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Myofascial trigger point perpetuating factor: nutritional deficiencies
Home Pain referral Trigger points Cranial nerve Spinal nerve Historical
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If lasting relief of myofascial pain syndrome is to be achieved, nutritional deficiencies must be assessed. There are three stages to be considered: Vitamin inadequacy, vitamin deficiency and vitamin dependence. To determine the amount of nutritional deficiency, a serum vitamin level must be checked. If the individual has a low serum level but within the normal range this would be considered a vitamin inadequacy.
A deficiency of vitamins and/or minerals can directly or indirectly effect the function of nerves and/or muscles aggravating a myofascial pain complaint by impairing the energy metabolism needed for the contraction of muscles and by increasing irritability of the nervous system. Chronic pain complaints with fatigue and depression may result.
Seldom does metabolic dysfunction affect just one system. The symptomatology usually is gradual in onset and diffuse. Metabolic change secondary to nutritional inadequacy is frequently easy to target.
However, when this metabolic change is secondary to a diseased state it can be quite stealth like in quality. Just as the aging process can transform an inadequacy into a deficiency, the practitioner will note a more rapid degenerative dysfunction with the progression of a disease. Frequently the cardinal indicator of this is the exacerbation of myofascial pain. However, many weeks may pass before additional clinical indicators will appear.
Only a few individuals will be observed with vitamin dependence. This may require pharmaceutical or mega doses of vitamins to compensate.
Recommended levels and daily requirements have the tendency to be somewhat controversial. Therefore, we will refrain from stating specific values as they frequently vary significantly from one authority to another.
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Vitamin A (Retinol)
Most Retinol is stored in the liver and is essential in the utilization of protein in the body, for repair and maintenance of epithelial tissue, for new cell growth and normal growth process. Retinol is needed for normal vision, healthy skin, and protecting against infections of the linings of the digestive, respiratory and urinary tract. It is being studied for its effectiveness as an antioxidant against cancer and other diseases.
Deficiency: The primary reason for deficiency of Vitamin A is diet. While deficiency is rare in developed countries, a secondary reason for deficiency can be malabsorption and distribution due to diseases such as cystic fibrosis, celiac disease (typified by fatty stools), pancreatic disease, and duodenal bypass, to name a few. Certain drugs such as antibiotics, laxatives and cholesterol reducers may also interfere with absorption. Deficiency can cause weak bones and teeth; dry, rough skin, dryness of the eyes with inflammation , night blindness, susceptibility to colds and infections, poor appetite; diarrhea, and in severe cases, corneal damage that when untreated can lead to blindness or sometimes death.
Toxicity: Excessive intake of Vitamin A over a prolonged period may cause hypervitaminosis A. These symptoms include bone pain, headache, fatigue, and nausea, hepatomegaly, splenomegaly, diarrhea, benign intracranial pressure, alopecia, rash, dry skin, and hair. In pregnant women, birth defects are possible. Ceasing intake of Vitamin A will diminish and resolve all symptoms without adverse conditions.
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Vitamin B Complex
...consists of B1, B2, B6, pantothenic acid, niacin, folic acid and biotin, described in detail below.
Vitamin B1 (Thiamine)
This vitamin is essential for the muscle tone of the heart, intestines and stomach, as well as optimizing brain and nerve function and cognitive activity. It is necessary for assisting in blood formation, circulation and proper digestion. Vitamin B1 also acts as an antioxidant against the effects of alcohol consumption, aging and smoking. Lack of this vitamin can cause Beriberi, constipation, GI dysfunction, fatigue, agitation, memory loss, ataxia, shortness of breath, paresthesia in hands and feet, generalized myalgia, hypoesthesia, general weakness, severe weight loss, edema, hepatomegalia, anxiety, and muscle atrophy.
Deficiency: Frequently observed causes of deficiency are directly related to lack of thiamine in diet; secondary causes are increased need due to pregnancy, lactation, fever, hyperthyroidism, impaired absorption or utilization, and alcoholism.
Toxicity: There are no known harmful effects of excessive intake of Thiamine.
Vitamin B2 (Riboflavin)
This vitamin is essential in the utilization of vitamin A as well as the other B vitamins. Riboflavin assists numerous enzymes in the breakdown and absorption of carbohydrates, fats, and proteins. Production of antibodies, hormones, red blood cells, and oxygen being absorbed by tissue are also assisted by Riboflavin.
