Fibromyalgia typically includes the symptoms of fatigue and pain, but the challenge is that many other conditions also cause fatigue and pain. So how do you know whether you have fibromyalgia and should peruse treatments for fibromyalgia or if you have something like hypothyroid or arthritis? We speak with Fibro-Fix author Dr. David Brady to answer this question.
If you need help determining if you have fibromyalgia, click here.
Dr. David Brady Bio … 1:46
Symptoms of Fibromyalgia … 5:46
Diagnosis of Fibromyalgia … 12:03
Early Life Trauma and Fibromyalgia … 18:02
Treatment of Fibromyalgia … 29:47
Episode Wrap-up … 48:40
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Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with Dr. David Brady to talk about fibromyalgia today, which is a topic we haven’t really discussed, I don’t think at all on the podcast previously. So I’m interested to get his take on this and have him here for the first time.
Dr. David, thanks for being on the show.
Dr. David Brady: Hey, thank you. I’ve always been so appreciative of your work and everything you do in functional medicine. So it’s more than a pleasure to be on your show.
DrMR: Absolutely. And it definitely goes the other way also. I remember being at your seminars back when I was a student and didn’t really one thing from the other. And I was trying to learn. And gosh! It must have been well over 10 years ago, I think.
So I know you’ve been a pretty prominent figure in the functional medicine field, especially with functional medicine education, for a while. So definitely thank you for all the work you’ve done. And I’d like to jump into the topic of fibromyalgia.
Dr. David Brady Bio
But before we do that, can you tell people just a little bit about your background and how you got more so specifically into fibromyalgia?
DrDB: Oh, sure! Okay. It’s a bit of a long, winding road. But I spend most of my time here at the University of Bridgeport, where I’m the vice president of health sciences. So I oversee all of the medical, dental, allied health academic programs here. But also our whole public clinic system called the UB Clinics and hospital affiliations and so forth.
But I’ve also been in private practice my whole career, almost 25 years now of integrative and functional medicine. And I really love to stay connected with patients. I see patients every week.
And then in my other sort of existence inside this industry, if you will, as the chief medical officer of Designs for Health, one of the professional, leading brand nutraceutical nutritional supplement manufacturers, and Diagnostic Solutions Lab, which develops laboratory tests like molecular GI mapping tests and things like that, I kind of understand the challenges of this chronic disease epidemic from a lot of different perspectives — as an academic, as a researcher, as a clinician — but also in the service industry that kind of comes up with some solutions, hopefully, for practitioners like us. And one of the most challenging disorders that we all face is this thing called fibromyalgia. And we have so many patients who come in, generally women, that have chronic pain and achiness all over the body. And they don’t sleep well. They have anxiety. They have depression. They have a lot of vague gastrointestinal problems. They have profound fatigue.
And I know in my training, whether it was back in the beginning when I first trained as a chiropractic doctor in more physical medicine, I really didn’t learn that much about fibromyalgia. What I was taught was not really that helpful. And I think looking back on it in retrospect, at least from this point, it was wrong.
And then in my medical training, I didn’t get much better, if better at all, information on it. And unfortunately, I’m embarrassed to say that I think even the physicians getting out of school this year don’t know much about fibromyalgia. They don’t know how to deal with it. They’re confused by it.
Not only do they not know much about it that’s accurate. Often, healthcare providers think they know a lot about it. And what they think they know is often exactly incorrect.
So I pretty much figured that out somehow on my own. And along with one or two other colleagues who were in a similar position and realized it, we kind of embarked on this multi-decade effort to make ourselves experts in it and to become the experts ourselves and do a lot of research and publishing.
And whether it’s in textbooks, medical journal articles, and now a popular book with my book The FibroFix that released in July, I’m trying to bring that 20+ years of experience directly to the patient because I’ve done a lot of writing and lecturing to doctors and to other healthcare providers about this, which is great and rewarding.
But I think ultimately, to change things you’ve got to bring the message to the streets, as they say. And you need a grassroots effort. And I think there’s nothing better than really educating the people who are afflicted with the problem on how to be their own best self-health advocate to kind of crawl out of that space and to be very actively engaged in their own recovery. Because if they’re just going from doctor to doctor hoping that they’re going to get it all done for them passively, it doesn’t happen that way, unfortunately.
DrMR: Right. I completely understand.
Symptoms of Fibromyalgia
And I want to work our way, of course, to methods that people listening can use to aid in determining if they do have fibromyalgia and then treatments that they can use if they have fibromyalgia.
But before we work our way to the actionables, there are some very non-specific symptoms that are often lumped into fibromyalgia. Most typical are probably going to be fatigue and pain.
DrMR: But can you tell us a little bit more about what fibromyalgia looks like and what can be used to help diagnose or differentiate it from other things that might look similar? Like hypothyroid may also manifest as a fatigue. So someone may be sitting there saying, “Well, I look at my symptoms. And a lot of them match hypothyroid.”
DrMR: “A lot of them match fibromyalgia. So where do I go?”
