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What Is It?

Fibromyalgia is a chronic condition that involves fatigue and widespread muscle pain that corresponds to specific points (called tender points) on the body. It was originally thought that fibromyalgia was a muscle disorder, but it is now known that people with this condition have what is called “central sensitization,” which involves the central nervous system.1 In central sensitization, the pain sensation is amplified. In essence, people with fibromyalgia are hypersensitive to pain.

What Causes It?

The cause of fibromyalgia is unknown. There are many factors which may contribute to the development and worsening of fibromyalgia. These include:

• Physical trauma event• Neurotransmitter imbalance• Sleep abnormalities• Adrenal dysfunction• Stress• Thyroid dysfunction• Infections• Parasitic infection• Dysbiosis• Leaky gut• Food sensitivities and allergies• Heavy metal exposure• Excitotoxins• Family history

Many people report the onset of fibromyalgia after a traumatic event, such as an accident or a head injury.

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Neck injuries like whiplash particularly seem to trigger fibromyalgia.2

An imbalance of neurotransmitters is found in people with fibromyalgia. This contributes to the increased pain perception. Serotonin is one neurotransmitter found to be low in fibromyalgia. Serotonin regulates pain as well as mood. Substance P, another neurotransmitter which increases pain perception, is found in higher amounts in those with fibromyalgia.3

Sleep dysfunction is another major feature of fibromyalgia. People with fibromyalgia do not reach the deep stage of sleep as most normal people do.4 This explains why they wake up unrefreshed even after a full night of sleep. It also contributes to the fatigue and muscle ache that is experienced. Stage-four delta sleep is the restorative sleep stage in which the body recovers energy and repairs muscle.5 (See the Insomnia section for more information on sleep stages.)

Fibromyalgia trigger points on the back of the female body

Fibromyalgia affects up to six million Americans.17 Fibromyalgia occurs much more frequently in women than in men, with a ratio of about 9 to 1. It usually a!ects women aged 20 to 50, but can occur at any age.18

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The hypothalamic-pituitary-adrenal (HPA) axis is part of the endocrine system, and regulates how the body responds to stress. The HPA axis is comprised of three glands: the hypothalamus gland, the pituitary gland and the adrenal glands. These glands are involved in regulating many different hormones in the body. When a person experiences stress, messages are sent throughout the HPA axis resulting in the adrenal glands secreting cortisol, the stress hormone. Throughout that messaging process, many reactions occur in the body which affect different systems—neurological, immunological, reproductive, digestive and metabolic. The varied symptoms of fibromyalgia involve each of these systems.6 When chronic stress is experienced, the adrenals become unable to secrete enough cortisol, as is seen in many fibromyalgia patients.7

Thyroid dysfunction is closely related to the HPA axis. It is actually part of the HPT (hypothalamic-pituitary-thyroid) axis. Due to this close relationship, and the fact that symptoms of thyroid dysfunction are similar to those of fibromyalgia, thyroid dysfunction should be ruled out. (See the Thyroid Dysfunction section for more information on this condition.)

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The central sensitivity experienced in fibromyalgia, in which the nervous system is hypersensitive to stimuli—touch, light, odors, temperature—is the result of dysfunction of the central nervous system.8 This has also been linked to the HPA axis dysfunction, mentioned previously, which explains why fatigue is so common in fibromyalgia.

Infections may also be involved in fibromyalgia. Infections can worsen symptoms of fibromyalgia, and may even trigger its onset.9 The inflammatory chemicals (cytokines) produced by the immune system in response to infection are thought to communicate with the brain via the vagus nerve, triggering the symptoms of fibromyalgia.10 Parasitic infections may also trigger fibromyalgia. The parasites Giardia, E. histolytica, Cryptosporidium parvum, Cyclospora cayetanensis, Trichinella spiralis as well as other tapeworms and flatworms have all been associated with fibromyalgia.11

Dysbiosis refers to an imbalance of good to bad bacteria in the intestine. It is an underlying factor in many health conditions including fibromyalgia. In fact, one study found bacterial overgrowth in the small intestine in all 42 fibromyalgia patients that were evaluated.12 There is a strong gut-brain connection actively being studied that links gut disturbances like dysbiosis to many different brain conditions. Toxins from the gut have been found to interact and influence chemicals in the brain. Illustration showing the trigger points associated with

fibromyalgia in males

Healing HOPETestimonial

“About a year ago I was diagnosed with "bromyalgia. I was given the standard medications for the pain and sti!ness. I didn’t really want to take the meds, but for a period of time in desperation, I did. I talked with my neurologist about alternative medicine and he suggested that I look into it. I went to my local health food store and was recommended a Total Body Cleanse. After about four days the pain began to subside and the sti!ness was fading. I had more energy and was amazed! ”– Jan

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This gut-brain connection is important because fibromyalgia primarily affects the central nervous system. Additionally, the majority of serotonin is produced in the gut, so gut dysfunction could explain the low serotonin levels found in people with fibromyalgia.

