Chronic Fatigue Syndrome VS. Fibromyalgia

Chronic Fatigue Syndrome VS. Fibromyalgia

Some of the immune disorders associated with CFS are:

• elevated levels of antibodies to various viruses.

• altered helper/suppressor T-cell ratio.

• decreased NK cells or activity.

• decreased levels of circulating immune complexes.

• low or elevated antibody levels.

• increased cytokine levels.

• increased or decreased interferon levels.

• fibromyalgia and multiple chemical sensitivities.5

Chronic Viral Infections and CFS

Individuals who we suspect have chronic fatigue syndrome will have an Epstein Barr Virus EBV and or Cytomegalovirus CMV blood panels drawn. This is to see if there is a virus lingering in the body that is weakening the immune system. These blood tests measure the antibodies immunoglobulin M (IgM) and immunoglobulin G (IgG). A test for IgM antibodies measures the acute (recent infection) phase of the virus. A test for IgG antibodies measures the dormant (inactive) phase of the virus. Our tests also measure Epstein-Barr nuclear antigen (EBNA) antibodies.

►  You don’t have to have a blood test to diagnose CFS. If you’re patient has chronic fatigue (hard to get out of bed each day), achy diffuse pain, and a lowered immune function (chronic infections,) then they either have CFS or they are at high risk of developing the illness.

Due to weakened immunity, individuals with chronic fatigue have terrible problems with energy as well as reoccurring bouts with the flu, colds, sinusitis, and other immune problems.

 As with so many complex chronic illnesses, CFS may be aggravated by a wide variety of environmental and physiological challenges. Food allergies, environmental sensitivities, heavy metal toxicity, yeast overgrowth, intestinal dysbiosis, parasites, and vitamin/mineral deficiencies can all contribute to CFS.

The syndrome’s principal causes are a weakened immune system and a reactivated virus.

All of us have been exposed to mono or the Epstein-Barr virus at one time or another (usually as teenagers), but our bodies are usually strong enough to overcome it. Individuals with CFS have been exposed to the Epstein-Barr virus or mono from some other source, and it has now returned. Its return has either caused the immune system to be compromised or has taken advantage of already compromised immune system.

How to quickly distinguish between FMS and CFS patients.

►  A quick way to distinguish between the two syndrome. 

A positive EBV panel showing elevated antibodies, especially IgM is clear indicator that someone has CFS.

ŸThe CFS patient usually has chronic infections (sinusitis, upper respiratory, UTI’s, colds, flu, etc.) and is sick several times a year. They get at least 2 or more (bad) infections a year. They will usually have chronic or intermittent sore throats, swollen lymph nodes, and periodic fevers. They usually ache all over. 

FMS patients may ache all over as well but usually have specific areas (neck, low back, etc.) that are the most troublesome. 

ŸCFS patients may not have a low serotonin state (“S” on Brain Function Questionnaire, see my book) and will have no problems falling and staying asleep each night.

ŸNote-some of these individuals have a low body temperature (suggestive of low thyroid). They may have a fever when their temperature is at or below 98.6.

Many of these individuals will have a sluggish liver (higher incidence than those with FMS). Clues that would lead you to suspect someone has a sluggish liver include, funny or negative reactions to medications (take something to put them to sleep and it wakes them up or a little goes a long ways), intolerance to caffeine, alcohol, or odors (longer they’ve had illness more sensitive they become to odors, perfumes, gasoline, smoke, cleaners, etc.), and a history of elevated liver enzymes on past blood work. Of course anyone with hepatitis or fatty liver has a sluggish liver. Long term prescription medication therapies can also create a sluggish liver.

True chronic fatigue syndrome patients are a real challenge. Their biochemistry is usually totally shot by the time they get to the right doctor. They can feel better but it requires hard work and requires a lot of patience by the doctor and the patient. 

Fibromyalgia patients aren't easy either but FMS patients respond rather quickly to restoring serotonin levels. Once FMS patients start going into deep restorative sleep, they usually feel better in a matter of days. 

Fibromyalgia and Irritable Bowel Syndrome Is There A Connection?

Fibromyalgia  syndrome is associated with chronic severe muscle or soft tissue pain. Fibromyalgia has also been linked to fatigue, sleep problems, headaches, cognitive dysfunction, depression, and anxiety.

Irritable bowel syndrome (IBS) is a disorder that involves abdominal pain, cramping, bloating, as well as changes in bowel movements – constipation or diarrhea, or alternation of both. People with IBS often experience anxiety and depression.

Millions of people have at least one of these conditions. Fibromyalgia affects over 5 million U.S. adults, and an estimated 25 million to 45 million people in the U.S. have IBS.

Studies are now showing that if you have fibromyalgia or IBS, you may be more likely to have the other one, too.

In one study, 32% of people with IBS also had fibro symptoms compared with 4% of people without IBS. Another study showed fibromyalgia occurring in 20% of people with IBS. And studies have estimated 32% to 70% of people with fibromyalgia also meet criteria for IBS.

I find that about 80% of my fibro patient’s has IBS.

Fibromyalgia and IBS don't always go together. They're two separate conditions.

Pain Processing

Researchers see a possible pain link between IBS and fibromyalgia. In short, people with those conditions respond to pain differently than people without the two conditions.

IBS patients are hypersensitive to intestinal pain; people with fibromyalgia are hypersensitive to skin, soft tissue, and muscle pain. Both have a lowered threshold to pain in general. In fibromyalgia, the central nervous system may be highly sensitive, making someone feel more pain than what someone without fibromyalgia would feel in a similar situation.

The neurotransmitter, serotonin has been linked with both fibromyalgia and IBS.

I find that once I start to return my patients serotonin level to normal their IBS goes away within a couple of weeks.

If you’d like to know more about reversing IBS please see my past article Treating and Beating IBS click on the link below-

http://treatingandbeatingfibroblog.blogspot.com/2011/02/reversing-irritable-bowel-syndrome-ibs.html

Treating and Beating Fibromyalgia With Orthomolecular Medicine

Dr. Janet Travell, White House physician for Presidents John F. Kennedy and Lyndon B. Johnson, and Professor Emeritus of Internal Medicine at George Washington University, co-wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is acknowledged as the authoritative work on muscle pain. In one chapter alone, 317 studies are referenced showing that problems such as hormonal, vitamin, and mineral deficiencies can contribute to muscle pain and soreness.

Vitamins, minerals, amino acids, essential fatty acids, and certain enzymes, when properly supplemented, can provide profoundly beneficial results for those suffering from poor health. 

Below is a sample listing of essential nutrients and their contributions to the treatment of FMS and CFS.

• Vitamin E helps to relieve pain in CFS patients. It can also improve nighttime leg cramps, which interfere with sleep.

