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  Wednesday, February 5, 2003


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Community Newsletter #37
Wednesday, February 5, 2003
1994 subscribers and 11 new subscribers. Welcome!
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Featured link: Article on Successful Adaptation to CFIDS/FMS

This week's article at the CFIDS/Fibromyalgia Self-Help program
(http://www.cfidsselfhelp.org) is "The Power of P.R.I.D.E." CFIDS/FM patient
Lynn Humphreys stabilized her life and increased her self-esteem when she
started living with P.R.I.D.E., an acronym she created to remind herself
about pacing, rest, information, delegating and enjoyment. Her article is
the latest in our series "Success Stories," personal accounts of successful
coping and recovery.

Other series include:

What Works for Managing CFIDS and Fibromyalgia: Students in our program
share what they have found useful in living with CFIDS and fibromyalgia.

Ten Keys to Coping and Recovery: Strategies for managing chronic illness and
improving chances for recovery

Check it out: http://www.cfidsselfhelp.org
AOL users: <a href="http://www.cfidsselfhelp.org">Read it here</a>
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This week's news:
1) ACR: Lower-Back and Fibromyalgia Pain Linked, Possible Source Identified
2) Are antidepressants effective in fibromyalgia?
3) Paul Cheney, M.D., on Balancing the Immune System in Chronic Fatigue
Syndrome
4) Dr. Anthony Komaroff's Recommendations for Chronic Fatigue Syndrome Care
5) Drug-Free Relief From Chronic Pain
6) Ending Bacterial Overgrowth Results in Better Motility in Some Irritable
Bowel Patients
7) Exercise: The Double-Edged Sword
8) Heartburn Headaches
9) Treating and Living with Fibromyalgia, Chronic Fatigue Syndrome and
Myofascial Pain Syndrome - A One Day Conference for Both Patients and Health
Care Professionals
10) Straight Talk About Herbal Supplements
11) Strapped US Health Care System Fails to Address Actual Health Needs

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1) ACR: Lower-Back and Fibromyalgia Pain Linked, Possible Source Identified

http://www.docguide.com/news/content.nsf/NewsPrint/8525697700573E1885256C600
0779702
AOL users: <a
href="http://www.docguide.com/news/content.nsf/NewsPrint/8525697700573E18852
56C6000779702">Read it here</a>

By Bruce Sylvester NEW ORLEANS, LA -- October 28, 2002 -- Lower back pain
appears to be caused by a malfunctioning pain pathways in the brain, in a
manner similar to fibromyalgia pain, University of Michigan researchers
report. "These patients get bad reputation for claiming to feel pain in
places where no physiological cause can be identified. It looks like the
pain has a physiological source indeed, but in problems in the brain," said
investigator Richard Gracely, Ph.D, professor of rheumatology at the
University of Michigan School of Medicine in Ann Arbor told United Press
International. The research was presented yesterday at the annual meeting of
the American College of Rheumatology in New Orleans. The investigators
enrolled 15 subjects experiencing chronic lower-back pain with no apparent
physical cause, such as muscle, joint or bone injury. They also recruited 15
fibromyalgia patients and 15 normal control subjects. All subjects underwent
functional magnetic resonance image (fMRI) scanning simultaneous with having
a device apply pulsing pressure to the base of their left thumbnail. The
variable pressure included painful and non-painful levels. The researchers
noted that mild pressure caused subjects with lower-back pain and
fibromyalgia to report significant pain, while control subjects tolerated
the same pressure with little pain. Among the back pain and the fibromyalgia
patients, the same mild pressure caused brain responses in areas that
process the sensation of pain. The same brain responses did not happen in
control subjects until pressure was raised substantially. All subjects
showed increased activity in eight areas of the brain, but lower-back pain
subjects showed no increased activity in two areas that were active in both
fibromyalgia subjects and normal control subjects. The fibromyalgia subjects
showed increased activation in two other areas not active in back pain
patients and healthy subjects. The study indicated that lower-back pain
patients have enhanced pain response in some brain regions, and diminished
response in others, the investigators reported. The study offers the first
objective method for correlating lower-back pain to unique brain activities
at the precise moment of adverse feeling. The research might eventually lead
to better treatments for lower back pain and fibromyalgia, by pointing
toward certain brain regions where pain-inducing disorders might be located,
Dr. Gracely noted. "So the bottom line is that fibromyalgia pain and
lower-back pain are really 'real,'" said Nancy Derby, spokesperson and
director of public policy and education for the National Fibromyalgia
Association in Orange, CA. "This pain is a moving target, it seems, and
perhaps now we see a bit better where it comes starts." Lower back pain is
common, especially among overweight and sedentary people and those whose
work is physically demanding. Lower back pain and problems stemming from it
rank as the second most frequent cause of lost work days in adults under the
age of 45, second only to the common cold. The study was supported in part
by the National Fibromyalgia Research Association, the U.S. Army and the
National Institutes of Health.

Copyright 2003 P\S\L Consulting Group Inc.

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2) Are antidepressants effective in fibromyalgia?

Joint Bone Spine 2002 Dec;69(6):531-3

Thomas E, Blotman F.

PMID: 12537258

Amitriptyline and other imipramine antidepressants are the cornerstone of
drug therapy in fibromyalgia. However, some patients fail to respond to
antidepressant therapy, and in responders the beneficial effects wear off
after some time. The effect on fibromyalgia seems independent from the
effects on depression.

Publication Types: Editorial

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3) Paul Cheney, M.D., on Balancing the Immune System in Chronic Fatigue
Syndrome (and Fibromyalgia Syndrome) by Carol Sieverling ImmuneSupport.com

By Carol Sieverling

This article is based on CFIDS patient Carol Sieverling's October 2000 vi
sit with Paul Cheney, M.D. Dr. Cheney gave her permission to share this
information, but has not reviewed or edited it. This article applies also to
fibromyalgia patients who experience cognitive difficulties in addition t o
pain and fatigue, since Dr. Cheney believes they may also have CFIDS.

