Guided-Wellness Module

Fibromyalgia, also called fibrositis, is more prevalent in adults, with a higher incident in women.  Decreased levels of ATP and changes in energy metabolism have also been found in the red blood cells of fibromyalgia patients, suggesting that fibromyalgia may be a more general and systemic problem than originally thought, possibly impinging on other organ systems.

SYMPTOMS:

  • Ache all over: waxes & wanes, similar to arthritis
  • Fatigue: feels like muscles are pulling: pain in ligaments and tendons
  • Muscles twitch & burn
  • More women affected
  • Lack of energy (severity of symptoms fluctuate)
  • Resembles post viral state
  • Possible relation to CFS
  • Sleep disorders (REM level of 3-4 interrupted) creates alpha EEG anomaly in deep sleep
  • Alpha wave intrusion
  • IBS
  • Chronic headaches
  • TMJ dysfunction syndrome
  • PMS, chest pain, morning stiffness, memory impairment, numbness & tingling sensation, muscle twitching
  • Skin sensitivities, swollen extremities, dry eyes & mouth, dizziness, impaired coordination
  • Vision problems
  • The chemistry of the brain is imbalanced because the chemistry of the brain is a mess (chemical pain)
  • Liberalism (see bullet point above)

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Diagnosis of fibromyalgia:

  • Can be very difficult, must rule out other diseases, as it mimics other disease states
  • Acupressure points
  • Must have pain in all 4 quadrants of the body for a minimum of 3 months
  • Muscular-skeletal pain & fatigue
  • Up to 18 sites clustered around the neck, shoulders, chest, hip knee & elbow
  • Usually bilateral, usually 11 out of 18 sites
  • No real definitive laboratory testing except, O2 Utilization & VO2max.
  • Not considered an inflammatory disease
  • A Cortisol inverted ratio
  • LOW SEROTONIN LEVELS                       
  • LOW TESTOSTERONE LEVELS (this modulates pain & endorphin levels)
  • Substance P, FM produces 4x’s as much here as in response to normal noxious stimuli
  • GH deficiency, due to non-REM sleep
  • Due to interruption of slow waves

Aggravating factors:

  • Deep level of sleep is interrupted, (stage 4-rem, you get an altered alpha; EEG
  • Changes in weather
  • Hormonal imbalances & fluctuations
  • Stress, depression and over-exertion
  • Physical exertion, even mild exertion
  • The aerobic capacity decreases as you age

 The Inflammatory Cascade Precipitating events that trigger onset:

  • Infections, viral or bacterial
  • Traumatic accidents
  • Most FM patients consume enormous amounts of CARBOHYDRATE-rich foods, which may greatly contribute to their symptoms!
  • Heavy metal toxicity
  • Rheumatoid Arthritis
  • Lupus Erythematosis
  • If resting oxygen is low, the thyroid is problematic
  • Hypothyroidism:
  •  Poor Dietary habits esp., HIGH FRUCTOSE CORN SYRUP, as this is toxic to the body’s metabolic process and affects fibromyalgic’s, to a greater degree!

 All the above events may awaken underlying physiological abnormalities

that are already present.

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TESTING and LABORATORY SCREENING for Chronic Myofascial Syndrome (Hematological Profile, Blood Chemistry & Vitamin testing)

~Janet G Travell, MD; The Trigger Point Manual, 1983, p 155.

BLOOD CHEMISTRY PROFILE   URIC ACID LEVEL: if increased: indicates gout (hyperuricemia)POTASSIUM: if low, can cause muscle cramps and increase myofascial TP’sFASTING BLOOD GLUCOSE:NERVE CONDUCTION VELOCITIES:SERUM IONIZED CALCIUM: if low could mean calcium deficiency.                                                                       SERUM CHOLESTEROL: if increased could indicate low thyroid function: if low could mean low folate deficiencyLOW MAGNESIUM                                                  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEMATOLOGICAL PROFILE

  1. ESR (Erythrocyte Sedimentation Rate). If normal, no chronic bacterial infection.

If elevated, it is non-specific and may indicate other conditions such as, RA or cancer.

