In Fibromyalgia

In my 20 plus years of practice I have literally seen hundreds of patients with fibromyalgia who have sometimes been to dozens of doctors before they ended up in my practice. These patients unfortunately often get told that it’s all in your head. 

Now, if there’s one thing that nobody wants to hear is what you’re truly feeling in your body and you know your body and you know you’re feeling something and somebody in a white coat says “I’m sorry Mrs. Smith I can’t find anything wrong with you it’s all in your head”, so this is something that I, a functional medicine practitioner like me, want to really put an end to by using a variety of very specific approaches to treatment as well as symptomatology. 

We have reversed this successfully in my practice. Another huge hurdle is the symptom game where you may have thought that you have chronic fatigue or chronic pain or even depression or anxiety or insomnia but really, it’s fibromyalgia and it’s all of these symptoms coming together under one umbrella. 

What is fibromyalgia? 

There’s so much misinformation about fibromyalgia misunderstanding. You know there’s a lot of doctors that don’t believe that fibromyalgia exists still to this day and those that do really don’t know how to treat it other than to tell them just to learn to live with it. But fibromyalgia is a syndrome made up of a group of symptoms that people have in common to fuse safety sometimes disabling pain brain fog poor sleep irritable bowel restless leg syndrome and these common symptoms are given a name fibromyalgia and it primarily affects females between the age of 36 and 68, 98% of those who have it are females. It affects probably about 8% of the worldwide population although I think that number is growing is more and more doctors and sometimes erroneously giving that diagnosis but also, I think more and more doctors are becoming aware about fibromyalgia even though they really don’t understand what to do with it.

It’s important to understand that a lot of times we have to have this umbrella where patients may have perhaps three out of five of those symptoms or what have you and they simply don’t know what’s wrong with them but they know and I always tell my patients you know your body best and you have to be your own advocate. So, if they have some of these symptoms this is something that they need to be thinking that they might have fibromyalgia.

How do you confirm the diagnosis? 

Typically, by the time they find me they’ve been to at least half a dozen doctors over a period of years. Oftentimes they get on the medical merry-go-round you’re really familiar with and they finally wind up you know seeking out because they realize that with fibromyalgia, they’re going to have to find somebody that knows something about the illness but typically it’s a diagnosis of elimination. So, patients will get blood work done to rule out MS and lupus autoimmune disease and other pain syndromes and then once that all comes back normal then they’ll be told, “well we think you have fibromyalgia”. So typically, it’s a process of elimination and then they get the diagnosis.

It’s more of a diagnosis of exclusion. It is important to rule those things out right because those other issues whether it’s lupus or another autoimmune disease or a neurodegenerative disease like MS, it’s a lot like ALS right MSN ALS very similar and as you know my husband has ALS unfortunately and he was diagnosed three years ago and I do a lot of work with neurodegenerative diseases now and ALS patients we have a foundation and what we have found is sometimes it takes patients years to come to the diagnosis. Now in this in the case of fibromyalgia it’s not something that’s going to kill them but in the case of something like ALS the average life expectancy is two to five years so they might be very close to losing the battle before they even get a diagnosis. So, I think the point to be made here is if you have these symptoms listen to your body and find yourself a doctor who can listen to your symptoms and help you get through the process quicker by listening to your symptoms and not just looking at a piece of paper, right?

What is the connection between fibromyalgia and sex hormones? Why is it more common in women? 

This is very often that it is mainly something that happens in women over 90%. We’re looking for 20 years specializing in fibromyalgia and obviously there’s got to be a connection, right? And obviously you would want to look at the female hormones, look at estrogen and progesterone in particular. I think what it really comes down to is there’s not a lot of science on this, but I really feel like for females typically they’re more vulnerable to becoming depleted in serotonin. And serotonin is a brain chemical it’s the happy hormone men typically are more likely to get depleted in norepinephrine which is another brain chemical another anti-depressant type hormone, I think that’s the distinction when I’m working with in anxiety and depression patients what I found is that my men patients really are missing out on having enough norepinephrine whereas the female patients have serotonin and serotonin really is the key for fibromyalgia because that’s really what makes up the whole bottle of wax for fibromyalgia is they’re deficient in serotonin because higher your serotonin level, the higher your pain threshold, the higher your serotonin level, the happier you are, less anxious you are, more mental clarity you have and less likely you already have the irritable bowel syndrome and you have more serotonin receptors in your intestinal tract you do in your brain, you get nervous, you get butterflies in your stomach so definitely connection and I think a lot of times what happens is patients will go from doctor, doctor and doctor and finally someone out of just what else is left they’ll say well you’ve got diffuse achy pain you know you’re exhausted, you can’t sleep can get a thought together, you have mental clarity issues, you must have fibromyalgia everything else all your blood work and tests look normal. 