DrDB: Well, you’re right. And it’s not easy. If it were easy, it wouldn’t be such a diagnostic quagmire.
DrDB: And I wouldn’t have had to write the book. Easy things are easy. And complex things are complex. And this is a complex one. And one of the things that confounds it is, as you mentioned, there are a lot of different medical disorders.
There are a lot of different things short of a medical disease that we would consider in functional medicine more metabolic issues or issues of biochemistry or what have you that can make one not have a lot of energy and feel fatigued and feel a lack of vitality.
And there are a lot of things that can make you achy or have pain. And there are a lot of things that can cause a lot of these individual symptoms that get lumped under the fibromyalgia banner.
And unfortunately, particularly if you’re a woman, particularly if you’re middle aged and you go into a healthcare provider and you start listing some of these symptoms and you say, “Listen, doc. I’m tired all the time. I hurt a lot. I’ve got a lot of gut problems. I’m always gassy and bloaty. I’ve got constipation. I can’t sleep great. I’ve got anxiety.” You will get diagnosed with fibromyalgia. There is no doubt about it.
It doesn’t mean you have it. In the end, the diagnostic criteria that have been established by the American College of Rheumatology and modified multiple times throughout the years are very, very clear in that they state it is a diagnosis of exclusion, which means you can’t make the diagnosis until you’ve really comprehensively run down and ruled out any other causes for the symptoms and the problems.
And a lot of docs and a lot of healthcare clinicians just simply don’t do that before they render the label or the diagnosis. And that’s unfortunate.
And there’s diagnostic criteria that list very specific things that need to be there. They list certain things that cannot be there to sustain or to establish a diagnosis of fibromyalgia. But a lot of people aren’t paying close enough attention to it.
And then it’s also complicated further by the fact that the diagnostic criteria are not that great even if you do pay attention to it. It’s very, very prone to overdiagnosis. It’s very prone to lumping many people into the diagnostic label of fibromyalgia who really have other things wrong with them.
So it doesn’t tease everyone out appropriately. And there are some very well-known masqueraders of fibromyalgia, things that get called fibromyalgia that are not but are commonly called it. You hit one of them right on the head, which is undiagnosed or underappreciated hypothyroidism, which is one. Energy production, mitochondrial difficulties are another which perhaps we can discuss.
And the other third big one is myofascial pain syndrome, actually problems in the muscles or the structural tissues because one of the biggest confusion points with fibromyalgia — and it’s not just with patients. That’s understandable — but with healthcare providers.
If you ask most doctors, “What is fibromyalgia?” they’ll tell you, “Oh, it’s a muscle problem.” And the reality is, true fibromyalgia, or classic fibromyalgia, is not a muscle problem. It has nothing to do with muscles or the soft tissues. The person perceives the pain there. But the problem is really in the brain. It’s in the central nervous system. It’s not out in the periphery in the tissues where you perceive the pain to be.
Therefore, if you direct therapies at those tissues where the person feels the pain — like you do physical medicine, muscle work, electrical muscle stim, body work, all those kinds of things — in a true classic fibromyalgia patient, it doesn’t really get to the heart of their true problem.
And a lot of people do get better with those kinds of therapies. But they don’t really have fibromyalgia. They have myofascial pain syndrome. So that confuses it even more because the doctors diagnose them fibromyalgia, treat them with physical medicine. They get better. So they go, “Aha, the physical medicine cured the fibromyalgia.” In reality, the physical medicine helped a condition that was not fibromyalgia to begin with.
So just because you misdiagnose something and then happen to help it doesn’t mean that you cured the diagnoses that you made incorrectly.
DrMR: Sure. Sure.
DrDB: So it creates even this feet-forward sort of cycle of misinformation and misimpressions out there in the healthcare community.
DrMR: So certainly, as you outlined, there are a number of things here to weigh. And so it’s probably beyond the scope of this call to go into how to diagnose it, per se.
But I think a practical takeaway for people listening is that you’d want to have a doctor who is well trained in this and who you trust so that you’re confident that they’re going to rule out the appropriate things, as David just outlined, but also that they don’t — lack of me putting this more tactfully — just get kind of lazy and just give you this diagnosis because they’re tired of doing detective work.
DrDB: Yeah, it’s a lazy…
DrDB: You pick great adjectives. It’s a lazy diagnosis. It’s a junk diagnosis. It’s a wastebasket diagnosis. You can call it all those things. And it generally is that. Now, that’s not to diminish it or minimize it in suggesting that some people don’t really have it because they do. The problem is a lot of other people get told they have it or think they have it when they don’t. So it just creates massive confusion.
Diagnosis of Fibromyalgia
But what I might be able to do for you, Michael, is to just maybe give you some 30,000-foot points on some things that have to be there for it to be fibromyalgia.
DrDB: What are some things that lend against it? Would that be helpful?
DrMR: Yeah, that would definitely be helpful.
