Fibromyalgia

Making A Difference In People’s Lives
Rob Robertson,M.D. is 1974 graduate of the University of Louisville School of Medicine. He completed his internship and residency in Emergency Medicine at the U.of L. Affiliated Hospitals and was appointed Director of Emergency Services at Baptist Hospital in Western Kentucky. During his tenure there, the EM Department grew to a patient load of over 50,000 visits annually. In 1994, Dr. Robertson opened a wellness and preventive medicine practice called Doctors Nutrition System and developed nutritional supplements and protocols that were incorporated into their practices by multiple physicians throughout the Midwest.

In researching products for his company, he discovered transfer factors through the over 3,000 articles that had been published since 1949. " I was simply overwhelmed. Why hadn't I heard about this?" Transfer factors and their use in augmenting the immune response seemed like the " the missing link in our attempt to provide patients with a natural, safe way to lessen their chances of becoming ill." When Dr. Robertson discovered that transfer factors were going to be made available commercially, he closed his medical practice and sold his supplement company because, " I simply had to become involved in helping to tell the world, literally the world, about what I consider to be one of the defining discoveries in the history of medical science."

The availability of transfer factors and his interest in the perplexing Fibromyalgia Syndrome led to his incorporating natural products developed by William J. Hennen, Ph.D. into a program which has been named THE FIBROMYALGIA RECOVERY PROGRAM. "Do we have all of the answers?I'm not certain that anyone will ever be able to make that claim. But we feel very confidant that by stressing and addressing the immune system breakdown and dysfunction, we have a way to intervene in the fibromyalgics multitude of symptoms in a beneficial way. One of the most gratifying experiences that I've ever had is to hear a fibromyalgic call and tell me that they just want to say thanks for having their life given back to them." Dr. Robertson is now involved full-time in THE FIBROMYALGIA RECOVERY PROGRAM and in continuing to help tell the transfer factor story.

Fibromyalgia is a complex syndrome characterized by pain amplification, musculoskeletal discomfort, and multiple systemic symptoms. In order to meet the criteria established by the American College of Rheumatology, the pain must have been present for at least 3 months' duration, and must be present in all 4 quadrants of the body. The pain must occur in certain specific anatomical sites and there have been 18 such sites identified. In the past, it was felt that at least 11 of these sites must produce severe pain when 8 pounds of pressure were applied in order for the diagnosis of fibromyalgia to be established. Recently, many researchers and clinicians have felt that even if less than 11 sites were active at the time of the exam, if other criteria were met, the diagnosis of fibromyalgia could still be made. The Four Quadrants The "Fibromyalgia Defined" area pointed out that in order to meet the criteria established by the American College of Rheumatology, the pain must have been present for at least 3 months' duration, and must be present in all 4 quadrants of the body. What exactly is a quadrant? Imagine dividing the body into four quarters: (1) Right side - above the waist (2) Left side - above the waist (3) Right side - below the waist (4) Left side - below the waist

The reference above to "multiple systemic symptoms" means that symptoms occur in such systems of the body as musculoskeletal, cardiovascular, genitourinary, nervous, lymphatic, immune, and respiratory systems.   Anatomical Tender Points (1) Occiput: bilateral, at the suboccipital muscle insertions. (2) Low cervical: bilateral, at the anterior aspects of the inter-transverse spaces at C5-C7. (3) Trapezius: bilateral, at the midpoint of the upper border. (4) Supraspinatus: bilateral, at origins, above the scapula spine near the medial border. (5) 2nd rib: bilateral, at the second costochondral junctions, just lateral on upper surfaces. (6) Lateral epicondyle: bilateral, 2 cm distal to the epicondyles. (7) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle. (8) Greater trochanter: bilateral, posterior to the trochanteric prominence. (9) Knees: bilateral, at the medial fat pad proximal to the joint line.

