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1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727

Fibromyalgia

Metabolically Directed Approach to Fibromylagia

  • Fibro = fibrous or connective tissue
  • Algia = pain
  • Therefore – fibromylagia is really a symptom of your problem, not the cause of your problem
  • Treat the cause – fix the problem

Conventional Medicine Approach

  • Anti-inflammatory Drugs
  • Narcotics
  • Gabapentin
  • Psychiatric Drugs
  • Cymbalta 
  • Muscle Relaxers 
  • Steroids
  • Over 30 different drugs listed to treat symptoms

Metabolically Directed Approach to Fibromylagia

  • Fix what is wrong
  • Frequently a sex and adrenal hormonal problem
  • Frequently a thyroid problem
  • Frequently a dietary problem
  • Frequently an unrecognized environmental issue
  • Frequently an oxido-reductive imbalance
  • Frequently a problem with abnormal tissue pH
  • Frequently a problem with systemic pH
  • Frequently a “stealth organism” 
  • Always chronic inflammation as part of the problem 




Hormones

Cholesterol

All of your Sex and Adrenal Cortex Hormones are Made from Cholesterol

Chronic Stress can Lead to Fibromyalgia

  • Fact – excessive cortisol impairs thyroid function, increases blood sugar, contributes to insulin resistance, reduces production of sex hormones and can lead to significant weight gain and fatigue
  • Myth – taking supplements that purport to control or reduce cortisol are helpful 
  • Solution – identify and reduce stressors like poor quality diet (edibolic stress), environmental stress, immune system stress, situational and emotional stress, circadian stress 

 

Chronic Stress Can Increase ACTH and Cortisol Levels

Metabolic Imbalance Contributing to Fibromyalgia

Anabolic-Catabolic Imbalance

The Work of Emanuel Revici MD

Fatty Acid vs Sterol Levels Leading to Metabolic Imbalance and Chronic Pain

Too Many Fatty Acids, Not Enough Sterols

A Balance Between Fatty Acids and Sterols

Too Many Sterols

Imbalances of Fatty Acid - Sterol Activity Contribute to Pain

  • Excess Sterols = Anaerobic Imbalance = =excess lactic acid production – leads to low tissue pH = acid (burning ) pain
  • Excess Fatty Acids = Dysaerobic Imbalance = sequestration of bicarbs in tissue – leads to high tissue pH = alkaline (sharp) pain

Abnormal Tissue pH is Very Common

  • Your saliva pH is a surrogate marker of tissue pH.
  • A normal saliva pH should be around 6.8
  • Saliva pH above 7.2 or below 6.2 should raise suspicions 

Chronic Stress Contributing to Fibromyalgia

Initially your cortisol levels can rise leading to Anerobic imbalance and therefore tissue acidity (low pH) and acid pain

However, some people respond to stress by secreting excess adrenaline leading to Dysaerobic imbalance and therefore tissue alkalinity (high pH) and alkaline pain 

Oftentimes with chronic stress, some hormones can go up (think cortisol and estrogen), some can crash (think cortisol, thyroid, testosterone, progesterone) creating various opportunities to produce acid-base tissue abnormalities and pain

Many Menstruating Women Suffer from Fatigue During Parts of Their Menstrual Cycle

  • Pain early in cycle can indicate hormonal deficiency 
  • Pain mid-cycle (ovulation) can indicate excess estrogen
  • Pain in mid-luteal phase can indicate hormone excess
  •  

Dietary Indiscretions Leading to Chronic Pain

  • Over-Consumption of Inflammatory Fats (“Bad Fats”) 
  • Insufficient Consumption of “Good Fats”
  • Excess Sugar 
  • Excess Carbs
  • Excess Consumption of Components of Inflammatory Grains – Glutens, Oxalates, Lectins, Phytates 

Saturated Fats Have no Double Bonds, They are very Stable and Tend to Increase Energy Production and decrease pain

Unsaturated Fats Have Double Bonds – They are Unstable and Tend to Decrease Energy Production and increase pain

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease

Patty W Siri-Tarino, Qi Sun, Frank B Hu and Ronald M Krauss 1 From the Children’s Hospital Oakland Research Institute Oakland CA   Harvard School of Public Health Boston MA. 

