Sunday, April 24, 2011

THE TREATMENT OF FIBROMYALGIA by Dr. John Whiteside with comments

Dr. John Whiteside is an Australasian College physician and Fellow of the Australian College of Nutritional and Environmental Medicine. He specializes in treatment of myofascial conditions including fibromyalgia. He had the grand opportunity to be mentored by and study under the world renowned expert and pioneer of myofascial medicine, Janet Travell, MD and lectured with David Simons, MD who later joined Dr. Travell in her research and authorship of medical textbooks regarding myofascial trigger points.

Hear what Dr. Whiteside has to say regarding myofascial trigger points in fibromyalgia, perpetuating factors like: amalgam fillings, hormonal deficiency in female and male fibromyalgia patients, hypothyroidism, diet, and supplements. You will also read about compounding pharmacies, myofascial therapies, physical therapy, and holistic treatments.

THE TREATMENT OF FIBROMYALGIA
By Dr. John Whiteside

The following information is the approach I take with my patients. I have selected the main factors I believe require attention. A full detailed account of all the factors can be found in the book by Celeste Cooper, RN and Jeff Miller, PhD, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain.

A spectrum exists running from a simple localized myofascial pain syndrome such as a hamstring injury in a young athlete, to the widespread pain and fatigue of fibromyalgia. The common denominator is the myofascial trigger point. In the first case the number of trigger points are few and the client/patient is healthy with minimal or no perpetuating factors. In the second case there are multiple trigger points and the patient is very sick.

With the athlete, all we have to do is inject the trigger points, and recovery is quick and usually permanent. With the fibromyalgia patient, we need to ask, “Why did this illness develop?” and we need to remove as many perpetuating factors as possible to allow healing.

My approach is to attend to as many perpetuating factors as I can first, then begin a series of trigger point injections. In practice this is difficult, because by the time I get to see these patients, they are usually unfit for work and have limited financial resources. Attention to perpetuating factors requires money, and the course of trigger point injections can be very long.

PERPETUATING FACTORS

DENTAL

This may well be the most important perpetuating factor in our modern society. If you have any amalgam fillings or root canal filled teeth, I urge you to read very carefully all the detail on the web site by Dr Robert Gammal. Robert is the leading alternative dentist in Australia, (now retired). Please spend time following the links and consider purchasing the DVD’s. www.robertgammal.com

This, together with the book by George Meinig, Root Canal Cover-Up, is compulsory reading. George was a Founding Member, and past president, of the Endodontic Society of the USA. After a lifetime of doing and teaching root canal therapy, he reviewed the evidence and renounced all his previous work to teach of the dangers of this practice. The evidence in this book is clear and conclusive: root canal fillings and amalgam fillings are toxic to humans.

Over 50% of the patients that come to me for assessment have root canal filled teeth, and a higher percentage have amalgam amalgam fillings. If this is representative of the general population then, clearly, there are many people walking around without obvious pathology. However in those with pathology this is the first perpetuating factor I would correct.

I watched a DVD about the Paracelsus clinic in Switzerland. This is one of the world’s finest holistic clinics. At the end of the presentation, the doctor in charge of the clinic summarized the information. He said, “the people who come to our clinic get better because of all the different things we do, but if I was able to do one thing only for each patient I would remove all their root canal filled teeth and all their amalgam fillings.”

I appreciate that this is a very difficult decision for patients to make. I explain that I can give no guarantee that their clinical condition will improve if they remove their root canal filled teeth and amalgams. I ask only that they read the evidence and then as informed consumers make up their own minds. Since I became aware of holistic dentistry 5 years ago I have seen many patients who became ill following root canal therapy and many who became well after their removal. I am a convert. I had a single root canal filling done when I was 23 years of age. I suffered chronic sinusitis from around that time until I had that tooth extracted 5 years ago. Since then I have had no episodes of sinusitis at all. My energy levels have been amazing and I have felt for the first time in my life really well.

My daughter fractured a front tooth at age 12 years and had a root canal filling. In recent years she suffered from bleeding gums. She was studying in Tasmania. She flew to Perth mid 2010 and I arranged for her to have the root canal tooth extracted and the gap bridged. The bleeding gums ceased immediately. She telephoned me 2 weeks later and told me her studies were so much easier as the constant low grade flu feeling she suffered from all her life was gone.

I have no doubt that root canal fillings and amalgams are major causes of illness in our society.