DrDB: Okay. So in fibromyalgia, if you ask people who really have classic fibromyalgia, “What is your biggest problem? If can help you with one thing, what would it be?” Invariably with them, it’s the pain and the achiness. And the pain and the achiness needs to be all over the body. It needs to be global pain, we call it. And by global, we mean it can’t be just in one or two or three places or regions around the body.
Now, a lot of people may have pain down in their pelvic area or low back pain and they also have a shoulder issue. And their neck also hurts. So when they think about it on the surface, they just think, “Oh, I hurt all over the place.” So when the doctor says, “Where do you hurt?” they go, “I hurt everywhere.”
But if you really tease it apart and ask them very closely, they’ll say, “Oh, it’s my neck. Oh, it’s my shoulder. And my low back hurts too.” Or when you examine them, you find out that they do have these areas of problems and pain in these certain regions. But they don’t have pain everywhere.
In the true classic fibromyalgia patient, they literally hurt everywhere — above the waist, below the waist, left side, right side, in the extremities, along the midline of the body. And because it’s a problem in processing pf information and processing of pain in the brain and in the spinal cord, it doesn’t really discriminate on area of the body. A true structural problem, a problem in the muscles, in the tendons, in the ligaments, in the joints will hurt where the problem is.
So the first thing you need to establish is that the person really has global pain. They feel pain everywhere. And the pain is generally perceived, though, in the softer compliant tissues like the muscles, the fascia, the tendons, the ligaments; not so much the bones, not so much the joints. So it’s not an arthritis. It’s not a joint problem.
So if you ask somebody on a good medical history, “Where do you hurt?” and they start saying, “Oh, my knees hurt. My hips hurt. My shoulders hurt.” And you say, “Is it in the joint?” And they say, “Yes.” That’s not fibromyalgia. I start looking for rheumatoid arthritis, degenerative joint disease, some sort of inflammatory arthridity — but not fibromyalgia.
So the pain of fibromyalgia is everywhere. It’s mainly perceived in the soft tissues. And it’s not in the joints. It doesn’t tend to come and go. It tends to be pretty persistent.
And there need to be all these other symptoms that are attached to it. It can’t just be pain. It’s generally, like you said, a persistent, ongoing fatigue where the patient doesn’t have very much energy at all.
And part of that is because they have very specific types of sleep disorders. They often have a hard time getting to sleep because they tend to have a racing mind. It’s a hypervigilance, almost bordering on anxiety.
DrDB: They’re always processing, always thinking. They can never shut their mind off. They’re always worried about what’s coming next. What’s the next problem? What’s the thing I have to do that I didn’t get to today? What bad is going to happen to my children, to my spouse? They’re real worrywarts, if you will. And that’s how their minds are sort of wired. And it’s stuck in that kind of loop. So they have a hard time getting to sleep.
But once they do get to sleep, they don’t go through all the normal cycles of sleep. They may sleep a long time. Some of them will sleep 12 hours, 14 hours. But they wake up, and they’ll tell you, “I wake up after 12 or 14 hours. I get up. And I feel like I never slept. I’m never refreshed or rejuvenated from sleep.” And it’s called unrefreshed sleep.
And when we put those people in sleep labs, we find out that they don’t go into the most restorative area of sleep which is known as delta-wave sleep or stage 3 and 4 sleep or deep sleep where you restore, and you rebuild, and you kind of get ready for the next day. They don’t go into those cycles of sleep.
So they can sleep a lot of clock hours. But they don’t have quality sleep. So therefore, of course, they’re more fatigued. And it’s a vicious cycle.
But there are also other things associated with most fibromyalgia patients that are all related to this problem in the central nervous system. It’s called a central sensitivity syndrome because you get sort of hyperactive stress responses, a hyperactive processing in the brain and in the spinal cord. And that’s why things like light touch, things that shouldn’t be painful, a little bit of pressure in areas is almost amplified to the point where you perceive it as pain.
But that also happens elsewhere in the body, like in the nervous system of the intestinal tract, called the enteric nervous system. So you get things like hyper responses in the gut to eating where you’ll feel distention.
You’ll feel bloating. You’ll feel a lot of gassiness, particularly after eating. Oftentimes, you’ll have constipation because of the slow movement in the bowels. Sometimes, you’ll get diarrhea or alternating constipation and diarrhea.
These are all things that will often be worked up by gastroenterologist. They don’t really find anything organically wrong. So they would tend to diagnose that patient as having irritable bowel syndrome or IBS. That’s almost 100% correlation with fibromyalgia and the person also meeting the criteria for irritable bowel syndrome.
It doesn’t work the other way around. A lot of people who have IBS don’t have fibromyalgia. But the vast majority of people with fibromyalgia, that really have classic fibromyalgia, have IBS.
And then the final component is anxiety, some level of mood disorder like mild to moderate depression.
Early Life Trauma and Fibromyalgia
And usually there is often sort of a history, when you really talk to these patients, of kind of a difficult or tumultuous early life. It could be abuse. It could be physical abuse. It could be verbal abuse. It could be sexual abuse. That’s the most damaging.