Deficiency: Causes of deficiency are usually from an insufficient dairy intake, chronic diarrhea, chronic alcoholism, liver disease, antipsychotic drugs, some antidepressants, and oral contraceptives containing estrogen. Early signs of deficiency would show as red blood cell enzyme reduction. Other signs could be paleness, dermatitis, lesions, ariboflavinosis, amblyopia, and photophobia.
Toxicity: There are no known harmful effects of excessive Riboflavin in the diet.
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Vitamin B3 (Niacin)
This vitamin is essential for the functioning of the nervous and digestive systems, circulation, assisting numerous enzymes in the breakdown and absorption of carbohydrates and fats, the manufacturing of sex hormones, and healthy skin and lowering of cholesterol. According to some authorities it is believed to be a memory enhancer and helpful in mental disorders.
Deficiency: A diet low in niacin or malabsorption diseases are the primary reasons for a deficiency. Pellagra is the main symptom of deficiency, although, other vitamin deficiencies can mimic the symptoms. Pellagra involves the central nervous system, skin lesions, the digestive tract, and mucous membranes. The CNS symptoms range from rigid extremities to disorientation, confusion, memory impairment, depression, delirium, and paranoia. Differentiating the CNS symptoms from Niacin or Thiamine deficiency is difficult. The skin lesions have varied appearances while the digestive tract disorders include burning sensations of the throat and mouth, abdominal pain and distention, nausea, vomiting and bloody diarrhea.
Toxicity: Although most experts agree that excessive niacin intake is not harmful, others believe that when taken excessively for prolonged periods of time it may cause liver damage.
Vitamin B5 (Pantothenic Acid)
This vitamin like B2 & B3 is essential for assisting numerous enzymes in the breakdown and absorption of carbohydrates and fats. Needed for normal growth and development, it is also necessary for production of neurotransmitters and the functioning of the nervous system and adrenal glands. It also helps in the manufacture of sex hormones & corticosteroids. Pantothenic Acid is believed to help reduce stress, depression, anxiety, enhance stamina and help prevent anemia.
Deficiency: Usually deficiency is rare. Most foods contain Pantothenic Acid. However, deficiency may occur from serious illness, malabsorption disorders or severe alcoholism. Symptoms of deficiency involve muscle cramps; tingling in the hands; numbness; burning feet; fatigue; headaches; nausea; abdominal pain; respiratory infections and peptic ulcer.
Toxicity: There are no known harmful effects of excessive intake of Pantothenic Acid.
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Vitamin B6 (Pyridoxine)
This vitamin is required for the nervous system and is critical in lipid metabolism, aids in the absorption of vitamin B12, and in immune dysfunction and antibody production. Normal brain function depends on Pyridoxine as well as the formation of red blood cells and the synthesis of nucleic acids. It aids in maintaining sodium and potassium balance, activates many enzymes and acids, and some authors are of the opinion that it plays a major role in immunity to cancer and prevention of arteriosclerosis. It also inhibits homocysteine, which allows the deposition of cholesterol by attacking the heart muscle. Pyridoxine reduces the symptoms of PMS, is a diuretic, valuable in the treatment of asthma, allergies and arthritis, and absorbs fats and proteins.
Deficiency: Frequently observed causes of deficiency are rare as it pertains to dietary intake. However, secondary causes are malabsorption, alcoholism and pharmaceuticals such as antidepressants, oral contraceptives and estrogen therapy as well as diuretics and corticosteroid drugs. Lack of this vitamin can cause sore tongue, inflammation of the mouth and gums, oily facial skin, acne, dermatitis, alopecia, impaired wound healing, nausea, vomiting, anorexia, arthritis, conjunctivitis, learning difficulties, hearing problems, anemia, lymphopenia, myelin degeneration, paresthesia, peripheral neuropathy, retarded growth, fatigue, headaches, irritability, vertigo, depression and convulsions.
Toxicity: Mega dosing of Vitamin B6 can lead to neurogenic dysfunction, ranging from inflammation to ataxia and loss of positional sense of the extremities. Sensory depravation of touch, temperature and pain is less frequently encountered. However, withdrawal of this excessive intake frequently does not lead to complete recovery.
