Fibromyalgia can be debilitating but can also be managed

Dealing with fibromyalgia

Fibromyalgia is defined as diffuse pain in connective tissue and muscle, not due to trauma or overexertion.

Its cause is unknown and it’s made worse by physical or emotional stress. Fibromyalgia is estimated to affect 3% to 6% of the adult Canadians and is four to nine times more common in females than in males. It typically affects otherwise healthy young females between the ages of 25 to 50 years old. It can also affect men in the same age demographic.

Classic signs of fibromyalgia include diffuse muscle pain, insomnia and poor sleep and severe fatigue. Sore and painful muscles, tendons and ligaments can occur all over the body. Areas involved include the back, trunk, arms and legs. Heightened sensitivity and a lower pain threshold are typical in this condition.

At least 11 of 18 specific pain points over the body must be positive for a diagnosis of fibromyalgia to be considered. Also, insomnia and poor sleep quality must occur and be present at the time of a diagnosis. Inability to fall asleep and frequent awakenings lead to daytime fatigue. Fatigue and lack of energy, especially with otherwise normal exertion must occur and be present at the time of diagnosis.

Other symptoms associated with fibromyalgia can include easy bruising, burning feet and legs, muscle cramps, numbness and tingling in extremities, poor memory and concentration, headaches, anxiety and panic attacks, depression and mood swings, blurred vision, dry mouth an poor taste, poor hearing and ringing in the ears, shortness of breath, irritable bowel syndrome, heartburn and stomach spasms, fluid retention and swelling, frequent urination and irritable bladder, cold hands and feet and poor immune system function.

The exact cause of fibromyalgia is unknown. Hypotheses suggested include autonomic nervous system dysfunction, abnormal stress response, accumulation of toxins within muscles, lactic acid buildup, lack of oxygen to muscle tissue, micro-trauma to muscles and connective tissue, poor recovery and healing, viral infection, lack of restful sleep and low levels of hormones in the body.

Diagnosis of fibromyalgia should include a detailed health history, comprehensive physical exam, including pressing on pain points, and lab tests to rule out other causes of illness. Lab tests should include blood work to test a complete blood count, witch measures red blood cells, white blood cells and platelets, a chemistry panel, which typically includes liver, kidney, electrolytes, protein, acid/base levels, muscle markers, a thyroid hormone test, inflammatory markers, like c-reactive protein and erythrocyte sedimentation rate.

An autoimmune panel may be suggested including rheumatoid factor and anti-nuclear antibody test. Additionally, hormone testing may also be suggested including cortisol, testosterone, estrogen and progesterone.

Lab tests are meant to rule out other causes that may contribute to fatigue and pain like low iron or anemia, low thyroid or hypothyroidism and low vitamin B12 levels. Lab tests are generally normal in patients with fibromyalgia.

Conventional medical treatment of fibromyalgia includes prescription of analgesics like Tylenol or acetaminophen, non-steroidal anti-inflammatories or NSAIDS like ibuprofen, naproxen, diclofenac or similar drugs, muscle relaxants like methocarbamol, cyclobenzaprine or Flexeril and Baclofen.

Antidepressants that raise serotonin including fluoxetine or Prozac, citalopram or Celexa and duloxetine or Cymbalta are also recommended. Sleeping pills may be suggested including older tricyclic antidepressants like amitriptyline or Elavil.

Drugs that increase gamma amino butyric acid levels including Gabapentin or Pregabalin may also be suggested. Sleeping pills such as Zopiclone and Zolpidem may also be prescribed to help improve sleep quality for the short term.

Benzodiazepine drugs like lorazepam or Ativan, oxazepam or Serax and alprazolam or Xanax are generally frowned upon because of their habituating and addictive potential.

Physical therapy strategies for fibromyalgia include moderate aerobic exercise like bicycling, hiking and walking, light anaerobic exercise like weightlifting, gentle muscle stretching like tai chi and yoga, massage therapy, electric muscle stimulation, transcutaneous electro neural stimulation and laser therapy. Many studies have confirmed exercise and movement, although difficult and painful, helps to improve this condition as much as drug therapy.

A healthy, balanced diet including whole foods, ample vegetables and fruits and healthy proteins helps to contribute to optimal nutrition and overall well-being.

