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 implicated, 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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  • Before You Reach For That Tylenol…

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    First, on names: we’ve titled this with “Tylenol” because that’s a well-known brand name, but the drug name is paracetamol or acetaminophen:

    • paracetamol is the drug name used by the World Health Organization, and thus also most countries.
    • acetaminophen is the drug name used in Canada, Colombia, Iran, Japan, US, and Venezuela.

    They are absolutely the same drug.

    Firstly, obviously, do avoid overdose

    The safe dosage described on the packet is generally accurate (usually around 4g/day, spaced out at 1g per 4 hours), and the dose required for toxicity is generally about 10g, or 200mg/kg body weight, whichever is lower. Since a single dose usually contains 2x 500mg = 1g, that makes overdose all too easy.

    The amount required for toxicity can be misleading too, because that’s assuming…

    • a healthy liver
    • no other health problems
    • no other medications that interact or add to the toxicity
    • no medications that strain the liver (as with many pro-drugs, and drugs in general that are metabolized by the liver, which is lots).

    Which is a lot of assumptions! Especially given that the liver can only process so much at once, meaning that if your liver has a lot of things to do, it can get a backlog, and you think “I’m not taking anything with this painkiller that I shouldn’t” but your liver is still metabolizing the last of last night’s glass of wine and one of your regular medications from this morning, because previously it was still metabolizing things from the day before yesterday, and so on.

    See also: How To Regenerate Your Liver ← the liver is an incredible organ that does an amazing job, but it can’t do that if you don’t do this

    Please don’t overdose deliberately either. Intentional overdoses make up a very large portion of acetaminophen overdoses (exact figures vary from year to year and place to place, but it’s always high), and what a lot of people doing that don’t realize is:

    1. it’s a very unpleasant way to die. You’ll take it, you might get some initial symptoms within the first hours or you might not, then you’ll probably feel better, and then the next day or so, you’ll enter the organs-shutting-down stage that usually will take most of a week to kill you slowly and painfully. Often your kidneys will go first but it’ll usually be liver necrosis that deals the final blow.
    2. it’s very difficult to treat. Stomach-pumping might work if you get it within 1 hour of overdose, and activated charcoal might help if you get it within 2 hours. Acetylcysteine may reduce the toxicity if you get it within the 8–48 hour window (depending on the speed of gastric emptying), but whether or not that will help depends on the severity of the overdose and other factors, so this is not something to bet on. After 48 hours, a liver transplant is the last resort, without which, mortality is around 95%.

    Unfortunately, this means that a lot of people who do not intend to die horribly, and hoped to either die peacefully or else be saved, die horribly instead.

    Ok, that was not a cheerful topic but it is important, before moving on, we’ll just put this here for anyone it may benefit:

    How To Stay Alive (When You Really Don’t Want To) ← this is about suicidality, in yourself or others

    Secondly, that dosage is for occasional use only

    The problem often starts like this:

    ❝Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications❞

    People with chronic pain, whether high or low on the pain level of that chronic pain, can very easily get into a habit of “I’ll just take this to take the edge off”, for example when getting up in the morning (often a trigger for pain starting) or going to bed at night (one needs to sleep and the pain is a barrier to that).

    But… Those events, getting up and going to bed, it means that taking the drug also becomes part of one’s morning/evening routine—with many people even metering the doses out into pill organizers for the week, with this in mind.

    A large (n=582,961) study looked at two groups of people, all aged 65+:

    • 180,483 people who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months)
    • 402,478 people of the same age who had never been prescribed paracetamol repeatedly

    The findings? Bearing in mind that “≥2 prescriptions within six months” is not something generally considered excessive…

    ❝Acetaminophen use was associated with an increased risk of peptic ulcer bleeding (aHR 1.24; 95% CI 1.16, 1.34), uncomplicated peptic-ulcers (aHR 1.20; 95% CI 1.10, 1.31), lower gastrointestinal-bleeding (aHR 1.36; 95% CI 1.29, 1.46), heart-failure (aHR 1.09; 95% CI 1.06, 1.13), hypertension (aHR 1.07; 95% CI 1.04, 1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13, 1.24).❞

    The researchers concluded:

    ❝Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, the use of acetaminophen as the first-line oral analgesic for long-term conditions in older people requires careful reconsideration.❞

    You can see the study itself here: Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink

    What to use instead?

    It’s been established that taking aspirin regularly isn’t great either:

    See: Low-Dose Aspirin & Anemia and Aspirin, CVD Risk, & Potential Counter-Risks

    And as for ibuprofen, we don’t have an article about that yet, but it’s gut-unhealthy (harms your microbiome), and besides, anything it can do, ginger can do as well or better (in head-to-head trials; we’re not speaking hyperbolically here):

    Ginger Does A Lot More Than You Think ← in fact, it was even found as effective as the combination of acetaminophen, ibuprofen, and caffeine

    There are other options though, and as pain is complicated and there’s no one-size-fits-all solution, we’ve compiled the following:

    Take care!

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  • Carrots vs Parsnips – Which is Healthier?

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    Our Verdict

    When comparing carrots to parsnips, we picked the parsnips.

    Why?

    There are arguments for both! But we say parsnips win on overall nutritional density.

    In terms of macros, parsnips vary quite a lot from region to another, but broadly speaking, parsnips have more carbs and fiber, and/but the ratios are such that carrots have the lower glycemic index. We’ll call this one a win for carrots.

