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The Metabolic Treatment Read about Your Guide to Metabolic Health
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Letter to the Editor, Dynamic Chiropractic In the October issue of JMPT, Drs. Michael Schneider and David Brady proposed a reclassification of fibromyalgia syndrome (FMS) as either classic (true) FMS or pseudo FMS (Brady, D.M. and Schneider, M.J.: Fibromyalgia syndrome: A new paradigm for differential diagnosis and treatment. J. Manipulative Physiol. Ther., 24(8):529-541, 2001). This proposal is of intense concern to me (as Director of Education of the Fibromyalgia Research Foundation), as it is likely to be to chiropractors who diagnose and treat FMS patients. Drs. Schneider and Brady explain that their idea is based on the fact that some FMS patients are "cured" simply by taking nutritional supplements or thyroid hormone. Since classic or true FMS is caused by a defect, they believe, of CNS pain modulation and is currently incurable, anything that eliminates the symptoms of FMS is obviously "curing" something else. It’s a catch-22, isn’t it? Since FMS is incurable by definition, if the patient fully recovers, then that patient must not have had real FMS. Under the umbrella of pseudo FMS, the authors include hypothyroidism. They believe that most physicians just never test for thyroid problems, which do, of course, mimic FMS. And they suggest using blood tests and taking a patient’s temperature to gauge the need for thyroid hormone. Within their paper, they reference Dr. John C. Lowe’s book, The Metabolic Treatment of Fibromyalgia. The implication is that what they say about thyroid problems and FMS in their paper is related to the information in Dr. Lowe’s book. Unfortunately, they seem to have totally misunderstood Dr. Lowe’s hypothesis and erroneously portray the relationship between thyroid hormone and FMS. I have space here to touch on only a few of the errors in Drs. Schneider and Brady’s paper. First and most simply, I doubt that any competently-diagnosed FMS patient has ever been cured simply by taking estrogen, which the authors categorically state. That said, let me address one of the authors’ "common thyroid disorders" named "euthyroid sick syndrome," under which they include "conversion disorders" and "peripheral receptor resistance." They imply that most of the patients they’ve seen (who don’t have primary hypothyroidism) have a conversion disorder. In all of his research and clinical experience, in treating hundreds of patients, Dr. Lowe has never found–despite laboratory testing–an FMS patient who had a T4 to T3 conversion problem. (This does not mean that conversion problems don’t exist. It simply means they are not common in FMS patients.) If a patient has a conversion problem, that patient would have high reverse T3. We tested our patients and not one had high reverse T3. Similarly, Richard Garrison, MD, a member of our Fibromyalgia Research Foundation team at the University of Texas Health Science Center, also failed to find a conversion problem with FMS patients. Of course, since Drs. Schneider and Brady believe that tests "cannot distinguish the difference between" blood levels of T3 and reverse T3, testing becomes a non-option for them. In truth, these blood tests are highly specific. Blood levels of T3 and reverse T3 are easily distinguishable and tests are commercially available. If a lucky patient’s FMS symptoms were being generated by euthyroid sick syndrome, that patient would be in for a speedy recovery. Conversion disruptions caused by secretion of glucocorticoids (the mechanism in euthyroid sick syndrome) last for only a short time, 2-to-3 weeks according to the research. The researchers studied people with hypercorticism. Even in patients who continued to secrete excess cortisol, T4 to T3 conversion returned to normal in a couple of weeks. As for peripheral receptor resistance, this, of course, should not be included in the category of euthyroid sick syndrome. Cellular T3 receptor resistance, according to the best science we have at present, is most probably caused by a mutation in the gene that codes for the T3 receptor. Dr. Lowe’s euthyroid FMS patients, when treated with higher than normal doses of T3, behaved exactly as do patients with peripheral resistance to thyroid hormone. They showed no signs of overstimulation, had high blood levels of T3, low blood levels of T4 and TSH, and were totally recovered from all signs and symptoms of FMS. Dr. Lowe assessed patients throughout their treatment according to their improvement on peripheral indices of metabolic status. The patients were also required to exercise to tolerance and use nutritional supplements as support for their improving metabolic status. Dr. Lowe used neither blood tests nor temperature in patient assessment, though temperature can certainly rise with the use of thyroid hormone. These patients recovered because of thyroid hormone’s ability to stimulate metabolic processes in the cells and increase the levels of enzymes needed for those processes. The increase in enzymes and thus metabolism, increases temperature. It is not, as Drs. Schneider and Brady state, the other way around. At the Fibromyalgia Research Foundation, under the Research Directorship of Dr. Lowe, we believe that all FMS is caused by severely slowed metabolism in the tissues that are involved in generating FMS symptoms. Dr. Lowe, in The Metabolic Treatment of Fibromyalgia, has presented compelling evidence for this hypothesis. And to date, his hypothesis of FMS is the only one that accounts for every symptom and sign of the condition. Dr. Lowe explains that the most common mechanism involved in generating fibromyalgia symptoms is inadequate thyroid hormone regulation of tissues. It is not the only one, however. Drs. Schneider and Brady ask, for example, "Why do dietary manipulation, vitamins, and herbal remedies relieve the gastrointestinal symptoms and fatigue of some cases of FMS, but not all?" The answer, according to our research, is simple. Metabolic chemical reactions require vitamins. If a patient is deficient in the necessary vitamins, that patient’s metabolism becomes sluggish. Eventually, that patient may develop FMS symptoms. For that patient (but not every patient), the answer to her metabolic slow down is enough nutritional supplementation to increase her metabolic cellular reactions to normal. That patient’s FMS is as real and as classic as any other patient’s–she fits the diagnostic criteria including many of the associated symptoms. To assume that "true" FMS comes only from something yet undiscovered is contrary to the newest research on the subject. According to Drs. Schneider and Brady’s reclassification, however, this patient would be considered as having pseudo FMS simply because treatment with vitamins was effective. If an effective treatment for appropriately-diagnosed FMS is disallowed simply because it works, we’ll never get to an understanding of the true nature of the condition. Shouldn’t we be studying what works instead of reclassifying it? Jackie Yellin Menu of Critical Comments on the Schneider/Brady Proposal
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