How to Overcome Fibromyalgia with Dr. David Brady

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In this episode of The Dr. Hedberg Show, I interview Dr. David Brady about how to overcome Fibromyalgia and his new book The Fibro Fix.  We talked about the history of fibromyalgia diagnosis, the causes of fibromyalgia, the difference between “Classic”  Fibromyalgia and “Pseudo” Fibromyalgia, treatment strategies, supplements for Fibromyalgia, and much more.  If you have Fibromyalgia or know someone who does, this is one interview you definitely don’t want to miss.

How to Overcome Fibromyalgia Dr. David Brady

Dr. Hedberg: Well, welcome, everyone, to “The Dr. Hedberg Show.” This is Dr. Hedberg, and I’m really looking forward to the conversation today. We have Dr. David Brady on. And if you look at the history of “The Dr. Hedberg Show,” we’ve actually never had a repeat guest. And so, Dr. Brady is gonna be the first repeat guest. Our last podcast discussed the GI map stool test from Diagnostic Solutions. So, I urge you to check that out.

So, for those of you who don’t know Dr. Brady, he really is the foremost authority on properly diagnosing and treating fibromyalgia, which is what we’ll be talking about today. He’s been featured in top media outlets like “Elle” and “NPR.” And he’s also published in leading peer-reviewed medical journals including “Open Journal of Rheumatology and Autoimmune Disease and Integrative Medicine,” a clinician’s journal. He’s published chapters on fibromyalgia in definitive medical textbooks, including “Advancing Medicine with Food and Nutrients” and “Integrative Gastroenterology.” He has presented at prestigious medical conferences, including the Annual Symposium of Functional Medicine and the Integrative Healthcare Symposium.

He is in private practice at the Whole Body Medicine in Fairfield, Connecticut. And Dr. Brady is also the Director of the Human Nutrition Institute at the University of Bridgeport, as well as the Chief Medical Officer of Designs for Health and Diagnostic Solutions Laboratory. So, Dr. Brady witnessed his own mother suffer through the ringer of the medical system. So, Dr. Brady is uniquely passionate not only as a doctor, but also as a patient advocate.

So, his website, more specifically for his book, we’ll be talking about today is fibrofix.com and then his practice website is drdavidbrady.com. So, Dr. Brady, welcome to the show.

David: Dr. Hedberg, thanks for having me back. I didn’t realize I would be the first repeat guest, so that’s quite an honor, and thank you.

Dr. Hedberg: Yeah. So, I’m looking forward to this. Let’s really dig into fibromyalgia. And so, you know, you witnessed your mother going through the medical system and then you became very interested in fibromyalgia. Is there any particular event that really got you interested in this condition?

David: Well, I got an interest in sort of integrative medicine, as we would call it today, or like just routes of care and ways of looking at healthcare conditions, particularly complex chronic conditions that were not the, you know, real standard orthodox way of doing things or standard of care probably because of that experience with my mom growing up. I mean, my mother battled breast cancer most of my childhood, and double mastectomy, got radiation and chemo, and all that stuff back in the ’70s when it was even more brutal than it is now.

And she found some of her best outcomes and best quality of life, unfortunately it was toward the end, with some providers who were doing more sort of integrative complementary medicine type of stuff. So, it really opened my eyes to that. And even though I originally went and became an engineer and worked in aerospace and stuff, I always had a sort of a desire to come back to dealing with the human condition, and I had originally thought I would use my sort of engineering background, and biomechanics, and things like that, and to go into research, you know, in biomedical research.

I had the engineering background, I was looking for ways to get the medical, clinical background. And I looked into a lot of different routes and books, more reasons than we probably have time to go into. Mainly one of the really good biomechanical background, I ended up first on the chiropractic college. And when I was there, I really took a left turn.

I had some mentors there that were really into, you know, dealing with chronic complex internal disorders from a different way, you know, and it came from some of the old chiropractic nutrition sort of influence. So, there’s a lot of interventional nutrition, dietary and lifestyle medicine changes, botanical medicine, and kind of what we would today call like naturopathic medicine. But I was immersed in it when I was down there. And even in my hospital rotations and all of that, I was always looking at disorders from, you know, how can you do this in a different way? I mean, how can you treat this without nine drugs, right? Or if you’re gonna use the meds, how can you make them, you know, work better and how can you complement them?

