After Reading: Figuring Out Fibromyalgia: Current Science and the Most Effective Treatments By: Ginevra Liptan, M.D.

“Deep sleep is inhibited because the brain is trying to stay alert to fend off danger. A lack of deep sleep causes fatigue and prevents adequate growth hormone release. A lack of growth hormone interferes with the normal muscle tissue repair process and leads to muscle pain. Muscles and their surrounding tissue are chronically tightened to respond to danger and become painful.” Ginevra, the author, believes this is the vicious cycle that brings so much pain to those affected and clouds the skies for the diagnosing weather(wo)men (AKA doctors) who remain with great doubt as to whether this disease is real or not.

Those affected by fibromyalgia often have these symptoms:

• They feel like they have the flu all the time.
• There is profound muscle pain, achiness, and fatigue.
• Repetitive motion makes the pain worse.
• Their sleep is unrefreshing
  1. “waking up in the morning feeling as if they had run a marathon overnight” → morning stiffness
  2. One study found that 95% reported poor sleep quality and persistent fatigue.
• Poor memory, reduced attention span, and difficulty multitasking, AKA ‘fibrofog.’
• Irritable bowel and bladder: “70% have enough bowel symptoms to be diagnosed with IBS.”
• Hypotension (low blood pressure).
• Dizziness upon standing.
• Poor balance.

Fibromyalgia has undergone a few name changes over the years and the views on this disease have acted likewise. Ginevra herself has had to take the back seat with this disease, allowing her fellow teachers and classmates to poke fun at it in order to make it through medical school without the extra burden. Although there are missing links to the actual cause, some key ones are known, and most importantly, the patients do exist. It is not a catch-all diagnosis, it is a tangible reality.

LINK TO TRAUMA

Unlike Chronic Fatigue Syndrome, which is believed to be caused by a virus, fibromyalgia can often be linked back to trauma. One study’s results showed that 50% of the studied individuals had their symptoms appear six months after a traumatic accident (motor vehicle accident). Other studies show that 50% of women—this disease is most commonly diagnosed in women—with fibromyalgia experienced childhood sexual abuse and 90% experienced sexual assault within their lifetime—Ginevra did not confront these statistics herself and provided no information if these were true in her case.

REPLICATING FIBROMYALGIA SYMPTOMS

If the symptoms can be replicated both in a study and willingly by some individuals, can certain lifestyle choices help reclaim the calm in these afflicted individuals. A 1975 study consisting of college students accompanied by loud noises interrupting their sleep at night, resulted in widespread muscle pain that disappeared after a few nights of regular sleep. By interrupting their ‘fight or flight’ mechanism, they were able to induce the symptoms of fibromylagia.

As for those willing individuals: marathon runners (more about them soon).

NUTRITION

“A stress response stuck in ‘fight or flight’ mode can lead to poor sleep, but it also leads to poor digestion.” Research suggests that those stuck in this mode tend to get leaky guts. A leaky gut permits forbidden substances entrance into our circulation and induces an immune response, thus further inflammation. Normally, only smaller particles gain entry to our circulation, but a leaky one grants the larger particles this same hall pass. Here are some ways to obtain a leaky gut for yourself:

• Stress – inflammation from release of the corticosteriod hormone
• Use of certain meds – especially NSAIDs and steroids
• Even some dietary choices (many actually) can easily provide this “opportunity.”

MILK

In a blinded milk challenge study, one group was given milk and another was given the placebo (alternate food item). Those who drank the milk were filled with the white substance and its reproducible symptoms while the placebo group remained unscathed. These symptoms peaked at 24-48 hours after the challenge and resolved within one to three days. As for their labs, their blood tested positively for milk antibodies, thus milk was literally getting into their circulatory system.

GINEVRA’S CONFLICT

Ginevra writes about the importance of nutrition with fibromyalgia, but she also seems to be fighting an inner conflict with herself as the pages turned. She clearly writes about the importance of certain dietary choices, then she professes self doubt about their necessity, and then she finally resolves in: “If you eat poor quality food, you get poor quality bricks (atoms) in your tissues…”  In total, you literally are what you eat, even if you can’t find the willpower and fortitude to believe it.

