Dicken Weatherby, ND
“Fibromyalgia” is a broad diagnosis, indicating a very real set of debilitating symptoms, but which can arise from a myriad of functional scenarios. One of the most important things to consider when searching for treatment options for fibromyalgia or any other process of dysfunction is that there may be a variety of influences contributing to the symptoms. Looking for the causal chain is of primary importance in determining the course of action each person needs to take to get well. Food selection, gut integrity, adrenal function and metabolic support are the first areas to consider. Heavy metals, chemical sensitivities, hypothyroidism, bacterial/parasitic/fungal/viral infections and hormonal imbalances also are significant influences that could be disrupting the whole process of cellular metabolism as it relates to lactate buildup, energy production, muscle pain, poor sleep and fatigue. Proper testing can identify many of these imbalances and help to determine which interventions are likely to be most effective for each patient.
The following lab tests are recommended to get a broad view of patients’ overall functional health:
- Comprehensive Blood Chemistry Panel and CBC I will focus on this later and in more depth than the other tests, since this is my area of expertise.
- Intestinal Barrier Function Test This test was developed by Dr. Vojdani and is designed to evaluate the mucosal lining of the intestines. The mucosal barrier is found in the small intestines, lung, sinuses, urinary tract, etc., and has many functions. It acts a protective barrier preventing “toxins” from entering the circulation. These toxins can be anything from viruses or bacteria to chemical exposures or food sensitivities, and are considered antigens. Ideally, the mucosal barrier is healthy, keeping antigens out while allowing beneficial substances into the circulation to supply nutrients to the cell. If toxins are getting through a compromised barrier, fibromyalgia symptoms can result.
- Cortisol/DHEA Levels An imbalance in the Hypothalamic-Pituitary-Adrenal axis (HPA axis) is strongly associated with the fatigue and body pains associated with fibromyalgia. People with fibromyalgia may present with different forms of adrenal imbalance. Studies have shown that people with fibromyalgia have high levels of cortisol on salivary testing (Catley et al., 2000), while other studies have shown that fibromyalgia is associated with adrenal exhaustion and low cortisol and DHEA output (Dessein et al., 1999). My recommendation is to run an adrenal stress hormone profile on all patients with fibromyalgia.
- Comprehensive Thyroid Profile A sub-clinical thyroid issue can be a major factor in fibromyalgia. An early study of the link between thyroid hypofunction and fibromyalgia showed that 75% of the study group with fibromyalgia was hypothyroid (Wilke et al., 1981). A later study showed that a majority of patients with fibromyalgia had either thyroid hormone deficiency or cellular resistance to thyroid hormone (Neeck and Riedel, 1992). Make sure to test for thyroid antibodies, not just TSH. Autoimmune thyroiditis is actually the most common thyroid condition, manifesting as hypothyroidism more often than not, yet TSH levels can be normal at times in these cases.
- Comprehensive Stool Exam Fibromyalgia is associated with candida, leaky gut syndrome and other bacterial, fungal or parasitic infections in the gut. Ordering a comprehensive stool assessment may provide that one piece of the puzzle that can explain fibromyalgia symptoms. If you suspect candida, you may also want to order antibody assays to diagnose a chronic candida infection. Depending on the results of the stool analysis, you may want to order an Intestinal Permeability Assessment test to rule out leaky gut syndrome.
Reading the Blood Chemistry Panel and CBC
When I suspect fibromyalgia, one of the first tests I turn to is a chem panel plus CBC. I look for what it tells me about the patient’s gut health, inflammation, pH balance and metabolic disturbance.
- High uric acid levels are a strong indicator of potential inflammation and metabolic disturbance. Chemical and physical stressors are the most common cause of raised levels, indicating reduced tissue oxygenation. While many associate high uric acid with gout, it can often be an indicator of a less obvious trend, what I call “sub-acute gout.” This category includes fibromyalgia, a diagnosis that many apply to inflammatory conditions that don’t yet fall under classical gout. While conventional laboratory ranges for uric acid are 2.2-7.7mg/dL, I prefer to see levels stay between 3.5 and 5.9mg/mL for men, and 3.0-5.5mg/dL for women.