Fibromyalgia affects approximately 10,000,000 people in the United States and Canada. There are some estimates that would place that number even higher.
The incidence of fibromyalgia is greater the farther North you go.
The average age at onset is between 35 and 55 years old, but fibromyalgia can affect any age.
Approximately 90% of those affected are female.
The average time between the onset of symptoms and the establishment of a diagnosis is 5 years.
The average person with fibromyalgia has seen multiple health care professionals in seeking an explanation for their symptoms.
The average person with fibromyalgia has had multiple diagnostic evaluations which include blood tests, x-rays, CAT scans, MRI's , EEG's, EMG's, urinalyses, etc. Many will say "You name it, I've had it done."
The average person with fibromyalgia has been told multiple times that all of their test results were normal.
Most people with fibromyalgia have at one time or another been on some or all of the following medications: pain pills (narcotic and non-narcotic); muscle relaxants, tranquilizers, sleeping pills, antidepressants including tricyclics, monoamine oxidase inhibitors and selective serotonin re-uptake inhibitors, steroids, and non-steroidal anti-inflammatory agents. "You name it, I've taken it." Other drugs may have been prescribed , but these are the most common.
Many individuals have also had such procedures as nerve blocks, been placed under the the care of a massage therapist or physical therapist, and have been referred for psychological or even psychiatric evaluation and counselling or treatment.
Fibromyalgia places great strain on relationships including those within a marriage and within the family, in the work place, and in interaction with friends - "The doctor said all your tests were normal...".
The average person with fibromyalgia has heard themselves described as lazy, selfish, without ambition, a hypochondriac, worthless, crazy, etc.
Many with fibromyalgia have lost all hope.
Everyone with fibromyalgia asks "WHY?"

Review of Systemic Symptoms
In a review of 1,500 patients with fibromyalgia, Robert Olin, M.D., Ph.D., has determined these symptoms to be present and has compiled the frequency in which they occur in those studied.

90 - 100%
Generalized Pain
Fatigue
Stiffness
Morning Fatigue

70 - 90%
Post-Exertional Malaise
Sleep Disturbances
Morning Stiffness
Headaches
Tenderness
Swollen Feeling in Tissues
Numbness and Tingling
Cognitive Impairment ("Fibrofog")
Dizziness
Sensitivity to Noise, Smell and Stress
Dysmenorrhea (severe menstrual cramping)
Dry Mouth

50 - 70%
Irritable Bowel Syndrome
Blurred Vision
Affective Lability (mood swings)
Heart Palpitations
Cold Extremities
Feverous Feelings
Allergies

15 - 50%
Restless Legs
Muscle Twitches
Itchy Skin
Heart Disturbances
Night Sweats
Migraines
Breathing Problems
Infection Proneness
Skin Manifestations (rashes)
Interstitial cystitis
TMJ Dysfunction
Multiple Chemical Sensitivities

Below 15%
Major Depression (concurrent)

Fibromyalgia and the Immune System
Our immune system is our natural defense against disease. When it is in a balanced and healthy state, it is a wonder to behold. However, many factors can contribute to a condition in which our immune system is no longer able to protect us. This section of the fibromyalgia program is to help you understand how your immune system can reach a state where it is functioning at its maximum capability, and how adding still more stress to an already maximally functioning immune system can result in immune system dysfunction.

The cascade of events that follow produce a state of chronic illness known as fibromyalgia. Ken Bock, M.D., in his excellent book "The Road To Immunity", has compared the immune system to a kettle. It can absorb and respond to multiple threats to our well being, but finally even the most vital immune system can reach its maximal functional level. Any added insult simply can't be adequately addressed so the kettle overflows, and the onset of fibromyalgia symptoms begin.


In utilizing Dr. Bock's kettle analogy, the added insults which cause the overflow are often events which fibromyalgia sufferers relate when they look back at their lives prior to the appearance of their symptoms. There are three events that have often occurred: (1) an illness that perhaps didn't seem too serious at the time, but after which the individual never seemed to fully recover. (2) An injury which may or may not have required medical treatment -- a whiplash, a fall or burn, or some other type of physical injury. (3) An emotional trauma such as the death of a loved one - a divorce, bankruptcy, or some other type of severe emotional trauma. Even if not all three events have occurred, often one or two can produce enough stress on an already maximally stressed immune system as to precipitate the onset of immune system dysfunction and fibromyalgia.


