Understanding The Genomics Of Fibromyalgia | El Paso, TX (2021)

Introduction

In today’s podcast, Dr. Alex Jimenez, Senior Health Coach Kenna Lee Vaughn, and Master Nutritionist Ana Paola Rodriguez Arciniega discuss what nutritional options are available for individuals who are suffering from fibromyalgia.

The Nutritional Options For Combating Fibromyalgia

[00:00:00] Dr. Alex Jimenez DC*: We have a presentation where our goal is to discuss the issues of what we have in the office now. The main topic we’re going to be discussing is fibromyalgia. We’re going to be talking about migraines. We’re going to be talking about the effects of what happens to an individual. Now I typically get patients who come into my office with many discomforts. I deal with chronic pain management. I deal with acute injuries. Our goal is to understand the basics of beginning the treatment protocols for individuals with chronic pain. Chronic pain is not a disorder of issues. It’s issues of not being appropriately treated. It’s a perpetual disorder that continues, and it just kind of lives on. We have to get to the basics of chronic inflammation; we have inflammation science. We have the science of understanding. We have laboratory assessments of all sorts. And what we’re going to do today is we’re going to present the issues now. A patient typically comes in and discusses, “Doctor, my body hurts. Everything hurts from my hair to my back. I’m depressed, socially disconnected. I’m having issues with my husband.” Typically it’s more often with fibromyalgia, more women than men. Statistically, that stance as well. So as I have these present, but by no means does it not affect men, and it would; it does brutally affect them. So as we deal with fibromyalgia, we have to look at the concurrent issues of what we’re going to be discussing today: the issues of fibromyalgia, even migraine issues, because not everybody has migraines has fibromyalgia. But many people who have fibromyalgia have, you know, disorders of what we call pain. And in essence, the presentations of the issues caused discomfort in individuals. So as you can see, here we are at a different type of presentation today. We’re presenting from our office. And what we want to do is to discuss those particular issues that affect each and individual one of you that have fibromyalgia now. In terms of this, we have a panel here, and our panel will ultimately discuss those issues, so let’s go ahead and present Kenna Lee Vaughn.

[00:02:59] Kenna Vaughn: Yes. Hi, I’m Kenna, and I am the office’s senior health coach. And with fibromyalgia, I’m going to be talking about genetics and laboratory work. Some supplements as well as body composition today.

[00:03:13] Dr. Alex Jimenez DC*: Excellent. And we also have our master nutritionist, Ana Paola Rodriguez Arciniega, who comes, and we’re all online at this point, and she’s going to be discussing specific issues. So Ana, why don’t you go ahead and introduce yourself there?

[00:03:27] Ana Paola: Hello, my name is Ana Paola Rodriguez Arciniega; I’m a nutritionist, and I will talk about the dietary interventions that can help people with fibromyalgia and how can it provide a better understanding and a better treatment for their nutritional issues that come with the diagnoses or with the syndrome or with the condition.

[00:03:54] Dr. Alex Jimenez DC*: You know, as we discuss those particular issues, what I like to do is I want to present the dynamics of the stories of what we have. So when I have the patients present to us, they draw patient diagrams. When I have fibromyalgia patients, not only do we have psychological issues or depressive issues as undertones, but we have pain all over the body. Clinically diagnosed, you know, fibromyalgia has been so easily diagnosed or diagnosable by the new standards and the chronic pain management institutes throughout the United States. That only five points and pretty much pain in certain areas, and pretty much you can be classified as fibromyalgia. The typical treatment is through treatment protocol, such as if you have pain, well, analgesics of some sort, whether powerful, you know, all the way to corticosteroids, as well as some anti-inflammatories. So analgesic anti-inflammatories. Now, if the individual has issues that start affecting, you know, anxiety issues, stress issues? For many common types, an SSRI is like a Prozac or the derivatives of that to alleviate the symptoms, to work with it. So again, we’re not treating the actual issues. We’re going to go here, we’re going to start opening the conversation to discuss the dynamics from that we’ve learned, and that science presents that we have been able to pinpoint inflammation at the level of the brain, inflammation at the level of the gut, inflammation of the brain and the spine. When we say inflammation of the brain, we need to understand that the brain is composed of an area inside, obviously the brain cavern. But as it extends down beyond the frame of Magnum, it’s called the spinal cord, but it’s still the brain connection. So it affects even the spinal cord area through disorders called central sensitization. We’re going to discuss those here, and we’re going to figure out some simple ways to treat them, along with some nutritional protocols that we can come up with. So what I like to start today with Kenna giving us a little bit of background as to what these individuals are suffering and what is the definition today based on what fibromyalgia is known for? OK, so go ahead, Kenna, and tell us a bit of the story of that now as she develops this presentation; we’re going to go back and forth and try to, you know, make it make sense now. I want to add that what we want to do is we want to give you take home, you know, nuggets, so to speak, to be able to make this better. But we’re going to go deep into the DNA and genomics because we have to understand who is susceptible to fibromyalgia. And for that, Kena is going to do some explaining right now.

