Fibromyalgia and Chronic Fatigue Syndrome: A Matter of Boundaries

Fibromyalgia Chronic Fatigue Dr. Eric Viegas Naturopathic Medicine Ottawa

Fibromyalgia and Chronic Fatigue Syndrome: A Matter of Boundaries


Dr. Eric Viegas, ND


Fibromyalgia (FM) affects 1.5% (444, 000) of Canadians over 12 years of age (1). Those who are most affected are women, people over 40, smokers, the obese, low income earners, and the physically inactive (1). However, it is unclear whether or not low income, educational status, smoking, and physical inactivity are consequences or determinants of the disease.


People who suffer with FM have disturbed sleep due to chronic systemic muscular and skeletal pain. Oftentimes FM co-occurs with chronic fatigue syndrome (CFS), a condition characterized by disabling physical and cognitive exhaustion. Unfortunately, 2 out of every 3 people with CFS and/or FM have at least 3 other chronic health conditions (1). As a result, CFS and FM cause significant impairment and stress, both at work and at home.


So how does one develop CFS or FM? About 50% of CFS patients can recall a viral infection triggering their CFS. Others triggers include motor vehicle accidents, surgery, or an unexpected fall (2). Adverse effects of some psychiatric medications may cause overwhelming fatigue.


Some environmental triggers to avoid when living with a diagnosis of CFS and FM include changes in sleep schedule, cold exposure, physical & mental overexertion, sensory & information overload, excessive stress, prolonged driving & air travel, alcohol, and caffeine.


Above all, scheduling “me time” and setting boundaries (both emotional and personal) will help to build energy and reduce the risk of burnout (3).


10 Ways to Kick Fatigue


It is not uncommon for digestive complaints to occur in the presence of CFS and FM (3). Optimizing your digestive function through the use of mindful eating, an elimination diet, and/or hypoallergenic diet may help to lessen digestive burden. Your naturopath may also opt for botanicals and/or supplements to increase digestive function. These interventions may include digestive enzymes, and/or bitters.


In terms of possible vitamin deficiencies in FM and CFS, it is important to know your vitamin B12 status. Deficiency of B12 can lead to anemia, and fatigue (4). Your family doctor, and your naturopath can test for serum values of vitamin B12. Other nutrients shown to be helpful in improving symptoms of CFS and FM target mitochondria and glutathione; the powerhouse of the cell, and your body’s main antioxidant, respectively. These nutrients include N-Acetylcysteine, Alpha-Lipoic Acid, L-Carnitine, and CoQ10.


For more information on what can be done to help your symptoms of FM & CFS, and to find the specific nutritional protocol best suited for you, contact your local naturopath.



  1. Rusu C., Gee M.E., Lagace C., Parlor M. Chronic fatigue syndrome and fibromyalgia in canada: prevalence and associations with six health status indicators. Health Promotion and Chronic Disease Prevention Canada: Research, Policy, and Practice 2015; 35(1): 1-9.
  2. Komaroff AL, Fagioli LR, Geiger AM, et al. An examination of the working case definition of chronic fatigue syndrome. American J Med 1996; 100: 56-64.
  3. Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. J Chronic Fatigue Syndr 2003; 11: 7-115.
  4. Beck WS. Cobalamin and the nervous system. NEJM 1988; 318: 1752-1754.

