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.
Be well,
David Edelberg, MD