Fibromyalgia: not at all what you think!

What if fibromyalgia is not your body attacking itself, but actually your body desperately fighting pathogens, irritants, and toxins together and not getting the help it needs to win the battle? 

It has been thought until recently that fibromyalgia is another “idiopathic”, unexplainable, genetic, stubborn disease with no cure. That it is your body attacking its own cells! That there’s nothing that can be done about it! But Functional Medicine has got a completely new view on this disorder, based on several years of studies, trials, clinical observation, and experience.
Once more, instead of just focusing on the symptoms of fibromyalgia, in Functional Medicine we focus on the underlying causes. We investigate them, until we find them. Then we remove them with natural agents, a healing diet, exercise, lifestyle prescriptions, and a positive and spiritual mindset. 
The conventional medical treatment for fibromyalgia is based on pharmaceutical drugs and psychotherapy. Here’s a list of the most common prescriptions:
  • Pain relievers (eg, opioids, nonopioid analgesics, local anesthetics)
  • Sleep aids
  • Anti-inflammatories (eg, nonsteroidal anti-inflammatory drugs [NSAIDs])
  • Antidepressants
  • Botulinum toxin (Botox)
  • Muscle relaxants
  • Anticonvulsants
  • Education concerning the diagnosis and treatment of fibromyalgia
  • Cognitive-behavioral therapy

However, none of these above therapies actually treats the root-causes of the disease! Once more, they’re just masking symptoms and remaining purely at the surface or “tip of the iceberg” of the problem.

Instead of working on the tip of the iceberg, or in other words on  the apparent pain, inflammation and depressed mood (please see image below), in functional medicine work on the submerged part of the iceberg, the one that is not apparent to the naked eye and where the underlying causes lie. This is the investigative side of functional medicine and our first line of action. We investigate underlying biochemical glitches causing the disease process at a cellular, molecular, and organ level, with the help of functional laboratory diagnostics. The functional medicine experts excel in this area of investigative medicine by caring to understand the causes, antecedents, and triggers of any chronic and degenerative disease before applying a remedy to solve the problem.

Root-causes hidden in the gut

There are several studies connecting fibromyalgia with digestive issues. A great study published by The British Journal of Medicine on March 12, 2004, found out that most patients with fibromyalgia test positive for high levels of SIBO in their gut, making SIBO one of the main causative factors of the disease – A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing, BMJ, Volume 63, Issue 4.
Let’s see some other findings by other studies:
  • Irritable Bowel Syndrome (IBS) is present in 30–70% of fibromyalgia patients.  (1)
  • 73% of patients with fibromyalgia report GI symptoms (2)
  • FM syndrome occurs in up to 60% of patients with functional bowel disorders. (3)
(1) Bowel Dysfunction in Fibromyalgia- Evans Memorial Department of Clinical Research, University Hospital, Boston, Massachusetts. – Dig Dis Sci. 1991 Jan;36(1):59-64.
(2) Fibromyalgia: the gastrointestinal link – Cedars-Sinai School of Medicine UCL University -Curr Pain Headache Rep. 2004 Oct;8(5):364-8.
(3) The association of functional gastrointestinal disorders and fibromyalgia – CURE Neuroenteric Disease Program, West Los Angeles VA Medical Center – Eur J Surg Suppl. 1998;(583):32-6.
Candida is a fungus or yeast normally present in small colonies in our intestine. It is normal to host small amounts of Candida in the gut. However, when this yeast finds an opportunity to overpopulate our gut (which can happen easily during chronic stress, alcohol drinking, poor diet, use of pharmaceutical drugs, repeated courses of antibiotics, etc.), the gut lining becomes irritated, inflamed, and finally ruptures. Candida then penetrates into the bloodstream and starts releasing toxic substances that are taken to all the tissues of the body by the blood circulation. 
This course of unwanted events is highly detrimental to our health and ends up manifesting as insomnia, skin issues, digestive pain, brain fog, unexplained fatigue, pain in joints or muscles, depression, and more. Most of the patients with fibromyalgia that I’ve seen in practice (about 95 – 100% of them) have had Candida overgrowth. 
So Candida is my first line of investigation. 
I use an advanced functional test to measure the by-products of microbial metabolism and detect the presence of pathogenic microbial overgrowth. 
When colonic bacteria translocate into the upper gut region, or small intestine, and decides to overpopulate it, a phenomenon called “small intestinal bacterial overgrowth” or SIBO occurs. SIBO comes with a host of very unpleasant symptoms, as well as pain and inflammation. With SIBO, the walls of the gut become irritated and severely compromised. Eventually, the one-cell-thick gut walls become porous and particles of proteins and bacteria invade the bloodstream. This phenomenon of developing a porous gut-lining is called Leaky Gut Syndrome, which has been determined in functional medicine as one of the initiating factors of all auto-immune disorders, including FM.
With SIBO, our digestive system struggles to properly absorb key nutrients like vitamin B12 or Zinc, which are needed daily for optimum immune function and cellular repair. To find a sustainable way out of fibromyalgia, the body requires a bunch of daily nutrients to restore cellular function, downregulate inflammation, and trigger a proper immune response. SIBO, if present, must be eradicated, in order to promote healing of the lining of the gut, healing of leaky gut syndrome, a healthy digestive process (digestion, assimilation, excretion), and thus, a proper and faster resolution of FM.
You will be astounded to know that in an important study, Researchers at the Cedars-Sinai Medical Center in Los Angeles found that 100% of fibromyalgia patients they studied (42/42) had small intestinal bacterial overgrowth (SIBO). (4 )
(4)   Annals of the Rheumatic Diseases, Volume 63, Issue 4 – 
You don’t need to have full blown Celiac disease to be gluten intolerant. A simple so-called “gluten sensitivity” is enough to wreak havoc with your health. I’m sure you’ll find very interesting to know that the majority of symptoms of gluten intolerance do not manifest in the digestive system, but rather in the neurologic system, and that they present as pain, sleep disturbances, cognitive impairment, behavioural issues, unexplained fatigue, anxiety and depression. 
I investigate gluten sensitivity with a functional multiple food reactivity (intolerance) test that also allows me to see if your immune system is also reacting to protein particles in other foods that resemble gluten (cross-reactivity). Removal of the offending foods for a given period of time during which I work towards repairing the damaged gut, is an essential stage in fully recovering from FM.