So, that got me into functional medicine and clinical nutrition, and then I went back to, you know, medical school and studied naturopathic medicine, and the rest is history. But the fibromyalgia stuff really started when I got out of chiropractic school and first went into practice because I started getting these patients’ neck that were really difficult patients, you know. And what I learned about fibromyalgia in chiropractic school and later even in medical school is not very much. What I did learn turns out it was wrong. It was often talked about by the presentor or lecturer in sort of a questioning way or almost a condescending way, you know, is this really real? Is it all made up in people’s heads? You know, all that kind of baggage that went along with it for so long.

But when I got out into practice, I realized these people are real, they’re not making it all up, they have better things to do with their lives than to make this all up, but they also weren’t all the same. There was a lot of different stuff I felt coming in under that label. And I thought even with the little I knew then that it was very dirty diagnosis. By that I mean, it was really a whole lot of different things all being called the same thing. And, you know, in medical school, one of the first things you’ll learn is proper diagnosis you have to cure. So, unless we can accurately figure out what these people really have and stop just calling it all the same thing and, you know, well then we’ll never gonna find the right treatment.

So, I realized that I was willfully and adequately prepared to deal with these patients. And I realized, even though they had a lot of achiness and they complained of muscle pain or they have fatigue, and they had anxiety, and they couldn’t sleep or they didn’t feel like they ever sleep even after they did, they have a lot of drug problems, I realized even back then this is not a muscle problem, right? This is not a musculoskeletal thing. This is a central nervous system issue.

And so, I started studying it on my own, literally going into the medical literature which as, you know, back then it wasn’t as easy as doing a PubMed internet search. I had to go to the medical library. I had to dig through card catalogs. I had a blow dust off journals. I had a copy of them with borders, you know. That’s what it was. And I read everything I can get my hand on. I found a sort of compatriot, some kindered colleague soul, kind of, person that was also really into myofascial pain working stuff, named Michael Schneider. He was a chiropractor then. He went to become a PhD. He does a lot of incredible integrative medicine research, more on musculoskeletal disorders at the University of Pittsburg.

But we started, kind of, getting together on this quest, and over time we became experts ourselves, not only by reading and teaching ourselves but by actually reaching out and meeting the world’s experts in fibromyalgia, and then we went on to, you know, do a lot of publishing, do some research, wrote lot of textbook chapters, things like that. So, we, kind of, made ourselves experts over time because it didn’t happen in school, I can tell you that.

Dr. Hedberg: Right. And I do remember that first paper I think that was published in “JMPT,” I remember reading that, and it gave a really great overview and, you know, diagnostic algorithm. It is a different way to look at fibromyalgia than I had been exposed to. And then there was a follow-up paper, I think, and Dr. Pearl was an additional author there.

David: Right. Yeah. 2001 was the first one, and 2006 was the follow-up paper to that first paper. Yeah. So, it’s a while ago.

Dr. Hedberg: Yeah, yeah, but it’s still applicable even today, everything that you guys wrote back then and…

David: Well, it is. And that was an interesting…you know, we realized that most doctors, and even today this is true, doctors getting out of medical school, chiropractic school, wherever, are coming out willfully and adequately trained in fibromyalgia and many of these, you know, hypervigilance central sensitivity driven disorders. They just don’t know how to deal with them. They have a lack of knowledge, but not a lack of arrogance. So, they end up telling patients, you know, that’s all in their head. And since they don’t have the answer, there must not be one kind of thing and that’s unfortunate.

So, we tried it and we recognized that. And we tried to publish in primary care journals, and journals that chiropractors would read, and journals that other kind of, like, primary care people who see people directly, you know, off the street as the first point of contact with a health provider, to try to get them to understand a little bit more how to properly tease out what is the real what we call classic fibromyalgia, this hypersensitivity, hypervigilance type of disorder versus what most of the people who get told they have fibromyalgia have, which is a whole litany of other things that the doctors are just not adequately diagnosing that’s kind of flying under the radar. We can talk what the most common things those are. But we try to basically take the story to the doctors, into the healthcare providers, so that they would know better and make better referrals and make better treatment decisions.

And in the end, I’m not sure that it really got very far. I don’t know if just a lot of those providers weren’t reading journals, it was hard to change what they did. So, that’s when I eventually after many, many years of people egging me on to do it and me, kind of, not wanting to do it for a long time, that’s when I wrote “The Fibro Fix” book and did the Fibro Fix Summit and all of that to try to, kind of, take the story to the street basically, take it to the patients, take it to the family members of people who have or been told they have fibromyalgia so they can really understand it frankly at a level higher than their provider and be their own advocate. Because if they’re not gonna do it, they’re probably gonna get routed through types of care that are ineffectual at best and side effect late and detrimental, the more common one.

