John C. Lowe, MA, DC, is Director of Research of the Fibromyalgia Research Foundation in Houston, Texas. He holds bachelors and masters degrees in research psychology from the University of West Florida, and a bachelor of science degree in human biology and doctorate in chiropractic from the Los Angeles College of Chiropractic. He formerly taught psychology at the Miami Dade Community College and was a faculty member in the Clinical Sciences Division of the Texas Chiropractic College. He is author of 115 papers that have appeared in journals such as Psychological Reports, the Journal of Behavior Therapy and Experimental Psychiatry, the American Journal of Pain Management, Massage Therapy Journal, Journal of the American Chiropractic Association, Medical Hypotheses, and the Journal of Myofascial Therapy. In 1977, he was awarded the Annual Scientific Paper Award by the American Chiropractic Association, and in 1992, was appointed an honorary lifetime member of the National Association of Trigger Point Myotherapists. Among his published books is the bestseller Spasm. He is board certified by the American Academy of Pain Management. Dr. Lowe is Editor-in-Chief of the Clinical Bulletin of Myofascial Therapy published by Haworth Medical Press.
Dr. Lowe began using myofascial therapy in 1980 under the tutelage of the late David Ramby, D.C. Dr. Lowe's main clinical focus was patients' hypertonic muscles, fascial adhesions, and myofascial trigger points. He used a broad spectrum therapeutic approach that included soft tissue manipulative techniques, stretch and spray, and various physical therapy modalities, especially ultrasound. After studying perpetuating factors as presented by Travell and Simons, he began tenaciously pursuing the factors that rendered some of his patients resistant to otherwise effective myofascial techniques. While studying the role of thyroid hormone deficiency in treatment resistance, he found that hypothyroid fibromyalgia patients usually recovered from their fibromyalgia symptoms when treated in one of two ways: 1) with a thyroid hormone dosage greater than the amount thought to be necessary to maintain a normal metabolic rate, and 2) with T3 rather than the typically prescribed T4. In addition, he found that many fibromyalgia patients who were not hypothyroid (those with normal thyroid hormone blood levels) also improved or recovered without overstimulation when given relatively high dosages of T3. Some patients who had recovered from their fibromyalgia symptoms through this metabolic approach established the Fibromyalgia Research Foundation. This nonprofit organization's first purpose is to enable Dr. Lowe and his multidisciplinary colleagues to conduct controlled studies to test the efficacy of, and refine his metabolic treatment for, fibromyalgia. Its second purpose is to determine the molecular pathophysiologic basis of fibromyalgia. Dr. Lowe and his research team are intensely engaged in these research activities at the present time, and results will be reported in the Clinical Bulletin of Myofascial Therapy as they unfold.
PENduke: WELCOME TO THE FIBROMYALGIA (FMS) CHAT THIS EVENING....
PENduke: DR. JOHN C. LOWE, MA, DC, IS DIRECTOR OF RESEARCH OF THE FIBROMYALGIA FOUNDATION IN HOUSTON, TX. HE HOLDS A BACHELORS AND MASTERS DEGREES IN RESEARCH PSYCHOLOGY , A BACHELOR OF SCIENCE DEGREE IN HUMAN BIOLOGY AND DOCTORATE IN CHIROPRACTIC. AMONG HIS 115 PAPERS PUBLISHED IN PRESTIGIOUS JOURNALS.....HE ALSO HAS A BEST SELLER BOOK SPASM...AND IS CURRENTLY WORKING ON A NEW BOOK....
PENduke: WELCOME TO OUR CHAT DR. LOWE...AND THANK YOU....
Thanks to all. I appreciate the chance to share our view of FMS with you.
I would like to begin my presentation by explaining the research we are doing at the Fibromyalgia Research Foundation, and why we are doing it. First, the assumption we make that guides our research decisions is this: FMS is the manifestation of impaired metabolism in various tissues of the body and brain. For convenience, we refer to this assumption as the hypometabolism hypothesis.
