Fibromyalgia – It Isn’t Just Pain.
I know a lot of people who suffer from some form of chronic pain, and alongside that, there are commonly many kinds of symptoms, which tend to get treated as if they are separate and completely unrelated. But it makes far more sense to look for a deeper, connecting cause.
“Fibromyalgia…is a chronic pain syndrome accompanied by other symptoms such as depression, anxiety, fatigue or sleep disturbances...it has…a greater presence in women than in men…Despite its high prevalence, its etiology is still unknown and there are no effective treatments.” (Mario D. Cordero, 2011)
Chronic pain can be a complex issue with a number of different driving forces and interconnected symptoms, but one thing that has been shown to be found at the heart of it all, is an underlying hypometabolic state.
People with ongoing and persistent pain issues, are sometimes told they have ‘fibromyalgia syndrome’ (FMS), and then given very little useful help or advice. Sadly, they are often told, and end up believing, that there really is ‘no effective treatment’. Other symptoms that coexist with the pain issues, are often disregarded or blamed on what are said to be separate issues, requiring unrelated specialized treatments. It’s good for business, and not so good for patients, and there is plenty of actual scientific (and logically coherent) evidence, suggesting a different story altogether.
““Fibromyalgia syndrome” (FMS) is the diagnosis clinicians most often give patients who have chronic widespread pain and abnormal tenderness. Most FMS researchers state that the etiology of the disorder is unknown. In doing so, they fail to account for a substantial line of evidence showing that the main mechanism of FMS is inadequate thyroid hormone regulation.” (John C. Lowe, Jackie Yellin, 2008)
Women suffer from FMS (as well as thyroid issues or hypo-metabolism) more commonly than men, and this is largely due to naturally greater exposure to estrogen, slower liver function, and a generally lower resting body temperature.
“Many features of fibromyalgia and hypothyroidism are virtually the same, and thyroid hormone treatment trials have reduced or eliminated fibromyalgia symptoms. These findings led the authors to test the hypothesis that fibromyalgia patients are hypometabolic compared to matched controls.” (Lowe JC et al., 2006)
“…women with FMS had significantly lower resting metabolic rates and basal body temperatures…consistent with too little thyroid hormone regulation of cell function…” (John C. Lowe, Jackie Yellin, 2008)
Recognizing the relationship between thyroid function and chronic pain or FMS, is a great place to start, however even when this does happen, many get told (after their thyroid system has been examined), that their thyroid function is normal.
And when they are diagnosed with thyroid issues, and if (as is often the case), the treatment does not make symptoms (including chronic pain) any better, they are led to believe that thyroid energy metabolism must not have been the underlying problem. This is most likely not an accurate and justified conclusion.
One important reason, is that when people are diagnosed with hypothyroidism, they are commonly treated with T4 (thyroxine, the inactive thyroid hormone), alone, for the purposes of hormone replacement. There is good reason to believe that this is often not an effective method (especially for women, due to natural biological differences reducing the ability to convert T4 into the active thyroid hormone), and that it can in fact make matters worse.
Tests sometimes show a buildup of T4 in the blood of hypothyroid women, especially when it is being supplemented, reflecting the fact that it is not being used to improve thyroid performance. One of the reasons for this, is that estrogen (as well as low thyroid function in general, as well as slow liver function, or suppressed body temperature), can interfere with the ability of the liver to convert T4 into active thyroid hormone, T3.
Over time then, attempts to improve thyroid metabolism, can sometimes be doing nothing more than further suppressing metabolic energy system function, ironically leading to a worsening of the chronic nature (and seriousness) of FMS type symptoms, which are being fuelled, most likely, by thyroid insufficiency.
Unfortunately however, a culture has been heavily promoted, which erroneously assumes that when thyroid related issues are suspected and tested for, they are being properly ruled out as a factor (or properly dealt with), including when it pertains to cases diagnosed as FMS.
It makes sense (from a logical perspective), and there is lots of good evidence which has demonstrated, that the most widely used modern methods, used to assess whether thyroid function is sub-optimal or not, lack genuine diagnostic meaning and accuracy.