Dysbiosis can lead to a condition called leaky gut syndrome. (See the Leaky Gut Syndrome section for more information on this condition.) Leaky gut is also known as increased intestinal permeability, and involves the passage of undigested food particles and toxins through the lining of the small intestine which has become, essentially, leaky. Leaky gut sets the stage for food sensitivities which occur as a reaction to the undigested food particles. These particles (as well as microbial and environmental toxins) pass through the intestinal lining, and activate the underlying immune system. Antibodies and cytokine messengers from the gut immune system (gut-associated lymph tissue, or GALT) then enter blood circulation, and travel throughout the body. Following an elimination diet, in which common fool allergens are avoided, has been found to improve symptoms of fibromyalgia.13

Heavy metal exposure may play a role in fibromyalgia.14 Elevated heavy metal levels are found in many fibromyalgia patients. These people are extra sensitive to toxins, so eliminating them becomes very important. This may be difficult, however, since people with fibromyalgia often have lowered glutathione levels (an important detoxifier), leaving them less able to detoxify heavy metals.15

Excitotoxins are substances that excite neurotransmitters (brain chemicals) which can destroy nerves and even brain cells. Two food substances known to cause excitotoxicity

are monosodium glutamate (MSG) and aspartame (NutraSweet). Eliminating excitotoxins from the diet has been found to improve fibromyalgia symptoms.16

What Are the Signs and Symptoms?

The most prominent symptom of fibromyalgia is widespread pain, which means pain on both sides of the body as well as above and below the waist. This pain is measured at specific points on the body called tender points. The symptoms of fibromyalgia include:

• Widespread pain• Stiffness• Fatigue• Unrefreshing sleep• Sleep disturbances• Headache• Allergies or sensitivities• Poor concentration• Poor memory• Allergic symptoms• Painful menstruation• Irritable bowel• Depression• Urinary complaints• Fatigue after exercise

Did You KnowInterestingly, "bromyalgia is thought by some to be the same illness as chronic fatigue syndrome (CFS), but by others it is considered a separate condition. Most of the symptoms of CFS and "bromyalgia are the same. The main di!erence is that people with "bromyalgia may not exhibit the cognitive symptoms such as memory loss or concentration di#culties, and people with CFS do not have trigger points, which are speci"c points on the body where pain is experienced in people with "bromyalgia. Some say that "bromyalgia and CFS are just two subcategories of the same illness.21 It is estimated that between 20 percent and 70 percent of patients with "bromyalgia have CFS, and that 35 percent to 70 percent of those with CFS also have "bromyalgia.22 (See the Chronic Fatigue Syndrome section for more information on this condition.)

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How Is It Diagnosed?

The diagnosis of fibromyalgia is based on a thorough medical history and physical exam. There are two criteria that have been established by the American College of Rheumatology:23

• Widespread pain lasting at least three months• At least 11 tender points out of 18

Lab tests may be used to rule out other conditions. These include:24

• Rheumatoid factor• Complete blood count (CBC)• Erythrocyte sedimentation rate (ESR)• Thyroid function tests• Antinuclear antibodies (ANAs)

Natural health practitioners may also suggest a food sensitivity test comprehensive stool analysis (CSA) that may be helpful to determine causes or contributing factors of fibromyalgia such as food sensitivity bacterial imbalance, fungal, yeast or parasitic infection.

What Is the Standard Medical Treatment?

Conventional treatment of fibromyalgia often begins with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or COX-2 inhibitors like celecoxib (Celebrex).25 These medications do not eliminate symptoms, however, and should not be used long-term as they have many side effects. These are best used for short-term pain relief. Another pain reliever used for

Other illnesses that may occur in conjunction with fibromyalgia include:19,20

• Chronic fatigue syndrome• Irritable bowel syndrome• Multiple chemical sensitivities• Interstitial cystitis• Temporomandibular disorder (TMD)• Chronic pelvic pain• Chronic low back pain• Gulf War Syndrome

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fibromyalgia is tramadol (Ultram).26 This drug may be prescribed in conjunction with acetaminophen (Tylenol).