The prefix "hypo" indicates that metabolism is sluggish and the word "hypothesis" simply means explanation. The hypometabolism hypothesis is a scientific explanation of FMS.
I hasten to say that we do not consider this the final answer to the problem. No truly scientific explanation is ever final and certain. If the available evidence is in favor of the hypothesis, then we can say the hypothesis is more probable. If the evidence contradicts the hypothesis, we say the hypothesis is less probable.
A hypothesis is merely the best explanation at the moment, according to the evidence available for us to assess. And hypothesis are essential if an answer is ever to be found through scientific investigation.
Hypothesis give researchers direction and for this reason hypothesis must be formed, tested and rewritten based on the outcome of studies. So, I say up front, we are not certain that our hypothesis is true. But, the bulk of the available evidence indicates that we are on the right track. The clinical studies and literature analysis we and others have conducted support different features of our overall hypothesis. This support has compelled us to maintain our theoretical point of view and to proceed with further studies. After years of truth seeking and after putting our ideas about FMS to test after test, we have acquired a high level of confidence that we are heading in the right direction.
We did not have that confidence until we completed three blinded studies that confirmed that patients can completely recover from their FMS, through the treatment based on our hypothesis. I know that getting well is the major concern of virtually all FMS patients. For that reason, the efficacy studies (showing that people may completely recover with our treatment protocol) is what patients tend to pay attention to. I share this interest because of the major driving force behind my study, of fms is compassion for fms patients. But the outcome of these studies is important to me for another reason. That is the outcome supports our hypothesis that the underlying disease process in fms is impaired metabolism due to a specific faulty mechanism. That mechanism is inadequate regulation....by thyroid hormone of DNA transcription.
At this time, evidence points strongly to this mechanism. But the outcome of our treatment studies is not the only. I'll cite some of the other evidence. First, every symptom and objective finding in FMS can be explained by inadequate thyroid hormone regulation of gene transcription. There are experimental studies showing this. This month, February 1997, a paper my colleagues and I wrote will appear in MEDICAL HYPOTHESIS, the world's foremost publication on the theoretical medical science. My coauthors, Malford Cullum, PhD (biochemist), Lloyd Graf, PhD (molecular biologist) and Jackie Yellin (Director of Education of the Foundation) wrote this paper to subject our hypothesis to the scrutiny of world class scientists. I'm not referring to medical physicians who do research. I am talking about real scientists.
In this paper, we argued our case that this faulty mechanism accounts for all symptoms and objective findings in FMS. Not only did the contents of the paper pass the test, but it was accepted for publication without one single revision--a phenomenon that is truly rare in science publishing. Because of this publication, our theoretical view--rebuffed or ignored by most medical researchers--is now available to other scientists the world over.
In 1996, my colleagues and I completed the 3 double blinded treatment studies I mentioned above. Shortage of funds limited each of the studies to a small number of patients. This gave rise to astonishment by other researchers. When most treatments are tested, large numbers of patients must be included in the study. Treatment results are typically so slight that the large number is necessary to show statistically whether there was any improvement with the active treatment.
But, despite the small number of patients in our studies, statistics showed that patients treated with T3 improved dramatically compared to patients who received sugar capsules. The results from the first study were so positive that the Dept. Of Family Medicine of Baylor College of Medicine provided support to conclude the study.
In another study, we determined the thyroid status of a group of status of a group of FMS patients. We found laboratory evidence of hypothyroidism in 53%. We are currently doing a larger version of this study in collaboration with our research team in Tulsa, Oklahoma, headed by Dr. Gina Honeyman, another chiropractic physician. The preliminary data is pretty consistent with those from the previous study.
We completed another study comparing the FMS status of patients treated 1 to 5 years before with our metabolic therapy with patients who were not treated. There was no difference in the patients' fibromyalgia status before half were treated. But after 1 to 5 years later, those who were treated were significantly better off than those who received no treatment. This study shows that improvement from metabolic therapy lasted for up to 5 years. This rules out a placebo effect.
