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Introduction The very first patient I saw with fibromyalgia was in 1998 whilst working as a locum Primary Health Care Tutor and Nutritionist on a small island in the South Atlantic. I was invited to a buffet supper. After everyone had helped themselves to food and found a place to sit, I noticed that the hostess was not sitting down. When I asked her why she did not take a seat, she replied: "It hurts too much on the dining chairs, because it presses all the sore points on the back of my legs and if I sit on the soft low down ones, it hurts on my arms too much to get myself up out of it." Various treatment approaches have been tried and orthodox medicine feels that reassurance, elimination of contributing factors, physical therapy to restore neuromuscular function, low impact cardiovascular exercise and medications for pain and sleep disturbances form the core of treatment options. Other drug therapies used include non-steroidal anti-inflammatories (NSAID's), antidepressants, trigger-point injections (1)... As many patients will testify and my own have told me, medication is often not a lot of help and for some people problems worsen over time regardless of medication. The explanation for this can possibly be found by looking at the way that Naturopathy and those who practice nutrition from a holistic naturopathic basis would see this disorder. A Chronic Disorder Chronic and debilitating disorders don't just happen all by themselves, neither do they happen overnight, but creep up insidiously and do not necessarily manifest themselves until all the balance in the scales between health and disease suddenly tips over - and health finds itself on the bottom. It doesn't take much to tip the scales, maybe a cold, a small accident, a bit of overwork or lack of sleep but it is not this 'bit' that has caused the host of problems manifesting as a chronic disorder. The slow build up of cellular toxicity coupled with the slow decline of the body's ability to deal with it underlies many disorders of a rheumatic nature. These often manifest as or contribute to chronic fatigue syndrome, rheumatoid arthritis, fibromyalgia and multiple chemical sensitivities (2). To understand what is going on in the body in the lead up to fibromyalgia, one needs to peel back the layers of degeneration and begin with the metabolism at the cellular level. On the cellular level chronicity begins as a shift in the balance of essential minerals within the individual tissue cells. This often begins with an excess of intracellular sodium and a deficiency of potassium, which tends to make the internal cellular environment more acidic and equally tends to displace magnesium, potassium and calcium, allowing for even more sodium to enter the cells. Potassium is then lost from the body and calcium is then 'dumped' in unwanted parts of the body (arteries, calculi in the kidneys and gallbladder), leading to a drop in blood calcium levels which in turn leads to a drop in blood glucose levels (hypoglycaemia). Symptoms arising from this are irritability, sleeping difficulties, fatigue and depression (3). Finally, the ability of the cells to generate energy via the production of ATP, protect themselves from damage and eliminate the toxic substances that enter on a daily basis from the environment becomes impaired. The toxic metabolites created during the natural processes of cellular metabolism also build up due to the inability of the body to deal with them. Cellular detoxification (known as level I detoxification) occurs more slowly. The liver - the main organ of detoxification - is involved in the elimination of toxic substances from the blood and their conversion into less harmful substances that can be safely excreted into the bile (and eventually the faeces) and urine. Researchers have linked several chronic disorders including that of fibromyalgia to impaired hepatic detoxification (sluggish liver), the symptoms of which are depression, general malaise, headaches, digestive disturbances, allergies and chemical sensitivities, PMS and constipation (4, 5). The resulting toxic overload on the body means that physiologically the unwanted waste materials have to go somewhere, after all we don't have a mechanism to make them disappear, like rubbish bags placed out on the pavement on the appropriate day of the week! Depending on the inherited constitution of the individual, the most likely place for these toxins to re-accumulate is in the weakest organ or system of the body (6). Where the joints and bone structure are inherently weak, this scenario may result in toxic accumulation in these areas, which contributes towards an inherited disposition to Rheumatoid Arthritis. Where the lymphatic drainage system is not functioning properly, toxic waste accumulates in the tiny lymph nodes situated in the areas surrounding joints and following the tracks of blood vessels and nerve pathways (6, 7) - i.e. below the surface of the skin at the pressure points. Hence the pain felt in Fibromyalgia is often related to the swollen lymph nodes at these points where there is insufficient lymphatic circulation to move the waste products and insufficient capacity of the liver to deal with the waste products. Recent research has found a link in patients with Fibromylagia with decreased metabolic energy levels and decreased levels of glutathione and antioxidant nutrients both of which are extremely important for detoxification of xenobiotics (drugs and chemicals) and metabolic waste products, in the body (8). The Problem of Delayed Diagnosis and Treatment From the standpoint of naturopathy and nutritional medicine there is only one healing force, that of nature. The body has its own innate wisdom, both to know its needs and in the ability to heal itself. This belief encompasses the existence of a 'life force', the inherent restorative power of the body to overcome disease. Diet, exercise, manipulation and natural therapeutic measures can harness this power more than the use of drugs or other suppressive measures to relieve the symptoms (9). With Fibromyalgia patients often the diagnosis is delayed sometimes for years and the patient is treated for a myriad of non-specific complaints with various types of medication from antidepressants to anti-inflammatory drugs, painkillers and sleeping tablets. Often when a diagnosis is finally made the medication does not change but simply increases, patients are advised to 'live within the limits' of their condition. This only adds to the total burden the body already has in dealing with the extra workload of eliminating the metabolites of these medications. Hence, a vicious circle ensues, the body has an ever increasing load of toxic products to deal with, so the symptoms of impaired hepatic detoxification worsen, and the patient is given more drugs to cope with it, further increasing the load on the liver. There is no way out of this downward spiral until something in the chain changes. Tracing the Path Back Backtracking to the place and time where one used to function as a well person is not easy or painless. One can sympathise wholly with people who feel that a full-blown detoxification and dietary program is just too much to handle. The only treatment protocol that is going to work is one that addresses the issues of emotional and practical support, available finances, and the degree of pain and immobility a person is experiencing. The symptoms may well continue to a degree whilst changing one's 'modus operandi' - way of life. For this reason individual assessment and support from a registered and competently trained professional in the field of nutritional medicine should ideally be sought whilst undergoing a long-term treatment program that takes into account the practical and emotional picture. This also includes gender, age, other medical problems, length of time since the onset of the illness and the amount of medication and length of time it has been taken. The recommendations given here are general guidelines and individuals will differ as to their own personal needs. The best approach to detoxification is to approach this slowly, gradually sliding into it over a period of a few weeks and continuing for several months until medication can be reduced to a minimum (gradually and under supervision) and eventually exchanged for herbal and nutritional alternatives. It is important to prevent the body from undergoing severe toxaemia as waste material is finally 'dumped' into the blood stream for disposal. This involves gradual change and herbal / nutritional support (10). The rationale behind this type of treatment protocol is not unfounded or unscientific. A multi clinic research study placed chronically ill patients suffering from chronic fatigue syndrome, fibromyalgia and related disorders on a comprehensive detoxification programme which included a hypoallergenic diet plus food supplements that facilitate liver detoxification. They reported a 52% reduction in symptoms after 10 weeks. Symptom improvement was mirrored by normalisation of hepatic detoxification (11). In a study conducted by Donaldson et al. Fibromyalgia patients were helped considerably in the relief of symptoms with a mostly raw vegetarian diet. After seven months 19 out of 30 participants had symptom scores that were no different than those found in normal healthy women of the same age group (12). Recommendations for Slow Detoxification
Possibility of Side Effects References
Further Reading
Summary of Qualifications: |
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