For the millions who suffer with chronic fatigue and fibromyalgia, I’m pleased to report some worthy breakthroughs in the past few weeks.
First, from the American College of Rheumatologists meeting in San Diego: Speaker and Tel Aviv physician Jacob Ablin, MD, described what I believe is a long-overdue paradigm shift in the diagnosis and treatment of fibro. To my knowledge, this is the first time the usually conservative rheumatologists are acknowledging the role of alternative medicine for fibromyalgia.
Dr. Ablin began his talk by remarking on the generally disappointing results produced by the three FDA-approved drugs for fibro–Savella, Cymbalta, and Lyrica–grading them all C- (the same grade they received in my book Healing Fibromyalgia). He refers instead to studies in both Israel and Germany showing better results with a variety of non-drug therapies, including acupuncture, massage, regular exercise, yoga, tai chi, and cognitive behavioral therapies. (The German contingent also recommended spa therapies–they do love their spas!) If medications are to be tried, Dr. Ablin suggests starting with those that improve sleep and raise serotonin (amitriptyline, trazodone), adding others as needed.
In the US, after the three mediocre FDA-approved meds the most commonly used fibro drugs are pain relievers (tramadol, Vicodin, etc.), muscle relaxants (cyclobenzaprine), and energy enhancers (Adderall, Nuvigil).
Canadian rheumatologist Mary-Ann Fitzcharles, MD, added that fibromyalgia is not a condition that requires a rheumatologist for diagnosis or treatment. Any primary care physician should be able to treat fibro patients without a rheumatology referral. Mayo Clinic, for example, will no longer accept fibromyalgia/CFS patients because it believes it has no treatment to offer beyond what a patient should be able to get locally.
Next, I’ve had some fascinating e-mail correspondence with Pennsylvania physician Henry Lindner, MD, whom I met through one of my favorite medical websites, Janie A. Bowthorpe’s stopthethyroidmadness.com. I’ve written about Ms. Bowthorpe’s work in the past. If you have thyroid issues, I urge you to become familiar with it.
Dr. Lindner, whose specialty is thyroid/cortisol/sex hormone replacement, offers compelling evidence that much of the fibro/CFS spectrum can be dramatically improved by supplementing with cortisol and thyroid hormone to achieve levels that would dismay most conventional endocrinologists.
He and I agree that low levels of these hormones are very much involved in fibro and CFS. What I refer to as “adrenal/thyroid fatigue” (as a consequence of a low-serotonin stress-buffering system) in Healing Fibromyalgia he believes goes well beyond glandular fatigue to full-blown and widespread cortisone and thyroid deficiencies. Since every cell in your body has a receptor site specifically for a hormone, when levels are low everything’s affected. Other deficiencies, including vitamin D, ferritin, and sex hormones, need to be corrected as well.
Dr. Lindner has gently encouraged me to be less timid in my dosing of adrenal hormones, using both cortisone and DHEA, and also of thyroid hormone (using natural desiccated thyroid, or NDT). We both follow the progress of patients clinically (“How do you feel?”), lending less credence to lab tests and pretty much tossing out TSH levels as useless.
Dr. Lindner says that many fibro patients no longer need muscle relaxants or pain meds when they’re getting sufficient hormone replacement, and here I do admit some skepticism. At WholeHealth Chicago we’ve seen pain levels in fibro patients that tear your heart out. I wonder if Dr. Lindner’s cortisone would be capable of making a dent in that suffering. Nevertheless, I’ve always believed the sign of a true skeptic is to be skeptical of his own beliefs, and since the program Dr. Lindner is suggesting is certainly safe, I’ll be working with it more in the future.
At the time I was reading Dr. Lindner’s material, I realized marijuana, which works wonders for fibro pain, boosts levels of cortisol literally in seconds. (Please don’t ask me for a cannabis prescription—it’s not yet available, but soon.)
For you who have been truly irritated with conventional medicine’s neglect of your thyroid and adrenal issues, you who find succor and salvation in Janie’s website, here’s a copy of the petition Dr. Lindner presented to the Scottish Parliament in support of a petition presented (apparently by some tired and angry Scot) about the inadequacy of hormone testing and treatment. Since Dr. Lindner’s paper is meant to be read by members of Parliament rather than endocrinologists it’s not overly technical.
The test for adrenal gland function (DHEA/cortisol) recommended by Dr. Lindner is occasionally not covered by insurance and costs $200. The thyroid, sex hormones, vitamin D, and ferritin are pretty much covered by all policies.