It is well established that (1) infection places an extra load on the immune system. It is also well documented that (2) physical and (3) emotional injury adversely affect the immune response as well.

The Immune System Kettle
Ken Bock, M.D., in his excellent book "The Road To Immunity", has compared the immune system to a kettle. It can absorb and respond to multiple threats to our well being, but finally even the most vital immune system can reach its maximal functional level. The example of the full kettle below illustrates the types of everyday attacks to our immune system and what it must defend against.

When additional immune system challenges such as injury, severe stress, or an infection occur, the already filled kettle can no longer respond - as characterized by the overflowing kettle illustration shown here. At this point, immune system dysfunction has begun.

Fibromyalgia - The Downward Spiral
There is a sequence of events that occur within your body which produce the symptoms and signs found in the fibromyalgia syndrome. The downward spiral takes you step by step through those events. The spiral begins with the onset of immune system overload as demonstrated in the immune kettle illustration. The end result is immune system dysfunction and the development of the fibromyalgia syndrome.

Fibromyalgia - The Symptoms Begin
So why does one begin to develop the symptoms characteristic of fibromyalgia? The illustration of the downward spiral into fibromyalgia shows us the build-up of intracellular toxins and the cell damage that occurs as the immune system becomes overwhelmed and dysfunctional. One role of the immune system is to take damaged cells out of circulation, to repair cell membranes, to clean up cellular debris, and to help usher waste products out of the body.

The inability of the now dysfunctional immune system to fulfill these roles results in a build-up of toxins and an increased population of now toxic cells which produces a feeling of toxicity in the body. Toxic cells within muscles can produce myalgias (muscle pain). Muscle pain can cause the sleep disturbances which are characteristic of fibromyalgia. Therefore the cascading effect begins, all precipitated by the onset and consequences of immune system dysfunction.

Fibromyalgia - The Sleep Disturbances
It is during sleep that healing processes take place. One must enter into a certain sleep pattern for this to occur. Numerous studies have been conducted which reveal that persons with fibromyalgia have a sleep disturbance that prevents healing. Here's what we know. Therapeutic or healing sleep occurs during deep sleep, and deep sleep is characterized by brain waves that are called delta waves. These are slow, deep brain waves and this pattern must be sustained. When a person with fibromyalgia is hooked up to a device called an EEG in a sleep lab, it can be demonstrated that the delta wave pattern is constantly being interrupted by something called alpha waves, which are brain waves that occur during light sleep. These brain waves are short and rapid. This is called alpha-delta intrusion. Constant alpha-delta intrusion prevents sustained therapeutic sleep from occurring and healing simply can't take place. It is during deep sleep that the regulation of the metabolism of an important neurotransmitter called serotonin takes place. We will discuss the importance of serotonin in another section. But let us establish one point here. Serotonin is necessary for the activation of an important immune system cell called "natural killer cells". Disruption of the metabolism of serotonin, the consequence of sleep disturbance, therefore is an important contributor to the inability of the body to heal in fibromyalgia due to its adverse affect on an immune system that is already dysfunctional.

A study published in the "Journal of Rheumatology" further sustains the role that sleep disturbances play in the symptoms of fibromyalgia. The subjects of this study did not have fibromyalgia and therefore had normal sleep patterns. However, for three consecutive nights they had their sleep interrupted by various sounds. This caused them to be deprived of any periods of sustained delta wave, therapeutic sleep. At the end of this experiment, after just three nights of the inability to achieve therapeutic sleep, they reported a significantly decreased pain threshold, increased discomfort, and fatigue. These results certainly confirm that disrupted therapeutic sleep is an important factor in the pathophysiology of the symptoms of fibromyalgia.