Author's Note: CFIDS patients are Th2 activated. This means they
over-respond to toxins, allergens, normal bacteria and parasites, and
under-respond to viruses, yeast, cancer and intracellular bacteria. Dr.
Cheney suggests six products that can help rebalance the immune system.

Dr. Cheney explained that the immune system has two different modes of
attack, based on the type of invader. One is Th1 (T Helper 1). It goes after
organisms that get inside our cells' [which are] intracellular pathogens. It
is also known as cell-mediated immunity. The other is Th2 (T Helper 2). I t
attacks extracellular pathogens' organisms that are found outside the cells
in blood and other body fluids. Some call this humoral or antibody-mediated
immunity. A healthy immune system is dynamic, able to switch back and forth
as needed, quickly eradicating one threat and then resting before responding
to the next. (Dr. Cheney began this conversation by drawing a large inverted
"V". At the top point he wrote "Th0", which he called "Th naught".

The left arrow pointed down to "Th1" and the right arrow to "Th2". The arrow
on the right was much darker and thicker, indicating that CFIDS patients
are Th2 activated.)

Th0 are the naive, or unformed, cells of the immune system. They are
resting, just waiting for an invader. When infection occurs, they convert to
either Th1 or Th2, depending on the type of threat. When the resting cell is
exposed to a virus, cancer, yeast, or intracellular bacteria (like
mycoplasma or chlamydia pneumonia), the Th1 response is initiated. (Dr.
Cheney wrote these organisms beside the left arrow.) The weapons of the T h1
system include cytotoxic T cells and Natural Killer (NK) cells. (Cheney drew
these below "Th1".)

On the other side are normal bacteria, parasites, toxins, and allergens.
(Likewise written beside the right arrow.) These trigger a predominately
Th2 response. Its weapons include eosinophiles (Eos), polymononuclear cells
(PMN), and antibody secreting cells (Ab). (Likewise written below "Th2".)

How does the naive cell know which pathway to take? It depends on the
cytokine information received. The presence of any organism from the left
side triggers production of a cytokine called Interleukin 12 (IL-12). IL-
12 causes the Th0 cell to move down the Th1 path. On the other hand,
organisms on the right side trigger the production of Interleukin 10
(IL-10), which causes the Th0 cell to move down the Th2 path. (Cheney added
small vertical dotted lines on each side, pointing upward to "IL-12" on the
left and "IL-10" on the right. He then drew horizontal dotted arrows from
"IL-12" and "IL-10", each pointing inward toward the "Th0", indicating that
these cytokines determine whether it will become Th1 or Th2.)

Cheney said this is the point where it gets very interesting. Viruses,
especially herpes viruses like EBV, CMV and HHV6, make proteins that mimic
IL-10. The virus deceives the immune system into thinking that the threat is
coming from the opposite side! So the immune system shifts from the Th1 m
ode that attacks viruses to the Th2 mode that does not. The virus increases
its chances of survival by diverting the immune system. It is now thought
that many, if not most, pathogens have this ability. (To represent this
effect , Cheney drew a horizontal arrow about half way down the inverted
"V", originating from the left side and pointing toward, but not quite
touching, the right side. The line was labeled "IL-10 like peptides". Below
it he drew a similar arrow from the right side that almost reached the left
side. It was labeled "IL-12 like peptides".)

Researchers have demonstrated that most CFIDS patients end up stuck in Th 2
mode. This has several consequences. When the Th2 system activates, it
blocks the Th1 system. This suppresses the Th1 weapons, particularly NK
function. Accordingly, there is also an increase in the Th2 weapons - the
white cells and antibodies. Most notable is increased antibody production.
Dr. Cheney said that if you measure antibodies to anything a CFIDS patient
has ever been exposed to, they will very likely be elevated. (At this point
he drew small arrows beside the "weapons": They pointed down on the left
side to indicate suppression / lower levels; and they pointed up on the
right side to indicate activation / higher levels.)

Cheney notes that other problems ensue. Patients get into trouble on both
sides: they overreact to things on the right side and under-react to those
on the left. When they are Th2 activated, they no longer have the defense
mechanisms to keep dormant all the things they caught in the past. They
cannot suppress or control them anymore, and the EBV, Chlamydia pneumonia ,
CMV, etc., reactivate. Yeast also begins to appear.

The only defense against being "eaten alive" at this point is RNase L. (F or
more information about RNase L, see The Three Phases of CFIDS and other
articles in the Cheney section of our website
http://virtualhometown.com/dfwcfids/menu.html) AOL users: <a
href="http://virtualhometown.com/dfwcfids/menu.html">Read it here</a> RNase
L cannot kill any of these things. It only stops them from reproducing.
According to Cheney, "It's a line in the sand saying 'no more replication,'
and it waits for Th1 to come and kill them. But Th1 never comes. RNase L
sits there and grinds away, possibly going up and down as the pathogens
activate and reactivate.
But they never get wiped out. RNase L holds the line, waiting for the
cavalry that never arrives."

While it is valiantly trying to hold the line, it is also chewing up human
messenger RNA, inhibiting all the enzymes in the body, disrupting protein
synthesis, and generally making patients miserable. As RNase L grinds away,
it eventually shifts into "after-burner" desperation mode - the more
powerful and deadly low molecular weight form discovered in CFIDS patient s
by Suhadolnik.

Cheney commented "RNase L is a very good anti-cancer defense. So as long as
you're involved in this scenario, you don't get cancer. But a lack of growth
hormone will wipe out RNase L, and we now know there is profound loss of
growth hormone in CFIDS. Growth hormone is responsible for protein
synthesis, and RNase L is a protein. So if you lose growth hormone, you lose
protein synthesis, including RNase L. That may explain why, as the disease
wears on and you acquire more injury, you stop seeing high levels of RNase
L. You can't make it anymore."

He believes this is a very scary situation. Patients are Th2 activated an d
Th1 suppressed. The things on the left come out and there is nothing to s
top them. There is no Th1, and eventually no RNase L. He also believes
patients need to balance the immune system - to push it a little more
towards Th1.
That way they will lose some of the overreaction on the right and gain so me
control on the left.

