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Health Column: Unraveling the mystery of chronic fatigue & fibromyalgia

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Imagine being so tired that you can't function. I'm not talking about being pooped at the end of a long day at work or exhausted after a big hike. I mean the kind of tired that prevents working a normal job or the kind of tired that only allows doing a few hours of chores before having to go back to bed from being so wiped out. Normally, exercise gives one a bit of energy, but not with this type of tired — if not careful exercise just makes it worse.

Now consider having this fatigue all the time, for months to years on end without relief, and even rest won't help. To make matters worse insomnia is usually present as well, so although one may be "dog-tired" they still can't get a sound night's sleep. This is the definition of "chronic fatigue syndrome" (CFS), and it is called a syndrome because there is not one simple cause for the fatigue.

As if this fatigue was not bad enough, now let's add pain. A deep aching kind of pain that moves throughout the body, in the tissues and bones and joints, as well as isolating to 18 specific points about the body. These tender points, called "trigger points," are like epicenters of pain and touching them with just enough pressure to blanch your fingernail produces severe pain. The pain syndrome that centers on the tender trigger points is called "fibromyalgia."

About half of people with fibromyalgia also have CFS and visa-versa. Fibromyalgia affects an estimated 10 million people in the U.S. and an estimated 3-6 percent of the population worldwide, according to National Fibromyalgia Association. For some reason about 80-90 percent of fibromyalgia sufferers are women. The good news is that effective treatment is possible for most of these patients.

WHAT IS FIBROMYALGIA?

First of all, fibromyalgia is a purely clinical diagnosis. There is not a specific lab test or imaging study that makes the diagnosis. Many of us practitioners familiar with treating fibromyalgia and CFS have quit making such a big deal out of needing the recommended 11 out of 18 tender trigger points to make the diagnosis. At the end of the day, having widespread persistent pain, above and below the waist, on both sides of the body and along the midline of the body, meets the definition of fibromyalgia.

Other symptoms that are often present with fibromyalgia include severe fatigue for more four to five months, fatigue that is worse after exercise, insomnia, depression or brain fog, bowel issues, recurrent or frequent infections, and multiple chemical or medication sensitivities.

Dysfunction in a few key systems seems to be the common denominator with fibromyalgia, including the cellular energy producing mitochondria, the "all controlling" part of the brain called the hypothalamus, and the immune system.

Defects in the mitochondria powerhouses lead to the lack of energy, fatigue, muscle shortening and pain. Abnormal control signals from the hypothalamus leads to disrupted sleep, which then causes a lack of important healing hormones, physical rest and tissue repair. Further changes in the autonomic nervous system are related to the abnormal pain signaling. The immune system changes lead to altered balance of immune pathways.

We are finding that these dysfunctional systems stem from underlying conditions such as hormone imbalances, genetic defects in metabolic and detoxification pathways, external stressors such as infections, toxic chemicals, or heavy metal accumulation in the body. Poor nutrition and stress are two very important lifestyle issues that play a role.

TREATMENT

There is no single treatment. A few prescription drugs are approved for the symptoms of pain and mood, and I prescribe them occasionally, but honestly they rarely do much good. A functional medicine approach that seeks the root cause of the syndrome usually leads to marked improvements.

Addressing hormone imbalances or deficiencies is a cornerstone for healing. A disturbed adrenal stress hormone system leads to alterations in cortisol regulation. Undetected or untreated low thyroid or thyroid resistance disorders are common. Imbalances in sex hormones such as estrogen dominance or menopause are triggers for fibromyalgia.

The most important role of the immune system is to defend the body from invaders, using chemical messengers called cytokines, which also influence mood, sleep, energy, cognitive function and many other important aspects of health. Physical triggers such as infections, toxins, or allergens, and psychological events such as emotional trauma or mental stress will lead to the increased production of cytokines. If these triggers are not resolved, cytokine levels will remain high, resulting in chronic systemic inflammation.

Fibromyalgia often starts after an infection and is sometimes associated with persistent, chronic infections. These infections can be yeast/fungal, parasitic, bacterial, or viral. Most infections involve the respiratory tract including bronchitis or sinusitis, bowel infections, and chronic prostatitis. If the infections don't resolve with general treatment then direct treatment is advised.

The exposure to heavy metals such as lead, mercury, arsenic, or cadmium will lead to deposits in the body that are not detected in blood work unless it is an acute exposure.

Heavy metal accumulation is well known to disturb the neurologic, endocrine and immune systems. Chelation is a process of giving a substance that will bind to metals and pull the metals out of storage so they can then be eliminated in the urine.

Working with nutrition, eliminating delayed food allergies, and healing the inflamed or leaky gut is absolutely critical. Lifestyle issues include removing stressors and aggravating factors — this might include situations, people, or toxins.

Sleep, pain, and mood management can all be addressed with combinations of natural supplements and prescription medications. We encourage time for relaxation, laughter and modest exercise. Psychological counseling and support of friends and family is key just like with other chronic health issues.

With fibromyalgia becoming less of a mystery, treatments based on integrative functional medicine can unravel the cause to "lift the veil" of suffering for many with this perplexing syndrome.

GJ Free Press health columnist Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.