[Celeste’s side note]. I dealt with a metallic taste and loss of the ability to smell for several months. During that period, I was evaluated by two different ear nose and throat specialists to no avail. I was put on a mouth wash to help with dry mouth, and evaluated by a dentist. Eventually this problem subsided, and at the time I believed the symptom improved because I switched from generic levothyroxin. As I look back, that period was the beginning of a series of crowns to replace large amalgam fillings because of severe bruxism. After reading what Dr. Whiteside has to say, it is my opinion; one should give serious consideration to replacing amalgam. I understand the expense; many insurance policies in the US will only cover amalgam because they are CHEAP! At least consider replacing them by attrition. This week I found a dentist that does not have amalgam in his office.

*Amalgam is a low cost mixture of mercury and metal used to restore teeth.

MALE AND FEMALE BIO-IDENTICAL HORMONE REPLACEMENT THERAPY (BHRT)
It is an indictment of our medical profession that these were never used as the treatment of choice in the first place. As we learned of the properties of the different hormones (progesterone, estrogen, DHEA, testosterone, etc.) , we had the ability to provide safe oral contraception to women and to provide safe treatment of heavy painful periods, premenstrual syndrome, post natal depression, and support the ageing process to minimize the onset of degenerative disease and cancer. But these substances were generic. They could not be patented. The Pharmaceutical Industry followed the dollar and proceeded to make and patent artificial hormones that were as close as possible to the real thing. But they were not the real thing, and they have been responsible, and continue to be responsible, for much of the illness we see in our modern society.

The best introduction is found in the Life Extension articles. Go to www.lef.org and enter bioidentical hormones into the search engine. For further research go to www.naturalnews.com and enter bioidentical HRT. Natural News is the best medical detective web site on the net. It is well researched and is not biased by product sales.

Fibromyalgia, women and BHRT

Fibromyalgia is more common in women. From puberty onward progesterone deficiency is common in women. In young women anovulatory cycles (absence of ovulation), produce no progesterone and in the cycles where an egg is released, often the progesterone production is less than optimal. Anovulatory cycles and luteal insufficiency are common due to the many stressors of modern life: poor diet, emotional stress causing excess cortisol, intensive exercise (elite female athletes frequently have no menstrual periods, with continual anovulatory status), and pollution. The use of the oral contraceptive pill containing false progesterone (progestagen) suppresses normal progesterone biochemistry.
Anovulatory, absence of ovulation
Luteal Insufficiency, less than optimal progesterone

Progesterone is the single most nourishing hormone for the female body. It is an antidepressant. It is a calmative, smoothing out mood swings. It is a diuretic assisting maintenance of ideal weight. It promotes deep delta wave sleep allowing better tissue repair overnight. It normalizes the blood clotting system to protect against deep vein thrombosis, heart attacks and strokes. It protects against breast cancer and osteoporosis. The “high” that most women feel in the last 2/3 of their pregnancies is due to the massive amount of progesterone produced from the placenta. It is a feel good hormone. When the placenta is delivered at childbirth this rich source of progesterone is removed and if the ovaries are low progesterone producers then post natal depression immediately follows. The treatment of post natal depression with bio-identical progesterone is quick and effective. These women are suffering from a low progesterone level, not an antidepressant deficiency.

There is no down side to the prescription of progesterone. There are no serious side effects. Because it can be given safely to all women, it is part of my regime for all women with fibromyalgia.

Estrogen is only needed for perimenopausal and post menopausal women. Before that time women suffer from estrogen dominance, mainly due to the pollution of our environment with false estrogens (xenoestrogens). This pollution is global, xenoestrogens are even found in the polar bears in the Arctic Circle. Perimenopausal and post menopausal women with fibromyalgia need a little estrogen in their cocktail.

DHEA and testosterone are repair hormones (androgens). In women they are very frequently suppressed by the progestagens in the oral contraceptive pill (OCP). It is really silly that the Pharmaceutical Industry made an artificial toxic substance that gave women the freedom to have sex without the fear of an unwanted pregnancy, while at the same time, suppressing the very hormones that make them want to have sex in the first place. How wonderful would it have been if they had made a bio-identical HRT oral contraceptive with progesterone and made women safe from blood clots and breast cancer and retained the repair properties of the androgens?

In women the androgens are produced in the adrenal glands and this function deteriorates with age. The production is also decreased by stress. Thus in a woman with fibromyalgia it is common to see low androgen production, and this problem becomes worse with age. After blood testing to confirm the fact, it is normally essential to include androgens in the cocktail for women with fibromyalgia.

