SPECIAL FEATURE

January 29, 2003

FIBROMYALGIA

Drug-Free Relief From Chronic Pain

By Dr. Len Saputo

The human body is miraculous. Although we have accumulated an enormous encyclopedia of information about it, the body’s function remain far too complex for human understanding. Nonetheless, the body still manages to operate quite well on its own. Despite the marvelous achievements of Western Medicine, the holistic healing wisdom of nature continues to command a clear element of reverence from many experienced health care practitioners.

This article will explore our current understanding of fibromyalgia (FM) from both conventional and alternative perspectives, and will offer management options that will substantially improve bodily energy and vitality.

FM is characterized by varying combinations of profound fatigue, muscle weakness, flu- like symptoms, non-restorative sleep, muscle and joint pain, abnormal bowel function, and a variety of mental symptoms that range from difficulty in concentration to outright depression.( 1,2,3) Its natural course is typically characterized by years of incapacitation that necessitates challenging lifestyle changes. Social and economic factors often create profound hardships on both patients and their families that can be catastrophically disruptive. It is no wonder that depression is such a frequent finding in FM! However, medical research has clearly documented that this depression is the result of FM, and is not the cause of it. Nonetheless, the frustration experienced by most health care practitioners in managing FM has led to many patients being labeled as "neurotics."

Understanding FM is a tall order because there are so many possible causes for it, and because it can involve so many systems of the body. There is a dysfunction in the regulation of the central nervous, immunologic, and endocrine systems, that is superimposed upon the malfunction of many organs. To make a long story short, however, conventional medicine does not understand either the etiology or the pathophysiology of this disease well enough to cure, or even manage it, satisfactorily.(4) Consequently, physicians and patients alike have experienced continuing frustration resulting from the typically poor treatment outcomes, as well as from the enormous economic burden incurred by ongoing medical costs and lost income. Even the insurance industry has been severely challenged by the mighty costs generated by this disease.

This predicament has created the need to conceptualize a new approach that can provide a better management of the mal-homeostasis (the body's physiologic adjustment to metabolic abnormalities) that results from FM, and causes its associated symptoms. This has been done! A new paradigm of natural healing has emerged that is based on supporting the innate healing capacity of the body, and relies on nutrition and natural therapies as its major tools. Unfortunately, conventional medicine has not yet acknowledged this paradigm. Why?

Conventional medicine is built on a premise of fighting and conquering disease with drugs and surgery. However, because of an inadequate understanding of the cause of FM, there is no clear target to direct its mighty technology and, therefore, effective therapies have not followed.

This new "natural healing" paradigm is based on what is called a "process oriented approach" (POA) to managing disease. The objective of the POA is to create a healthier homeostasis by identifying and correcting metabolic imbalances, and in responding to the specific increased metabolic needs created by the disease process. No attempt is made to intervene with the disease process itself to effect a cure, or to suppress the symptoms of the disease. The innate wisdom of the body to heal itself is respected and is allowed to restore a more functional homeostasis, which can then manifest the healing process.

Much of the basis for this concept is developed form the premise that if all your cells are healthy and functioning perfectly, how can you be sick? Each individual human cell is analogous to a microscopic industrial plant. Without an adequate supply of appropriate raw materials, it cannot be expected to manufacture all of its products properly. Similarly, if it is supplied with the wrong raw materials, it will be unable to produce a product that is perfect. Put simply, we must consume all the nutrients (food) that our cells require, and avoid those that are not needed (and potentially toxic), if our cells are to manufacture everything required for perfect function.

As a culture, we do not appreciate the widespread nature of the nutritional deficiencies in the standard American diet (SAD).( 5) As we migrated from the country, where we consumed whole, unprocessed, and unrefined foods, to the city, where there was an incredible increase in population to be fed, we became faced with new problems that made it difficult to easily provide this kind of sustenance. Storage became a new and important challenge, and we responded by developing a sophisticated technology for refining and processing our food. As this technology improved, we began creating "foods" that were so deficient in nutrients that many of them were not food at all. Nonetheless they stored well, tasted good, and above all, sold.

