Treating and Beating Fibromyalgia
by Rodger H. Murphree II, D.C., C.N.S.
www.TreatingandBeating.com
Fibromyalgia
Fibromyalgia (FMS) is an illness characterized by diffuse muscle pain, poor
sleep, and unrelenting fatigue.
Leading FMS researchers estimate that between 2% and 4% of the general
population suffer from the syndrome. Ninety percent of those diagnosed with
FMS are women.
In 1990 The American College of Rheumatology first proposed the current
criteria for defining FMS.
The diagnosis requires that all three of the major criteria and four or more of
the minor criteria be present:
Major Criteria:
1. Generalized aches or stiffness of at least three anatomical sites for at least
three months.
Six or more typical, reproducible tender points
Exclusion of other disorders that can cause similar symptoms
Minor Criteria:
Generalized fatigue
Chronic headache
Sleep disturbance
Neurological and psychological complaints
Numbing or tingling sensations
Irritable bowel syndrome
Variation of symptoms in relation to activity, stress, and weather changes
Depression
Causes of FMS and CFS include:
•
Trauma
•
Emotional/physical/mental stress
•
Yeast overgrowth
•
Chemical sensitivity
•
Allergies
•
Liver Dysfunction
•
Leaky Gut syndrome
•
Low thyroid function
•
Nutritional deficiencies
•
Deficient serotonin
•
Adrenal dysfunction
•
Chronic Viral/bacterial infections
•
Endocrine disorders
•
Autonomic disorders
Theories of Causation
1. Neuroendocrine disorder – particularly involving thyroid hormone
dysfunction
(Honeyman, 1997, pp. 19-49).
2.
Hypothalamus disorder – involving the hypothalamus, pituitary, and
adrenal glands.
3.
Sleep disorder – low serotonin, poor sleep, and consequent reduction in
the pain-modulating effects of endorphins and increased “substance P” levels
(Duna & Wilke, 1993, pp. 60-63).
4.
Limbic system dysfunction – resulting in pain modulation disorder
(Goldstein, 1996).
Hypothalamus Gland Dysfunction
The main function of the hypothalamus gland is homeostasis, maintaining the
body’s status quo. It is the body’s master computer, or the little brain with in
the brain.
The Hypothalamus regulates such bodily functions as:
•
Blood pressure
•
Digestion
•
Skin temperature
•
Circadian rhythms (sleep/wake cycle)
•
Hunger
•
Sex drive
•
Body temperature
•
Balance and coordination
•
Heart rate
•
Blood volume
•
Sweating
•
Blood vessel constriction
•
Adrenal hormones
•
Thyroid hormones
•
Metabolism
The (hypothalamus) autonomic nervous system is an entire little brain unto
itself; it runs bodily functions without our awareness or control.
We don’t have to think about taking 12-18 breathes per minute or pumping
blood through miles of arteries and veins every 60 seconds. We don’t have to
think about digesting the foods we ate today or that we need to sweat to cool
down from a brisk walk in the sun. Our little computer, the hypothalamus does
this for us.
A Vicious Cycle
Dysfunction in our circadian rhythm or sleep/wake cycle results in poor sleep.
Decreased sleep leads to depletion of stress coping chemicals including
serotonin, dopamine, and norepinephrine.
Poor sleep increases our stress which can then alter thyroid function. Low
thyroid causes decreased metabolism, fatigue, depression, poor immune
function, and weight gain.
Chronic stress leads to adrenal “burn out” or low energy states and lowered
resistance to stress. Decreased stress coping abilities then lead to lowered
immune function. Lowered blood volume from adrenal dysfunction (and
resultant low blood pressure) leads to further fatigue. Chronic stress depletes
serotonin, which then causes an increase in pain by failing to properly regulate
Substance P.
• Substance P is a chemical known as a neurotransmitter.
• Substance P increases and enhances pain receptors.
• Substance P is normally kept in check by the neurotransmitter serotonin.
• An increase in substance P causes a decrease in pain threshold and
increased pain.
Normally all the systems in the body speak to and coordinate with one another.
