Health Update : Fibromyalgia

Fibromyalgia :   
Dietary Guide

Fibromyalgia (FM) is a chronic condition affecting multiple body systems is not limited to any one aspect of health. Because of this, there is no ONE diet that works the same for all FM patients. Since most dietary guidelines that address FM are based on general healthy eating principles utilized for many conditions such as hypoglycemia, diabetes, food allergies, headaches, digestive disorders, and fatigue, let’s review some of the most popular and successful dietary approaches that have been reported regarding FM.

Basic Guidelines:

1. Carbohydrates: AVOID all refined carbs (white flour products). Eat whole grain bread, oatmeal, granola, nuts. Avoid artificial sweeteners and limit sugar intake to a max. of 40g/2000 calories. Eat roughly 14 grams / 1000 calories consumed of soluble dietary fiber such as apples, oats, and legumes vs. insoluble fiber such as bran. Your total carb intake from all sources should be between 30-55% of your total calories.

2. Fats: AVOID saturated fats (these clog up circulation, lead to inflammation and pain). That means <10% of total calories consumed, so limit or eliminate foods such as cheese, beef, milk, oils, ice cream, cakes, cookies, mayonnaise, margarine, chips and chicken skin. Eat mono- and poly-unsaturated fats and include regular amounts of omega 3-fats. Eat < 300mg/day of cholesterol; Try to avoid ALL trans fats such as cakes, cookies, crackers, pies, bread, margarine, fried potatoes, chips, shortening. Take omega 3 fatty acids like alpha-linolenic acid (ALA) as these help make other omega 3 fats like EPA and DHA, and are very helpful for the brain. ALA is found in flaxseed, linseed oil, or cod liver oil. Limit total fat intake to 20-35% of calories consumed.

3. Protein: Go easy on red meat as they are high in saturated fat. Instead, eat more fish and vegetable protein (legumes and soybeans are great). When eating meat or poultry, remove all visible fat and skin before eating. Maintain protein at 20-40% of total caloric intake. AVOID: processed meats, especially salt-cured, smoked or nitrate-cured.

4. Fruits & Vegetables: Whole fruits are superior to juices. Include blackberries, strawberries, raspberries, kiwis, peaches, mango, cantaloupe melon and apples. Some FM sufferers cannot tolerate citrus fruits but if you can, fruits like oranges and grapefruits are great. Vegetables are crucial. Good choices include carrots, squash, sweet potato, spinach, kale, collard greens, broccoli, cabbage, and Brussels sprouts. These foods reduce the risk of developing chronic diseases (diabetes, heart disease, stroke and cancers).

5. Dairy Products: Choose reduced or fat-free varieties of cow or soy milk. This also applies to yogurt and cheese.

6. Healthy drinks: Drink 8 glasses of water a day or diluted fruit juices, or herbal teas. Drinking water helps flush out toxins. Avoid coffee, tea, and alcohol as these increase fatigue, increase muscle pain and interfere with normal sleeping patterns. Limit or eliminate alcohol.

7. Healthy Snacks: Chopped vegetables, unsalted nuts and/or seeds; AVOID ALL commercial snack foods (except salt-free air-popped popcorn) as these are high in trans fats & salt. Avoid chocolate and candy.

8. Junk Food: Regular consumption of this is BAD for FM patients due to the high levels of fat, sodium, calories and general lack of nutrition.

9. Artificial Sweeteners: AVOID them! Examples: aspartame, NutraSweet, & saccharine.

10. MSG: (monosodium glutamate (MSG) and Sodium (Salt) can aggravate FM!

11. QUANTITY: Eat smaller light meals, especially in the evenings.

Video: Fibromyalgia Nutrition

To find out if you are a candidate for their customized treatment approach call 732.719.8148 or visit us online at New Jersey Pain Management.

Health Update: Fibromyalgia

Fibromyalgia: How Do I know I Have It?