French researchers in collaboration with our research team have begun exploring T3 receptor gene on chromosome 3. They are looking for the mutation that I hypothesized may underlie some patient's fibromyalgia. One of the French researchers gave patients beta-adrenergic receptor stimulants. Seventy (70%) percent of the patients had improved exercise tolerance and reduced pain. This confirmed a prediction from our hypothesis and therefore provides supportive evidence for the hypothesis. Also in a study done several years ago, researchers found an increase in a protein called alpha2-adrenergic receptors on the platelets of FMS patients.
Although 3 researchers were not testing a prediction from our hypothesis, the finding nevertheless supports our hypothesis. At this time, ours accounts better than any other for the symptoms and objective abnormalities of FMS. As I said, this does not mean our explanation is totally absolutely correct. It is enough that it explains well so much about FMS. A good scientific explanation does not have to be the final, perfect and complete solution to a problem. It only has to point us in the right direction in our continuing search for the final answer. The accumulating evidence certainly indicates that we are not far from that answer.
PENduke: DR. LOWE, AFTER TREATMENT WITH YOUR PROTOCOL, HOW LONG TIL RECOVERY?
The time it takes for patients to respond to metabolic therapy, centered around thyroid hormone, varies. We have had some patients--rarely--who have virtually recovered within a month. Most are seeing substantial benefits within the first couple of months. I would guess that most patients who significantly improve or recover do so somewhere between 3 and 6 months.
BEmory8705: I have had numerous T3 and T4 test and they have been normal.
PENduke: AS I UNDERSTAND THIS TREATMENT, THE NORMAL THYROID PROFILE MAY NOT INDICATE WHAT DR. LOWE IS SAYING.... IS THAT CORRECT?
This is an issue that is EXTREMELY IMPORTANT, so I want to spend some time discussing it.--NORMAL THYROID FUNCTION TEST RESULTS.
TISSUE METABOLIC STATUS MAY NOT BE CORRELATED WITH THYROID HORMONE BLOOD LEVELS. AS A RESULT, MANY PEOPLE HAVE NORMAL T4 AND T3 LEVELS, YET THEY ARE SO HYPOMETABOLIC THAT THEY HAVE SERIOUS HEALTH CONSEQUENCE BECAUSE OF IT.
CRISB45: 1. What is T 3? 2. How does one test for Hypothyroidism? 3. What is metabolic therapy?
T3 is the metabolically active thyroid hormone. The other thyroid hormone, T4, is not metabolically active. T4 has to be converted in cells by an enzyme to T3 before any metabolic stimulation results from the molecule.
MJDGDC: Wasn't the BMR-FMS connection proposed 40 yrs ago?
BMR evaluations would be more useful. The problem is that in the early 1970's, endocrinologists made a deal with BC/BS (Blue Cross/Blue Shield). The deal was that insurance would pay for the new thyroid blood tests, and would no longer pay for BMRS.
MJDGDC: Then wouldn't BMR evaluation be more accurate screening?
Within short order, BMR technicians took up other jobs, and the BMR units disappeared. Today, it is difficult to find a BMR unit.
JZysman: what is bmr?
MJDGDC: JZ: basal metabolic rate
ScootRN2: I had a Thyroidectomy several years ago, However, have been on Synthroid, any connection?
Bemory8705: What is the proposed course of treatment?
Crafty1221: So what is the treatment a doctor would perscribe?
Many FMS patients, when they first come to us, are on synthroid. They have been diagnoses as having a thyroid hormone deficiency. The physician prescribes synthroid, which is T4, and adjusts the dosage so that the TSH level (a pituitary hormone that regulates thyroid gland function) stays in the middle of the normal range. The problem is that this leaves the free T3 level in the lower end of the normal range. There isn't enough T3 in the blood then to adequately stimulate metabolism.
