Fibromyalgia

Claudia McNeel of A Time to Heal, interviews Dr. Patricia Gerbarg about Fibromyalgia.

Dr. Gerbarg talks about her personal experience with fibromyalgia and how complementary treatments helped restore her health. She discusses the scope of fibromyalgia and the use of complementary therapies that can improve health for those who may be suffering with this painful condition.

Claudia: What is fibromyalgia?

Dr. Gerbarg:
Fibromyalgia is a multisystem condition that’s characterized by widespread pain, along with other symptoms. According to the CDC definition, there has to be a pattern of pain for more than three months, in all four quadrants - that means in both arms and legs - but not centered in the joints.

In addition, to pain, there can be other symptoms such as sleep disturbance, fatigue, morning stiffness, headaches, cognitive impairment, depressed mood, anxiety, tingling, irritable bowel, or hypersensitivity to noise, heat and cold. Fibromyalgia can affect many aspects of the body and brain as well.

Cynthia: What caused you to get interested in fibromyalgia?

Dr. Gerbarg:
I’m a psychiatrist, trained in standard psychiatric practice at Harvard. That’s what I was doing for many years. I did not have any serious medical problems; I didn’t have fibromyalgia; I was quite active and healthy.

In the early 1990s, I developed diffuse pain all over my body, weakness, fatigue along with other disturbances. Everything continued to get worse. I went from doctor to doctor at top medical centers, and had specialist testing for years, trying to get a diagnosis. After 5 years, I was quite ill, with severe fibromyalgia and chronic fatigue – which often occur together. I was severely debilitated, barely able to walk and often unable to use my hands. I finally found a doctor who diagnosed me as having neurol-Lyme disease. Lyme disease, transmitted by deer ticks, is very common in our area. When the infection affects the brain, it is called neuroLyme.

After getting treated with antibiotics, I was partially improved, but I was left with pretty severe fibromyalgia, fatigue, and cognitive impairment, including difficulty thinking and poor memory. At that point, my husband, Dr. Brown, who is a psychopharmacologist, and a specialist in complementary herbal treatments, began treating me with some special herbs. The herbs put me back on my feet, brought my nervous system back to normal and restored my memory. When that happened, I realized that standard medicines are often not adequate to treat fibromyalgia, and there are treatments – herbs and other supplements – that can make a tremendous difference in recovery. This inspired me to learn all that I could and to bring this information to my colleagues, and to the general public.

I began to do a lot of research and investigation . Now, many patients come to me – even though I’m a psychiatrist – because the standard treatments just don’t get them well. Fortunately, I’m able to help quite a few of them.

Cynthia: What kind of things do you recommend for treatment for fibromyalgia?

Dr. Gerbarg:
We need to understand what the underlying problem is, in order to understand what kinds of treatments can help.

There are many causes for fibromyalgia. It’s not just one thing, which is what makes it complicated. There can be genetic factors. It often occurs after there’s been an illness or an infection, such as Lyme disease, and the person just doesn’t recover. It can happen after trauma from an accident due to tissue damage; it can happen from severe, prolonged stress or environmental toxins. Ultimately, there are many causes for the symptoms of fibromyalgia.

One aspect of fibromyalgia involves the nerve endings that process pain are in the muscle tissues. If there is an injury in those tissues, there may be inflammation. If that continues for a while, the nerves can become hyperexcitable. Once that occurs, then even a minor stimulus which wouldn’t normally cause pain, can elicit pain in muscles and tissues.

Another aspect relates to cellular energy. Little organelles called mitochondria inside the cells produce high energy molecules called adenosine triphosphate (ATP), which float inside the cells and provide energy for whatever needs to be done throughout the cell. Our cells are constantly subjected to wear and tear, and while they have innate repair mechanisms, they need energy to repair. In fibromyalgia, evidence indicates that mitochondria have been damaged. The damage creates a decreased ability to produce the energy transport molecules. If you can’t produce enough energy, then the cell will fatigue quickly as it runs out of energy. That is why weakness and fatigue are common in fibromyalgia. When the cell runs out of energy, it has to use a short cut in order to produce it. One of the consequences of that short cut is a byproduct called lactic acid, or lactate. When lactic acid accumulates inside the muscle, it creates pain.

It is important to improve the diet to make sure you’re getting all of the nutrients and vitamins that your mitochondria need to function and to repair themselves.

Good quality sleep is also essential. During deep sleep the body repairs itself. Most people with fibromyalgia get what is called non-restorative sleep. Even though they are sleeping, they are not really getting the rest, or the deep quality of sleep that they need.