Supplements recommended include B12 and B-vitamins, calcium and magnesium. Many patients with fibromyalgia take magnesium daily, especially at nighttime to help relax muscle and promote sleep. B12 and B-complex vitamins are important for proper nerve function and energy generation.

Other supplements to help improve sleep duration and quality include melatonin, valerian, kava, GABA and l-theanine.

Herbal anti-inflammatory compounds include turmeric, ginger, Boswellia and willow bark may help reduce inflammation. Saint John’s wort works like a tricyclic antidepressant and may be beneficial to help improve moods, sleep and nerve pain. Some patients also report the use of cannabis products containing lower doses of THC and higher CBD levels help to control pain and improve sleep.

Although fibromyalgia can be a debilitating condition, there are effective strategies including diet, lifestyle, supplements, physical therapy and prescription medicines that can help improve this illness.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Ads used to say 'milk does a body good'—but does it?

Should you drink milk?

Cow’s milk was once touted as the perfect food, supplying the body with a lot of carbohydrates, fats, protein and calcium.

We are often reminded by dairy consumer groups that we should drink milk daily to be healthy and get our daily calcium requirements. However, we should be aware we are the only species on Earth that continues to drink milk once we are weaned as infants.

Lactose is the primary sugar derived from milk. Lactose is actually two sugar molecules stuck together by a chemical bond. The enzymes lactase helps to break the bond and release the two individual sugars, glucose and galactose. Lactase is located in the wall of the small intestine. The enzyme breaks down lactose into two simple sugars that are then easily absorbed and burned for energy.

Lactose intolerance is caused by a deficiency of lactase enzyme and therefore an inability to break down the sugar lactose. A hereditary deficiency of lactase occurs in 70% to 90% of people of Asian descent and 70% to 80% of people of Arab decent and Indigenous peopleTen per cent to 20% of Scandinavians and 10% to 15% of people of European Caucasian descent have a hereditary deficiency of lactase.

Lactose intolerance usually manifests itself between infancy and early childhood. Symptoms of lactose intolerance include abdominal pains, bloating, cramping, diarrhea, flatulence, gas and stomach aches. Many of those symptoms are created by bacteria in the gut that are able to digest and breakdown lactose. During the breakdown process, the sugars are fermented. The bacteria release large amounts of gas that results in many of the symptoms associated with lactose intolerance.

One cup of whole milk contains 12 grams, or 30%, of lactose by weight. One cup of 2% milk contains 13 grams or 41% and once cup of skim milk contains 11.4 grams or 57%. Two ounces of cheddar cheese contains about one gram or 2% of lactose by weight. Cheeses are generally better tolerated by many lactose intolerant individuals, but are considerably higher in fat content.

Milk contains more than 60 different proteins and at least 35 of these proteins have been documented to cause allergic reactions in humans. Two highly allergic proteins in milk are casein and lactalbumin.

Approximately 50% of the protein in milk is from casein. Casein is a rather large protein molecule that is used primarily to make curds and cheese. It was once believed casein was too large to be absorbed through the small intestines. More current research suggests considerable amounts of casein are directly absorbed from the intestines into the blood stream.

Once in circulation, intact casein molecules combine with other larger sugar molecules to form slimy complexes that increase mucous in the body. Milk is considered to be a mucous-forming food. Many individuals notice an increase in mucous production following the ingestion of milk and other dairy products. Nasal congestion, post-nasal drip, recurrent ear infections, lung congestion, gastro-esophageal reflux can be a consequence of increased dairy intake.

Milk is high in fat. Forty eight percent of the total calories of one glass of whole milk is from milk fat. Thirty one percent of the total calories of one glass of 2% milk is from milk fat. Fifteen percent of the total calories of one glass of 1% milk if from milk fat and 5% of the total calories of one glass of skim milk is from milk fat.

One glass of 2% milk weighs about 240 gram and contains 145 calories. Two percent of 240 grams equals about five grams of milk fat. One gram of fat equals 9 calories. Therefore, five grams produces 45 calories of energy per glass of 2% milk. That equals about 31% of the total calories.

One glass, or 250 millilitres, of cow’s milk contains about 300 milligrams of elemental calcium. Other vitamins in cow’s milk include some vitamin A, small amounts of B vitamins such as vitamin B12 and folic acid, and minerals like magnesium, phosphorus and zinc. It should be pointed out the calcium content between whole milk, 2%, 1% and skim milk is about the same. The difference between these milk products is the fat content.

