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Dr. Rodger Murphree's Health News

Helping Others Help Themselves

Important Health Information - March 2007

Are Fibromyalgia Patients Crazy?

Have you’ve been told that you’re crazy, lazy, or depressed? If so, you are not alone. Friends, family, and doctors may try to make you think your illness isn’t real. They’ll probably say, "its all in your head."

Ok, so you forget appointments, cancel at the first sign of bad weather, get lost on the way, show up on the wrong day or at the wrong time. You ask the same questions over and over and often lose your train of thought in mid-sentence, you have strange reactions to medications and suffer with an assortment of health problems; yet all of your lab results look normal. You’ve got numerous complaints including anxiety, depression, fatigue, chronic pain, insomnia, IBS, MVP, chronic sinusitis, tingling in your extremities, night sweats, chemical sensitivities, headaches, reflux, and other symptoms. Are you crazy? You may think you’re a brick short of a load, but in your defense, I’d feel crazy too if I went days without sleeping, had diffuse chronic pain, had no energy, had no life, no hope, and had been bounced from one doctor to another and given dozens of tests, had taken numerous drugs which didn’t help, and then proceeded to get worse year after year!

The traditional drugs of choice for fibromyalgia include NSAIDS, antidepressants, anticonvulsant medications, muscle relaxants, tranquilizers, and pain medications. These drugs may provide short-term relief but their results are often fleeting and their side-effects are detrimental. It’s not unusual for FMS patients to be taking twelve or more prescription drugs, many of which contribute to erratic behavior.

The sleep drugs Ambien and Lunesta may cause short-term memory loss, fatigue, flu-likesymptoms, and depression. Tricyclic antidepressants, including Trazadone and Elavil, may cause early-morning hangover, mental confusion, and lethargy. SSRI drugs may cause anxiety, depression, mental blunting, and lethargy. Klonopin and other benzodiazepines may cause depression, fatigue, and decreased mental function. Beta-blockers (Inderal and others) are commonly prescribed for MVP. These drugs may cause depression, mental and physical fatigue.

Neurontin and Lyrica have potential side effects that include depression, somnolence, fatigue, thought disorders, fuzzy thinking, and ataxia. Zanaflex and other muscle relaxant drugs may cause mental confusion, speech disorder, lethargy, psychosis, and even hallucinations. Adderall and other stimulants may provoke nervousness, mental instability, and psychosis. All of these drugs are known to deplete at least one or more essential mood-dependant vitamin, mineral, or nutrient (B6, B12, CoQ10, Folic acid, etc.). Individuals with fibromyalgia are also deficient in the brain chemicals, which help regulate mood and mental function.

 

Neurotransmitter Deficiencies

Research shows that the majority of fibromyalgia patients are deficient in serotonin, dopamine, and norepinephrine. These three neurotransmitters are essential for optimal mood and mental function. Serotonin, also known as the "happy hormone," helps regulate mood, sleep, digestion, bowel movements, pain, and mental clarity. Individuals with fibromyalgia have low levels of the amino acid tryptophan, as well as 5HTP, which are needed for the production of serotonin.

Studies show that fibromyalgia patients have higher levels of metabolites in the kynurenine pathway, which diverts tryptophan away from serotonin production, thus causing low brain serotonin levels.

Derived from the amino acid L-phenylalanine, norepinephrine and dopamine boost mental energy and clarity as well as prevent a condition known as anhedonia. Anhedonia is the lack of ability to feel pleasure or remorse in life. L-phenylalanine derived norepinephrine, when released in the brain, causes feelings of arousal, energy, drive, and ambition. No wonder you suffer with "fibro fog."

 

Hypothalamus-Pituitary-Adrenal Axis
(HPA) Dysfunction

And while we still don’t know for certain what causes fibromyalgia, we do know that fibromyalgia patients have an imbalance of the hypothalamus-pituitary-adrenal (HPA) axis. This imbalance creates far-reaching hormonal imbalances which interferes with the body’s ability to maintain homeostasis. This can create a host of unwanted health conditions.

Many of the most common fibromyalgia symptoms, including widespread muscle pain, fatigue, poor sleep, gastrointestinal problems, and depression, regularly occur in people with various neuroendocrine disorders, including those manifested by HPA dysfunction.

