Fibromyalgia and Chronic Fatigue Syndrome

No longer a mystery

 

Imagine being so tired that you can’t function.  I’m not talking about being pooped at the end of a long day at work or exhausted after a big hike.  I mean the kind of tired that prevents working a normal job or the kind of tired that only allows doing a few hours of chores before having to go back to bed from being so wiped out.  Normally exercise gives one a bit of energy but not this type of tired – if not careful exercise just makes it worse. 

 

Now consider having this type of fatigue all the time, for months to years on end without relief, and even rest won’t help.  To make matters worse insomnia is usually present as well, so although one may be “dog-tired” they can’t even get a sound night’s sleep.  This is the definition of “chronic fatigue syndrome” (CFS) and it is called a syndrome because there is not one simple cause for the fatigue.

 

As if this fatigue was not bad enough now let’s add pain.  A deep aching kind of pain that moves throughout the body, in the tissues and bones and joints, as well as isolating to 18 specific points about the body.  These tender points, called “trigger points”, are like epicenters of pain and touching them with just enough pressure to blanch your fingernail produces severe pain.  The pain syndrome that centers on the tender trigger points is called “fibromyalgia”.

 

About half of people with fibromyalgia also have CFS and visa-versa.  Fibromyalgia affects an estimated 10 million people in the U.S. and an estimated 3% to 6% of the population worldwide, according to National Fibromyalgia Association.  For some reason about 80-90% of fibromyalgia sufferers are women.  The good news is that effective treatment is possible for most of these patients.

 

What is Fibromyalgia?

 

Dysfunction in a few key systems seems to be the common denominator with fibromyalgia.  Areas involved include the cellular energy producing mitochondria, the “all controlling” part of the brain called the hypothalamus, and the immune system.

 

Defects in the mitochondria powerhouses lead to the lack of energy, fatigue, muscle shortening and pain.  Abnormal control signals from the hypothalamus leads to disrupted sleep, which then causes a lack of important healing hormones, physical rest and tissue repair.  Further changes in the autonomic nervous system are related to the abnormal pain signaling.  The immune system changes lead to altered balance of immune pathways that result in excess inflammatory chemicals called cytokines.

 

We are finding that these dysfunctional systems are caused by a combination of conditions from genetic defects in metabolic and detoxification pathways, to external stressors such as infections, toxic chemicals, or heavy metal accumulation in the body.  Poor nutrition and stress are two very important lifestyle issues that play a role.

 

Diagnosis

 

The first step for most patients is getting a proper diagnosis.  Many physicians still doubt the diagnosis of fibromyalgia even exists and rather simply point to depression, pain or insomnia as the main issue.  Fortunately, this is changing and along with it more and more patients are getting the correct diagnosis, followed by successful treatment that is rooted in integrative and functional medicine.  That is, there are many different body systems to investigate and treatment modalities to integrate into a plan that gets to the root cause of this tricky syndrome.

 

First of all, fibromyalgia is a purely clinical diagnosis.  There is not a specific lab test or imaging study that makes the diagnosis.  Many of us practitioners familiar with treating fibromyalgia and CFS have quit making such a big deal out of needing the recommended 11 out of 18 tender trigger points to make the diagnosis.  At the end of the day, having widespread persistent pain, above and below the waist, on both sides of the body and along the midline of the body, meets the definition of fibromyalgia.

 

Other symptoms that are often present with fibromyalgia include severe fatigue for more 4-5 months, fatigue that is worse after exercise, insomnia, depression or brain fog, bowel issues, recurrent or frequent infections, and multiple chemical or medication sensitivities.

 

Treatment

 

Our general treatment goals are to “rest, fortify and restore”.   We restore function with natural supplements, nutrition, sleep control, nervous system balance and hormone supplementation.  It is critical to eliminate energy drains such as stress, allergies, intestinal disorders, infections and heavy metal accumulations.

 

Restoring cellular energy involves using numerous supplements that help heal and “tune-up” the energy producing mitochondria.  Specific brain neurotransmitter levels can be obtained through a simple urine test and imbalances may be treated with amino-acid precursors and natural compounds that increase or decrease production of certain neurotransmitters.  As patients improve most of the supplements for energy and brain chemistry support are usually discontinued.

