibro and chronic fatigue, although I don’t pay it attention and don’t let it slow me down. But I have struggled with sleep my whole life. Lately, I’ve been doing magnesium, L-theanine, GABA, L-tryptophan, sometimes low dose melatonin (high dose makes me wired) and sometimes try mixing in various other sleep herbs. Combined with breathing exercises and mantras, I can USUALLY get to sleep ok. (also I commented above that I try to do Buteyko breathing and get my controlled pause up so breathing isn’t obstructed). But I still tend to wake up several times (or more) during the night – no idea why. Any ideas on that?
(btw I found Lidtke L-tryp wasn’t very effective for me – I’m using some other brand now that seems better)
Jill
So glad to hear you’ve benefitted from the pyroluria protocol and amino acids. I am curious to hear which brand of tryptophan works better for you than Lidtke).
Good to hear re Buteyko breathing – how long have you been doing that and what benefits have you seen?
For sleep we make sure to optimize the amino acids and I always start with addressing low serotonin with tryptophan and low GABA with GABA – and make sure to find the ideal dose.
Next we also look at high cortisol, SIBO, parasites, blood sugar balance, gluten/sugar/caffeine consumption (and other dietary factors like histamine/glutamates/oxalates and collagen consumption etc), meds side-effects, sex hormone imbalances, sleep apnea, dietary oxalate issues and EMFs when someone has waking in the night.
My book “The Antianxiety Food Solution” addresses all this in addition the amino acids: real whole food, quality animal protein, fermented foods, organic produce, health fats, gluten/sugar/caffeine removal, blood sugar control, gut health. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Trudy I have a question about GABA. I take 5 mg Klonopin per day for anxiety, and I know it’s a big dose. A while back I did your Amazing amino acids program. I got a bottle of GABA Calm and I tried to use it as directed in the program. However, I did not get a significant benefit from it. I was wondering if maybe the reason I didn’t get benefit from the GABA Calm was because I take the Klonopin? Any thoughts on this?
Thanks, Patrick Lewis.
Patrick
That could be a reason (and is a common one) but it may also be that the optimal dose of GABA was not used. It’s always best to start low and increase until the ideal dose is found for symptom relief. How much did you start with and increase to? And did you get any symptom relief? If yes it’s a clue to continue.
Dear Trudy
I have been taking l-tryptophan since new year. My mood improved immediately but I’ve noticed my muscle aches are getting worse and also I’ve started grinding my teeth at night and get head aches in the morning now (never used to this head aches) . I think my sleep is not restful. I’ve had this muscle flare up on and off for 11 months now (since my 2nd covid jab) but this grinding teeth and head aches are new and recent. Could this be from tryptophan? I used to grind my teeth when I was taking Prozac and other prescription meds years ago! I’m thinking of looking at 5-htp but I’m not sure if my cortisol levels are too high eg stress head sleeping. What is normal & where do I get a swab test? … that’s a lot up ask! Thanks in advance! I appreciate and love what you do! Rx