The main function of the hypothalamus is homeostasis, or maintaining the body's status quo. Because of its broad sphere of influence, the hypothalamus could be considered the body’s master computer. The hypothalamus receives continuous input about the state of the body and must be able to initiate compensatory changes if anything drifts out of line.

The Hypothalamus regulates such bodily functions as:

1. Blood pressure - often low in those with fibromyalgia.

2. Digestion - bloating, gas, indigestion, and reflux are common in FMS patients.

4. Circadian rhythms (sleep/wake cycle) - consistently disrupted in FMS.

6. Sex drive - loss of libido is a common complaint for FMS patients.

7. Body temperature - often low in FMS patients.

8. Balance and coordination - FMS patients often have balance and coordination problems.

9. Heart rate - mitral valve prolapse (MVP) and heart arrhythmias are a common finding in FMS patients.

10. Sweating - it’s not unusual for FMS patients to experience excessive sweating.

11. Adrenal hormones - consistently low in FMS patients.

12. Thyroid hormones and metabolism - hypothyroid is a common finding in FMS patients.

Recent studies show that over 43 percent of FMS patients have low thyroid function. It's estimated that those with FMS are 10 to 250,000 times more likely to suffer from thyroid dysfunction.

So what causes the HPA-axis to go haywire? After researching and specializing in the treatment of fibromyalgia for the last eleven years, I believe chronic stress is the underlying catalyst for the onset of HPA dysfunction and fibromyalgia. Several studies have demonstrated how chronic stress undermines the normal HPA function.

 

Stress Coping Savings Account

I like to use the analogy of being born with a stress-coping savings account. We have certain chemicals, vitamins, minerals, and hormones like serotonin, dopamine, norepinephrine, and cortisol that allow us to handle moment-to-moment, day-to-day, stress. The more stress we’re under, the more withdrawals we make. Individuals with fibromyalgia have made more withdrawals than deposits. Poor sleep, chronic stress, nutritional deficiencies, prescription drugs, and other stressors have taken their toll. The patient has bankrupted their account. This leads to the HPA-axis being overtaxed, and poor health follows.

Fortunately, there are some tried-and-true nutritional protocols that can help build up the bankrupted stress-coping savings account. Reestablishing optimal neurotransmitters, especially serotonin and norepinephrine levels, is critical for these folks.

5-Hydroxytryptophan 5HTP

Double-blind, placebo-controlled trials have shown that patients with FMS were able

to see the following benefits from increasing serotonin through 5HTP replacement therapy:

�?Decreased pain.

�?Improved sleep.

�?Less tender points.

�?Less morning stiffness.

�?Less anxiety.

�?Improved moods in general, including in those with clinical depression.

�?Increased energy.

There are more serotonin receptors in the intestinal tract than there are in the brain. This is one reason people get butterflies in their stomach when they get nervous. Serotonin controls how fast or how slow food moves through the intestinal tract. IBS symptoms, commonly seen in fibromyalgia, typically disappear rather quickly once serotonin levels are boosted. I have my patients take 300mg of 5HTP along with a good optimal daily allowance multivitamin (680mg of magnesium) and pancreatic digestive enzymes.

 

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S-adenosyl- L-methionine (SAMe)

S-adenosyl- L-methionine (SAMe) increases the action of several neurotransmitters including serotonin, norepinephrine and dopamine, by binding these hormones to their cell receptors. SAMe helps keep mitochondrial levels at peak levels, increase brain function, and has potent pain-blocking properties. Normally the brain manufactures all the SAMe it needs from the amino acid methionine. However, patients with fibromyalgia have been shown to be deficient in this essential amino acid.

Studies involving FMS patients and SAMe have shown dramatic improvements in pain reduction. One study shows that patients taking SAMe for a period of six weeks had an improvement of 40 percent in pain reduction and 35 percent improvement in their depression. More than 100 peer-reviewed studies show SAMe to a safe, effective, and fast-acting antidepressant.

Along with 5HTP and SAMe, I’ve found that a good optimal daily-allowance multivitamin with a free-form amino acid blend, fish oil, malic acid, and generous amounts of magnesium help reverse the "brain fog," poor energy, chronic pain, mood disorders, and sleep disturbances so common in fibromyalgia.

Please know that, while you might not think you’re the sharpest tool in the shed at the moment, with the right nutritional therapy you can replenish your brain chemicals and enjoy having a "normal brain" once again.

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