FIBROMYALGIA CAN BE RESOLVED BY MEDICAL HERBALISM

A talk by Morwenna Given

Medical Herbalist

www.medicusherbis.com

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WHO AM I?

I am

MORWENNA GIVEN

BA MA ( Oxon ) BSC m.OHA BHG RH

A Medical Herbalist practising in downtown Toronto treating a variety of disease from

constipation to cancer

I trained in the UK in university, hospital & clinic environments on an evidence base basis

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TRAININGTraining Medical

Herbalistvs. Medical

Doctorvs. Naturopath

Degree Yes Yes Yes

Prof.body Yes1542

Yes 1540

Yesc.1901

Hospital training Yes Yes No

Surgery No Yes No

Evidence based

Yes Yes No

Specialist Yes Yes No

A medical herbalist only uses plants & professional supplements to treat holisticallyA medical herbalist has 2-3 times more training than an MD in Both conventional drugs and plant medicine Drug interactions & contraindications & Dosage Nutrition and preventive medicine

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What is Fibromyalgia?

• Fibromyalgia, an illness characterized by chronic, widespread pain and tenderness, is estimated to affect about 5 million U.S. adults. Fibromyalgia was formerly classified as an inflammatory musculoskeletal disease but is now considered to be an illness that primarily affects the central nervous system.

( Medscape 2008 )

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MEDICAL STUDENT TEACHING 2011

• Fibromyalgia (FM) is a common, idiopathic, chronic musculoskeletal pain condition associated with widespread pain, tenderness in various anatomically defined tender points on the body, fatigue, sleep abnormalities, and common comorbidities with psychiatric and medical disorders (Arnold, Bradley, Clauw, Glass, & Goldenberg, 2009). An estimated 6 million (2% of the US population) men, women, and children have been diagnosed with FM (Krypel, Rospond, & Chen) with the overwhelming majority being middle-aged women (7:1) (Lawrence, Felson, & Helmick, 2008). Although FM is the most common presentation of pain in general medicine and rheumatology (Perrot, Dickenson, & Bennett, 2008), it continues to be under-recognized and misunderstood. The lack of understanding of the pathophysiology of FM has made this condition frustrating for patients and clinicians alike (Harris & Clauw, 2009). A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about FM: nearly half of the general public (45%) has never heard of FM, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).

• Medscape 2011

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MERCK

• Pain on 11 out of 18 points on the body

• Widespread pain for 3 months minimum

• Pain widespread in axial skeleton and right and left of the body on deep palpation.

• Pain gradual diffuse and achy

• Co morbidities

• As described in the Merck Manual 18th Ed.

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DOES NOT FIT

• In other words this is a disorder which conventional medicine cannot neatly classify as it is multi aetiological in origin requiring multi level resolution

• Conventional medicine is organised vertically in a system in which specialists ignore each other creating further problems with no suitable drugs for chronic auto immune disease and where surgery is inappropriate

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NOTHING NEW

• Fibromyalgia is not a new disease

“First recorded as far back as the 16th century, medical literature contains descriptions of clinical manifestations of musculoskeletal pain. In 1904, Sir William Gowers, coined the term "fibrositis": the idea that there were changes in the muscular beds and connective tissue that represented inflammation. Those changes were never found, so that is 1 reason we no longer use the word "-itis.“ In 1975, the first objective findings that were ever associated with the disorder were discovered by Dr Harvey Moldofsky, a Canadian psychiatrist working in sleep medicine and suggested that FM be reclassified as a nonrestorative sleep syndrome. Today there are still parties who believe that FM is a primary sleep disorder.”