       ABSTRACT 

  • Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health.
  • Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies.
  • Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD.
  • Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results.
  • Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat. 

 

Harvard Medical School Published in the American Journal of Clinical Nutrition January 2010

  • Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD

 

Breast Milk

  • 55% of the calories from breast milk come from Saturated Fats
  • Also high in Cholesterol

 

Low Intake of Saturated Fat

  • Lowers Levels of HDL “good cholesterol”

Effect of low-fat diets on plasma high-density lipoprotein concentrations.

  • Katan MB.
  • Department of Human Nutrition, Wageningen Agricultural University, The Netherlands.
  • Low concentrations of HDLs in plasma are a strong predictor of risk for coronary as well as other cardiovascular diseases. There is increasing evidence that this relation is causal and that interventions that change HDL concentrations also change risk. One such intervention is exchanging fat and carbohydrate. In controlled trials, low-fat, high-carbohydrate diets decrease HDL concentrations. The effect is strongest when carbohydrates replace saturated fatty acids, but is also seen when carbohydrates replace mono- and polyunsaturated fatty acids carbohydrates. The effect is seen in both short- and long-term trials and therefore appears to be permanent. This finding is supported by epidemiologic studies in which populations eating low-fat, high-carbohydrate diets were shown to have low HDL concentrations. Weight losses with consumption of low-fat diets could theoretically counter effects on HDL, but in published trials weight losses have been modest and insufficient to offset the decrease in HDL concentrations induced by carbohydrates. Thus, replacement of saturated fat by carbohydrates adversely affects plasma HDL concentrations; replacement of saturated fat by unsaturated fatty acids deserves consideration as an alternative.
  • PMID: 9497172 [PubMed – indexed for MEDLINE]

American Journal of Clinical Nutrition

  • In controlled trials, low-fat, high-carbohydrate diets decrease HDL concentrations. The effect is strongest when carbohydrates replace saturated fatty acids

Metabolic Syndrome

  • A syndrome of high blood pressure, diabetes, obesity and heart disease initially recognized by Dr Reavens  
  • One of the most important causes of disease in the world

Manifestations of Low Saturated Fat Diet

  • Lowers HDL (“good” cholesterol)
  • Lowers sex hormone levels
  • Contributes to metabolic syndrome (weight gain, high blood pressure, diabetes, heart disease) 

Excess Omega 6 Fatty Acids

  • Can lead to alkaline pain, and excess production of inflammatory prostaglandins
  • The only true benefit of omega 3 supplementation is to inhibit inflammatory prostaglandins resulting from excess omega 6 
  • Fish Oil – active ingredient is omega -3 
  • Snake Oil – active ingredient is omega -3 
  • Therefore – Fish Oil = Snake Oil

Undiagnosed or Poorly Treated Thyroid Problem as a Cause of Chronic Pain

  • A common contributor to pain issues
  • Myth – “All my thyroid labs are within normal limits” means “there is nothing wrong with my thyroid”
  • Fact – The ranges for thyroid hormones (and many other ranges) by definition are based on a statistical analysis such that 95% of all patients will always be within the “normal” range
  • Thyroid dysfunction and disease affects your immune, endocrine and nervous systems, contributing to chronic pain 

There are a Few Forms of Thyroid Hormones

  • T4 = levothyroxine, four iodine molecules, also known as Synthroid, most commonly prescribed thyroid hormone. NOT the active form of thyroid hormone 
  • T3 = liiothyronine, 3 iodine molecules, also known as Cytomel, rarely prescribed by primary care doctors and endocrinologists. THE active form of thyroid hormone
  • RT3 = Reverse T3, a mirror image of T3. BLOCKS T3 effectively putting the brakes on the active hormone by blocking the T3 receptor. Rarely measured by primary care doctors and endocrinologists
  • Natural forms of thyroid hormone (dessicated porcine hormone)
  • Gluten free T4 = Tirosint 
  • Gluten free T3 – not commercially available – needs to be compounded 
  • Gluten free dessicated procine thyroid hormone – available commercially as NP thryoid or can be compounded 