But it could just be being in an unsafe environment or an environment that was never steady, like moving all the time; being a child of divorce; acrimonious relationship between mother and father; a very authoritative, demanding parent, particularly a father figure to a young girl where she could never feel she would measure up, never be good enough no matter how well she did.
These people tend to be overachievers, very fastidious. They like to be in control of everything and in their environment. So therefore, they are high achievers. But they never feel they can meet the mark. Now, that’s not in every classic fibromyalgia patient. But it’s really, really much higher in their history than people who don’t have fibromyalgia.
So when the nervous system was young and pliable and what we call neuroplastic and it was learning to deal with its environment, if the person was stressed, felt unsafe, was under some abuse situation, the nervous system learned to sort of be hypervigilant, hyperprotective, and hyper responsive.
And then later in life, if the person is stressed again, maybe it’s by life or a bad relationship, or whatever it may be, then all of a sudden, this final emergence of classic fibromyalgia, IBS, anxiety disorders — they manifest themselves.
It’s a very, very interesting phenomenon. We don’t fully understand it. We know that it’s much more prevalent in women than in men. We don’t really understand why other than the nervous system of women generally reacts to stress differently than males.
Males in similar, challenging upbringings, let’s say, they go on to have dysfunction. But it’s not the same dysfunction. They tend to, for instance, be repeat abusers, doing the same things with their family or children. If it was substance abuse, they turn to the same substance abuse. And they tend to react more with easy frustration, acting out in some sort of physical violence or things like that.
Women don’t do that. They tend to develop things like anxiety disorder, fibromyalgia, and irritable bowel syndrome, which one can argue is a much healthier way to deal with it for themselves and society. But it’s still not great.
DrMR: As you’re saying that, I think about how analogous this is to the microbiota and how so much of early life, maybe the first 3-ish years of life, are so influential in colonization of our gut microbiotas and probably just our whole global microbiotas and how much of an impact that has for the rest of one’s life on their immune system and how a lot of the things that we end up doing for someone in their 30s, 40s, 50s are trying to adjust for the imbalances that formed at age 2 or 3 or what have you.
DrDB: That’s precisely right.
DrDB: Especially with the microbiota. That pattern sets in very, very early. And it’s very, very difficult to change it and dislodge it later on. You can get rid of a pathogen here or there or be a little bit strategic. But the body tends to want to go back to where it was for a very long time.
And yeah, geez. I never realized that stuff before I went into practice and observed it for myself because I wasn’t really taught that in any of my clinical training. That’s starting to get on the radar now.
There’s some really good research into that. And there are even great, popular books like the one — I think it’s called The Body Keeps the Score. Great book on adverse childhood events, adverse life distressing events, [inaudible Maul? 22:11] calls it, for instance.
And they’re doing the statistical analysis now on your level of stress, the type of upbringing you had, the kind of adverse life events you had early in life and how that relates to the emergence later of a whole host of chronic diseases from heart disease to cancer to diabetes to things that you wouldn’t even connect to such things. And it’s amazing. The statistics are really, really incredible.
And like I said, before I went into clinical practice, I never realized how early years are so formative. And I’m glad I recognized that before I became a parent myself. I think I was lucky in that I was an older parent. I was in school too long. And by the time I had kids, I was a little bit older, a little bit more mature, and was able to notice some of the things.
And geez, I’m far from perfect, but I’m a much better dad than I would have been if I had kids in my early or mid- or even late 20s and didn’t have the benefit of this information because before I went into practice, quite frankly, Michael, I never knew how much, as a parent, you can screw up your kid for the rest of their life with just basic dysfunctions that we probably learned from our parents.
Sometimes, it’s overt abuse and really horrible stuff. But a lot of times, it’s not. A lot of times, it’s just sort of dysfunctional behaviors that are getting perpetuated that have some devastating effects later on in life.
DrMR: Absolutely. And as I’ve been writing my book on the gut and the microbiota, the series of chapters that I think might has the most potential to change the whole health situation is the series of chapters on early life factors and the microbiota. Because if we can, as you said, David, be an educated parent and intervene the right way for our children, we’re going to set them up for a lifetime of health rather than a lifetime of dis-ease. I don’t want to say disease, per se, but dis-ease — not being that easy to feel well in some cases.
So I think that’s really important to understand. A lot of these things, we maybe can’t change fully at 30. But we can do a whole heck of a lot to set up our children for a healthy life if we can give them a healthy nurturing environment across the board.
And something else I just would like to chime in with. And this is just my own opinion on this. But sometimes, I see people getting almost obsessed with things that happened early in life. And they come in with a six-page report of how long they were breastfed for, the antibiotics they were given early in life. And it’s great information to have.
But if you’re coming in with this detailed analysis of what happened in your first 2 years of life but you’re 43 with IBS, really in my mind, we focus on the strategies for improving your gut health then and there. And there’s not a whole lot we can go back in time and unwind. But if we have a good mastery of the clinical tools for IBS, then we can apply those and help someone feel a lot better.