FOOD SENSITIVITIES

In a study among 40 patients with fibromyalgia where they were tested for food sensitivities as evidenced by immune responses (ELISA/ACT test), the most frequent sensitivities were (in order):

1. MSG
2. Candida albicans
3. Caffeine
4. Food coloring
5. Chocolate
6. Shrimp
7. Dairy products

The treatment group, who had their diets modified according to their specific sensitivities:

• Less pain
• Less depression
• More energy at the three and six month marks.

The control group had:

• Increased pain
• Increased depression
• Similar levels of stiffness and energy, compared to their initial levels, at the three and six month marks.

“Other studies have also shown improvement in fibromyalgia symptoms during periods of fasting or very limited diets (such as raw food or vegan) with worsening symptoms once regular diet resumed. I suspect that any benefit is due to effectively eliminating most common allergens from the diet, rather than to any effect of the diet itself.”  She also recommends a diet that is varied or one that does not include the same things every day.

Her ELISA/ACT sensitivities were

• Chicken
• Xantham gum
• Carrots
• Watermelon
• Blueberries
• Dairy

I feel she offers a wealth of knowledge extracted from her personal struggles with this ailment, but she really needs to read what she is writing. Her belief in variety is inappropriately focused on not having these allergens on a daily basis, with this mentality equipped, she believes it is ‘okay’ to introduce them occasionally, just not every day. Translated into how this affects one’s health: the symptoms may lessen, but they will remain dormant. An example is when she testifies that dairy continues to give her problems whenever she ingests it, but she continues to reintroduce it!

OMEGA FATTY ACIDS

She makes great recommendations for making dietary choices, but she is not a disciple herself. Another one is about the unbalance of omega fatty acids. These essential fatty acids are known for their cholesterol lowering effects and their ability to counteract inflammation. A typical Westerner diet is high in omega-6 fatty acids and low in the anti-inflammatory omega-3 fatty acids. A balance needs to be found and the typical diet in America is most certainly not the answer.

WHAT IS THE RIGHT DIET?

Ginevra’s final thoughts on food and how to make the diet healthier are:

1. Increase fiber, fruit, and vegetables.
2. Eat organically.
3. Minimize processed foods, especially those with additives (MSG, Aspartame).

A healthy gut is so vital to the treatment of this disease. When things get out of whack and bacteria become displaced—traveling from large intestine to the small intestine—causing bacterial overgrowth, what results is diarrhea, bloating, and gas. Candida overgrowth can also occur with the use of antibiotics (kills normal bacteria too), steroids (inflammation), and high sugar diets.

Two small studies were done utilizing a raw food vegetarian diet—mostly fruits, vegetables, and nuts. Those enlisted in this diet show improvement in stiffness, pain, and quality of life. Maybe something else caused such outstanding results, maybe something else caused this: “improvements rapidly disappeared after returning to regular diet.”

“These diets are so different from the average American’s diet that it effectively eliminates all allergens.”  In total, certain methods of eating are more than methods, they tend to naturally cure the human body. Eat to live, don’t live to eat and die by doing so.

CANCER

One study even found the presence of NF-Kappa B in the fascia. NF-Kappa B plays an important role in the inflammatory process (identified as cancer’s single pro-inflammatory factor).

EXERCISE

Fibromyalgia is not an exciting experience and many would argue that exercise could not possibly be considered for treatment. With their already overworked and highly strained muscles, why would anyone want to invigorate them some more? About 750 studies have been done to uncover the potential benefits of exercise with this disorder and warrant its use. Almost all of them show decreased pain and improvement in quality of life. We cannot escape the fact that aerobic, strength, flexibility, and other very low impact exercises such as yoga and tai chi, have proven to be great natural treatments.

“Muscles from frequent marathon runners show scarring and extra collagen between muscle fibers.” Those with fibromyalgia can often feel this level of pain from activities of daily living and this feeling only gets worse with decreased activity levels due their elevated pain intolerance. “When  tissues are under excessive strain or the repair process is inadequate, tissue repair and remodeling can become dysfunctional.” Take your time, never force your body to do more than it is capable, even if you can force it. Forcing it leads to small bodily injuries that do add up and culminate into a permanent remodeling and a higher potential for a serious injury.