  • ESR, if decreased, or low hemoglobin, indicates anemia which tends to make muscles hypoxic and increases TP (trigger point) irritability. Anemia can be caused by a folate or cobalamin deficiency.
  • MCV, if increased above 92 (95-100), a folate or cobalamin deficiency is likely increased.
  • Eosinophilia, if elevated, may be due in part to an active allergy or an intestinal parasite like E..histolytica or tapeworm.
  • Monocytes, may be due to low thyroid function or an acute viral infection

(if elevated, more than 50%)

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VITAMIN DETERMINATION

  1. B1, B6, B12, FOLIC ACID & VITAMIN C: abnormally low levels of any of these vitamins perpetuate TP’s
  2. esp., if in of lower quartile of normal

THYROID TESTS

T4- T3 And Basal Body Temperature

~Janet G Travelle, MD; The Trigger Point Manual, 1983, p. 156                             

ETIOLOGY

Theories explaining fibromyalgia:

  • Hormonal system imbalances (PMS, ERT, HRT, etc.)
  • Viral symptom imbalance
  • Alterations in sleep physiology
  • Low levels of IGF-1 are present in most FM patients
  • Sleep apnea
  • Mitochondrial derangement in small muscle fibers
  • Sleep deprivation
  • Alterations in immune system function
  • Alterations in brain chemistry & function, esp., neurotransmitters (esp., serotonin)
  • Toxin exposure can result in prolonged firing of the body’s pain receptors, increasing sensitization and exaggerating the central nervous system response. Exposure to heavy metal mercury may contribute to altered inflammatory and immune responses and have neurotoxic effects.

Muscle hypoxia and prolonged energy deficiency, may be causes of fibromyalgic pain.   Biochemical studies have confirmed that energy metabolism is abnormal in fibromyalgia, thus requiring appropriate metabolic therapy.                             ~Olson NJ, Journal of Health Page 2

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Most current theory is that oxygen deprivation may be the culprit!

Blood flow to the tissue in fibromyalgia patients is lower than normal thus leading to:

                               “LOW TISSUE OXYGENATION LEVELS”                 

Reduced blood flow, changes in capillary wall thickness and structural changes to the mitochondria contribute to hypoxia, decreased oxidative phosphorylation, lower ATP synthesis and reduced levels of Adenine Nucleotides in fibromyalgic muscle. (2,4)pg.,1

Recent research has shown that those with fibromyalgia have capillary walls (capillaries are the smallest of blood vessels that bring blood and oxygen to affected muscles) that become thickened and are unable to deliver enough oxygen to fully meet the need in the tissue.  This lack of oxygen creates localized ischemia, draining energy from muscles.

Energy depletion then unleashes a cascade of physiological events that cause mild to severe pain; muscle stiffness and soreness; and overwhelming fatigue.  One of the major impacts of the cellular energy deprivation associated with fibromyalgia is the muscles’ inability to manage their own calcium load. 

The subsequent lack of cellular energy inhibits the activity of the cellular calcium pump, so that calcium cannot be adequately discharged from the cell following a muscle contraction. YOU MUST HAVE AN ADEQUATE MAGNESIUM LEVEL.

This buildup of calcium in the cell sustains the muscle’s contraction, keeping it tense.  The increase in intracellular calcium also causes potassium ions to rush out of the cell, activating pain receptors on the cell membrane called nociceptors.  Most of us experiencing muscle pain do the same thing:  tense and tighten that painful area even more. 

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All this contraction contributes to more muscle stiffness and exacerbates the drain on energy reserves.  We all know how exhausting pain is, both physically and emotionally.  And so, the downward spiral continues. 

Some patients, having been in an automobile accident, for example, go on to develop symptoms. Others, exposed to environmental toxins like heavy metals, insecticides, and pesticides, become so poisoned that they develop these symptoms. These factors, and others, are causing the incidence of FM and CFS to increase. 

Additionally, the poor bioenergetic status of muscles in the fibromyalgia syndrome may be due to reduced blood flow in the affected tissue, which in turn would limit production of ATP.  Just as a heart in failure is energy-starved, so is a fibromyalgic muscle.  Since decreased levels of ATP and changes in energy metabolism have been found in red blood cells of fibromyalgic patients, and that blood is circulated throughout the body, some researchers now believe that fibromyalgia may be more of a systemic problem than a localized one.