And a quick example of how that may play out — you were cesarean birth. You were not breastfed. And you had a lot of antibiotic use. This has thrown off the immune system in your gut. And now your gut is very, kind of, reactive to your microbiota.
So this type of person may never do great on a dietary approach that involves a lot of feeding of their gut bacteria. And they may just do better on a little bit of a lower-carb type diet or a lower-FODMAP type diet.
And it may be as simple as that for these people where the immune system formed a little bit out of balance. And now, we just have to make some slight environmental modifications to help keep their internal gut environment appropriate for the immune system that has kind of been hard wired in now.
DrDB: Yeah, I agree. And with things like the microbiota, it goes beyond parenting. It goes into whole public health. It goes into big food, big pharma.
DrDB: How medicine treats children, and what they bomb their immune systems with, and antibiotic use, and on and on and on and on. And how we train parents to overuse triclosan-laden antibacterial soaps, to not let the kids ever get dirty. We’ve really sent the immune system off the rails in a lot of different ways. And it’s coming home to roost.
And I do agree with the not sort of ruminating on the past to the level of it being continually a destructive presence.
DrDB: But sometimes, particularly with these disorders like fibromyalgia, IBS, if there are significant histories of abuse and things, you don’t wallow in it. And you don’t go back and relive it. That’s sort of older-school psychology.
And I’m not a psychologist. So I’ll put that right out there. I’m not a mental health professional. But I work with a lot of them who understand this type of — almost like a post-traumatic stress disorder type of variant issue.
And the new trend is forgiveness therapy. And it’s not meant to say if someone really abused you horribly that you just forgive them. But you have to come to terms with it yourself and kind of go beyond it and put it in its place, acknowledge it. Don’t let it become the scab that keeps getting picked. But somehow deal with it. And make an affirmation to move on.
And a lot of people think that requires some level of forgiveness of the person who may have inflicted it upon you. Even if it doesn’t excuse it, it’s sort of a place you go in your mind.
And I’ve had patients where they’ve actually had situations where they maybe were physically abused by their father or something. Or the father was yelling all the time. He was an alcoholic or something like that. And now, the father is an elderly person and is different. He has calmed down and is kind of remorseful. And they forge a whole new relationship. And there’s a lot of healing power in that.
Sometimes, it’s not possible. The person has not changed at all. Or they’re deceased. But the person has to move on. And a really skilled counselor or psychologist can help people do that.
But also, we use a lot of tools to help change the brain and the way it processes a lot of these things. So we use a lot of cognitive behavioral therapy techniques. So everything from things that patients do on their own from mindfulness meditation to yoga to tai chi to qigong to prayer. We try to find something that works for them.
But then we use sort of instrument-assisted cognitive behavioral therapy, like real-time EEG, and having the patient sort of trained in-office on how to modulate their own brainwaves to more calming, healthy brainwaves.
And then move them off that because we don’t want them dependent on coming into the office or on something that they have to come for treatment. We’ll move them off to even — there are great devices that are made for iPads and iPhones and things like that which do heart rate variability which do EEG, which the patient can use on their own.
Treatment of Fibromyalgia
So we combine all of these things. We combine a lot of good circadian rhythm therapy, which is respecting the light/dark cycles throughout the day, good sleep hygiene to improve sleep.
And then we also attack it on the biochemical side, whether it’s with modifications to their diet, the key use of nutritional supplements, nutraceuticals, particularly those that modulate key neurotransmitters, which are aberrant in this condition, as well as the psychological or counseling component of it.
So it’s really a comprehensive approach to dealing with this disorder. It’s not something that you can fix with a magic pill, whether it’s Lyrica or Cymbalta or any of the FDA-approved drugs for fibromyalgia — which, by the way, there’s never been a drug developed to treat fibromyalgia from the ground up. These are repurposed, retread drugs.
So of the FDA-approved drugs for fibromyalgia, two of the classes of drugs are repurposed antidepressant drugs. And one of them is a repurposed antiepileptic drug. And the data on outcomes on them are not that impressive.
So there’s no great answer in pharmacology. There are some things that can help in some patients for sure. But it’s not a cure. And the approach needs to be much more comprehensive than that.
DrMR: It’s unfortunate that sometimes it seems when a drug is being repurposed, probably because of the allure of the financial gain of being able to repurpose a drug, it gets pushed through to approval without really the best data behind it.
And it’s, of course, one of the criticisms of the current pharmaceutical model that sometimes the financial incentive becomes too strong. And then we end up with drugs that really shouldn’t be approved for X, Y, or Z condition.
DrDB: Yeah, well, in the case of these retread drugs, I think the approval process is not as rigorous because they’re already approved. They’re just approved for a different reason. So they already think, “Well, they can’t be that bad,” because they’re out there being used for depression or for anxiety or for epilepsy. This is just an off-label use that has come into vogue with physicians based on anecdotal experience.
And then they run them through another process to try to get them — they rename them. And then they get approved for that specific use. And it’s almost like they got a whole new product out of it. And they didn’t have to go through the whole development process.