The recommended daily intake of calcium for adults is between 800 and 1200 milligrams per day. One glass of cow’s milk supplies about one-third, or 300 milligrams, of elemental calcium. Cow’s milk is a good source of dietary calcium.

If you are not lactose intolerant or allergic to casein or other milk proteins, or suffer from copious amount of mucous and phlegm, it is likely OK to consume milk in moderation.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Hot tubs not only sooth our muscles, they can help stimulate our brains

Hot tub health advice

As I age, and endure the repercussions of too many sports injuries when I was younger, I enjoy swimming during the cold and dark winter months at our local recreation centre.

Swimming is considered a low impact sport primarily because of the effects of water buoyancy on the human body. High impact sports like running, soccer and tennis endure the potential trauma of repetitive high-pressure activity on weight-bearing joints like the ankles, knees and hips.

This, of course, can lead to degeneration, injury and the development of osteoarthritis. However, I must confess I can’t jump in a cold pool like I used to and begin my lengths before warming up in the hot tub before starting. And this is where a vexation ensues.

Humans are generally gregarious creatures. People enjoy talking and communicating. Individuals like exchanging information, offering opinions and sharing ideas. Most people are courteous and respectful. Talk is generally light and frivolous but can also be entertaining and informative. Sometimes, when I exchange some information, I learn something. Discussions are often about sports, travel, weather and work, while other times, about newsworthy events. I have also observed that discussing politics and religion or mentioning politicians like (former U.S. president) Donald Trump are a social faux pas that create arguments and embarrassment.

Like the Canadian YouTube psychologist Jordan Peterson says, “In order to be able to think, you have to risk being offensive.”

Whatever the topic, you have the option to opine your view or keep your mouth shut.

Thinking involves using logic to find the truth. Logic is a systematic stepwise pathway using the information provided to evaluate something and make a conclusion based on the available facts. Our brains think and use logic to evaluate data to come to a “true” conclusion. Truth is an accurate depiction of fact or reality. Because we are individually a small part of a bigger whole, we can conclude that our thinking is subject to bias. Bias is an inherent prejudice towards something or somebody. Nobody knows everything but everybody knows something and some know more than others.

One early morning, at the ripe hour of 7:30 am, a couple of middle-aged blokes entered the hot tub and continued their passionate talk about health-related issues. One individual explained he followed his doctor’s advice for a problem, took the drugs prescribed and got sick. The other fellow countered he doesn’t take drugs for virtually anything, uses essential oils and is taking some multi-level marketing products that are supposed to cure his problems.

I couldn’t help but listen and concluded they both were pandering to some misinformation about their conditions and their respective treatments. I, as a partially knowledgeable health professional, could have interjected, offered my opinion and recommendations and directed them to the truth, as I see it. But I concluded it wasn’t in my place to do that. Besides, I had to swim my laps.

In medicine there is something called “evidence-based medicine.” Evidence-based medicine uses the best available data by medical professionals from around the world to make accurate and reasonable decisions for individual health care. Evidence is based on both practical clinical experience and scientific research into a therapy or treatment for a specific condition.

Surprisingly, a lot of drugs and therapies used in modern medicine have not been conclusively proven to help a specific condition for which they are currently used. Bleeding and bloodletting to cure infection, frontal lobotomies for clinical depression, mercury for bacterial infections, morphine for minor pains, physicians not washing hands between deliveries, are all common examples of bad medical practices not based on scientific evidence.

Of course, natural medicine practices are also rife with examples of lack of evidence-based medicine, including the use of herbal medicines, homeopathy and psychic healing. Best-evidence practices can also be prescribed to naturopathic medicine. It is paramount the practitioner is impartial and uses the best-evidence practices to treat a patient. It does not matter so much if it is natural or not, but it is in the best interests of the patient.

A middle-aged fellow came to our office with genetically high cholesterol that occurred in his family. He went to a local health food store and was sold more than a dozen different products that were supposed to lower his cholesterol, treat his liver and clean his arteries. He took the products as recommended and his cholesterol went up.

He threw them all away, regressed from his healthy diet and started eating more fast food. His cholesterol came down.

We re-evaluated his supplement regime, used an evidence-based approach and drastically simplified his nutritional program. We recommended some supplements that worked and his cholesterol came down.

