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Advances in Fibromyalgia: Part 2

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Doctors like me who work with many fibromyalgia (and chronic fatigue) patients try a variety of alternative approaches. These make perfect sense physiologically because they address the root cause of fibro, rather than supplying yet another painkiller (like Lyrica).

And some of these approaches are actually being embraced, albeit reluctantly, by some mainstream physicians.

These treatments are not so much directed at the pain component as the utterly intractable sense of exhaustion, unrefreshing sleep, and brain fog. Both the diagnostic tests and most of the treatments do require a doctor’s prescription, so if you’re an out-of-town reader, you might show this article to your personal physician.

To understand what follows, picture unchecked stress slamming into your stress-receptor endocrine glands: your adrenal glands, thyroid, ovaries/testicles, and pituitary, the master gland that controls them all from its perch under your brain.

When your doctor says “your blood tests are normal,” she’s not testing the function of these endocrine glands. But for most people who have fibro, these abnormalities frequently appear:

Serotonin: levels of this stress-protecting brain chemical (neurotransmitter) are low.
Pituitary gland: levels, measured as insulin-like growth factor, are low.
Adrenal glands: levels, measured as cortisol and DHEA (a pre-hormone that converts to other hormones as needed), are low.
Thyroid gland: levels of thyroid hormones, measured by taking your basal body temperature, are low.
• Ovaries: levels of the sex hormones–estrogen, progesterone, and testosterone–are all low, causing PMS and low sex drive.

Treatments
Your primary job is to reduce stress. Sometimes, in a vicious cycle, the pain/fatigue/absence of medical or family support are your main stressors. Once you limit stress and start increasing your serotonin stress buffer (first item below, and I’ll discuss it more next time), you can break the cycle and can start eliminating medications.

Your individual treatment depends on the results of your lab tests, so please do show this list to your doctor. And realize that if she asks you to start taking one or more of the following, you probably won’t be on it forever.

To boost serotonin: St. John’s wort, 5HTP, B complex, Fish Oil, and/or a conventional antidepressant (Lexapro, Cymbalta).
Pituitary: If you have low insulin-like growth factor (IGF) 1, consider growth hormone precursors. These are amino acids that help your body make more growth hormone and are sold without a prescription. Short-term growth hormone injections can help, but they’re not approved by the FDA for this purpose and as a result are not covered by insurance (they cost about $300 a month). In the low doses needed to restore IGF levels, growth hormone injections are safe.
Adrenals: DHEA, cortisol (Cortef).
Thyroid: Armour thyroid (T3/T4) or Cytomel (pure T3).
Ovaries: Bio-identical replacement hormones from a compounding pharmacy.


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