The synthroid dosage in most cases would have to be increased so that it reduced the TSH into the lower end of the normal range, and the T4 level into the upper end of the normal range. Then, the free T3 would be close to the middle of the normal range, and metabolism would stand a better chance of being normal.
Unfortunately, however, most physicians have been misled by the conventional thinking of endocrinologists. They trust the opinion of these specialists. This is unfortunate because the endocrinologists are in error. By the way, I shoul not include all endocriniologists in this statement, because some of them have tried without success to explain to the others exactly what I have just said about blood tests and the free T3.
Bemory8705: FMS Symptoms are so Vast and vary from all parts of the body. How can this be thyroid?
WE do more advanced blood tests, we "reason" that the patients have a thyroid hormone deficiency. So interpreting the tests is tricky in many cases, and after all the so-called advances in thyroid function testing, I must conclude that it is a moderately crude and insensitive technology.
CRIS45: I am going to doctor.. What kind of test do I ask for to test for hypthyroidism??? please???
The first thing I would suggest is that patients get expertly interpreted thyroid function test results. That's a problem, unless the patients consults one of our team researchers. I'm not taking patients for an indefinite period of time. I would recommend Dr. Gina Honeyman in Tulsa, Okla. Her phone number is 918-749-3663.
MORONI525: Please state what serious health consequences were you speaking about Dr. Lowe
Someone asked about the other health effects of hypometabolism. There are many. Excess blood during the menstrual period. Others include excess cold, depression, poor memory and concentration, chronic fatigue, and stiffness. These, of course, are symptoms of FMS also.
There are many adverse health consequences for hypometabolism. One is atherosclerosis. Many people with elevated blood fats are simply hypothyroid, but no one has diagnosed the condition. Thyroid function testing is disappointing to me. Dr. Broda Barnes argued long ago that the testing was unreliable. That was before many of the more sensitive tests were developed.
CRISB45: K....What tests are you recommending and meds to take???
I have spent years studying these tests and using them to classify FMS patients according to thyroid status. It is important to do this, because we need to show rheumatology researchers that there is in fact a high incidence of hypothyroidism in FMS. But in interpreting the tests requires far more subtle analysis than most physicians do many times, a patient's test results appear normal, but questionable after.
GCKM: Can you reccomend anyone in Chicago?
The best doc in Chicago is David Flemming, M.D. He is a Pain Management Physician who works with a psychologist. They use hypnosis a lot, but they do not contend that fibromyalgia is an emotionally caused problem. Dr. Flemming uses T3 and T4 with some patients, according to our protocol. If the Dr. Reichlin several people have mentioned is the one who published a book a few years ago on trigger point treatment, I have the book. An endocrinologist named Lawrence Sonkin wrote a chapter in the book on hypometabolism. Dr. Sonkin is one of the rare endocrinologists who have come close to our line of thinking. I regret that Dr. Sonkin did not pursue this more. I know he is elderly, and I would love to have him working in conjunction with our team.
MJDGDC: Some of us did continue Sonkin and Rachlin (Rachlin also did MBR work)'s work...
PENduke: DR. LOWE....WILL YOUR TREATMENT WORK IF ONE DOES NOT HAVE A THYROID ANY LONGER?
Not having a thyroid gland does not make any difference. The problem I have seen most often is that these patients are undermedicated--that is, they are taking too little thyroid hormone orally. We've had many, many of these patients who had FMS as their pattern or response to slow metabolism. All we do is increase their dosage usually. Of course, we require them to do the other lifestyle things that allow them to benefit from their improved metabolis, such as exercising and taking nutritional supplements.
Kstrick247: DR> LOwe...are FMS and RA related?
I don't believe Rheumatoid arthritis and FMS are related. I know of one study showing some overlap, but I have no reason to think they are related.
SJohnson61: Dr Lowe, what about SERATONIN???
