A 2015 article in the journal Mitochondrion begins with the sentence, “Fibromyalgia is a chronic pain syndrome with unknown etiology.”[1] It goes on to describe three findings that are commonly present in skin biopsies of patients diagnosed with this condition: oxidative stress, mitochondrial dysfunction, and inflammation. As a clinician I cannot tell you how many times I have heard patients and colleagues say, “they don’t know what causes it,” or worse, “do you believe in fibromyalgia? My doctor does not believe it is a real disease.” I find these statements striking considering the fact that CDC estimates fibromyalgia affected 5 million United States citizens in 2005. This represented 2% of the population in that year.[2] In 2015 numbers the prevalence of fibromyalgia should be closer to 6.4 million Americans. Appropriately, Sánchez-Domínguez, et al., the authors of the article, do go on to say, “Our findings may support the role [of these processes] as interdependent events [which, taken together, cause] fibromyalgia with a special role in peripheral alterations.” While I would argue that oxidative stress, mitochondrial dysfunction, and inflammation underlie the biology of fibromyalgia period (not just in the skin) I do applaud their decision to stay focused on the subject of the paper that reports the findings of skin biopsies exclusively.
Here is the real problem. Doctors (M.D.s and D.O.s) are not taught to think in terms of oxidative stress, mitochondrial dysfunction, and inflammation when it comes to understanding the ailments that affect our patients. As conventional physicians (and I’ve been one of them) we are taught to make a diagnosis, then match a treatment (generally a drug or a procedure) to that diagnosis. Functional medicine digs deeper. In functional medicine we want to know about the lifestyle factors of sleep & relaxation, exercise & movement, nutrition, stress, and relationships. Because together these factors interact in the context of our lives to set the stage for what we recognize as disease. And, because we as human beings are more than biological machines functional medicine providers dig into the mental, emotional, and spiritual aspects of our lives as well as our experiences, attitudes, and beliefs. Finally, we consider how our unique genetic predispositions factor into the equation. It is a complex interaction that we know causes disease, not a simple cause-and-effect.[3]
Putting it another way, we take the story of your life very seriously. A medical history in functional medicine terminology is called The Functional Medicine Timeline.[4] The Functional Medicine Timeline helps to identify the factors that laid the groundwork for the final triggering event, the moment when you knew your health had changed and you developed fibromyalgia, and for the factors that continue to perpetuate or sustain this pattern of disease. In effect, one could think of fibromyalgia as having many causes, and our job is to identify those causes (note the plural) and help you address them. In future blogs we can get into the details of what is oxidative stress, mitochondrial dysfunction, and inflammation, but for now let’s look at a few of the factors that drive these processes in the first place.
Epigenetic mitotic inheritance
Did you know that life experiences which affected your parents or even grandparents can be coded into their genes and passed onto you?
Adverse Childhood Experiences
In a study that was a collaboration between Centers for Disease Control and Kaiser Permanente more than 17,000 individuals chose to provide detailed information about their childhood experiences. This became known as the ACE Study. The findings suggest that childhood maltreatment is a major risk factor for the leading causes of illness and death in the United States.[5] From a root cause perspective this means that adverse childhood experiences not only make us sick, but drive chronic inflammation to affect our hormones, our immune systems, our gut microbiome, and the mitochondrion.
Nutrition
Food is information, and food is medicine. Every bite of real food we put into our bodies give specific instruction to our cells, including our DNA, about how to act. The opposite is also true: Bad food—fake food, inflammatory food is mis-information, poison to our cells, including our DNA. Furthermore, we can have nutritional imbalances in both macronutrients like proteins, carbohydrates, and essential fatty acids, or micronutrients like vitamins, minerals, and plant-based micronutrients (phytonutrients).
Toxin exposure
From heavy metals, to pesticides, herbicides, to estrogen analogs (like Bisphenol A), drugs, and the numerous chemicals from burning and inhaling natural or processed tobacco.
Impaired detoxification
From decreased or increased activity of family of enzymes collectively known as the cytochrome p450 family, the first step in metabolic elimination (phase I elimination), or impaired phase II conjugation in which the products of phase I are made water soluble and excreted.
This is a difficult shift to make for all of us. I had to change the way I think to make the switch from conventional physician to functional medicine physician. I have to teach my patients to make the same shift when it comes to thinking about how they got sick and what they need to do to work back towards health. “Natural treatment” does not mean using a conventional medicine approach, but substituting herbs and vitamins – things found in nature – to treat conditions like fibromyalgia. This line of thinking would suggest a simple cause-and-effect. Natural treatment means recognizing our nature as human beings to go from the holistic to the cellular, subcellular, and even the molecular, and then back again; it means embracing what a friend and mentor describes as the driving principle of our approach, a deep appreciation that all is connected and “everything affects everything.”[6]
Ken Sharlin, M.D.
[1] Sánchez-Domínguez B., et al. Oxidative stress, mitochondrial dysfunction, and inflammation common events in the skin of patients with fibromyalgia. Mitochondrion, 2015 vol. 21: 69-75.
[2] http://www.cdc.gov/arthritis/basics/fibromyalgia.htm
[3] https://www.functionalmedicine.org/files/library/IFM-Functional-Medicine-Tree-.pdf
[4] http://www.welllifefm.com/pdfs/ifm-timeline-clinical.pdf
[5] http://www.cdc.gov/violenceprevention/acestudy/
[6] My friend and mentor Dr. C. Norman Shealy