• Vitamin C boosts the immune system by increasing natural-killer (NK) cells, B cells, and T cells.

• Magnesium and malic acid have been found by controlled
studies to be effective in relieving the symptoms of FMS. Magnesium is essential to healthy muscle function, and, working with malic acid, it increases cellular energy, reduces pain, and enhances immune function by increasing NK cells. Magnesium is also a natural muscle relaxant and critical for the relief of muscle pain.

• Inositol enhances the immune system by increasing NK cells.

• Selenium supports the immune system by enhancing antibody production.

• Vitamin D regulates many immune functions.

• Amino acids, such as glycine, serine, taurine, and tyrosine, are essential for the production of energy in the body and for brain function.

• Zinc supports the immune system by enhancing white-blood-cell activity and supporting healthy antigen-antibody binding.

But I Already Take Vitamins

You might be thinking, I’ve taken  vitamins for years, and I haven’t noticed a difference. You probably haven’t been taking enough to even make a dent in your deficiencies. If you compare Centrum or One-A-Day vitamins to the Essential Therapeutics multivitamin and mineral formulas, including the CFS/Fibromyalgia formula, you’ll notice that our specially designed vitamins have 50 times—and in some cases, 100 times—the recommended daily allowance (RDA). 

This is because the RDA is an outdated system that does not take into account the depletion of our nutrient-rich top soil, environmental pollutants, chemical food processing, the addition of artificial ingredients, and the increased demands placed on an individual’s homeostatic system in the 21st century.

So nearly as criminal as not recommending vitamin and mineral supplements is the recommendation of them based on the RDA. It was never intended to advance health, only to prevent deficiency diseases like scurvy and rickets. 

Taking the minimum amount of a nutrient to prevent gross deficiency doesn’t help those people who want to be truly healthy and not just free of severe symptoms. And optimal health should be the goal for all of us.

The key to reversing disease and the unwanted symptoms, pain, fatigue, depression, poor sleep, etc. is to take the RIGHT DOSE AND RIGHT COMBINATION of optimal daily allowance nutrients. The reason my patients see such a drastic improvement on the CFS/Fibromyalgia Jump Start supplements.

Are these higher doses safe?

One of the arguments against megavitamin treatment is that a high dose of certain vitamins are toxic and may cause certain adverse reactions. Let me present some statistics to you and let you decide for yourself.

The American Medical Association reports that death from medical errors is now the third leading cause of death in the United States, behind only heart disease and cancer. As reported in JAMA,
over 250,000 Americans die each year from medical therapies, including at least 113,000 from the negative effects of prescription medications.

The total number of deaths from vitamin/mineral therapy during the years of 1983 to 1990 was zero.

what is orthomolecular medicine?

When we establish nutritional deficiencies, our health suffers. Man-made chemicals (synthetic prescription drugs) can’t correct these deficiencies, but a nutritional-replacement therapeutic program can. This is the very premise of orthomolecular medicine, which means, “right molecules in the right concentration.”

Linus Pauling, two-time winner of the Nobel Prize, is regarded as one of the greatest biochemists of our times. He defines orthomolecular medicine as “the preservation of good health and the treatment of disease by varying the concentrations in the human body of substances that are normally present in the body.” This concept involves a medical approach based on the physiological and enzymatic actions of specific nutrients present in the body, such as vitamins, minerals, and amino acids. The idea that to beat a disease one has simply to “get healthy” may seem trivial to those with such life-robbing illnesses as FMS and CFS. Still, it’s hard to argue with the results.

Synthetic drugs may be helpful at times, but they always have an inherent ability to cause harm. Not only are nutrients such as vitamins, minerals, amino acids, and essential fatty acids unharmful, the body depends on them for survival. The body knows what to do with—and depends on—vitamin B6. The same certainly can’t be said for Lyrica. The World Health Organization’s definition of health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” These words advocate to us the need to correct the biochemical causes of disease rather than merely covering up the symptoms with drugs.

The Centers for Medicare and Medicaid stated in a recent report that the nation spent $140.6 billion in the year 2000 on prescription drugs. And of course this number is rapidly escalating; over one billion prescriptions were written last year. But even though the United States spends more money on health care per capita than any other country in the world, The World Health Organization ranks the overall health of the United States as 15th among the 25 industrialized countries.

Even with this dismal ranking, things in the United States are changing. A new paradigm is emerging, one based on taking responsibility for our own health through abstinence from dangerous habits—like nicotine, trans-fats, sedentary lifestyles, and excessive stress—and through proactive behavior like regular exercise, healthy diet decisions, and optimal nutritional supplementation.

You can reverse fibromyalgia and get your life back. It won’t happen with a magic new drug though, that is a dead end (see Lyrica, Savella, and Cymbalta). Having specialized in treating fibromyalgia for almost 14 years I know orthomolecular medicine is the only true way to beat fibromyalgia.

Fibromyagia-Stress Coping Savings Account

We’re all born with a stress-coping “savings account” filled with chemicals—such as hormones, amino acids, and nutrients—that can be deposited and then withdrawn when needed. Depending on our genes, some of us have large accounts, and some of us have smaller ones. The more stress we’re under, the more withdrawals

We make. If we make more withdrawals than deposits, we get overdrawn, and poor health quickly follows. Individuals with fibromyalgia and/or CFS have bankrupted their stress-coping savings account.

Although some patients bankrupt their accounts with one overwhelming event, most experience a series of stressful events over the years. These events typically involve stressful jobs, marriages, family dynamics, surgeries, illnesses, loss of a loved one, divorce, financial failure, etc.

Many of my patients can remember the day when their account went belly-up. It might have been after a surgery or following the loss of a parent. Whatever happened, the person was never the same from that point on; she just couldn’t get well. My CFS patients often relate how they came down with a bad case of flu and just never completely got over it. Once these individuals get enough rest and stop making withdrawals, they may attempt to do something as mundane as sweep the kitchen floor only to be wiped out once again. And forget about grocery shopping! 

That could put them in bed for weeks.

FMS and CFS are the result of internal biochemical (hormonal, enzymatic, neuronal, and chemical) imbalances that manifest themselves as physical symptoms (pain, weakness, and mental impairment). So in order to right the homeostatic system, you must correct the underlying biochemical problems. Just like an onion, you peel away one layer at a time until you get to the core. But we’ll discuss these practical steps soon. For now, let’s make sure that you understand all of these “layers of the onion.” One of these is dysautonomia.