“I wake up every morning with this stiff, sore lower back pain. When I roll over to get out of bed, I feel like a log and almost have to fall out of bed. When I finally get to my feet, I’m all bent over and can’t stand upright for what seems like forever! It takes a couple of hours before it gradually loosens up enough so I don’t have to shuffle with each step. I was told by a friend that I might have something called fibromyalgia and should ask my chiropractor. What do you think?”

To answer this inquiry, let’s first define fibromyalgia (FM) so that we can compare the two properly. FM is a condition that is diagnosed basically by eliminating all other possible causes, including inflammatory joint conditions, by running various blood tests such as an arthritic profile. This usually includes tests for rheumatoid arthritis, gout, lupus, and infection. A Lymes disease test is often included as that condition can often manifest as a chronic back condition from any cause. There are essentially no blood tests, x-ray or other imaging tests, or neurological tests that can specifically diagnose FM. It is when all these tests come back negative, that the diagnosis of FM is then entertained. The history is probably the most important aspect of the clinical encounter that helps in the diagnosis of FM. Most of these patients will report that the onset is gradual, often present for years. There is usually no specific cause though there are specific conditions (such as irritable bowel syndrome, trauma, rheumatoid arthritis and others) that can result in “secondary fibromyalgia” where the cause is well known. The big differentiating historical feature is the presence of widespread, whole body pain – NOT just low back pain, as reported in the first paragraph above. In FM, there is often pain in the legs, arms, torso, back, neck and these people basically, “…hurt all over.” Typically there is no radiating pain down the leg or arm that follows a specific nerve pathway and no exam findings of neurological deficits. Another unique feature of FM includes sleep dysfunction. In many cases, sleep interruptions occur 2, 3 or more times a night, often with difficulty in returning back to sleep. The quality of pain is often described as numbness, tingling, burning, achy, deep, boring, and most importantly generalized in location (all over the body). The intensity is usually reported as high (>6/10 pain scale scores). The past history usually includes multiple visits to many different types of doctors and many attempts at different medications is common – most of which do not help significantly.

Even with these unique historical features that are consistent with the diagnosis of FM, it is still necessary to “rule out” other conditions by running tests as previously described. This is especially important when FM is secondary to other conditions as FM can get “lost” in the shuffle, overshadowed by the other condition.

Treatment for FM includes many of the same methods for treating other musculoskeletal conditions. Spinal manipulation, soft tissue release techniques (massage therapy, trigger point therapy, myofascial release), and various forms of physical therapy (low level laser therapy – LLLT, ultrasound, interferential electrical current – IFC, and pulsed magnetic therapy can also improve function, reduce pain, and reduce the need for medications. Cognitive therapy, addressing psychosocial issues, can also be very effective. One of the most important treatment approaches is exercise. This has been consistently described as being an important form of care for the FM patient. In addition, dietary management using an anti-inflammatory diet (gluten free diet) and supplementation (a multiple vitamin, calcium/magnesium, omega 3 fatty acids, Vit. D, and CoQ10) can also be very effective.

We recognize the importance of including chiropractic in your treatment and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Health Update: Fibromyalgia

Fibromyalgia Challenges

Fibromyalgia (FM) is a condition that usually affects different organ systems in the body, causing a number of symptoms. Some of these include:

1. The muscles (the musculoskeletal system): tender, achy, stiff, tight muscles, trigger or tender points all over the body
2. The nerves (the nervous system): headaches, light headedness, sleep disruption, depression, anxiety, numbness/tingling (overlaps with the cardiovascular system)
3. The stomach and intestines (the gastrointestinal system): diarrhea, constipation, irritable bowel, leaky gut, heart burn, lack of appetite, abdominal cramping
4. Breathing (the respiratory system): hyperventilation, rapid / shallow breathing patterns; 
5. The heart (the cardiovascular system): racing heart rate – palpitations, feeling cold all the time, numbness/tingling (overlaps with the nervous system)

Because of the multiple systems involved, there are many challenges to managing Fibromyalgia.  Studies suggest a balance between several approaches works best.  Some of these approaches include biomedical treatments, organ-specific treatments, and cognitive interpersonal treatments.  Within these categories, the following can be broken down further:

1. General – those treatments directed at the whole body such as anti-inflammatory measures.  These include (but are not limited to) medications (corticosteroids, NSAID’s – such as Advil, Aleve) and nutrients (ginger, turmeric, boswellia, Vitamin D, and others).  Other anti-inflammatory measures include diet, such as the Paleo Diet or “caveman diet.”  This diet eliminates grains or flour-based products from the diet.  That means no more breads, pastas, crackers, cookies – anything made with flour.  This approach emphasizes consuming fruits, vegetables, grass-fed lean meats and fish.  The main ingredients in grains that are of concern in the Paleo Diet are gluten and lectins
2. Central – those treatments directed at the chemical factors in the brain that control mood, depression, anxiety and so on.  These include (but are not limited to) medications (tricyclic antidepressants, muscle relaxers like Cyclobenzaprine, SSRI, SNRI and Trmadol) and certain nutrients (neurotransmitter support such as 5-HTP – tryptophan, DHEA, phenylalanine, and others).
3. Psychotherapy and active behavioral therapy – treatments that are supportive of nervous system such as cognitive behavior therapy, aerobic exercise, patient education, multidisciplinary therapy, hypnotherapy, biofeedback, and strength training.
4. Passive physical intervention – chiropractic therapy, massage therapy and other forms of manual therapy, and acupuncture.

The goal of this article is to look at fibromyalgia from a holistic perspective so that those struggling with FM and similar conditions can better appreciate the concept of multidisciplinary treatment, of which chiropractic care plays a significant role.  Coordination of care and finding the “right” health care providers cannot be over-emphasized.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR A FREE NO-OBLIGATION CONSULTATION CALL (732) 719-8148

Health Update: Fibromyalgia

Fibromyalgia: The Challenges of Diagnosis

Fibromyalgia (FM) is a chronic condition where there is widespread / whole body pain that is often difficult to diagnose.  Some patients may spend years of going to different doctors, undergoing many tests (of which most, if not all, are “negative”), and they may be diagnosed with different conditions such as rheumatoid arthritis, hypothyroidism, or mononucleosis before a diagnosis of FM is finally given.  Needless to say, this process can be very frustrating!

The reason for this dilemma is that there is no single diagnostic test (blood test, x-ray/image finding, etc.) that verifies the diagnosis of FM, leaving doctors in a position to “rule out” all other possible “diagnose-able” conditions first, before considering FM as “the” diagnosis.  Another challenge is the fact that FM symptoms vary widely from one person to the next and even vary within the same person at different times of the year.  There are a few “guidelines” doctors can use to help secure the diagnosis of FM.

One such guideline is from The American College of Rheumatology (ACR) which requires that “widespread” pain be present throughout the body for at least 3 months (“widespread” is defined as pain on both sides of the body, above and below the waist).  The ACR also has identified 18 points on the body of which at least 11 of the 18 “tender points” must be present to secure the diagnosis of FM.  There is debate as to the accuracy of this rather stringent criteria as FM symptoms can come and go and vary, making the 11 of 18 tender point findings sometimes change between visits.  Hence, widespread pain above/below the waist on both left/right sides of the body for at 3 months has become a more accepted indicator for diagnosing FM.

Yet another challenge in pinning down the diagnosis is that the FM sufferer may experience signs and symptoms seemingly unrelated to FM, such as stomach ache/digestive problems or headaches. This can lead the doctor down other paths before considering FM as a diagnosis.

Fibromyalgia can be primary (no other condition caused it) or secondary (other condition(s) lead to the development of FM).  Hence, the diagnosis process focuses on identifying conditions which can be identified through standard diagnostic tests, often overshadowing the diagnosis of FM.  Testing for conditions such as lupus, multiple sclerosis, sleep apnea, diabetes, Crohn’s Disease, and/or others, often makes sense to both you and your doctor, but adds to the delay in diagnosing FM.  Here are some suggestions to help your doctor through this diagnostic maze:

Ask questions:  Ask about what each test is for and what the next plan is if the tests are negative.  By increasing your understanding, this will reduce your frustration in this process.

Keep records:  Obtain a copy of EVERY test you have and share the information with any new doctor or specialist.  This can save time and money!