Fibromyalgia, men and BHRT

In men, the main hormones that need attention are DHEA and testosterone. The most important is testosterone produced by the testes. Decreased production is documented as occurring from the 50’s onward, but I am seeing this in much younger men. This more widespread age group of presentation is again manly due to false estrogens (xenoestrogens) in the environment. A man with fibromyalgia must have his testosterone levels checked and if the levels are in the low normal range (not necessarily below the lower limit of normal), then a trial of testosterone therapy should be given. Correctly prescribed, the only contraindication to testosterone therapy is an established prostate cancer. Until the appearance of a prostate cancer, keeping the testosterone levels high protects against the development of prostate cancer. There are no other problems with testosterone in men. It is as good for men as progesterone is for women. Any man presenting to me with pain and fatigue, unless his blood levels are very high, will be given a trial of testosterone replacement.

Hormones for men and women to consider

Pregnenolone

Another hormone worth considering in both men and women is pregnenolone. This was widely used with great success for arthritic pain in the 1940’s, but fell out of favor when synthetic cortisone was developed and patented by the Pharmaceutical Industry. Pregnenolone was safe and effective and synthetic cortisone was dangerous, but pregnenolone was generic and again it was more important to make money than to heal people.

Thyroid hormone

The final hormone that needs attention in both men and women is thyroid hormone. Nutritional medical doctors look at where the thyroid levels are in relationship to the normal range. If the level of TSH (thyroid stimulating hormone) is in the upper half of the normal range (indicating low tissue thyroid levels, it is reciprocal), and the patient has symptoms of low thyroid function, then it is worth a trial of thyroid replacement. The main symptoms of low thyroid levels are fatigue, foggy brain, constipation, increasing weight, dry skin, and pain. Yes pain. Any patient with fibromyalgia must be seriously considered for a trial of thyroid replacement.

[Celeste’s side note]: “How does Hypothyroidism, Hypometabolism, Hashimoto’s and Thyroid Resistance Relate to Fibromyalgia of Chronic Fatigue Immunodysfunction?”

http://fmcfstriggerpoints.blogspot.com/2011/02/what-are-hypothyroidism-hypometabolism.html

Optimal thyroid replacement requires the prescription of both T4 and T3. Traditional medicine normally only prescribes T4. This must be converted to T3 to be active. T4 is a storage hormone and exerts no effect on its own. In patients with fibromyalgia this conversion may be sub-optimal and they will fail to benefit from T4 alone. T3 is best given as a slow release capsule dispensed from a compounding pharmacy.

With all the other hormones described above there are no serious problems with regard to side effects. With thyroid replacement it is important to know that too much thyroid hormone can cause palpitations. This problem can be minimized by taking high dose magnesium, together with a good quality multivitamin. It is also important to be careful about using other stimulants such as coffee. This should only be prescribed by a physician skilled in bio-identical HRT.

DIET
If you have fibromyalgia then your diet needs to be as non toxic as possible. The symptoms of fibromyalgia are emanating from widespread myofascial trigger points. To decrease the sensitivity of these trigger points we need to provide a clean, low allergy, high nutrient diet. Your diet should be organic as much as possible.

Dairy

I recommend removing all normal dairy produce from the diet. Normal dairy is genetically A1, a type of protein found in milk. The A1 cows produce milk containing the A1 beta-casein. After digestion this liberates a fragment called beta-casomorphine-7 (BCM7), a powerful opioid (narcotic). It is an oxidant, the opposite of antioxidant, and therefore acts as a free radical to damage tissues. From research beginning in 1993 it is now implicated in many illnesses, including heart disease, Type 1 diabetes, autism, and a range of auto-immune diseases.

The new A2, also a type of protein found in milk, is non allergenic. This milk has been available in Australia and New Zealand since 2003, and can now be found at select locations in the US. Goats and sheep milk and yoghurt and cheese are all A2 and can be consumed safely.

In New Zealand, the dairy farmers are secretly converting their herds to the A2 genotype. This takes about 10 years to complete. In 20 years time we may look back and see that this staple food we have been encouraging our children to eat has been one of the main causes of illness in our society.
If you have fibromyalgia you do not want A1 milk in your diet.

For further detail, I thoroughly recommend the book, Devil in the Milk by Thomas Cowan, MD.

[Celeste’s side note] Well folks, I Google searched this and it appears Hy-Vee Grocery in the Midwest is the only store that sells A2 milk. I suggest you do an on-line search on A2 milk and the benefits to those with allergies and gut problems, and see if you can find a distributor near you.

Gluten

The next most important food intolerance to consider is gluten. Gluten is the protein in grains, bread, cereal, and pasta. Gluten intolerance is common and it is the great mimicker of the 21st Century. It can mimic any illness. Any patient with fibromyalgia must be considered gluten intolerant until confidently excluded by a trial and challenge.