Dysautonomia is defined by Taber’s Cyclopedic Medical Dictionary as “a rare hereditary disease involving the autonomic nervous system with mental retardation, motor in coordination, vomiting, frequent infections, and convulsions.” But dysautonomia symptoms are usually nowhere near this severe. Dysautonomia patients are more likely to be suffering from mitral valve prolapse and neurally mediated hypotension (dizziness upon standing) than mental retardation and vomiting.

A better description, then, of dysautonomia would be a malfunction in the body’s master regulating (homeostasis) system, which—as you may recall from earlier chapters—is known as the autonomic nervous system or the HPA axis. The HPA axis (comprised of the hypothalamus, the pituitary gland, and the adrenal glands) controls millions of involuntary actions such as breathing, releasing of endocrine hormones, blood flow, smooth muscle tone, immune response, heartbeat, detoxification, and elimination. We don’t have to think about breathing; we just do it. We don’t try to pump blood through the heart and into the muscles; it is initiated and monitored by our HPA axis.

Normally all the systems in the body speak to and coordinate with one another. This is the essence of homeostasis. But when a person depletes her savings account of stress-coping chemicals, her HPA axis begins to self-destruct. This is dysautonomia. It’s as if the immune system starts to speak in Spanish, the endocrine system in German, the musculoskeletal system in Greek, and the digestive system in French! And when no one can communicate, chaos results!

Most of us can handle the ups and downs of our daily lives, even the occasional catastrophe. We dig in our heels, persevere, and eventually learn to cope. However, some individuals have an altered stress-coping system, which prevents them from managing daily stress. Human studies suggest that for some folks, the cumulative effects of physical, mental, chemical, or emotional burdens in early childhood may increase the affects of stress later in life. (It’s possible that the reason for his effect is an overstimulation or dysfunction of the HPA-axis). Retrospective studies show that the stress of emotional, physical, or sexual abuse during childhood also increases the future risk of developing certain symptoms, including many associated with FMS and CFS.

Apparently, for some children and adolescents, too many traumatic or stressful events decondition their normal homeostatic stress-coping abilities. Thus stress, particularly traumatic stress, early in life may alter the set point of their stress-response system. As they get older, have more responsibilities, and experience an increase in their daily stress, they often find their health beginning to suffer. They may start to have bouts of anxiety and depression, or perhaps they’re just tired all the time. They become extremely vulnerable to major stressors: the death of a loved one, chronic illness, invasive surgery, physical trauma, etc. Like a ticking time bomb, it’s only a matter of time before they explode.

This is especially true for those who have a genetic predisposition that makes them more susceptible to the ill effects of daily stress, including reduced serotonin levels. Some research has suggested that FMS/CFS patients may in fact by afflicted by this genetic abnormality.

Sadly, I find that many of my FMS and CFS patients have experienced physical, emotional, or sexual abuse as a child. Some patients report abuse from their spouse (sometimes physical but more often emotional). This stressful situation, though begun in adulthood, can still eventually deplete their stress-coping chemicals and lead to a state of disease.

The symptoms of fatigue, pain, poor sleep, poor digestion, irregular bowel movements, mental confusion, poor memory, anxiety, and depression are all warning signs that certain stress-coping chemicals (including vitamins, minerals, amino acids, essential fatty acids, and hormones) have become deficient. These deficiencies then complicate one another until the body’s homeostatic mechanism and 

HPA-axis become dysfunctional.

The final tick of the time bomb may be just another part of chronic daily stress, or it may be a sudden traumatic event like the birth of a new baby. I know I didn’t think I’d survive the first colic-plagued six months of my daughter’s life. And I’m extremely healthy! I pulled my weight and spent every other night walking and rocking my crying daughter into the early morning, and this is main reason it took another nine years before my wife could convince me to have another child!

It’s no wonder that many of my patients report that their fibromyalgia began after the birth of a child, often a firstborn. Anyone with children can relate to sleeping (if you can call it that) with one eye and two ears open, making sure the baby is breathing. Or how about trying to sleep without moving so that you don’t wake the baby up? Then there’s the endless nights of breast and bottle feedings, diaper changes at two in the morning, and the early morning piercing cry: “I’m awake, folks!” It’s enough to bankrupt anyone’s stress-coping savings account! Whew! Let’s move on.

we are all born with a stress-coping savings account filled up with chemicals we need for the body to work properly. These chemicals—serotonin, dopamine, norepinephrine, cortisol, DHEA, HGH, and others—help us deal with stress.

Every time we are exposed to stress (chemically, emotionally, mentally, or physically), we make withdrawals from our stress-coping savings account. These withdrawals can be triggered by any stimulus, including sounds (especially loud or irritating noise), odors, and bright light. You may have noticed that the longer you’ve had your illness, the less tolerant you are to certain odors, chemicals, or noises.

Emotionally stressful situations cause the body to release adrenaline, cortisol, and insulin, and these stress hormones stimulate the brain to secrete serotonin. Long-term stress and poor dietary habits can therefore deplete the body’s serotonin stores. If we aren’t careful we’ll find that we are making more withdrawals than deposits, bankrupting our own account. And when we do, FMS and CFS are often the result.

But when a person enters deep, restorative sleep, she makes more serotonin, which then gets deposited into her stress-coping savings account. The more stress a person is under, the more serotonin she’ll need to replenish. It’s a vicious cycle. If she doesn’t have enough serotonin, she won’t be able to go into the stage of sleep in which she is able to make more serotonin!

solving your serotonin problem

The first reaction of many physicians to a patient’s serotonin deficiency is to recommend a selective serotonin reuptake inhibitor (SSRI) drug. But while prescription antidepressants can be helpful, they have some serious potential side effects (see chapter 6). In addition, they tend not to work for FMS patients. And here’s why: SSRIs can help a patient hang onto and use their naturally occurring stores of serotonin. They work like a gasoline additive would work in your car, helping to increase the efficiency of “fuel.” But most of the patients I see with fibromyalgia are running on fumes! A gasoline additive is not likely to help. If you don’t have any serotonin to re-uptake, then using a serotonin re-uptake inhibitor drug is pointless.

And by pointless, I mean exactly that. It’s money thrown away. In fact, depending on which study you quote, from 19% to 70% of those taking antidepressant medications would do just as well on a placebo. 

This is precisely why I recommend that my fibromyalgia patients boost their serotonin levels by taking 5-HTP, not an antidepressant. Why put an additive in your gas tank...when you can just fill it up with what it’s really thirsty for? The proper function of our adrenal glands is second only to a good night’s sleep in winning the battle against fibromyalgia and chronic fatigue syndrome.

The importance of restoring optimal adrenal gland function can’t be overstated. An individual with FMS or CFS who suffers from adrenal fatigue will find her stress-coping abilities to be severely depleted. Simply put, she “stresses out” easily. Consequently, she has to avoid stressful situations in order to just feel OK (which makes for complicated relationships). Stress causes her physical pain, worsens her other symptoms, and can cause a flare-up that lasts well beyond the time of the stressful incident.

