Adrenal & Cortisol Status in Fibromyalgia: H-P-A Dysregulation

Fibromyalgia patients have stronger, measurable stress responses as measured by increased stress signals secreted by the pituitary to recruit more stress hormone production from the adrenals, ie the brain signals the stress system to activate.

In contrast, the adrenal glands demonstrate less ability to perform under stress and less ability to bounce back when stimulated.

The studies below substantiate what Fibromyalgia patients already know and live and what we often see in clinical practice – Fibromyalgia patients experience events much more intensely [ catastrophic ideation], and stress is very likely to induce anxiety, hypoglycemia and increase physical symptom burden like pain.

From a physiologic and body systems interrelationship perspective in functional medicine, there is so much more we do for Fibromyalgia patients than pain control, anti depressants, sedatives and sleep medicine. When you help compensate for neuro-endocrine dysregulation, sleep, mood, pain and sense of well being is much improved, a whole layer of medications become redundant, and you can pay more attention to the items that bring tangible lasting change and quality of life.

 

 

 

The low-dose dexamethasone suppression test in fibromyalgia.

This study observed increased sensitivity to glucocorticoid feedback, manifested at the adrenal level, in FMS. The interesting part of this study is that ACTH was normal after dexamethasone suppression testing, indicating normal Hypothalamic-Pituitary-Adrenal axis function, and that there was in internal negative feedback inhibition at the adrenal level or adrenal suppression as compared to healthy controls. Fibromyalgia patients adrenals have less bounce-back, is the final observation here.

 Enhanced reactivity of interleukin-6 levels and reduced glucocorticoid sensitivity in patients with fibromyalgia.

In this pain pressure threshold [stress] test on fibromyalgia patients, cortisol levels increased three fold, WITHOUT an in crease in ACTH. This is highly irregular and abnormal, indicating that the hypothalamic control is absent and that there is an endogenous organ level control over adrenal secretion of cortisol.

Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia.

This study explains very clearly, at the hormonal level, why Fibromyalgia patients have increased sensitivity to stress, lower stress tolerance, anxiety with stress, and need to eat a low carbohydrate diet that resembles the Paleo diet.

Studying the adrenal control system in Fibromyalgia patients, the effects of Corticotropin-releasing hormone (CRH) and insulin induced hypoglycemia in patients with Fibromyalgia caused dysregulation of the HPA axis in patients with Fibromyalgia.

Hypocortisolemia, hyperreactivity of pituitary ACTH release to CRH, and glucocorticoid feedback resistance.  There is a reduced containment of the stress-response system by corticosteroid hormones is associated with the symptoms of Fibromyalgia.

 

Werner Vosloo ND, MHom

 

 

 

 

Adrenal & Cortisol Status in Fibromyalgia: Cortisol Receptor Resistance

In addition to lower cortisol levels in the morning and throughout the day [in patients who really need higher levels to support them through their daily stress and pain], Fibromyalgia patients demonstrate decreased cortisol receptor sensitivity. This adds insult to the injury.

To achieve the same cortisol-mediated stress, blood sugar and energy metabolism support, fibromyalgia patients need higher levels of circulating cortisol than average patients. Lower cortisol levels plus compromised cortisol receptor sensitivity accounts for much of the symptom load exhibited by fibromyalgia patients, esp as relates to day-night rhythm problems, increased perceptions of stress and decreased stress tolerance with anxiety during stressful situations.

Yet again, this situation need not be an obstacle to better health. Moderately increasing cortisol levels through micro-dosing with appropriate hormone therapy makes the world of difference with anxiety, sleep and day-to-day function.

 

Evidence for an association between an enhanced reactivity of interleukin-6 levels and reduced glucocorticoid sensitivity in patients with fibromyalgia.

Reduced and disturbed glucocorticoid sensitivity was observed in fibromyalgia patients. The very interesting observation in this study, in addition to the disturbed cortisol receptor function, that fibromyalgia patient’s ACTH did not increase during pain pressure point threshold testing: cortisol did increase 3 times [from the pain of the test] and IL-6 increased 4 times [an inflammatory hormone that is problematic in FMS].

Glucocorticoid sensitivity in fibromyalgia patients: decreased expression of corticosteroid receptors.

Fibromyalgia patients exhibited changes in glucocorticoid receptor (GR) affinity and disturbances associated with loss of hypothalamic-pituitary-adrenal (HPA) axis resiliency. There is a lower expression of corticosteroid receptors  in FM patients when compared to healthy controls.

Changes in salivary cortisol and corticosteroid receptor-alpha mRNA expression following a 3-week multidisciplinary treatment program in patients with fibromyalgia. 