Dr. Cheney recommends the following treatments* to help shift the immune
system from one mode to another. They are called "right-to-left shifters. "

1) Kutapressin (prescription): Kutapressin is an immune modulator and a
broad spectrum antiviral. Dr. Cheney has found that it is most effective
when the dose is varied or "pulsed." The dose should vary from 1 to 4 cc
daily; see the section on Isoprinosine for this theory. Dr. Cheney strongly
suspects Ampligen is a right-to-left shifter also. He has said in the pas t
that Kutapressin is rather like a weak form of Ampligen.

2) Isoprinosine: (prescription): For use in CFIDS, this antiviral enhance s
NK function. Dr. Cheney believes it would also be good against intracellular
bacteria since it is a Th2 - Th1 shifter. It appears to raise IL-12 and
lower IL-10, which turns off Th2 and turns on Th1. It is also called
Imunovir. It has been approved in Europe and Canada for just about any viral
infection for 18 years. It is not approved in the US [as of 2000].

Week one, take 6 tablets a day, Monday through Friday, and none on the
weekend. Week two, take 2 tablets a day, Monday through Friday, and none on
the weekend. Repeat this cycle - but do not treat every month. Do two months
on and then one month off of this "pulsing" dose. This medicine works best
when you do not treat regularly. If you treat continuously at the same do
se, it stops working. It is an immune modulator, and Dr. Cheney suspects all
immuno-modulators are like this. If taken continuously they stop working.
The dose must vary so the immune system never knows what to expect.

3) Pine Cone Extract: Cheney said, "They make a tea from this in Southern
Japan and they have significantly reduced cancer rates. It's thought to work
at the gene level in lymphocytes, where it turns on IL-12. It also shuts
down IL-10 at the gene level, and that causes a shift towards Th1. Pine C
one extract is expensive, but at just 10 drops a day (in the morning), of
all the possibilities, it's probably the cheapest per day.

4) Earth Dragon Peptides: Earth Dragon (ED) is round worm peptides. It
causes a shift to the left, and is believed to be very similar to IL-12.
There has been a huge surge in the use of ED peptides to treat Inflammatory
Bowel Disease, and specifically Crohn's Disease. One professor at UNC treats
all of his Crohn's Disease patients with Earth Dragon. It is [considered to
be] non-toxic and safe. This is a good choice for those who want to balance
their immune system and also have bowel problems. Earth Dragon is about $36
for 150 caps. The dose is two a day.

5) Heparin (prescription): Heparin is a Th2 - Th1 shifter. One advantage
for many patients is that it is also an anticoagulant. Dr. Cheney only
recommends this if a patient has a coagulopathy. About half of his patients
do, according to the ISAC test. (See http://www.hemex.com or "Blood Related
Disorders in CFS/FM" in our October 2000 newsletter on the website.)

6) Transfer Factor [Formula 560 - identical to Transfer Factor System
100(tm)]: Transfer Factor Formula 560 is an immune modulator. Dr. Cheney
likes this product. It reportedly works against HHV6 and Lyme Disease, as
well as other problems.

*Note: This is not medical advice. See your healthcare provider for medic al
advice.

Source: Chronic Fatigue Syndrome and Fibromyalgia Support Group of DFW:
http://virtualhometown.com/dfwcfids/menu.html
AOL users: <a href="http://virtualhometown.com/dfwcfids/menu.html">Read it
here</a>


(c) Carol Sieverling 2000-2003.

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4) Dr. Anthony Komaroff's Recommendations for Chronic Fatigue Syndrome Care

01-22-2003 By John W. Addington

Persons with Chronic Fatigue Syndrome (CFS) can be thankful that Dr. Anthony
Komaroff is on their side. To begin with, he is a staunch advocate of the
disorder's legitimacy. He is also a Professor of Medicine at Harvard Medical
School, the Senior Physician at Brigham and Women's Hospital, and the
Editor-in-Chief of Harvard Health Publications. Thus, Dr. Komaroff has the
right clout to influence others to accurately understand this disorder.

Dr. Komaroff has put that clout to good use in his roll as member of the
U.S. Department of Health and Human Services CFS Coordinating Committee.
Aided by Komaroff, a particularly noteworthy accomplishment of that
committee was the identification of CFS funds that had been misallocated
for other purposes by the Centers for Disease Control. The committee's work
led to the restoration of those funds for CFS research as originally
designated.

Research

Dr. Komaroff publishes and lectures widely on research that he and other
experts have conducted regarding CFS. His own CFS research has addressed
immune dysfunction, viral involvement, allergies, and nervous system
problems including cognitive difficulties and hormonal imbalances. Dr.
Komaroff explains that "the most exciting area of research in the past 5
years has been the many studies finding neuroendocrine [hormone related]
abnormalities in CFS. These studies provide further evidence of a biological
process involving the central nervous system in CFS."

Distinguishing Other Ailments

When it comes to patients with fatigue, Dr. Komaroff advises doctors to b e
concerned about making the proper diagnosis. In fact only two to five
percent of patients who complain of fatigue to their doctors actually have
CFS. Others problems that should be ruled out are anemia, hypothyroidism
and hidden malignancies. In some cases, Dr. Komaroff believes simply
overworking can be the cause of fatigue.

Psychological problems should also be considered. This is because, as
Komaroff notes "depression and anxiety appear to be the most common
underlying causes...of chronic fatigue." Thus, this Harvard expert on
fatigue says that doctors "should carefully evaluate the possibility of a n
underlying primary psychiatric disorder in any patient with fatigue." (As
will be seen below, however, this does not mean that Komaroff believes that
CFS is really just a manifestation of a psychological problem.)

Drug Therapy

Dr. Komaroff is frustrated that the current state of CFS research has only
yielded therapies of limited value. Nonetheless, since tricyclic drugs such
as amitriptyline (Elavil) has helped in a number of cases he feels patients
should consider their use. "In the very low doses we use, these medicines
help improve the quality of sleep and thereby improve some of the symptom s
of CFS," Dr. Komaroff states.