If she has a day when she feel good, she’ll usually overdo it. Her reason? “I’ve got so much to do! And who knows when I’ll feel good again.” So she cleans the house, stays late at work, re-sods the front yard, goes Christmas shopping, and plays outside with the kids. Then she crashes—hard—the next day. 

She just doesn’t have any resistance to stress. If her sister calls at 9:00 p.m. with some bad news, she can just forget about sleeping. And of course she’ll feel terrible the next day, so she can go ahead and cancel that lunch date. “But how can I cancel on my friend again? She already thinks I’m avoiding her!” She just can’t make any firm plans, because she never knows if she’ll be having a good or bad day. Below are some sample accounts from patients of mine who have suffered from adrenal fatigue. Does any of it sound familiar?

Adrenal fatigue is already known to cause many of the same problems associated with CFS/FMS, such as muscle or joint pain, dizziness, fatigue, decreased mental acuity, low body temperature, a compromised immune system, depression, constipation, diarrhea, and abdominal pain.

For the past 14 years, I’ve successfully treated thousands of patients with high does of certain vitamins, minerals, amino acids, and other nutrients—an approach known as orthomolecular medicine (see ch. 7). It’s based solely on biochemistry, using the right chemicals inherently natural to your body’s optimal functioning.

In short, by using the natural building blocks that make up your normal biochemistry, we can correct, drastically improve, or even reverse the cause of your illness. Nutrients— including vitamins, minerals, and amino acids—make the hormones that regulate your body. They compose every essential chemical in the body, including thyroid hormone, testosterone, estrogen, neurotransmitters (serotonin, norepinephrine, etc.), antibodies, adrenaline, cortisol, and white blood cells.

Unlike with drug therapy, there is never any danger in getting healthy. Once you become familiar with my protocols, you’ll realize that they’re safer and often more effective than drug therapy alone. And they often work quickly, having a person feel better than she has in years.

I’ve found that it’s best to start with the following core nutrients, which I call the Jump-Start Package. The supplements in this package are essential for reversing fibromyalgia and CFS symptoms, and they don’t take a lot of measuring, counting, or reorganizing of your medicine cabinet. Ninety-nine percent of the time, I start my pain-and-fatigue patients on the four pillars of the Jump-Start Program from day one: 5-HTP, adrenal cortex, digestive enzymes, and an optimal daily dose multivitamin and mineral formula.

When my patients begin the jump-start package, they consistently report feeling better within 2–4 weeks. 

That’s because these supplements help address the core issues of fibromyalgia and CFS. I call these the four pillars, and we begin them all at the same time.

1. 5-htp

This builds serotonin and promotes deep restorative sleep, the most important step in beating fibromyalgia and CFS. See chapter 10 to read all about it, including what to do if it doesn’t seem to be working for you.

2. Adrenal cortex

Once you get sleeping well and restore you serotonin levels, you should start feeling better than you have in years. However, if you don’t repair your sluggish adrenal glands, you’ll crash every time you attempt to overdo it. I know you can relate to having a day or two when you feel good and then overtaxing yourself only to “flare up” again and end up in bed for several days. Supplementing with adrenal cortex (500 mg. daily divided into two doses) and/or other supplements that help the adrenal gland repair itself is a crucial step towards avoiding these flare-ups. Check out chapter 11 again if you’re not convinced.

3. Digestive enzymes

The majority of my patients are suffering from poor digestion, and most are taking antacids or proton-pump inhibiting medicines to block their stomach acids. As I’ve already discussed, this can cause further nutritional deficiencies. If you’re not breaking down and assimilating the nutrients in your foods or the supplements your taking, you’ll be wasting your money and never feel as good as you could. That’s why I recommend that all of my patients take an 8X pancreatic digestive enzyme—or betaine HCl with pepsin enzyme—with each meal. Read more in chapter 12.

4. The CFS/Fibro formula

I’ve already established the important roles vitamins, minerals, essential fatty acids, and amino acids play in reversing many of the most troubling symptoms of fibromyalgia and CFS. After working with fibromyalgia and CFS patients for over a decade, I’m firmly convinced that without taking a good optimal daily allowance multivitamin-and-mineral formula similar to the one I’ve developed, patients are doomed to a life-long battle with poor health. Chapters 26–29 will give you more details about the ingredients in the CFS/Fibro Formula.

The CFS/Fibro Formula is taken as one pack with food, twice a day. I’ve designed what I consider to be (and which has proved itself to be) the best on the market, if I do say so myself.

get jumping

This Jump-Start Package is the place to begin in your journey to wellness. Start here, and give yourself some time to improve. As your stress-coping savings account builds up for a couple of weeks, you should definitely feel better. Some of you will show a dramatic improvement. You won’t be totally well yet, and you might never feel like you did when you were 20. But you shouldn’t have to suffer like you have been.

Stress and Fibromyalgia

A survey by The Fibromyalgia Network reports that 62% of their respondents list physical or emotional stress as the initiating factor in their acquiring fibromyalgia.

I believe chronic stress is the underlying catalyst for the onset of HPA dysfunction and fibromyalgia. Several studies have demonstrated how chronic stress undermines the normal hypothalamic-pituitary-adrenal axis (HPA) function.

When explaining the role of stress in fibromyalgia, I find the following analogy helps put stress and fibromyalgia into perspective.

“We are all born with a stress coping savings account. This account is filled with numerous chemicals we use to help us deal with daily stress-serotonin, norepinephrine, cortisol, magnesium, and other important hormones and nutrients al help counter stress. The more stress we encounter, the more stress coping chemicals we use. We replenish our stress coping savings account with adequate rest. Consistent deep restorative sleep ensures we are making more deposits than withdrawals from our stress coping account.

Since fibromyalgia patients struggle with getting a consistent good nights sleep they eventually bankrupt their stress coping account. Once tyour stress coping savings account is depleted poor health and the many symptoms associated with fibromyalgia, pain, fatigue, brain fog, anxiety, depression, low thyroid, etc. start to raise their ugly heads.

With so many different symptoms, it’s no surprise that fibromyalgia and CFS patients are typically taking 6–12 different prescription drugs. Lyrica, Elavil, Klonopin, Paxil, Effexor, Xanax, Trazadone, Neurontin, Zanaflex, Ambien, Lunesta, Cymbalta,  and Provigil have all been heralded as “the drug” for fibromyalgia. Some of these are helpful, some worthless, and some really dangerous.