“…..Increased resiliency and sensitivity of the stress system is probably related to stimulation of Glucocorticoid Receptor-alpha synthesis by the components of the treatment.”     The conclusion of this study is that due to changes in cortisol receptor sensitivity, Fibromyalgia patients improved in many respects, including pain threshold and resilience of the stress system.

 

Werner Vosloo ND, MHom

 

 

 

Adrenal & Cortisol Status in Fibromyalgia: Not Enough Cortisol

Fibromyalgia is characterized by a lack of energy, drive & motivation and a general lack of “get-up-and-go”. Mornings are pretty bad, you feel more tired than when you went to bed.

Cortisol levels in the mornings and also throughout the rest of the day are much lower than you need to get through the day’s stress, fatigue and pain.

Adrenal dysfunction is strongly responsible for this lack of restorative sleep or not feeling rested in the morning.

Cortisol is a key adrenal hormone that is essential to maintain healthy:

  • Blood glucose levels   
  • Converting fat, protein and carbohydrate to maintain blood sugar  
  • Immune balance and healthy immune responses    
  • Endogenous anti-inflammatory [more allergies and inflammation when cortisol low]  
  • Blood Pressure
  • Heart and blood vessel tone and contraction
  • Central nervous system activation and motivation
  • Healthy and happy optimistic mood  
  • Stress tolerance
  • Sleep and day-night cycles

Just like thyroid hormone, it is very safe and easy to correct low cortisol levels.

Evaluation consists of symptomatic evaluation and laboratory investigation of cortisol levels at 4 different times of the day, or total cortisol production for a whole day.

 

Studies to read:

Comparison of the cortisol awakening response in women with shoulder and neck pain and women with fibromyalgia.

Fibromyalgia patients have lower cortisol levels than woman with shoulder and neck pain. Fibromyalgia patients have more symptom burden: pain levels, sleeping problems, perceived stress, and psychological problems related to their condition.

 

Fibromyalgia syndrome is associated with low cortisol.

Fibromyalgia patients had significantly lower cortisol levels during the day, most pronounced in the morning . As expected, Fibromyalgia patients reported more pain, stress, sleeping problems, anxiety, and depression.

This confirms dysfunction in the hypothalamus-pituitary-adrenal axis in Fibromyalgia patients, with generally lower cortisol values, most pronounced upon awakening.

 

Delineating Psychological and Biomedical Profiles in a Heterogeneous Fibromyalgia Population Using Cluster Analysis 

An analysis of various subgroups of Fibromyalgia patients indicated that the more symptomatic patients with more severe pain and disability had the lowest levels of cortisol.

Childhood abuse and family dysfunction is reported in 64% of fibromyalgia cases.

When present in the history, there was a greater tendency to a flattened day-night cortisol curve with lower cortisol production.

 

Werner Vosloo ND MHom

 

Rheumatoid Arthritis – low zinc and fully leaded!

Several studies found an inverse correlation between Zinc (↓) and toxic metals (↑) in arthritis patients. Taking antioxidant micronutrients, particularly a zinc supplement, may protect against the development of rheumatoid arthritis.

In addition to giving focused nutrients to reduce abnormal biochemistry and inflammation, you also have to remove the undesirable elements. In this case, there is more toxic metals like lead, arsenic and cadmium in patients with arthritis than in the average person.

Chelation is a very effective and safe process practiced since the 1940’s to remove undesirable metals from the body, which usually improves more than only the targeted disease.

In this instance, lead, arsenic and cadmium are known mitochondrial energy production inhibitors, linked to chronic fatigue syndrome, cardiovascular disease, auto-immune disease, thyroid and other hormone problems.

Action item: If you have rheumatoid arthritis, ensure you take appropriate, condition focused nutrients AND ask a board certified natural or integrated doctor to test if you have excessive toxic metals in your system that can fuel the disease along.

 

Rheumatoid Arthritis: low zinc, high lead, cadmium & arsenic

Anti-inflammatory neutraceuticals  as therapy for rheumatoid arthritis.

Interaction between zinc, cadmium, and lead rheumatoid arthritis subjects in relation to controls.

A pilot study on zinc levels in patients with rheumatoid arthritis.

Psoriasis – It’s More Than Skin Deep

Psoriasis – It’s More Than Skin Deep

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This August is Psoriasis Awareness Month, and a good time to become more familiar with this diagnosis which affects millions of Americans. Despite being a relatively common condition, many of us hold onto the false assumption that it is only skin deep. Psoriasis, in all of its forms, actually goes much deeper, to the level of the immune system. Interested in knowing more? Read on for an introduction to this autoimmune disorder, related health concerns, and how it can be treated.

 

Psoriasis – An Immune System in Distress
Like other Autoimmune (AI) diseases, Psoriasis is a chronic inflammatory condition caused by a dysfunctional immune system. Though psoriatic presentations may differ, they are caused by the same underlying imbalances that exist within all AI diseases.