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Current treatment regimens for fibromyalgia:

  • Physical therapy & aerobic therapies
  • Acupuncture & acupressure
  • Stress & relaxation therapies
  • VIBRATIONAL POWER PLATE

or DKN Vibration Plate technology (3x’s QW.)

  • OXYGEN UTILIZATION: a 45-minute test utilizing a pulmonary gas analyzer & an exercise ergometer
  • Mitochondrial energy optimizer by Life Extension, (for energy & fatigue)
  • Body-Bio the P-K Protocol for membrane detoxification,(888-320-8338)
  • IAG & Amino Sport : Biotics research Inc.(arabinogalactins & amino acid formula for muscle strength)
  • Cognitive Reframing
  • Txt in a hyperbaric oxygen chamber
  • SAM-e, a methylator
  • Ambien gives steady sleep pattern BUT is addictive, use KAVINACE instead
  • Tramadol (Ultram) decreases the use of opioids to decrease tolerance and addiction
  • NEO-40, increases NO Levels
  • PQQ, boosts mitochondrial biogenesis
  • PEMF bio-magnetic mats, BEMER or iMRS brands
  • NAD+, from Life Extension
  • Magnesium Orotate, 600 mg qd. to bowel tolerance
  • NT-Factor, Trace minerals, and OZONE THERAPY!
  • D-RIBOSE, D-RIBOSE, D-RIBOSE, (15 mg per day, dispense TID.) D-Ribose supplementation accelerates the metabolic pathways responsible for making the ATP molecule itself, rebuilding energy pools and promoting normal heart and skeletal function.
  • Balance all HORMONES, esp. thyroid & testosterone
  • Balance all NEUROTRANSMITTERS, esp. Serotonin and Dopamine
  • Control insomnia, OSA, esp., stage 4 REM-sleep
  • Trigger point injections
  • Address ADRENALS
  • NSAIDS
  • Myotherapy
  • Humira, a TNF-alpha blocker (for severe arthritis)

  (polyarticular arthritis and CROHN’s), suppresses the immune system and can cause SERIOUS SFX.

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  • Testing for V-max and O2 utilization potential
  • Move around and move often, aerobic exercise is hugely important
  • CFS & FM: have a higher Inflammatory Cytokine Index and this inhibits IGF-1
  • Remove all heavy metal toxins, see next step:
  • The key botanicals in Ultra Clear Renew may modify upstream signaling pathways. Such as:
  •   Phase II enymes in the liver (GST,NQO-1,and activators such as:
  •   Nrf-2, HO-1, associated with the antioxidant response element (ARE) and metal   response element (MRE)- Transcriptional elements that induce toxic element metabolism and liver detoxification
  • VERY LOW- CARBOHYDRATE DIET esp., no HFCS
  • Proper exercise techniques
  • ULTRA CLEAR RENEW (Metagenics) helps patients manage pain and stiffness as well as helping with urinary output of heavy metals. Txt with: Ultra Renew & Ultra Clear Renew for 4 weeks qd. caused a reduction in:   
  • FIQ total score, (fibromyalgia impact quotient or Questionnaire)
  • Decrease in fibro-quest score
  • An increased mRNA expression of METALLOTHIONEIN, a cellular     protein that plays a role in the metabolism of heavy metal elimination.
  • An increase in Creatinine-adjusted excretion of Hg++

 

ENERGY STATUS OF FIBROMYALGIC MUSCLE

Biopsy studies investigating the metabolism of ATP, creatine phosphate (PCr), ADP, AMP, pyruvate and glycogen have shown that levels of PCr and ATP are significantly lower (21% and 17%, respectively) in fibromyalgic muscle and the synthesis of PCr, the most important store of high energy phosphate in the cell, is defective.

P-31 MRS looks directly into the muscle to determine the absolute values of energy compounds, muscle pH and changes in metabolism as they occur at rest and during exercise. In addition, during exercise there is an increase in metabolic breakdown products of ATP energy metabolism and disruption of cell membranes, both associated with muscle disease.