• The current post war WW2 organisation of conventional medicine based on acute disease with single action drug mechanisms

• The current construct cannot deal with chronic disease and there are no drugs for lifestyle

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epidemiology

• Not present in any significance in the 3rd world

• A chronic disease of the western world but not new – dis/ease of excess

• Women 7:1 Men

• Some evidence to suggest overweight lower socio-economic groups more susceptible and BRICK countries now showing the syndrome

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HOMEOSTASIS

• As a medical herbalist which treats wholistically and aims to return the body to homeostasis I understand syndromes such as fibromyalgia as I operate on a the physiological multi cellular level inter relating with all aspects of the body. Our biochemical training allows us to understand how the differing aspects of this syndrome actually relate to the symptoms of dysbiosis and of which pain is merely a symptom

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Treatment by Conventional Physicians

• Muscle biopsy studies do not conclusively show abnormalities specific for FM, moth-eaten fibers, ragged red fibers, and type II fiber atrophy indicate that muscles are often involved in the pathogenesis of FM. One of the most important findings is that the regulation of deep tissue microcirculation is abnormal in FM, which may result in sensitization of intramuscular nociceptors. Abnormalities may lead to lowered pH during mild to moderate muscle load sufficient for activation of muscle nociceptors. Altogether, this may result in peripheral sensitization of afferent pain pathways, which then provides impulse input to central pathways resulting in central sensitization.

• A better understanding of peripheral and central pain mechanisms in FM will aid in the development of new and effective therapies for patients. Some of the clinical implications include pharmacological and nonpharmacological therapies that modify peripheral and/or central mechanisms operant in FM.

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Treatments (2)

• These treatments may consist of cognitive-behavioral therapies, treatment with antidepressants (particularly serotonin-norepinephrine re-uptake inhibitors) and antiepileptic drugs, just to name a few. At this time, stress reduction, restful sleep, and exercise are known to positively affect FM pain mechanisms.

• NO ADDRESSING OF CAUSES, NO EVALUATION OF DEFICIENCES WITHIN THE BODY, or LIFESTYLE ISSUES

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drugs

• Commonly prescribed drugs are:

• Tricyclic anti depressants and SSRI’s

• Non opioid analgesics

• Opioids

• NSAIDS

• Muscle relaxants

• ALL HAVE SERIOUS SIDE EFFECTS & THEY JUST DEAL WITH SYMPTOMS

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Side effects

• Addiction

• Ulcers

• Incontinence

• Insomnia/nightmares

• Weight gain

• Impaired hepatic function

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Conventional drugs

• Benzodiazepine tranquillisers e.g. Xanax side effects as below + ataxia, rashes, libido decreased

• Anti depressants:

• SSRI’s – Prozac

• Sleeping drugs -

• Amitriptyline e.g. Venflaxamine, Elavil – weight gain dry mouth/eyes, constipation, decreased perspiration & arrhythmias, addictive, impact normal muscle function

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Drugs (2)

• Muscle relaxants – anti spasmodics and similar to anti depressants in pharmacological mechanism.

• Pain – opioids, NSAIDs, CABA (tramadol)

• All the drugs have very limited effectiveness, only treat the symptoms and cause major side effects over short and long term

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Aetiologies

• Genetic

• Psychogenic & social causes

• Nutrition

• CFS & other co morbidities

• Environmental toxins

• Neuroendocrine

• Stress

• HPA axis

• Hypothyroidism ( especially in Ontario

• Immune deficiencies

• Hormone deficiencies

• Physical trauma

• Whiplash

• Neuroplasticity

• Cerebral circulation

• Phosphate deficiency

• GH & impaired Calcium metabolism

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Typical symptoms

• Muscle stiffness & aching

• Tender points

• Disturbed sleep

• Fatigue

• Sensitivity to temperature

• Bruxism

• IBS/ Digestive disturbance

• Reproductive hormone im-balance

• Genito/urinary issues

• Sensory overload

• Brain fog

• Depression

• Dry mouth and eyes

• Headaches

• Rhinitis – sinus issues

• Skin, hair, nail problems

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Drivers

• Hyperstimulation of the CNS with raised levels of glutamate, low tryptophan serotonin

• Increased levels of IL6 and other prostaglandins –immune dysfunction

• Hyperstimulation of peripheral pain receptors

• Relationship to beta estrodiol & women’s hormones

• Thyroid malfunction / hormone imbalance GH

• Ca metabolism impaired, Vit D deficiency,

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How do I treat

• Each patient is an individual and assessed accordingly in a 2 hour consultation – Symptoms and causes addressed - and given a bottle of tincture ( medicine ) to take as directed and a tea, supplements if relevant. A physical examination may be applicable and blood pressure taken. Bloodwork may be requested.

