Updates and current research for fibromyalgia/CMP sufferers and their doctors.
- Rule out other auto-immune problems that have similar symptoms, especially lupus and M.S. Also diabetic neuropathy and back problems.
- Fibromyalgia sometimes occurs in symphony with auto-immune diseases (especially lupus & M.S.) The endocrine system is the foundation of the immune system. Even victims of auto-immune diseases, who do not also have fibromyalgia, can benefit from bio-identical hormone replacement, and the additional lifestyle changes.
- I have found that when one person in a family suffers from fibro, others in the family might have auto-immune diseases, especially lupus and M.S.
- Fibromyalgia sufferers have often had either a tubal ligation or hysterectomy (even keeping the ovaries). Some can trace onset to the weeks after a hysterectomy. Ovaries cease to function gradually or suddenly after a hysterectomy or tubal. The body realizes that procreation cannot take place, and blood supply dwindles, with resulting upsetting of hormone balance.
- When I meet a woman who is hypothyroid and has had a hysterectomy, I can predict that she will end up with fibromyalgia.
- According to Dr. John Lowe, Chronic Fatigue Syndrome is a manifestation of fibromyalgia, with an emphasis on fatigue rather than pain. British researchers have newly classified fibromyalgia into 7 sets of symptoms, which are simple gradations from fatigue to pain as the major symptom. These gradations are genetically influenced. They are as follows.
- High anxiety and depression levels, along with poor sleep and high pain levels.
- Significant post-exercise fatigue and joint and muscle pains.
- Mild symptoms–the mildest form of the disease.
- Moderate levels of body pain and sleep problems. (More common.)
- Stomach complaints and the most marked muscle weakness.
- Specifically connected to fatigue. (More common.)
- Seven had the most severe symptoms including pain, swollen glands and headaches.
- Check for prescription drugs that have side-effects similar to fibromyalgia symptoms.
- Check for leaky breast implants which can cause connective tissue disease.
- Check for clusters of symptoms and conditions that often occur with fibromyalgia—hypoglycemia, IBS, depression, foggy mind
- Watch for manifestations of estrogen dominance in the patient’s history: endometriosis, uterine fibroids, fibro-cystic breasts, ovarian cysts.
- Watch for a traumatic, precipitating event following a long period of stress. Such an event might be surgery (especially reproductive surgery), emotional loss, or accident.
Current research on fibromyalgia sufferers shows that they manifest the following physiological anomalies:
- An abundance of substance P (pain)
- Poor cell and mitochondrial aeration
- Poor cell and mitochondrial membrane integrity
- Sluggish or disrupted cellular metabolism
- Low ATP production
- Electrolyte imbalances
- Disrupted calcium metabolism
- Poor thyroid regulation, either due to deficiency or resistance
- Irregular blood-sugar levels, especially reactive hypoglycemia
- Iodine deficiency
- Multiple other nutrient deficiencies (Vitamin D, B-complex, manganese, magnesium, malic acid)
- Low serotonin output
- Unrestful, shallow sleep
- Poor calcium metabolism; osteoporosis; calcium deposits
- Acid pH
- Magnesium disruption (often caused by estrogen dominance)
The importance of balanced electrolytes:
All higher life-forms require a subtle and complex electrolyte balance between the intracellular and extracellular milieu. In particular, the maintenance of precise osmotic gradients of electrolytes is important. Such gradients affect and regulate the hydration of the body, blood pH, and are critical for nerve and muscle function. Various mechanisms have evolved in living species that keep the concentrations of different electrolytes under tight control.
Both muscle tissue and neurons are considered electric tissues of the body. Muscles and neurons are activated by electrolyte activity between the extracellular fluid or interstitial fluid, and intracellular fluid. Electrolytes may enter or leave the cell membrane through specialized protein structures embedded in the plasma membrane called ion channels. For example, muscle contraction is dependent upon the presence of calcium (Ca2+), sodium (Na+), and potassium (K+). Without sufficient levels of these key electrolytes, muscle weakness or severe muscle contractions may occur.”