Dr. Hedberg: Right. So, why don’t we establish, kind of, a definition and, kind of, a framework of the diagnostic algorithm? So, how do you currently define fibromyalgia? And what are those different algorithms and associated conditions that we want to be thinking about when we’re talking about fibromyalgia?

David: Okay. First of all, you know, the official diagnostic criteria which is put out by the American College of Rheumatology first in 1990, it has been modified a multitude of times since then, the latest one is sort of a 2016 version of it, which was modified in 2017, is in my, and most of my colleagues who deal with a lot of fibromyalgias, opinion woefully inadequate. It’s gotten a little better over time, some people arguing, in some way it’s gotten worse, but it’s really prone to overdiagnosis, so it catches way too many people with way too many problems.

So, my comments are not gonna be referencing that official ACR criteria directly. They’re gonna be talking about when you say algorithmic kind of the way we were advocating docs look at this whole thing. And right from the beginning of when someone comes in and says, “I have fibromyalgia,” or, “I think I have fibromyalgia,” that can happen for a lot of reasons. It could be that their neighbor told them they have fibromyalgia, it could be that they went on, you know, Doctor Google, it could be WebMD, it could be that they went to their family physician and got diagnosed, a massage therapist could have diagnosed and more even, a rheumatologist could have diagnosed them.

But regardless, they’re in front of you, right, and they think they have fibromyalgia. They may be right, they may be wrong. And our algorithm starts with basically two possibilities, the right or the wrong, right? They have it or they don’t. So, clearly there’s enough stuff going on in their life and in their symptoms that they think they have it or someone thought they had it. So, we, kind of, then bifurcate them into two camps. We’re trying to find out do they really have fibromyalgia? And we call it classic fibromyalgia just to differentiate it as the fibromyalgia that has all of the classical characteristics and signs and symptoms of what the researchers are really talking about when they’re talking about fibromyalgia in a contemporary definition.

The other stuff, you know, we’ve talked about it sometimes in our algorithm as pseudofibromyalgia. And, you know, pseudo means false. So, it really just means a false diagnosis or a false designation or labeling of fibromyalgia. And it doesn’t mean that the patient doesn’t have something wrong with them. They do, right? And they usually have multitude of things. So, it’s not meant to diminish their scenario, right, or to question them. It’s just meant to say, “Well, it’s not really this classic fibromyalgia thing. It’s something else.”

So, the first thing we try to establish is, do they have this classic fibromyalgia thing? So, that’s where I probably start talking about this, where, in classic fibromyalgia, if you ask most doctors, for instance, like what is fibromyalgia? You’ll have them say things like, “It’s a muscle problem. It’s an inflammatory disorder because it’s painful. It’s autoimmune. It’s the same as chronic fatigue syndrome.” And every one of those things I just said is incorrect. It’s not a muscle problem, it’s not overtly inflammatory, at least systemically throughout the entire body, it’s not autoimmune, and it’s not the same as chronic fatigue syndrome.

They go over four generally. It really is a brain processing disorder. It’s a central sensitivity disorder. What that means is there is heightened sense of the set point, if you will, or the alarm, or the danger, kind of, physiology in what we would call stress physiology, right? The HPA access and all of that. They’re really dialed up to a very sympathetic dominant fight or flight kind of wiring, if you will, in a set point in their central nervous system on a continual basis. So, it’s not related to an actual occurring threat. It’s just the way they’re wired, or the way they’ve learned to deal with their world. We’ll talk about that more in a bit.

But they tend to overprocess things, where, what would be light touch to a normal person or something that’s mildly painful would become very painful, or a light touch would be perceived as pain, even the wind blowing on them, right? But it’s all sensory stimuli. Although one of the biggest complaints, usually the most predominant complaint, a true classic fibromyalgia patient comes in with, is that they’re achy all over the body. They’re achy, and they perceive it mainly in the softer tissues, so the muscles, the tendons, the ligaments, the fascia.

It’s not in the joint. It’s not joint pain. Like if someone comes in and they say, “I think I have fibromyalgia. I hurt all over,” and I ask him, “Well, where do you hurt?” and they start pointing to their hips, and their knees, I’m thinking, “Well, that’s not fibromyalgia.” That’s articular. Maybe they have rheumatoid arthritis, or maybe they have some sort of, you know, autoimmune inflammatory arthropathy, but they don’t have fibromyalgia.