The Genomic Factor

[00:06:42] Kenna Vaughn: So the first part we want to talk about is, of course, genetics. We are constantly finding out more about our genes and how they can be influenced by environmental factors and the foods that we’re eating. So the first genes that I want to look at are the ones you can see up on the screen. And I also put the study down below. Suppose anybody wants to go further in and look at it. In that case, it’s a super great study. I highly recommend it to see that genetic factors are possibly responsible for up to 50 percent of disease susceptibility, which is a massive amount if you think about it. So I’m going to break down each of these genes just a little bit. And so that first one we see is an SLC six-four A four, which is for an encoded protein with a transmembrane protein of that inner mitochondria. And the mitochondria are often referred to as the cell’s powerhouse. So mitochondria are super important in our body, and it’s required for homeostasis. And just like many other SLC genes, it has also been linked to other inflammatory diseases, such as rheumatoid arthritis. Most people who come in with fibromyalgia aren’t just suffering from fibromyalgia, as Dr. Jimenez said earlier; they’re also suffering from other things linked to inflammatory processes like migraines. And there’s just there’s a lot more too. The second gene we look at is TRP v2 encodes for an active ion channel activated by high temperatures above fifty-two degrees Celsius. The protein involved in this one is responsible for our sensory ganglia. So that one, as well as other tissues.

[00:08:40] Dr. Alex Jimenez DC*: So you know, sensory ganglia, it’s where we perceive. But it is an area where all the nerve synapses come together to snap at a certain point. So they all get together, and the area is typically called a ganglion. In that region, the synaptic cleft of those nerves is very important. It also adds to understanding a bit of fibromyalgia, specifically central sensitization, which we’ll discuss in a few moments. Go ahead.

[00:09:05] Kenna Vaughn: Yes, thank you, Dr. Jimenez. The following gene is that NYT-1L. And this is a member of the zinc superfamily, and it is responsible for expression and neural tissues. So this has a lot to do with fibromyalgia, as you said earlier and how it comes into play with the brain and the central nervous system. And with this gene in combination with other transcription factors, it can convert fibroblasts and neuronal cells. So this gene is super essential to look at when considering fibromyalgia with our patients. And the last one we’re going to take a look at today is the NRX-three. And this one also encodes for the nervous system and adhesion molecules. And this one is a promoter of the transcript variants and protein isoforms for the gene, and the full-length nature of these variants has not yet been determined, but we can link it back, as I said to that the nervous system.

[00:10:15] Dr. Alex Jimenez DC*: I’d like to present the fact that, look, you’re not going crazy. People may believe that after they suffer fibromyalgia, that people don’t understand them. They look at them like there’s no way you can suffer this way. However, today with nutrigenomics, nutrigenetics, and DNA assessing, we can find out if we have single nucleotide polymorphisms, which is a simple word of SNPs that are out there that make you susceptible to this. So Kenna is very well-versed in understanding and interpreting these particular DNA says we run these labs through DNA life or three-X genes different companies for specific genetic coding to understand what nutritional supplementation is or what can we do to adapt now? We want you to understand that we need to understand the depth of knowledge that genomic expression can change. Now the genes are to give you a practical sense. We all have genes, a pair from our parents, and our team equal mom and dad, and it goes on from lineage, from our ancestors. But these presentations do not have to be activated all the time. So I call it the essence of the gene is the gun and your lifestyle changes and what you eat, what you do is the trigger that fires these genes. So when we look at these, we here have a philosophy from the genes to the kitchen kind of neat nomenclature or a little bit of a descriptive word that we understand what kind of things we can do nutritionally, that we can change the genes because we’re not going to go in and change and edit the genes, obviously. However, what we were going to do is we’re going to do nutritionally what can make the genes work in a better way. And I don’t want to get into the dogma of saying that we eat a certain way, take a certain drug, and change our genetic expression. That’s not what we want to do, but we want to understand that we can assist our body in its dynamics with its environment. So I hope that makes sense because we got to bring this thing into the understanding that it is a very new world, but we are learning enormous amounts of information daily. As this information comes in, we’re going to be able to assess what your predispositions are. And if you do have these predispositions, we need to work with your lifestyle and change your food and nutrition. When it comes down to it, nutrition is everything. Even in bodybuilding, all bodybuilders know that you can look all pretty, but you’re still going to be bony without the proper nutrition. So we have to understand that nutritional components are very crucial to understanding. So now, the world opens up into the chasm of understanding how the chromosomes work in a much more dynamic way. And again, it’s evolving quickly across the globe, and we’re where we’re able to run these tests. So let me ask you this, Kenna, regarding the testing you mainly do. Tell me a bit about what kind of tests you like running, what companies you use, or what kind of dynamic patterns you look for specifically for those particular, assessing an individual’s predisposition to, let’s say, fibromyalgia undertones?