LACTIC ACID & MUSCLE SORENESS

You know that feeling after a session at the gym or a long distance run, especially when you are just getting back into it again? For a long time it was believed that this feeling was directly related to the build up of lactic acid within your muscles, but this is not true. Lactic acid disappears within an hour after exercise, so when do you begin feeling that unavoidable muscle soreness? For most, it is usually the next day upon waking, when you realize rolling over and hopping to your feet is not a viable option.

It is believed that this muscle soreness is due to the release of chemicals responsible for repairing the muscle. Fibromyalgia patients are under constant attack, like marathon runners and many body-builders, but many believe it is due to a problem within the fascia. The fascia, as described by Ginevra, is like a tape that holds and encompasses all of the muscles within the body. It is what allows for super human strength during real life ‘fight or flight’ situations. Below is an example of what Ginevra personally recommends—provides relief for her as well as her patients: Myofascial Release Therapy.

Three recommendations for safe and effective exercise by Ginevra are:

1. Warm up before hand.
   • Warming up has been shown to prevent injuries and result in less pain afterwards.
2. Exercise gently.
   • Avoid pushing yourself too hard and only do what your body can actually handle.
3. It is vital to get enough rest and recovery time in between sessions.
   • Keeping at it won’t necessarily make you stronger, but it will put your body at a disadvantage by impairing its ability to repair the continual damage you force upon it.

How does exercise benefit both you and someone diagnosed with this disease?

• It promotes deep sleep.
• It promotes the release of endorphins, which are our natural pain killers.

SLEEP

As you have already read, deep and effective sleep is severely limited by the constant activation of the ‘fight or flight’ mechanism and the end result is pain. This cycle can continue or you can attempt to improve it. Ginevra’s Sleep Hygiene list of recommendations consists of behaviors and habits to improve your sleep:

1. Do not drink any caffeine after noon.
2. Do not smoke or drink any alcohol within six hours of going to sleep.
3. Avoid heavy meals just before bed.
4. Avoid strenuous exercise four hours before bed.
5. Develop bodily rhythms and avoid having unusual and varying sleeping schedules.
6. Do not nap during the day.
7. Sleep in a quiet and stimulus-free environment.

SLEEPING MEDS

As for those addicting sleeping meds that are being popped left and right, they put you to sleep, but they do not promote or induce a deeper sleep. Ginevra writes about one sleeping med used off label for fibromyalgia that has shown benefits for some, but these other drugs literally just pull the blinds over many people’s eyes. One study backed this up by showing no benefits in quality of sleep and no improvement in symptoms.

DEEP BREATHING & FIGHT OR FLIGHT

Slow and deep breathing as in yoga and meditation has also been shown to provide some relief for those with fibromyalgia. Deep inhalation and slow exhalation while in a relaxed state of mind slows down the ‘fight or flight’ mode and counters it with a parasympathetic reaction. Go ahead, take a deep breath and exhale slowly. By doing this, you will stimulate the ‘rest and digest’ mode within the nervous system.

When you become over stimulated or are in ‘fight or flight’ mode, your body devotes much of your blood and the energy it carries to areas that need it the most. Your gut and your need to rest are only notions that become obliterated by the adrenaline rushing into your system. You need the ability to pounce and keep going in order to live and find safety, not the ability to digest and take a nap. In fibromyalgia, they live this way day in and day out. They may not be in imminent danger, but their muscles, especially their fascia, are ready for constant action. The action never presents itself and if it did…

I truly wonder what their reactivity levels would be like if they were indeed placed in a situation where ‘fight or flight’ mode was reality. Would they be able to produce and gather enough energy within themselves in order to fight their way through it, or would they be in too much pain and easily succumb. I personally believe they would be overwhelmed and would not have the ability to find the strength to lift that car off that child like the mothers we always hear about—true story, happens more often than we think.

CONCLUSION

That is my personal belief, but you never know, because our bodies are absolutely amazing. With the right lifestyle choices, these individuals can indeed reclaim that superhuman strength that only needs to be called upon in times of crisis. As humans, we are constantly weakening our bodies and subduing its hidden powers and it is clearly evident that we decide how we will perform. So decide…

Do you have fibromyalgia or do you know anyone who does?

What seems to work best?

Have any lifestyle modifications been utilized?

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