So, the fibromyalgia patients are achy in the softer compliant tissues. And that’s where the name comes from, fibro-myo, fibro-myo-algia, algia means pain, myo muscle, fibro the softer fibers, compliant tissues, so fibromyalgia. Most researchers hate the name at this point because it implies the pain is coming from the muscles and the soft tissues, and we know now that’s not the case, it’s just where the pain is perceived. The pain is actually a product of incorrect or dysfunctional processing deep in the centers of the brain where pain is processed and sensory stimuli is processed.

So, in addition to this, kind of, achiness or pain because of this hypersensitivity or what we call hypervigilance, like they’re vigilant for a catastrophy or for a threat or something coming at them almost subconsciously, but because of that they tend to have anxiety, they can’t calm their mind, therefore, they have a hard time getting to sleep because their mind is racing. When they do sleep, they wake up feeling like they never slept. It’s called unrefreshed sleep. And if you actually put them into sleep, well, it’s a very distinct kind of pattern where they don’t go into the stage three and four deep restorative sleep, what they call delta wave sleep. They have alpha waves popping over their deltas. So, it’s called alpha wave intrusion technically. But it’s like a false sleep. They can sleep 14 hours, but they never get into the stages of sleep where they really get regenerated and restored. So, they wake up feeling like they never slept.

And this hypervigilant sort of high level sympathetic dominant kind of scenario plays out not only in the central nervous system, brain and, you know, and then the spinal cord, but also in the enteric nervous system of the gut. So, these patients that have classic fibromyalgia, virtually 100% of them have what would meet the diagnostic criteria for irritable bowel syndrome, or IBS, because the same dysfunction going on in the brain is going on in the nervous system of the gut. So, they tend to have, you know, gas bloating, constipation and/or diarrhea or alternating between the two. So, they have a lot of vague gastrointestinal complaints that never get a clean diagnosis. They have anxiety, they can have panic attack, unrefreshed sleep, achy all over, and then the final thing is most of them have profound unrelenting fatigue that is separate and distinct from chronic fatigue syndrome.

Dr. Hedberg: Right, right. So, it’s very obvious just listening to you how easily this could be misdiagnosed, and I was thinking back, I remember first reading the American College of Rheumatology’s diagnostic criteria. They have these trigger points. You know, if you had a certain number of trigger points then…

David: Tender points, actually. Yeah, yeah, tender points. Yeah, yeah, I remember those.

Dr. Hedberg: You know, tender points, the funny thing was…

David: Eleven out of 18.

Dr. Hedberg: Yeah. The funny thing was, is that everyone I was seeing had…

David: Yeah, because if you look at those 18 points any chiropractor would tell you, “Everyone hurts there.” They were all in these places where, if you drive, work on a computer, have any stress, a postural distortion, they were in places where, you know, muscles that are firing all the time in normal, daily, repetitive activity. It’s where they were anchoring, you know, to an insertion point or something. And if you go dig in your finger in those areas, they hurt on everybody. So, it’s really comical.

And I actually pulled the minutes from the conference where that criteria first came out of. And they locked a bunch of these rheumatology experts in a room, and they wouldn’t let them come out basically until they came up with a diagnostic criteria. And it was literally like a…it was a negotiation. You know, one of the experts said, “We should have 24 points,” and the next one said, “No, we should only do 12,” and then they settled on 18. And then they negotiated how many out of the 18, how to be…you know, had a heightened level of pain response to be positive, and then negotiated it to 11, and yet doctors would take this as the bible like, “Oh. They only have 10 points positive. They don’t have it. They have 11 points. They do have it.” It’s just comical on its face. This is ridiculous. They have since, by the way, done away with the whole tender point challenge index in the diagnostic criteria.

Dr. Hedberg: Okay. Good. So, we talked a little bit about the classic fibromyalgia, the achiness ideas, anxiety. In your experience and your research, have you seen, kind of, a theme as the underlying causes of this particular classic fibromyalgia? I mean, are you seeing a lot of adverse childhood experiences, or physical, emotional traumas?