Vitamin B12 (Cyanocobalamin)
Vitamin B12 (Cobalamin) works in conjunction with folic acid and iron. Cobalamin deficiency can be diagnosed as a folic acid deficiency, since the cobalamin is not available to change inactive folic acid to active. This theory is referred to as the “Folic Trap”. B12 is vital for producing red blood cells in bone marrow, the functions of the nervous system, preventing anemia, helping in utilizing carbohydrates and fats, absorption of foods and proper digestion, synthesis of protein, production of materials for DNA, maintaining fertility, and is believed to assist in the production of neurotransmitters that aid memory and learning ability.
Deficiency: Frequently observed causes of deficiency are vegetarian or fad diets, and sometimes, but rarely, alcoholism. Lack of this vitamin can cause abnormal gait or spastic ataxia, muscle pain due to susceptibility of TrP’s, proprioceptive deficit with diminished reflexes, spinal cord degeneration, constipation with occasional diarrhea, abdominal pain, various digestive disorders including anorexia, splenomegaly, hepatomegaly, pernicious anemia, postural hypotension, labored breathing, dizziness, ringing in the ears, inflammation of the tongue, eye disorders, depression, chronic fatigue, drowsiness, irritability, headaches, memory loss, moodiness, nervousness and easily startled, paranoia and hallucinations.
Toxicity: There are no known harmful effects of excessive vitamin B12 in the diet.
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This vitamin is essential for the functions of a coenzyme for carbon dioxide transfer, metabolism of carbohydrates, fatty acids, and the excretion of waste products caused by protein breakdown. Some experts agree that Biotin is needed to help relieve muscle pain, promotes healthy nerve tissue, bone marrow and sweat glands, as well as healthy hair and skin.
Deficiency: Biotin is produced in the intestines therefore deficiency is rare. However, the excessive intake of raw egg whites depletes biotin absorption as well as prolonged use of antibiotics and sulfa drugs. When this occurs the symptoms include dermatitis, hair loss, weakness, fatigue, depression, and poor appetite.
Toxicity: There are no known harmful effects of excessive intake of Biotin.
As stated above, works with Vitamin B12 for the synthesis of DNA and RNA. It is vital for the healthy function of the nervous system and brain, red blood cell formation, formation and functioning of white blood cells (which aids in immunity), prevention of anemia, energy production, alleviating depression and anxiety, and is very important during pregnancy.
Deficiency: Lack of this vitamin can cause: muscular irritability, generalized muscle pain with susceptibility to TrP’s, peripheral neuropathy, “restless” legs at night, spinal cord degeneration, insomnia, fatigue, weakness, depression, apathy, paranoia, forgetfulness, glossitis, anemia, pallor, digestive disturbances, graying hair, growth impairment, labored breathing, and birth defects in offspring. Frequently observed causes of deficiency are diets that have been overcooked or secondary to alcoholism, malabsorption syndrome, or as a side effect of the chemical breakdown caused by oral contraceptives, primidone, phenytoin, barbiturates, and cycloserine.
Toxicity: Most authorities do not attribute any side effects to folic acid toxicity. However, some report that mega dosing on folic acid over a persistent period of time should be discouraged with individuals who either have convulsive disorders or a hormone related form of cancer.
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Vitamin C (Ascorbic Acid)
This vitamin is needed for the metabolism of folic acid. It is also essential in the production of certain neurotransmitters, adrenal hormones, in the deposition of calcium to form bones and teeth, in the production of collagen, increases absorption of iron, promotes wound and burn healing and helps prevent bruising and blood clots. As an antioxidant it helps to protect against infections, the effects of pollution and prevents post exercise muscle soreness or stiffness. It is also believed that when Vitamin C and Vitamin E work together, they may increase their antioxidant activity.
Deficiency: Lack of this vitamin can cause Scurvy, anemia, joint and muscle pain, fatigue, weight loss, poor digestion, prolonged healing time, tendency to bruise easily, bleeding gums, nose bleeds, and tooth loss. Frequently observed causes of deficiency are smoking, alcohol, antidepressants, anticoagulants, oral contraceptives, steroids, and analgesics. While commonly thought that a lack of vitamin C increases susceptibility to common colds and that increased usage diminishes this risk; vitamin C is also thought to aid in, arthrosclerosis and serve as a means of combating malignant carcinoma. The Merk Manual, Seventeenth Edition, however, states that these reports are unproven.