The energy reserve, or phosphorylation potential (PP), and the ability to utilize oxygen (total oxidative capacity or Vmax) have been determined using P-31 MRS. The mean PP is significantly lowered in FM patients and V-max is also significantly reduced.  These findings are consistent with reduced oxidative phosphorylation and ATP synthesis in the muscles of fibromyalgia patients and may translate into the clinical symptom of fatigue.

Poor bio-energetic status of muscles in fibromyalgia may be due to reduced blood flow to affected tissue and thickening of capillary walls, leading directly to reduced levels of ATP, lower energy reserves and oxidative capacity (V-max) and abnormal levels of phosphor-diesters in the muscle. 

The additional complication of impaired oxidative phosphorylation in the mitochondria and diminished glucose metabolism, both lowering ATP turnover, suggests that fibromyalgic muscle is energy starved. Decreased numbers of capillaries that reduce oxidative capacity may increase pain, while thickened capillary walls lowering oxygen delivery and abnormal mitochondria lead to fatigue and weakness.  All are associated with reduced levels of ATP and energy metabolism that, in turn, leads to disruptions in calcium stasis, muscle soreness and stiffness. 

 

Ribose in Maintaining Tissue Energy Stasis

 

Tissue hypoxia leads to a progressive depression of the cellular purine nucleotide pool creating an energy deficit.  The adenine nucleotide ATP is the primary energy source of all living cells.

Exogenous ribose administration provides the metabolic support required to bypass the rate limiting enzymes of the PPP, form PRPP and restore energy stasis in metabolically stressed muscle.

The effect of ribose treatment in myoadenylate deaminase deficiency (AMP deaminase deficiency) and adenylosuccinase deficiency has been well documented.  Like fibromyalgia, these conditions lead to progressive depletion of cellular energy pools, leading to muscle pain, soreness and stiffness.  The beneficial role in energy recovery in these disease conditions with ribose treatment is suggestive of its potential role in energy recovery in fibromyalgia.

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WHAT IS THE CONNECTION?

What do all of these conditions have in common with each other?

They are what you would call Chronic Degenerative Diseases.

CDD’s all have a common thread running through their cause and they take many years to develop.

WHAT IS THE COMMON THREAD RUNNING THROUGH ALL OF THESE CONDITIONS?

  • Age-Associated macular degeneration
  • Allergic diseases
  • Alzheimer’s disease
  • Aortic valve stenosis
  • Asthma
  • Atherosclerosis
  • Autoimmune disease
  • Cancer
  • Congestive Heart Failure
  • Diabetes
  • Fibromyalgia
  • Fibrosis
  • Heart attack
  • High blood pressure
  • Kidney failure
  • Lupus
  • Metabolic syndrome
  • Obesity
  • Osteoporosis
  • Pancreatitis
  • Periodontal disease
  • Psoriasis
  • Rheumatoid arthritis
  • Stroke
  • Surgical complications 
  • Wrinkles

Remember to always think in terms of WHOLE BODY SYSTEMS!

THE ANSWER: “Chronic Inflammation” 

Thanks to the Harvard Medical School, the connection is now firmly established.   In 2000 they linked cardiovascular disease to periodontal disease.  Since that time many other CDD’s have now been linked to silent inflammation as well.

FIBROMYALGIA THERAPIES

You must consider any and or all of these factors, nutrient’s, or determinants in the treatment of fibromyalgia! Talk to, and seek, the counsel of your chosen clinical practitioner.

Acetyl-L-carnitine

Acupuncture

Adrenal health

Alpha –lipoic- acid

Balneotherapy

B vitamins

Chlorella

Coenzyme Q-10

D-Ribose

Ginkgo biloba

Guaifenesin

IV nutrients

Magnesium

Melatonin level

Mild exercise after 3 months

NADH

Probiotics

SAM-e

Avoid salicylates

Thyroid health

Tryptophan/5HTP

Vitamin D

American Academy of Anti-Aging Medicine; www.a4mcom

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