Focusing on Fibromyalgia
FibromyalgiaNatural practitioners can help their patients with fibromyalgia address the symptoms head on.
Fibromyalgia has been recognized by physicians since the early 1800s, but it wasn’t until 1981 when the first scientific study confirmed that its symptoms were found in the body, according to Fibrocenter.com. Soon after, in 1990, the American College of Rheumatology composed the first set of guidelines for physicians to diagnose fibromyalgia, and in 2005, the American Pain Society published the first guidelines for medical treatment. Soon after, in 2007, the first prescription medication to manage fibromyalgia was approved by the FDA (U.S. Food and Drug Administration).
Still, it is very confusing to many people; as its key symptoms are often seen as singular, or as representative of something else. It is closely related to chronic fatigue syndrome, of which there are several shared symptoms.
Vladimir Badmaev, MD, PhD, CEO of American Medical Holdings, explained, “Fibromyalgia (FM) and chronic fatigue syndrome (CFS) represent a syndrome, or a group of closely associated symptoms, including generalized muscular and skeletal pain, tissue tenderness, persistent fatigue, sleep disturbances, cognitive impairment and psychological distress.”
He elaborated that the fatigue characteristic in both FM and CFS is that it comes suddenly and is relentless or relapsing, causing debilitating tiredness in someone who has no apparent reason for feeling that way. The onset of CFS often mimics flu, however unlike a flu that comes and goes away, this conditions leaves a person with long-term/enduring flu like symptoms. Overall, body aches normally associated with the onset of the flu is commonly associated with CFS and, in fibromyalgia there’s also chronic diffuse pain of muscles and bones.
Fibromyalgia, said FM expert Jacob Teitelbaum, MD—author of numerous books including The Fatigue and Fibromyalgia Solution, is characterized by muscle pain—sometimes all over the body, or sometimes only in specific areas. These painful areas can be transient or persistent, and a shortening, or tightening of the muscles causes FM pain. As with the rest of the body, healthy and normal muscle function requires adequate sleep and nutrition. “People with CFS/FM typically suffer from a combination of different problems,” he pointed out. “The pattern can include infections (viral or bacterial), insomnia and hormonal problems, a combination I call the ‘autoimmune triad.’ Other possible underlying issues include immune system dysfunction, mild chronic low blood pressure, low blood sugar (hypoglycemia), and iron deficiency anemia.”
Symptoms & Causes
The rate of FM cases has risen, observed Amber Lynn Vitse, CN, ayurvedic practitioner and regional educator for Florida-based Garden of Life. She ascribes it partially to the fact that more medical professionals are recognizing FM as a “syndrome with a collection of coinciding symptoms, and that there are diagnostic algorithms in place.” She believes as well that the increase in FM cases may also reflect rising rates of stress, obesity, underlying inflammation, and more consumption of processed foods that abet obesity and inflammation.
“Fibromyalgia cases are increasing,” agreed Dr. Teitelbaum. What used to be a rarer diagnosis, he said, now impacts between 2 and 6 percent of the population. The prevalence “is rapidly increasing, as lifestyle changes result in a perfect storm for a worsening energy crisis.”
Dr. Teitelbaum also agreed with Vitse about the processed-food/junk food diet, which depletes a significant percentage of nutrients, thus causing corresponding obesity and malnutrition. He also points to diminished sleep—now typically about six to seven hours a night, as opposed to the nine hours received by our ancestors. “This is a 30 percent pay cut for the body,” he described. Exacerbating this pay cut is the rapidly increasing speed of life, with instantaneous demands on our time and our response. Finally, he points to the marketing of fear, which results in increasing adrenal fatigue.
“There are other causes, but these are some of the more common ones—the increased speed and stress of modern life result in adrenal fatigue which then triggers fibromyalgia. The other problems cause the energy crisis, which triggers the fibromyalgia directly (fibromyalgia basically represents an energy crisis in the body),” Dr. Teitelbaum summarized, adding, that it is not the increased cortisol from adrenal stress that triggers FM. Instead, fatigued adrenals are unable to maintain normal cortisol output, resulting in lower cortisol.
Although the symptomology and aggravating factors of FM as described above are accepted as FM, it is still generally agreed upon by the medical community that the exact cause of FM remains unclear. Vitse doesn’t think that FM has a singular causation, but may be the result of “multiple possible initiating causes. For years in functional medicine and integrative nutrition we’ve seen the relationship between fibromyalgia and underlying inflammation and gut health.”
