Why Fibromyalgia Is Not An Acceptable Diagnosis

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Dr. Efrat Lamandre makes the case that fibromyalgia is less of a useful diagnosis and more of a rubber stamp, much like the role historically often fulfilled by “heart failure” as an official cause of death (because certainly, that heart sure did stop beating). It’s a way of answering the question without answering the question.

…and what to look for instead

Fibromyalgia is characterized by chronic pain, tenderness, sleep disturbances, fatigue, and other symptoms. It’s often considered an “invisible” illness, because it’s the kind that’s easy to dismiss if you’re not the one carrying it. A broken leg, one can point at and see it’s broken; a respiratory infection, one can see its effects and even test for presence of the pathogen and/or its antigens. But fibromyalgia? “It hurts and I’m tired” doesn’t quite cut it.

Much like “heart failure” as a cause of death when nothing else is indicated, fibromyalgia is a diagnosis that gets applied when known causes of chronic pain have been ruled out.

Dr. Lamandre advocates for functional medicine and seeking the underlying causes of the symptoms, rather than the industry standard approach, which is to just manage the symptoms themselves with medications (of course, managing the symptoms with medications has its place; there is no need to suffer needlessly if pain relief can be used; it’s just not a sufficient response).

She notes that potential triggers for fibromyalgia include microbiome imbalances, food sensitivities, thyroid issues, nutrient deficiencies, adrenal fatigue, mitochondrial dysfunction, mold toxicity, Lyme disease, and more. Is this really just one illness? Maybe, but quite possibly not.

In short… If you are given a diagnosis of fibromyalgia, she advises that you insist doctors keep on looking, because that’s not an answer.

For more on all of this, enjoy:

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Want to learn more?

You might also like to read:

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  • What Menopause Does To The Heart

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    World Menopause Day: Menopause & Cardiovascular Disease Risk

    Today, the 18th of October, is World Menopause Day.

    The theme for this year is cardiovascular disease (CVD), and if your first reaction is to wonder what that has to do with the menopause, then this is the reason why it’s being featured. Much of the menopause and its effects are shrouded in mystery; not because of a lack of science (though sometimes a bit of that too), but rather, because it is popularly considered an unimportant, semi-taboo topic.

    So, let’s be the change we want to see, and try to fix that!

    What does CVD have to do with the menopause?

    To quote Dr. Anjana Nair:

    ❝The metabolic and clinical factors secondary to menopause, such as dyslipidemia, insulin resistance, fat redistribution and systemic hypertension, contribute to the accelerated risk for cardiovascular aging and disease.

    Atherosclerosis appears to be the end result of the interaction between cardiovascular risk factors and their accentuation during the perimenopausal period.

    The increased cardiovascular risk in menopause stems from the exaggerated effects of changing physiology on the cardiovascular system.❞

    Source: Cardiovascular Changes in Menopause

    See also: Menopause-associated risk of cardiovascular disease

    Can we do anything about it?

    Yes, we can! Here be science:

    This (in few words: get your hormone levels checked, and consider HRT if appropriate) is consistent with the advice from gynecologist Dr. Jen Gunter, whom we featured back in August:

    What You Should Have Been Told About The Menopause Beforehand

    What about lifestyle changes?

    We definitely can do some good things; here’s what the science has to say:

    For a full low-down on all of these:

    Revealing the evidence-based lifestyle solutions to managing your menopause symptoms

    Want to know more?

    You can get the International Menopause Society’s free downloadable booklet here:

    Menopause & Cardiovascular Disease: What Women Need To Know

    You may also like our previous main feature:

    What Does “Balance Your Hormones” Even Mean?

    Take care!

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  • Vitamin C (Drinkable) vs Vitamin C (Chewable) – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing vitamin C (drinkable) to vitamin C (chewable), we picked the drinkable.

    Why?

    First let’s look at what’s more or less the same in each:

    • The usable vitamin C content is comparable
    • The bioavailability is comparable
    • The additives to hold it together are comparable

    So what’s the difference?