When the autonomic nervous system becomes dysfunctional (dysautonomia)
the immune system starts to speak in Spanish, the endocrine system in
German, the musculoskeletal system is speaking Greek, the digestive system
communicates in French, etc. The systems are not on the same page. These
systems are all supposed to work together. A malfunction in one sets up a
chain reaction in which they all become dysfunctional. Our “little computer”
has short-circuited and in those with FMS and CFS anything that can wrong,
will go wrong.
FMS and CFS are the result of internal biochemical (hormonal, enzymatic,
neuronal, and chemical) imbalances that manifest themselves as physical
symptoms (pain, weakness, and mental impairment). In order to right the
homeostatic or self-regulating system you must correct the underlying
biochemical problems. Just like an onion, you peel away one layer at a time
until you get to the core. Start with the “First Things First” (sleep dysfunction)
and then peel another layer (vitamin/mineral deficiencies, thyroid disorder,
adrenal fatigue, etc.) away at a time.
Treating patients with fibromyalgia can be very challenging. I’ve found that by
restoring serotonin levels, normal sleep patterns, optimal adrenal function, and
digestion through the use of high dose nutraceuticals, consistently helps these
folks get their life back.
Other biochemical disorders including low thyroid, food allergies, yeast
overgrowth, and mood disorders, may also need to be addressed.
In the brief time we have together I’d like to discuss how I lay the foundation for
getting my fibromyalgia patients headed in the right direction.
The Importance of a Good Night’s Sleep
One study showed that college students who were prevented from going into
deep sleep (REM sleep) for a period of a week develop the same symptoms
associated with FMS and CFS; diffuse pain, fatigue, depression, anxiety,
irritability, stomach disturbances, and headaches (Koch-Sheras & Lemley,
2000).
Years of poor sleep create an imbalance with a persons sleep regulatory system
known as the circadian rhythm.
The longer someone’s sleep cycle has been compromised, the longer it usually
takes for them to experience lasting symptom relief. But just a few nights of
consistent deep sleep will provide a tremendous amount of improvement for
most individuals.
The Importance of Serotonin
Serotonin is a neurotransmitter or brain chemical that helps regulate sleep,
digestion, pain, mood, and mental clarity.
Normal serotonin levels help:
•
raise the pain threshold (have less pain).
•
promote falling asleep and staying asleep through the night.
•
regulate moods. “The happy hormone.”
•
reduce sugar cravings and over-eating.
•
increase a person’s mental abilities.
•
regulate normal gut motility (transportation of food-stuff) and irritable
bowel syndrome (IBS).
You have more serotonin receptors in your intestinal tract than you do in
your brain. Low serotonin interferes with proper intestinal function.
Symptoms associated with IBS, diarrhea and constipation; usually disappear
within one to two weeks once serotonin levels are normalized.
5HTP and Serotonin
The brain chemical serotonin is made from the amino acid tryptophan (5hydroxytryptophan or 5HTP) along with synergistic vitamins and minerals,
including vitamins B6, B3, and magnesium. Tryptophan is one of the essential
amino acids. Our bodies can’t make tryptophan and must get it from the foods
we eat.
5-Hydroxytryptophan (5HTP)
This is a derivative of the amino acid tryptophan. 5HTP when taken correctly
turns right into serotonin.
Once again, serotonin is the neurotransmitter or brain chemical that is
responsible for regulating your sleep (getting you to sleep), raising your pain
threshold (decreasing your pain) and elevating your moods.
Many of my patients are on Serotonin Re-Uptake Inhibitors (SSRI’s). SSRI’s are
supposed to help a patient hang onto and use their naturally occurring stores
of the brain chemical serotonin. It’s like using a gasoline additive to help
increase the efficiency of your cars fuel. Most of the patients I see are running
on fumes and a gasoline additive won’t help. Using 5HTP is like pouring
gasoline straight into your tank. You fill your brain with serotonin. No need for
an additive when you can simply replace your serotonin stores anytime you get
low.
5HTP and Fibromyalgia
Double blind placebo controlled trials have shown that those with Fibromyalgia
were able to see the following benefits from taking 5HTP:
•
Decreased pain.
•
Improved sleep.