These unnatural foods are generally high in calories and low in nutrient density, thereby setting the stage for a pandemic of both obesity and malnutrition. In this era of "fat phobia," it is ironic that we are significantly malnourished in the omega 3 and 6 fats that are absolutely essential for good health, and are overdosed with saturated and trans fats that are not only making us fat, but are also killing us. It is interesting that these imbalances in fat metabolism have been found to be particularly common in patients with FM, and that normalization through supplementation usually leads to clinical improvement.( 6)

It is tragic that nutrition is not valued as critically important therapy for patients with any disease, let alone FM. Metabolic demands are dramatically increased in FM, further highlighting the vital importance of nutrition. Woefully, conventional medicine has persisted in its frantic search for the magic bullet that might cure FM. As this approach has failed, the search has shifted to seek out unnatural, synthetic pharmaceuticals that might at least suppress its symptoms.

Making matters worse, like all of us, patients with FM are continually exposed to the estimated one hundred thousand synthetic chemicals that have been synthesized within the past 100 years. These chemicals frequently interfere with an already stressed out metabolism, as the thousands of years that are probably required to evolve and enable our bodies to render these chemicals non-toxic, have not yet lapsed. These ubiquitous chemicals have saturated the food, water, and air that sustain and poison us on a daily basis. While most healthy people have the necessary metabolic capacity to compensate for many of these insults, sick people very often do not. This is the reason why people with FM are called "chemically sensitive," and why they decompensate from what seems trivial to the rest of us.

Typically, traditional laboratory testing is normal in patients with FM. However, a myriad of abnormal findings are discovered when the POA tests are performed. These tests are designed to measure how well we are nourishing our bodies, how much toxic activity is occurring in it, and how effectively our defense systems are operating to sustain normal homeostasis.

The gastrointestinal tract provides a great window through which we can assess our body’s capacity to nourish itself and to defend itself against toxic exposures.(7) Three tests are particularly informative in this regard. First, a comprehensive digestive stool analysis provides information about gastrointestinal digestive and absorptive capacities, and offers important clues about the gut’s ability to keep toxic chemicals out of the body. It assesses the ecological balance of the intestinal microflora, the adequacy of digestive enzyme and acid production and of digestion itself, the capacity of the gut’s immune system to defend itself, and screens for parasitic infections. It is easy to appreciate that cell metabolism can significantly improve when abnormalities found in these tests are corrected.

Second, permeability across the intestinal surface is very often increased in FM, creating the so-called "leaky gut syndrome." Intestinal permeability is very simple to measure, is economical, and provides information that is vital in terms of assessing the potential extent to which the body is challenged to cope with toxic and allergy provoking chemicals that can gain entry into the internal body. Third, by means of a liver detoxification profile test, it is possible to assess the liver’s capacity to detoxify what does get across the intestinal lining. This information allows us to devise a nutritional protocol that will support liver detoxification in such a way that fewer toxins are allowed access into the general circulation.

The immune system in FM is in a state of sustained hyperactivity.(8) This continual strain results in diminished resistance to candida and viral infections, which are frequently seen in FM. The POA approach to this is to simply reduce this stimulation to the immune system, and give it a chance to "catch its breath." Correcting the leaky gut syndrome can be of tremendous value in this regard by decreasing the influx of abnormal, immune stimulating chemicals into the internal body. Another approach that can also be of value in this regard, involves specialized allergy testing for specific foods and chemicals (Elisa/Act test), and then eliminating further exposure to the offending substances. This can also be accomplished through the use of hypoallergenic diets. Other measurements of immune parameters, such as natural killer cell activity (involved in defense against cancer and viral infections) can also be assessed and modified.

Recent discoveries in mitochondrial (the small energy producing factories within our cells) biochemistry have revealed exciting new possibilities for managing the chronic fatigue that is characteristic of FM. Supporting defects in energy production with supplements such as magnesium, acetyl carnitine, and coenzyme Q10 can be very effective in many patients.(9) Clinical trials with these OTC supplements can be tried empirically, although laboratory confirmation of deficiencies can be verified if desired.