Gesundheit! Seasonal Allergies and Asthma: Histamine Part 2

Allergies Asthma Dr. Eric Viegas Naturopathic Medicine Ottawa

Gesundheit! Seasonal Allergies and Asthma: Histamine Part 2


Dr. Eric Viegas, ND


With spring (hopefully) around the corner, warmer weather is a cause for celebration. However, for the 20-25% of Canadians suffering from seasonal allergic rhinoconjunctivitis (aka seasonal allergies) the thought of going outside in the spring, summer, and fall months causes significant stress. Sniffling, sneezing, itchy watery eyes, and rashes are all common symptoms of seasonal allergies. In order to feel better, allergy sufferers typically reach for diphenhydramine (aka Benadryl) and other over the counter antihistamines like Claritin, Aerius, Allegra, etc. Benadryl acts on H1 (histamine) receptors and can reduce sneezing, itchy eyes, and itchy runny nose(1). While antihistamines directly blunt the effects of histamine in the body, they do not stop mast cells from releasing histamine (1). Thus, both Benadryl and the newer class of antihistamines have little effect on nasal congestion, and cause significant drowsiness(1). Antihistamines can be effective in the short term, but it is possible to build a tolerance to them, which is why many doctors recommend that patients cycle between different brands. Another option for allergy sufferers is to get “allergy shots”; subcutaneous injections of allergens in increasing amounts over a period of months to years. These shots are given to discourage the immune system from activating mast cells, and an ensuing allergic response, by producing different antibodies.


So, what can be done if you either do not want to take antihistamine medications and “allergy shots”, or find that these therapies do little to quell your sniffles?

To understand what your body needs to deter an allergic response, first you need to take a look at the cascade of reactions that cause it. When an allergen is inhaled, your body relies on IgE antibodies to capture them and signal mast cells or basophils to release histamine and other inflammatory intermediates. These other inflammatory intermediates include free radicals and are therefore susceptible to being quenched by antioxidants. A “mediterranean” diet rich in fruits, vegetables, lean meats (fish, chicken), nuts, seeds, and low in refined carbohydrates, has been associated with lower rates of childhood asthma and allergy (2,4). In a 2005 study, Mao et al. demonstrated that daily consumption of a spirulina supplement reduced inflammatory intermediates in allergic rhinitis patients by as much as 32% (3). Quercetin is an antioxidant found in onions, broccoli, asparagus, green peppers, tomatoes, red leaf lettuce, black & oolong teas, grapes, apples, berries, and wine (5). Known for scavenging free radicals during an allergic reaction, quercetin also: promotes a healthy immune response, has antiviral activity, and stops histamine release from mast cells (5). In 2004, a 21 day study conducted by Takano et al. established that the use of rosemary extract in patients with mild seasonal allergies improved symptoms of itchy nose, and itchy watery eyes(6).


In my last blog post about Histamine Intolerance (HIT), I discussed some of the health consequences and what you can do to help your body with an increased histamine burden. Histamine release is increased by your body when you are dehydrated, hypoglycemic, and stressed. So to properly manage your response to seasonal allergens this spring, make sure to stay hydrated. If you rely on sugary snacks and coffee to get you through your day, then you may notice blood sugar crashes make you groggy. Blood sugar crashes can worsen your response to histamine release, so pair your snacks and meals with a handful of nuts, some avocado, or a serving of protein to promote stable blood sugar. Finally, if you are having trouble managing the stressful factors in your life, consider seeing a Naturopathic Doctor. NDs have an excellent knack for stress management and can get you back on the right track. Gesundheit.




  1. Guilliams TG. “Allergies: the natural approach.” The Standard. May 1998; 1(2): 1-8.
  2. Ulugbek Nurmatov, Graham Devereux, Aziz Sheikh. “Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis”. Journal of Allergy and Clinical Immunology. March 2011; 127(3): 724-733.
  3. T.K. Mao, J. Van de Water, and M.E. Gershwin. “Effects of a spirulina based dietary supplement on cytokine production from allergic rhinitis patients.” Journal of Medicinal Food. April 2005; 8(1): 27-30.
  4. Chatzi L, Apostolaki G, Bibakis I, et al. “Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete.” Thorax 2007; 62:677-683.
  5. Mlcek J, Jurikova T, Skrovankova S, Sochor J. “Quercetin and its anti-allergic immune response.” Molecules 2016; 21(5): 623-638.
  6. Takano H, Osakabe N, Sanbongi C, Yanagisawa R, Inoue K, Yasuda A, Natsume M, Baba S, Ichiishi E, Yoshikawa T. “Extract of perilla frutescens enriched for rosmarinic acid, a polyphenolic phytochemical, inhibits seasonal allergic rhinoconjunctivitis in humans.” Society for experimental biology and medicine. March 2004; 229(3).


