FIBROMYALGIA: WHY NO ONE UNDERSTANDS IT

by James Gruft, MD,  FAAPMR, DABP

Do you know the difference between a syndrome and a disease? That’s o.k. I teach at Rush University, Chicago and have to teach the difference to the resident physicians there.

A syndrome is a collection of signs & symptoms.To be a disease you have to fulfill two out of three criteria:

1. A collection of signs & symptoms.
2. A definitive etiology (cause)
3. A definitive tissue marker (test)

Fibromyalgia does not have a definitive cause or a definitive tissue marker (an objective test that tells you the person has Fibromyalgia). That is why it is just a syndrome; it is just a collection of signs (something the doctor clinically finds on exam) and symptoms (manifestations of illness that the patient tells the doctor).

Herein lies some of the mystery of what makes Fibromyalgia so hard to understand: being just a group of signs and symptoms doesn’t tell you a lot about why the person is having these symptoms. What I have found as a result of treating thousands of people with Fibromyalgia is that these symptoms can have different causes from different types of biological imbalances.  It is by exploring the nature of these imbalances — using a systems biological approach called Functional Medicine — that can reveal some of the imbalances leading to the symptoms of Fibromyalgia and illuminate what may be used to treat the condition.

Before going further, I would like to lay out the definition of pain given out by the – IASP (International Association for the Study of Pain) :

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of tissue damage.
Note: pain is always subjective. Each individual learns the application of the word through experience related to injury.”

In 1990, the American College of Rheumalology made an attempt to standardize the criteria for diagnosing Fibromyalgia.

They wrote that there must be:

1. A history of widespread pain, defined as: pain in the left side and right side of the body as well as above and below the waist. Axial skeletal pain (cervical, anterior chest, thoracic or LBP) must also be present.
2. Eleven out of 18 recognized tender spots. These spots are at the back of the head, at the shoulders, anterior neck, above the shoulder blades, at the second rib, the lateral elbow, the head of the hip bone, the medial aspect of the knees and the upper outer quadrants of the buttocks”

They also noted associated symptoms, besides pain:

• Fatigue, Sleep Dysfunction and Morning Stiffness (73-85%)
• Headaches [occurance 28-58% Caro (1989)]
• Irritable Bowel Syndrome 34-53% Goldberg (1987) (Alternating constipation/diarrhea, bloating).

I have come to believe that Fibromyalgia is heterogeneous (there are many different types).

I classify different types of Fibromyalgia as:

1. Myofascial
2. Neuropathic
3. Immunological
4. Endocrinological

So, widespread pain, fatigue, and sometimes headaches and gut symptoms can have many different causes.

Using a systems biology approach, I characterize the condition as either a problem with :

• Energy – deficiency (oxidative, mitochondrial)
• Hormonal/Neuro-endocrinological
• Inflammation
• Toxicity
• Structural/barrier
• Gut dysfunction
• Psychological/ Spiritual dysfunction

In my next installment, I will show how to characterize these sub-types of Fibromyalgia and how this leads to different approaches to treatment.

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Dr. James Gruft explores the relationship between nutrient deficiency and disease

Our typical understanding (and I mean most people, including doctors) is that the only reason we need to take nutrients (vitamins, minerals, etc.) is to prevent deficiency diseases like scurvy, rickets, beriberi, etc.  It is also common for me to hear that a particular patient of mine was told by his or her primary care physician that whoever takes supplements is wasting their money; all he or she needs to do is eat a balanced meal, according to the food groups listed in the food pyramid. Unfortunately, this thinking is wrong on many levels.

Let’s take a look at the first supposition:

“the only reason we need to take nutrients (vitamins, minerals, etc.) is to prevent deficiency diseases like scurvy, rickets, beriberi, etc.”

Taking enough nutrients to prevent a deficiency disease (defined as the RDA or recommended daily allowance) is no guarantee that we are taking the optimal amount of nutrients for optimal health. As Dr. Bruce Ames, Professor of Biochemistry and Molecular Biology, University of California, Berkeley, and a Senior Scientist at Children’s Hospital Oakland Research Institute (CHORI), explains, there are about 50 different diseases that may result from genetic variants that interfere with biochemical reactions in the body The disease then manifests partially as a result of a decreased binding capacity of enzymes to nutrients, which in many instances, act as cofactors (enabling the enzyme to work). According to Dr. Ames these problems “can be remedied by feeding high dose B vitamins, which raise levels of the corresponding coenzyme; many polymorphisms also result in a lowered affinity of enzyme for coenzyme and thus may be in part remediable.”

Let’s take a look at the second supposition:

“Whoever takes supplements is wasting their money; all he or she needs to do is eat a balanced meal”

Unfortunately, our food today is less nutritious than before WWII! From 1940-1991 vegetables lost 76% of their copper, 46% of their calcium, 27% of their iron and 24% of their magnesium. Fruits have lost 19% of their copper, 16% of their calcium, 24% of their iron, and 15% of their magnesium. Why? The soil in our food has been depleted of nutritional treatment, so that depletion is passed onto our produce. There is a movement apace to correct this deficiency, called the Real Food Campaign at www.realfoodcampaign.org.

Best regards,
Jame Gruft, M.D.

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A recent report shows the Affordable Care Act (ACA) will transform the treatment of chronic pain…a health problem affecting 116 million American adults.

“We can’t wait. We want the government to step in,” says James Gruft M.D., founder of From Pain To Wellness in Oakbrook Terrace. The nationally known board-certified pain specialist has treated Chicago-area patients for over two decades.