[00:13:33] Kenna Vaughn: So we use a ton of different labs. We work with so many of the very best, and I’ve just put together a little snippet so we can see these first here. The first one here, we are talking about, is DNA life. They have an entire collection of DNA testing that we can run. The more we run, the more we understand what we’re dealing with on the inside of the body and how we can help express those genes positively rather than trying, letting them express in a way that we don’t want them to. So just kind of lets us see what they are predisposed to like you were saying. Those tests that they have include DNA health, the DNA mind. Those two are super huge DNA diets. This one also comes into play when we’re trying to figure out with our nutritional list what foods will be great for them in that kitchen to impact their genes the most. They also offer DNA, skin, estrogen, smile, and grow babies. Another one that I love to run on the patients is from fiber wellness, and it is the neural zoomer plus. And this test has genetic testing that comes down to show their risks for specific neurological conditions. And so, when we’re dealing with fibromyalgia, we also want to take a look, as we were saying, at that brain and the inflammation and everything that goes into it. The other one that I would like to pair with the other two tests is Fiber America, and it’s a connective tissue panel. This one is a panel of 48 well-studied neurological antibodies, and it’s able to help us create a treatment protocol that pinpoints the mechanisms behind that disease and the progression and provides us with a good roadmap and solutions. That way, we’re not just shooting in the dark. We have so much more information to compile and a more detailed history, and we can look for those associated markers.

[00:15:36] Dr. Alex Jimenez DC*: One of the things that I had mentioned there earlier was that not only can we assess the predispositions of the genomic presentation, but we can also see what type of diets are more favorable to your genomic expression. You know, the genotype is looking at the genes, and the phenotype of the gene is how it expresses. So our phenotypic expression is wildly different in individuals. You would assume that in the genetic composition of two identical twins, you would have the same genetic coding through that, and you do. However, you can see that an individual who is brought up differently in a different environment and you take two twins that and you separate them from, let’s say, at birth, you’ll see that by the time they hit 70, they may not look like each other. So environment plays a vital role in dynamic changes. So we do have the ability to change the expression based on environmental and nutritional components. So I know, Kenna, you got some nutritional presentation there that I want to go ahead and show? Let’s talk about how we can start giving people a little bit of understanding of how this affects fibromyalgia, precisely the types of supplements and cells because these aren’t all the exact ones. Still, we review a lot of different subsets of supplements. So tell us a bit of that.

The Nutritional Factor

[00:17:04] Kenna Vaughn: Yes, of course, the supplements you will be taking depend on your lab work and your DNA. They’re all personalized to you. This is just kind of an overview snapshot of the supplements that have been shown to help fibromyalgia patients. It is from Dr. Alex Vasquez. He is incredible, brilliant, and talented. And so he works with this company called Bionics, with who we also work within our clinic. And so these are just kind of the basic ones that he recommends to start. We have a promo type plus, which will be just a multivitamin. It’s going to give us our vitamin A, our vitamin C, D, E, K, B’s, biotin, and N-Acetyl-L- Cysteine. It’s going to pack a punch in that small pill that we’re going to be getting every single day to help our systems work better. The next one that you see is called promo type plus. This one is a mineral supplement, and it provides the body with antioxidant activity and micronutrients that are effective and stable while also providing phytonutrients support. And what that does is it helps us absorb everything that we’re taking in that way nothing is going to waste, and our cells, we’re feeding them. We’re giving them everything they need to function. The next one you see there is bioD-motion, which is vitamin D3. It is 400 IU’s per drop. And it just also helps aid in the uptake of everything and is essential for that musculoskeletal health and cardiovascular health. And the next one right there we see is that B12. This one has more B vitamins that B5 B6s B12 and contains a high level of folate used in many chemical systems throughout the body. The next one that we have is the optimal E-phase. These will be a balance of our omega, so we’re going to get that omega-three, that omega six and nine, all the fatty acids that we need from the highest quality fish and flaxseed, as well as other oils. And each capsule provides optimal ratios of ALA, EPA, DHEA, and it helps find those imbalances because many of us don’t have enough healthy fats in our system. So it helps us complete that circle that our body needs. And then the last one that we have right there is ADP, and this one delivers just standardized oil of oregano, and it helps us with our digestive tract where it functions the best, and it helps us in those intestinal organs.