David: Yeah, and certainly not just me. There’s been even much larger, broader scope observations of these types of things and digging into the literature and doing pretty systematic sort of medical histories on these patients that have been pretty consistent, that this is almost universally a female disorder. It’s really rare…if there is a male in my office coming in and saying they have fibromyalgia, I am exceedingly doubtful that they actually have fibromyalgia. They have something else if someone called that because the male brain is just different than the female brain. And what we find is many of these patients, who like I said are predominantly female, have a common story.

They have a history of generally…now, this isn’t universal, but it’s amazingly consistent, a very difficult childhood experience and that can take many forms. It could take the form of a very authoritarian, impossible to please male figure, like father figure, particularly if they were very stern, very strict, yelled at them, verbal abuse, physical abuse certainly, and any kind of history within the family, you know, of sexual abuse is almost an express ticket to fibromyalgia, anxiety, panic disorder, IBS, things like that.

It doesn’t always have to be that overt. Sometimes it’s just a lot of they move constantly as a family unit because of work scenarios. The person never felt grounded, never felt safe, particularly if they felt threat from what should be someone who protects you like a family, you know, like abused by a family member. Mothers who didn’t show a lot of affection or love to the young girl, fathers who they can never please once again, difficult relationships parentally like, you know, the mother and father always fighting, and yelling, and screaming, and going through divorce at critical ages, all those kind of things can really rewire the brain.

And it’s much more devastating to the female brain for some reason that we really don’t understand. But it’s observable that females, when they’re put in those difficult situations, when their nervous system is young, its neuroplastic, it’s kind of learning how to behave, learning how to frame up its world, if they’re in that situation they get into this locked pattern of being on guard, if you will. That’s the hypervigilance.

It’s almost very similar to what you see playing out in post-traumatic stress disorder. In that disorder, you know, that is usually diagnosed later in life after you…you know, not in childhood necessarily, it could be, but, you know, you see it in a lot of, you know, the classic thing is the military, kind of, experience, battlefield stuff. But it can happen after seeing horrific accidents, rapes, things like that. So, this is not exactly PTSD, but it’s a very, very similar pattern from a neurotransmitter standpoint and from a neurological behavior standpoint.

And it could be then triggered later in life when the woman now is in her 20s, or 30s, or 40s, if there is a lot of additional stressors put on their life. So if they go through another abuse scenario as an adult, if they go through a divorce, if they, you know, just have tremendous job stress, whatever it may be, it could, kind of, be a re-emergence sort of with a straw that breaks the camel’s back.

Now, certainly young boys who are in these kind of bad upbringing scenarios as well, but they don’t tend to go and develop things like IBS, panic attack. They develop other things. They get dysfunctions, it’s just different. They tend to be very easy to anger, very easy to frustrate. They tend to act out on others. They commit acts of violence. If they were abused in a certain way, they tend to repeat the abuse in their family unit. Females don’t do that. They don’t act out on others as much, they don’t repeat abuse. They, kind of, turn it inward, and this is how they manifest it.

Dr. Hedberg: So, when you’re working with a patient and you’ve identified them as a classic, you know, fibromyalgia case obviously you’re identifying these traumas. Do you have any of your favorites? Because I’m sure you’re working with other practitioners. Are you referring out for EMDR or somatic experiencing neurofeedback? How do you approach the trauma aspect?

David: Yeah. And, you know, I’m not a mental health professional. I’ve been practicing, you know, it’s getting really close to 30 years and it’s, you know, frightening to say. And I’ve dealt with so many patients with so many disorders like that. I’m certainly not a formally trained mental health professional, but I’m pretty good at picking up things, you know, and noticing things, and mining these things out of people’s histories in a respectful way. But it does take a team.

So, I’m lucky enough to be in a larger group practice, like you mentioned, a whole body of medicine up here in Fairfield, Connecticut, where, you know, one of my colleagues, Dr. Adam Breiner, is an expert in functional EEG, does a lot of traumatic brain work, does a lot of other, you know, work with PTSD people and so forth.

So, we use some real-time EEG analysis and different types of training, in-office training initially, where we train people to sort of change their brain waves, you know, change their brain state in the waking state. But then we move them off to non-provider dependent types of things such as, you know, different forms of cognitive behavioral therapy, or CBT, like a heart rate variability is a really good type of technique to use with many of these hypervigilant patients. And they can do that on apps, you know, on phones, and tablets, and things like that at home. But not at night, not in the evening because we don’t want them on those things then.

And then I have a team of, like, counselors. They tend to be either family counselors or psychologists that understand this hypervigilance, PTSD-type of variant, and work with the patients with either cognitive behavioral therapies or different types of therapies. You know, if there was abuse, if there’s unresolved psychological overlay that is really a barrier to recovery, then they have to deal with that.