Significant Percentages of Thyroid Patients are Inadequately Treated with Inappropriate Medications

  • T4 only Thyroid Hormones are inactive and must first be activated by your liver and peripheral tissues to be biotransformed to T3 (active)
  • Many people, do not properly biotransform T4 to T3 and make significant amounts of Reverse T3 (blocks active T3)
  • Many factors can contribute to Reverse T3 syndrome – excessive estrogen, excessive insulin, excessive cortisol

Several Factors can Contribute to Reverse T3 Syndrome

Biotoxin Illness

A Common, Underecognized Cause of Fibromyalgia

Environmental Illness Contributing to Chronic Fatigue

  • About 24% of the general population react to biotoxin exposure with production of inflammatory cytokines
  • The gene known as HLA –DR is carried on your sixth chromosome and helps your immune system differentiate “friend from foe”
  • These cytokines create a huge burden on your body and can contribute to chronic fatigue

Chronic Inflammation Contributing to Fibromyalgia

  • Fact – Chronic inflammation as a result of various stressors increases your cortisol, contributes to insulin and leptin resistance leading to fatigue
  • Solution – Fix what is wrong! Unhealthy foods, unhealthy air quality, stealth organisms, food sensitivities, unhealthy relationships, negative thoughts, metabolic imbalances need to be rectified
  • A very common cause of chronic inflammation is environmental illness
  • There are usually other symptoms like fatigue, brain fog, headaches, sinus issues

HLA DR Susceptible Genetic Patterns

  • 4-3-53
  • 11-3-52B
  • 12-3-52B
  • 14-5-52B
  • 7-2-53
  • 7-3-53
  • 13-6-52A,52B,52C
  • 17-2-52A
  • 15-6-51
  • 16-5-51

Stealth Organisms

  • Hidden or “stealth organisms” – viruses, bacteria, parasites can contribute to chronic inflammation of chronic fatigue

Test and Treat for Tick Borne Diseases

  • Lyme Disease
  • Erlichiosis
  • Babesiosis 
  • Bartonella 
  • Rocky Mountain Spotted Fever (RMSF)
  • Anaplasmosis
  • Tickborne Relapsing Fever (TBRF)
  • Rickettsia
  • Tularemia
  • Powassan Disease
  • Borrelia mayonii
  • Borellia miyamotol  

Consider other Sources of Toxicity

  • Chronic Mold Exposure leads to immune dysfunction which can contribute to downstream distortions in your microbiome, paving the way for:
  •  Fungal overgrowth – Candida, yeast, small intestinal fungal overgrowth (SIFO)
  • Dysbiosis – small intestinal bowel overgrowth (SIBO), imbalance in bowel flora, H Pylori
  • Parasites 
  • Heavy Metals 



Energy Production Imbalance as a Cause of Fibromylagia

The Work of George Watson PHD

Systemic pH Imbalances can Cause Pain, Spasms and Muscle Tension

  • If your overall body (systemic) pH is either too low (acidic) or too high (alkaline), this can contribute to pain syndromes 
  • Some people are genetically predisposed to high or low pH, but these acid-base imbalances are also affected by your diet, air quality, hormone balance, thyroid status and many other factors.

Energy Produced Mostly by Two Processes

  • Metabolizing Fat – little carbon dioxide produced – pushes body pH Alkaline
  • Metabolizing Carbohydrates – much carbon dioxide produced – pushes body pH Acid 
  • When protein is metabolized, the amino groups are removed and what is left over is carbohydrates – pushes body pH acid

Metabolically Directed Approach to Fibromylagia

  • Fix what is wrong
  • Frequently a sex and adrenal hormonal problem
  • Frequently a thyroid problem
  • Frequently a dietary problem
  • Frequently an unrecognized environmental issue
  • Frequently an oxido-reductive imbalance
  • Frequently a problem with abnormal tissue pH
  • Frequently a problem with systemic pH
  • Frequently a “stealth organism” 
  • Always chronic inflammation as part of the problem

To learn more about Michael Rothman MD contact us today by giving us a call at (732) 268-7663, emailing us at [email protected] or by requesting an appointment online.

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