Although Dr. Komaroff recommends tricyclics, drugs normally used for
depression, it is not an endorsement by him of the assertion that CFS is   a
form of depression. A reason Komaroff sees for the distinction is the
difference in time and dosage required for tricyclics to benefit CFS as
opposed to depression. Thus, Dr. Komaroff notes that with CFS the "rapid
effect and the low doses used (relative to doses used in the treatment of
depression) are not consistent with an effect on an underlying depression
."

Other CFS symptoms can be addressed with medications as well. For pain an d
headaches, Dr. Komaroff feels nonsteroidal anti-inflammatory drugs (aspirin,
Ibuprofen, naproxen, etc.) may be the best bet. In patients with anxiety
or panic problems, anxiolytic drugs (Buspar, Klonopin, Paxil, etc.) can be
used. Regarding hypotension, Dr. Komaroff explains, "some patients with
fatigue after long periods of standing improve with added salt or
fludrocortisone, but none has completely recovered [using these
treatments]."

Although research seems to support viral activity in a portion of CFS
patients, studies on antiviral medications have not proven the merit of t
his therapy. Likewise, no drugs have been able to relieve the immune system
dysfunction often seen with CFS. Further, Dr. Komaroff thinks the side
effects of hydrocortisone weigh against its use in counteracting diminished
cortisone levels.

Cognitive Behavioral Therapy & Exercise

Dr. Komaroff recognizes the benefits of cognitive behavioral therapy (CBT )
with some patients. A British doctor, Michael Sharpe, has studied cognitive
behavior therapy and its implications for CFS extensively. He explains that
CBT is "based upon the hypothesis that inaccurate and unhelpful beliefs,
ineffective coping behavior, negative mood states, social problems, and
pathophysiological [abnormal functioning] processes all interact to
perpetuate illness. Treatment aims at helping patients re-evaluate their
understanding of the illness and to adopt more effective coping behaviors
."

CBT therapists encourage patients to modestly increase their activity, even
including light exercise. Dr. Komaroff explains that "the diagnosis of CF S
can encourage an unnecessarily restricted level of physical activity that
leads, in turn, to deconditioning and further physical dysfunction. Grade
d, modest, regular physical activity is encouraged and found to be
beneficial."
He also cautions, however that, "the success of [CBT] therapy is very
therapist-dependent."

Psychological Issues

That Dr. Komaroff acknowledges the value of cognitive behavioral therapy
is no indication patients have just imagined their symptoms. Komaroff
commented on this issue in a special issue of The American Journal of
Medicine devoted to CFS. He said, "there is now considerable evidence of an
underlying biological process in most patients who meet the CDC definition
of chronic fatigue syndrome."

Continuing, Dr. Komaroff stated that recent research "is inconsistent wit h
the hypothesis that chronic fatigue syndrome involves symptoms that are only
imagined or amplified because of underlying psychiatric distress symptoms
that have no biological basis. It's time to put that hypothesis to rest and
pursue biological clues...in our quest to find answers for patients
suffering from this syndrome."

Research that Dr. Komaroff has personally been involved in has helped to
distinguish CFS from depression. In a recent study, Komaroff and his
associates compared the cognitive functioning (thinking ability, memory,
language skills) and psychological symptoms of depressed patients and
patients with CFS. While both groups had symptoms of depression as well a s
cognitive problems, the researchers found that, "the depressed patients w
ere significantly more impaired overall compared to CFS patients." Thus,
Komaroff and his associates concluded that the cognitive difficulties
experienced by CFS did not appear to relate to depression but rather were
more "consistent with...brain alterations."

Conclusion

Dr. Anthony Komaroff's dedicated research efforts have brought us further
in understanding the exact nature of this perplexing malady. His sage
treatment guidelines have also proven their value. Just as remedial for many
CFS patients, however, has been Dr. Komaroff's respect for the legitimacy of
the ailment. With his help, the battle against CFS is a little easier.

Sources:

Evengard, Schacterle, Komaroff: Chronic fatigue syndrome: new insights and
old ignorance, J Intern Med, 246(5):455-69 (1999)

Fisher, Interview with Anthony L. Komaroff, M.D., in Chronic Fatigue
Syndrome (1997)

Komaroff, A 56-year-old woman with chronic fatigue syndrome, JAMA,
278(14);1179 (1997)

Komaroff, Buchwald, Chronic fatigue syndrome: an update, Annu Rev Med,
49:1-13 (1998)

Komaroff, The Biology of Chronic Fatigue Syndrome, Am J Med, 108(2):169-1
71 (2000)

Komaroff, The Physical Basis of CFS, CFIDS Assoc. Am. (2000)
www.cfids.org/archives/2000rr/2000-rr2-articlel01.asp
AOL users: <a
href="http://www.cfids.org/archives/2000rr/2000-rr2-articlel01.asp">Read it
here</a>

Komaroff, Lecture to Mass. CFIDS (2000)
www.ncf-net.org/conferences/komaroff1200.html
AOL users: <a href="www.ncf-net.org/conferences/komaroff1200.html">Read it
here</a>

Komaroff, et. al, Neuropsychological Function in Patients With Chronic
Fatigue Syndrome, Multiple Sclerosis, and Depression, Applied
Neuropsychology 8(1);12-22 (2001)

Komaroff, The Biology of Chronic Fatigue Syndrome, Lecture, Myalgic
Encephalopathy /Chronic Fatigue Syndrome-"The Medical Practitioners'
Challenge in 2001" www.ahmf.org/01komaroff.html

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5) Drug-Free Relief From Chronic Pain

http://www.redflagsweekly.com/features/2003_jan29P.html
AOL users: <a
href="http://www.redflagsweekly.com/features/2003_jan29P.html">Read it
here</a>

SPECIAL FEATURE

By Dr. Len Saputo

The human body is miraculous. Although we have accumulated an enormous
encyclopedia of information about it, the body’s function remain far too
complex for human understanding. Nonetheless, the body still manages to
operate quite well on its own. Despite the marvelous achievements of Western
Medicine, the holistic healing wisdom of nature continues to command a clear
element of reverence from many experienced health care practitioners.

This article will explore our current understanding of fibromyalgia (FM)
from both conventional and alternative perspectives, and will offer
management options that will substantially improve bodily energy and
vitality.