Emerging science from the human microbiome, she said, demonstrates the connection between gut microbial imbalance and inflammation. Vitse asserted that most of her clients presenting FM symptoms need a lot of help with their diet, with cleaning out and supporting total cellular function, with recognizing the duration and quality of exercise best for them, and with addressing the toxic emotional aspects of their daily lives and human interactions.
In Dr. Teitelbaum’s professional opinion, FM signifies an energy crisis where the person essentially “trips a circuit breaker,” the hypothalamus, which controls sleep, hormones, temperature and autonomic function. An energy deficiency causes the muscles to get locked in the shortened position, causing chronic pain, which then triggers what he calls “brain pain” (central sensitization) and nerve pain. Infections, stress, poor diet (lack of adequate nutrition), lack of healthy sleep, hormonal deficiencies and/or inflammatory illness, he said, can cause this energy crisis.
Dr. Badmaev points to chronic inflammation as a potential culprit. This complex clinical presentation has resulted in a multidisciplinary therapy utilizing therapies in chronic muscle and bone pain conditions, nerve pain caused by diabetes, shingles but also in treatment of depression and anxiety. The lead compounds used in fibromyalgia are SSRIs and SSNRI (selective serotonin and norepinephrine reuptake inhibitors), which treat mood conditions as well as modulate the immune system. “The effect on the immune system may be particularly important in fibromyalgia since there is a growing evidence that the condition is in large part caused by the chronic inflammatory process or chronic inflammation—as seen in chronic degenerative conditions,” he explained. “Thus regulation of the serotonergic system, operated by neurohormones like serotonin, in FM patients may have positive effects on the psychological distress but importantly may regulate the immune functions—addressing the chronic inflammation component.”
According to Dr. Teitelbaum, there is no one specific lab test to confirm that an individual has FM or CFS. An FM diagnosis, he pointed out, is often made by a practitioner and patient after medical evaluation and lab testing have eliminated other possible causes. “An experienced practitioner can see subtle nuances in traditional blood testing that indicate CFS/FMS. Because of the need to exclude other disorders with similar symptoms, such as Lyme’s disease, MS (multiple sclerosis) or depression, it can often take months of evaluation before a person realizes they have CFS/FMS,” he said. Nutritional Protocols There are certainly an attractive number of natural tools to help FM clients achieve higher senses of well-being. “We have much at our disposal in natural medicine to promote relief, to help a person get to the point they can start exercising and can take responsibility for making better food choices and nourishing themselves,” said Vitse.
She will work with her client to address five key areas she feels will help bring back balance and manage symptoms.
Pain and inflammation can be addressed both herbally through anti-inflammatory blends that include turmeric, bioperine, boswellia, gugguls, adaptogens like holy basil, rhodiola, ashwagandha and mushrooms; and metabolically with systemic enzymes taken on an empty stomach. Beyond a supplement protocol for pain alleviation, Vitse also recommends manual therapies like chiropractic, osteopathic, various types of massage, acupressure, yoga and then acupuncture, and somatic therapies like Feldenkrais. “A progressive exercise program is also crucial, creating a feedback loop of beneficial endorphins, blocking pain receptors,” she said.
GI (gastrointestinal) symptoms and each person’s history of assaults to the gut, such as medications and chronic stress, must be addressed with a gut-healing protocol, Vitse said. “I would say it’s nearly impossible for a person to have the symptoms that can be assessed as fibromyalgia without having intestinal permeability, or leaky gut,” she asserted. Practitioners of functional medicine and integrative nutrition have long addressed food allergies or sensitivities, toxic burdens, hormonal imbalances, elevated inflammatory markers in the bloodstream, and irritated or inflammatory symptoms in the bowels including chronic constipation, by adjusting diet. When necessary, digestive enzymes and probiotics are added to support digestive function.
Third, Vitse addressed cognitive function to help alleviate anxiety and depression associated with and as well as the physical symptoms of chronic fatigue, pain and malaise. She recommends fish oils and co-therapy with pharmaceuticals when necessary.
Fourth is addressing the fatigue and malaise typically via herbal adaptogens addressing the HPA Axis, diet (good quality sources of essential amino acids, good quality fats, reduction of sugar producers) and a gradual increase in exercise.
