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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  • The Vagina Bible – by Dr. Jen Gunter

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    The vagina is mysterious to most men, and honestly, also to a lot of women. School education on this is minimal, if even extant, and as an adult, everyone’s expected to “just know” stuff. However, here in reality, that isn’t how knowledge works.

    To remedy this, gynecologist Dr. Jen Gunter takes 432 pages to give us the low-down and the ins-and-outs of this remarkable organ that affects, and is affected by, a lot of the rest of our health.

    (On which note, if you think you already know it, ask yourself: could you write 432 pages about it? If not, you’ll probably still learn some things from this book)

    Stylistically, this book is more of a textbook in presentation, but the writing is still very much easy-reading. The focus is mostly on anatomy and physiology, though she does give due attention to relevant healthcare options; what’s good, what’s bad, and what’s just plain unnecessary. In such cases, she always has plenty of science to hand; it’s never just “one woman’s opinion”.

    If the book has a downside, it’s that (based on other reviews) it seems to upset some readers with unwelcome truths, but that’s more in the vein of “she’s right, of course, but I didn’t like reading it”.

    Bottom line: if you have a vagina, or spend any amount of time in close proximity to one, then this is a great book for you.

    Click here to check out The Vagina Bible, and upgrade your knowledge!

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  • Vit D + Calcium: Too Much Of A Good Thing?

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    Vit D + Calcium: Too Much Of A Good Thing?

    • Myth: you can’t get too much calcium!
    • Myth: you must get as much vitamin D as possible!

    Let’s tackle calcium first:

    ❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞

    Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.

    But what about too much?

    Hypercalcemia

    Having too much calcium—or “hypercalcemia”— can lead to problems with…

    • Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
    • Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
    • Stones: kidney stones causing pain.
    • Moans: refers to fatigue and malaise.
    • Thrones: polyuria, polydipsia, and constipation
    • Psychic overtones: lethargy, confusion, depression, and memory loss.

    (mnemonic courtesy of Sadiq et al, 2022)

    What causes this, and how do we avoid it? Is it just dietary?

    It’s mostly not dietary!

    Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…

    Too much vitamin D

    Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.

    This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.

    Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.

    See for yourself:

    How much is too much?

    The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.

    See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too

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  • Why do I poo in the morning? A gut expert explains

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    No, you’re not imagining it. People really are more likely to poo in the morning, shortly after breakfast. Researchers have actually studied this.

    But why mornings? What if you tend to poo later in the day? And is it worth training yourself to be a morning pooper?

    To understand what makes us poo when we do, we need to consider a range of factors including our body clock, gut muscles and what we have for breakfast.

    Here’s what the science says.

    H_Ko/Shutterstock

    So morning poos are real?

    In a UK study from the early 1990s, researchers asked nearly 2,000 men and women in Bristol about their bowel habits.

    The most common time to poo was in the early morning. The peak time was 7-8am for men and about an hour later for women. The researchers speculated that the earlier time for men was because they woke up earlier for work.

    About a decade later, a Chinese study found a similar pattern. Some 77% of the almost 2,500 participants said they did a poo in the morning.

    But why the morning?

    There are a few reasons. The first involves our circadian rhythm – our 24-hour internal clock that helps regulate bodily processes, such as digestion.

    For healthy people, our internal clock means the muscular contractions in our colon follow a distinct rhythm.

    There’s minimal activity in the night. The deeper and more restful our sleep, the fewer of these muscle contractions we have. It’s one reason why we don’t tend to poo in our sleep.

    Diagram of digestive system including colon and rectum
    Your lower gut is a muscular tube that contracts more strongly at certain times of day. Vectomart/Shutterstock

    But there’s increasing activity during the day. Contractions in our colon are most active in the morning after waking up and after any meal.

    One particular type of colon contraction partly controlled by our internal clock are known as “mass movements”. These are powerful contractions that push poo down to the rectum to prepare for the poo to be expelled from the body, but don’t always result in a bowel movement. In healthy people, these contractions occur a few times a day. They are more frequent in the morning than in the evening, and after meals.

    Breakfast is also a trigger for us to poo. When we eat and drink our stomach stretches, which triggers the “gastrocolic reflex”. This reflex stimulates the colon to forcefully contract and can lead you to push existing poo in the colon out of the body. We know the gastrocolic reflex is strongest in the morning. So that explains why breakfast can be such a powerful trigger for a bowel motion.

    Then there’s our morning coffee. This is a very powerful stimulant of contractions in the sigmoid colon (the last part of the colon before the rectum) and of the rectum itself. This leads to a bowel motion.

    How important are morning poos?

    Large international surveys show the vast majority of people will poo between three times a day and three times a week.