Drug management alone typically fails to yield lasting relief from the most common fibromyalgia and CFS symptoms, and patients’ and doctors’ optimism over a new drug treatment eventually gives way to this sad reality. Oh well, a new drug with an even larger marketing budget is on the horizon. (Forgive my cynicism. I’ve just seen this situation so many times!)

After seventeen years of specializing in treating and beating fibromyalgia I’ve learned that traditional medicine alone yields little if any long-term results.

The best hope for those with fibromyalgia is to find and work with a doctor who practices integrative medicine-combining judicious use of prescription drugs (short-term if possible) and natural therapies (vitamins, minerals, and other nutrients).

Combining prescription drugs (when needed) with natural supplements allows the symptoms associated with fibromyalgia to be corrected, not just covered-up.

Hang in there-you can beat fibromyalgia. Don’t give up.

Here We Go Again-Another Idiot Doctor

I was just made aware of a story on fibromyalgia that The New York Times ran early last year. How many arrogant idiotic doctors are there in this world. Just when I feel like patients with fibromyalgia are finally getting the support and understanding they deserve, some prehistoric physician, locked in the dark ages, paints fibromyalgia with the "all in their head" label. It would be funny if it weren't so offensive to those who battle this illness on a daily basis. Fibromyalgia is a real disease and those with  the syndrome suffer real pain. Who would want to make all this up in their head?


Here is a partial snippet of the article


The Voices of Fibromyalgia

People who suffer from fibromyalgia experience problems beyond the pain caused by their illness. Their condition is little understood and hard to explain, and often they are disbelieved by doctors. Even friends and loved ones may express skepticism toward the fibromyalgia sufferer, who, burdened with inexplicable pain, may cancel social plans, miss work and recoil from physical affection because it hurts too much.

For a glimpse into the frustrating world of fibromyalgia sufferers, listen to the latest installment in the Patient Voices series by producer Karen Barrow.

You’ll meet Christine Wysocki, 33, of St. Augustine, Fla. who waited three years before a close friend and co-worker believed she had a health problem.

“Frankly I still don’t know if I understand exactly what it is,” says Ms. Wysocki. “Everything seems so vague about what fibromyalgia is, and it feels like no one wants to commit to what an actual answer is.”

And there’s Leon Collins, 59, of Clayton, N.J., who was relieved when he heard he had fibromyalgia because he at least had a diagnosis after many other doctors had dismissed his symptoms.

“We even experienced one doctor who wanted to send me to a psychiatrist because he felt my pain was imagined,” he said.

The Skeptic 

Count me as one of the skeptics. Not necessarily whether fibromyalgia exists, just that the vast majority of sufferers actually have it. I won’t use the word hypochondria, because I think that is inadequate. I think that many of these people suffer from a somatiform or somatization disorder. Still a disorder in need of treatment, but not fibromyalgia.

Understand, I think that this has definitely had a “wolf-crying” effect on people who do have it, and also on people who suffer, quite beyond their control, from untreated somatiform disorders. This results, not from the inability of medical science to test and confirm the diagnoses of fibromyalgia beyond cataloging the symptom complaints of sufferers, but from the fact that so many people who report these symptoms also complan of other vague maladies and bring to doctors their own self-diagnoses that the doctors have little choice but to attempt to treat them as they are reported.

This is how I put it to the last such person I spoke to: “What are the odds, mathematically, that one person should suffer from so many obscure and medically unconfirmable maladies? Maladies that have symptoms that can only be accepted or rejected based on your word that they exist?” The simple mathematical improbability that one person suffer from Meniere’s Disease, Epstein-Barr Syndrome, and Fibromyalgia, all three vague disorders that seem to show up in varied combinations among middle aged women, commonly with a history of childhood abuse, begs the question: Why are doctors being guilt-tripped into rejecting the possibility that these patients don’t suffer from what they think they suffer from, but indeed do suffer from something? Is the mere social stigma of psychological and emotional disorders enough that we should reject the possibility? I say no.

— Dr Hirschberg

Dr. Hirscberg validates that there are stupid doctors in this world and you should avoid them like the plague. If you have a skeptic for a doctor, if he or she isn't listening to you FIRE THEM and get another doctor! 

Should You Take a Daily Aspirin?

What About Aspirin?

The logic behind using aspirin is based on the idea that it inhibits the formation of blood clots. It does this by preventing the production of cyclooxygenase, an enzyme responsible for making prostaglandins. Prostaglandins are hormones that perform various bodily functions. Some prostaglandins cause platelets to become stickier and adhere to one another while attaching to arterial walls. However, other prostaglandins help prevent the platelets from attaching to one another. Thus, aspirin prevents the body’s own natural self-regulating mechanisms.

This is similar to what happens when taking non-steroidal, anti-inflammatory drugs (NSAIDS). By the way, aspirin is the original NSAID. It reduces inflammation by blocking prostaglandins 1, 2, and 3. The problem with this is that prostaglandins 1 and 3 are the body’s own natural anti-inflammatory hormones. Blocking prostaglandins 1 and 3 prevents the body from releasing its own natural pain blocking chemicals.

Vioxx and Other NSAIDS Pulled from Market

Merck pulled the drug Vioxx off the market because a long-term clinical trial showed that some patients, after taking the drug for 18 months, developed serious heart problems. The data that ultimately persuaded the company to withdraw the drug indicated 15 cases of heart attack, stroke, or blood clots per thousand people each year over three years, compared with 7.5 such events per thousand patients taking a placebo.

Internal memos show disagreement within the FDA over a study by one of its own scientists, Dr. David Graham, who estimated Vioxx had been associated with more than 27,000 heart attacks or deaths linked to cardiac problems.

Studies have shown Vioxx users had twice the number of heart attacks as those taking Naproxen. These new drugs, which block COX-2 enzymes, may promote excessive blood clot formation. It appears that COX-2 enzymes counteract some of the effects of COX-1 enzymes, which narrow the blood vessels. This narrowing then causes blood to be more likely to clot.

A person taking NSAIDS, including aspirin, is seven times more likely to be hospitalized for gastrointestinal adverse affects. The FDA estimates that 200,000 cases of gastric bleeding occur annually, and that this leads to 10,000 to 20,000 deaths each year.

NSAIDs can cause high blood pressure. In one study, 41% of those who had recently started on medication to lower their blood pressure were also taking NSAIDs. NSAIDs more than double a person’s risk of developing high blood pressure.

Why isn’t my doctor telling me these things?

Good question. Most doctors and the public at large has been brainwashed into believing that these drugs pose little harm. As you’re now finding out nothing could be further from the truth.

You won’t find this behind the scenes, undercover reporting in the typical brochures on high blood pressure.

These pamphlets are by the way written by the drug companies, who of course don’t won’t you know just how dangerous their drugs are.