Fibromyalgia - The Role of Serotonin
Serotonin is an important neurotransmitter and its manufacture, regulation, and levels all play an important role in understanding fibromyalgia. A neurotransmitter is a substance that passes signals or information across the synapse (junction) that separates one nerve cell from another. Neurotransmitters are stored in the nerve cell's end. When an electrical impulse travels down the nerve cell, it causes the release of the neurotransmitter which then travels across the synapse and either promotes or inhibits continued electrical impulses along the nerve. Serotonin is involved in multiple functions including regulating sleep cycles, influencing mood, learning, pain perception and the immune system. Serotonin production takes place in the brain and the gastrointestinal tract. Fibromyalgia is one of the conditions that are known as "low serotonin syndromes". Here is what we know about the relationship of serotonin and fibromyalgia. Regulation of serotonin metabolism takes place during the deep or therapeutic sleep patterns which are discussed in another section. With the sleep disturbances of fibromyalgia, the metabolic regulation is disrupted. This causes further immune system dysfunction due to the role serotonin plays in the activation of natural killer cells.

Compounding the sleep disturbance is the fact that since serotonin helps induce deep sleep, its low levels then further aggravate the inability to achieve this desired sleep pattern. There is another neurotransmitter called substance P which works together with serotonin. Substance P is responsible for transmitting painful impulses to the brain and spinal cord. It produces a nerve generated impulse that dilates blood vessels, and in addition, it can cause fluid and proteins to migrate from the cells to outside the cells. Low serotonin levels can cause elevated substance P levels. These elevated levels, sometimes three times greater in people with fibromyalgia, could explain the enhancement of pain perception which is experienced. While much research is still being conducted, it would appear clear that there is evidence that "low serotonin syndrome" and the symptoms of fibromyalgia are strongly associated.

The fact that females have a lower capacity to produce serotonin than men may help explain the fact that over 90% of fibromyalgics are female. When events occur that produce the "low serotonin syndrome", this lessened capability to produce serotonin could be a crucial component in the greater female susceptibility to the onset of symptoms.

Fibromyalgia and Magnesium
Magnesium is one of the most important minerals found in the human body. It is involved in more than 300 enzymatic reactions involving all of the bodily systems. There is an important fact that needs to be understood. The routine test done to determine magnesium levels is a test performed on the blood's serum. This is the test that was probably performed on you if you have had a blood chemistry screening. Only 1% of your magnesium is found in the serum. Slightly over 31% is found in your muscle cells (intracellular) and the rest is found in your bones and other tissues. A normal serum magnesium level can't predict a normal total body magnesium level. A special test that measures magnesium inside of red blood cells is a much more accurate determinant of your magnesium status. Numerous studies have shown that a low total body magnesium level is present in fibromyalgia. Let's review some of the symptoms that occur when a magnesium deficiency occurs.

SKELETAL MUSCLES (1) muscle soreness (2) muscle tension (3) neck pain (4) back pain (5) muscle twitches/cramps (6) tension headaches (7) tmj (jaw joint) pain

SMOOTH MUSCLES (1) urinary spasms (2) dysmenorrhea (excessively painful periods) (3) constipation

CENTRAL NERVOUS SYSTEM (1) sleep disturbances (2) anxiety (3) hyperactivity and restlessness with constant movement (4) increased PMS irritability

CARDIOVASCULAR (1) arrhythmias (irregular heartbeats) (2) palpitations (occasional extra heartbeats) (3) chest pain (4) high blood pressure.

Magnesium also plays a critical role in the production of energy in our cells. The Krebs cycle (energy cycle) produces adenosine triphosphate (ATP) which is the main immediate source of usable energy for the cells. Magnesium is essential for the production of ATP. Magnesium deficiency causes a disruption of our source of energy.

Magnesium plays an important role in the immune system. It is a crucial factor in the growth and transformation of lymphocytes. A deficiency is associated with a lowered level of the cells that produce antibodies. Finally, a magnesium deficiency is implicated in increased production of free radicals that place even more stress on our immune system. One word of warning: a person with kidney disease should consult their physician prior to magnesium supplementation.