So it’s a really popular thing for the drug companies to do because it’s a cheap way to get a new drug on the market.
DrMR: Yeah, I’m glad you made some of those comments about treatments. And I’d like to expand on treatment options a little bit further in just a moment. But there’s one thing I’d like to provide as maybe an analogy for our audience because I know we talk a lot about digestive conditions. And we’ve been hearing more and more about the importance of early-life psychological and emotional trauma.
And the way I’m starting to look at this is, in terms of how we can personalize these treatment recommendations, for some people who have had early-life gut trauma, they may need a long-term probiotic or a diet that’s slightly different than the norm, like a low-FODMAP diet.
People who have had early-life emotional or psychological trauma may need some ongoing therapy or meditation or tai chi or qigong that’s similar to offsetting the early-life gut trauma. But this is working toward offsetting the early-life emotional trauma.
And so I think it’s just important for us all to keep that in mind: The same way that not everyone responds the same to diet, some people may need more stress reduction, more sleep, more quiet time, more meditation, more relaxation than others.
And so I think for both clinicians and just the healthcare consumer, it’s important to keep that in mind so that we can all continue to get to the individual recommendations that we need to feel our best.
DrDB: Absolutely. I couldn’t agree more.
DrMR: And then to move us now further into treatment — just one or two quick notes before you expand on — because I really want to get your clinical takeaways. There are several different treatment options, I’m sure. But what seem to be some of the most effective?
Just a couple things that go through my mind that I think would make it easier for a doctor who specializes in fibromyalgia is if you try to lay a little bit of groundwork for them. And of course, David talked about the gut connection here. And while it seems like the gut connection isn’t incredibly clear, certainly I have seen a lot of patients, of course, improve immensely after improving their digestive health.
So if you could look into some of these things and try to at least weed out some of these symptoms and cover some of the basics with your gut health and your lifestyle and your diet, then I’m assuming it’ll be easier for the doctor that you go see to sort all this out because you’ve already parsed out some of the variables. But that’s my two cents from a somewhat gut-centric view on this.
David, tell us a little bit more about treatment options. And I know that there’s a difference between more of a functional medicine treatment paradigm and a conventional medicine paradigm. So can you give us maybe some of the broad strokes with these two different approaches?
DrDB: Yeah, the first thing is — what we learned in medical school, chiropractic school, whatever, right in the beginning — is proper diagnosis is half the cure. You have to know what you’re dealing with. So that’s the first thing.
You’ve got to know, is it this central pain processing disorder with central sensitivity, this thing called classic fibromyalgia? Or is it something else that’s causing the symptoms? If it’s a thyroid problem, you’ve got to figure that out. And you’ve got to treat the thyroid problem.
DrDB: If it’s an energy production/mitochondrial issue, you’ve got to figure that out and treat that. If it’s a musculoskeletal problem, you’ve got to figure that out and treat that appropriately. Because you can’t treat all of them the same because you’re calling it all the same disorder and think you’re going to get good outcomes. It just doesn’t work that way.
But I do think there’s value in starting foundationally like you’re talking about. Even in my book The FibroFix, the first thing the patient or the reader is asked to do is to do this 21-day foundational program. And that involves cleaning up their diet so it’s less inflammatory, so it’s less antigenic. They’re pulling out the gluten-containing grains, the dairy, and all.
Why? Is it because that’s a cure for fibromyalgia? No, it’s just getting them less inflammatory, less reactive. Their immune system less jacked up. And they’re going through this 21-day detox kind of program. And once again, it’s not a cure for fibromyalgia. But it’s setting the stage for recovery by rebooting their metabolism, giving their mitochondria what they need to make energy, getting them less inflammatory.
And at the same time, get them to safely start moving again. So incorporating motion and mobility back into their lifestyle. I give very, very specific instructions with pictures and everything else on how to do that safely without exacerbating your condition.
And then also starting to do these sort of stress-relieving, neurological system-rebooting therapies — whether it’s progressive relaxation, deep breathing, tai chi, any of those kinds of things that are calming — while they’re reading the book and trying to figure out through various scenarios and questionnaires and gateways that allow them to figure out, does it really sound like I have this classic fibromyalgia thing? Or might I have a problem in one of these other what we call buckets — other medical conditions or functional problems or musculoskeletal problems?
And we cover all of those. And then we lead people down treatment recommendations and pathways that are specific to their situation. Because you have to get specific, or people don’t get better.
Now, the gut thing, I agree with you. The gut is a very important thing. Like Mechnikov said, “Death begins in the colon.” If you have really bad gut health, you’re not going to be healthy.
On the other hand, I don’t think the microbiota is the root of every disease known to mankind. And I don’t think if we fix the microbiota there’ll be peace in the Middle East.
DrDB: You know what I mean?
DrDB: It’s become the cause for everything.
DrMR: Totally agreed.
DrDB: I don’t think that’s the case. I think a lot of people don’t have great microbiota. And they’re not very healthy. How much the microbiota is contributing to that, how much other things are contributing to that, we just simply don’t know yet.
