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

 

 

 

Thyroid dysfunction in Fibromyalgia 3 Mercury and other toxins inhibit conversion of T4 to T3

3. Mercury, cadmium, inflammation, stress, nutrient deficiencies and infections affect thyroid metabolism adversely, even if your thyroid gland is producing a normal and healthy amount of thyroid hormone.

T4 is the main product of the thyroid gland, with deiodinase enzymes in the liver, kidneys, brain and other organs changing T4 into the metabolically active T3. Most [>95%] PCP’s and endocrinologists do not test for free T3, free T4 and the ratio to reverse T3. Reverse T 3 acts as an anti thyroid, slowing metabolism and contributing to fatigue, pain and disease symptoms.

Action item: Don’t settle for just TSH and fT4 as the only thyroid tests ordered for you. Be pro-active and test your fT3 and reverse T3 to assess all of the important thyroid hormones, which enables your integrated, open minded doctor to adjust your thyroid hormones based on your metabolism and enzyme system function.

Next, test for the toxins known that affect deiodinase enzyme function adversely. We know how to remove these toxins safely, but you will only make this an action item if you test for it.

 

 

Effects of low mercury vapour exposure on the thyroid function in chloralkali workers.

Reverse triiodothyronine (rT3) was statistically significantly higher in the mercury exposed subjects, with the free thyroxine (T4)/free T3 ratio also higher in the highest mercury exposed subgroups compared with controls.

Thyroid hormones and methylmercury toxicity.

High exposures to the organometal, methylmercury (MeHg), may perturb neurodevelopmental processes by selectively affecting thyroid hormone homeostasis and function.

Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis.

Removal of mercury-containing dental amalgam in patients with mercury hypersensitivity may contribute to successful treatment of autoimmune thyroiditis.

Effects of perinatal exposure to low doses of cadmium or methylmercury on thyroid hormone metabolism.

Thyroid hormone metabolism in fetuses and neonates might be a potential target of Cd and MeHg.

 

Cheap Medicine Effective for Fibromyalgia Too: New Study

Our take:

“This is a recent post by Dr. Jacob Teitelbaum for Dr. Oz’s blog. This is most interesting, and our clinical observations completely support Dr. T’s, as well as the study results–the older medicines, used judiciously and in combination, usually trump the newer more expensive meds in better symptom relief and fewer side effects.”

 

5¢/day medication beats $8/day medication in recent Fibromyalgia studies

Two new studies give a fascinating insight into medications for Fibromyalgia pain and sleep– that you won’t likely  hear about elsewhere. It will also help you understand first hand why our health care system costs are unnecessarily spiraling out of control.

A large study of 747 patients taking Lyrica (Pregabalin)1 showed that the 300 and 600 mg dose did not have a significant pain benefit overall, but they were able to show mild benefit from the 450 mg/day dose—in part, largely because of the large number of patients in the study allowed modest benefits to be statistically significant.

On the other hand, another placebo controlled study2 by Dr Harvey Moldofsky, my favorite FMS Sleep researcher, showed that very low dose Flexeril (generic cyclobenzaprine) was very effective for Fibromyalgia sleep and pain. Though in most cases, I find generics and brand name medications to work equally well (with some rare exceptions), this is a case where the generic will even work BETTER than the expensive brand name, whose release to too slow to give the benefits here, where you want a quick bedtime rise in blood level, but still have the medication out of your system by morning to avoid side effects.

In the Flexeril study, pain dropped 25% and energy improved 14% by 8 weeks. Sleep also improved significantly.  Patients were given a very low doses (beginning with 1 mg at bedtime and increasing to a maximum 4 mg at bedtime). Severe side effects were more common in the placebo group than the treatment group. The medication was well tolerated overall, but mild side effects (mild enough that no patient needed to stop the medication for side effects)  included headache, sedation, dry mouth, dizziness and constipation. If side effects are an issue, the dose can even be lowered further. The lower doses work better than the standard 10 mg 3 x day dose used  for muscle pain, which is more likely to cause side effects than this very low dose. So more is not better!

So let’s do the math

Lyrica at 150 mg 3 x day costs $8.64/day (Costco price—which is usually lower than elsewhere), is high in side effects and has modest benefit (though it can be very helpful in some patients, so I am glad to have it in our “tool kit”)

vs.

Flexeril (Cyclobenzaprine) 5 mg generic 10 CENTS a pill (So the treatment cost is 2 to 8 Cents a day—less than 1% of the cost of Lyrica). It has less side effects and appears to be more effective in both the studies and my experience than the Lyrica.

So which one will most physicians likely hear about? The Lyrica of course!  Why???? Being over 100 times the cost makes it far more profitable, so the company can spend $70 million a year advertising it to you and your physician. At 2 cents a day, no one will pay to advertise the Flexeril, so most physicians will never hear about this research (though I keep the Fibromyalgia and Fatigue Center physicians up to daye). In fact, keep an eye out and see how many times you see ads for each (a lot for Lyrica and none for flexeril will be my bet), so you can see for yourself that this is so.

This same scenario plays itself out for literally hundreds of medical treatments (In fact, I suspect for most of them). So it should be no surprise that health care costs are skyrocketing.

So which health care plan will solve this? Will it be the president’s plan (dubbed “ObamaCare”) or our current system? If you guessed neither, you guessed correctly. This is why I consider the current health care debate to be doomed to failure, as both sides recommendations will cause prices to skyrocket without improving care.

There is a 3rd alternative which would work though. Reread the above and see if you can figure it out. If you guessed have expert panels decide, recent studies showed that most of these expert panels are stacked with doctors paid by the drug companies—so that doesn’t work.4

Can you figure it out? Stay tuned!

SOURCES:

1- An International, Randomized, Double-blind, Placebo-controlled, Phase III Trial of Pregabalin Monotherapy in Treatment of Patients with Fibromyalgia

LYNNE PAUER, ANDREAS WINKELMANN, PIERRE ARSENAULT, ANDERS JESPERSEN, LAURENCE WHELAN, GARY ATKINSON, TERESA LEON, BERNHARDT ZEIHER on Behalf of the A0081100 Investigators
J Rheumatol. 2011; 38:2643-2652.

2-Effects of Bedtime Very Low Dose Cyclobenzaprine on Symptoms and Sleep Physiology in Patients with Fibromyalgia Syndrome: A Double-blind Randomized Placebo-controlled Study
HARVEY MOLDOFSKY, HERBERT W. HARRIS, W. TAD ARCHAMBAULT, TERENCE KWONG, and SETH LEDERMAN
J Rheumatol. 2011; 38:2653-2663.

http://www.jrheum.org/content/38/12/2653.full

3- Costco Price Checker (a VERY helpful tool!) http://www.costco.com/Pharmacy/DrugInformation.aspx?p=1

4-“Prevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and the United States: cross sectional study.” Neuman J, Korenstein D, Ross J, and Keyhani S. BMJ 2011; DOI: 10.1136/bmj.d5621.

“Practice guidelines developed by specialty societies: The need for a critical appraisal.” Grilli R, Magrini N, Penna A, et al. Lancet2000; 355:103-106.

“Conflicts of Interest Abound in Diabetes Guidelines Committees.” Gale EAM. BMJ 2011; DOI: 10.1136/bmj.d5728.