“…a small percentage of hypothyroid FMS patients recover with T4 alone…For most patients to fully recover, however, they must use either combined T4/T3 therapy (with a 4:1 ratio of T4-to-T3) or T3 alone.” (John C. Lowe, Jackie Yellin, 2008)
Adding insult to injury, popular dietary recommendations, suggested to people who are suffering from symptoms of stress and hypo-metabolism (including FMS symptoms in general), can be explained to be exacerbating the progression of the illness, as well as even getting in the way of the potential effectiveness of less than optimal treatments (for example T4 alone), which, in the context of a pro-metabolic diet, might have more of a chance to help.
Polyunsaturated fats (PUFAs), including fish oils, are often recommended as being a ‘healthy’ alternative to animal fats, in many diet related treatment protocols for FMS (and related issues), regardless of the fact that there is a great deal of evidence, showing that the highly unstable and reactive nature of the PUFAs, powerfully promote inflammation, suppress metabolism, and are thereby part of the problem.
The PUFAs are well known to be a major factor damaging liver function and thyroid energy system performance in general, and so this can add fuel to the fire, when it comes to interference with the usefulness of supplementing with T4 alone to deal with FMS or thyroid issues.
The PUFAs get in the way of the ability of the liver to prevent circulating estrogen levels from increasing, and estrogen further suppresses thyroid metabolism, and directly or indirectly promotes a number of anti-metabolic stress substances (including serotonin, lactic acid and nitric oxide), which can all be seen to be an additional part of the whole problem.
The PUFAs, as well as activation of the stress system in general, can lead to temporary symptom improvement, and short term symptom reduction is often used as an argument to promote the most popular treatment and dietary approaches. But metabolic suppression is not the same as overall thyroid energy metabolism improvement, and long term metabolic damage tends to get ignored or misinterpreted.
FMS is an inflammatory condition associated with increased oxidative stress, and this is demonstrated in part by higher levels of exposure to the breakdown products of the polyunsaturated fats (due to lipid peroxidation), throughout the body.
“Skin biopsies from patients showed a significant mitochondrial dysfunction…and increased levels of oxidative stress….related to increased levels of inflammation…correlated with pain, the principal symptom of FM…findings may support the role of oxidative stress, mitochondrial dysfunction and inflammation as interdependent events in the pathophysiology of FM.” (Sánchez-Domínguez B, et al.,2015)
“…lipid peroxidation, one of the main consequences of oxidative stress, can interfere in the etiology of pain perception, either by induction of central or peripheral hyperalgesia…oxidative damage can cause a local reduction of nociceptors and thereby reduce the pain threshold.” (Andrei Pereira Pernambuco, et al.,2016)
Studies suggesting that so called iron deficiency is a factor causing FMS, are more likely misinterpretations of the symptoms of hypothyroidism, or overall energy system dysfunction (anemia for example), and this is another scenario where the likely treatment approach (iron supplementation or increased dietary iron intake), could have unintended negative consequences. Iron dysregulation and oxidative stress are closely connected issues that exacerbate each other.
Oxidative stress and the breakdown products of the PUFAs, can be seen as an important link between FMS and thyroid dysfunction, as well as a number of other largely overlooked connections which help explain the relationship between chronic pain and many kinds of metabolic diseases or conditions.
“…involvement of oxidative and antioxidative parameters and to evaluate the relation between fibromyalgia (FMS) and obstructive sleep apnea syndrome (OSAS)…In the OSAS + FMS group, CAT (catalase), SOD (superoxide dismutase), and GDX (glutathione peroxidase) were found to be statistically significantly lower and MDA (malondialdehyde) was found to be statistically significantly higher than in both the control group and the OSAS group…which indicated that oxidative stress might play a role in the pathophysiology of both diseases…” (Yildirim T, Alp R., 2017)
FMS symptoms and diabetes have been shown to be closely associated, and this makes sense in the context of the role of thyroid energy system suppression, and exposure to oxidative stress and the breakdown products of the PUFAs, in the promotion of insulin resistance, blood sugar dysregulation and other diabetes related problems.