FM is characterized by varying combinations of profound fatigue, muscle
weakness, flu- like symptoms, non-restorative sleep, muscle and joint pain,
abnormal bowel function, and a variety of mental symptoms that range from
difficulty in concentration to outright depression.( 1,2,3) Its natural
course is typically characterized by years of incapacitation that
necessitates challenging lifestyle changes. Social and economic factors
often create profound hardships on both patients and their families that can
be catastrophically disruptive. It is no wonder that depression is such a
frequent finding in FM! However, medical research has clearly documented
that this depression is the result of FM, and is not the cause of it.
Nonetheless, the frustration experienced by most health care practitioners
in managing FM has led to many patients being labeled as "neurotics."

Understanding FM is a tall order because there are so many possible causes
for it, and because it can involve so many systems of the body. There is a
dysfunction in the regulation of the central nervous, immunologic, and
endocrine systems, that is superimposed upon the malfunction of many organs.
To make a long story short, however, conventional medicine does not
understand either the etiology or the pathophysiology of this disease well
enough to cure, or even manage it, satisfactorily.(4) Consequently,
physicians and patients alike have experienced continuing frustration
resulting from the typically poor treatment outcomes, as well as from the
enormous economic burden incurred by ongoing medical costs and lost income.
Even the insurance industry has been severely challenged by the mighty costs
generated by this disease.

This predicament has created the need to conceptualize a new approach that
can provide a better management of the mal-homeostasis (the body's
physiologic adjustment to metabolic abnormalities) that results from FM, and
causes its associated symptoms. This has been done! A new paradigm of
natural healing has emerged that is based on supporting the innate healing
capacity of the body, and relies on nutrition and natural therapies as its
major tools. Unfortunately, conventional medicine has not yet acknowledged
this paradigm. Why?

Conventional medicine is built on a premise of fighting and conquering
disease with drugs and surgery. However, because of an inadequate
understanding of the cause of FM, there is no clear target to direct its
mighty technology and, therefore, effective therapies have not followed.

This new "natural healing" paradigm is based on what is called a "process
oriented approach" (POA) to managing disease. The objective of the POA is to
create a healthier homeostasis by identifying and correcting metabolic
imbalances, and in responding to the specific increased metabolic needs
created by the disease process. No attempt is made to intervene with the
disease process itself to effect a cure, or to suppress the symptoms of the
disease. The innate wisdom of the body to heal itself is respected and is
allowed to restore a more functional homeostasis, which can then manifest
the healing process.

Much of the basis for this concept is developed form the premise that if all
your cells are healthy and functioning perfectly, how can you be sick? Each
individual human cell is analogous to a microscopic industrial plant.
Without an adequate supply of appropriate raw materials, it cannot be
expected to manufacture all of its products properly. Similarly, if it is
supplied with the wrong raw materials, it will be unable to produce a
product that is perfect. Put simply, we must consume all the nutrients
(food) that our cells require, and avoid those that are not needed (and
potentially toxic), if our cells are to manufacture everything required for
perfect function.

As a culture, we do not appreciate the widespread nature of the nutritional
deficiencies in the standard American diet (SAD).( 5) As we migrated from
the country, where we consumed whole, unprocessed, and unrefined foods, to
the city, where there was an incredible increase in population to be fed, we
became faced with new problems that made it difficult to easily provide this
kind of sustenance. Storage became a new and important challenge, and we
responded by developing a sophisticated technology for refining and
processing our food. As this technology improved, we began creating "foods"
that were so deficient in nutrients that many of them were not food at all.
Nonetheless they stored well, tasted good, and above all, sold.

These unnatural foods are generally high in calories and low in nutrient
density, thereby setting the stage for a pandemic of both obesity and
malnutrition. In this era of "fat phobia," it is ironic that we are
significantly malnourished in the omega 3 and 6 fats that are absolutely
essential for good health, and are overdosed with saturated and trans fats
that are not only making us fat, but are also killing us. It is interesting
that these imbalances in fat metabolism have been found to be particularly
common in patients with FM, and that normalization through supplementation
usually leads to clinical improvement.( 6)

It is tragic that nutrition is not valued as critically important therapy
for patients with any disease, let alone FM. Metabolic demands are
dramatically increased in FM, further highlighting the vital importance of
nutrition. Woefully, conventional medicine has persisted in its frantic
search for the magic bullet that might cure FM. As this approach has failed,
the search has shifted to seek out unnatural, synthetic pharmaceuticals that
might at least suppress its symptoms.

Making matters worse, like all of us, patients with FM are continually
exposed to the estimated one hundred thousand synthetic chemicals that have
been synthesized within the past 100 years. These chemicals frequently
interfere with an already stressed out metabolism, as the thousands of years
that are probably required to evolve and enable our bodies to render these
chemicals non-toxic, have not yet lapsed. These ubiquitous chemicals have
saturated the food, water, and air that sustain and poison us on a daily
basis. While most healthy people have the necessary metabolic capacity to
compensate for many of these insults, sick people very often do not. This is
the reason why people with FM are called "chemically sensitive," and why
they decompensate from what seems trivial to the rest of us.

Typically, traditional laboratory testing is normal in patients with FM.
However, a myriad of abnormal findings are discovered when the POA tests are
performed. These tests are designed to measure how well we are nourishing
our bodies, how much toxic activity is occurring in it, and how effectively
our defense systems are operating to sustain normal homeostasis.

The gastrointestinal tract provides a great window through which we can
assess our body’s capacity to nourish itself and to defend itself against
toxic exposures.(7) Three tests are particularly informative in this regard.
First, a comprehensive digestive stool analysis provides information about
gastrointestinal digestive and absorptive capacities, and offers important
clues about the gut’s ability to keep toxic chemicals out of the body. It
assesses the ecological balance of the intestinal microflora, the adequacy
of digestive enzyme and acid production and of digestion itself, the
capacity of the gut’s immune system to defend itself, and screens for
parasitic infections. It is easy to appreciate that cell metabolism can
significantly improve when abnormalities found in these tests are corrected.