    This still leaves a lot of people who don’t have regular bowel habits, are regular but poo at different frequencies, or who don’t always poo in the morning.

    So if you’re healthy, it’s much more important that your bowel habits are comfortable and regular for you. Bowel motions do not have to occur once a day in the morning.

    Morning poos are also not a good thing for everyone. Some people with irritable bowel syndrome feel the urgent need to poo in the morning – often several times after getting up, during and after breakfast. This can be quite distressing. It appears this early-morning rush to poo is due to overstimulation of colon contractions in the morning.

    Can you train yourself to be regular?

    Yes, for example, to help treat constipation using the gastrocolic reflex. Children and elderly people with constipation can use the toilet immediately after eating breakfast to relieve symptoms. And for adults with constipation, drinking coffee regularly can help stimulate the gut, particularly in the morning.

    A disturbed circadian rhythm can also lead to irregular bowel motions and people more likely to poo in the evenings. So better sleep habits can not only help people get a better night’s sleep, it can help them get into a more regular bowel routine.

    Man preparing Italian style coffee at home, adding coffee to pot
    A regular morning coffee can help relieve constipation. Caterina Trimarchi/Shutterstock

    Regular physical activity and avoiding sitting down a lot are also important in stimulating bowel movements, particularly in people with constipation.

    We know stress can contribute to irregular bowel habits. So minimising stress and focusing on relaxation can help bowel habits become more regular.

    Fibre from fruits and vegetables also helps make bowel motions more regular.

    Finally, ensuring adequate hydration helps minimise the chance of developing constipation, and helps make bowel motions more regular.

    Monitoring your bowel habits

    Most of us consider pooing in the morning to be regular. But there’s a wide variation in normal so don’t be concerned if your poos don’t follow this pattern. It’s more important your poos are comfortable and regular for you.

    If there’s a major change in the regularity of your bowel habits that’s concerning you, see your GP. The reason might be as simple as a change in diet or starting a new medication.

    But sometimes this can signify an important change in the health of your gut. So your GP may need to arrange further investigations, which could include blood tests or imaging.

    Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

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

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  • Why You Can’t Deep Squat (And the Benefits You’re Missing)

    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.

    Matt Hsu fought his own battle with chronic pain from the age of 16 in his feet, knees, hips, back, shoulders, elbows, forearms, wrists, hands, and head. Seeking answers, he’s spent a career in corrective exercise, posture alignment, structural integration, orthopedic exercise, sports medicine, and has more certifications than we care to list. In short, he knows his stuff.

    Yes you can (with some work)

    The deep squat, also called Asian squat, Slav squat, sitting squat, resting squat, primal squat, and various other names, is an important way of sitting that has implications for a lot of aspects of health.

    Why it’s so important: it preserves the mobility of our hips, ankles, and everything in between, and maintaining especially the hip mobility makes a big difference not only to general health, but also to reducing the risk of injury. It also maintains lower body strength, making falls in older age less likely in the first place, and if falls do happen, makes injury less likely, and if injury does happen, makes the injury likely less severe.

    An important misconception: there is a popular, but unfounded, belief that the ability or inability to do this is decided by genes—or if not outright decided, that at the very least Asians and Slavs have a genetic advantage. However, this is simply not true. Westerners and others can learn to do it just fine, and on the flipside, Asians and Slavs who grew up in the West may often struggle with it. The truth is, the deciding factor is lifestyle: if your culture involves sitting this way more often, you’ll be able to do it more comfortably and easily than if you’re just now trying it for the first time.

    Factors that you can control: you can’t change where you grew up, but you can change how you sit down now. Achieving the squat requires repeated position practice, and the more frequently you do so (even if you just start with a few seconds and work your way up to longer periods), the better you’ll get at it. And, on the contrary, sitting in chairs weakens and shortens the muscles involved, so any time you spend sitting in chairs is working against you. There are many reasons it’s advisable to avoid sitting in chairs more than necessary, and this is one of them.

    10almonds tip: a limiting factor for many people initially is ankle flexibility, which may result in one’s center of gravity being a bit far back, leading to a tendency to have to change something to avoid toppling over backwards. Rather than holding onto something immobile (e.g. furniture) in front of where you are sitting, consider simply holding an object in front of you in your hands. A book is a fine example; holding that in front of you (feel free to read the book) will shift your center of gravity forwards a bit, and will thus allow you to sit there a little longer, thus improving your strength and flexibility while you do, until you can do it without holding something in front of you. If you try with a book and you’re still prone to toppling backwards, try with something heavier, but do use the minimum weight necessary, because ultimately the counterbalance is just a crutch to get you to where you need to be.

