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That's how he met her, recalled Siegfried Schmidt, M.D., Ph.D., a family physician and clinical faculty member at the University of Florida who often gets referrals for fibromyalgia patients other health professionals can't seem to help.

"She'd been told it (fibromyalgia) was all in her head," he said. But Schmidt put the problem somewhat lower - in her stomach.

Her stomach? Schmidt and his medical colleagues have been documenting, on a case-by-case basis, the influence of food, or more precisely food additives, on fibromyalgia (Ann Pharmacother 2001;35:702-6). Schmidt is medical director of the department of community health and family medicine at the University of Florida College of Medicine.

He's quick to say he doesn't have a definitive answer - his research is only one piece of the emerging portrait of fibromyalgia. Nonetheless, he hopes it's making a contribution. "Fibromyalgia is chronic condition, and there's no cure," he said. "But there are ways that seem to (aid in) managing it."

In the recent journal article, he and his fellow investigators in Gainesville showed that striking improvements can be achieved in patients who eschew monosodium glutamate, a "taste enhancer" popularly known as MSG. There is evidence to indicate the same may be true with aspartame, a sweetener.

In fact, it's become pretty widely accepted that both additives can affect the human nervous system. When both were eliminated from the diet, there was a dramatic improvement in a handful of patients. The same thing is being seen in more since the publication. Jerry Smith, Pharm D, the senior author of the study, said the results "don't mean that every patient will respond to this."

"But I tell them: 'Try It. It is not going to hurt you.'" Those who respond typically have what Dr. Schmidt calls "an aggressive form" of fibromyalgia - persistent pain and sleep disorders. "We do not state unequivocally that MSG caused their fibromyalgia," he cautioned.

Smith, Schmidt and the other researchers used some past studies as a springboard: Investigations of laboratory animals have shown injections of glutamate result in damage to nerve cells in the brain.

Could it be that there will be an anti-fibromyalgia diet on the horizon? Schmidt doesn't discount it. "It's very complex," he warned. "It may be that diet plays such an important role in some people, that increasing certain nutrient-rich foods will lead to better health for some of them. In others, ordinary meals and a daily multivitamin perhaps would do comparably."

He noted that there have been reports of both the beneficial effects of magnesium and other supplements; One review of the medical literature turned up promising evidence for herbal medicines in the treatment of osteoarthritis (Rheumatology 2001; 40:779-793). In yet another, a vegan diet free of gluten was shown to improve the signs and symptoms of rheumatoid arthritis, when 22 patients in the vegan group were compared with 25 others (Rheumatology 2001:40:1175-1179).

It's likely that there is such a spectrum of factors, from genetic to environmental to nutritional, that the response to any regimen will vary among groups of patients, Schmidt pointed out. In any event, when it comes to fibromyalgia this much is certain: It needs more attention. "I am seeing patients who have been to 20 other doctors," he observed. His first response is to curb the problems that seem to be causing some troubling disruptions in a normal life. First and foremost, that's usually pain.

When pain medications work, the less-intrusive symptoms can be addressed. "There is no one program," Schmidt said, stressing that it usually takes some time to tailor the treatment to the individual.

He's found that fibromyalgia patients to be among the most compliant he has ever treated, and he believes that the depression so commonly seen - and blamed - for the condition frequently is an outgrowth of it, not an underlying cause.

That is just what he told his formerly suicidal patient, a successful business woman who seemed caught up in a destructive cycle of symptom control, followed by flare-ups. "I can't fix you," he told her. But her could help her "manage" the illness, he said.

Schmidt said effective drugs for pain and eradication of dietary additives helped in this case. The result? A relatively happy ending. By maintaining a good diet, getting enough rest and taking a daily bout of exercise that involves a short walk, "she stays functional," he said. Perhaps most of all, the patient has learned her health complications are not all in her head. Every holiday season, as the pressures mount and she exerts herself, she discovers that all over again. "During that season, she may require more medication," Dr. Schmidt said. "Even though I tell her, ‘don't overdo it.'"