Our immune systems are designed to create antibodies which tag harmful foreigners such as viruses & bacteria so that our white blood cells know where to attack. In AI disease, the body loses the ability to differentiate between a true foreigner, and our own tissues. As a result, antibodies toward our own cells are produced, directing our immune system to target tissues and organs. Inflammation develops, followed by tissue destruction and dysfunction within the body.

While there is no single cause for AI disease, there are suspected triggers that may lead to development of auto(self)-antibodies. Additionally, there can be a genetic predisposition to developing an AI disease. Common triggers that may increase the risk for autoimmune disease include:
     Chronic Infections (viral, bacterial, fungal & parasitic)
     Continuous Allergen Exposure (including food sensitivities)
     Chronic Heavy Metal Toxicity
It is especially important to limit these potential triggers in your daily life if you have a known family history of autoimmune diseases.

Psoriasis In Its Many Forms
Plaque Psoriasis
The most common form – Plaque psoriasis occurs when overactive inflammatory immune cells create cytokines (proteins that act as immune cell signals) which target keratinocytes in the skin. The result is an inflammatory, raised plaque which appears red and exhibits a silvery build up of dead cells. When removed, pinpoint bleeding known as Auspitz’s Sign is seen. Plaques tend to arise on the outer aspects of joints (knees, elbows) but can occur anywhere on the body. They may also arise in areas of recent skin trauma.

Psoriatic Arthritis
Approximately 30% of patients with Psoriasis will develop a type of Psoriatic Arthritis. This painful and debilitating condition is categorized as a spondyloarthropathy, meaning it is similar in symptoms and presentation to arthritis disorders such as Ankylosing Spondylitis, & Reactive Arthritis. The joints may become very swollen, red & extremely tender to palpate. The arthritis may develop on one or both sides of the body, and may affect the spine. Types of psoriatic arthritis include Symmetric, Asymmetric, Distal Interphalangeal predominant (joints closest to the fingertips), Spodylitis (affecting the spine) and Arthritis Mutilans (rare, but severely debilitating).

Additional Forms
Though plaque psoriasis is more commonly seen, individuals may also be diagnosed with:
Guttate Psoriasis (thinner, smaller lesions that are greater in number)
Inverse Psoriasis (red, smooth lesions that arise in body folds)
Pustular Psoriasis (red, non-infectious pustules develop on the skin)
Erythrodermic Psoriais (widespread, poorly defined red lesions with pain & peeling)

How is Psoriasis Diagnosed?
Diagnosis of psoriatic skin lesions can be based on appearance, and may include biopsy for confirmation. Additional testing for other psoriatic presentations may include X-rays or synovial fluid testing for joint symptoms, and blood tests to assess for inflammation (ESR, CRP) or a genetic component (HLA-B27). Further testing may be recommended to effectively rule out other potential causes.

Treatment – Conventional & Alternative Approaches
Conventional treatments for psoriasis are primarily suppressive, meaning they cover symptoms by blocking the activity of the inflammatory cells without addressing the underlying causes for immune dysfunction. For skin changes, these treatments usually consist of topical creams, whereas systemic immunosuppressive drugs are more commonly prescribed for arthritic symptoms. These medications can be of great value for symptom relief and interruption of tissue destruction, but it is equally important to treat the underlying imbalance.

An in-depth investigation of potential triggers is often indicated, followed by avoidance of those which are found to be significant. Even the basic removal of dietary and environmental allergens can help to decrease symptoms and decrease the number and duration of treatments needed. In addition to the chronic infections, allergens and heavy metals noted above, you should also speak with your healthcare provider about mental & emotional stressors, gastrointestinal dysbiosis, medications, and nutrient deficiencies. Each of these may contribute to auto-immune activity and aggravation of your psoriatic symptoms.

Potential treatments worth investigating for longer-lasting relief and healing include:
Heavy metal testing & Chelation therapy (when indicated)
Food allergy elimination diets (based on diagnostic test findings)
Anti-inflammatory protocols
Essential macro & micro nutrient supplementation (to reverse deficiencies)
Diagnosis & treatment for chronic infections
Gastrointestinal support (including diagnostic testing for SIBO, leaky gut syndrome, & more)
Ozonotherapy IV’s & topicals (to modulate inflammation & decrease immune dysfunction)
Low Dose Naltrexone (to modulate inflammation & decrease autoimmune activity)

 

Questions about treatments for Psoriasis and other autoimmune disorders? Contact Dr. Kaley at Restorative Health Clinic (503) 747-2021.

 

Dr. Kaley Bourgeois

 

References:

National psoriasis foundation. (n.d.). Retrieved from https://www.psoriasis.org/

Blauvelt, MD, A. (July). Pathophysiology of psoriasis. Retrieved from http://www.uptodate.com/contents/pathophysiology-of-psoriasis