• Exercise is discussed and recommended including:

• CBT, Yoga ,Tai Chi ,Aerobic exercise which have all shown to be beneficial

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“ Let food be thy medicine and medicine thy food – Hippocrates”

• Diet is key in any chronic auto immune disease and is believed to be part of the aetiology

• FRUITS AND VEGETABLES , • basic principles & Palaeolithic diet

Altern Ther Health Med. 2011 Mar-Apr;17(2):36-44.A program consisting of a phytonutrient-rich medical food and an elimination diet ameliorated fibromyalgia symptoms and promoted toxic-element detoxification in a pilot trial.Lamb JJ, et al.Dept. of Molecular and Cellular Biology, MetaProteomics LLC, Gig Harbor, Washington, USA.

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Reduce the drivers

• Chemical imbalances in the brain corrected

• Inflammation reduced

• Immune system modulated

• Hormonal imbalances corrected

• Environmental issues addressed

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Solution!

• PLANTS ARE MULT FACETED AND MULTI FACTORIAL OPERATING ON BIOCHEMICAL PATHWAYS WE ARE ONLY BEGINNING TO UNDERSTAND capable of treating CHRONIC DISEASE WITH NO SIDE EFFECTS.

• ' Everything man needs to maintain good health can be found in nature - the true task of science is to find these things ' Paracelsus

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Plants

• Muscle stiffness & Pain:

• Alteratives, anti inflammatories, circulatory stimulants, connective tissue tonics, analgesics

• Devils claw, Prickly Ash Bark, Celery seed• Kava black cohorsh scentella lobelia

J Pharmacol Sci. 2003 Nov;93(3):367-71.Harpagophytum procumbens suppresses lipopolysaccharide-stimulated expressions of cyclooxygenase-2 and inducible nitric oxide synthase in fibroblast cell line L929.Jang MH et al. Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Korea.

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Plants

• Pain and lack of sleep:

• Analgesics, hypnotics, neurotransmitter regulator

• Valerian, passionflower, Jamaican dogwood , anemone, Skullcap, wild lettuce, Californian poppy, meadowsweet

Evid Based Complement Alternat Med. 2011:403591. Epub 2011 Apr 26.Selective Interactions of Valeriana officinalis Extracts and Valerenic Acid with [H]Glutamate Binding to Rat Synaptic Membranes.Del Valle-Mojica LM, et al. Ortiz JG. Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico-Medical Sciences Campus,

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Plants

• Connective tissues:

• Regenerator of muscles and tissues:

• Scentella, hawthorn, horsetail, fo ti, bilberry,

• Plantain, comfrey

BMC Plant Biol. 2011 Jul 29;11:112.

New insight into silica deposition in horsetail (Equisetum arvense).Law C, Exley C.Lennard-Jones Laboratories, Keele University, ST5 5BG, UK.

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Plants

• Muscle relaxants:

• Cramp bark, prickly ash bark, willow, paeony

J Med Food. 2011 Apr;14(4):434-40. Epub 2010 Dec 27.Anti-acetylcholinesterase and antioxidant assets of the major components (salicin, amentoflavone, and chlorogenic acid) and the extracts of Viburnum opulus and Viburnum lantana and their total phenol and flavonoid contents.Erdogan-Orhan I, Altun ML, Sever-Yilmaz B, Saltan G.SourceDepartment of Pharmacognosy, Faculty of Pharmacy, Gazi University,

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Plants

• Lack of Energy:

• Siberian ginseng, liquorice, verbena, ginger

• Nettle, schizandra

• Nettle and alfalfa contain between them nearly all the micro nutrients the body needs.

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More Plants

• Digestive issues – carminatives, anti spasmodics, bitters

• Peppermint, chamomile, milk thistle, marshmallow, ginger

• Excretion

Anti spasmodics Diuretics and liver herbs

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And so on……

• Brain fog:

• Cerebrovascular stimulants and HPA

• Rosemary gingko, periwinkle, scentella

• Anxiety/depression:

• Neurotransmitter balance and HPA

• Arctic rose, rose, verbena, St John’s wort, passionflower,

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THYROID

• A previous slide showed how important the thyroid is in governing hormones

• In Ontario there is a huge problem of sub clinical hypothyroidism

• The Thyroid governs all metabolic function if this is out of balance then hormones will rage!