“…the numbers of tender points, pain scores, and the prevalence of sleep disturbances, fatigue, and headaches were higher in this group of patients…Fibromyalgia is a common finding in patients with types 1 and 2 diabetes, and its prevalence could be related to control of the disease. As with other diabetes complications, FM might be prevented by improved control of blood glucose levels.” (Tishler M, et al., 2003)
The over consumption of PUFAs and difficult to digest grains, seeds, nuts, beans and legumes, as well as too much under cooked starchy and fibrous vegetables (and even certain fruits), can promote an overgrowth of bacteria in the intestines, particularly when metabolism is suppressed and digestion and liver function are already sluggish.
More exposure to bacteria, generally means an increase in endotoxin and serotonin release in the intestines, which can then lead to greater stress on the liver, eventually causing levels of estrogen circulating throughout the body, to rise. This can be a big factor in the worsening of inflammation, promoting further interference with thyroid function and metabolism, and escalation of FMS symptoms.
Tissue injury and inflammation cause more serotonin to be released into the system, and rising levels of serotonin are powerfully anti-metabolic, and have been directly implicated in the progression of chronic pain, and many of the other issues which often go along with it, including depression and anxiety.
“Peripheral tissue and nerve injury can lead to hyperalgesia, a state in which painful stimuli are perceived as more painful than normal. One major contributor to hyperalgesia is augmented sensitivity of primary nociceptive neurons, a phenomenon called peripheral sensitization…our results reveal a novel pain mechanism in which…5-HT [serotonin]…maintains central terminal sensitization by activation of presynaptic 5-HT3A receptors…” (Kim YS, et al., 2014)
A number of different things which lower exposure to serotonin, and help to promote overall metabolic function, have been used to successfully reduce pain, and a variety of other symptoms of fibromyalgia or FMS.
“…a novel antidepressant…mirtazapine was used…characterized by selective blockade of 5-HT2 and 5-HT3 [serotonin] receptors…for fibromyalgia…Intensity of pain, sleep disturbances, fatigue and other symptoms were measured…the majority…experienced…improvement…of > or = 40% reduced intensity of fibromyalgia symptoms as well as reduced severity of depression….suggests a common pathophysiology of depression and symptoms of fibromyalgia.” (Samborski W, et al., 2004)
A hypometabolic state and digestive distress tend to go hand in hand for a number of biologically logical reasons, and they can probably all be explained under the general blanket of excess metabolic stress. It’s likely not just a coincidence that inflammatory bowel issues such as IBS and SIBO have been shown to be involved in the progression of thyroid dysfunction and FMS.
“Up to 32% of patients with fibromyalgia are labelled as having IBS, and 81% report irregular bowel habits…a common finding in both fibromyalgia and IBS is…the presence of bacterial overgrowth…it is likely that endotoxin produces hyperalgesia…” (Pimentel M, et al., 2004)
Many of the substances which rise under stress, and which are also promoted by excess bacteria and endotoxin release (including serotonin, estrogen and nitric oxide) have been directly implicated in FMS and thyroid energy system dysfunction in general.
“Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT…stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in…FMS patients.” (Neeck G, Crofford LJ, 2000)
“…NO [nitric oxide] can actively participate in the hyper sensitization in FM…the use of [nitric oxide] inhibitors can be a very plausible alternative for the treatment of painful symptoms such as those presented in FM syndrome.” (Andrei Pereira Pernambuco, et al., 2016)
Methylene Blue (MB) has been shown to provide protection from bacterial endotoxin, serotonin, estrogen and nitric oxide, and it is known to directly promote mitochondrial energy system (metabolic) function. MB has also been shown to inhibit prolactin (which is known to rise alongside increasing estrogen levels), and which has been demonstrated to be high in another chronic pain related condition, polymyalgia rheumatica (PMR).
Under circumstances where sugar is being avoided (or where the use of sugar for energy production is being interfered with), levels of stress substances such as adrenaline and cortisol, generally increase, helping to move things in a direction, likely to become increasingly hypometabolic over time.