Fibromyalgia and Fatigue
We all get tired after strenuous work or exercise. We rest, get a good night's sleep and our normal energy levels are restored. This isn't true in fibromyalgia. One of the most prevalent and most distressing symptoms is the unrelenting fatigue. Certainly one of the factors involved is the inability to achieve quality sleep patterns which we've discussed.

Another cause is the disruption of what is called the "energy cycle" (also known as the Krebs cycle). Foods which we eat are metabolized through many steps and the end product of those metabolic steps is our ultimate energy source which is called ATP (adenosine triphosphate). If our bodies are functioning properly and we receive adequate nutrients through our food intake, we will have sufficient energy for our normal functions. Unfortunately, this often isn't the case. Enzymes can function too slowly, required nutrient co-factors may be in short supply and necessary feedback mechanisms don't occur or are inappropriate. This disruption of the "energy cycle" certainly can be a major contributing factor in the total body fatigue experienced in fibromyalgia. Magnesium plays a critical role in this whole process as it is essential to have sufficient magnesium to stabilize ATP after its production. Without magnesium, ATP can be produced but it falls apart before it can be utilized. This not only deprives our cells of an optimal level of energy-producing ATP but this random release and breakdown actually causes cellular damage.

An important but often overlooked study about ATP reserves in the muscles of fibromyalgics was conducted by two researchers at Vanderbilt University. Jane Park, PhD and Nancy Olsen, MD, found that ATP levels in the muscles of those who suffer from fibromyalgia where 60% lower than in healthy subjects. Not only is there a relationship to fatigue but in these patients the lower the ATP energy reserve the greater was their pain!

Two essential steps which we can take to restore and re-vitalize our production of energy are to assure that we have a sufficient supply of magnesium and to consume something called malic acid on a daily basis. Malic acid enters the "energy cycle" at its most efficient site and is quickly converted to something called NADH and then to ATP. Support of the "energy cycle" is absolutely essential in the recovery phase of fibromyalgia.

Fibromyalgia and Free Radicals
Free radicals are highly reactive molecules that can be harmful to our cell membranes and the cellular damage they can produce puts additional stress on the already dysfunctional immune system found in the fibromyalgia syndrome. Free radicals are produced during the oxidative processes in the production of energy. An excess of harmful free radical production can result from the effects of air pollution, radiation, toxic wastes, food additives and pesticide residues. Other contributors to excessive free radical production include consuming foods which are high in something called trans-fatty acids.

Free radicals are unstable molecules. This instability results from their having an unpaired electron. So what does this mean? It is the natural state to attempt to reach stability in the physiological processes going on in our bodies and in their attempt to reach this state, free radicals seek out another electron to pair with their unpaired one which will make them stable. So where do they get this new electron? Unfortunately, often by attacking our normal tissues and particularly the membranes of our cells. This attack can rupture the cell wall and the cell may begin to leak. It also becomes more vulnerable for the entrance of viruses and bacteria. Cellular death can be the result.

One of the functions of the immune system is to remove the cellular debris that results from cellular damage and death. A dysfunctional immune system can't adequately fulfill this function, further contributing to the symptoms found in fibromyalgia. Addressing the free radical issue is a vital part of taking excessive loads off the immune system so that it can begin the healing process.

Fibromyalgia - Vitamins, Minerals, and The Essential Fatty Acids
No healing process can adequately begin in a chronic, debilitating disease such as fibromyalgia without the availability of the necessary nutrients required to allow the body to heal itself. It has been said by a wise counselor who teaches about the use of safe, non-toxic natural products that "given sufficient time and provided with the necessary nutrients, the body has an almost unlimited ability to heal itself." Unfortunately, we live in a time and in a society where obtaining the nutrients we need has become most difficult, if not impossible.