Histamine Intolerance: More Than Just Seasonal Allergies

histamine intolerance Dr. Eric Viegas Naturopathic medicine Ottawa

Histamine Intolerance: More Than Just Seasonal Allergies

Dr. Eric Viegas, ND


Histamine is an important inflammatory molecule used by your immune system. Seasonal allergies and asthma are both affected by histamine release in your body, but did you know that gut issues and pain are also affected? In a healthy gut, histamine is produced in large amounts, but your gut cells also do a great job of producing diamine oxidase (DAO) to breakdown histamine. If your gut is inflamed from a chronic digestive issue, your gut cells–called enterocytes–have a limited ability to produce DAO. When the production of histamine outpaces your body’s ability to break it down, histamine can spread from the gut to other parts of your body. Flushing, headaches, rashes, diarrhea and abdominal pain can all result from an imbalance in the breakdown of histamine; this is called histamine intolerance (HIT). HIT has been implicated in anxiety, depression, chronic pain, estrogen dominance, interstitial cystitis, urinary tract infections, IBS, and IBD. Certain medications can also affect HIT.

Children with a history of chronic abdominal pain may benefit from a diet low in the amino acid histidine, and foods that free histamine in your body. Histidine is converted to histamine through a series of steps in your gut. Aged cheeses, red wine, yeast products, and cured meats have all been identified as ‘histamine-rich’ foods; those that can add more histamine to your system. Citrus fruits, while not histamine-rich, have been implicated as a histamine liberator. If DAO is not being produced in sufficient quantities, both histamine-rich foods and histamine liberators can worsen HIT.

Your doctor may be able to test for blood levels of DAO, but unfortunately low DAO blood levels are not always a reliable way to predict HIT. If avoidance of histamine-rich foods improves your symptoms, chances are good that HIT is the culprit. Working with your doctor to strengthen your digestion, immunity, and response to stressors is what will ultimately provide meaningful change in HIT.


Osteoarthritis: How to manage your pain and have a better quality of life

osteoarthritis Dr. Eric Viegas Naturopathic Medicine Ottawa

Osteoarthritis: How to manage your pain and have a better quality of life

Dr. Eric Viegas, ND


An estimated 10% of Canadians over the age of 15 live with a diagnosis of osteoarthritis [OA] (1). 70% of these Canadians experience the majority of their arthritic symptoms in their hips and knees (1). Unfortunately, among Canadians with a diagnosis of arthritis, the average time between onset of their symptoms and an accurate diagnosis can be up to 7.7 years (1). This period of time between onset of symptoms and diagnosis of the disease could be spent making dietary and lifestyle changes to reduce pain and improve quality of life. By 2036 an estimated 7.5 million Canadian adults will have a diagnosis of OA.


So what are the symptoms of OA? Increased stress and aging of our joints leads to breakdown of joint tissue known as cartilage. Cartilage acts as a cushion between the bones of our joints, and without it bones begin to rub against each other. When cartilage is sufficiently worn down, joints are left with bone-on-bone contact; limiting range of motion. As a result, people with OA experience pain, stiffness, and swelling in their affected joints (2).


Lifestyle treatments for OA aim to reduce further injury, relieve pain, and improve joint function. Some of these treatments are as simple as self-management; avoiding repetitive stress on the affected joints. For example, musicians and dancers place repetitive stress on their joints, and they may be at higher risk of developing OA. Obese Canadians are also at risk for OA, and adhering to a lifestyle plan of healthy eating and weight management will help to reduce the pain and damage of OA. Deep breathing and massage therapy can help to relax tense muscles around an inflamed and stiff joint (2). In some cases, joint replacement surgery is required to limit the damage of OA and provide a better quality of life.


So how can naturopathic medicine help with the prognosis of OA?


Naturopathic doctors are able to provide acupuncture, which has been shown to help with the pain, stiffness, and limited range of motion observed in OA.