The individual is happy to finally get a diagnosis. That’s where the challenge begins because once you get the rubber stamp that says fibromyalgia on your head, you’re differently the rest of your life. And when that happens doctors when they interact with you, they’re looking at a fibromyalgia patient that’s all they see, they see that they really don’t understand and they’ve already for the most part come to the false conclusion that this patient’s just going to have to learn to live with this condition. 

It has become a personal struggle and for me it’s been a personal passion and a personal mission fibromyalgia has because one of my sisters has dealt with this for literally decades now it’s been so interesting to go through this journey with her because she started all her first symptoms before I went into functional medicine. So as you know, when you’re in traditional medicine what are you taught to do exactly what you’re saying you know you do these tests, you rule this out, we don’t know what it is, it could be this, and then it’s sort of in traditional medicine we used to call it a trash can diagnosis right because we just, “hey okay well let’s just throw them in this trash can because we don’t know what to do about it” and then when I entered functional medicine it was super interesting because that’s when we started as a family and our sisters really looking into the more holistic approaches which you and I will get to managing fibromyalgia you know so can we completely say “oh well you know you’re done, no more you know” it’s like a constant manage it’s a constant daily you know protocol and you have to perform  those mechanisms of self-care you know, the stretching and the yoga and the nutrition and the healthy eating and decreasing inflammation and meditation. So I don’t want to take away our punch lines there but it’s really important and it’s been incredible, I mean her personal journey has been incredible where she just is a totally different person and it’s so amazing to see that in a personal level and then also in my patients so I think it’s just wonderful when you know you always say things god blesses you with things in yourself and your family for a mission like he just hands you these missions, what was your impetus to get into fibromyalgia? So, for me you know I treat tons of patients with fibromyalgia now and I just mentioned to you why it’s been such an important thing for me. 

Research has found that people with fibromyalgia have abnormally low levels of the hormones or neurotransmitters serotonin, noradrenaline, dopamine all of those in their brains. And low levels of these hormones may be a key factor in the cause of fibromyalgia perhaps as they’re important in regulating things like mood and other such things. 

What causes fibromyalgia? 

Stress is the catalyst for the disease and probably for you know if we really want to be honest, we probably say that 95% of all the diseases out there are probably triggered by some type of chronic stress or acute stress but fibromyalgia without a doubt is stress and we look at the individuals that have fibromyalgia. The majority of them came from a stressful household and then verbal abuse, it could have been just a toxic environment or they could have been that they were just not healthy as a child maybe they had some type of illness Epstein Barrs or that really was traumatic as a child lose that plasticity and so when they go off to school or they get married or they get their first job or they get in a toxic environment whether that’s a marriage or a work environment whatever it is or surgery, something is the straw that breaks the camel’s back and then the symptoms of fibromyalgia start. 

A part of that is the research shows us is that the hypothalamus pituitary the adrenals as you just mentioned so astutely about the different hormones but when that hypothalamus gland is not able to regulate the other systems in  the body then you start getting so many different symptoms because these systems can’t be coordinated and adjusted like they’re supposed to so individuals with fibromyalgia have problems with digestion and elimination they have problems with their circadian rhythm or sleep wake cycle, they have a low pain threshold a thing called allodynia as you know and I think, I use this analogy that we’re all born with a stress coping savings account and in a scoping savings account we have certain chemicals and hormones that we need to allow us to deal with stress and all day long we’re all under stress especially right now but when we get under stress we just make withdrawals from our stress scoping savings account helps us to deal with stress or we use serotonin and dopamine and DHEA and cortisol and we have these chemicals when we need them but with the fibromyalgia individuals have made more withdrawals and they bankrupt that account and the slippery slope starts when they start to struggle with their sleep, that’s what gets them. 

They may start off with the use of achy pain because they’re run down and fatigued but once their sleep becomes compromised and they’re not getting consistent delta weight deep sleep that’s when we see the symptoms of fibromyalgia start to show up because you make deposits into your stress coping savings account by going into deep sleep each night that’s when you’re filling up your account with serotonin dopamine and human growth hormone and all these chemicals that the body needs to repair itself. But if you’re not sleeping and as you know with your fibromyalgia patients that’s something that they’re really challenged with they become depleted and then and then stress becomes more magnified now things that didn’t used to bother them bright lights, the weather, send them into a flare whereas you and I it’s just you know no big deal.