• Issues include, lack of iodine, bromine in foods• Lack of exercise

• Withania, nettle, myrrh, reishi, bacopa, coleus, • Liquorice, melissa, blue flag, motherwort,

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Control of Hormones implicated in Fibromyalgia

• Thyroid specifically matters in fibromyalgia

Because:

• Growth Hormone, somatostatin, and IL6

• Calcium, calcitonin and muscle function

• Regulated by HPA/thyroid axes

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Consequences of thyroid dysfunction

• Immune dysfunction - Tsh T 3 T4

• Cone flower, milk vetch, skullcap, schizandra,

• Ginsengs, scentella, arctic rose

• Susceptibility to colds, flu other infection

• FMS patients have higher levels of IL2, T helper cells and alpha interferon which mediates immune response.

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CASE STUDY

• Female 46 yrs. single, sales administrator

• PMHx: abusive relationship, frozen shoulder,

• Ovarian cysts, endometriosis, frequent earaches, bronchitis, reflux, dysphagia, recurrent cystitis,

Nasal polyps, rash, sub clinical hypothyroidism

finally ddx fibromyalgia

• Drugs: SSRI’s

• Diet high in pasta low in vegetables

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Case study

• Amended diet and encouraged to exercise

• Compound included:• devil’s club, marigold, golden seal, verbena,

rosemary, withania, reishi, Poke, skullcap, black cohorsh, golden rod

• Tea

• Supplements recommended Vit D magnesium,B12, zinc, fish oils

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OUTCOME

• In 4 months:

• No muscle aches and pains

• Subclinical thyroid becoming normal

• No breast pain, no ovarian pain, no discharge

• Mental fog significantly reduced

• Bowels, digestion normal, no reflux

• No nasal polyps, no ear aches,

• Skin ‘big improvement no longer dry’

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NEW LIFE

Opened new business with partner!

• Gone back to study for diploma

• Sleep normal, sex life normal!

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Vitamin D

• Vitamin D is poorly understood ; currently 8 forms identified - most common form - Vitamin D3

• Pathogenesis of cancer, hypertension, MS, auto immune, osteoporosis, osteoarthritis, pulmonary disease, Crohn's, diabetes, thyroid function, blood clotting, liver function

• Endocr Pract. 2009 Apr;15(3):203-12.Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial.( in fibromyalgia Px’s) Arvold DS, et al. St Luke's Internal Medicine Associates, Duluth, Minnesota 55802, USA.

• Most Canadians deficient.

• Grant W, et.al. An estimate of the economic burden and premature deaths due to vitamin D deficiency in Canada, Molecular Nutrition and Food Research, volume 54, Issue 8, p. 1172-1181, août 2010.

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Supplements

• As a rule I do not advocate supplements for reasons shown in the next slide but some are useful in Fibromyalgia

• Melatonin, Fish oils, glutathione, bromelain and NAC; zinc, selenium, B6

• Other symptoms such as anaemia may require short term supplement use

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Supplement cautions

• Illegal to sell a medically efficacious dose

• Most are not pharmaceutical grade

• No evidence base / extrapolation claims

• Contents /label/marketing claim

• Unnecessary

• No consideration of individual needs

• Failure to address polysupplementation

• Arch Intern Med. 2011;171:1625-1633,1633-1634.

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References

• I have a large number of references which I am happy to supply if you would like to email me at mrsmg@sympatico.ca or leave your own email address with me today

• www. Pubmed, Science Direct

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Please note :

• PLEASE NOTE IT IS ADVISED, THAT ANY PLANTS MENTIONED IN THIS TALK ARE ONLY USED UNDER PROFESSIONAL GUIDANCE.

• BOTANICAL MEDICINE AS SUPPLIED BY A PROFESSIONAL IS NOT AVAILABLE OVER THE RETAIL COUNTER.

• It is not advisable to self treat

• A professional will recognise all the issues within the body and • Select herbs that will impact positively on these issues without • Causing problems in order to co exist with orthodox drugs,

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Thank you for listening

Morwenna Given

www.medicusherbis.com03/12/2014 © 43