And, you know, I’ve seen that evolve. It used to be, you know, you have to confront it, you have to process it, you have to relive it and get beyond it. They don’t really do that much anymore. It’s more now it’s about reframing. Some people do what’s called forgiveness therapy. A lot of times maybe if they were abused, the abuser is deceased or they’re an elderly, you know, parent or relative and they’re, kind of, different, if you will, now, and they forge a new different relationship with them. And it’s not about excusing something horrific that was done, but it may be a level of personal forgiveness in a way to get beyond it neurologically. I’m not the best explaining that side of it, but I let the others, kind of, handle that side of it confidently, and I’m dealing with the, you know, the neurotransmitter, biochemical, kind of, support side. And we do that all at the same time.

Dr. Hedberg: Yes. So, why don’t we talk a little bit about that? So, there are clearly some effective nutriceutical approaches, and we know that, you know, increasing serotonin levels centrally is helpful. Can you talk a little bit more about some potential dietary and nutriceutical approaches that are beneficial?

David: Yeah. Well, first, you know, like you mentioned, diet, it really starts with diet, just not unique to fibromyalgia, but anybody with a chronic health challenge and a chronic metabolic disorder. You know, it goes for anybody really. If you eat junk, you’re gonna have junky outcomes. So if they’re eating really processed foods, you know, fast foods, just junk and lots of sugar or lots of, you know, antigenic type of stuff, then when you try to get them on whole fresh, you know, kind of, diet that’s varied, that they get good lean protein with every meal, and they’re getting lots of different vegetables from different colors. In many of them we are de-emphasizing at least for a while why we clean them up and just get them healthier, less inflammatory. We’ll maybe do some food immune challenge testing like Alcat or something like that, or we’ll just try a gluten-free, dairy free sort of a whole food diet.

In the beginning of my program that’s in the book, “The Fibro Fix”, there is like this 21-day detox thing, and it’s not because it’s a cure for fibromyalgia. A lot of people think that even though I’ve stressed that that’s not the case. It’s just sort of setting the stage for recovery. You don’t want a big barrier to getting healthy and well, which is a junky diet. But beyond that, from a nutriceutical standpoint, there’s a lot of great options.

We know from the literature in many, many studies, these patients with global pain and fatigue syndromes like classic fibromyalgia and hypervigilance in general have a low brain serotonin state. They have a low central nervous…I’m sorry, cerebrospinal fluid serotonin state. So, their serotonin is low. And when serotonin goes low, another neuropeptide that’s inversely proportional called substance P goes high. And if there’s more substance P lurking around the associated neuron pools in the spinal cord through the cerebrospinal fluid, they’re much more likely to activate or turn on, so you’re more sensitive to sensory information being amplified. So, you’re more sensitive to something that’s non-painful being interpreted as painful, for instance. So, what we need to do is get the serotonin up, drive the substance P down.

And we also need to take a look at the catecholamines, you know, the dopamine, the norepinephrine, epinephrine. A lot of times the epinephrine, norepinephrine is high. That’s a sympathetic dominant fight or flight, kind of, pattern you see in PTSD. You see it in hypervigilance. So, we’re using things like 5-hydroxytryptophan for instance as a precursor to get serotonin up.

Now, we know, you know, there has never been any drugs developed from the ground up and approved for fibromyalgia. The drugs that are approved are retrade drugs. They’re repurposed drugs because they were originally used in an off label way for fibromyalgia. And one of those classes of drugs is SSNRI, or selective serotonin norepinephrine reuptake inhibitors. They are basically repurposed class of antidepressants. The other classic drug is alpha-2 delta ligands. They are anti-epileptic drugs. Both of those drugs have a lot of side effects. They’re not easy to take, particularly the anti-epileptics. But in the properly selected patient with classic fibromyalgia, some of them definitely get better on these agents, particularly the SSNRIs. That’s the one that I think is more useful and has less side effects.

But so many people get put on these things that don’t have fibromyalgia because of lazy diagnosis. They get all the side effects, they don’t get any benefit. With even the people properly selected, only about somewhere, depending on the study, you look at 25% to 35% gets functionally significant outcome benefits. Many of those benefits decay over several months of use of the drugs. So, there is no gray solution in pharma.