Always look at their adrenal hormones so always do a salivary cortisol level to check what their circadian rhythm is like and I oftentimes and almost always find adrenal disruption whether it’s you know absolute adrenal exhaustion or adrenal fatigue and just for the audience you know we want to kind of describe you know the adrenal gland is the gland that sits on top of our kidneys and it releases the hormone called cortisol hormone. This hormone is responsible for our stress and when we’re in a constant sympathetic state of fight or flight because of different kinds of trauma, different kinds of stressors that you might have currently or past that you’re dealing with you are not able to have enough gas to actually make it to where you need to go so you’ve depleted your tank and you really just don’t have any repletion. So definitely look at the adrenal hormones and then of course like you mentioned sleep, sleep is when you heal, you don’t sleep, you don’t heal and that’s just the easiest way I mention it to my patients and I explain it to my patients is if you’re not sleeping nothing in your body is regenerating or healing. And if you had to compromise and you know they’ll ask me well “I don’t have enough time to sleep because I got to do this, I got to do that, I got to do that” and I said “well you’ve got to work backwards you’re blocking eight hours no matter what and then everything else has to fit into life because if you don’t block that eight hours all of the rest of 16 hours is going to be strictly unproductive or inefficient because you’ll just be hurting and not feeling well during that entire time”. 

So adrenal hormones are incredibly important, neurotransmitters incredibly important, my background being an OBGYN, you know one of the biggest things I do in my practice is hormone balancing with bio-identical hormones. And I truly find and there are so many studies also done right in fact I think one was done from University of Alabama that you mentioned where they actually looked at fibromyalgia patients for an entire cycle and had them do a log of their symptoms and drew their blood every single day to measure their hormones and saw that there was definitely a correlation because we do see that when you have periods in a woman’s life of hormonal fluctuations whether it’s postpartum, whether it’s menopause, whether it’s during pregnancy, whether it’s during different cycles of their menstruation, there are some ebbs and flows there. So, let’s maybe talk about it because in my practice I think supplementing and balancing their hormones using either nutrients or bio-identical hormones has really been a big part of getting these patients back to feeling great again. 

What are those medications doing and what are some of the downsides of using those medications long term?

The thing is such a challenge for the doctor who encounters somebody fibromyalgia is they’ve got 12, 13, 15, 20 different symptoms conventional medical world it’s about and there’s a place for this I’m not anti-drug, I’m anti to many drugs, drug only you know in in the wrong drug, but in this there’s certainly a place but when someone’s got 12 different symptoms you know before you know it if you’re treating the symptoms only they’re going to you know drug to put them asleep the drug come up a drug to speed them up a drug to slow them down before you know it they’re on half a dozen to a dozen drugs and each drug has a potential side effect. 

Unfortunately for fibromyalgia doctors have learned that the medications are a dead end at least long term they can be helpful short term sometimes but long term they really don’t change the quality of life. In a positive direction for these individuals, surveys have shown this, so those in traditional medical practices get frustrated because they’re doing what they know to do which is trying to help somebody with the prescription medication, but it doesn’t work so they give up on the patient they blame the patient, right? But if you look at the go-to medications for fibromyalgia, Lyrica, guerrillas, Neurontin, gabapentin, pregabalin, these medications and you look at the potential side effects of these medications. Ironically is number one is it use aching muscle pain, nerve pain, even though it’s supposed to block nerve pain confusion in coordination balance issues, poor sleep, anxiety, depression, weight gain, increased risk of type 2 diabetes, macular degeneration and other issues you know you look at those potential side affects you think “oh my  goodness which is worse” you know fibromyalgia or some of these side effects and then the antidepressants you know there’s definitely a place for antidepressants, no doubt there’s definitely a place. 

But if you look at the studies, 70% of the time a sugar pill a placebo is as effective as an SSRI, selective serotonin reuptake inhibitor and this is the best we’ve got for fibromyalgia it’s not you know it’s just it’s just not, it’s not a good fit, it’s just traditional medicine and a chronic condition like fibro is just not a good fit the only way that you can feel good again with fibromyalgia and you can, you can, you can feel good but you got to get healthy and I know that sounds so simplistic when people hear that who have fibromyalgia but it’s the only way and it me and it’s different things to different people, right? I mean as you’ve already mentioned the underlying issues you know fibromyalgia is just a name that’s all it is it’s a name given to these group of common symptoms but it doesn’t cause the pain it doesn’t cause the low energy doesn’t cause the brain fog there’s underlying reasons for these symptoms and the goal for us as functional medicine practitioners is to find and fix the we’ve already mentioned some of those right poor sleep, adrenal fatigue, a poor diet, these are the causes of the symptoms 

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