Sugar restriction promotes the release of polyunsaturated fats (PUFAs) out of storage as free fatty acids, aggravating inflammatory issues and causing an increase in oxidative stress issues. The polyunsaturated fats damage the liver, intensify problems associated with endotoxin, estrogen and serotonin, and interfere with thyroid hormone function and overall energy system metabolism, worsening general blood sugar dysregulation issues, further inhibiting the use of sugar for energy production. This is a vicious circle type of scenario, which can play a big part in the promotion of FMS.
In this type of circular scenario, the responsiveness of tissues to T3 can be significantly suppressed, adding to the difficulty of getting positive treatment results, at least in the short term. When T3 is ineffective, metabolic function starts to be driven largely by the stress system, rather than with proper energy system function, and this can be a major factor worsening chronic pain and related symptoms.
There are many different ways to approach the issue of chronic pain, and yet they are probably all interrelated one way or another. True biology, to the extent that it is understandable, is holistic in nature. In this sense fibromyalgia or FMS, is as much a brain issue, as it is an hormonal, nervous system or energy production problem.
A great example of this is the way that pain dysfunction is now being shown to be able to be treated with the use of ‘brain based’ therapies, such as neurological drills which tap into vestibular and ocular function, in an attempt to improve overall nervous system performance. Such methods can be said to work directly on the brain and nervous system, but in saying that, they can also be understood to be attempting to improve thyroid metabolism and energy systems, as well as liver and digestive function.
“Medical records of 124 patients (78 women, 46 men) were reviewed. Vestibular deficits were detected in 83 patients (66.9%)…Patients being treated with medications for chronic, noncancer pain or other underlying neurologic disorders may have a higher-than-average incidence of vestibular dysfunction.” (John W. Gilbert, et al., 2014)
Exposure to chronic stress can lead to many different ‘disease’ outcomes, with interrelated and overlapping physiological conditions, and symptomology. Fibromyalgia and chronic fatigue are sometimes considered to be expressions of the same underlying problems. High levels of nitric oxide, endotoxin, serotonin and estrogen, as well as hypo-metabolism in general, have all been implicated.
“…chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD)…share common symptoms…Many patients meet the criteria for diagnosis for two or more of these disorders and each disorder appears to be often induced by…stress…followed by a chronic pathology…” (Pall ML, 2001)
Iron dysregulation, excess PUFAs in circulation, endotoxin, thyroid energy system suppression, and increased exposure to the substances of stress, such as serotonin, estrogen and nitric oxide, are interrelated and central to many metabolic diseases including diabetes, and can probably explain many cases of FMS and its co-occurance with a long list of symptoms.
In combination with pro-metabolic treatments, a diet avoiding the polyunsaturated fats, and limiting difficult to digest fibrous and starchy foods, including regular intake of milk, cheese and gelatin, sweet ripe fruits, fruit juice, white sugar, and honey, has the potential to help deal with the causes and symptoms of hypometabolism and thyroid dysfunction, including FMS or chronic pain issues.
Hypo-metabolism and irregularities in body temperature and pulse regulation go hand in hand. Measuring and tracking temperature and pulse variations (commonly upon waking and after breakfast and lunch), as well as other old fashioned reliable indicators of thyroid function, can help determine the success of attempts to improve thyroid and metabolism, and help understand the impact of changes in diet (and other therapeutic methods) being experimented with, and provide useful information which can increase the chances of healing and recovery.
“…likely that too little thyroid hormone regulation of cell function is the main cause of most patients’ FMS...to ignore the evidence…is…not respectable scientific conduct.” (John C. Lowe, Jackie Yellin, 2008)
Some pro metabolism things which have had success in treating pain related conditions, include thiamine (B1), red light therapy (also in combination with MB), aspirin, activated charcoal, cyproheptadine, low dose naltrexone, progesterone, magnesium and certain antibiotics.
Although I am not a doctor or health professional, and none of this is intended as treatment advice, I have seen a lot of different types of evidence, which have convinced me of the value in approaches (to FMS and related symptoms), which work on metabolic improvement, in the true sense.
In line with the same pro-metabolism outlook, evidence and explanations show the reasons why popular anti-depressants (such as the SSRI’s) and many current and commonly prescribed pain medications, have at the very least, been far from successful.
See more here
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