Second, permeability across the intestinal surface is very often increased
in FM, creating the so-called "leaky gut syndrome." Intestinal permeability
is very simple to measure, is economical, and provides information that is
vital in terms of assessing the potential extent to which the body is
challenged to cope with toxic and allergy provoking chemicals that can gain
entry into the internal body. Third, by means of a liver detoxification
profile test, it is possible to assess the liver’s capacity to detoxify what
does get across the intestinal lining. This information allows us to devise
a nutritional protocol that will support liver detoxification in such a way
that fewer toxins are allowed access into the general circulation.

The immune system in FM is in a state of sustained hyperactivity.(8) This
continual strain results in diminished resistance to candida and viral
infections, which are frequently seen in FM. The POA approach to this is to
simply reduce this stimulation to the immune system, and give it a chance to
"catch its breath." Correcting the leaky gut syndrome can be of tremendous
value in this regard by decreasing the influx of abnormal, immune
stimulating chemicals into the internal body. Another approach that can also
be of value in this regard, involves specialized allergy testing for
specific foods and chemicals (Elisa/Act test), and then eliminating further
exposure to the offending substances. This can also be accomplished through
the use of hypoallergenic diets. Other measurements of immune parameters,
such as natural killer cell activity (involved in defense against cancer and
viral infections) can also be assessed and modified.

Recent discoveries in mitochondrial (the small energy producing factories
within our cells) biochemistry have revealed exciting new possibilities for
managing the chronic fatigue that is characteristic of FM. Supporting
defects in energy production with supplements such as magnesium, acetyl
carnitine, and coenzyme Q10 can be very effective in many patients.(9)
Clinical trials with these OTC supplements can be tried empirically,
although laboratory confirmation of deficiencies can be verified if desired.

It is important in this setting to assess endocrine function, and screen for
hypothyroidism, adrenal insufficiency, and hypoglycemia. These endocrine
disorders can masquerade as FM and should be differentiated, as they are
often easily treated. Studies of the levels and balance of the adrenal
hormone, cortisol, and its counterpart, DHEA, may also provide information
that can be helpful in both the diagnosis and management of FM.

FM is associated with high levels of oxidative stress. This is a technical
way of saying that the body is producing large quantities of powerful toxic
chemicals called "free radicals," that cause severe inflammation and
destruction in its tissues. Fortunately, these free radicals can be
neutralized by means of a diet that is rich in whole, fresh foods, and
through supplementation with appropriate antioxidants such as vitamin C, E,
beta carotene, picnogenol, coenzyme Q 10, glutathione, and lipoic acid. It
is now realistic to measure the amount of free radical activity and of
antioxidant levels in serum, and to create healing nutritional protocols
based on this data.

The reductionistic approach of Western Medicine is designed to primarily
focus on the body as the major malfunctioning factor that "needs fixing."
The inseparability of body, mind and spirit is acknowledged, but not
revered. No healing therapy would be complete without honoring this holism.
It is not surprising that there is scientific evidence supporting the value
of other disciplinary approaches such as Tai Chi (10), Qi Gong, Ayurveda,
Chinese Medicine, and a multitude of others, where attention is paid to
"balance and movement" as reflected by breathwork, physical exercise, and
"mobilization of the life force." It is especially important to work in
collaboration with other disciplines when requested by our patients,
especially when what we are doing isn’t working very well.

In a patient-centered approach, it is imperative that we not view our
patients as "a set of symptoms that should be managed with our bag of
tools." Operating from an attitude of "being with," rather than "doing to"
our patients, carries with it a message of personal responsibility and
empowerment. This inspires participation in the decision making process, and
also provides hope that it is possible to recover from any disease process.
These important attitudes have profound effects on our belief system and act
as very potent healing agents.

Healing from any disease is best accomplished by using an integrative
approach that is holistic and patient-centered.

REFERENCES


1. Wolfe, F., Smythe, H., Yunus, M., et al. The American College of
Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis
and Rheumatism 33:160-72,1990.

2. Bennett, R. The Fibromyalgia Syndrome: Myofascial pain and the chronic
fatigue syndrome. In: Kelly, W., ed. Textbook of Rheumatology. Philadelphia:
W. B. Saunders, 1993: 471-83.

3. Bennett, R., Smythe H., Wolfe, F. Recognizing Fibromyalgia. Patient Care
15:211-15, 1992.

4. Bell, David S. Chronic Fatigue Syndrome Update. Postgraduate Medicine
96:73-81, 1994.

5. Adams, C. The Nutritive Value of Foods in Common Units. Washington, DC.
US Dept. of Agriculture (US Printing Office). 1975. Health and Nutrition
Examination Survey (HANES) 1971-74.

6. Behran, P. O., Behran, W. M., Horrobin, D. Effect of high doses of
essential fatty acids on the post viral fatigue syndrome. Acta Neurol Scand
82 (3):209-16, 1990.

7. Galland, Leo, MD, The Four Pillars of Healing. Random House, NY, 1997.

8. Bates, David, Buchwald, D., Clinical Laboratory Test Findings in Patients
With Chronic Fatigue, M. J., and Dawson, D.: Red Blood Cell Magnesium and
Chronic Fatigue Syndrome. Lancet 337:757-60, 1991.

9. Cox, I. M., Campbell tai chi quan exercise. Int J Sport Med 10:217- 9,
1989.

10. Xusheng S, Yugi X, and Yunjian X: Determination of E-rosette forming
lymphocytes in aged subjects with Syndrome. Arch Intern Med 155:97-103,
1995.

Len Saputo, MD, is a graduate of Duke University Medical School and is board
certified in Internal Medicine. He has been in private practice in
affiliation with John Muir Medical Center in the San Francisco Bay Area for
more than 30 years. His approach to healing is based on an integrative style
of mainstream medicine, nutritional therapies and prevention.

