Archive for July 7, 2008

Oxalates and their role in Fibromyalgia Syndrome (FMS)

July 7, 2008 at 2:16 am · Filed under Fibromyalgia ·Tagged

Nicola McFadzean, N.D.

Oxalates are organic compounds naturally occurring in certain foods, mainly vegetables and fruits. An accumulation of oxalic acid crystals in the muscle and connective tissue cells may be the cause of the muscle aches and pain associated with FMS.

FMS can be a debilitating condition, involving many systems within the body. It stands apart from arthritis and autoimmune reactivity in that the muscles are not inflamed on biopsy. However, the pain can be every bit as bad and it is often resistant to treatment. Associated symptoms of FMS include chronic fatigue, headaches/ migraines, brain fog, yeast overgrowth, insomnia and hormone imbalance.

For many years, people with a condition called congenital hyperoxalosis have been prescribed low oxalate diets. These people have an accumulation of oxalates that may result in kidney stones and crystalline arthritis. It is also recognized that vulvodynia and vestibulitis (pain and inflammation in the vulvar area) may be associated with oxalate deposition in the tissues. So the idea of low oxalate diets is not new – it’s the association with Fibromyalgia that is under more recent investigation.

Dr. St. Amand, author of What Your Doctor May Not Tell You About Fibromyalgia, promotes the use of a medication called guaifenesin to treat FMS. Guaifenesin was found to increase excretion of 60% phosphates, 30% oxalates and 30% calcium. The medication guaifenesin itself is fairly benign. The challenge with this protocol is strictly avoiding all salicylates (another organic compound found in certain foods, personal care products etc). Also, guaifenesin is not a quick fix remedy, may take months to show real benefits, and can cause a worsening of symptoms initially as the body dumps phosphates and oxalates. That being said, a number of FMS sufferers have found relief with guaifenesin. (For those interested in this protocol, I would recommend reading the book by Dr. St. Amand as a starting point).

There may be an interaction between calcium, magnesium and oxalate. People with high oxalate levels sometimes do not tolerate magnesium well, leading to irregular heartbeat, nausea, stabbing pains and increased muscular aches (this may also occur with Epsom Salts baths which are magnesium sulfate). Certainly, FMS sufferers should make sure to take calcium and magnesium in the citrate forms, which are best suited to block the absorption of oxalates and help excrete them from the body.

Another oxalate connection relates to candida and yeast overgrowth. Good bacteria in the gut help to keep oxalates in check by breaking them down. Bad bacteria in the gut can produce oxalates. Oxalates are said to suppress the immune system and make one more susceptible to candida overgrowth. Therefore, along with a low oxalate diet, addressing yeast is imperative to reduce the overall oxalate load.

There are even more implications of oxalates in the body. Oxalates deplete glutathione, one of the key antioxidants; oxalates change how zinc works within the body, which can affect immune function; and they also fuel inflammation which is a major issue in FMS.

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Overlaps with Fibromyalgia

July 7, 2008 at 2:08 am · Filed under Fibromyalgia ·Tagged , , , , ,

Overlaps with Fibromyalgia

Fibromyalgia syndrome (FMS), chronic fatigue syndrome (CFS), multiple chemical sensitivity syndrome (MCS), myofascial pain syndrome (MPS), and other conditions form a family of overlapping syndromes. In fact, researcher Muhammad Yunus, M.D., of the University of Illinois College of Medicine, claims, most patients have more than one syndrome. Thus, he views FMS and CFS as being part of a larger spectrum of conditions, which he calls Dysregulation Spectrum Syndrome or DSS (see diagram below). Dr. Yunus uses the term dysregulation to mean biophysiological abnormalities, possibly in the body’s neurological, hormonal and chemical systems.

Overlaps with Fibromyalgia

Backing up Dr. Yunus’ commentary are studies by Dedra Buchwald, M.D., of the University of Washington, Anthony Komaroff, M.D., of Brigham and Women’s Hospital and Don Goldenberg, M.D., of Newton-Wellesley Hospital. It is always important to keep these overlapping syndromes in mind because the presence of one or more syndromes could impact your treatment. These three researchers have shown that CFS and FMS overlap in patients by as much as 75%. When it comes to MCS, this syndrome is present in roughly 50% of FMS- and CFS-diagnosed patients.

Most practicing physicians and researchers alike will tell you that the chronic pain diagnosis a person first receives is often colored by their chief symptom complaint. For example, widespread muscular pain is often diagnosed by rheumatologists as fibromyalgia syndrome. A person who is overcome by extreme fatigue and flu-like symptoms might consult an infectious disease expert and receive the diagnosis of chronic fatigue syndrome. A person who has severe jaw pain might see a dentist and be told that they have temporomandibular joint dysfunction (TMJD). People who appear to have allergic-type symptoms to a number of chemicals, foods, or odors may be informed by an allergist that they have MCS. Similar situations occur with the other conditions in the family of Dysregulation Spectrum Syndrome.

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Sleep Disorders in Fibromyalgia

Two common sleep disorders that may be present in fibromyalgia patients are: restless leg syndrome (RLS) and periodic limb movement during sleep (PLMS). According to sleep researcher Harvey Moldofsky, M.D., of the University of Toronto, RLS has been described as someone playing soccer all night long. The patient’s arms and legs just cannot stay still. PLMS may feel like a startling response that occurs when you think you have reached the last step going down a flight of stairs and you fling your limbs to catch your balance as you discover that there is one step remaining. Both RLS and PLMS can cause continuous arousal movements during sleep and impede your ability to wake up feeling rested.

Referring to the specific sleep disorders of RLS and PLMS, Dr. Yunus comments that a sleep study might be helpful if a physician suspects either condition. First of all, it may offer an objective test finding that is lacking for most fibromyalgia patients. Secondly, the treatment for RLS or PLMS is a benzodiazepine with anti-seizure properties such as Klonopin (clonazepam), or a dopamine-like drug such as Mirapex or Requip. The most commonly used medications for fibromyalgia, such as tricyclics like Elavil and trazodone, can actually make this subgroup (30%) of patients worse. Therefore, it is important that you assist your physician by providing accurate symptom information regarding your sleep to help identify related syndromes. This can aid in the development of appropriate treatment strategies.

Could fibromyalgia be part of a newly discovered sleep disorder?

Novel findings are continuing to shape the direction of research and theories about the cause of these overlapping syndromes. In the October 2004 issue of the Fibromyalgia Network Journal, a recently identified sleep disorder was found in 27 of 28 fibromyalgia patients tested. Is this just a fluke or could a disruption of sleep truly be the origin of your symptoms? Jed Black, M.D., Medical Director of Stanford’s Sleep Clinic addresses this topic in the January 2006 issue of the Fibromyalgia Network Journal. To read about answers to new and intriguing questions, become a Member of Fibromyalgia Network. As new research discoveries are presented by scientists in the field, you can rely upon Fibromyalgia Network to cover them! To join, call (800) 853-2929, or click here to become a Member online.

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