    With the drinkable, you also drink a glass of water

    If you’d like to read more about how to get the most out of the vitamins you take, you can do so here:

    Are You Wasting Your Vitamins? Maybe, But You Don’t Have To

    If you’d like to get some of the drinkable vitamin C, here’s an example product on Amazon

    Enjoy!

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  • What are heart rate zones, and how can you incorporate them into your exercise routine?

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    If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.

    Heart rate zones reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.

    But what are the different heart rate zones, and how can you use these zones to optimise your workout?

    The three-zone model

    While there are several models used to describe heart rate zones, the most common model in the scientific literature is the three-zone model, where the zones may be categorised as follows:

    • zone 1: 55%–82% of maximum heart rate
    • zone 2: 82%–87% of maximum heart rate
    • zone 3: 87%–97% of maximum heart rate.

    If you’re not sure what your maximum heart rate is, it can be calculated using this equation: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.

    There are also other models used to describe heart rate zones, such as the five-zone model (as its name implies, this one has five distinct zones). These models largely describe the same thing and can mostly be used interchangeably.

    What do the different zones involve?

    The three zones are based around a person’s lactate threshold, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.

    Aerobic exercise uses oxygen to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.

    On average your lactate threshold tends to sit around 85% of your maximum heart rate, although this varies from person to person, and can be higher in athletes.

    A woman with an activity tracker on her wrist looking at a smartphone.
    Wearable technology has taken off in recent years. Ketut Subiyanto/Pexels

    In the three-zone model, each zone loosely describes one of three types of training.

    Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.

    Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences.

    Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.

    Striking a balance

    To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.

    While zone 3 is thought to produce the largest improvements in maximal oxygen uptake – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much.

    Training in different heart rate zones improves slightly different physiological qualities, and so by spending time in each zone, you ensure a variety of benefits for performance and health.

    So how much time should you spend in each zone?

    Most elite endurance athletes, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.

    Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate more than 250 kilometres per week, which would be impossible to recover from if it was all performed in zone 2 or 3.

    Of course, most people are not professional athletes. The World Health Organization recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week.

    If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines.

    What if I don’t have a heart rate monitor?

    If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training.

    The three heart rate zones discussed in this article can also be prescribed based on feel using a simple 10-point scale, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.

    With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.

    Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.

    Hunter Bennett, Lecturer in Exercise Science, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • High Histamine Foods To Avoid (And Low Histamine Foods To Eat Instead)

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    Nour Zibdeh is an Integrative and Functional Dietician, and she helps people overcome food intolerances. Today, it’s about getting rid of the underdiagnosed condition that is histamine intolerance, by first eliminating the triggers, and then not getting stuck on the low-histamine diet

    The recommendations

    High histamine foods to avoid include:

    • Alcohol (all types)
    • Fermented foods—normally great for the gut, but bad in this case
    • That includes most cheeses and yogurts
    • Aged, cured, or otherwise preserved meat
    • Some plants, e.g. tomato, spinach, eggplant, banana, avocado. Again, normally all great, but not in this case.

    Low histamine foods to eat include:

    • Fruits and vegetables not mentioned above
    • Minimally processed meat and fish, either fresh from the butcher/fishmonger, or frozen (not from the chilled food section of the supermarket), and eaten the same day they were purchased or defrosted, because otherwise histamine builds up over time (and quite quickly)
    • Grains, but she recommends skipping gluten, given the high likelihood of a comorbid gluten intolerance. So instead she recommends for example quinoa, oats, rice, buckwheat, millet, etc.

    For more about these (and more examples), as well as how to then phase safely off the low histamine diet, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Further reading

    Food intolerances often gang up on a person (i.e., comorbidity is high), so you might also like to read about:

    Take care!