Over the past seven years, Len has guided the development of an integrative,
holistic model of healthcare that is focused on wellness and prevention. In
order to accomplish this mission, in 1995 Len founded the Health Medicine
Forum, which he continues to direct. "The Forum" is a non-profit educational
foundation that has sponsored more than 100 public and professional events,
including monthly presentations, workshops, and conferences. In 2001 Len
co-founded the Health Medicine Institute, an integrative medicine center in
Lafayette, California that is bringing the model of Health Medicine into
clinical practice. Further information on Health Medicine, the Forum, and
the Health Medicine Institute are available on the Web at
http://www.healthmedicine.org
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6) Ending Bacterial Overgrowth Results in Better Motility in Some Irritable
Bowel Patients

A DGReview of :"Lower frequency of MMC is found in IBS subjects with
abnormal lactulose breath test, suggesting bacterial overgrowth."

01/17/2003 By Elda Hauschildt

source:
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256C9B0001E1
B7?OpenDocument&id=A6E0482132A777A485256B3E001FD3A7&c=&count=10
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it here</a>

Eradicating bacterial overgrowth in patients with irritable bowel syndrome
(IBS) and small intestinal bacteria overgrowth (SIBO) appears to result in
some normalization of motility, researchers in the United States say.

Patients with IBS with SIBO still present were found to have less frequent
phase III small intestinal motility on antroduodenal manometry than IBS
patients with eradicated overgrowth.

Investigators from Cedars-Sinai Medical Centre in Los Angeles, California,
compared 68 consecutive IBS patients with SIBO and 30 controls in a
case-control study designed to investigate the role of small intestinal
motility. Patients with SIBO were identified by lactulose breath test.

Four-hour fasting recordings were obtained after fluoroscopic placement of
an eight-channel, water-perfused manometry catheter. Using the results, the
researchers compared the number and duration of phase III events in IBS/SIBO
patients and controls.

IBS patients who had had breath tests within five days of manometry were
also compared to see whether there was a relationship between the motility
abnormalities observed and SIBO status.

Number and duration of phase III events were lower in the IBS/SIBO patients
than in controls. Patients with SIBO present at manometry had less frequent
phase III events.
Digestive Diseases and Sciences, 2002;47:2639-2643. "Lower frequency of MMC
is found in IBS subjects with abnormal lactulose breath test, suggesting
bacterial overgrowth."

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7) Exercise: The Double-Edged Sword

by Diana Karol Nagy

We’ve heard about the importance of exercise when we have fibromyalgia,
chronic fatigue syndrome, or other chronic pain disorders, but we also
realize that exercising can be like the proverbial double-edged sword for
those of us with these conditions. We know we should do it, but it hurts!

Regular exercise benefits everyone, but especially those with chronic pain
conditions. Muscles that are well conditioned and well toned can reduce
chronic pain. In addition, regular aerobic exercise can promote and improve
sleep. Exercise is also known to raise levels of serotonin and endorphins,
which can boost moods and reduce pain.

People who have chronic fatigue syndrome or fibromyalgia may hesitate to
begin an exercise program, especially if they are already tired and in pain.
However, even gentle movement can pay out great benefits in pain reduction.
Gentle, low-or non-impact aerobic exercise won’t tax already painful
muscles. You may choose walking, biking, swimming or water aerobics.
Regardless of which type of exercise you choose, you should always begin
slowly.

To improve your overall fitness, you should exercise regularly, and
gradually increase your duration and frequency. Gently stretch your muscles
both before and after exercising, and your endurance will increase. Don’t
try to match your pre-FMS or CFS activity levels. Take it easy. It’s more
important that you’re moving. You don’t need to run a marathon, or take part
in a swim meet.

Don’t let the word "exercise" deter you. Exercise can be fun. Think of it as
recreation, not "working" out. Start slowly, and do something you enjoy. For
example, if you love photography, then take some short nature walks with
your camera, and photograph what you see along the way. If you love
gardening, but don’t have the energy level yet to stage a massive
landscaping project, take a stroll around your yard. Maybe you love to chat
with friends; so take your conversation on the road, and walk and talk. What
ever you choose to do, start slowly and gradually increase your exercise as
your endurance increases and you become stronger.

The important point here is to find something you love to do, and then do it
just for the sake of doing it. This is finding intrinsic motivation for
activity. If you do something because you enjoy doing it, you’re more likely
to keep doing it. If this is the case, you have the internal drive to keep
moving. On the other hand, if you begin an exercise program because your
doctor tells you that you have to do it for the sake of keeping your muscles
active, you are less likely to stick with the program. This is why many
exercise programs in the traditional sense, don’t work. Even if you tell
yourself you should exercise so you don’t get sick, you are still receiving
external motivation, and that won’t last long.

Set a goal for yourself that is reachable and realistic, and before long,
you’ll be participating in active recreation, doing something simply for the
sake of doing it. Remember that one of the side effects of recreation is the
therapeutic benefit you can receive.

So, find something you love to do, and start moving!

Sources:

The Arthritis Foundation’s Guide to Good Living with Fibromyalgia. Arthritis
Foundation, Atlanta, GA. 2001.

Stephanie A. Nagy, B.S., Recreational Therapist. University of Florida and
Shands at Vista. Personal Communication, 23 September 2002.

http://chronicfatigue.about.com/library/weekly/aa092302a.htm
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8) Heartburn Headaches

Mystery migraines solved

by Paula Rasich

Acid indigestion (also called reflux) may be the sneaky cause of some
"mystery" migraines. And mopping up that extra acid could ease head pain.

Two longtime migraine sufferers who had frequent, untreated headaches
finally got relief when they took bigger doses of their acid reflux
medicines, reports Harvard Medical School headache expert Egilius L. H.
Spierings, MD. Acid reflux can make pain radiate from the upper gums and
teeth into the cheek and, from there, into the eye, a common location of
migraine headache, notes Dr. Spierings (Cephalalgia, Sept 2002).

If you have unrelieved migraines and acid reflux, ask your doctor about
lifestyle changes and medications that might help.

http://www.prevention.com/cda/feature2002/0,4780,4719_P,00.html
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9)   Make the Most of It! - Treating and Living with Fibromyalgia, Chronic
Fatigue Syndrome and Myofascial Pain Syndrome

A One Day Conference for Both Patients and Health Care Professionals

Saturday, March 22, 2003
8:00 a.m. to 6:00 p.m.
Clarion Hotel
Cincinnati, Ohio

Increase your understanding and awareness of current medical and wellness
trends for Fibromyalgia, Chronic Fatigue Syndrome (CFS) and Myofascial Pain
Syndrome (MPS)

For The First Time Medical And Legal Professionals From Across The Country
Join Together For A One-Day Conference

Patients - If you or your loved one suffers from FMS, CFS or MPS, you need
to attend.