Vitamins must be supplied in our diet or by dietary supplements because with few exceptions, the body cannot manufacture or synthesize them. Vitamins are used to make substances that are vital participants in many of the chemical reactions in our cells and are essential for their proper function. In order to obtain the maximum benefit from the vitamins one consumes, it is necessary to make certain that they are both "bio-active" and also "bio-available". These terms are used to describe a vitamin preparation that has been shown to be absorbable into the body and to be formulated so that the ingredients work synergistically with the metabolic requirements of the body. The "building blocks" provided by proper vitamin supplementation are an absolutely necessary pre-requisite for the rebuilding process to begin in fibromyalgia.

While vitamins are derived from organic (living) sources, minerals are derived from non-organic (non-living) sources. These nutrients are involved in a multitude of biological and physiological processes necessary for the maintenance of health or in the rebuilding of bodies ravaged by the consequences of chronic illnesses such as fibromyalgia. While the amount of these essential nutrients is relatively small when compared to our overall food intake -- (we need on the average of 500 grams of carbohydrate, proteins and fats each day while only requiring about 1.5 grams of minerals, or 0.3% of daily food intake)-- these nutrients are so potent and important that without them we wouldn't be able to utilize the other 99.7% of food intake and a deficit in the amount of any of the minerals required would greatly and adversely affect our body's healing efforts. Sheldon Saul Hendler, MD, PhD, has stated in his "The Doctors' Vitamin and Mineral Encyclopedia" that mineral insufficiency is even more prevalent that vitamin insufficiency, further emphasizing the need for adequate daily mineral intake.

Then there are the essential fatty acids (EFAs). In the 1980's the health consequences of consuming a diet high in fat began to be ingrained in the consciousness of the population. The Surgeon General actually began a high priority campaign to educate consumers about the dangers of such dietary habits. Even though this was an overall beneficial endeavor, for many it produced a "throwing out the baby with the bath water" end result. Many persons went on low fat diets and therefore didn't ingest the essential fatty acids which are just that - ESSENTIAL. Foods high in the EFAs include plant seeds such as flax and cold water fish such as mackerel, salmon, herring, bluefish and sardines. Even those who don't consciously restrict their fat intake often have difficulty in reaching a sufficient EFA intake. One of the many important functions of the EFAs is their role in the construction of our cell walls. In order to have a healthy immune system, not only must we build and maintain our cell wall's integrity, but we must provide the EFAs in order to have the necessary building blocks to form the particular components of our immune system such as macrophages, lymphocytes, natural killer cells, immune system messengers, and in the production of antibodies.

Fibromyalgia and Female Hormonal Imbalance
If all of the signs and symptoms of fibromyalgia aren't enough of a physical challenge, many females (remember that approximately 90% of those affected are female) have the added burden of having severe premenstrual syndrome (PMS) symptoms.

The physical symptoms of PMS include:
(1) abdominal bloating
(2) backache
(3) breast tenderness
(4) constipation
(5) diarrhea
(6) dizziness
(7) fatigue
(8) headache
(9) nausea
(10) swelling of hands/feet.

There are emotional symptoms which include:
(1) anger
(2) anxiety/depression
(3) irritability and nervousness

These physical and emotional symptoms can then produce behavioral symptoms such as:
(1) clumsiness
(2) appetite changes, either increased or decreased
(3) changes in libido (sexual desire)
(4) forgetfulness and difficulty concentrating
(5) sleep disturbances
(6) tearfulness
(7) a desire to be alone.

The symptoms of PMS typically occur from 5 to 11 days prior to the onset of the menstrual period. Many of these same females have dysmenorrhea which is the name used when menses is accompanied by severe debilitating pain. It is felt that many of the symptoms of PMS and much of the excessive menstrual pain is caused by female hormonal imbalance involving estrogen and progesterone. Achieving hormonal balance by the use of natural products is the goal of many with PMS and dysmenorrhea. There is also a recognized role for supplementation with calcium, magnesium, manganese and vitamins E and B-6

Fibromyalgia - Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is one of the most distressing symptoms of fibromyalgia. What can be so frustrating to a person with IBS is that just as in fibromyalgia, the medical evaluation results in a "good news, everything is normal" comment after a medical evaluation because there is no structural, biochemical or infectious cause uncovered. Yet again, just as in fibromyalgia, the person with IBS knows that even though the studies may be normal, their symptoms are very abnormal. These symptoms include abdominal pain and altered bowel habits, including diarrhea, constipation or alternating diarrhea and constipation. In addition, there may be symptoms referable to the upper gastrointestinal tract such as non-cardiac chest pain, heartburn, dysphagia (difficulty in swallowing) and a feeling of fullness in the throat. One person with fibromyalgia and IBS has called it "the cry of the wild gut!"