Curcumin, a strong anti-inflammatory component of the spice turmeric, may help to reduce the pain and stiffness of OA (3,4). Curcumin has also been shown to be an effective remedy to alleviate symptoms of Ulcerative Colitis.


Fish oil also has great evidence for use as a strong anti-inflammatory and antioxidant in OA (5).


Certain people also benefit from a hypoallergenic diet; cutting out potentially aggravating foods that may be contributing to pain and dysfunction.


Finally, for topical pain relief, boswellia serrata AKA frankincense oil mixed with your favourite carrier oil (think sweet almond, olive, coconut, etc) and applied to your affected joints daily may help reduce inflammation and pain (6). In one study of 30 patients with OA of the knee, 8 weeks of boswellia extract significantly improved knee pain, swelling, range of motion, and walking distance compared to placebo (7).


If you are interested in learning more about how naturopathic medicine can benefit your arthritis, please book a visit with your local naturopathic doctor.




  1. MacDonald KV, et al. Symptom onset, diagnosis and management of osteoarthritis. Stats Can Sept 2014.
  2. accessed Sept 5, 2017.
  3. Belcaro G, Cesarone MR, Dugall M, et al. Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev. 2010:15(4):337-344.
  4. Nakagawa Y, Mukai S, Yamada S, et al. Short-term effects of highly bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. J Orthop Sci. 2014;19(6):933-939.
  5. Chen Y, Huang YC, Lu WW. Low-dose versus high-dose fish oil for pain reduction and function improvement in patients with knee osteoarthritis. Ann Rheum Dis. 2016;75(1):e7.
  6. Kimmatkar N, Thawani V, Hingorani L, Khiyani R: Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial. Phytomedicine 2003, 10:3–7.
  7. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis on knee-a randomized double blind placebo controlled trial. Phytomedicine. 2003;10:3–7.

NAC: A Helpful Nutrient for Smoking Cessation, COPD, PCOS, Addiction, and Obsessive Rituals

N-acetylcysteine Addiction Dr. Eric Viegas Naturopathic Medicine Ottawa


N-Acetylcysteine: A Helpful Nutrient for Smoking Cessation, COPD, PCOS, Addiction, and Obsessive Rituals


Dr. Eric Viegas, ND


Cysteine is a sulfurous amino acid found in garlic, broccoli, brussel sprouts, oats, lentils, eggs and meat. Interestingly, sheep require cysteine in order to produce larger quantities of wool. Just like sheep, humans need dietary sources of cysteine because we can’t make it on our own. Cysteine can combine with glycine and glutamate to form glutathione (GSH); one of your body’s key antioxidants. GSH is synthesized in the lungs, and by its main reservoir, in the liver.1 Damage from free radicals, peroxides, and heavy metals is severely limited by adequate levels of GSH.


If these benefits sound appealing, and you’re about to reach for that bottle of reduced GSH, don’t bother. Oral GSH use does not raise the levels of GSH in your bloodstream.2 Instead, SAMe, Vitamin D3, and NAC are nutrients that have been shown to increase levels of GSH in the human body.3,4 This article will focus on NAC’s long use as a safe adjunct to treatments, and as a therapy on its own.


NAC, or N-acetylcysteine, is a dietary supplement that was originally created to combat liver toxicity from tylenol/acetaminophen overdose; the most common cause of poisoning worldwide.5 Currently, there is a growing body of evidence favouring the use of NAC as an adjunctive therapy for various addictions, mental illnesses, hormonal & metabolic problems, and cancer-related conditions.6,7


In 2002, 37 women with polycystic ovarian syndrome (PCOS) and insulin resistance were treated for 6 weeks with 1800-3000 mg/day of NAC. Researchers noted that women treated with NAC had increased insulin sensitivity compared to controls 8 ; their bodily tissues more readily responded to insulin and pulled sugars out of their bloodstream. In addition, NAC induced a significant reduction in testosterone levels. High levels of testosterone are implicated in the worsening of PCOS symptoms.  