But I bring that up because this class, these anti-depressants, modulates serotonin. But they do so by stopping the uptake or recirculation of serotonin in the nervous system. And many of these patients don’t do well on those drugs, just like many anti-depressents don’t do well on those drugs, if they’re not fundamentally making enough serotonin to begin with. So, I actually find that using a precursor therapy where the body can make more serotonin like a 5-hydroxytryptophan is, in many cases, more useful. It works when the drug doesn’t, or it makes the drug work better if you are using the drug and you can use less of it.

So, we use a lot of 5-HTP, but we use a lot of things to calm the catecholamines. So, you know, we will usually use this, kind of, formulary products like I use something called NeuroCalm from Designs for Health or CatecholaCalm. They’re meant to do this, but they have calming botanicals, like German chamomile, they have ashwagandha or Withania somnifera. They have things like L-threonine and inositol, phosphatidylserine, calming things. These make calming neurotransmitters, they back off the production of the catecholamines, which are adrenaline essentially.

And we strategically use something called GABA, which is a neurotransmitter. We use a fermented form of GABA called Pharma GABA that’s in some of these formulations. I use a sublingual, like chewable form that works really well as well particularly in anxiety and panics. And the other agent I do find very, very helpful with anxiety, hypervigilance, pain response, getting into deeper sleep is CBD, actually. So, cannabinoids, CBD in the form of, you know, a good quality standardized hemp oil, and then also we use sleep aids. We got to drive them into deeper sleep. So, we use a sustained release melatonin to try to drive them into deeper sleep.

We’re also trying to help their energy metabolism. I’m usually pushing their mitochondria a little bit with things like CoQ10, and ribose, and B vitamins, and things like that. Although a lot of functional medicine docs think fibromyalgia is just a mitochondrial issue and it’s not. Mitochondrial issues are mitochondrial issues. They just produce a lot of the same symptoms.

And then the other thing we really do is we really look hard at the patient’s thyroid state, including peripheral conversion of thyroid hormones, response to thyroid hormones, and we really optimize thyroid and mitochondria as a side to treating the classic fibromyalgia because it’s very important. And those are two of three most common things that get inappropriately labeled as fibromyalgia, low thyroid, poor mitochondrial energy production. And it’s not uncommon for the patients to have classic fibromyalgia and not a great thyroid function, not a great mitochondrial function, because those things are very ubiquitous and common. So, you know, we always try to remember the patient has the right to more than one disorder at any given time.

Dr. Hedberg: So, the pseudofibromyalgia, let’s just talk a little bit more about that. We mentioned hypothyroidism can be included there, Lyme disease…

David: And as you know, as good as anybody, Nick, you’ve done some of the best work on this and got some of the best awareness out there for people. The thyroid story is a very complicated one, and it’s way more complicated than the family doctor, even the internal medicine doc, or even the conventional endocrinologist is willing to talk about and go to with patients even if they understand it. So, you know, as you know doing a TSH isn’t enough or a TSH and maybe a total T4. We look into how the hormones are not only being produced but how they’ve been further being metabolized in the periphery, which is paramount, and if there is autoimmunity, if there’s stealth infections, all of that kind of stuff that you laid out brilliantly is extremely important to dive through.

Dr. Hedberg: Exactly. Well, this has been a really great overview of the classic and the pseudofibromyalgia. Was there anything else you wanted to add?

David: Well, I told you I was going to talk about three masqueraders of fibromyalgia, like the three things that are often in play that doctors don’t queue up on. But if it’s a middle aged women because she is gonna complain of fatigue, brain fog, achiness, some gut issues maybe commonly, they just slap the fibromyalgia diagnosis on them. But we talked about really working up thyroid comprehensively. That’s number one masquerader.

Number two is looking at mitochondrial function and ATP production. If energy metabolism is disrupted and you’re not making enough ATP, you will be tired, your brain won’t work well, and your muscles get achy because you back up into anaerobic metabolism, you make a bunch of lactic acid. So, we look at a lot of that stuff based on organic acid analysis, but also on symptoms. You know, if the patient is coming in saying, “I’m tired all the time and I’m achy,” but they don’t have anxiety, they don’t have unrefreshed sleep, they don’t have gut problems, they don’t have histories with a lot of, you know, trauma or angst or whatever, you know what, they probably don’t have classic fibromyalgia. They probably have something like a mitochondrial problem or a thyroid issue.

