| Each time you or I purchase a vitamin or | | | | Dysphagia is a common symptom of fibromyalgia, |
| nutritional supplement- whether at our local | | | | so dosage sizes need to be kept to a minimum, |
| pharmacy, grocery, or favorite internet shop- we | | | | and they should be encapsulated or film-coated so |
| are validating the formulation and design decisions | | | | as to be as smooth as possible. Consideration |
| made by that particular manufacturer. The | | | | should be given to how easily the dosage form |
| problem is that we usually aren't aware of these | | | | can be divided or crushed. For some fibromyalgia |
| design choices, making it impossible to accurately | | | | patients, liquid dosage forms will be the only |
| evaluate similar products. | | | | option, so these formulations should always be |
| Of course, some of the design decisions are | | | | evaluated. |
| obvious, and it is a relatively simple matter for us | | | | 4. Taste And Smell Are Important, Too |
| make our selection based upon them. For | | | | Just as size and texture are unusually important |
| instance, a manufacturer's choice of ingredients is | | | | to fibromyalgia patients, so are taste and smell. |
| usually the first thing we would want to know in | | | | Fibromyalgia can heighten these senses to the |
| making our purchasing decision, and we shouldn't | | | | point that tastes and smells barely noticed by |
| have much difficulty determining this information. | | | | healthy individuals can cause extreme discomfort |
| Unfortunately, other important design decisions | | | | in fibromyalgia patients. |
| aren't listed on the label for us. In fact, without | | | | 5. Exile The Excipients |
| some diligence, we probably wouldn't even be | | | | Sometimes, formulation decisions are made that |
| aware that many of these decisions have been | | | | aren't necessarily in the patient's best interest, |
| made. | | | | such as when dyes are added to make a product |
| Wise product selection requires that we know a | | | | more visually attractive. Excipients (non-active |
| little about the design process. I'm not suggesting | | | | ingredients) are added to dosage forms for a |
| a course in pharmacokinetics, but we do need to | | | | number of reasons, and while many are essential, |
| understand the conceptual design process that | | | | some are not. This is of particular concern to |
| occurs before production ever begins. | | | | fibromyalgia patients who often have multiple |
| Product design usually begins with broad goals | | | | chemical sensitivities. While a detailed examination |
| which are narrowed rather quickly as the process | | | | of individual excipients is beyond the scope of this |
| proceeds. For example, the goal in designing a | | | | article, more information on this topic is |
| fibromyalgia supplement might be to create a | | | | available.[1] |
| small, easily swallowed capsule of an odorless, | | | | 6. Find A Good Source |
| tasteless, and completely safe ingredient requiring | | | | It is a dirty secret of the vitamin and supplement |
| infrequent dosing while completely eliminating all | | | | industry that most ingredients are imported- |
| symptoms of fibromyalgia. For many reasons, | | | | usually from China or India. Many times, even |
| these goals need to narrowed, and from here the | | | | products touted as "Made in the USA" are actually |
| design process begins. | | | | created using imported raw materials. The |
| Dosage design is primarily a series of | | | | situation is so severe that, at times, it may be |
| compromises made in getting from the ideal | | | | impossible to find domestic sources for a |
| product to the marketable product. In our | | | | particular ingredient. Given the recent |
| example, the elimination of all fibromyalgia | | | | contamination cases involving imported food |
| symptoms isn't a realistic goal, so every | | | | products, finding a reputable source is more |
| manufacturer must make the same compromise | | | | important than ever and should not be |
| and use an ingredient that actually exists. Other | | | | overlooked. |
| choices, however, are not so clear, and different | | | | 7. More Isn't Always Better |
| manufacturers will reach different conclusions. | | | | Some manufacturers seem to think that simply |
| For instance, the goal of creating an extremely | | | | having the most ingredients is the goal of dosage |
| small capsule may conflict with the goal of | | | | formulation, and I must admit it makes for an |
| infrequent dosing. In fact, the goals may be | | | | impressive label as long as you don't look at the |
| mutually exclusive, and one manufacturer may | | | | numbers. Having all those ingredient comes at the |
| subsequently choose to go with small capsules | | | | cost of not being able to have very much of any |
| dosed multiple times daily, while another may | | | | one ingredient. In some formulations, the bulk of |
| choose large capsules with infrequent dosing. For | | | | the ingredients are available only in token |
| fibromyalgia patients with dysphagia, this is not a | | | | quantities. For fibromyalgia patients, in particular, |
| trivial issue and may well be the determining | | | | this low-dose exposure would seem to be a bad |
| factor in wise product selection. After all, if the | | | | design principle. |
| capsule is too big to be swallowed, it isn't very | | | | 8. Sometimes New Is Just New |
| likely to be effective. | | | | A similarly ineffective design principle (from the |
| By the time the design process is over, many | | | | patient's perspective) is the practice of putting the |
| compromises will have been made, and products | | | | newest, trendiest, or most exotic ingredients in a |
| that began with similar design goals may wind up | | | | product. While it can drive market share for the |
| being quite distinct from one another. The | | | | manufacturer, it usually does little good for the |
| importance placed on a particular design choice is | | | | fibromyalgia patient. Sometimes new is just new, |
| often a matter of personal preference, but | | | | and waiting for the science to catch up is the |
| fibromyalgia patients should always be aware of | | | | wisest course of action. |
| several key design concepts. | | | | 9. Kill The Miracle Cures |
| 1. Science Matters | | | | Miracle cures for fibromyalgia do not exist- not |
| When it comes to nutritional supplements, good | | | | through nutritional supplements, prescription |
| research can be difficult to find. This makes it | | | | medications, dietary modifications, psychotherapy, |
| important to be faithful to the quality studies that | | | | hypnosis or books. Fibromyalgia doesn't have a |
| do exist. For the fibromyalgia patient, this means | | | | switch that simply can be turned off. Instead, we |
| following the protocols used in clinical research. | | | | are dealing with degrees of relief. I would |
| Typical supplements aren't designed this way. For | | | | personally be very skeptical of the design |
| instance, a magnesium supplement designed for | | | | principles behind any product marketed as a |
| the general populace would likely be sub-potent | | | | miracle, cure, or secret. Remember, extraordinary |
| for a fibromyalgia patient. | | | | claims should always require extraordinary |
| 2. The Dosing Schedule Should Be Simple | | | | evidence. |
| Fibromyalgia patients forget stuff; they misplace | | | | This list is not definitive by any means, but it does |
| things; they get confused. If frequent dosing is | | | | cover the basic design concepts that fibromyalgia |
| required, or if the schedule varies, dosing mistakes | | | | patients should consider before purchasing |
| are likely to be made. Pill boxes and timers may | | | | vitamins or supplements. An informed decision |
| help, but dosing schedules should always be kept | | | | should lead to proper product selection, and |
| as simple as possible. | | | | ultimately, a better quality of life. |
| 3. Keep It Small and Smooth | | | | |