Fibromyalgia: The Elusive Hypometabolic Disease

This controversial condition was first recognized by the American Medical Association as recently as 1987. It is defined by the presence of disperse body pain and tenderness with often debilitating fatigue and depression. It is currently a condition that is ineffectively treated and at times even ignored. Despite being present in approximately 2% of the general population, many patients still find proper diagnosis and treatment elusive.

The diffuse pain of fibromyalgia is identified as a series of painful points on the body called trigger points. A doctor, such as a rheumatologist, makes the diagnosis of fibromyalgia based on the presence of 11 of 18 specific trigger points that elicit pain when pressed. The diagnosis also includes six months or more of persistent related signs and symptoms. Another significant complaint is extreme fatigue. Fibromyalgia is often found in conjunction with a diagnosis of “chronic fatigue.” Fibromyalgia may also result in sleep disturbance, weight gain, skin complaints, and irritable bowel syndrome, to name a few. Cognitive dysfunction is evident by anxiety, depression, and a common “brain fog” referred to as “fibro fog.” Symptoms are extremely varied in intensity but often render the patient handicapped by interfering with normal daily activities. Doctors often have difficulty in agreeing on a diagnosis for fibromyalgia due to a lack of significant supportive laboratory evidence. Due to fibromyalgia’s nonspecific presentation, it is often considered a diagnosis of exclusion or a diagnosis made when no other disease pathology is found.

Fibromyalgia’s wide spread effects and most doctor’s inability to properly assess related laboratory evidence, makes it necessary to identify the underlying cause to effectively treat this complicated disease. At the core of fibromyalgia lies either undiagnosed or poorly treated hypothyroidism or “resistance” to what thyroid hormone is present in the body. “Thyroid hormone resistance’ means the body cells cannot use the thyroid hormone effectively even though adequate thyroid hormone levels are present. It is similar to Type II Diabetes, or “Insulin resistance”, where insulin is present in adequate amounts but is unable to do its job effectively, resulting in elevated sugar levels. Clinical evaluation includes assessing the patient’s symptoms and the symptoms of fibromyalgia almost perfectly match the clinical presentation of hypothyroidism. When a doctor knows how to properly assess the patient’s metabolic and endocrine functioning, which is almost invariably low in patients with fibromyalgia, a diagnosis and course of effective treatment become possible.

Hypometabolism can only be determined through analysis of blood thyroid hormone levels (beyond what is often done conventionally), measuring basal metabolic rates, assessing nutritional status, and by thorough clinical examinations of medical history, and symptoms and signs. This type of thorough examination is often by-passed by physicians because they inappropriately rely on a simple blood test that measures the TSH (Thyroid Stimulating Hormone) level. It is this mainstream practice of relying on a TSH reading alone to evaluate thyroid function that has resulted in many patients inaccurately being dismissed by their physician as having “normal” thyroid function, whether they are diagnosed as hypothyroid with concomitant treatment or not.

When undergoing proper metabolic evaluation and treatment, the patient must use a holistic metabolism-raising approach that includes thyroid hormone replacement, diet modifications and nutritional support, exercise, mental and emotional support, soft tissue manipulative medicine, and when medically appropriate, avoidance of metabolism lowering medications such as pain medications and antidepressants. It is through appropriate hormonal support coupled with a holistic, comprehensive approach, that the patient achieves full body recovery.

Many fibromyalgia patients are already being treated for hypothyroidism with thyroid hormone medication in the form of inactive T4, most commonly Synthroid® or synthetic levothyroxine. If a patient finds that they are already being treated for hypothyroidism, they should not be satisfied with the use of a thyroid product containing only T4. Most hypothyroid or fibromyalgia patients will not recover if their thyroid hormone treatment includes the use of a T4-only product. Most patients find greater success on a product containing the active form of thyroid hormone called T3. A common thyroid hormone medication that has decades of successful treatment is natural desiccated thyroid such as Armour® thyroid or Naturethroid®. At times, plain synthetic T3 is necessary for fibromyalgia patients to achieve full recovery.

Fibromyalgia, although presently considered an incurable condition, has the potential to be effectively controlled. Focusing treatment on the underlying cause of the hypometabolism, rather than attempting to dissect the condition into seemingly unrelated symptoms with ineffective drug therapy, will help ensure successful and permanent results. Patients and physicians must understand that fibromyalgia is ultimately a hypometabolic condition dependant on diminished thyroid hormone levels or a resistance to the hormone that is present. Fibromyalgia patients must remain hopeful and understand that the condition can be treated effectively if the hypometabolic state is properly addressed.

For more information contact Dr. Bosch by email at drbosch@iluminartherapy.com