There have been several studies which have looked at the role aspirin may play in reducing heart attacks. But one in particular, The Aspirin Component of the Ongoing Physicians’ Health Study, is cited by physician groups, the media, and of course the drug companies who make aspirin.

This study involved 22,071 male physicians. Half of the study participants took Bufferin and half took a placebo. The study shows that over a 4.8-year period, there were 44 deaths in the Bufferin group and 44 deaths in the placebo group.

The Bufferin group did have fewer heart attacks (139 compared to 239) than the placebo group. Looking at the numbers above, we would conclude that taking Bufferin prevented 100 heart attacks. However, if we look at these numbers a little closer, you may not want to take a daily aspirin.

If we take the 11,037 who took Bufferin and divide by 100 (the number who benefited from taking Bufferin) we see that .906% of those taking Bufferin benefited. This is of course less than one percent, a number not worth the fanfare it has received.

The researchers reported that those taking Bufferin had between a 44 and 47% reduction in heart attack risk. How did they get this number? They took the 100 people who presumably didn’t experience a heart attack because of taking Bufferin and divided it by the 239 who didn’t take Bufferin and had a heart attack. This turns out to be 44%.

Researchers can do wonders with statistical analysis!

An interesting finding that somehow wasn’t revealed by this now famous study was that those taking Bufferin had a higher incidence of stroke (119), than those in the placebo group (98). Conventional doctors advocate the use of aspirin for the prevention of stroke. If we were to use the same statistical parameters by the authors of this study, we’d see that those taking Bufferin had a 21.4% increase in strokes!

Other studies that have evaluated the effectiveness of aspirin to prevent cardiovascular deaths have shown no benefit at all.  A 1975 study involving one million American men and women showed there was no benefit in taking aspirin.

The National Heart, Lung, and Blood Institute evaluated the effects of taking aspirin in a group of 4,524 participants. Half took aspirin and half took a placebo. The group who took aspirin had a 14.1% increase in heart attacks, while those taking a placebo had a 14.8% increase.

In 2003, a study linking low dose aspirin use among elderly patients caused decreased kidney function.

An Aspirin a day may not be in  your best interest after all. 

Fish Oils Help Prevent and Reverse Depression

Fish Oils Help Prevent and Reverse Depression

Omega-3 fatty acids may help alleviate depression but only when a particular type of fatty acid called DHA is used in the right ratio with another fatty acid known as EPA, a new study suggests.

The researchers analyzed the results of some 15 previous controlled clinical trials on the use of omega-3s -- commonly found in oily fish or in fish oil supplements -- to treat depressed people.

They found that when used by itself, DHA (docosahexaenoic acid) alone did not seem to offer any benefit. However, DHA combined with a rather high dose of EPA (eicosapentenoic acid) did improve depressive symptoms.


I recommend taking 2 grams of fish oil a day. If you experience an unpleasant aftertaste try freezing the fish oil capsules and the be sure to take with food.

Traditional Medicine Offers Little for Fibromyalgia

With so many different symptoms, it’s no surprise that fibromyalgia and CFS patients are typically taking 6–12 different prescription drugs. Lyrica, Elavil, Klonopin, Paxil, Effexor, Xanax, Trazadone, Neurontin, Zanaflex, Ambien, Lunesta, Cymbalta,  and Provigil have all been heralded as “the drug” for fibromyalgia. 

Some of these are helpful, some worthless, and some really dangerous.

Drug management alone typically fails to yield lasting relief from the most common fibromyalgia and CFS symptoms, and patients’ and doctors’ optimism over a new drug treatment eventually gives way to this sad reality. Oh well, a new drug with an even larger marketing budget is on the horizon. (Forgive my cynicism. I’ve just seen this situation so many times!)

Many of the most commonly prescribed drugs for fibromyalgia have side effects that are similar or identical to the symptoms of FMS and CFS. These similarities can cause a lot of confusion when doctors are trying to determine the effectiveness of treatment. Ambien, for instance, can cause flu-like symptoms, achy muscle pain, sore throat, and fatigue. Sounds like CFS, doesn’t it?

Tranquilizers are often prescribed for restless leg syndrome; achy, tight muscles; and sleep problems. But these drugs deplete the sleep hormone melatonin, which then leads to a disruption of a person’s circadian rhythm (sleep-wake cycle). Instead of promoting deep restorative sleep, these drugs prevent it!

It’s important to realize that your drug or drugs may be causing or contributing to some or all of your symptoms. 

I spend a great deal of time with my new patients reviewing and discussing their current drugs—how they interact with each other, and the potential side effects. I often find that by asking the right question, I can help the patient realize that her symptoms began or worsened soon after the drug treatment began.

Sometimes, though, I do find drug-induced symptoms that began months after the start of the drug treatment. Drugs deplete essential nutrients that the body needs to properly function, but it can take weeks, months, or even years for the drug to fully deplete the nutrient and for you to see the side effects surface.

Still, not everyone can be drug free, and most of my patients are on at least one prescription medication. But the least offensive drug should be used—sparingly—and only to manage symptoms unresponsive to more natural therapies.

A study conducted by the Mayo Foundation for Medical Education and Research demonstrates the need the limitations of traditional medicine alone for treating fibromyalgia.

Thirty-nine patients with FMS were interviewed about their symptoms. Twenty-nine were interviewed again 10 years later. Of these 29 (mean age 55 at second interview), all had persistence of the same FMS symptoms. 

Moderate to severe pain or stiffness was reported in 55% of patients, moderate to a great deal of sleep difficulty was noted in 48%, and moderate to extreme fatigue was noted in 59%. These symptoms showed little change from earlier surveys. 

The surprising finding was that 79% of the patients were still taking medications to control symptoms. 

We can conclude that the medications weren’t making a significant impact.

Conventional medical treatments for FMS and CFS is a controversial topic, and I certainly have no desire to offend the many brilliant medical doctors out there. 

Still, in my experience, most traditional doctors continue to rely on prescription medications to treat fibromyalgia, even though their own studies show them to be ineffective and potentially dangerous. 

They still just don’t get it. Those with fibromyalgia and CFS are sick and they want to feel well, not drugged.

Just try to find a doctor who really knows anything about these illnesses. Most don’t. It’s even harder to find one who is having any lasting success treating these illnesses. How many folks with fibromyalgia get well under the care of a traditional rheumatologist? 

I rest my case.

I speak to fibromyalgia support groups across North America, and I can tell you what the answer is: very few. The three-month wait for a new patient appointment typically ends in a two-hour interview and exam followed by a 10 minute visit to discuss test results, and then several prescription drugs and a follow-up appointment every 3–6 months.