We certainly know that certain aberrant patterns of the gut microbes are associated with higher incidence of different diseases, particularly autoimmune diseases. We don’t know yet why.
There are a lot of theories on even causality of microbes overgrowing in the gut, causing autoimmune reactions. We know certain bugs have certain proteins on them or certain structures that look like the structure of the body being attacked. And we think it’s a molecular mimicry crossover reaction. I don’t want to get too deep in the weeds.
A lot of people have talked about aberrant microbiota in fibromyalgia, for instance. Okay, well, it’s true. If you have dysbiosis, really bad microbiota, and they’re producing a lot of toxic metabolites, or they’re expressing these LPS (lipopolysaccharide) molecules, or they’re expressing proteins or peptides that the body’s immune system is reacting to, you can become more inflammatory. You can get more leaky gut. And then mites and these LPSs get across the gut lining.
And then there are even theories that they can transmit through the vagal nerve to the brain and create a hyperactivation of the brain’s immune system, which we call the microglia.
And there is some evidence now that people with persistent achiness or global pain have microinflammation in the level of the brain, in the microglia. And this might be fueled by problems in the gut.
But we do not know by any stretch of the imagination that that is what’s going on universally in fibromyalgia patients. In fact, there’s no data to support that.
It seems like this gut-brain axis thing inflaming the microglia might be just yet another issue or variant of a problem that can cause someone to be achy all over, to have fatigue, and to have cognitive problems and anxiety and what have you, but it seems that it’s a distinct entity from those people who have this classic fibromyalgia who have a lot of stress in upbringing and abuse histories and have all these other issues.
Because one doesn’t explain it. The gut-brain axis thing doesn’t explain all the symptoms of fibromyalgia and all the central sensitivity syndrome. It certainly doesn’t explain why it’s way more prevalent in women than it is in men, for instance.
DrDB: But I do think there is something there. There’s meat there. I don’t know that that’s the classic fibromyalgia. It might be just another confusion point on getting people diagnosed with fibromyalgia.
But everyone wants to find the universal cause and cure. So everyone says, “Well, that’s the cause of fibromyalgia,” just because there’s some evidence saying that it might be involved. I think we need to put the brakes on it a little bit and look at these things and thoroughly flesh them out.
On the other hand, I don’t think there is anything ever wrong with improving someone’s gut health. I think it’s only going to help the individual, help them be healthier. Whether it ultimately is the fix for their fibromyalgia diagnosis, you never know. I don’t know.
But it’s certainly part of what we do. We map the GI microbiota. We try to optimize it. We certainly try to get rid of any opportunistic or pathogenic organisms that we know are associated with chronic disease, particularly chronic inflammatory conditions, and take that off the table.
But we’re doing the other things too. We need to thoroughly investigate their thyroid function way beyond the kind of investigation that’s done by the family practitioner.
We need to thoroughly look at the mitochondrial function and how the cells make energy because if that’s wrong, they will have almost all the symptoms of fibromyalgia, certainly enough to get the diagnosis. So for that, we turn to testing like organic acid tests.
And then we’re actually doing good, hands-on physical examination to find out, do they really have structural issues? Do they have trigger points in myofascial pain syndrome versus tender points of fibromyalgia?
So it takes someone who’s kind of skilled across these different possible conditions. And that’s where I feel very fortunate in my training in both physical medicine and in internal, integrative, functional medicine. Because I really call on all of that when I’m working through these patients in particular because they can really be challenges.
And if someone really does have classic fibromyalgia, there are a lot of things involved in the aberrant brain response. Now, we don’t know cause or effect here. But we know they generally have very low central nervous system serotonin levels.
So their brain serotonin is low. Their cerebrospinal fluid serotonin is low. Therefore, their substance P (a peptide that modulates pain perception) is elevated. So they’re hyper perceptive to pain, number one.
If they’re low in global serotonin or central serotonin specifically, they won’t sleep well. They won’t go into stage 3 and 4 sleep. They’ll have unrefreshed sleep. They’ll tend to have depression. They’ll lend toward anxiety, which is all a part of this syndrome. And if their gut serotonin is low, they will have constipation IBS.
So the serotonin model as a component of the dysfunction does hold up to scrutiny. So we do test that. And we often are augmenting serotonergic function with things like serotonin precursors like 5-hydroxytryptophan or tryptophan.
And some of the main medications that are used in fibromyalgia are serotonin modulators. They are selective serotonin norepinephrine reuptake inhibitors. So sometimes, we work with them. But we’re very careful about the patients we select to use those agents. I really prefer to use precursors to do that.
But we also use things that calm this hyperactive, hypervigilant, sympathetic dominant nervous system. So we use calming neurotransmitters like GABA. We’ll use calming nutraceuticals and nutritional substances like L-theanine, onositol, magnesium threonate. We’ll use calming adaptogenic herbs like ashwagandha (or Withania somnifera). We’ll use GABAergic botanicals like valerian, passion flower, chamomile, things like that.