 

Treatment for hormone imbalances or deficiencies is frequently a cornerstone of treatment.  A disturbed adrenal stress hormone system leads to alterations in cortisol regulation.  Undetected low thyroid or thyroid resistance disorders are common.  Imbalances in sex hormones such as estrogen dominance or menopause are triggers for fibromyalgia. 

 

The most important role of the immune system is to defend the body from invaders.  The cytokines that are made help maintain a balance in the immune system.  Cytokines influence mood, sleep, energy, cognitive function and many other important aspects of health.  Physical triggers (infection s, toxins, allergens) and psychological events (emotional trauma, mental stress) lead to the increased production of cytokines.  If these triggers are not resolved, cytokine levels will remain high, resulting in chronic systemic inflammation, which may cause symptoms that are not immediately recognized as inflammatory in nature.

 

Fibromyalgia is often started after an infection and is often associated with persistent, chronic infections.  These infections can be yeast/fungal, parasitic, bacterial, or viral. Most infections involve the respiratory tract including bronchitis or sinusitis, bowel infections, and chronic prostatitis.  If the infections don’t resolve with general treatment then direct treatment is advised.

 

The exposure to heavy metals such as lead, mercury, arsenic, or cadmium will lead to deposits in the body that are not detected in blood work (unless it is an acute exposure). 

Heavy metal accumulation is well known to disturb the neurologic, endocrine and immune systems.  Chelation is a process of giving a substance that will bind to metals and pull the metals out of storage so they can then be eliminated in the urine.

 

Working with nutrition, eliminating delayed food allergies, and healing the inflamed or leaky gut is absolutely critical.  Lifestyle issues include removing stressors and aggravating factors – this might include situations, people, or toxins. 

 

Sleep, pain, and mood management can all addressed with combinations of natural supplements and prescription medications.  We encourage time for relaxation, time out, laughter and modest exercise.  Psychological counseling and support of friends and family is key just like with other chronic health issues.

 

With fibromyalgia becoming less of a mystery treatments based on integrative functional medicine are emerging to “lift the veil” of suffering for many with this perplexing syndrome.

 

Free seminars

 

Fibromyalgia and Chronic Fatigue Syndrome

Monday, October 1^st at 6pm, at the IMC

 

The Acne Cure:  Functional Medicine & Aesthetic Skin Care

Monday, October 15^th at 6pm, at the IMC

 

RSVP at 245-6911 or online at rsvp@imcwc.com

 

Bio

 

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado and Integrative Weight Solutions.  Call 245-6911 for an appointment or more information. 

 

 

 

The Hidden Epidemic Low Vitamin D

 

Mention vitamin D and most people think “sure, we need it for strong bones.”  But did you know we need it for prevention of heart disease, cancer, diabetes, and more?  How about for a healthy immune system?  And would you have guessed that about 50% of us are deficient in this vitamin powerhouse! 

 

Vitamin D is actually a pro-hormone that is made in our skin upon exposure to sunlight.  The sun’s ultra-violet B (UVB) rays convert cholesterol into vitamin D3 (cholecalciferol).  Diet provides a small amount of vitamin D2 (ergocalciferol) found in fish, egg, fish liver oils and mushrooms.  It seems nature did not intend for us to get vitamin D from food, rather we are designed to make vitamin D from the sun.

 

To be fully functional vitamin D must first be transformed by the liver into calcidiol which is the main storage form.  From there, it moves down one of two pathways.  In the first pathway, through the kidney, calcidiol is turned into calcitriol, which works to regulate calcium levels in the body and is essential for life and for strong bones.  Vitamin D receptor (VDR) activation in the intestine, bone, kidney, and parathyroid gland leads to the maintenance of calcium and phosphorus levels in the blood and to the maintenance of bone content.  A lack of vitamin D leads to soft bones or “rickets” and this is the primary reason we now have vitamin D fortified foods, notably milk and orange juice. 

 

It is the second pathway that is generating so much excitement in the medical world.  This pathway for calcitriol production is in the various tissues of the body where it acts locally, either inside or around the cells.  It activates the VDRs that are found in most organs, including the brain, heart, skin, gonads, prostate, and breast.  VDRs are also found in the white blood cells of the immune system. 