- With suspected fibromyalgia, I also look for a high percentage of basophils. The basophil count is used to study allergic and inflammatory reactions. With inflammation, basophils deliver heparin to the affected tissue to prevent clotting, so a high presence of basophils can point to a condition like fibromyalgia. While the conventional reference range for basophils is 0%-3%, in my blood chemistry system, I consider anything above 1% as high.
- If basophils are high, you might also expect to see increased alpha1 globulin and alkaline phosphatase. The latter can be an indicator of inflammation in the digestive tract.
- Decreased CO2 is another pattern associated with fibromyalgia is. CO2 is involved in acid-base balancing, so it is easy to see its role in hydrochloric acid neutralizing and, therefore, gut health and digestion. I consider optimal levels of CO2 to be 25-30mEq/L. Low levels can indicate a metabolic acidosis, which can be part of the fibromyalgia profile.
- Low CO2 can show up along with an increased anion gap, another indicator of metabolic acidosis, and decreased serum or RBC magnesium. I consider anion gap levels above 12mEq/L as elevated. I like to see magnesium levels above 2.0mg/dL. Increased anion gap and decreased magnesium levels would fit with fibromyalgia.
I also suggest taking a look at C-reactive protein and sedimentation rates, which are used to detect systemic inflammation, and antinuclear antibodies to test for lupus.
In terms of treatment, restoring gut health is usually my first priority, and more often than not, it addresses the cause of the patient’s fibromyalgia. There are many naturopathic approaches to this, from homeopathy to restoring gut flora to herbal support and beyond. As mentioned, a number of patients with fibromyalgia have experienced relief on a candida control diet. Another approach is to address the inflammatory-related issues. Basic considerations that come to mind include a low-purine diet and elimination of inflammatory substances, such as caffeine, trans fats and alcohol. Suggestions for supplemental therapies might include B-complex, folic acid (which prevents crystal formation associated with sub-acute gout), organic lithium (which breaks down crystals), magnesium, cetyl myristoleate, S-adenosylmethionine (SAMe) and malic acid, a Kreb’s cycle intermediate that plays a role in the production of ATP without the buildup of lactic acid. Lactic acid buildup is associated with the muscle pain seen in fibromyalgia.
If these tests come back in optimal range, look to the other potential causes of fibromyalgia, including thyroid or adrenal issues, leaky gut syndrome, heavy metals and bacterial/parasitic/viral/fungal infections.
Dicken Weatherby, ND is based in southern Oregon. A graduate of NCNM, Dicken is co-author of the bestselling book Blood Chemistry and CBC Analysis – Clinical Laboratory Testing from a Functional Perspective. He has self-published seven other books in the field of alternative medical diagnosis, has created numerous information products and runs a number of successful Web sites (www.BloodChemistryAnalysis.com, www.Health-E-Marketing.com and www.StrawBale.com). He is involved in research, writing and consulting, and teaches functional diagnosis seminars in both the U.S. and his native country, the U.K.
REFERENCES
Catley D et al: A naturalistic evaluation of cortisol secretion in persons with fibromyalgia and rheumatoid arthritis, Arthritis Care Res Feb;13(1):51-61, 2000.
Dessein PH et al: Hyposecretion of adrenal androgens and the relation of serum adrenal steroids, serotonin and insulin-like growth factor-1 to clinical features in women with fibromyalgia, Pain Nov;83(2):313-9, 1999.
Wilke WS et al: Hypothyroidism with presenting symptoms of fibrositis, J Rheumatol Jul-Aug;8(4):626-31, 1981.
Neeck G and Riedel W: Thyroid function in patients with fibromyalgia syndrome, J Rheumatol Jul;19(7):1120-2, 1992.