Traditional medicine describes celiac disease as true gluten intolerance and looks with suspicion on all those other alternative thinkers who talk about their gluten sensitivity. Traditional medicine uses a blood test for antibodies to gluten and endoscopy to take a sample of bowel lining to confirm or deny the existence of celiac disease. In my experience very few people have true celiac disease but many are intolerant to gluten.

[Celeste’s side note] The following is so commonsensical, if you don’t do anything else, DO THIS! This approach will give YOU control in your treatment. I am asked all the time, is there something I can do in my diet? Well, here you go.

The best way to test this is to eat a diet totally free of gluten for 3 weeks then challenge over 2 days by eating as much gluten as you can. If you are gluten intolerant you will have a very large reaction when you challenge.

If your challenge is negative, meaning it produces no aggravation of your symptoms, theoretically, you can bring gluten back into your diet. However, gluten foods are all foods that convert quickly to glucose and are therefore not good foods in the first place, so you will be healthier without them.

Sugar

The third most important item is sugar. Sugar is a poison. It contributes to leaky bowel syndrome and thus allows large allergenic molecules to pass through and set up auto-immune illness. Fibromyalgia is an autoimmune illness.

[Celeste’s side note] A great alternative to sugar and artificial sweeteners is honey. If you can get your hands on locally produced honey, all the better. Local pollen is carried by bees during pollination and may help desensitize you to allergens, boost your immune system, and decrease your need for antihistamines. The pitfalls and comorbid conditions regarding a high glycemic index diet are discussed in the book.

*caution: Because allergens are in amounts sufficient to desensitize the adult, honey can be toxic to an infant with allergies.


Increasingly it is documented that if you can keep your insulin levels consistently low then you will enjoy the optimal level of health. Thus you need to avoid all foods that quickly convert to glucose, and this includes the gluten foods.

The diet I recommend, and the diet I eat myself, is as follows.

Breakfast

For breakfast a protein shake is best. I recommend a specific product “The Sun Warrior” brand protein (contact www.sunwarrior.com to find your local distributor in the USA). This is made from bio-fermented raw sprouted whole grain brown rice, and sweetened with Stevia ®. There are no artificial chemicals and no sugar. Please note I have no financial connection to this company apart from retailing their product through my clinic.

Make up a shake in a blender with the powder alone or add a banana and/or frozen blueberries if desired. As a general rule one scoop per day is sufficient for a sedentary person. This can be increased to 2 or 3 scoops as your exercise levels increase.

An alternative to this would be a cooked breakfast, such as, an omelet.

The rest of the day

Eat normal food; red meat, chicken, sea food, vegetables, salad, nuts, seeds, fruit. If you get hungry, have another protein shake. This is a low allergy, low sugar diet. It is what I eat and I have plenty of energy. I am 66 years of age, work out at the gym 3 times per week, do my clinical work Monday to Friday, and spend time at the computer on the weekends. It works for me!

If you have fibromyalgia it important you consider this type of healthy eating.

NUTRITIONAL SUPPLEMENTS

Even if you are eating a totally organic diet including your meat, chicken, and fish, you are still exposed to all the pollutants in the environment. You will benefit from good quality nutritional supplements.

There are 2 groups of supplements. There are those that are necessary to build the foundations of your health. These are high dose B vitamins, magnesium, zinc, selenium, C, E, D, other trace minerals, and omega 3 fatty acids. Then there is everything else. I call this group the “add ons”. This includes all the many things marketed as the best thing for your health; spirulina, Gogi berries, acai berries, etc. these are all beneficial but are of little use unless you have first laid down the foundation.

Over the nearly 20 years of practicing nutritional medicine I have tested many different combinations. I have settled on the Usana brand as the world’s best. I state here that I am not distributor of this product. I do retail the product through my clinic and if you wish to have this distributed to your home you can contact my wholesaler Vitaly and Jenny Orban at jenovita@bigpond.com

If you begin with the Usana Essentials supplement you will have all the items needed to build the foundation for your program. If you add the Usana Biomega, then you will have good quality clean omega 3 fatty acids. For fibromyalgia patients, I would also recommend Cal Plus. This is a high dose calcium and magnesium tablet. If you take T3 and T4, I would definitely add Cal Plus.

If you do not want to purchase the Usana brand, try to get the highest dose multi containing the items noted above.

[Celeste’s side note] Because you should take thyroid medication on an empty stomach, and some vitamins and supplements, particularly calcium and magnesium, can interfere with absorption, either wait four hours or switch to taking your thyroid medication at night.