    For more visual advice on how to do it, enjoy:

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  • Lost Connections – by Johann Hari

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    Johann Hari had a long journey through (and out of!) depression, and shares his personal findings, including his disappointment with medical options, and a focus on the external factors that lead to depression.

    And that’s key to this book—while he acknowledges later in the book that there are physiological factors involved in depression, he wants to look past things we can’t change (like genes accounting for 37% of depression) or things that there may be unwanted side-effects to changing (as in the case of antidepressants, for many people), to things we genuinely can choose.

    And no, it’s not a “think yourself happy” book either; rather, it looks at nine key external factorsthat a) influence depression b) can mostly be changed.

    If the book has a downside, it’s that the author does tend to extrapolate his own experience a lot more than might be ideal. If SSRIs didn’t help him, they are useless, and also the only kind of antidepressant. If getting into a green space helped him, a Londoner, someone who lives in the countryside will not be depressed in the first place. And so forth. It can also be argued that he cherry-picked data to arrive at some of his pre-decided conclusions. He also misinterprets data sometimes; which is understandable; he is after all a journalist, not a scientist.

    Nevertheless, he offers a fresh perspective with a lot of ideas, and whether or not we agree with them all, new ideas tend to be worth reading. And if even one of his nine ideas helps you, that’s a win.

    Bottom line: if you’d like to explore the treatment of depression from a direction other than medicalization or psychotherapy, then this is will be a good book for you.

    Click here to check out Lost Connections, and reforge yours!

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  • A drug that can extend your life by 25%? Don’t hold your breath

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    Every few weeks or months, the media reports on a new study that tantalisingly dangles the possibility of a new drug to give us longer, healthier lives.

    The latest study centres around a drug involved in targeting interleukin-11, a protein involved in inflammation. Blocking this protein appeared to help mice stave off disease and extend their life by more than 20%.

    If only defying the ravages of time could be achieved through such a simple and effort-free way – by taking a pill. But as is so often the case, the real-world significance of these findings falls a fair way short of the hype.

    Halfpoint/Shutterstock

    The role of inflammation in disease and ageing

    Chronic inflammation in the body plays a role in causing disease and accelerating ageing. In fact, a relatively new label has been coined to represent this: “inflammaging”.

    While acute inflammation is an important response to infection or injury, if inflammation persists in the body, it can be very damaging.

    A number of lifestyle, environmental and societal drivers contribute to chronic inflammation in the modern world. These are largely the factors we already know are associated with disease and ageing, including poor diet, lack of exercise, obesity, stress, lack of sleep, lack of social connection and pollution.

    While addressing these issues directly is one of the keys to addressing chronic inflammation, disease and ageing, there are a number of research groups also exploring how to treat chronic inflammation with pharmaceuticals. Their goal is to target and modify the molecular and chemical pathways involved in the inflammatory process itself.

    What the latest research shows

    This new interleukin-11 research was conducted in mice and involved a number of separate components.

    In one component of this research, interleukin-11 was genetically knocked out in mice. This means the gene for this chemical mediator was removed from these mice, resulting in the mice no longer being able to produce this mediator at all.

    In this part of the study, the mice’s lives were extended by over 20%, on average.

    Another component of this research involved treating older mice with a drug that blocks interleukin-11.

    Injecting this drug into 75-week old mice (equivalent to 55-year-old humans) was found to extend the life of mice by 22-25%.

    These treated mice were less likely to get cancer and had lower cholesterol levels, lower body weight and improved muscle strength and metabolism.

    From these combined results, the authors concluded, quite reasonably, that blocking interleukin-11 may potentially be a key to mitigating age-related health effects and improving lifespan in both mice and humans.

    Why you shouldn’t be getting excited just yet

    There are several reasons to be cautious of these findings.

    First and most importantly, this was a study in mice. It may be stating the obvious, but mice are very different to humans. As such, this finding in a mouse model is a long way down the evidence hierarchy in terms of its weight.

    Research shows only about 5% of promising findings in animals carry over to humans. Put another way, approximately 95% of promising findings in animals may not be translated to specific therapies for humans.

    Second, this is only one study. Ideally, we would be looking to have these findings confirmed by other researchers before even considering moving on to the next stage in the knowledge discovery process and examining whether these findings may be true for humans.

    We generally require a larger body of evidence before we get too excited about any new research findings and even consider the possibility of human trials.

    Third, even if everything remains positive and follow-up studies support the findings of this current study, it can take decades for a new finding like this to be translated to successful therapies in humans.

    Until then, we can focus on doing the things we already know make a huge difference to health and longevity: eating well, exercising, maintaining a healthy weight, reducing stress and nurturing social relationships.

    Hassan Vally, Associate Professor, Epidemiology, Deakin University

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

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