And then the third one, because we did thyroid, mitochondrial energy production, the third one is myofascial pain syndrome. People who really have muscular, you know, somatic issues, they have trigger points in myofascial pain syndrome and, you know, postural distortions and as chiropractors would call subluxations and all kinds of other stuff, they need physical medicine. They are the ones that respond well to, you know, physiotherapy, chiropractic, massage, acupuncture, those kind of things, where the classic fibromyalgia patient, all that therapy directed at the muscles is really not doing anything because the problem is not in the muscles, the problem is in the brain, that you got to attack it centrally.

Now, the patient may also have some myofascial pain syndrome and stuff like that because a lot of people do. So, you might help them on the edges, but you’re not gonna really get to the core of the classic fibromyalgia. But unfortunately, a lot of these docs or providers who do physical medicine or, you know, they work on the body, if you will, body workers of any kind, they really honestly think they’re treating fibromyalgia all the time. And, you know, because a lot times people come in and say they have fibromyalgia, they treat them, they do what they do, and the patients get better. But usually that patient didn’t have classic fibromyalgia. They have myofascial pain syndrome or some other disorder that that therapy is amenable to treating. But just because you called it the wrong name and got it better, it doesn’t mean you cured the name that you…you know, the disease that you misnamed. So, that’s another thing that we try to get these other providers to understand, not to diminish what they’re doing because what they’re doing is extremely valuable, but they should understand what they’re treating or what they’re not treating effectively.

Dr. Hedberg: Right. I mean, because even just human touch is going to affect a lot of these issues. I mean…

David: Definitely, absolutely. And those kind of providers are the ones that touch you, they spend time with you, they get to know you. I mean, how many studies have you seen through the years on patient satisfaction with different kinds of medical providers? Who always comes out on top the list? Chiropractors, right?

Dr. Hedberg: Mm-hmm.

David: Massage therapists, people who touch people, who spend time with people. The people who sit on the other side of the desk and see him for six minutes like their family doctor, or the PA sees them, they’re not as satisfied with them because they never develop the patient-doctor healing encounter, that may mean something.

Dr. Hedberg: Is there anything else you’d like to add to the classic and the pseudofibromyalgia story that we haven’t touched on today?

David: Oh, I would just say if anyone’s , you know, listening to this podcast that has fibromyalgia, has a family member who has it, that think they have it, or you’re dealing with patients who are trying to struggle through this, I really wrote my book, “The Fibro Fix,” to let people go through that journey and not make them doctors, but to understand what is fibromyalgia, what is classic, what is all the other stuff that gets called classic, and where do I seem to apply in this whole array of possibilities? So, we utilize a lot of questionnaires, a lot of gateway, kind of, scenarios to have them answer that question for themselves, and then give them information on all these different things, whether it’s classic fibromyalgia or a lot of these pseudo, you know, different things that may be getting them erroneous diagnosis.

It will reinforce what you’re trying to do as a provider. If the patients reading it, they don’t have a provider, it helps them find, you know, a functional medicine provider. So, it’s a really good resource. It’s good for clinicians to read. They learn a lot. It’s good for patients to read. And for the clinicians on the call as well, if you wanna access any of those papers that we had talked about and you referenced, Nick, they can just hit my website at drdavidbrady.com. And in the media or the articles tab, there is all kinds of papers on fibromyalgia. Also, probably even more direct is on fibrofix.com, F-I-B-R-O-F-I-X.com. There is a lot more interviews, you know, TV interviews, seminars, all kinds of content on there if you want to learn more about this.

Dr. Hedberg: Excellent. Well, thanks for coming on and giving us such a great overview of fibromyalgia. I think this will really clarify a lot of things for people that are out there who may have it or they might be thinking now, “Maybe I don’t have it. Maybe I have a thyroid issue, or a mitochondrial issue, or something else.”

David: Yeah. Well, that’s why I put the content out there. So, if it helps anybody, then that’s great.

Dr. Hedberg: So, to all of our listeners go to drhedberg.com, and I’ll be posting a full transcript of this interview for those who like to read as well and to share, as well as links to everything that we talked about today, Dr. Brady’s website and his book, “The Fibro Fix,” which I highly urge you to read if you have fibromyalgia or suspect it, or if you know someone who has it, you know, buy them a copy, it will be, you know, one of the best gifts they’ve ever gotten. So, this is Dr. Hedberg. Thanks for tuning in. And I will talk to you next time. Take care.

"So happy to have Dr. Hedberg on my team! He was able to balance and tip me back on to the side of good health!"

by - M.P.

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