 

Calcitriol is the most potent steroid hormone in the body, and that means it is very effective in turning genes on or off.  Some of these genes control proteins that fight cancer.  Some of the genes affected by vitamin D are very ,close to other genes that relate to every disease known to man and we are learning that the human genome has over 2,000 binding sites for calcitriol!

 

For many years low levels of vitamin D have been known to be associated with higher rates of cancer, especially prostate, breast and colon.  It is believed that the local production of calcitriol may be responsible for the anticancer benefit of vitamin D, by acting to regulate cell growth and decrease the risk of the cells becoming malignant.  It is estimated that there is a 30 to 50% reduction in risk for developing colorectal, breast, and prostate cancer either by increasing vitamin D intake to least 1000 IU/day or getting enough sunlight to raise blood levels of vitamin D into a normal range.

 

Vitamin D deficiency is now thought to play a role in the pathology of at least a dozen varieties of cancer as well as high blood pressure, heart disease, stroke, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, periodontal disease, and more. 

 

What is the optimal amount of vitamin D for the body?  It is estimated that the body will naturally produce about 20,000 IU of vitamin D with just 20 minutes of full body sunlight exposure.  This is full intensity sunlight, say between 10am and 3pm, only from spring to fall, and is called the erythema dose as it is just barely enough to turn Caucasian skin to pink.  We have a control mechanism to limit further production as the skin begins to darken and further UVB light starts to degrade vitamin D.  Darker skin requires as much as 6 times the exposure to make the same amount of Vitamin D, which limits natural production but also means darker skinned people need even more sun.

 

It is virtually impossible to get enough vitamin D from our diet.  Our distant ancestors spent their entire lives in the sun, and over time we’ve migrated to latitudes so far north or south of the equator that the UVB rays get filtered out, especially in the winter months.  Furthermore, we now cover with clothing, live and work indoor, drive instead of walk, and have gone overboard with sunscreen and sun avoidance.  It is no surprise we are deficient in our most potent steroid hormone and anti-cancer wonder!

 

You can test for vitamin D deficiency with a simple blood test for 25-hydroxyvitamin D (calcidiol).  Normal levels are 30-100 ng/ml, with 70-100 ng/ml being optimal, and at least 50 ng/ml as the minimum to insure benefit. 

 

People at high risk for vitamin D deficiency include the elderly (who don’t make as much in the skin), people that are overweight, and people that spend all their time indoors.  Consider patients that are seriously ill or hospitalized – they are usually indoors constantly and missing out on one of nature’s most potent hormones – while they need it most!

 

Increase your vitamin D levels naturally by getting 20 minutes of full sun exposure daily to as much of the skin as possible.  DON’T burn!  In the winter, periodic tanning bed exposure is ok.  Again, DON’T burn. 

 

Taking a vitamin D supplement is the most practical and easy way to increase vitamin D levels.  I recommend a D3 supplement of at least 2,000 IU/day for children and adults.  The half-life of vitamin D is so long, that one can take weekly or even monthly doses to average out at a good daily dose.  Most doctors will prescribe a 50,000 IU capsule of D2, once every few weeks or monthly.  I prefer the natural D3 form given daily.  Doctors still panic with concern of vitamin D toxicity, but the fact is that doses of up to 5,000 IU/day are shown to be very safe.  But, simply take what you need to get your blood level right, and recheck blood levels every 3-6 months until you get it right!

 

For further reading I recommend “The Vitamin D Solution” written by one of the world’s experts on vitamin D, Professor Michael Holick of Boston University School of Medicine.

 

Free seminars

 

Low Thyroid:  Misunderstood, Misdiagnosed, And Missed!

Monday, September 17^th at 6pm, at the IMC

 

Fibromyalgia and Chronic Fatigue Syndrome

Monday, October 1^st at 6pm, at the IMC

 

RSVP at 245-6911 or online at rsvp@imcwc.com

 

Bio

 

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado and Integrative Weight Solutions.  Call 245-6911 for an appointment or more information.