•
Less tender points.
•
Less morning stiffness.
•
Less anxiety.
•
Moods in general were improved including those with clinical depression.
•
Increased energy.
(Birdsall, Alt Med Journal 1998, pp. 271-280)
Stress
The General Adaptation Syndrome
The general adaptation syndrome (GAS) is divided into 3 phases:
Fight or Flight
The first phase is known as the “fight or flight response.” This response is an
alarm reaction triggered by messages in the brain that cause the pituitary gland
to release adrenocorticotropic hormone (ACTH). This hormone then causes the
adrenal glands to secrete adrenaline, cortisol and other stress hormones. The
fight or flight response encourages the body to go on red alert and be ready for
physical and mental activity.
The Resistance Reaction
The next phase is known as the “resistance reaction.” While the alarm reaction
is usually short lived, the resistance phase can last for quite some time. The
major player in this phase is the hormone cortisol. Cortisol helps increase
cellular energy and acts as a potent anti-inflammatory. It can be a lifesaver
when used in allergic reactions (anaphylactic shock). The resistance reaction
allows the body to endure ongoing stress (pain, fatigue, injury, etc.,) for long
periods of time. However, long-term stress can generate a host of health
problems including, high blood pressure, anxiety, fatigue, headaches,
hypoglycemia, decreased immune function, thyroid dysfunction, diabetes and
adrenal exhaustion.
Exhaustion
The third stage is a result of chronic over secretion of cortisol. This leads to
adrenal exhaustion. Adrenal exhaustion accelerates the downward spiral
towards chronic poor health. Chronic headaches, nausea, allergies, nagging
injuries, fatigue, dizziness, hypotension, low body temperature, depression, low
sex drive, chronic infections, and cold hands and feet are just some of the
symptoms that occur with adrenal exhaustion.
The majority of patients I see for chronic illnesses, including FMS and CFS, are
suffering from adrenal exhaustion. They have literally burned their stressmonitoring organ out. Between years of poor sleep, unrelenting fatigue, chronic
pain, excessive stimulants, poor diet, and relying on a plethora of prescription
medications, the adrenal glands and the hormones they release have been used
up.
Adrenal cortical extracts
Adrenal cortical glandular supplements help repair and restore normal adrenal
function.
I recommend adrenal cortex glandular supplements from grass fed, organically
raised, certified BSE (Mad Cow) free cows from New Zealand. Before using over
the counter adrenal cortical glandulars, I used prescription cortisol. I’ve found
glandular supplements to be superior to prescription cortisol in many ways.
Those on cortisol will usually have to stay on it for lasting benefits. However,
those taking over the counter adrenal cortical glandular supplements usually
repair their adrenal glands within 6 months. I put my patients on adrenal
cortical glandular supplement (500mg taken 2x a day with food). This allows
them to have more resistance to stress and avoid the ups and downs associated
with adrenal fatigue.
Digestion Disorders and Fibromyalgia
Over 40 million Americans have been diagnosed with irritable bowel syndrome.
We are literally eating ourselves into the grave. Surveys have shown that as
many as 73% of those with FMS have irritable bowel syndrome.
Deficient digestive enzymes are the primary reason for mal-digestion or
malabsorption syndrome. Intestinal permeability and dysbiosis can also cause
malabsorption problems, as well as chronic pain syndromes.
The advantages of taking digestive enzymes, especially for anyone over the age
of 35, include better digestion and assimilation of nutrients from the foods we
eat.
A digestive enzyme should contain lipase, protease, and amylase either from
plant or animal sources. I use a high potency digestive enzyme that is twice as
strong as regular enzyme supplements. This reduces the cost and number of
pills a patient has to take.
Take one digestive enzyme with each meal.
Vitamin and Mineral Supplements.
Dr. Janet Travell, White House physician for Presidents John F. Kennedy and
Lyndon B. Johnson, and Professor Emeritus of Internal Medicine at George
Washington University co-wrote Myofascial Pain and Dysfunction - The Trigger
Point Manual, which is acknowledged as the authoritative work on muscle pain
(Simons, Travell & Cummings, 1993).
