The Metabolic Treatment of Fibromyalgia. - Review - book review

Alternative Medicine Review, June, 2001 by Alan L. Miller

The Metabolic Treatment of Fibromyalgia By John C. Lowe McDowell Publishing Company Boulder, CO http://www.mcdowellpublishing.com ISBN 0-914609-02-5 Hard Cover; 1,260 pgs. $99.95

The Metabolic Treatment of Fibromyalgia is a textbook-sized book written for practitioners who are in need of a comprehensive text that provides an in-depth look at the diagnosis and "metabolic" treatment of fibromyalgia. As anyone who has treated fibromyalgia patients knows, this is a challenging task. Dr. Lowe's clinical experience and research provide the basis for this book, in which he breaks new ground in the treatment of fibromyalgia. His is a different paradigm than the rheumatological treatment of the past 25-30 years in that he promotes the theory that inadequate thyroid hormone production, and/or inadequate thyroid hormone regulation in the tissues, is the root cause of fibromyalgia.

He states his case by first laying out his belief that fibromyalgia is not a somatoform disorder, and should not be treated as such; i.e., treatment based on the use of antidepressants. He then delves into thyroid physiology and the effect of thyroid hormones on peripheral tissues, thyroid-stimulating hormone, and thyrotropin-releasing hormone. A very in-depth discussion of molecular actions of thyroid hormones on the cells follows, along with a detailed description of cellular effects of thyroid hormone deficiency. Lowe's basic premise here is that the common symptoms of fibromyalgia (slow-wave sleep abnormalities, irritable bowel syndrome, decreased HPA axis function, increased pain perception, depression, cognitive dysfunction, exercise intolerance, orthostatic hypotension, fatigue, anxiety, and others) are in fact symptoms of inadequate tissue levels of T3.

Chapter 5.1 outlines conventional and other treatments of fibromyalgia and research studies relevant to the efficacy of each type of therapy. In Chapter 5.2, the author provides a protocol he states he and his colleagues have utilized successfully in fibromyalgia treatment. This treatment begins with an assessment of thyroid status. A trial of T4, T3, or desiccated thyroid is then performed, with the objective that fibromyalgia symptoms will improve. The reader/practitioner is asked to objectively chart all symptoms and objective assessments using fibromyalgia assessment forms and line graphs (provided in the book for copying). Doses are adjusted according to symptomatic change and objective measurements.

A detailed examination of different thyroid preparations follows, as well as rationale for choosing a particular type for an individual patient. Nutritional supplementation is also advised, and these guidelines are provided.

Published papers by Dr. Lowe and colleagues are included in full-text form, so readers can judge for themselves the validity of his research.

This book provides a well-researched, effective case for the use of thyroid hormone in the treatment of fibromyalgia. Although a daunting read, the book is full of information vital to any clinician treating patients suffering from this challenging malady.