    When it comes to vitamins, carrots have more of vitamins A, B2, B3, B6, and choline, while parsnips have more of vitamins B1, B5, B9, C, E, and K. A small win for parsnips here.

    In the category of minerals, carrots are not higher in any minerals, while parsnips are higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. An overwhelming win for parsnips.

    While the overall vitamin and mineral content puts parsnips ahead, it’s still worth noting that carrots have highly bioavailable megadoses of vitamin A.

    Another thing to note is that the glycemic index recorded for both is when peeled and boiled, whereas both of these root vegetables can be enjoyed raw if you wish, which has a much lower GI.

    In short, enjoy either or both, but parsnips are the more nutritionally dense overall.

    Want to learn more?

    You might like to read:

    Glycemic Index vs Glycemic Load vs Insulin Index

    Take care!

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  • The Aesthetic Brain – by Dr. Anjan Chatterjee

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    Dr. Anjan Chatterjee (not to be mistaken for Dr. Rangan Chatterjee, whose books we have also sometimes reviewed before) is a neurologist.

    A lot about aesthetics is easy enough to understand. We like physical features in humans that suggest a healthy mate, and we like lush and/or colorful plants that reassure us that we will have plenty to eat.

    But what about a beautiful building, or a charcoal drawing of some captivatingly eldritch horror? And what, neurologically speaking, is the difference between a bowl of fruit and a painting of a bowl of fruit? And what, if anything, does appreciation of such do for us?

    In this very readable pop-science book, we learn about these things and many more, from the perspective of an experienced neurologist who explains things simply but with plenty of science.

    Bottom line: if you’d like to understand how and why your brain does more things than just process tasks necessary for survival, this book will give you plenty of insight.

    Click here to check out The Aesthetic Brain, and learn more about yours!

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    Cori Lefkowith, of “Redefining Strength” and “Strong At Any Age” fame, has her formula to share:

    Know your priorities

    We’ll not keep the 7 tips a mystery; they are:

    1. Determine your primary goal: decide whether your main focus is losing fat while building muscle or building muscle while trimming up. This choice will influence your calorie intake, macros, and cardio approach.
    2. Start tracking: spend 7–14 days logging your current food intake, including calories, protein, carbs, and fats, without taking any particular action to change them yet. Understanding your baseline will help tailor your diet and exercise plan.
    3. Prioritize strength training: focus on strength work over cardio to build muscle. Avoid turning strength sessions into cardio by rushing between sets—allow adequate rest for muscle progression.
    4. Center your meals on protein: adjust your protein intake based on your primary goal. For fat loss while gaining muscle, aim for 40-45% of calories from protein. For building muscle while losing fat, aim for 30-40% protein, with attention to maintaining sufficient carbs.
    5. Set your calories: after adjusting protein, fine-tune your calorie intake. However, make only small changes (e.g. 100 calories up or down) and reassess every 2–3 weeks to avoid extreme deficits or surpluses.
    6. Adjust your cardio: prioritize strength training but use walking as low-impact cardio. Avoid excessive cardio that may hinder muscle gains, and use strategic HIIT sessions if needed.
    7. Ditch the scale: avoid using the scale as your sole measure of progress. Instead, rely on measurements, progress photos, and how your clothes fit to track body recomposition effectively.

    For more on all of these, enjoy:

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    Want to learn more?

    You might also like to read:

    Can You Gain Muscle & Lose Fat At The Same Time? ← we got this question in our Q&A day not long back, and here was our answer. We went for a less numbers-based approach, and a more principles-based approach. Both ways work, so by all means pick whichever method you personally find better suits how you like to do things!

    Take care!

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  • The Five Invitations – by Frank Ostaseski

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    This book covers exactly what its subtitle promises, and encourages the reader to truly live life fully, something that Ostaseski believes cannot be done in ignorance of death.

    Instead, he argues from his experience of decades working at a hospice, we must be mindful of death not only to appreciate life, but also to make the right decisions in life—which means responding well to what he calls, as per the title of this book, “the five invitations”.

    We will not keep them a mystery; they are:

    1. Don’t wait; do the important things now
    2. Welcome everything; push away nothing
    3. Bring your whole self to the experience
    4. Find a place in the middle of things
    5. Cultivate a “don’t know” mind

    Note, for example, that “do the important things now” requires knowing what is important. For example, ensuring a loved one knows how you feel about them, might be more important than scratching some item off a bucket list. And “push away nothing” does mean bad things too; rather, of course try to make life better rather than worse, but accept the lessons and learnings of the bad too, and see the beauty that can be found in contrast to it. Enjoying the fullness of life without getting lost in it; carrying consciousness through the highs and lows. And yes, approaching the unknown (which means not only death, but also the large majority of life) with open-minded curiosity and wonder.

    The style of the book is narrative and personal, without feeling like a collection of anecdotes, but rather, taking the reader on a journey, prompting reflection and introspection along the way.

    Bottom line: if you’d like to minimize the regrets you have in life, this book is a fine choice.

    Click here to check out The Five Invitations, and answer with a “yes” to the call of life!

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  • Latest Alzheimer’s Prevention Research Updates

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    Questions and Answers 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!

    This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! 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

    I am now in the “aging” population. A great concern for me is Alzheimers. My father had it and I am so worried. What is the latest research on prevention?

    One good thing to note is that while Alzheimer’s has a genetic component, it doesn’t appear to be hereditary per se. Still, good to be on top of these things, and it’s never too early to start with preventive measures!

    You might like a main feature we did on this recently:

    See: How To Reduce Your Alzheimer’s Risk

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