In one chapter alone, Dr. Travell and co-author, Dr. David Simons, referenced
317 studies showing that problems such as hormonal, vitamin, and mineral
deficiencies can contribute to muscle pain and soreness.
If you compare a typical over-the-counter vitamin to most high-potency
multivitamin and mineral formulas, you’ll notice that the latter have 50 times,
and in some cases 100 times what the recommended daily allowance (RDA)
requires. This is because the recommended daily allowance is an outdated
system that does not take into account the depletion of our nutrient rich top
soil, environmental pollutants, chemical food processing, the addition of
artificial ingredients, and the increased demands placed on an individual’s
homeostatic system in the twenty first century.
Nutritional Deficiencies are the Norm
Most of our foods are processed and, therefore, the nutrients have been leeched
out of them. 70% of the population is deficient in magnesium, 65% are
deficient in zinc, 48% are deficient in calcium, and 56% of the population is
deficient in Vitamin C. It's clear that everyone can benefit from taking a good
multivitamin.
Researchers at Tufts University found that by supplementing the diet with 200
I.U.S of Vitamin E, control groups had a 65 percent increase in immune
fighting abilities.
According to research done at Harvard School of Public Health, people who
supplement their diets with 100 I.U.'s of Vitamin E reduced their risk of heart
disease by 40 percent (100 I.U.'s is seven times the RDA for Vitamin E.)
A deficiency of Vitamin B-1 can lead to fatigue, mental confusion, emaciation,
depression, irritability, upset stomach, nausea, and tingling in the extremities.
Vitamin B-1 has been reported to be deficient in almost 50 percent of the
elderly. Could this be one of the reasons pre-senile dementia and Alzheimer’s
disease have increased so dramatically over the last few decades?
Vitamin B-6 is crucial for making neurotransmitters, including Serotonin,
epinephrine and Norepinephrine. Neurotransmitters are brain chemicals,
which regulate our energy, moods, sleep, memory, drive, and ambition.
Vitamin C increases the immune system function, and is involved in the
formation of important stress hormones produced by the adrenal glands. A
deficiency in Vitamin C can cause bleeding gums, loose teeth, dry, scaly skin;
tender joints, muscle cramps, poor wound healing, lethargy, loss of appetite,
depression, and swollen arms and legs.
A deficiency in magnesium can cause depression, muscle cramps, high blood
pressure, heart disease and arrhythmia, constipation, insomnia, loss of hair,
confusion, personality disorders, swollen gums, and loss of appetite.
Magnesium is a natural sedative and has successfully assisted with problems such as muscle
spasm, anxiety, depression, insomnia, and constipation.
Amino Acids
Disorders associated with Amino Acid deficiencies include:
•
Fatigue
•
Depression
•
Anxiety
•
Mental confusion
•
Chemical sensitivities
•
Dermatitis
•
Cardiovascular disease
•
High blood pressure
•
Inflammatory disorders
•
Poor detoxification
•
Insomnia
•
Osteoporosis
•
Poor immunity
•
Arthritis
Essential Fatty Acids
A study involving 63 adults with CFS were enrolled in a double blind placebo
controlled study with essential fatty acid therapy. These individuals were ill for
an average of 1-3 years after a viral infection. They all suffered from severe
fatigue, myalgia (muscle pain), and a variety of psychological symptoms. After
one month, 74% of those taking EFA supplements, and 23% of those on
placebo, assessed themselves as improved.
(Behan & Behan, 1990, pp. 209-216.
About Dr. Murphree
Dr. Murphree is a board certified nutritional specialist and chiropractic physician who has been in private
practice since 1990. He is the founder and past clinic director for a large integrated medical practice located
on the campus of Brookwood Hospital in Birmingham Alabama. He is the author of 5 books for patients
and doctors, including "Heart Disease What Your Doctor Won't Tell You,’” "Treating and Beating Anxiety
and Depression with Orthomolecular Medicine," and "Treating and Beating Fibromyalgia and Chronic
Fatigue Syndrome." Dr. Murphree is a regular columnist for a variety of professional health publications
including The American Chiropractor magazine.
His website is at www.Treatingandbeating.com