JUNE NEWSLETTER: REAL ANSWERS FOR FIBROMYALGIA

By: Gleason Center Editors, Dr. Daniel Gleason DC

Dr. Gleason has just returned from The EPIC Functional Medicine Conference in Houston, Texas. For some time now functional medicine has approached fibromyalgia using a comprehensive model for understanding the cause(s). Applying these principles can lead to dramatic improvement in symptoms where sufferers often describe their status as “cured”.

​Fibromyalgia is a painful and debilitating disorder that has moved from being officially labeled psychosomatic to one that has now received widespread acceptance by the medical establishment. It now has its own CPT codes and diagnostic criteria. This has allowed patients who suffer from this painful syndrome to receive a more sympathetic ear when reporting their symptoms to conventional medical providers. The downside to this acceptance is that patients are now often only offered treatment that involves a lifetime of analgesic and immunosuppressant medication.​

During his presentation at The EPIC Conference, Dr. Alex Vasquez laid out a model for understanding the underlying pathology that leads to fibromyalgic symptoms. Dr. Vasquez has written extensively in the field of Functional Medicine, most recently completing the fourth edition of his massive text Inflammation Mastery. Recently he has released an excerpted portion of that book called Brain Inflammation. These books go to the heart of the triad of pain, inflammation and fatigue.

In 1990 the criteria for a diagnosis of fibromyalgia was based on a physical examination where 18 points on the body were investigated and if more than 11 were very tender the diagnosis was made. In 2010 the diagnostic criteria changed to one based solely on a patient’s reported pain level and locations; there was no longer the need for a physical exam to make the diagnosis. This diagnosis could then be added on to any arthritic diagnosis and the indicated medications prescribed. This change was at the request of the pharmaceutical companies.

Dr. Vasquez’s studies have led him to a causative model that is much more in line with a functional medicine approach. The three primary causes of fibromyalgia are:

1. Dysbiosis
2. Mitichondrial Dysfunction
3. Neural Inflammation/Central Sensitization

Dysbiosis
Dysbiosis translates as “Bad Bugs”. This is a condition when the normal intestinal flora has been disturbed. Common causes are: the overuse of antibiotics in food production and medicine. The standard American diet that is full of preservatives and toxins. Nutritional deficiencies due to diet choices and the production, processing and transportation of food.

The problem with dysbiosis is that the immune system and nervous system are totally dependent on the relationship humans have with their intestinal bacteria. Dysbiosis can lead to Leaky Gut Syndrome and SIBO (Small Intestinal Bacterial Overgrowth). Those with fibromyalgia often respond to a challenge of oral, non-absorbable antibiotics, thus illustrating the connection between gut flora and this muscular inflammation.

Mitochondrial Dysfunction
The second major factor that contributes to fibromyalgia is Mitochondrial Dysfunction. Mitochondria are the “power plants” of our cells. Muscle biopsy confirms that this condition includes damage to the mitochondria. Muscle cells have some of the highest concentrations of these work-horses. The causes of mitochondrial malfunction fall basically into two categories: toxic exposure and nutritional deficiency.

In addition to the environmental toxins that we are all familiar with, dysbiotic compounds from the intestines are major sources of mitochondrial damage. These include hydrogen sulfide, d-Lactate and lipopolysaccharides. Typical symptoms of these toxins include constipation, diarrhea, bloating, gas, and abdominal pain. Mitochondria require nutrition for optimal function. They require Coenzyme Q10, Carnitine, essential fatty acids as well as normal insulin and glucose function.

Neural Inflammation
The third contributing factor for fibromyalgia is Neural Inflammation. Skin biopsy reveals disappearing nerves in the skin in up to 50% of those suffering with fibromyalgia. While this is too low of a percentage to use as a diagnostic indicator, this fact shows that fibromyaglia is a condition of nerve inflammation. Certain nerves known as microglia become activated leading to up-regulation of the glutamate receptors. These nerves are responsible for the pain, depression, fatigue, psychosis, seizures and degeneration. This excess glutamate can be converted to the “good” neurotransmitter GABA using P5P supplementation with the help of magnesium and B2. (P5P is the natural form of vitamin B6).

Comprehensive Treatment Includes:

• The Paleo Diet (Low in fermentable carbs)
• Constipation Management (To reduce intestinal toxin absorption)
• Quality High-Potency Multivitamin
• Vitamin D Supplementation @ 4,000-10,000/day
• Magnesium Malate @ 600 mg/day (with Vitamin C)
• High Quality Essential Fatty Acids (ALA, EPA, DHA, GLA, Oleic acid)
• Probiotics
• Antimicrobials
• Exercise
• Sleep/Rest/Relaxation

For Mitochondrial Malfunction Include:

• Coenzyme Q10 @ 100-300 mg/day
• Acetyl-L-Carnitine @ 1000-2000mg 2X/day
• Lipoic Acid @ 200-400 mg 3X/day
• Intermittent Fasting

For Neuro Inflammation Include:

• Treatment for SIBO
• Treatment for Mitochondria
• Magnesium (To reduce neural excitation)
• P5P @ 250-500 mg/day in divided doses
• Anti-Inflammatory Botanicals

Thanks to doctors of Functional Medicine like Dr. Vasquez we have a science-based, safe and effective approach to understanding and treating Fibromyalgia.

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