Mandated by the ACA, The Institute of Medicine released its new blueprint for treating chronic pain this summer.[1] Its strategy calls for a “cultural transformation” and turns traditional concepts of pain management upside down.

The blue panel’s recommendations include 1) customized pain approaches for different ethnic groups, socioeconomic classes, genders, and other variables, 2) more stress on treatments that prevent future pain, 3) a greater focus on improving the patient’s overall quality of life and 4) extensive data outcomes to reward the most effective centers.

Dr. Gruft says, “The government seems to finally be encouraging, and rewarding, state of the art multi-disciplinary pain centers. The standard cookie-cutter approach of just using medications, physical therapy or interventions has not worked. It’s acknowledging that every patient perceives pain in his or her own unique way. Hopefully, these changes will soon be implemented at all pain clinics.”

At From Pain To Wellness every patient receives a customized care plan that along with physical therapy incorporates a tailor-made diet based on the patients unique nutritional status, stress management techniques, and special therapeutic lifestyle modifications.

“For instance,” says Dr. Gruft, “our center will mimic a patient’s home kitchen and teach them how to navigate that environment without pain. They’ll learn what specific motions to avoid. In the same vein patients spend up to three hours a day in a customized one-on-one physical therapy program, and they learn to prepare special pain-relieving food so they can continue that life-style modification at home.”

The goal is change a patient’s entire lifestyle so he can effectively transform his or her pain into something significantly more manageable. Under the ACA that comprehensive, preventive approach is being rewarded for the first time.

Better outcomes will also finally be rewarded. “Our success rate is far higher than average,” says Dr. Gruft. “That’s partly because of our comprehensive approach and partly because of the emphasis of our program on life-style modification. Now with accurate data outcomes we’ll finally be able to prove that…and be rewarded for that fact.”

The pain specialist says the ACA’s focus on wellness and preventive care may actually allow him to use “a larger set of tools” to help those with chronic pain. The center, for example, hopes to routinely perform hormonal and nutrient deficiency testing. He says the effects of nutritional treatment are also unique and doses should be customized.

“Our goal can’t just be to relieve pain, “says Dr. Gruft. “We literally have to transform our patients’ lives. The ACA finally acknowledges that for the first time. For us, the new era in pain management can’t come soon enough.”

By: Michael Breen

The post Naperville Area Pain Center Points Way To The Future appeared first on From Pain To Wellness, LLC -.

After three years of back pain, failed surgery, and countless ineffective epidurals, this May Eric Awalt described himself as “a recluse, a living death.”

Today Eric does 500 sit-ups and walks fifty flights of stairs every day.

What finally transformed him? Chicago’s first comprehensive pain program that incorporates intense one-on-one physical therapy, stress management techniques, a customized care plan for every patient.…and a special diet that helps relieve pain.

The 40-year-old Joliet area native now eats a raw foods diet: four-to-five small meals a day of lettuce, spinach, cabbage, kale, other vegetables like carrots, and nuts for protein. “When I started I felt less pain within days,” he says. “After a week I was on a bicycle for the first time in over two years.”

“Diet can be a treatment for pain,” says James Gruft M.D. founder of From Pain To Wellness in Oakbrook Terrace. The nationally known board-certified pain specialist has authored a book, was formerly on staff at Marianjoy Rehabilitation Hospital, and has treated Chicago-area patients for two decades.

Dr. Gruft says, “A new diet is just one element of our program. However, that said, in 20 years of treating pain, I’ve never seen the kind of results I’m seeing now and it’s largely this added component of nutrition.”

The researcher had long noticed that his pain patients consistently ate junk food diets. He decided to test their blood nutritional levels. The results? Recurring deficiencies in Vitamin D, omega 3 fatty acids, B vitamins and amino acids. Patients in pain also had high levels of toxic metals. The specialist’s next step was to replace those deficiencies with patient-customized diets.

Those diets are now a key treatment in Dr. Gruft’s intense 21 day, 6-hour-a-day comprehensive pain program. The meals are actually catered by a Chicago gourmet restaurant called Cousins IV. A typical lunch consists of a salad of pumpkin seeds, walnuts, and olive oil, all served in a corn husk. All foods are raw, organic, and gluten free. In addition some patients receive FDA-designated “medical foods” for obesity, Type II diabetes, inflammation and other chronic conditions.

Within a few days Eric’s new diet, along with his other treatments, transformed his life. “The combined program did what surgery, injections, and other pain programs couldn’t,” he says. “I had less pain, was sleeping better, and losing weight. It all just turned me around.”

Five months later, Eric is still faithful to his new diet. Dr. Gruft says patients are rarely totally loyal to the strict regimen but most integrate more raw and “nutritional” foods into their daily diets.” Compliance hasn’t been that much of a problem,” he says, “because the diet works. I tell patients, ‘give this just diet three weeks and you’ll feel less daily pain’…and that’s exactly what happens.”

During his 21 days of treatment Eric went from walking 1000 to 15,000 steps every day. For that he largely credits 2-4 hours a day of grueling physical therapy. The one-on-one sessions were customized for his particular pain and tolerance level. “Everything was customized,” he says. “We’re all different, we have different kinds of pain, and we handle it in different ways. This center understood that.”

Dr. Gruft says a diet that relieves pain isn’t just a new treatment; it’s the beginning of a whole new paradigm for treating chronic pain. “Away,” he says, “from generic interventions and toward a customized molecular and physiologic approach to pain.”

“I was skeptical that my diet could really play a role in changing my pain,” says Eric Awalt. “Now I believe in it 100-percent. I’ve emerged from a very dark place…and there’s no question my new diet is a big reason why.”

By: James Gruft M.D.

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