Root-causes hidden in the endocrine system

Adrenal fatigue develops due to unmanaged chronic stress. Stress can be due to a very demanding job with little time to rest and recover; raising small children without help; daily distant commuting, constant mental negative ruminations and worrying, food intolerances, Candida, heavy metal toxicity, nutrient deficiencies, or bacterial or mould infections. With severe adrenal fatigue the adrenal glands shut down leading to a series of painful and even life-threatening physiological events that affect pretty much all the systems in the body and manifest with pain, inflammation, insomnia, depression, suppression of the immune function, and more. 
I use a fantastic functional lab test that analyses your daily adrenal stress curve and output of cortisol and DHEA hormones throughout the day and evening. This test helps me to pinpoint factors affecting my patients with FM at those specific times of the day or evening that may be contributing to their extreme fatigue, and to apply a therapy to solve them. Repairing and replenishing severely fatigued adrenals takes years of committed and dedicated work, but the improvement that you can experience starts occurring within a few days from the beginning of the right treatment. It is very important for you to understand that addressing the adrenals is essential in boosting proper thyroid function. The health of your thyroid will depend to a large extent in the health of your adrenals.
More than half of the people with thyroid issues have no idea their thyroid is not functioning properly. Interestingly, inadequate thyroid hormone regulation may be one of the primary underlying factors in many patients with fibromyalgia. Getting my client’s thyroid levels to an optimal range usually revitalizes them and relieves their fatigue, removes their brain fog, improves their sleep quality, and resolves their depressed mood. Having said this, this improvement is never achieved by taking Thyroxine alone. 
The approach that has a profound and positive impact on the healthy and optimal functioning of the thyroid in people with fibromyalgia is functional and it includes the following steps: 
1) Resolving nutritional deficiencies
2) Implementing an anti-inflammatory diet
3) Practicing exercise according to the patients’ constitutional type & physical capacity 
4) Getting off medications that impede metabolism & remission
5) Addressing cortisol deficiency
6) Balancing steroid hormones
7) Correcting underlying problems causing T4 to convert into reversed T3 and not into T3
8) Using effective herbal/botanical complexes and other nutrients in therapeutic doses in combination with thyroid hormone therapy.