This is the first time that these top experts in the nation will all be
together in one place. You will learn the latest trends in treatment, and be
brought up to date on related legal and disability issues by two top-notch
attorneys

Health Care Professionals - (Doctor, Nurse, Physical Therapist,
Psychologist, Chiropractor, Massage Therapist, Body Worker, etc.)

You owe it to yourself and your patients to attend our special educational
sessions specifically geared toward health care professionals.

Our series of renowned speakers will explore the latest advances in
effective treatment for FMS, CFS and MPS and how to handle disability
issues.

Featured Speakers Include:

Hal Blatman, MD
Scott E. Davis, JD
Pamela Gilchrist, APR, CPT
Steven P. Krafchick, MPH, JD
Devin J. Starlanyl
Jacob Teitelbaum, MD

For complete information and to register:
http://blatman.56kdialup.net/index.php
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10) Straight Talk About Herbal Supplements

A new Web site by Memorial Sloan-Kettering Cancer Center discusses their
safety, effectiveness.

By Jennifer Thomas
HealthScoutNews Reporter

-- If you have high blood pressure, did you know you probably shouldn't take
ginseng?

Or that St. John's wort can interfere with chemotherapy?

Or that garlic capsules and gingko biloba can hinder blood coagulation, a
potentially major problem if you had to undergo surgery?

A new Web site created by experts at Memorial Sloan-Kettering Cancer Center
in New York City provides up-to-date information on the safety and efficacy
of 135 of the most popular herbal remedies and dietary supplements, from bee
pollen to shark cartilage and skullcap to milk thistle.

Each entry includes a summary and a critique of all the known medical
studies on the supplement, as well as a link to the original research on the
National Institutes of Health's Medline.

In the past decade, use of alternative treatments has skyrocketed, says
Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering,
who started the site. "But until now there was no easy access to current,
comprehensive information about these agents," she adds.

Research is under way around the globe to scientifically document the
effects of hundreds of herbs and other dietary supplements.

Some studies have proven that certain natural substances do have benefits,
though in nearly all cases research is mixed. The element zinc, for example,
has shown promise in lessening the duration of a cold by making it difficult
for the rhinovirus to replicate. And some research shows St. Johns wort can
help ease depression.

But that means the converse is also true -- herbs can be dangerous.

"Herbs are powerful, biologically active products that do have important
biological effects," Cassileth says. "Those effects can be useful at some
times and harmful under other circumstances."

"Herbs should not be used in a casual fashion because they are serious
medicines," she adds.

For instance, ginseng can cause low blood sugar in diabetics. And valerian
and kava can lessen the effectiveness of prescription drugs by interfering
with the liver's ability to process the medicines, Cassileth says.

Another thing to keep in mind: While much is known about the effects of
herbs on the body, much more is not known.

Dietary supplements are not regulated by the U.S. Food and Drug
Administration, or any government agency. That means the potency in one
bottle of St. Johns wort, for example, can -- and often does -- vary
dramatically from that in another bottle, Cassileth says.

And you can't even be sure you're getting St. Johns Wort.

"Anybody can put anything on a bottle and put it on a health food store
shelf," she says. "Some of the herbal remedies have virtually none of what
is assumed to be the active ingredient, some have much higher levels and
some are contaminated with other substances."

On the new Web site, the 135 supplements are listed in alphabetical order by
scientific name. The common name is below it. (Acanthopanax Senticosus is
better known as ginseng. Allium Sativun is better known as garlic).

Each entry includes the brand names the herb is sold under, its purported
uses, its chemical properties, and what's known about how the herb works on
the body.

Each entry also includes a summary and a critique of all the known published
medical studies, instances of adverse reactions, and warnings about
potentially dangerous drug interactions.

Each critique is fully cited and linked to Medline, so that doctors or
patients can retrieve the original research and read further if they wish.

The site will be continually updated, Cassileth says. In a few weeks,
Cassileth and her colleagues are planning to launch a second Web site that
will be less technical and more easily understood by patients.

Dr. David Rosenthal, past president of the American Cancer Society, endorses
the Web site.

"This resource is an invaluable tool for both doctors and patients looking
for comprehensive information about dietary supplements," Rosenthal says.

http://www.mskcc.org/mskcc/html/11570.cfm
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11) Strapped US Health Care System Fails to Address Actual Health Needs

*this is very relevant to the FM/CFS population. We live in an age of zip
zap medicine with conditions that require more than zip zap care.

More than half of US health care dollars are spent to treat individuals with
chronic health conditions according to a recent report from Johns Hopkins
reported by the Caregiving Resource Center. Chronic conditions are defined
as conditions that last a year or longer, limit what one can do and/or may
require ongoing medical care.

Some 60 million people live with chronic conditions and the number only
increases as the population ages. Even though the bulk of health care
dollars is going to individuals with chronic conditions, these same
individuals pay five times more out-of-pocket than individuals without
chronic conditions - regardless of the type of insurance they have. Medicare
beneficiaries typically pay the most out-of-pocket expenses despite
two-thirds of Medicare spending is on behalf of people with five or more
chronic conditions.

The US health care system is organized to treat acute episodes of illness.
However, many illnesses that once could not be effectively treated,
resulting in episodes of acute crisis, can now be managed in a way that
enables patients to live for years with a serious disease. Chronic
conditions require management specifically geared to avoiding or limiting
acute episodes and enhancing day to day functioning. Our health care system
is not designed to effectively manage chronic conditions, and insurance
reimbursement is not structured to compensate for these new treatment
requirements. With government dollars for health care shrinking
significantly, these scarce resources need to be more effectively managed.
If steps are not taken to make the system respond more rationally to the
actual needs of patients, the current health care crisis will only deepen
more rapidly.

To view the article and link to the report go to:
http://atsh.org/news/chartbook.html
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