It is important in this setting to assess endocrine function, and screen for hypothyroidism, adrenal insufficiency, and hypoglycemia. These endocrine disorders can masquerade as FM and should be differentiated, as they are often easily treated. Studies of the levels and balance of the adrenal hormone, cortisol, and its counterpart, DHEA, may also provide information that can be helpful in both the diagnosis and management of FM.

FM is associated with high levels of oxidative stress. This is a technical way of saying that the body is producing large quantities of powerful toxic chemicals called "free radicals," that cause severe inflammation and destruction in its tissues. Fortunately, these free radicals can be neutralized by means of a diet that is rich in whole, fresh foods, and through supplementation with appropriate antioxidants such as vitamin C, E, beta carotene, picnogenol, coenzyme Q 10, glutathione, and lipoic acid. It is now realistic to measure the amount of free radical activity and of antioxidant levels in serum, and to create healing nutritional protocols based on this data.

The reductionistic approach of Western Medicine is designed to primarily focus on the body as the major malfunctioning factor that "needs fixing." The inseparability of body, mind and spirit is acknowledged, but not revered. No healing therapy would be complete without honoring this holism. It is not surprising that there is scientific evidence supporting the value of other disciplinary approaches such as Tai Chi (10), Qi Gong, Ayurveda, Chinese Medicine, and a multitude of others, where attention is payed to "balance and movement" as reflected by breathwork, physical exercise, and "mobilization of the life force." It is especially important to work in collaboration with other disciplines when requested by our patients, especially when what we are doing isn’t working very well.

In a patient-centered approach, it is imperative that we not view our patients as "a set of symptoms that should be managed with our bag of tools." Operating from an attitude of "being with," rather than "doing to" our patients, carries with it a message of personal responsibility and empowerment. This inspires participation in the decision making process, and also provides hope that it is possible to recover from any disease process. These important attitudes have profound effects on our belief system and act as very potent healing agents.

Healing from any disease is best accomplished by using an integrative approach that is holistic and patient-centered.

REFERENCES

1. Wolfe, F., Smythe, H., Yunus, M., et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis and Rheumatism 33:160-72,1990.

2. Bennett, R. The Fibromyalgia Syndrome: Myofascial pain and the chronic fatigue syndrome. In: Kelly, W., ed. Textbook of Rheumatology. Philadelphia: W. B. Saunders, 1993: 471-83.

7. Galland, Leo, MD, The Four Pillars of Healing. Random House, NY, 1997.

8. Bates, David, Buchwald, D., Clinical Laboratory Test Findings in Patients With Chronic Fatigue, M. J., and Dawson, D.: Red Blood Cell Magnesium and Chronic Fatigue Syndrome. Lancet 337:757-60, 1991.

9. Cox, I. M., Campbell tai chi quan exercise. Int J Sport Med 10:217- 9, 1989.

10. Xusheng S, Yugi X, and Yunjian X: Determination of E-rosette forming lymphocytes in aged subjects with Syndrome. Arch Intern Med 155:97-103, 1995.

Len Saputo, MD, is a graduate of Duke University Medical School and is board certified in Internal Medicine. He has been in private practice in affiliation with John Muir Medical Center in the San Francisco Bay Area for more than 30 years. His approach to healing is based on an integrative style of mainstream medicine, nutritional therapies and prevention.

Over the past seven years, Len has guided the development of an integrative, holistic model of healthcare that is focused on wellness and prevention. In order to accomplish this mission, in 1995 Len founded the Health Medicine Forum, which he continues to direct. "The Forum" is a non-profit educational foundation that has sponsored more than 100 public and professional events, including monthly presentations, workshops, and conferences. In 2001 Len co-founded the Health Medicine Institute, an integrative medicine center in Lafayette, California that is bringing the model of Health Medicine into clinical practice. Further information on Health Medicine, the Forum, and the Health Medicine Institute are available on the Web at http://www.healthmedicine.org