So we’re looking to alter the biochemistry for sure. But we’re also looking to these other things I talked about with the daily practices that create calming. They’re super important. The sleep hygiene, the circadian rhythm stuff is really important. And often the counseling is actually very, very important for these people. You’ve got to put it all together for them.
DrMR: Very well said, David. And certainly you can tell from your description there that you’re looking at this in a very global and holistic fashion. And I love the fact that your book is kind of starting with a foundations-up approach rather than just going into esoteric and exciting treatments. You’re really laying the foundation and then working your way up. I think that’s a very sound clinical process to go through.
And I’m excited for people who need it to have access to this book because it sounds like a great guide to walk people through how to personalize a lot of these different available treatment options. Because certainly you ran through a number of different things which I would anticipate would be very hard and probably very expensive for someone to go through on their own without some sort of guide or map to select them through that. So that, I think, is terrific.
DrDB: I wrote the book from the perspective of making the patient not a doctor, but knowledgeable enough to where they know when they’re getting good, comprehensive care or not.
DrDB: I do think patients with this kind of problem would do better to have someone who is in their corner who is trained in these things. So I give a lot of resources in the book on how to find a trained functional, integrative medicine practitioner to help them as their ally. And if they can’t find one close to them, I give suggestions on how to bring information to their conventional provider and find one who’s open-minded and doesn’t have their ego in the game.
DrDB: If they’re full of ego and arrogance and they won’t listen to anything you say or be open to any suggestion that you have, then you need to find another provider. That’s just how it goes. There’s a market out there. Find one that’s doing the right job for you.
But ultimately, I give enough information for the patient to start to figure out, “Hey, maybe my neighbor told me I have fibromyalgia. Or maybe another fibromyalgia patient told me I had it. Or maybe my family doctor, maybe even my rheumatologist told me I had fibromyalgia. But looking at all of this stuff, that doesn’t sound like me. It’s not lining up with me. And I think I’m more over in this camp here.”
And the book really helps you determine those things and then take action steps, everything you can do on your own to tilt the scales in your favor and then help you find the right kind of provider if you need it to help you over the goal line which means, what kind of test do you consider having them order? What kind of other treatment options are out there for them to look into?
And I wrote it for that purpose. And I’m getting great feedback. It’s been out several months. But I hear from people all over the world every day, literally. So it’s very rewarding.
DrMR: And where can people learn more about the book or other information on you if they wanted to look at other writings that you’ve had or speaking that you’ve done? Where can they get more?
DrDB: Oh, thank you, yeah. A couple of places. If they want to learn more about the book, which is called The FibroFix, they can just go to FibroFix.com. There are all kinds of resources there.
There’s a media tab with all kinds of lectures that I’ve done, TV appearances, interviews. You can see some of those. There are papers I’ve written both in professional medical journals and just direct-to-consumer type of articles.
There’s a free preview of the book, of the introduction and first chapter. There’s a free paper I wrote on helping yourself determine if you have fibromyalgia. And there is a way to just purchase the book right from that site. It’ll basically launch you out to the e-vendor of your choice — Amazon, Barnes and Noble, Books-A-Million, what have you.
Then you can come back to the site and put in your receipt and validate your purchase of the book. And it unlocks a whole bunch of other free resources. So you can check that out.
Also, in June, I did The FibroFix Summit, where I had about 40,000+ people on it from all over the world listening to me basically interview 35 experts from all around the world on fibromyalgia and a lot of the conditions that get misdiagnosed as fibromyalgia.
So if you really want to take a crash course and really know everything about fibromyalgia — and you’ll probably know more than your doctor knows — read the book, number one. But you might want to consider checking out the FibroFix Summit. Even though it has run already, you can still access it digitally perpetually. You can learn more at FibroFixSummit.com. Just FibroFixSummit.com.
And then finally, my main mother ship website is just DrDavidBrady.com. And that has media tabs with all kinds of resources on there. Join my email list. And we send out blogs on all kinds of great information.
If you have a particular interest in fibromyalgia, I would join the newsletter or the email list on the FibroFix site because that’ll get you information specific to fibromyalgia.
And I have an appearance calendar on there. People can learn about where I’m speaking. And they can learn about my private practice if they should want to come see me in my practice in Connecticut. And then that’s about it.
DrMR: Well, I can tell you’re a busy guy. That’s for sure.
DrDB: Well, I try. I inflict it on myself. So I need to say “no” more often. But I like everything I’m doing. So that’s invigorating. It’s tiring at times. But it’s invigorating, as well.
DrMR: Yeah, same here. It’s a labor of love for sure.
DrDB: Yeah. Great.
DrMR: Well, David, thank you so much for taking the time. This was a great conversation. I really appreciate it. Check out David’s work. As you can clearly hear and see, he’s got some great work out there that is helping a lot of people.
So David, until the next time we cross paths, I’ll look forward to seeing you. And thank you again for all the work that you’re contributing to the field.
DrDB: Hey, thank you. I appreciate it.
DrMR: Absolutely. Take care, David.
If you need help determining if you have fibromyalgia, click here.