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Exhaustion is often rated worse than the pain in fibromyalgia (FM) and recent research shows this could be due to a dwindling supply of mitochondria to power your muscles. At the very least, treatment of this aspect of your illness might be getting closer. And speaking of fatigue, if you are unable to get your Armour Thyroid prescription filled at your retail drugstore, this month’s eNews provides you with an alternate solution. Stay up-to-date with the sleep/weight loss connection, the two recently published studies on XMRV and chronic fatigue syndrome, and the new hormone therapy guidelines for menopausal women. |
In this eNews Alert:
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Six years ago, researchers showed that the muscles of fibromyalgia patients had a substantial drop in the number of mitochondria, the part of the cell known for its energy-producing abilities. Even the shape of the muscle mitochondria were noted to be irregular in individuals with fibromyalgia compared to age-matched healthy control subjects. As impressive as these findings were, they remained unexplained until biochemists Placido Navas, Ph.D., and Jose A. Sanchez Alcazar, Ph.D., began exploring an enzyme needed by the mitochondria: Co-Enzyme-Q10 (CoQ10). Read more about this study and how doctors are looking at restoring the function of the mitochondria in the Latest News section of our website. |
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Many of us would like to lose a few pounds. If we have indulged over the holidays, some of us might want to lose even more. But the thought of starting an exercise program leads to concerns of pain and the strong possibility of throwing yourself into a flare. While reducing your caloric intake is a good idea, you might consider improving your sleep. Several studies have related fewer sleep hours at night to increased weight gain, and most of these studies involve healthy men and women. A group of researchers studying occupational and environmental health of employees in Japan also made a connection between less sleep and weight gain.1 They started with 35,247 employees of an electric power company working at 12 different locations. Taking height and weight into consideration, all of the employees with a body mass index (BMI) considered obese (11,640 or 33%) were excluded from the one-year study. Almost half of the participants reported that they slept for 6 to 7 hours on the average. Preliminary data after one year showed the BMI was significantly greater for participants who slept 6-or-less hours than those who slept 7-to-8 hours for both men and women. Weight gain also was reported for those who spent more than nine hours sleeping a night. Overall, 1,171 (5.8%) new cases of obesity were identified among the men, with a disproportionate amount falling in the 6-or-less hours of sleep categories. After adjusting for shift work, smoking, alcohol consumption, physical activity, and depressed moods, the weight gain among women was not significant. The researchers felt this discrepancy between the genders was primarily due to the overall lower number of women (3,189) versus men (20,023) in the study. Researchers attributed the weight gain to common factors involving too many calories ingested compared to energy spent. Admittedly, they did not take into account problems that could interfere with obtaining proper sleep, including obstructive sleep apnea, restless legs syndrome, insomnia, or any difficulties associated with a chronic illness. This study supports a 2006 Nurse’s Health Study of 68,183 women over a 16-year period.2 They found that women who slept fewer than 5 hours gained at least 2.5 pounds more than the women who slept 7 hours. In a commentary on the Japanese sleep study, Majib T. Anays, M.D., of Vancouver, Canada, brought up other potential explanations for the weight gain that may be more pertinent to fibro patients.3 Sleep disturbances, such as obstructive apnea, can cause abnormalities in glucose control. This may result in daytime tiredness that leads to less activity, metabolic disease, and diabetes. Weight gain can involve changes in hormones, particularly an imbalance of ghrelin and leptin that stimulates hunger. While these studies emphasize the importance of a good diet and regular exercise on the impact of weight, for fibro patients they should strongly stress the value of obtaining good sleep on a regular basis. 1. Watanabe M, et al. Sleep 33(2):161-7, 2010. |
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The Fibromyalgia Network wants to remind patients who take medications that contain or enhance serotonin to be aware of the possible life-threatening effects of serotonin syndrome (SS). Serotonin syndrome occurs when there is an excess of serotonin in the blood. The reaction happens when patients take more than one serotonin-enhancing drug or when taking a serotonin agent along with one or more medications that interfere with the liver’s ability to clear the body of the excess serotonin from the bloodstream. Antidepressants, MAOI inhibitors and other medications commonly taken by fibro patients can produce SS. The February issue of Neurology reports its first case of SS involving an 79-year old man who came down with symptoms several days after he started taking Savella (milnacipran), the latest FDA-approved fibro medication.* Apparently, the patient had been taking paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression for five years prior. Eight days after starting a regimen of 50 mg of Savella, another serotonin-boosting agent, he was taken to the hospital. Fortunately, this individual was properly diagnosed by doctors who recognized the symptoms and was on his way to recovery within 48 hours. However, since SS is not common and there is no simple blood test diagnosis, many doctors are not educated about the symptoms that could lead to this very dangerous situation. Classic symptoms include:
Increases in heart rate and blood pressure can eventually lead to seizures, shock, or even death. That’s why it is important for you to understand this condition. Keep in mine that you may not be having a bad reaction to the new medication you just started, it may the combination of medications you are taking. Don’t hesitate to call emergency medical response or 911 and your doctor if you suspect you are having such a reaction.