NAC restores glutamate concentrations which then stimulates group II mGluR receptors. Glutamate transmission is inhibited and reduces the perceived reward of nicotine.9 In a 2011 3.5 day-long double-blind pilot study, smokers were given 3600 mg/day of NAC or placebo.The group smoked an average of 17.5 cigarettes per day, but they refrained from smoking during the study. When participants were given a cigarette after the trial concluded, those that received NAC reported less satisfaction from smoking that cigarette than individuals in the placebo group.9 Moreover, the NAC group reported less withdrawal symptoms than the placebo group.9 It is important to consider that no addiction therapy is truly successful in the long-term without the help of counselling. Cigarette cravings were not reduced in the NAC group compared to placebo.


Chronic obstructive pulmonary disease (COPD) is a common complication from a history of tobacco use. COPD patients given 600-1800 mg/day of NAC for 2 months had improved red blood cell function, and decreased peroxide levels by up to 54%.1 Mucus hypersecretion in the lungs by elastase activity, and severity of cough also decreased. NAC is also a strong mucolytic, meaning it can break down the chemical bonds in mucus, and allow it to be excreted more easily. The mucolytic activity of NAC makes it a promising nutrient in other respiratory concerns like cystic fibrosis, asthma, sinusitis, and seasonal allergies. To cap things off, NAC can protect DNA in the respiratory and digestive tracts from damage; DNA damage is one of the first steps in carcinogenesis.7


NAC has also demonstrated promising outcomes in cocaine addiction, and bipolar disorder when combined with counselling and medication.6 After 8 weeks of 1800 mg/day of NAC, 16 of 29 pathological gamblers experienced significant reductions in gambling behaviour.6  Since Obsessive Compulsive Disorder (OCD) shares similarities with addiction in terms of brain region activity, NAC may benefit obsessive rituals. Only one case report exists of NAC use in OCD. The patient initially only partially responded to antidepressant medication. With the addition of 3000 mg/day of NAC for 13 weeks, the patient showed improvements in control of compulsive washing and obsessional triggers.6  Trichotillomania (TTM), a grooming disorder where patients obsessively remove body hair, may also benefit from NAC supplementation. 45 women and 5 men with TTM were given 1200 mg/day of NAC, or placebo, for 6 weeks. In the second 6 week period, the dosage was increased to 2400 mg/day of NAC. The participants also received psychotherapy and were medicated. At week 9, and until the end of the study, symptoms of TTM decreased in the NAC group compared to placebo.6


NAC is a nutrient with a long history of safety and efficacy. For more information on the benefits of NAC, and to find out if it is right for you, consult your Naturopathic Doctor.



  1. Dekhuijzen PNR. Antioxidant properties of n-acetylcysteine: their relevance in relation to chronic obstructive pulmonary disease. Eur Respir J 2004; 23: 629-636.
  2. Allen J, Bradley RD. Effects of oral glutathione supplementation on systemic oxidative stress biomarkers in human volunteers. J Altern Complement Med 2011; 17(9): 827-833.
  3. Garcion E, et al. New clues about vitamin D functions in the nervous system. Trends in Endocrinology and Metabolism 2002; 13(3): 100-105.
  4. Lieber CS. S-adenosyl-L-methionine: its role in the treatment of liver disorders. The Amer J Clin Nutr 2002; 76(5): 1183-1187.
  5. Gunnell D, et al. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide & Life Threatening Behaviour 2000; 30(4): 313-326.
  6. Dean O, et al. N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci 2011; 36(2): 78-86.
  7. De Flora S, et al. Mechanisms of n-acetylcysteine in the prevention of dna damage and cancer, with special reference to smoking-related end-points. Carcinogenesis 2001; 22(7): 999-1013.
  8. Fulghesu AM, et al. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertility and Sterility 2002; 77(6): 1128-1135.
  9. Lianne S, et al. Efficacy of n-acetylcysteine in the treatment of nicotine dependence: a double-blind placebo-controlled pilot study. Eur Addict Res 2011; 17: 211-216.