Muscle relaxants like cyclobenzaprine (Flexeril) can help relieve muscle aches.27 This medication can cause drowsiness, however, and should be used with caution.

Antidepressants may be prescribed because of their ability to regulate neurotransmitters in the brain, particularly serotonin,28 which is found to be low in people with

Healing HOPETestimonial

“ The Parasite Cleanse and Parasite Enzyme have helped alleviate the pain of "bromyalgia for me. I have "nally been able to sleep and exercise without pain.” – Paula

fibromyalgia.29 Antidepressants are used to improve pain, depression, fatigue and sleep disturbances in fibromyalgia.30 Fibromyalgia is another condition that many conventional doctors view as “all in your head.” Antidepressants are commonly prescribed in these cases.

Adequate rest is advised to encourage deeper sleep. Sleep medications may also be prescribed for this purpose. When taken over time, however, these medications become less effective as tolerance builds.

Exercise is also recommended for those with fibromyalgia. It must be approached gradually, however, to avoid excess fatigue. Exercise which involves stretching and strength building is the most effective, swimming being the most recommended form.

“Fibromyalgia is another condition that many conventional doctors

view as ‘all in your head’. ”

Adequate rest encourages deeper sleep, necessary for people with fibromyalgia.

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There is good evidence that muscle pain in patients with documented fibromyalgia (FM) may partly be due to small intestinal bacterial overgrowth (SIBO), which involves an overgrowth of bacteria in the colon that backs up into the terminal ileum, or the end of the small intestine. Many FM patients also have irritable bowel syndrome (IBS) and leaky gut syndrome. In fact, in one study, 42 out of 42 FM patients (or 100 percent not often found in clinical research) had positive hydrogen breath tests (which measures SIBO) compared to 84 percent of patients with irritable bowel syndrome (IBS). In the FM patients higher hydrogen levels were correlated with increased pain.31

It is believed that the connection between FM and the gut involves translocation of bacteria and bacterial endotoxins that increase the inflammatory cytokines IL-6, IL-1, and TNF-alpha, all of which can travel from the gut to the circulation, and then to the nervous system, increasing sensitivity to pain. This gut-brain connection has also been illustrated in studies which have shown depression and anxiety could be ameliorated by changing the gut flora with probiotics.

Furthermore, when gut bacteria die, they liberate toxic cell wall lipopolysaccaride (LPS) molecules. These LPS molecules can be easily taken across the epithelial gut lining. This mostly occurs with a high-fat diet because LPS is absorbed with excess dietary fat. Once in circulation, the problem starts when LPS molecules connect with a receptor (CD14-TLR4 complex) on the surface of immune cells (monocytes, neutrophils and macrophages). The result is a major increase in the secretion of pro-inflammatory cytokines, which create inflammation. An animal study found that a high-fat diet consumed for two to four weeks resulted in these inflammatory markers being found in the liver, fat, and muscles.32 This suggests that both the central nervous system, as well as the muscles themselves, are affected in FM patients. This part of the problem can likely be greatly helped with a low-fat, plant-based diet and probiotics. Probiotics alone seemed to decrease the blood levels of LPS, suggesting the types of gut flora may have to do with how much LPS is absorbed.

Another issue with FM is low energy and high oxidative stress. Researchers found that there was a high level of intracellular oxidative stress, and a 40 percent decrease in coenzyme Q10 (CoQ10) in isolated immune cells in FM patients. The cells were then given CoQ10 which resulted in a decrease in oxidative stress. The authors of the study suggest that CoQ10 maybe helpful in treating patients with FM.33

Dr. Smith’s Comments

High-fat foods increase the absorption of bacterial toxins.

The health of the gut dictates the health of the rest of the body.

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Digestive health plays a huge role in "bromyalgia. If the gut is out of balance, or digestive issues are underlying this condition, it will be di#cult to heal. That is why starting by addressing gut imbalance is so important.

In my experience, I have seen that Candida overgrowth is present in many people with this condition. I recommend following the Steps of Cleansing (see the Cleansing Protocol in the Appendix) as a complete program to support the body’s detoxi"cation and elimination. The Candida Diet is also recommended for a period of at least three months.