New book on Hashimoto’s thyroiditis Hashimoto’s thyroiditis is unrelated to fibromyalgia/CFS, though certainly the two conditions can occur in the same person. Hashimoto’s is definitely an autoimmune disorder, in which a person’s immune system creates antibodies that slowly but steadily destroy the gland. Here at WholeHealth Chicago, we routinely check for the presence of these antibodies when we perform thyroid function tests. We do this based on new evidence showing the presence of antibodies alone (even with normal hormone levels) is enough to warrant starting a patient on thyroid hormone.
Hashimoto’s is by far the most common cause of underactive thyroid, with a female-to-male ratio of 7 to 1. It affects 10% of all women, and Hashimoto’s antibodies alone are present in 20% of women. If you ask your endocrinologist “why?” or “how?” you’ll get a standard “We don’t know.”
Chicago pharmacist Izabella Wentz, herself a sufferer of Hashimoto’s, decided to devote herself to answering these questions and creating a treatment plan that slows down the vicious progression of thyroid destruction. She sent me a copy of her book, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, and I do recommend it for the proactive patient. At WholeHealth Chicago, we offer the tests, supplements, and prescriptions she recommends. Until we get our own copies to sell, here’s a link to amazon.
David Edelberg, MD
0 thoughts on “Fresh Approaches To Fatigue and Fibromyalgia, Hormone Update, and A New Book on Hashimoto’s Thyroiditis”
Hi Dr. Edelberg-
After reading your article I noticed the comment you made regarding how marijuana helps fibro pain and boost cortisol levels in seconds. Being I have Addison’s Disease and take hydrocortisone and florinef could I benefit from smoking the marijuana? Thank You. Carrie
Good round up of info., Dr. E. And thanks to fellow patients here on such interesting, informative comments.
Years ago (about 35?) I was diagnosed with a low thyroid. Went to an Endocrinologist for several years where he gave me synthroid. I later took an anatomy class and the instructor said “once you have a thyroid problem of a low or high thyroid, you always have a problem with your thyroid.” Later I was diagnosed with Fibro and the doctors say my thyroid is fine….the fatigue is the worst, not counting the sleep disturbance, reflux, etc. I believe you are on the right track. Keep on working on this!!!
would be interesting to know what role GMO’s play in adrenal fatigue and fibro.
I’ve been struggling with Hashimoto’s Disease for several years and have learned the importance of being a self advocate. Most of the medical community is clueless about how to treat this autoimmune condition and often finds it easier to prescribe antidepressants and claim that the myriad of symptoms is psychological in nature, especially if you’re female . Then, the patient has to balance what she know is real with what the experts say. At first you question your own sanity because, after all, doctors know more than you, but the real epiphany
Is when you realize that only you really knows your body and that’s when the real journey to healing begins. I learned to always question and listen to what only you know, which is what Izabella Wentz did. She was lucky to have the educational background and a doctor for a mother for support. I’m glad to see that there is a growing amount of literature on this very complex autoimmune condition and that WholeHealth is on the cutting edge in treating patients with Hashimotos Disease. Thank you for posting this.
Dear Doc, always enjoy your perspective on the world. Did you ever get a chance to read Dr. John Lowe’s “The Metabolic Treatment of Fibromyalgia”? If you can find a copy it would be worth your time. Dr. Wentz is one of the new younger generation adding their voice to intelligent ways to deal thyroid problems. Another is Dr. Kelly Brogan, a shrink who jumped the tracks.
Then of course there is methylation. Dr. Yasko, Dr. Mullan, Dr. Lynch, another fascinating area. The Scottish Thyroid Petition was brought by three women. We will see if they can shake things up. The Scots are a little more practical than the Brits. Thyroid care in the UK is like an episode of the ‘Twilight Zone’. Keep up the good work. PR
Ok Dr. E,
How do we as informed patients deal with our hormone imbalances & thyroid challenges when our doctors ignore our myriad symptoms and ONLY consider TSH?
And then imply that we’re crazy (and lazy, and…). Advise please!
I think what Dr David Brownstein is explaining in this video will answer all problems of thyroid disorder.
Interesting information Dr. E. Thank you for all you do.
I whole-heartedly agree with this article. My best friend has suffered from debilitating fibro for over 15 years. She saw countless doctors and none could help her. She tried many drugs and all the natural methods (low stress, CBT, massage, etc.). Finally, she discovered the Hotze Health and Wellness Center in Houston, TX , where she lives, and their doctors started her on cortisol and her pain level went from high to literally zero most days. She feels so thankful to have discovered this cure that most doctors are totally unaware of. Hopefully over time more and more doctors will read Dr. Jeffries’ book The Safe Uses of Cortisol and feel comfortable prescribing physiological doses to provide relief for a variety of ailments such as fibromyalgia, chronic fatigue, severe insomnia, etc.
Any thoughts on Dr.Frank Rice’s research which links FMS to small fiber neuropathy?
Another great piece that lays out the problem and possible treatment in laymens terms
John D. Roberts