Becca first came in to see me a year ago for a combination of symptoms that lingered after a bad virus and months of overwork: nausea, weakness, dizziness, crushing fatigue and hip pain. A self-deprecating and put-together 28-year-old looking forward to her wedding in less than a year, Becca described how she was so tired, she couldn't think straight. Her hips were in excruciating pain such that she could barely bend at the waist. She described feeling flu-like all the time and despite 12 hours of sleep most nights, she always woke feeling unrefreshed. She had recently received a graduate degree but was too depleted to look for work.
Becca had been to a battery of other doctors who couldn't clearly determine what the problem was. When she arrived in my office, she was a bit hopeless about her state but eager for a different approach. At our first visit, Becca reported that on an "overall feeling well scale" scale of one to 10 -- with a 10 equated to feeling fantastic -- she was typically a three. My goal was to get her back to being at a consistent 10 (or at the least, a nine!) every day.
I quickly recognized Becca's collection of symptoms as fibromyalgia (FM), which I see in my practice mostly in women between the ages of 20 and 45. In fact, women suffer from FM more than men at a ratio of 7:1. FM is a disease that afflicts about 5 million people a year in the United States, but it is a diagnosis that many doctors miss altogether. Why is this? It's a disease of description, rather than one that easily shows up on laboratory tests. (A new lab diagnostic called the FM test claims to conclusively diagnose fibromyalgia, but its reliability is under scrutiny.) Fibromyalgia is a condition that mimics other diseases (Lyme, lupus, arthritis, to name a few) so doctors who are used to looking for certain types of problems will often miss it altogether. Often, these patients are dismissed as hypochondriacs.
The most relied-upon technique for diagnosing FM is the trigger point method: If a patient has 11 of 18 designated trigger points that are tender, a diagnosis is made. Many of these patients that I see have a range of symptoms like Becca's. In addition to her fatigue, joint pain and brain fog, I have also seen insomnia, tingling extremities and even depression in FM sufferers. Often there is no one causative event for FM. It is thought to be the result of an accumulation of assaults on the body such as infection, stress, and physical trauma. Genetics, neuroendocrine dysfunction and abnormal pain processing have all been cited as possible factors, as well. The bottom line is that we don't know the precise etiology of fibromyalgia, and it certainly varies from person to person.
But we do know that the cumulative effect is an overall, devastating inflammatory load on the body. In my practice, every single fibromyalgia patient has some kind of digestive problem, ranging from constipation and gas to diarrhea and bloating. Recent research has highlighted a clear connection to small intestine bacterial overgrowth as a cause of fibromyalgia. In naturopathic medicine, the gut is seen as one of the controllers of overall inflammation in the body because the majority of the immune system is found there. When the gut is compromised by insufficient or imbalanced microflora, the intestinal lining becomes hyper permeable, allowing inflammatory molecules to migrate throughout the body.
When I asked Becca about her digestion, she groaned and described bad gas and bloating, as well as constipation. My first step with Becca was to do a Comprehensive and Digestive Stool Analysis (CDSA) to determine just how much good and bad bacteria was growing in her gut and to see how her gut function was doing overall. Indeed, her results came back showing large amounts of bad bacteria, yeast and dysfunctional digestion and absorption. We got to work right away on her treatment.
We started with the Four-R Plan for gastrointestinal health popularized by Jeffrey Bland, Ph.D. and the Functional Medicine Institute:
1. Remove harmful toxins. Eliminating foods Becca was sensitive to was the first step; we identified them with a food allergy test. She ended up taking out gluten, dairy, eggs, bananas, potatoes, corn and a few other vegetables. I also had her remove red meat from her diet. I also wanted to eradicate the yeast and parasites in her body. This we did with a combination of anti-fungal and antibacterial botanicals. She concentrated on eating a diet heavy in fish, poultry, vegetables, rice, olive and coconut oil.
2. Replace digestive functionality. Often, bloating and gas indicates poor digestive capability and, indeed, Becca's CDSA test confirmed that. We had her take a digestive enzyme with every meal.
3. Re-inoculate the gut with good bacteria. Probiotics (20-30 billion live organisms) at each meal were necessary to improve intestinal immune function.
4. Repair the gut lining. It's imperative to heal the gut lining with things like l-glutamine, fish oils and n-acetyl-d-glucosamine.
5. A few other things we did: biotherapeutic drainage to detoxify her liver, adrenal support with adaptogenic herbs, lots of greens drinks to provide energy and aid in detox, and stress reduction techniques such as craniosacral therapy.
Becca stayed on this plan for several months, which she complemented with acupuncture. In that time, her joint pain all but disappeared. She had no more constipation and her bloating and gas cleared up completely. She began to sleep soundly, without the numbness and tingling in her legs that would wake her at night. She lost some weight (without having to do a bridal boot camp) and her brain fog completely lifted. Her energy was back. A few days before her wedding, she came to me for a check-in and was an entirely different person from the one I had started working with. She showed me pictures of her in her wedding gown and talked excitedly about her honeymoon. "So where are we on the scale today?" I asked. "Nine out of 10, doc," she sad. "These days, every day is a nine out of 10."
I'll take it, I said with a smile.
If you're struggling with similar symptoms a naturopathic doctor who can focus on creating ultimate health through the use of natural therapeutics is what your gut just may need. If you want to schedule an appointment with Dr. Maura Henninger, click here. To follow her on Facebook, click here.
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