Root-causes due to toxic load and poor detoxification capacity

Mycotoxins are very toxic and highly damaging substances produced by moulds and fungi present in houses, schools, offices, and even in foods and drinks. We can easily inhale their volatile organic compounds (VOCs) into our lungs without noticing it, or inadvertently consume them in contaminated foods and drinks. 
The gut is a target of mycotoxins. 
Some people are genetically more sensitive to mycotoxins than others, which is why I investigate their individual susceptibility with an outstanding functional diagnostic test that analyses genes of detoxification and genes of immune function. I also use a urine comprehensive mycotoxins panel that analyses 15 different types of mycotoxins to determine each of my patient’s individual exposure.  
Mycotoxins have been shown to damage the immune system, which is one of the main reasons why in my practice I focus on investigating presence of mycotoxins and removing them if present.
This revives the immune response enabling the patient’s body to recover faster from FM.
Mercury toxicity is very common nowadays. Mercury is present in foods, cookware, fish, seafood, and dental amalgams. The target organ for inhaled mercury vapor is primarily the brain. Mercurous and mercuric salts (present in fish) chiefly damage the gut lining and kidney. (5)
Most human metallic mercury exposure comes from mercury vapor outgassing from amalgam fillings, at a rate of 2 to 28 micrograms per facet surface per day, of which about 80% is absorbed, according to the World Health Organization and Berglund et al. (6)
Mercury is a poison capable of causing chronic illnesses such as chronic fatigue syndrome, fibromyalgia, other autoimmune diseases, neurological disorders like Parkinson’s and even cancer. I use a functional lab test to analyse presence and levels of various heavy metals in blood and urine. 
Detoxification of heavy metals is a total must in fibromyalgia. 
(5) Berlin M, Zalups RK, Fowler BA – Handbook on the Toxicology of Metals, 3rd edition. Chapter 33. New York, NY, USA: Elsevier; 2007
(6) World Health Organization – International Programme on Chemical Safety. Geneva, Switzerland: World Health Organization; 1991. Inorganic mercury: environmental health criteria 118.
The liver is the master detoxifier in the body. In Traditional Chinese Medicine, the liver is the one responsible for the flow of Qi (life-force) through the body. If the liver is overwhelmed / inflamed due to leaky gut, mycotoxins, SIBO, heavy metals, etc., the body won’t stand a fair chance to heal itself from any illness or disease.
Foods like aspartame, MSG, glyphosate weed killer and GMOs have been found to be leading causes of fibromyalgia (7). These chemical substances present in non-organic, genetically modified, and flavour-enhanced foods like crisps, Chinese food, chocolate bars, and breakfast cereals, hamper liver detoxification pathways, raise dangerous toxic levels in the body, and cause highly damaging inflammation. 
If you have been affected by the HBV virus or Hepatitis, this can explain the painful and tender points of FM. An increased frequency of musculoskeletal manifestations is present in patients infected with HBV (Hepatitis C virus) and HCV (Hepatitis C virus). (8)
I take the health of your liver extremely seriously in my practice. 
I use functional lab tests to investigate your current liver detox pathways and liver health to support your precious organ in its multiple daily tasks. Detoxification is key in FM and we do not want to leave your wonderful liver behind.
(7) Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins – Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA – Ann Pharmacother. 2001 Jun;35(6):702-6.
(8) Rheumatological Manifestations Associated with Viral Hepatitis B or C – Rev Soc Bras Med Trop. 2019 Dec 2;52:e20180407.

Root-causes due to untreated genetic flaws

Scientific studies in genetics have investigated genes potentially involved in the development of fibromyalgia and have highlighted the fact that genetic factors are responsible for up to 50% of the disease susceptibility. Furthermore, environmental factors like diet, stress, toxins, lifestyle, etc., have been proposed as triggering mechanisms, through epigenetic alterations: In particular, fibromyalgia appears to be characterized by under-methylation in genes implicated in stress response, DNA repair, nervous system response, and subcortical neuronal abnormalities.(10)  
Methylation is a metabolic pathway that converts B vitamins and folic acid into energy for various activities in the body (reproduction, sleep, liver detoxification, immune function, modulation of pain & inflammation and other). (11) The more mutations you have at the MTHFR gene (the methylation gene) the less able you are to methylate and process the toxins that cause fibromyalgia. 
In my practice, I am able to switch on or off genes that are mutated and that dramatically affect my patients’ health. I do this through the practice of epigenetics, or in other words, with the therapeutic use of agents and factors that influence the expression of our genes, like healing foods, nutrients in therapeutic doses, lifestyle prescriptions, exercise, stress management advice, yoga, meditation, etc.
I use an advanced methylation profile to investigate genetic variants –called SNPs- in my patients’ MTHFR and other genes.
(10)  Fibromyalgia: Genetics and epigenetics insights may provide the basis for the development of diagnostic biomarkers- Mol Pain. 2019 Jan-Dec;15: 1744806918819944
(11) Wang F, Stefano GB and, Kream RM. Epigenetic modification of DRG neuronal gene expression subsequent to nerve injury: etiological contribution to complex regional pain syndromes (Part II). Med Sci Monit 2014; 20: 1188–1200. 

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