What You Should Know About Fibromyalgia
Fibromyalgia syndrome is one of those mystery diseases with a convoluted and vague etiology where medical doctors hastily and erroneously dish out the diagnosis to patients. Within the past 10 years, its prevalence has increased by 200-400% for an important reason. FMS is defined as a true central nervous system (CNS) disorder involving an overactive limbic system, heightened perception of pain that pervades the entire body (allodynia and/or hyperalgesia) from stimuli that is not painful in most people. Frequently, there is an array of symptoms concomitant with FMS like IBS, sleep dysfunction and fatigue, to name a few. In this context, “classic fibromyalgia” is the diagnosis given that is only epitomized by a small demographic of the population.
In modern medicine, FMS has instead become this umbrella term that doctors inappropriately shove patients under when a series of symptoms like the traditional “pain and fatigue” are mentioned by the patient, when there is actually some other cause and no true CNS disorder is present. Diagnosis of fibromyalgia typically follows the criteria set forth by The American College of Rheumatology, which is contingent upon a total severity score of pain, fatigue and other factors.
Since this criterion is not useful in determining primary causes, four subsets have been identified under FMS to help pinpoint a more precise diagnosis of the situation.
Classic FMS or impaired pain perception
Pathology/disease (i.e. hypothyroidism),
Musculoskeletal disorder (i.e. injury)
Metabolic disorder (i.e. food allergy, IBS, nutrient deficiency).
Since this disorder lacks objective measures, many people are overdiagnosed when really they fall into any of these four categories, except for “Classic FMS.” In fact, studies have shown that 66% of patients have mistakenly been diagnosed with fibromyalgia. As a result, a very attentive analysis of the patient, involving multiple testing and ruling out of other conditions is fundamental before making a concrete diagnosis of FMS.
Potential Causes & Comorbidities With FMS
In “classic FMS”, abnormalities in the CNS and malfunction of the descending anti-nociceptive system (which decreases pain) are purported to stem from chronic stress and physical or psychological trauma. It’s been discovered that these patients have an impaired catecholamine/neurotransmitter production such as lowered dopamine, serotonin, oxytocin and acetylcholine levels as well as elevated substance-P (a pain modulating peptide) and NMDA activity (excessive neuronal firing). Over-activity of the sympathetic nervous system (which controls the “fight or flight" response), imbalances in adrenal glands resulting in high cortisol release and consequently, and down-regulation of the HPA axis starting in the brain, is noticed with these neurotransmitter fluctuate, which may contribute to sweating, IBS related symptoms, depression and anxiety.
Ultimately, ruling out the possibility of a “classic FMS” diagnosis must start with investigating why the chronic pain is there to begin with.
True Symptoms Of FMS
Nonetheless, people diagnosed with FMS display a panoply of other conditions that occur simultaneously with FMS or are the true culprits for the symptoms.
These include but are not limited to: Adrenal fatigue, fatigue, IBS, dysbiosis/SIBO (gut bacteria imbalance), depression, hypotension, dysautonomia, endometrioiosis, anxiety, fatigue, hypothalamic and pituitary dysfunction, hypothyroidism, interstitial cystitis, migraines, PCOS, sleep apnea, Raynaud’s syndrome and restless leg syndrome.
Let’s look more closely at some of these symptoms.
Fatigue – Fatigue is incredibly ubiquitous these days with numerous causes. However, in chronic fatigue states, evidence has pointed towards malfunctions in the hypothalamus and its ability to secrete hormones as one fundamental cause. But perhaps more importantly, evidence shows mitochondrial dysfunction is present and hence, so are deficits in energy production.
Irritable Bowel Syndrome (IBS) – IBS is rife amongst Americans and impacts nearly 14% of the population. IBS holds multiple causes including a gut-brain disconnect, bacteria imbalances, food sensitivities, visceral hypersensitivity, autonomic dysfunction and changes in gut motility (i.e. constipation, diarrhea, etc). Anyone who experiences any discomfort in the GI tract knows how quite painful it can be, which is why anywhere between 30-80% of patients with FMS have these symptoms of hypersensitivity.
Small Intestinal Bacteria Overgrowth (SIBO) – SIBO occurs when there is an overgrowth of residential aerobic and anaerobic bacteria in the small intestine that creates an opportunity for commensal bacteria to flourish and create mayhem in the gut. It is considered to play a prominent role in the pathogenesis of IBS, Crohn’s disease and according to some experts, is the “ultimate” cause of FMS. In one study where 123 people were diagnosed with FMS, 78% of the subjects were found to have SIBO. The implications of overgrowth of pathogenic bacteria and yeast cannot be overstated as it can impact the body systemically by inducing inflammation from endotoxins produced by them with a host of accompanying symptoms.
Approaching A Diagnosis
Before interventions can be applied, there needs to be an in-depth investigation and metabolic work-up of the patient to conclude if “classic FMS” is present. This would include a comprehensive, thorough physical exam, and a series of lab screenings to rule out musculoskeletal issues, organic (autoimmunity, hypothyroid, anemia, etc.) and functional (mitochondrial disorders, nutrient deficiencies) disorders. Some of the testing I would suggest are, of course, the organic acid test, complete CBC, thyroid panel, inflammatory markers, adrenals, CDSA, fatty acid levels, food sensitivities and allergies and possibly an autoimmune panel.
The organic acid test might be, clinically, the most relevant and informative test because it reveals bacteria overgrowth potential, vitamin deficiencies, imbalances in neurotransmitters and other metabolites that play a role in the central energy pathway and susceptibility to fatigue.
Traditionally in allopathic medicine, not much is done with the debilitating patient with FMS as medical doctors are truly lost with solving the case. Certain FDA approved medications for FMS like pregabalin, minalcipran and duloxetine can be useful for mitigating pain. However, a majority of people will not find substantial decrements in pain. Gabapentin, amitriptyline and nortriptyline have been validated to be effectual at very low doses to improve mood and pain sensitization. Despite this, these drugs are not a long-term solution which discernibly ignores the root issues involved.
A More Pragmatic Approach
Addressing nutrient deficiencies and imbalances based on lab results to get them into normal range is the first sensible step of action that must be taken to resolve the affliction. Some worthy examples include assessing sex and thyroid hormone levels, supporting the adrenal glands if high stress is present and combating any microbial infections. Dietary and supplemental interventions vary considerably with each patient, and my recommendation is to adopt the diet that improves or sustains your life. However, I would strongly recommend abstaining from pro-inflammatory trans fats, vegetable oils, processed and refined carbohydrates, alcohol, caffeine, artificial sweeteners, while also adopting a lower carbohydrate diet. Supplements are needed to correct any steep deficiencies fond in lab reports. Maintaining adequate sleep of at least 8 hours and partaking in some form of exercise is absolutely vital.
I use a specific protocol for FMS patients that improve quality of life and reduce symptoms, including pain. It has been demonstrated to be effective 90% of the time as it is supported by clinical trials.
Whether or not you think you are suffering from fibromyalgia, much work needs to be done. I suggest finding a doctor who appreciates and understands the complexity of fibromyalgia, and work with a clinical nutritionist who satisfies your needs.
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