Someone asked about serotonin. Serotonin secretion is controlled by thyroid hormone. It is indirect control, but control nonetheless. Hypothyroid animals and people have reduced serotonin levels. Incidentally, they also have all the other objective findings of FMS--Low growth hormone, low somatomedin C, high substance P, low CNS norepinephrine, low corticotropin releasing hormone, blunted ACTH and low cortisol.
Essence5: Dr., Lowe, or anyone, please inform us of where you practice, what you've published.
I am in Houston, but, as I said, I'm not taking patients for an indefinite time. I have worked carefully with Dr. Gina Honeyman in Tulsa so that she uses our protocol expertly. I recommend patients consult her.
PENduke: DR. LOWE.....IS YOUR ARTICLE FROM FEB. AVAILABLE YOU CAN SEND TO ME?
The first two of our blinded studies are coming out in the Clinical Bulletin of Myofascial Therapy. This is a peer reviewed indexed research journal. It is published by Haworth Medical Press in Binghamton, New York. This is the publication that will publish most of the studies on the metabolic basis of FMS in the future. It is the competitor of the Journal of the Musculoskeletal Pain, The Rheumatologists FMS Journal. You can contact the Bulletin by calling 1-800-HAWORTH. Subscriptions are $36.00 per year.
MJDGDC: Do you also advocate aerobic conditioning for FMS patients?
We insist that our patients engage in both aerobic and resistance exercises WHEN their Metabolism accelerates sufficiently to enable them to do so. We don't push them to do it immediately because if they do so too early, their symptoms may worsen. But they must exercise as soon as their metabolism increases enough. Thyroid hormone only gives most patients the capacity to engage in exercises. If they don't exercise, they never obtain optimal metabolism, and they don't completely recover from FMS.
We just completed a 1-5 year follow up study that showed that patients who underwent metabolic therapy maintained their improved or recovered status through that period. This eliminates the likelihoood that their improvement was due to a placebo or that it was merely a remission that would have occurred without the treatment.
The best way to try and get a physician in your area to use our treatment protocol is to obtain copies of our studies.
PENduke: I WOULD LIKE TO ALSO WELCOME ANOTHER CHIROPRACTOR HERE TONIGHT. DR. JONATHAN GARZILLO (MJDGDC) OF PHILADELPHIA IS HERE WITH US AND HAS BEEN PARTICIPATING IN THIS DISCUSSION...WELCOME DR. GARZILLO.
Essence5: Please tell how to obtain copies of your protocol
Most of the studies will appear in the Clinical Bulletin of Myofascial Therapy. Subscriptions are only from Haworth Medical Press and subscription is $36/yr. The E-MAIL address for HAWORTH MEDICAL PRESS is GETINFO@HAWORTH.COM
TLEngland: Dr. Lowe - can FMS complicate artery flow to the brain (in the vertibral artery)?
Thyroid hormone can increase brain blood flow. This happens because thyroid hormone regulates a type of protein receptor called the alpha-adrenergicreceptor. When there is too little thyroid hormone, these receptors increase all through the body.
They constrict blood vessels, and this reduces blood flow throughout the brain. When the thyroid deficiency is relieved, the alpha receptor count decreases, and blood vessels dilate, increasing blood flow. Incidentally, this is why the skin of the hands and feet get warmer in people who take thyroid medication.
Fibrofog, which is cognitive dysfunction, relieve when patients use thyroid hormone. Poor memory and concentration are very common in hypothyroidism, and clears up with treatment. We showed that patient's cognitive function improves in our blinded studies.
AnnMarieII: SHOULD I SEE A NEUROLOGIST FOR MIGRAINES OR IS IT FMS STUFF
FMS patients need to be careful about neurologists. There are many rational ones out there. I taught classes arround the country with one who understood FMS. Many many are still believing that Sigmund Freud--who was a neurologist--was right when he attributed any condition without a known cause to repressed emotions that were forcing themselves out of the deep recesses of the psychy through physical symptoms. Great care should be taken with these guys until they clean up their cognitive and intellectual act. >WE do not have a list at the moment of doctors. We have a few doctors who are using our protocol around the country, but we can't testify to their doing it correctly. There is an internist in North Carolina named Bob Starkenberg. Dr. David Flemming in Chicago is using it. And DR. Gina Honeyman (PHONE NUMBER IS 1-918-749-3663). in Tulsa, Okla. Does an excellent job. I can testify to her high level of competence in using our protocol.