And let’s face it, those with fibromyalgia are medical misfits, they don’t usually respond to medications like other folks. The ACR has, like many physicians, thrown up their hands and admitted they have little if anything to offer for those suffering from fibromyalgia. They focus more on helping their patients “cope.” At least they’re honest about their limitations.

Treating and Beating Fibromyalgia

Note this is an abbreviated version of my feature article that appeared in the November issue of the medical journal "Townsend Letter for Doctors and Patients."

Fibromyalgia syndrome (FMS) is an illness characterized by diffuse muscle pain, poor sleep, and unrelenting fatigue.

Individuals with fibromyalgia may also experience headaches, anxiety, depression, poor memory, numbness and tingling in the extremities, cold hands and feet, irritable bowel syndrome, lowered immune function, and chemical sensitivities. Over 10 million Americans suffer with fibromyalgia; ninety percent of them are women between 25 and 45 years old. 1

Fibromyalgia is now thought to arise from a miscommunication between the nerve impulses of the central nervous system. The neurons, which supply the brain, become more excitable, exaggerating the pain sensation. This over-amplication of pain is referred to as "central sensitization". 19

Fibromyalgia patients have a reduction in their pain threshold (allodynia), an increased response to painful stimuli (hyperalgesia) and an increase in the duration of pain after nociceptor stimulation (persistent pain).

Individuals with fibromyalgia syndrome have low levels of serotonin, a 4-fold increase in nerve growth factor, and elevated levels of substance P.20 Nerve growth factor (NGF) is a member of a family of peptides known as the neurotrophins. The exposure of nociceptive sensory neurons to NGF leads to up-regulation of substance P in sensory neurons. 21

Substance P, the neuropeptide in spinal fluid, is a neurotransmitter that is released when axons are stimulated. Increased levels of substance P increase the sensitivity of nerves to pain or heighten awareness of pain. Although it’s not fully understood, fibromyalgia patients have an imbalance of the hypothalamus-pituitary-adrenal  (HPA) axis. This imbalance creates hormonal inconsistencies, which disrupt the body’s ability to maintain homeostasis.

Many of the most common fibromyalgia symptoms including widespread muscle pain, fatigue, poor sleep, gastrointestinal problems, and depression regularly occur in people with various neuroendocrine disorders, including those manifested by HPA dysfunction. 22

Researchers believe suppression of the HPA (quite likely from chronic stress), which results in lowering human growth hormone (HGH), dehydroepiandrosterone (DHEA), cortisol, and other hormones, is aggravated by the chronic pain and poor sleep associated with fibromyalgia. 23, 24

Hypothalamus-Pituitary-Adrenal Axis (HPA) Dysfunction 

The main function of the hypothalamus is homeostasis, or maintaining the body's status quo.

The hypothalamus receives and transmits messages from the nervous system and hormonally through the circulatory system. Because of its broad sphere of influence, the hypothalamus could be considered the body’s master computer. The hypothalamus receives continuous input about the state of the body, and must be able to initiate compensatory changes if anything drifts out of line.

The Hypothalamus regulates such bodily functions as:

1. Blood pressure- is often low in those with fibromyalgia.

2. Digestion- bloating, gas, indigestion, and reflux are common in FMS patients.

4. Circadian rhythms (sleep/wake cycle)- which is consistently disrupted in FMS.

6. Sex drive- loss of libido is a common complaint for FMS patients.

7. Body temperature-   is often low in FMS patients.

8. Balance and coordination- FMS patients have balance and coordination problems.

9. Heart rate- mitral valve prolapse (MVP) and heart arrhythmias are a common finding in FMS patients.

10. Sweating- it’s not unusual for FMS patients to experience excessive sweating.

11. Adrenal hormones- are consistently low in FMS patients.

12. Thyroid hormones and metabolism-hypothyroid is a common finding in FMS patients.

Recent studies show that over 43% of FMS patients have low thyroid function. It's estimated that those with FMS are 10 to 250,000 times more likely to suffer from thyroid dysfunction.25

Stress and Fibromyalgia

A survey by The Fibromyalgia Network reports that 62% of their respondents list physical or emotional stress as the initiating factor in their acquiring fibromyalgia. 32

I believe chronic stress is the underlying catalyst for the onset of HPA dysfunction and fibromyalgia. Several studies have demonstrated how chronic stress undermines the normal hypothalamic-pituitary-adrenal axis (HPA) function.33

When explaining the role of stress in fibromyalgia, I find the following analogy helps put stress and fibromyalgia into perspective.

“We are all born with a stress coping savings account. This account is filled with numerous chemicals we use to help us deal with daily stress-serotonin, norepinephrine, cortisol, magnesium, and other important hormones and nutrients. The more stress we encounter, the more stress coping chemicals we use. We replenish our stress coping savings account with adequate rest. Consistent deep restorative sleep ensures we are making more deposits than withdrawals from our stress coping account.

Since fibromyalgia patients struggle with getting a consistent good nights sleep they eventually bankrupt their stress coping account.

The Importance of a Good Night’s Sleep

Studies have shown that individuals who were prevented from going into deep sleep for a period of a week develop the same symptoms associated with FMS and CFS; diffuse pain, fatigue, depression, anxiety, irritability, stomach disturbances, and headaches. 34,35.

Sleep deprivation markedly increases inflammatory cytokines (pain causing chemicals)—by a whopping 40%. 36

Serotonin

Serotonin helps regulate sleep, digestion, pain, mood, and mental clarity.37

Serotonin helps:

1. Raise the pain threshold (have less pain), by blocking substance P.

2. You fall asleep and stay asleep through the night.

3. Regulate moods. “The happy hormone” reduces anxiety and reduces depression.

4. Reduce sugar cravings and over-eating.

5. Increase a person’s mental abilities.

6. Regulate normal gut motility (transportation of food-stuff) and reverse irritable bowel syndrome (IBS).

Surveys have shown that as many as 73% of FMS patients have irritable bowel syndrome.

You have more serotonin receptors in your intestinal tract than you do in your brain.

Emotionally stressful situations cause the body to release adrenaline, cortisol and insulin. These stress hormones stimulate the brain to secrete serotonin. Long term stress and poor dietary habits can deplete the body’s serotonin stores.38

Tryptophan, 5 Hydroxytryptophan  (5HTP) and Serotonin

Individuals with fibromyalgia have low levels of tryptophan38, serotonin39, and

5-HTP.40 Studies show that fibromyalgia patients have higher levels of metabolites in the kynurenine pathway, which diverts tryptophan away from serotonin production.41

Tryptophan is one of eight essential amino acids. Tryptophan is absorbed from the gut into the bloodstream and then dispersed throughout the body. Ninety percent of tryptophan is used for protein synthesis, one percent is converted to serotonin, and the balance is used to make niacin. In the formation of serotonin, tryptophan is hydroxylated to 5-hydroxy-tryptophan (5-HTP) by tryptophan hydroxylase.