Finally, Vitse recommends addressing hormone imbalances and toxic load, which, she said tend to go hand in hand. “As with the gut, toxic offenders must be removed from the diet,” she asserted. “Supported through clean foods, the body can start to clean house on its own, and when a person is stronger and has more nutrient reserves, an herbally and dietarily supported cleanse can be considered. This is a gradual and ongoing process. If the client is overweight or obese, it will be a longer-term process. When fat is accessed and reduced, toxins encapsulated in the adipose tissues are released again into circulation. So weight loss and detox support must go hand in hand. Again, this is an area in which a person’s history of exposure is so important. The practitioner must have detailed information on past environmental exposures and all exogenous hormones both from pharmaceuticals and the food and water supply.”
Another believer in an ayurvedic (and Tibetan) adaptogenic approach is Dr. Badmaev, who explained that the nutritional and/or pharmacological means to maintain and restore energy balance in ayurveda are termed “vitalizers.” The concept of vitalizers, he explained, recognizes “the need to shield the psyche and physical body from the effect of various stress factors that deplete energy.” Some traditional vitalizers became prime examples of relatively recently defined adaptogens—pharmacological agents that result in adaptive reactions to physical and psychological stress. Improved economy of bioenergetic processes in the body may be particularly useful in improving chances against the disturbed energy characteristic of FM and CFS; the approach that would alleviate “loss” of energy due to stress would seem an appropriate therapeutic regimen. Adaptogens can be particularly useful in treatment of bioenergy disturbances, because by definition they act as ‘smart drugs,’ which help utilize biological energy as well as conserve it for the use when needed.”
American Medical Holdings offers Adaptrin, a botanical and mineral formula based on Tibetan medicine principles, to support the immune system affected by chronic stress. Based on the long-standing tradition of nutritional use and published studies, Dr. Badmaev explained, “Adaptrin lowers stress levels, sharpens memory, overall energy and alertness, sleep patterns; and promotes an increased general subjective sense of well-being.” Further, Dr. Badmaev said that Adaptrin’s synergistic mechanism of sub-optimal dose ingredients provides a cumulative mechanism that may help the body mobilize its own means to improve health via the gradual buildup of adaptation energy.
Dr. Badmaev also recommends Zembrin, another botanical formula that also appears to operate through the adaptogenic mechanism, lowering the psychological distress in those with FM and CFS. Zembrin is a standardized extract of Sceletium tortuosum, used for centuries by the San people of South Africa for building mental and physical stamina and nutrition. A 2014 peer-reviewed published clinical study evaluated the cognitive effects of Zembrin, as well as its safety and tolerability in healthy subjects, who received either 25 mg capsules of Zembrin or placebo once daily for three weeks. “Zembrin statistically significantly improved cognitive and executive functions (performance of daily tasks) compared with the placebo group, and the Zembrin group showed improvements in mood and sleep patterns,” Dr. Badmaev reported. The study authors ascribed Zembrin’s effects to preserving neurohormones involved in maintaining communication between brain cells, facilitating effective flow of information in the neural system.
Dr. Teitelbaum, who originated the SHINE protocol—(Sleep, Hormones, Infections, Nutrition, Exercise as able)—stated that his published placebo-controlled study showed that the protocol helped 91 percent of cases with an average 90 percent increase in quality of life. SHINE is customizable for each individual presenting with FM complaints, and is geared toward helping him or her increase energy production naturally and optimally.
Dr. Teitelbaum said that he recommends the following supplement protocol: “Ribose, 5 grams two to three times per day; two studies performed on 257 people at 53 clinics showed an average 61 percent increase in energy after only three weeks of taking ribose. Daily Energy Enfusion vitamin powder by Integrative Therapeutics; one drink replaces 35 pills, which promotes better compliance. And from EuroMedica, both Euromega 3, one a day for omega-3 support (replaces eight fish oil pills with one pill) and Curaphen for pain alleviation.
There is neither a cure nor short-term solution to FM and its presenting symptoms. Using the whole health approach combined with stress management and energy production and balance, may go a long way for your clients with FM to achieve and sustain a much higher quality of daily living.
For More Information:
Amber Lynn Vitse, CN, www.amberlynnvitale.com
Jacob Teitelbaum, MD, www.endfatigue.com
Vladimir Badmaev, MD, PhD, www.adaptrin.com