The incidence of IBS in fibromyalgia is very high. Studies have shown that there is up to a 70% association. Some clinicians even call IBS "fibrogut" due to the strong correlation. The sequence of events in producing IBS symptoms is felt to begin with the inability of the cells in the gastrointestinal (GI) tract to form enough energy. The GI tract has three layers of muscles that when functioning normally churn and mix nutritive elements with digestive juices. This allows a breakdown of ingested fats, proteins and carbohydrates into components that are small enough to be absorbed into the body. The GI musculature is also designed again when functioning normally to propel the foodstuff throughout the GI tract. The decreased GI cell energy level and the consequent decrease in the churning and propelling function create the setting in which IBS symptoms begin - the buildup of gas, the sieges of diarrhea, the constipation, the bloating, the pain, the uncertainty of going out socially because of the concern about an "attack

Fibromyalgia - Leaky Gut Syndrome
Complicating the picture for those with fibromyalgia, there is a strong correlation between fibromyalgia, IBS and "leaky gut syndrome" (LGS). LGS, in fact, may well be the major contributory factor in many of the symptoms of fibromyalgia. Here is what happens in LGS. The lining of the intestinal tract is called the intestinal mucosa. The mucosa is responsible for allowing essential nutrients to be absorbed across it into our bodies and also is the barrier which keeps harmful microorganisms, toxins and by-products from digestion from being absorbed. In LGS, there is increased permeability of the mucosa due to damage to something called "desmosomes" which can be thought of as the "glue" that holds the mucosal cells together. This allows larger sized particles that are normally not absorbed to find a passage open to them and to pass through the mucosa and to enter the bodily circulation. This can set up a cascade of events that can cause many of the symptoms present in fibromyalgia. Here are the symptoms known to occur in the person who is known to have increased intestinal permeability:

(1) fatigue and malaise
(2) arthralgias (joint pain)
(3) myalgias (muscle pain)
(4) fevers of unknown origin
(5) food intolerances
(6) abdominal pain
(7) abdominal distension
(8) diarrhea
(9) skin rashes
(10) toxic feelings
(11) cognitive and memory deficits ("fibrofog")
(12) shortness of breath
(13) poor exercise tolerance

Certainly many of these symptoms are similar to those of fibromyalgia. The genesis of these symptoms is due to two processes that occur secondary to an increased mucosal permeability. The first is an immune system response. Our immune system recognizes presence of the invading large particles that are absorbed as "non-self". The immune system responds by attacking them by direct contact and also by producing antibodies. Since some of these large particles have the same appearance as our own tissues, this immune response can result in attacks on our "self" through mis-recognition causing an auto-immune reaction and condition. The second way that increased permeability adversely affects the body is by the stress that the abnormally absorbed particles place on the liver. The liver is responsible for removing these macro (large) molecules and also to oxidize toxins that enter in the LGS setting because all these substances as well as normally absorbed nutrients are first carried to the liver via the portal vein. This can result in placing an overload on the liver's capacity of detoxification and removal of harmful particles, further accentuating the symptoms produced by increased permeability, by causing hepatocyte (liver) cell damage, excess free radical production and increased strain on an already dysfunctional immune system.