Find the “right” doctor:  Find a doctor you can trust and “talk to.” Not all doctors “believe” FM exists and some are close minded to considering it.  Try to locate a doctor with a lot of experience with FM cases and is willing to “…work with you.”

Build a good relationship: Be open, honest and avoid anger, skepticism and don’t be confrontational.  Be upfront about what is frustrating you about your symptoms.

Take care of yourself: Ultimately, “success” of treating FM demands a “team” effort between you and your doctor.  Managing stress (eg., deep breathing exercises), obtain care that works (eg., chiropractic, massage), eat a healthy diet (eg., gluten-free), exercise regularly but don’t overdo it, and get plenty of sleep and rest.



If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.                            
                                    
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR A FREE NO-OBLIGATION CONSULTATION CALL (732) 719-8148

Health Update: Fibromyalgia

Fibromyalgia & Chiropractic Care

Do you wake up feeling tired, washed out, and dragged down?  Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried?  Do you wake up multiple times a night and fight getting back to sleep?  These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled.  Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers.  The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.

Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives.  Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing.  Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?

The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system.  The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system.  When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis.  When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction.

Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications.  Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities.  Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.

Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain.  Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture.  Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM.  Diet and nutritional counseling may also be beneficial.  Research has been very supportive of chiropractic care for patients suffering from FM.


We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 
732-984-9597 OR VISIT US AT ADVANCED-WELLNESS.NET

Health Update: Fibromyalgia – What Exercises Should You Do?

Fibromyalgia – What Exercises Should You Do?

Fibromyalgia (FM) is a chronic condition that gradually interferes with many aspects of one’s life. The challenge of treating FM is finding the right combination of approaches that positively impacts the structural, emotional, and chemical aspects of the body in such a way the FM patient can function “normally” in day to day activities. Exercise is one of the most important methods patients can use to successfully reach these goals.

First, because FM is a condition that is currently thought to affect the central nervous system where the threshold of reaching pain levels is lower than normal, pain is perceived when is shouldn’t normally be noticed. Therefore, the KEY to exercise integration is to start out SLOWLY and CONSISTENTLY. It is more important to work out in a way that muscles and joints can gradually accommodate to the new activity or movement. Many patients with FM are afraid to exercise for fear of hurting worse than they already do. In fact, many will report that, “…every time I exercise, I feel worse so I just don’t do it.” When asked what types of exercises they’ve tried, it becomes clear it wasn’t the exercise but rather the dose or amount of exercise they engaged in (often overdoing it) that made the next 48-72 hours quite uncomfortable with post-exercise soreness.

Second, is to choose a type of exercise you enjoy so it's more likely you'll stick with it. Popular exercise options include yoga, Pilates, biking, swimming, and walking. These exercises can also be combined. For example, one might perform 15 minutes of yoga, followed by a 15 minute walk on a daily, consistent basis. The use of an exercise bike and/or a treadmill, stepper, or elliptical type of exercise equipment allows you to monitor heart rate, speed, and other data that allows you to compare yourself between sessions. One of the new "kids on the block" exercise options includes the Wii-Fit which offers a scoring system with various types of exercise. This type of biofeedback can be educational, rewarding, and motivating as it helps you appreciate the benefits and improvements you've made over time. Pick a time of day when you can be consistent with the exercises so you’re not “fitting it in” your busy daily schedule – make it part of your daily routine, similar to brushing your teeth or taking a shower. The morning or evening may work best but many find a noon hour break a good time to exercise, as well.

Third, as you start to feel more in shape, gradually increase the intensity of the exercises. You may exercise for the same amount of time, say 30 minutes, but you’ll do a more intense work out such as walking faster, farther, or increasing the pace of the yoga, Pilates, swimming, etc. Try not to be too intense (over aggressive) or do too little (under aggressive). You know your personality better than anyone else – hold yourself back if you tend to be overly aggressive or, push yourself if you tend to be overly cautious. Expect the first 3-5 times you exercise to be challenging with associated post-exercise soreness but know you will adapt to the process.