[00:19:50] Dr. Alex Jimenez DC*: Keep that up there Kenna, I want to go ahead and elaborate a little bit about those? We notice that when we supply or have the right amount of nutrients or experience deficiencies in certain areas, the body starts not functioning correctly. These particular products that we have here not to point towards these particularly, but these types of products. Once we understand the human genomic expression, we run labs to see what’s happening with complex labs that tell us what we could not find out today. Let’s say I’d say five years ago when we run these assessments; we determine what kind of mineral imbalances, what kind of supplements you have deficiencies, and what kind of fatty acids you have. We ultimately have learned a lot about supplements such as vitamin D and its implications for inflammation. It is beyond the scope of this presentation to go on there, but I can tell you that the studies are powerful, and they’re coming in every day. You may have noticed that even vitamin D has shown with COVID presentations. So the vitamin B complex, the effect is that we focus on areas in fibromyalgia that affect the neurological implications and the impact on the mitochondria; we end up looking at the mitochondria as a source of any time we have energy issues. So CoQ10, a product we can never go wrong by giving CoQ10 specifically for metabolic issues pertaining to the mitochondria. So, we learn about these things as we go. We understand the, you know, essential fatty acids. How are we using those particular fat products or fat-producing energy-producing products or essential fatty acids makes the difference. So ATP has always been a product that is well known for its effect on the mitochondria and areas of dysbiosis. I didn’t touch much on dysbiosis, but we must understand that many people with fibromyalgia have intestinal. Not all, but they have many suffer from intestinal dysbiosis. We understand intestinal dysbiosis that goes awry and has gram-negative bugs. We have liberal protein-like bases formed or exit dates or products from these bacteria that somehow leak into the system that causes inflammation. So our whole basis of this entire process is to stop inflammation and get our mitochondria to function better. So many studies on this, and we’re going to elaborate as we go. So what I like to do is pause on that subject matter and now discuss a little bit with Ana Paola, our nutritionist who evaluates those things. So Ana, go ahead and see if you can log in and get your camera ready, and when you’re posting ready and your video presentation. So then I can start presenting that because we have to understand Ana brings things home in terms of its logic and how to make it simple to understand how dietary changes affect a person with fibromyalgia. The person has come in with extreme pain, depression, sadness, irritability, and many things that happen due to discomfort or chronic pain syndromes. But they have sickness syndrome, so they’re depressed or sad. They don’t want to go anywhere. They’re in pain. So we need to say, OK, well, maybe we don’t understand the genetic genome, but what can we do in terms of dietary changes that will ultimately adapt and fix these musculoskeletal presenting disorders? So take it away, Mrs. Ana Paola.

The Diets To Combat Inflammation

[00:23:32] Ana Paola: Hello. One thing that I’ve noticed about fibromyalgia patients is that they always come to our nutritionist as the last part of the treatment. Maybe that should be done because they are very interested in the beginning. They’re very interested in losing all of their pain and symptoms that it’s like the most important thing for them. But once they start getting into their heads and being aware of everything that is going on with them, they start like getting into that, OK, I’m feeling bad. I am feeling really bad, so I must take care of it. So that’s something that I’ve always seen in these patients. They are concerned about the pain and start noticing another kind of issue. So, after all, this condition is multifaceted, and he has a lot of factors. So one of the principal factors in which I can participate is that we have to put food first. So, yes, supplementation is an essential part of treating fibromyalgia. But ultimately, the things that you do in your kitchen are the ones that are going to produce and maintain this and provide the habits you need to keep those symptoms at bay. So the first thing that you have to do that I recommend is that you take nutrition as the first line or the first strategy to deal with those symptoms. And another thing maybe this is one of the things that we are going to be doing in the back part of your treatment is that we want nutritional treatment, has to deal with the low-grade inflammation that is going on in the body. That is one of the main factors of fibromyalgia. There’s a lot of inflammation, and we have to live with that. Another thing is that the pro-oxidative status needs to be lower as well. And this is like the thing that we have to use supplementation for this because sometimes, while you’re trying to be a nutritionist and then keep the wellness, most people think that nutritionists are here to lose some weight or something. And yes, that’s one of our main focuses.