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  • The Healthiest Bread Recipe You’ll Probably Find

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    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝[About accidental scalding with water] Is cold water actually the best immediate treatment for a burn? Maybe there is something better, or something I should apply after the cold water.❞

    If this is a case of spilled tea or similar—as in your story, which (apologies) we clipped for brevity—indeed, cold running water is best, and nothing else should be needed. It’s up to you whether you want to invest the time based on the extent of the scalding, but 10 minutes is recommended to minimize tissue damage.

    If it’s a more severe scalding or burning, seek medical attention immediately. If it’s a burn to anywhere other than the airway, cold running water is still best for 10 minutes, but if you have to choose between that and professional medical attention, don’t delay the help.

    If it’s a burn you’ve given 10 minutes of cold running water and it still hurts and/or has blistered, cover it in a sterile, non-adhesive dressing that extends well beyond the visible burn (because the actual damage probably extends further, and you don’t want to find this out the hard way later). If the burn is to the face, do still irrigate but not cover it; wait for help.

    Do not apply any kind of cream, lotion, oil, etc. No matter how tempting, no matter where the burn is.

    All of the above also goes for splashed oil, chemical burns, and electrical burns too (but obviously, make sure to get away from the electricity first).

    Source: this ex-military writer was trained for this sort of thing and, suffice it to say, has dealt with more serious things than spilled tea before now.

    Legal note: notwithstanding the above, we are a health science newsletter, not paramedics. Also, circumstances may differ, and best practices may change. In the case of serious injury, call emergency services first, and follow their instructions over ours.

    Take care!

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  • How To Beat Loneliness & Isolation

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    Overcoming Loneliness & Isolation

    One of the biggest mental health threats that faces many of us as we get older is growing isolation, and the loneliness that can come with it. Family and friends thin out over the years, and getting out and about isn’t always as easy as it used to be for everyone.

    Nor is youth a guaranteed protection against this—in today’s world of urban sprawl and nothing-is-walkable cities, in which access to social spaces such as cafés and the like means paying the rising costs with money that young people often don’t have… And that’s without getting started on how much the pandemic impacted an entire generation’s social environments (or lack thereof).

    Why is this a problem?

    Humans are, by evolution, social creatures. As individuals we may have something of a spectrum from introvert to extrovert, but as a species, we thrive in community. And we suffer, when we don’t have that.

    What can we do about it?

    We can start by recognizing our needs, such as they are, and identifying to what extent they are being met (or not).

    • Some of us may be very comfortable with a lot of alone time—but need someone to talk to sometimes.
    • Some of us may need near-constant company to feel at our best—and that’s fine too! We just need to plan accordingly.

    In the former case, it’s important to remember that needing someone to talk to is not being a burden to them. Not only will our company probably enrich them too, but also, we are evolved to care for one another, and that itself can bring fulfilment to them as much as to you. But what if you don’t a friend to talk to?

    • You might be surprised at who would be glad of you reaching out. Have a think through whom you know, and give it a go. This can be scary, because what if they reject us, or worse, they don’t reject us but silently resent us instead? Again, they probably won’t. Human connection requires taking risks and being vulnerable sometimes.
    • If that’s not an option, there are services that can fill your need. For some, therapy might serve a dual purpose in this regard. For others, you might want to check out the list of (mostly free) resources at the bottom of this article

    In the second case (that we need near-constant company to feel at our best) we probably need to look more at our overall lifestyle, and find ways to be part of a community. That can include:

    • Living in a close-knit community (places with a lot of retirees in one place often have this; or younger folk might look at communal living/working spaces, for example)
    • Getting involved in local groups (you can check out NextDoor.com or MeetUp.com for this)
    • Volunteering for a charity (not only are acts of service generally fulfilling in and of themselves, but also, you will probably be working with other people of a charitable nature, and such people tend to make for good company!)

    Need a little help?

    There are many, many organizations that will love to help you (or anyone else) overcome loneliness and isolation.

    Rather than list them all here and make this email very long by describing how each of them works, here’s a great compilation of resources:

    Healthline: How To Deal With Loneliness (Resources)

    Don’t Forget…

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    Learn to Age Gracefully

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