Furthermore, some of health benefits of hot tubs include muscle relaxation, joint pain relief, improved circulation and better quality sleep.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Wheat intolerance affects an estimated 15% of the population

Wheat intolerance

Wheat intolerance is one of the most common food sensitivities.

The grain is a staple that is consumed in large quantity by billions of people around the world every day And accounts for between 15% and 20% of the calories of most people’s diet in the western world, including Canada.

Wheat is a grass that is cultivated throughout the world for its seeds. There are several dominant species and hybrids that have been developed for food consumption, including durum and Triticum, red winter, red spring and white varieties.

The content of wheat seeds varies by species but, on average, contain 71% carbohydrates including 12% dietary fibre, 13% protein, 2% fat and 13% water. It also contains vitamins like B1, B3, B5 and B6 and appreciable amounts of minerals like iron, manganese, magnesium, phosphorus and zinc.

Although quite high in protein compared to other grains, wheat is not considered a complete protein because it does not contain all the essential amino acids like lysine.

Gluten is a the most common protein found in wheat. It makes up 75 to 85% of the total protein content of this grain. Gluten is a large structural protein made up smaller protein sub-units, like glutelin and prolamin, including gliadin. The elastic quality of gluten gives wheat its adhesive, gummy and stretchy properties. Those effects hold wheat together in bread, giving its texture and traps gases created by fermentation.

Celiac disease is an inflammatory disease of the small intestine caused by an autoimmune reaction to gluten. It is known to occur in one 1% to 2% of the general population. Gluten and gliadins accumulate in intestinal epithelial cells and cause an immune cascade that produces widespread inflammation along the intestinal lining.

That leads to damage and flattening of the delicate brush border that is involved in absorption of carbohydrates, fats and proteins. Malabsorption of nutrients occurs. Other symptoms include widespread gas, bloating, indigestion, diarrhea, fatigue, weight loss, anemia, headache and general feeling of being unwell.

True gluten or wheat allergy is rare. An immunological reaction between the protein and antibodies from IgE and IgG occurs. More common is a non-immunological wheat or gluten intolerance or sensitivity.

Wheat intolerance is estimated to affect up to 15% of the general population. Many of the same symptoms of celiac disease, including gas, bloating, diarrhea, fatigue, headache and weakness occur. Other symptoms that could be related to wheat sensitivity including eczema and other skin rashes, arthritis and joint pains, dizziness and brain fog, heartburn and upset stomach, muscle weakness, head, lung and sinus congestion.

If conventional diagnostic tests for wheat and gluten allergy are negative, an elimination and challenge test can be done. It removes all wheat for several weeks to one month and then is challenged with the reintroduction of wheat products. The occurrence and development of symptoms are then monitored in relationship to the quantity of wheat that is reintroduced into the diet.

More than 20 different herbicides, including paraquat, 2,4 D and glyphosate are used on wheat to control weeds during and after the growing season. Glyphosate or roundup is one of the most used herbicides. Environmental protection agencies like Canadian Food Inspection Agency monitor herbicide levels on different foods.

Levels of those herbicides are limited to acceptable levels that are believed not to pose a significant health risk to consumers. However, glyphosate and other herbicides have been associated with adverse health issues. Glyphosate has been banned in Europe because it is widely considered to be carcinogenic (cancer-causing).

Genetic manipulation of food is another contentious issue for food consumers. Modifications to increase crop size, yields and prevent damage to the food. While there are certainly concerns about the health and safety of genetically modified products there are currently only five GMO foods approved in Canada, including sugar beets, canola, corn, potatoes and soy.

According to government authorities, there is no genetically modified wheat produced in Canada.

Many health experts believe hybrid selection of different wheat species allowed for an increase in the consumption of mono-culture wheat products. That led to an increase in the consumption of larger quantities of the same protein. Over-exposure to the same wheat proteins overburdened both immune and non-immune regulatory mechanisms in the human body. That causes many of the symptoms associated with wheat intolerance.

It goes without saying whole wheat contains higher amounts of dietary fibre, vitamins and minerals compared to refined white flour. During the processing, the bran and germ portions of the wheat kernel are removed leaving the endosperm. The presence of wheat bran gives whole wheat a darker colour and generally a courser texture.

Meanwhile, white flour can be bleached to give a more appealing whiter texture. White flour generally contains more gluten than whole wheat flour.

Sourdough bread is generally tolerated better by wheat sensitive individuals because the fermentation process breaks down some of the gluten proteins.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.