Bhas: Dr Lowe how is the lack of rem sleep effected by the throid?
It is non REM sleep that is most involved in FMS. The sleep abnormality that has been documented in FMS is exactly the same as that in hypothyroidism. WE don't have studies showing that the pattern is corrected in our treated patients, but it certainly is corrected in treated hypothyroid patients.
Somebody asked awhile back about the books that will be published soon....One is titled THE METABOLIC TREATMENT OF FIBROMYALGIA. The other is for the general public and patients and is titled SPEEDING UP TO NORMAL--METABOLIC SOLUTIONS TO FIBROMYALGIA.
If anyone wants information on them, he or she should send a card to MCDOWELL PUBLISHING COMPANY, P.O. BOX 980005, HOUSTON, TX 77098. Include your address, and when the books are ready, the company will let you know. The books are not even completed. It may take the next four or five months to complete the books.
KStrick247: DR. Lowe what is your belief of relation between MS and FMS..any connection?
I don't believe FMS is related to MS. I have seen a few MS patients who were amazingly hypometabolic, but unfortunately, we weren't able to treat them. They came under the influence of neurologists who convinced them to take corticosteroids. These tend to make FMS worse. But, I don't know the ultimate outcome of these cases.
Abrad94101: Dr. Lowe - can you tell us about the nutritional and exercise parts of your protocol?
We have found that patients who recover but stop taking B vitamins, become fibromyalic again. WE are certain that this happens because thyroid hormone accelerates carbohydrate metabolism and causes more B vitamins to be expended in the process. I firmly do not believe that most people can get enough B vitamins from today's food to sustain health. This is especially true of people driving their metabolism with thyroid hormone. I can't overemphasize this point. People who have beriberi (due to Vit. B1 deficiency) because they develop a cardiomyopathy. The heart becomes so damaged that the people die. We're very concerned about cardiac health in our patients and push them to take all the necessary nutrients (including anti-oxidants) and to exercise to increase the thickness and strength of the muscle and connective tissues of the heart.
Kstrick247: Dr. Lowe..is FMS and MPS same? or related or how do they relate?
Yes, a lot of FMS patients do have MYOFASCIAL PAIN SYNDROME. I just read a paper reporting that between 30% and 90% of all patients with widespread pain also have trigger points.
In my practice, I have certainly seen a high incidence of trigger points in multiple muscle. In my FMS patients, the trigger points don't respond nearly as well to treatment as do patients without FMS.
MJDGDC: FMS AND MPS DIFFERENT, BUT OFTEN HAPPEN AT SAME TIME
Kcarter952: Myofascial pain is caused by a covering over the muscles called fascia tightening up causing tight bands of muscles that bunch up and cause knots and hard spots
MJDGDC: One big difference between FMS and MPS is that FMS affects the whole body, and MPS can be localized. The disorders are very different, but often
COCHAZZ: What to do if allergic to Vit. C?
It is impossible to be allergic to Vit. C. That is incompatible with life. Most likely, you are allergic to some of the filler that the Vit. C is packed in. I would suggest that you try other brands, or order pure ascorbic acid crystals from Bronson Pharmaceuticals.
Dr. Lowe: Your studies show thyroid and nutritional supps reverse FM, correct?
We have had many, many patients who were health fanatics (if there can be such a person), who took every imaginable nutrient and exercised regularly, too, but still had FMS. When we add thyroid hormone and a few other things, some of them significantly improve or recover. Thyroid hormone without the nutritional supplements and exercise doesn't do a particularly great job. They are all essential for optimal effects.
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