Regular exercise is one of the interventions that is most consistently helpful in fibromyalgia. It’s hard for people who are in pain, and who feel exhausted, to do a regular, daily exercise program, but it is necessary. The type of exercise is important as well. You have to pace the activity so that you don’t deplete your mitochondrial energy. The exercise has to be very gradual – not doing too many repetitions, and building up the activity slowly over time. Movement in water seems to help a lot. When you’re supported by water, there is less stress on the body.

Certain nutrients help the metabolism of the mitochondria. For fibromyalgia we often use SAMe or Sadenosyl-L-methionine. Six studies have shown that SAMe can reduce the pain of fibromyalgia. In addition, it increases production of some of the molecules required to maintain healthy joints. SAMe also increases production of glutathione, our body’s most important antioxidant.

Glutathione helps provide defense against oxidative damage from free radicals, and helps protect mitochondria in the cells. This is important to maintain cellular energy supplies. SAMe is a natural antidepressant already present in every cell of our bodies. In fact, it is an essential molecule, involved in over 200 chemical reactions within the cell. Unlike adding a synthetic molecule, SAMe is something the body recognizes and accepts. This means that SAMe has very few side effects. SAMe has been used for about 30 years as an antidepressant in Europe, and it is available as an over-thecounter nutraceutical in the United States. SAMe increases the neurotransmitters involved in mood regulation. It is essential to get a really good quality of SAMe. Low quality products lose their effectiveness while sitting on store shelves. The appendix in our book provides information on finding the highest quality products.

People with fibromyalgia can also benefit from special herbs called adaptogens. Adaptogens increase the ability of the mitochondria to produce high energy molecules – which is exactly what is needed. Of all the supplements I have used, Rhodiola rosea gave me the greatest benefit. It literally restored the functioning of my neurons. Within a matter of weeks, I began to get better than I had been before, and my ability to function was restored to almost normal over a period of months. Fibromyalgia patients often have chronic fatigue. Rhodiola rosea, by increasing energy, helps relieve this kind of fatigue.

Before taking any herb or nutraceutical, it is important to read about it and discuss it with your doctor. It must be taken properly. It is also very important to get a good quality brand. In our book How to Use Herbs, Nutrients and Yoga in Mental Health Care, we have information to assist people in making those choices, and information on quality herbs.

Rebalancing the stress response system is crucial for recovery. Most of the medications used for depression and anxiety work to damp down the sympathetic system, but do not strengthen or boost the parasympathetic system. You can boost the parasympathetic system by using certain mind-body practices. The fastest way to do this is by using certain breath techniques. If you change your pattern of breath, you can activate the parasympathetic system.

Some breath practices are quite simple and easy to learn. Simply slowing your breathing down to about 5 breaths per minute will boost the parasympathetic system. Breathing at this rate is called resonance or coherence breathing.

Cynthia:
How can somebody learn these breath techniques?

Dr. Gerbarg:
We give weekend seminars – The Breath~Body~Mind Workshop. It is the best way for those who are able to travel to learn mind-body practices for fibromyalgia. Those who are unable to travel can learn by using our book and CD set, The Healing Power of the Breath.

Cynthia: There are so many products out there. How do people know what’s a good product?

Dr. Gerbarg:
In our book How to Use Herbs, Nutrients and Yoga in Mental Health Care, we included an appendix that has tables of products we feel to be of good and reliable quality. We have identified products from scientific studies, gotten information from companies, tried the products ourselves, and made sure that they work and don’t cause serious side effects.

We have no financial interest in any of this and accept no money from supplement companies. We feel that it is important. People aren’t going to be able to help themselves if they don’t know which bottle to take off the shelf. That information is covered in our book.

There are also some websites like www.consumerlab.com and www.supplements.com, which have good reports. You can go there, join their website and get an impartial report of many preparations of whatever supplement you want.

Adapted from: Claudia McNeel of A Time to Heal Interviews Dr. Patricia Gerbarg about Fibromyalgia

Learn more about fibromyalgia and complementary therapies

How to Use Herbs, Nutrients and Yoga in Mental Health Care
Richard P. Brown, MD Patricia L. Gerbarg, MD Philip R. Muskin, MD
W. W. Norton (2009)

The Healing Power of the Breath Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions
Richard P. Brown, MD Patricia L. Gerbarg, MD
Shambhala (2012)

Resources

Purity and quality varies among products because of differences in root stock, oil, climate, harvest time, adulterants and methods of extraction and drying. Lists of high quality herbs and nutrients can be found in How to Use Herbs, Nutrients and Yoga in Mental Health. Additional resources that help identify high-quality brands are available through:

American Botanical Council
www.herbalgram.org

Supplement Watch
www.supplementwach.com

Federal Drug Administration
www.fda.gov/medwatch

Consumer Lab
www.ConsumerLab.com