Toxicity: Mega dosing on Ascorbic Acid causes diarrhea, acidic urine, urinary calculi, and promotes iron overload. Rather than taking one mega dose of vitamin C, it is advised to take several smaller doses throughout the day due to our inability to store it. This is especially essential for smokers. Utilizing Vitamin C simultaneously with aspirin therapy has a tendency to cause gastric inflammation. Therefore we recommend coated aspirin and Ester-C. Chewable C can damage tooth enamel. Esterified C seems to be more effective in rapidly metabolizing in the body, storing longer in the cells, which results in less excretion and the preferred choice in its application of chronic disease.
Made of two substances, ergocalciferol (found in irradiated yeast) and cholecalciferol (formed in human skin by ultra violet rays), this vitamin is essential for normal development of teeth and bones, protects against muscle weakness, regulates the balance and absorption of calcium and phosphate, protects against osteoporosis, and enhances immunity.
Deficiency: Balanced diet and normal sun exposure provides the small amount of vitamin D required by the body. However, deficiency can be caused by lack of ultraviolet rays, poor diet, liver and kidney disorders, and prolonged use of some anticonvulsants. Conditions of deficiency are osteomalacia and rickets.
Toxicity: Mega doses of vitamin D may cause weakness, depression, anorexia, nausea, vomiting, nervousness, pruritus, impairs renal function, impairs calcium and phosphate blood levels, excessive urination, polydipsia and metastatic calcifications.
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Vitamin E (Tocopherol)
While well known for its usefulness in repairing scar tissue and burns, Vitamin E is also renowned for its ability to relax leg cramps, and enhance athletic and sexual performance. It is essential for normal cell structure, the formation of red blood cells, maintaining certain enzyme activity, promotes normal blood clotting, reduces blood pressure, improves circulation, and helps in treating fibrocystic breast disease and premenstrual syndrome. It also helps in preventing destruction of red blood cells by poisons in the body, protects lungs and other tissue from pollution damage, maintaining nerve and muscle function, prevents red cell damage and subsequent anemia, as well as promoting healthy hair and skin. As an antioxidant, Tocopherol helps prevent cataracts, cancer, cardiovascular disease, neuromuscular impairment, as well as retards the aging process and aging spots. Vitamin E appears to be more effective when working synergistically with vitamin C and aids other vitamins in their utilization.
Deficiency: Lack of this vitamin may cause anemia, infertility in both sexes, neuromuscular dysfunction, and is associated with heart disease. Some reports also associate lack of vitamin E compound with breast and bowel cancer.
Toxicity: Usually adults can take large amounts of vitamin E over a prolonged period of time without side effects. However, excessive intake can cause muscle weakness, fatigue, diarrhea, nausea, abdominal pain, and vomiting. It may also retard the absorption of vitamins A, D and K.
...is a generic term for derivatives of 2-methyl-1, 4-naphthoquinone. This vitamin is essential for the production of substances in the liver which causes the blood to clot. Some experts believe vitamin K may help prevent osteoporosis and some cancers.
Deficiency: Since the body produces some vitamin K, a normal balanced diet should keep a deficiency from occurring. However, malabsorption disorders and prolonged antibiotic treatment, chronic diarrhea and some liver disorders can cause deficiency. Symptoms of deficiency are internal bleeding, nosebleeds and bleeding of the gums. Intracranial hemorrhage can result in extreme cases.
Toxicity: Mega doses of vitamin K usually have no toxic effect, however, flushing and sweating can be a side effect. Its precursor, Menadione, can cause hemolytic anemia and hyperbilirubinemia (jaundice).
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The effects of the sodium/potassium pump are well acknowledged as it pertains to the contractile response of muscle. While most individuals have an adequate if not excessive amount of sodium in their system, some individuals do experience sodium deficiency (Hyponatremia). When this is observed, it usually results from lack of dietary intake, excessive physical activity or in individuals who use diuretics, which also depletes potassium levels.
