April 30, 2003

NEWSLETTER #42

A condition named for the pain it causes in fibrous muscle tissues, fibromyalgia has been the focus of research and controversy for decades. Its main symptoms--sever, total-body muscle pain and fatigue--are often accompanied by allergies, headaches, sleep disorders, irritable bowel syndrome, dizziness, anxiety, or depression. In addition, patients diagnosed with fibromyalgia syndrome (FMS) may suffer mood swings, dry eyes alternating with watery eyes, carpal tunnel syndrome, tender skin, sensitivity to cold, numbness or tingling sensations, painful menstruation, or a heightened sensitivity to light, sounds, odors, or textures.

Because fibromyalgia is difficult to diagnose and resembles chronic fatigue syndrome (CFS), the American College of Rheumatology has published a chart of 18 fibromyalgia-related "tender points" on the neck, upper ches, upper thigh, knee joint, upper and middle back, elbow, and buttocks. If at least 11 of these points hurt when touched, the diagnosis is FMS rather than CFS.

An estimated 70 to 90 percent of America's 3 to 6 million fibromyalgia patients are women, most between 34 and 56 years old. "Symptoms usually appear between the ages of 25 and 45," says Mark J. Pellegrino, MD, a fibromyalgia specialist in North Canton, Ohio, who has treated more than 10,000 FMS patients and has the disorder himself. "The prevalence of fibromyalgia increases in the opoulation as the age increases. Among 70-year-olds, 12 percent have fibromyalgia.

Dr. Pellegrino explains that fibromyalgia is not a new disease, since it was described and diagnosed a centry ago. But it was not recognized by the American Medical Association until 1987, and physicians still disagree about whether it is a legitimate medical condition whose unique symptoms require specific therapies. "I don't expect that the controversies will disappear as long as there are people who don't understand and believe in fibromyalgia," he says. Dr. Pellengrino considers fibromyalgia a chronic, permanent condition for which there is no known cure.

Chiropractor James P. Kotorac, DC, who treats people with fibromyalgia in Congers, New York, disagrees. "I'm convinced that America's fibromyalgia epidemic is just a reflection of our country's nutritional deficiencies and lack of exercise," he says. "One result of inactivity combined with inadequate nutrition can be the muscle-pain "tender points" associated with fibromyalgia. The pain has been attributed to a high degree of gluconeogenesis, or muscle tissue breakdown. And that breakdown is caused not by a disease but by the patient's diet and lifestyle."

A RECENT STUDY BY Jacob E. Teitelbaum, MD, and his colleagues at the Annapolis Research Center for Effective FMS/CFIDS Therapies supports the need for nutritional therapy as part of an integrative approach. Treating fibromyalgia patients every morning with a daily multivitamin plus magnesium and malic acid, as well as a bedtime regimen of melatonin, valerian, and lemon balm, proved effective when compared with placebo. An independent, randomized, multicenter replication of this study is in the works.

Dr. Kotorac treats fibromyalgia with deep-tissue chiropractic a djustments combined with active exercise and nutritional supplements. "The adjustments help relieve pain and increase mobility," he explains, "but the most important part of the therapy is increased exercise and the right nutritional supplements. For my patients, I recommend an easily assimilated vitamin/mineral supplement plus the nutrients that have been shown to relieve fibromyalgia symptoms. These include malic acid, magnesium, manganese, vitamin B6, and thiamine."

For fibromyalgia, Dr. Kotorac suggests a combination of easy cardiovascular exercise and simple resistance work. "Walking is a perfect cardiovascular exercise," he says, "and for resistance work I refer patients to a personal trainer who shows them the right way to start lifting weights with hand-held dumbbells. So far, all of my patients who took the right supplements and got the right exercise improved immediately."

"Some people with firbromyalgia find that taking supplemental coenzyme Q10, a nutrient used as an energy source by the muscles, can be helpful," says Dr. Teitelbaum, who also recommends acupuncture and yoga for some patients. "Treating structural problems is also critical infibromyalgia," he adds. "However, you should see a chiropractor who does a lot of hands-on work, as opposed to one who mainly uses machines."

Clinical nutritionist Phyllis A. Balch and James F. Balch, MD, recommend a well-balanced diet of 50 percent raw foods and fresh "live" juices to renew energy and build immunity. Their FMS diet plan avoids fried or processed foods, shellfish, dairy foods, caffeine, alcohol, white flour products such as bread or pasta, and sugar in any form, including fructose and honey. While these are common offenders, individual reactions vary, and any food can be a "problem" food for someone. Keeping a journal that tracks down what you eat and how you feel is an inexpensive way to discover foods that are best avoided.

Mark Stengler, ND, emphasizes nutrition and digestion in the treatment of fibromyalgia. Toxins from the environment and the patient's diet play a role, he finds. So he recommends gentle detoxification with

Chlorophyll-rich green foods and supplements as well as liver-supporting herbs like milk thistle seed and dandelion root.

"Poor digestion has been conclusively demonstrated by clinical studies to be a major factor in conditions such as fibromyalgia," he says. "I recommend the use of bitter herbs, such as Swedish bitters, and a hydrochloric acid (HCl) supplement as well as digestive enzymes with each meal. All of these improve the assimilation of food, especially protein, which the body needs for muscle tissue repair."

For pain relief, Dr. Stengler's favorite supplent is MSM (methylsulfonylmethane), an organic sulfur compound that occurs naturally in plant and animal tissues. MSM, which is abundant in raw foods, is so fragile that the heat of cooking or processing destroys it. One result of our dependence on convenience foods is a nationwide MSM deficiency. As a supplement, MSM has been shown to help detoxify the body, relieve pain and inflammation, speed the healing of injuries, and improve overall health.

By focusing on his patients' digestive weaknesses, hormone imbalances, and exposure to toxins, Dr. Stengler estimates that he has helped 90 percent of his patients resume their normal activities. "In some cases," he reports, "it seems that people are cured, as they have not had symptoms for five or more years since being treated"

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