PHYSICAL THERAPY

When all the above items are attended to, then you are ready for physical therapy. The best therapy is the local anesthetic injections by a skilled doctor. The next best is the use of acupuncture needles to release trigger points. This is usually called dry needling or intramuscular stimulation. If you cannot find therapists with the above techniques then the next best therapy is good old fashioned deep tissue massage. This needs to begin gently and gradually increase in intensity as you heal. This will take a very long time. But if you correct the perpetuating factors I have noted above, then weekly massage over many months should see gradual recovery.

[Celeste’s side note] Here in the US other modalities may be available to you, which include myofascial trigger point therapy, myofascial release, and active release therapy (ART). Specialists you might want to consider for treatment are physical therapists, physiatrists, sports medicine physicians, chiropractor’s, and pain management physicians trained to treat myofascial trigger points. I have not been able to convince pain management doctors in my care to leave out the steroids, which have not been shown to be of any greater benefit in the FM patient, limits the number of trigger points (TrPs) that can be treated and can cause trigger points to calcify. That is why I see a sports medicine physician that understands fibromyalgia and myofascial trigger points. However, even she will not treat more than 5-7 TrPs at a time and will not inject those in the neck, which are a primary source of dysfunction.

SUMMARY

1. Begin Bio-identical HRT. Look in the telephone book for Compounding Pharmacists in your area. They will give you a list of the doctors that send them prescriptions. These should know how to prescribe your bio-identical hormones. I prefer the use of a troche rather than the creams. A good starting point is for a woman is a troche with progesterone 200 mg, taken a ¼ twice daily. For perimenopausal and menopausal women I would add Biest 1mg, and if the blood tests showed low normal range testosterone and DHEA, I would add DHEA 25 mg and testosterone 4 mg. This is a perfectly safe mixture and you can take this all your life. (disclaimer: in this litigation conscious age I state that taking BHRT will not totally eliminate the chance of developing breast cancer, or having a heart attack or stroke, but there is good evidence to suggest it will reduce your chances of these conditions. You must read the evidence and make your own decision)

For thyroid replacement a safe beginning would be T4, 50 mcg per day and T3 in a slow release capsule 10 mcg per day. You will need to find a doctor to monitor this.

2. Eliminate dairy, gluten, and sugar from your diet.

3. Remove all root canal fillings and amalgams. Follow the links on the site www.robertgammal.com to find an alternative dentist near you.

4. Ideally begin Usana Essentials and Biomega.

5. Begin physical therapy.

[Celeste’s side note] In the United States, we are split between seeing a rheumatologist that only looks at the centralization of fibromyalgia, and someone to treat myofascial trigger points. This is grueling, disconnected, and lacks continuity of care. Australia is lucky to have Dr. Whiteside, who is taking into account all aspects of fibromyalgia, the centralization, effects on the immune system, treatment for myofascial trigger points AND therapies that address each person individually.

Learn more about Dr. Whiteside at http://www.myomed.com.au/ and be sure to click on the download button and watch the video in the supplements link.

6 comments:

Britta said...

I am so tempted to copy and paste this entire post to my blog because just this morning I discussed the link between amalgam fillings and fibromyalgia!

Thank you for an outstanding and highly informative post!

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome & Chronic Myofascial Pain said...

TY Britta. I will forward your comment on to Dr. Whiteside. Harmony and Hope, Celeste

Nicky Reiss said...

Just one point: fructose malabsorption (identified using the hydrogen breath test) is frequently overlooked but can cause serious health problems - and fructose is found in wheat, several vegetables such as onions, leeks, and asparagus, as well as in some fruits and also honey.

Gebie said...

Natural desiccated supplements are suggested by some medical doctors. Sometimes referred to as bovine thyroid, it relieves the symptoms of hypothyroidism that synthetic supplements can’t and may eventually improve thyroid function

Judloved said...

I am a middle-aged man who has had CFS for 10 years. It took me a while to accept that I can't cure this; I can only manage it. I have done that but regularly fall victim to the push-and-crash cycle: I feel good, do too much, and then crash. It takes weeks to get back to "normal." I take meds for mood (Prozac), sleep (Ambien) and chronic pain (vicodin) but Concerta has made the biggest difference; it regulates my energy level, helps me focus, and stabilizes my cognitive functions. I am able to be productive during the day (though I am still very tired at night). I hope this helps someone.

alferdoz said...

i have heart problems and was on synthetic drugs. Then I was super weak and stressed all the time but when i started taking porcine supplements, my energy renewed!

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