Dr. Lowe claims that even with normal thyroid test results, a patient who does not gradually recover with treatment can benefit from supraphysiologic doses of T3 thyroid (watching carefully for toxicity). Dr. Lowe has an 85% success rate in curing patients who follow his treatment plan, emphasizing thyroid replacement, but also demanding lifestyle changes. The complex avenues of cellular resistance (complicated by genetics) might account for the other 15 %. It might be impossible, at this stage of medical knowledge, to fathom molecular/intra-cellular interactions in some patients that might render them incurable. Here are some things Dr. Lowe says to watch for when treating patients with thyroid at the center of focus:
- Body temperature doesn’t always increase with treatment, and some patients have normal body temperature to begin with.
- Many fibromyalgia patients have puffy skin and puffy swelling around joint connective tissues. T-3 relieves the puffiness, so watch for that result.
- With hypo-metabolism, the Achilles reflex speed is affected. The foot stalls after the tendon is tapped, or comes back slowly. Watch for good reflex with treatment.
- Watch for low adrenal output mimicking fibromyalgia, especially when there is low blood pressure
- Low adrenal reserve during times of stress manifests itself with muscle fatigue and weakness with thyroid supplementation
- DO NOT administer pharmacologic doses of cortisol = too strong. Use physiologic doses
- The patient should not take prednisone
- Test for potassium. The patient should avoid licorice.
- Determine the need for iodine supplementation, usually needed when taking thyroid (Iodorol or Lugol’s Solution along with ATP Cofactors (riboflavin, thiamine)
- Over-stimulation. Extremely rapid Achilles response. Propanolol can be administered to calm down the thyroid. Caffeine, decongestants, and some anti-depressants can increase over-stimulation response. Doctors sometimes decrease thyroid supplementation until it is too little to do any good. Instead, cut back on stimulants and keep dose up.
- Postpartum response=HPA axis disturbed, or low thyroid, or low progesterone
- Norplant induced over-stimulation response
- The liver is more efficient when thyroid is up = decreased cortisol
- Avoid administering HGH, since it makes connective tissue more susceptible to injury
The following are substances that depress thyroid:
- Sulfa drugs
- Anti-diabetic agents
- Synthetic estrogens (also exogenous, environmental estrogens)
- PCBs, PCBEs
- Flame retardants
- Cigarette smoking
Symptom tracking is necessary with any patient, or the patient might not realize she is getting well. Choose six most prominent symptoms and create a simple chart for tracking them bi-weekly. The patient rates the severity of the symptom with a simple 1 to 5 rating, five being virtually unbearable.
Coaching: Most fibromyalgia sufferers can’t think straight. The patient should have a coach, probably a close family member, to help him/her through the recovery process, which first includes understanding the protocol. The coach should come to all appointments with the sufferer.
Supplementation: The following are supplements that help cell membrane integrity and mitochondrial energy production:
- Co-enzyme B complex
- Calcium AEP to 1100 mg
- Magnesium chelate 500 mg
- Manganese 15 mg
- Malic Acid 800 mg
- Alpha lipoic acid 600 mg
- Acetyl-L-carnitine 500 mg
- Co-enzyme Q10
- Arabinogalactan to 1500 mg
- Ribose 750 mg+
The following are perpetuating influences or barriers to recovery:
- Auto-immune responses
- Back problems
- Injuries (+calcification)
- Surgeries (tubal ligation, hysterectomy, thyroidectomy, etc.)
- Breast implants (leaky)
- Chemical exposure
The following are lifestyle barriers to recovery:
- Diet─ Some patients have very poor nutrition and are unable or unwilling to make changes. They may be inexperienced or may lack knowledge regarding nutrition. They may lack will-power. Enlist family/ coach support. Soy should be limited, as it interferes with thyroid function. Both chlorine and fluoride bind with iodine receptors.
- Ongoing stress─ Stress is often the straw that breaks the back of barely-maintained health. Relieving it can greatly aid recovery. Stress can be physical, mental, emotional. Try to decrease noise in the environment, use pH-correct cosmetics, lower stress at home, say no to the demands of others.
- Addiction to doctors’ care─ Some will decide to abandon the recovery treatment in favor of continuing a close relationship with their doctors. They decide to continue on anti-depressants and pain killers just to continue the relationship.