* Yacoub HA, et al. Neurology 74(8):699-700, 2010. |
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The January issue of the Fibromyalgia Network Journal gave an update on the study in Science linking the XMVR retrovirus to exceptionally ill patients with chronic fatigue syndrome (CFS). Since the initial announcement of this research, several scientific groups have been studying and trying to verify these findings. In January, however, a team from University College London reported in the journal PLoS One they were not able to replicate the findings. This month, virologists with the National Institute for Medical Research (Britain's equivalent of the U.S. National Institutes of Health) reported in Retrovirology that they too could not find the virus. Researchers are now trying to figure out whether the discrepancies result from studying different patient populations or from fundamental problems between the laboratories involved. Suzanne D. Vernon, Ph.D., scientific director of the CFIDS Association of America, offers an excellent perspective and comments on the XMRV situation on its website. |
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Ever since the early termination of the Women’s Health Initiative a few years back, confusion regarding the role of hormone therapy (HT) has lingered. You may be uncertain about whether HT is right for you. This is naturally a question for your healthcare provider because therapy must be individualized and depends upon a woman’s genetics (e.g., family history). However, the 2010 position statement of The North American Menopause Society on estrogen and progestogen use in postmenopausal women provides a few useful guidelines.* The position statement also explains what previously seemed to be conflicting information. Previously, large controlled trials tended to take postmenopausal women in their mid-60s (most of whom were 10 years beyond menopause and without any symptoms) and looked at the effects of placing half of them on HT. The result was an increased risk in coronary heart disease. But it is now appreciated that this risk cannot be applied to women who initiate HT within 10 years of menopause. In fact, observational studies indicate that women have the same or lower risk of heart disease if they begin HT within 10 years of menopause. Keeping in mind that the benefit-risk ratio for an individual woman continually changes with her age and menopausal-related symptoms, here are a few of the guidelines promoted in the new position paper:
* The North American Menopause Society (a panel of 17 clinicians and researchers). Menopause 17(2):242-255, 2010. |
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If you have been going nuts for the past year not knowing when your prescription for Armour Thyroid would get filled at your local pharmacy, there are compounding alternatives. For an extra $10 a month, your local compounding pharmacy can measure out your daily dose of thyroid medication that is in your prescription tablet of Armour Thyroid and put it into a capsule for daily use. All you need to do is call your prescribing physician with the phone number for the compounding pharmacy that you would like to use. You will no longer be at the mercy of Forest Labs and whenever they decide to get their act together on fixing their formula problems. The active ingredient for Armour Thyroid is purified thyroid gland extract from pigs, consisting of T4 and T3 hormones in a ratio of 4.22 to 1 (roughly 80% T4 and 20% T3). Most synthetic thyroid hormone supplements consist of only T4, which is the body’s version of your inactive thyroid hormone. Your body keeps a reservoir of T4 while converting a small amount to the active hormone, T3, for use in your tissues. Many people, particularly fibromyalgia patients, have difficulties using T4-only formulas because their body has trouble converting T4 into T3. So a formula that contains a little T3 tends to keep the body’s metabolism running a bit smoother. If you have discovered the hard way that T4-only formulas do not work for you (e.g., taking these formulas is about as helpful as going without), then don’t let the processing problems at Forest Labs rob you of energy. Most retail pharmacies will tell you that you don’t have a choice but to ask your doctor for a new prescription for T4, but that’s not true. Take your business to a compounding pharmacy and have the active ingredients in Armour Thyroid placed into a capsule for daily use. The cost of a one month’s supply will be around $24. |
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