Deficiency: Deficiency of this mineral can cause muscular weakness or spasm, headache, anorexia, nausea, vomiting, vascular collapse, and mental confusion or convulsions.
(Sodium Potassium Pump –Na+,K+-ATPase ion pump) This pump requires the energy of Addison Triphosphate (ATP) to transport sodium extracellular while transporting potassium intracellular. This osmotic transportation is conducted through the semi permeable membrane of the cell and controls the water balance.
This mineral affects the nervous system in addition to skeletal smooth and cardiac muscle. Although dietary deficiency is rare in developed countries, when it does occur excessive vomiting, diarrhea, GI disorders, and some kidney diseases may result. Some causes of potassium deficiency may be from excessive use of diuretics, laxatives, sugar, coffee, and alcohol.
Deficiency: Potassium deficiency (Hypokalemia) can cause elevated sodium and cholesterol levels, hypothyroidism, fatigue, muscle weakness, drowsiness, dizziness, arrhythmia, and possible paralysis in severe cases.
This mineral is essential for muscle growth and contraction, the transmission of nerve impulses to nerve endings to muscle fibers, prevention of muscle cramps, functioning of cells, bones, teeth, gums, lower cholesterol levels, and helps in preventing cardiovascular disease. Calcium deficiency is usually caused by heavy exercise, high protein and fat diet, high sugar intake, alcoholic beverages, coffee, excess salt and lack of vitamin D.
Deficiency: Calcium deficiency (Hypocalcemia) can cause aching joints, tetany, paresthesia, rheumatoid arthritis, rickets, osteomalacia, osteopenia, osteoporosis, tooth decay, hypertension, elevated cholesterol levels, heart palpitations, brittle nails, pallor, eczema, nervousness, insomnia, convulsions, depression, delusions, hyperactivity, and cognitive impairment.
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This element is vital to prevent the calcification of soft tissue, muscle weakness, twitching, PMS, assists in the transmission of nerve and muscle impulses, and is a catalyst in enzyme activity, especially energy production. It also protects the arterial linings and helps in the formation of bone as well as assisting vitamin B6 in preventing calcium oxalate kidney stones. Alcohol, diuretics, diarrhea, high levels of zinc, vitamin D, fluoride, foods high in oxalic acid and fat-soluble vitamins can cause deficiency, which is rare.
Deficiency: Magnesium deficiency can cause chronic fatigue, chronic pain syndromes, generalized myalgia, insomnia, depression, confusion, anxiety, irritability, irritable bowel syndrome, digestion dysfunction, tremors, seizures, hypertension, heart palpitations, arrhythmia, sudden cardiac arrest, asthma, and pulmonary disorders.
This mineral is essential for oxygenation of red blood cells and production of hemoglobin and myoglobin (found in muscle tissue), energy and a healthy immune system. Deficiency may result from a lack of vitamin B6 or B12, a high phosphorus diet, poor digestion, internal bleeding, menorrhagia (heavy menstrual bleeding), long-term illness, and excessive amounts of antacids, coffee or tea. Also, excessive amounts of zinc, vitamin E, rheumatoid arthritis and cancer may also interfere with iron absorption and utilization. Iron is stored in the body; therefore, excessive iron intake could also cause hemochromatosis (bronze diabetes).
Deficiency: can cause anemia, which effects oxygen transport. This hypoxic state affects the energy of the muscles, creates ischemic tissue and fatigue. Lack of iron can also cause obesity, fragile bones, pallor, hair loss, misshaped or ridged nails, difficulty swallowing, and inflammation of the tissues of the mouth, dizziness, nervousness, and cognitive impairment.
This trace element is essential for the manufacture of nucleic acids and proteins, wound healing, development of the sexual organs and hormones, normal growth, prostate gland functions, and controlling enzymes.
Deficiency: A balanced diet contains small amounts of zinc, and therefore, deficiency is rare in western civilization. However, zinc deficiency can cause dwarfism, retard development of the sexual organs, anemia, immune disorders, hypo spermia, impaired taste and healing, night blindness, and dermatitis.
Toxicity: Excessive intake of zinc will interfere with the absorption of iron and copper. Symptoms of excessive amounts of zinc can range from vomiting and diarrhea to RBC microcytosis.
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