- Avoidance of “natural” medicine
- Using fibro as an excuse
- Withdrawal from activities/ responsibilities
- Pampering/ hypochondriac tendencies
- Drug dependence
Some notes on other hormones:
- Watch for adrenal deficiency before administering thyroid
- Low cortisol can mimic fibromyalgia
- Low blood pressure can bring on flu-like symptoms
- Look for Addison’s disease, salt cravings
- Look for low adrenal reserve in times of stress
- Post-partum—the HPA axis can be disturbed; look for low progesterone, then low thyroid
- Norplant can induce adrenal fatigue
- The liver becomes more efficient when thyroid is supplemented, and therefore cortisol levels decrease
- If a patient receiving thyroid experiences muscle weakness and fatigue, look for low adrenal reserve
- Never administer pharmacological doses of cortisol = too strong; administer physiologic doses
- Feed adrenals with progesterone.
- When treating adrenals, test for potassium; no licorice
- Decreases anxiety, helps sleep, helps mental acuity
- Good for arthritis
- Test before prescribing; do not administer when testosterone is elevated
- DHEA is low in cases of Chronic Fatigue Syndrome
- When androgens are up, so is metabolism and muscle health
To Watch For
- Thyroid stimulates HGH production and decreases somatomedin C (a hormone that stimulates protein production in tissues), resulting in connective tissue that is more vulnerable to injury; take thyroid, not HGH to keep this side effect in check
- Men who take DHEA should take pygeum, saw palmetto, & stinging nettle to protect prostate
- Research shows that fibro patients have a deficiency in muscle isoenzyme lactate dehydrogenase, causing oxygenation to fail. Patients suck air when exercising, & the reduced oxygen supply results in abnormal accumulation of glycogen in the muscles. Symptoms = pain, fatigue, and muscle stiffness after exercise. There is an increased pyruvate to lactate ratio, which is also consistent with thiamine deficiency.
- Insulin facilitates entry of glucose into the cell and activates the enzyme glycogen synthase. “The inhibition of glycogen synthase activity by exogenous female sex hormones (as in birth control pills) appears to be a factor underlying treatment resistant myofascial trigger points and pain in some women. In most cases, myofascial pain underlain by this mechanism affects multiple muscles and may be misinterpreted as fibromyalgia.”
- Exercise and other catecholamine-releasing stresses can worsen the symptoms of fibromyalgia when the condition is a manifestation of inadequate thyroid hormone regulation of adrenergic gene transcription.
- For the normal interactions of malate in the malate-aspartate shuttle, magnesium and vitamin B6 must be present.
- In fibromyalgia, too little ADP is transported into mitochondria; too little ADP to convert to ATP.
- Availability of oxygen and the respiratory metabolism it permits is the crucial component that allows cells to move beyond glycolysis. T3 increases mitochondrial oxygen consumption. Progesterone is necessary for cellular oxygenation.
- Thyroid hormones may regulate the synthesis of their own receptors. T3 especially does this.
- Thyroid hormone deficiency impairs muscle energy metabolism in susceptible individuals.
- Norepinephrine metabolite levels in the cerebro-spinal fluid of fibro patients has been reported to be low. Low thyroid in infants predisposes them to develop fibromyalgia later. (How does this relate to the fact that most fibro sufferers are female?)
- T3 has a direct effect on the maturation of hypothalamic dopamine neurons. Dopamine stimulates growth hormone secretion. Decreased dopamine due to hypothyroidism lowers locomotor drive and activity. Can account for the fatigue and low motor drive of fibro patients.
- When norepinephrine and serotonin levels are low due to inadequate thyroid hormone regulation of MAO inhibitors, treatment with thyroid hormone should be used instead of pharmaceutical MAO inhibitors. Don’t prescribe anti-depressants.
- Salbutamol increased exercise tolerance and decreased pain in 7 out of 10 FS patients. Also increases brain serotonin synthesis.
- It’s possible that low thyroid in infants (which could be induced by environmental estrogens) can yield permanently low serotonin levels, leading to depression, hypersensitivity to pain, and disturbed sleep.
- High estrogen/low progesterone (especially exogenous estrogens) causes the liver to produce more thyroid-binding globulin, causing thyroid resistance.
Note: Metformin is not only helpful for Type 2 diabetes, but also for hypoglycemia, from which many people with fibromyalgia suffer. Metformin mediating insulin production can help with general hormone balance.
For very detailed analysis of thyroid hypometabolism related to fibromyalgia, see The Metabolic Treatment of Fibromyalgia, by Dr. John Lowe.