The benefits of adding a well designed, graduated exercise program include: 1) strengthening ligaments, muscles, tendons and improving muscle tone; 2) increasing flexibility; 3) increasing blood flow to the muscle tissue; 4) increase endorphins-a morphine-like substance that has a natural pain relieving and sleep deepening effect that can help curb anxiety, depression as well as pain associated with FM; 5) reduces the risk of high blood pressure, high cholesterol, diabetes heart disease and stroke; and 6) promotes weight loss/control which in turn, reduces stress on your muscles and joints.

We recognize the importance of including chiropractic in your treatment of FM and realize you have a choice of providers. We would be honored to be part of your management team.

Health Update: Fibromyalgia

Fibromyalgia – Does This Sounds Familiar?

“I am exhausted and hurt all over.  I can’t get to sleep at night and when I do, I wake up at the drop of a dime.  I went to my doctor and they ran some blood tests and took some x-rays and said that nothing was wrong.  I just don’t know what is wrong or what to do about it.”

This is a classic history obtained from a patient suffering from fibromyalgia or FM.  Because the onset of fibromyalgia is slow and gradual, it is common for patients to postpone visiting their health care provider until the symptoms are quite significant. The diagnosis may also be delayed as many healthcare providers do not feel fibromyalgia is a legitimate medical condition and minimize the symptoms frequently categorizing them as "depressed," which postpones an appropriate diagnosis and treatment.

The classic definition as defined by the American College of Rheumatology includes at least a three-month duration of symptoms with the presence of 11 out of 18 potential tender points although diffuse, widespread pain not necessarily restricted to these exact locations may also represent an appropriate diagnostic finding in fibromyalgia.

Fibromyalgia is more common in females and affects approximately 2% of the population in the United States. The risk of developing fibromyalgia increases with age, usually developing during early and middle adulthood but can also develop in children and older adults. Other risk factors include a positive family history where one may be more likely to develop FM if a relative suffers with the same condition.

A major risk factor of developing fibromyalgia includes is disturbed sleep pattern and this remains controversial as to whether sleeping disorders are a direct cause or simply the result of fibromyalgia. However, in either case, people with FM cannot obtain deep "restorative" sleep and feel fatigued and tired upon waking in the morning. Sleep disorders including sleep apnea and restless leg syndrome are often present in patients with fibromyalgia.

Certain conditions such as rheumatoid arthritis, irritable bowel syndrome, hypothyroid, and other endocrine/hormonal conditions may preceded the onset of fibromyalgia in which case the condition is considered "secondary fibromyalgia." Hence, a diagnostic evaluation usually includes a blood test for hypothyroid, autoimmune diseases such as rheumatoid arthritis, and a complete blood count to rule out infections and/or anemia. In most cases, these tests prove negative and the diagnosis is made by excluding other possible primary conditions.

Other causes can include physical and/or emotional trauma where a high-level of stress can trigger this condition. Although experts still debate why patients with fibromyalgia hurt so intensely, the current explanation centers around a theory called central sensitization. This is essentially a lower pain threshold where patients with FM feel pain much sooner than those without it because of increased sensitivity in the brain and/or spinal cord to incoming pain signals.

Treatment of FM relies on a multidiscipline, multifactorial approach including stress reduction, obtaining enough sleep, exercising regularly, pacing yourself, and maintaining a healthy lifestyle, including diet and exercise. Medications to facilitate sleep, treat depression and any other underlying medical conditions may be appropriate. Other highly effective treatments, according to the Mayo Clinic website, include chiropractic treatment, massage therapy, and/or acupuncture. The concepts of chiropractic treatment includes restoring movement in restricted spinal joints resulting in improved nerve function and subsequently, improved overall function and reduced pain. Chiropractic care also includes soft tissue therapies, physical therapy modalities, nutritional counseling, patient education and many utilized in-house massage therapy. We recognize the importance of including chiropractic in your treatment of FM and realize you have a choice of providers. We would be honored to be part of your management team.
                      
YOU MAY BE A CANDIDATE FOR OUR FIBROMYALGIA PROGRAM! FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597