Fibromyalgia: A Functional Medicine Approach

By Susan Blum, MD, MPH Board Certified in Preventive Medicine and a Chronic Disease Specialist Founder and Director of Blum Center for Health

Fibromyalgia: A Functional Medicine Approach

Fibromyalgia is a diagnosis based on a grouping of symptoms including fatigue and muscle pain. While the pain and inflammation are very real, this conventional medical diagnosis itself doesn’t help us understand what causes the problem. 

It is a descriptive diagnosis, which is why it took so long to believe that there was a real medical condition causing the symptoms. Of course, in the conventional medical world this has been a helpful first step – having this diagnosis has helped many people get some form of treatment. But it still doesn’t help us understand the cause of the fatigue, inflammation and pain. That’s where functional medicine comes in.

Functional medicine focuses on the prevention and treatment of chronic disease by finding the cause of the imbalance or symptom the person is experiencing.

From the viewpoint of functional medicine, fibromyalgia is an inflammatory condition – receiving the diagnosis is just the beginning of the investigation. While we can all agree that the fatigue, inflammation and pain are real, that is simply not enough. We want to know WHY. Treating the person with painkillers is not the answer, as most people with fibromyalgia will tell you.

From a functional medicine perspective, it is critical to look at the foundational systems that are involved in controlling inflammation in the body. The three areas we look at are: the digestive system, food sensitivities, and the liver detoxification system.

The Digestive System

The reason the digestive system (referred to as the gut) is so important is because 70% of your immune system lives just under the surface of your intestinal lining, and any disruption in the beneficial bacteria – think lactobacilli and bifido bacteria, those good bugs in yogurt –or the intestinal lining, will cause immune reactions that release inflammatory molecules that travel throughout the body causing inflammation at distant sites. This is one of the core beliefs and approaches of functional medicine, supported by studies in the literature, and evidence I see every day in my practice. Fixing the gut can sometimes completely relieve pain and inflammation in the muscles and joints.

Every patient with fibromyalgia has a comprehensive digestive stool analysis to help in the diagnosis of what might be out of balance in the digestive tract.  I look for dysbiosis, an overgrowth of “bad” bacteria, yeast, and/or parasites, and I look for signs of leaky gut syndrome, a condition where there is increased permeability in the intestinal lining. These conditions can cause distant inflammation and have been implicated in fibromyalgia, arthritis, and autoimmune disease. 

Once I make a diagnosis of dysbiosis and/or leaky gut syndrome, I begin the treatment with herbs and supplements that restore health of the digestive tract.

Food Sensitivities

Have you ever wondered why so many people have food sensitivities? Without a good intestinal barrier, a “leaky gut” allows partially digested food to get into the blood stream. This can be the cause of systemic inflammatory reactions resulting in painful muscles, joints, or tendons, and also fatigue and “brain fog.” I believe that this increased intestinal permeability is why many people have developed food sensitivities later in life. In order to treat fibromyalgia, most people need to eliminate certain foods from their diet while the leaky gut is being treated. 

The most common foods that create inflammation are gluten, dairy, eggs, corn, and soy. We recommend removing all five foods for 3 weeks, and then reintroducing them one at a time, every 4 days, and see if your symptoms get worse. If you have a reaction, it’s likely that this food is causing inflammation and you should remove it from your diet for at least 6 months. If no reaction occurs, you can reintroduce it into your diet.

Liver Detoxification System

The final step is detox. Once you have cleaned up your gut and removed trigger foods, you should focus on your detox system. Many people with fibromyalgia have “liver fatigue” and have accumulated toxins in their body that cause the inflammation and pain. 

First, look around and explore your environment to make sure you aren’t being exposed to too many toxins. This includes mercury in fish; lead in water from the pipes in your house; lead in your cosmetics; PCBs and dioxins from the pesticides in your foods; and now we also have to worry about chemicals in plastics. All of these environmental toxins create a big burden on your liver, the organ that is responsible for processing and clearing out these compounds every day. If you haven’t been giving your liver enough of the nutrients it needs to keep up with the toxic demand, it might be failing at its job in detoxification.

While we can’t live in a bubble, there is a lot you can do to reduce your exposure. The Internet is a great tool. Cleaning up your environment is the first step, and supporting your liver is the second.

You can do this very simply with food. Greens like kale and collards, cruciferous vegetables like broccoli, cauliflower and cabbage, and eating enough protein during the day (beans, nuts and seeds are ideal) will all help your liver do its job. You can boost this process by making green drinks and smoothies, or by doing a medically supervised detoxification program. If you are very sick, I don’t recommend a juice cleanse for more than 1-2 days. Instead, find a functional medicine practitioner to help you. 

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