A paradox in LGS is that not only are harmful particles allowed though the incompetent intestinal mucosa but essential nutrients are not absorbed adequately. How can this seeming inconsistency occur? Here is what happens and why. Nutrient absorption is achieved by transportation though the intestinal mucosal cells and depends on the integrity of these cells being maintained. However, disruption of mucosal cells results in disruption of the effectiveness of certain carrier proteins that transport minerals such as magnesium and zinc. Therefore, a total body magnesium deficit is often seen in fibromyalgia even in those who are using supplementation of this essential mineral due to the fact that it is present in the intestinal lumen but can't be absorbed across the mucosal cell. The same can be true for zinc. The end result in LGS is a vicious cycle of harmful particles being inappropriately absorbed by going around the mucosal cells and essential nutrients not being absorbed because they can't get through.

Digestive Enzymes & Probiotics

Digestive Enzymes & Probiotics Digestive Enzymes and Probiotics with EnzyGuard-D™ blends important digestive enzymes with probiotics (good bacteria) to give your body the necessary tools to digest and process your food, promote a healthy balance of bacteria, and protect your body against harmful invading microorganisms. EnzyGuard-D™, a proprietary, cutting edge technology by 4Life, helps stabilize these enzymes and probiotics to provide a longer shelf life and more activity once inside your body. What is an enzyme? Enzymes are protein molecules that are necessary for life. Without enzymes we wouldn't be able to eat, breathe, drink or digest our food. There are enzymes naturally present in all raw foods. These enzymes help our bodies properly digest the foods we eat. As a result of poor dietary habits, microbial contamination, and the world's fixation with fast foods, we just are not getting enough raw foods in our diets.

Unfortunately for us, the ability to digest our foods properly decreases as we get older. Foods you loved when you were younger may now give you gas and bloating. Researchers also believe that as our body works overtime to make up for the lack of enzymes in the food we eat, that extra stress puts pressure on our immune system, making it harder to fight off illness and disease. What Are Probiotics? You might think that all bacteria are bad for your body, but that is far from the truth. The word probiotic means "in favor, or support of life." Millions of "good" bacteria exist in your body, helping us to fight off disease, produce vitamins, metabolize hormones, nourish new cells, and produce enzymes that help food with digestion. Without good bacteria, the harmful microorganisms would take over our bodily functions, making us extremely ill. Antibiotics by nature kill all bacteria, even the good. Food sensitivities, arthritis, excessive flatulence, irritable bowel syndrome, and auto-immune diseases are just a few of the conditions that can be caused by a disruption in good bacteria. How can 4Life™ help? Digestive Enzymes and Probiotics with EnzyGuard-D™ contains effective enzymes to help your body break down the proteins, sugars, carbohydrates, and fats that you consume on a daily basis. These enzymes aid in the absorption of key nutrients, as well as the digestive process throughout the body. This product will help replenish your body of the "good" bacteria it desperately needs. Taking probiotics will help restore the bacterial balance in your body and protect against many harmful conditions. Good bacteria can also help restore healthy enzyme levels in your body. Common Symptoms of Enzyme and Probiotic Depletion include: Belching - Bloating - Bowel Problems - Abdominal Cramps Fatigue After Meal - Food Allergies - Gas - Heartburn What is EnzyGuard-D™? EnzyGuard-D™ is 4Life™'s proprietary technology to stabilize enzymes and probiotics for manufacture, storage, and activation. Previously, both substances had a very short shelf life because of their delicate molecular structure. But with EnzyGuard-D™, we can help the enzymes and probiotics withstand temperature changes during manufacture and storage. This process also helps the elements work quickly once inside the body.

Supplement Facts Serving Size: One(1) Caplet Servings Per Container: 90 Digestive Enzymes & Probiotics Amount Per Serving - % Daily Value* Vitamin C (as calcium ascorbate) 60 mg 100% Proprietary Enzyme Blend 221 mg ** Amylase Invertase Glucoamylase Proteases Cellulase Peptidase FP alpha-Galactosidase Lipase Proprietary Probiotic Blend 250 million CFU ** Lactobacillus acidophilus Lactobacillus casei Bifidobacterium bifidum Bifidobacterium longum Lactobacillus plantarum Lactobacillus reuteri Proprietary Blend 150 mg ** Fructooligosaccharides (FOS) Jerusalem Artichoke *Reference Daily Intake (RDI) ** Daily Value not established

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