It can take time for the body to heal, for pain to subside, and for energy to be regained. A strong commitment is needed here, and it may take some investigation into the underlying causes of your condition. Follow the recommendations below and on the next page as a guide to taking control of your health.

Rule Out:

• Food allergies or sensitivities (See the Allergies section or the Gluten Sensitivity section.)

• Parasitic infection (See the Parasitic Disease section.)• Candida overgrowth (See the Candidiasis section.)

Recommended Testing

• Comprehensive stool analysis (CSA) (See the Appendix.)• Food sensitivity test (See the Appendix.)• Heavy metal hair analysis (See the Appendix.)

Diet

• If Candida overgrowth is present, follow the Candida Diet for at least three months. (See the Appendix.)

• A diet high in fruits and vegetables, and low in saturated and trans fats is bene"cial for "bromyalgia. (Follow the Fiber 35 Eating Plan found in the Appendix.)

• Replace saturated fats with monounsaturated and polyunsaturated fats.

• Limit sugar and simple carbohydrate (white $our, white rice, white pasta, etc.) intake, which may worsen symptoms of "bromyalgia. Replace these carbs with complex carbohydrates found in whole grains.

• Avoid ca!eine and alcohol, which may interfere with sleep.

• Avoid arti"cial sweeteners and additives, especially monosodium glutamate (MSG) and aspartame, which may trigger symptoms of "bromyalgia.

Lifestyle

• Regular, low-intensity exercise is important in "bromyalgia, but should be introduced gradually, to avoid exacerbating symptoms.

• Be sure to get enough sleep and establish regular sleeping patterns, which is essential for those with "bromyalgia.

Complementary Mind/Body Therapies

• Stress can be a major component of this disease, so "nd ways to reduce it with therapies such as meditation, yoga, deep breathing, massage (also helpful for muscle pain), biofeedback, or music therapy.

• Acupuncture may be helpful for pain reduction in people with "bromyalgia.

• Colon hydrotherapy is helpful to remove excess toxins.

Brenda’s Bottom Line

“Digestive health plays a huge role in !bromyalgia. If the

gut is out of balance, or digestive issues are underlying this condition,

it will be di"cult to heal. ”

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Recommended Nutraceuticals Dosage Benefit Comments

Critical

Energy Support Formula

Use as directedImproves the

body’s energy production and muscle function.

Should contain CoQ10, L-carnitine, NADH and Rhodiola.

Total Body Cleanse See Appendix Encourages bowel elimination and detoxi"cation.

Herbal formula should support the seven channels of elimination.

Candida Cleanse See Appendix Helps to eradicate Candida overgrowth.

Look for ingredients such as uva ursi, caprylic acid, undecylenic acid,

barberry, garlic, neem, grapefruit and olive leaf extracts.

Heavy Metal Detox See Appendix Helps support the body in eliminating heavy metals.

Look for a two-part formula with vitamins/minerals and a formula

containing chlorella, cilantro, NAC, L-leucine and alpha lipoic acid.

Helpful

Multivitamin/mineral Formula

High potencyTo correct any insu#ciencies

that may a!ect metabolic function.

Be sure vitamins are in their natural forms.

Calcium/magnesium 500 mg/250 mg Helps relax muscles and nerves. Best if taken before bed.

D-ribose 5 g twice daily Helps with body’s ATP production in muscles. Helps to improve muscle function.

Daily Maintenance

Omega-3 Fatty Acids At least 2 grams dailyReduces in$ammation,

omega-3s often low in people with "bromyalgia.

Get a concentrated, enteric coated, high dose EPA/DHA formulation.

Digestive Enzymes Take with meals Helps digest and absorb nutrients from food.

If low stomach acid is found, "nd a formula that contains

hydrochloric acid.

Fiber4-5 grams twice daily as part of a 35 gram

per day "ber diet

Helps regulate bowel movement and

eliminate toxins.

Use a combination soluble/ insoluble "ber supplement.

Probiotics 30 - 80 billion culture count twice daily

Stimulates immune system, reduces in$ammation and protects digestive lining.

Look for high amount of bi"dobacteria, the main bene"cial

bacteria in colon.

Vitamin D31000-5000 iu daily

Anti-in$ammatory. Most people are low or de"cient.

Blood levels should be between 50 and 70 ng/mL.

See further explanation of supplements in the Appendix

Daily maintenance recommendations should also be taken during this phase unless otherwise indicated.

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