5-HTP is converted to serotonin by the decarboxylase enzyme, which is vitamin B6 dependent.

Selective Serotonin Reuptake Inhibitor (SSRI) Medications

Prescription antidepressants can be helpful. However, antidepressant drugs have potential side effects including anxiety, depression, fatigue, decreased sex drive, and disruption of normal circadian rhythms.42

SSRI’s are supposed to help a patient hang onto and use their naturally occurring stores of the brain chemical serotonin. It’s like using a gasoline additive to help increase the efficiency of your cars fuel.

Most of the patients I see with fibromyalgia are running on fumes and a gasoline additive won’t help. 

Please keep in mind that several studies show that between 19-70% of those taking antidepressant medications do just as well by taking a placebo or sugar pill.43

I recommend my patients boost their serotonin levels by taking 5HTP.

5HTP and Depression

Studies (including double-blind) comparing SSRI and tricyclic antidepressants to 5HTP have consistently shown that 5HTP is as good if not better than prescription medications in treating mood disorders. Furthermore, 5HTP doesn’t have some of the more troubling side effects associated with prescription medications. 44, 45

5HTP and Sleep

5HTP has been shown to be beneficial in treating insomnia, especially in improving sleep quality by increasing REM sleep and increases the body’s production of melatonin by 200%. 46,47

5HTP and Fibromyalgia

Double-blind placebo-controlled trials have shown that patients with FMS were able to see the following benefits from taking 5HTP: 48.

• decreased pain.

• improved sleep.

• less tender points.

• less morning stiffness.

• less anxiety.

• improved moods in general, including in those with clinical depression. 49

• increased energy.

Irritable Bowel Syndrome, 5HTP and Serotonin

There are more serotonin receptors in the intestinal tract than there are in the brain. This is one reason people get butterflies in their stomach when they get nervous.50

Serotonin controls how fast or how slow food moves through the intestinal tract.51, 52

It’s common for the symptoms associated with IBS, diarrhea and constipation, to disappear within 1–2 weeks once serotonin levels are normalized with 5HTP replacement therapy.

My 5HTP and Sleep Restoration Protocol

I instruct my patients to take 50mg of 5HTP 30 minutes before bed on an empty stomach (90 minutes after or 30 minutes before eating), with 4 ounces of grape juice. I know 5HTP doesn’t have to compete with other amino acids to cross the blood brain barrier, but this routine seems to heighten the effect of 5HTP.

One of three things will happen when taking 5HTP.

1. The patient falls asleep within 30 minutes and sleeps through the night. If so, they stay on this dose until their next scheduled visit with me (typically 2 weeks).

2. Nothing happens. This is typical response to such a low dose. The patient should add an additional

50 mg. each night (up to a max of 300 mg.) until they fall asleep within 30 minutes and sleep through the night.

3. Instead of making the patient sleepy, the first dose makes them more alert. This occurs more often in CFS and chemical sensitivity patients who have a sluggish liver. If this happens, they’re to discontinue taking 5HTP at bedtime and instead take 50 mg. with food for 1–2 days. Taking 5HTP with food seems to help slow down it’s absorption, allowing the liver to process it more effectively. Taking 5HTP with food will not (usually) make a person sleepy. After 1-2 days on 5HTP with no further problems, they should increase to 100 mg. of 5HTP with each meal (300mg a day).

Can patients take 5HTP along with antidepressant medications?

Yes, patients can take 5HTP with antidepressant medications. I’ve treated thousands of patients with amino acid replacement therapy, 95% of which were already taking antidepressants when they come to see me. I’ve never had a patient report a problem with combing 5HTP with prescription drugs. It can happen, but I believe it to be rare.

Can patients take 5HTP with sleep medications?

Yes. I don’t recommend patients discontinue taking their sleep medications. Instead I suggest they start using 5HTP and increase the bedtime dose until they sleep through the night. At some point they should be able to work with their doctor and slowly wean off the prescription sleep medication. Remember all prescription sleep medications have side effects. No one has an Ambien deficiency, however, fibromyalgia patients certainly have 5HTP and serotonin deficiencies, which need to be corrected.

What if my patient is taking a prescription sleep medication and sleeping through the night?

Prescription drugs that promote deep restorative sleep include Ambien, Elavil, Trazadone, Flexeril, and Lunesta. These medications can be helpful. However, these medications have potential side effects that may cause the very symptoms associated with fibromyalgia. Ambien may cause short-term memory loss, fatigue, depression, and flu-like aches and pains.

Other common sleep inducing drugs, including benzodiazepines (Klonopin, Ativan, etc.), muscle relaxants (Zanaflex), Neurontin, and Lyrica don't promote deep delta wave sleep and therefore are not recommended. Remember the reason they’re taking these prescription drugs is because they have a serotonin (and perhaps a melatonin) deficiency, not a drug deficiency. You want them to build up their serotonin levels so that eventually they may not need prescription sleep medications. You should have them add 5HTP (50 mg.) three times daily with food. If no problems arise after 2–3 days, they should then increase to 100 mg. with each meal.

What if someone has a serotonin syndrome reaction?

A serotonin syndrome may occur if a person gets too much serotonin. This can cause rapid heartbeat, increased pulse rate, elevated blood pressure, agitation, and in its worst-case scenario, life threatening irregular heartbeats (arrhythmia).

I’ve recommended 5HTP to thousands of individuals over the last 7 years, rarely have I encountered a problem. I always start with a low dose (50 mg.) and warn the patient to stop taking it at bedtime if she has a funny reaction.

What are some of the other potential side effects of 5HTP?

Other than some patients becoming more alert when taking 5HTP at bedtime, I have had very few complaints from patients. The literature reports that individuals may have transient headaches and nausea from taking 5HTP. I have had less than half a dozen patients have one of these side effects. The headaches and any nausea usually go away after a couple of days.

What do you do when your patient still can’t fall asleep and sleep through the night even when taking 300mg of 5HTP?

If after two weeks, someone is not falling asleep and staying asleep through the night, I add melatonin. First, I make sure she is taking 5HTP as she should be and at the maximum dose of 300mg.

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55. Dollins AB, Zhadanova IV, Wurtman RJ, Lynch HJ, Deng MH. Effect of inducing nocturnal serum melatonin concentrations in daytime on sleep, mood, body temperature, and performance. Proc Natl Acad Sci USA 1994;91: 1824–28.

56. Functional Assessment Resource Manual from Great Smokies Laboratory, 1999.

57. ibid.

58. ibid.

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