[00:26:16] Dr. Alex Jimenez DC*: Ana, just to kind of jump in there a little bit when you mentioned something about oxidative load. What we’re trying to do is we’re trying to lower the overall oxidative burden on the individual, and that’s what you’re discussing. Maybe the reactive oxygen species there, the level in the body is a too high oxidative state. So our goal through dietary changes is to change and influence that. And that’s is that what you’re mentioning?

[00:26:42] Ana Paola: Yes. Eventually, and while you’re trying to treat that progressive stage, you need to lower that inflammatory state so that this can be treated in the same way with the same nutritional aspect. So right now, the first thing that I need to add is that dietary approaches are mainly focused on lowering this kind of overlapping symptoms that come with fibromyalgia. And that’s why there are so varied. And there is a lot of studies that show that nutrition can help, but there are not enough like sufficient and very well done studies in this. So this is like the first thing that I like to say that one of the main dietary approaches used in fibromyalgia is the low FODMAP diet. I don’t know if you ever heard of that, Dr. Jimenez. Absolutely, yes. OK. Like the first one, which is a very important dietary approach. Another one is the gluten-free diet, hypercaloric diet, the vegetarian diet. And, of course, a lot of nutritional components like extra virgin olive oil, omega three fatty acids, curcumin, or turmeric. But one thing that I would like to focus on here is that, as you see in the outcome measures, there are a lot of questionnaires right there, and that has to do with the fact that most people with fibromyalgia come with a deficient quality of life. They want to go out, they want to eat, they want to have fun, they want to move, but they can’t. So obviously, the emotional part, the subjective part of this condition, is crucial, which plays a main role in the dietary approach is so most of the results.

[00:29:07] Dr. Alex Jimenez DC*: Can I interject there? Let me ask you this. In terms of when you individually look at these individuals, tell me what you see in their life qualities in terms of how it’s affected them. Because I think that if the more people who understand this, more couples who understand that their spouses are going through this, or maybe both are going through this, we can kind of open the conversation as to the approaches nutritionally that we can make. What do you see these individuals kind of show in their lives? Tell me a bit about how you discovered how they feel?

[00:29:49] Ana Paola: The first thing I see is maybe a little bit overweight, but they can focus a little more on bloating. I think that is like the first thing they come to see me for is that I am bloated, my face hurts. Everything hurts. So the bloating, I think that’s like the main thing. And that’s why I tend to go a little more with the low-fat diet that is like the primary approach I use. And yeah, something in their quality of life affects them. Just like the fact that you’re bloated after, I don’t know, your three o’clock meal and you can go out afterward, that annoys them. So I think that is the main thing that I can see. But many of those studies have focused on the fact that they are not happy with their body composition. They just don’t want to feel happy with that. And that is linked to the depression factor of this condition.

[00:31:04] Dr. Alex Jimenez DC*: Well, one of the things is because you’ve mentioned that a couple of times in terms of the bodyweight dynamics, I’m going to ask Kenna if she can talk a little bit about how we assess because you’re correct, as we look at these individuals, we see that they look bloated. So we know now that there’s what we call an anthropometric, measurable change in their body. So when it comes to anthropometric what we look at, and we’ll wait for her to queue up, we see that there are issues that affect the individual. So when we look at those particular dynamics, we want to look and see how anthropometric measures are done within the office now because we now have technology that wasn’t available, let’s say, ten years ago, we can see the type of inflammation, the type of swelling, the type of muscle mass. Inflammatory markers can be assessed through anthropometric measures. So right off the bat, we are in a much better layer of understanding in present modern technology of what goes. Kenna, tell me what you do in assessing that inflammation that Ana is speaking about?

[00:32:11] Kenna Vaughn: Yes, we have seen that strength training can improve some aspects of inflammation, fibromyalgia, and muscle. This is a super great study if you want to find it later.

[00:32:30] Dr. Alex Jimenez DC*: No worries, we are used to this; we have children.

[00:32:36] Kenna Vaughn: The InBody machine has the 770 models at our location. And what this does is allow us to measure the water inside the body.

[00:32:46] Dr. Alex Jimenez DC*: Let me put you on mute there, and I’ll go ahead and help you out there because I see your stress, and let me go ahead and leave that camera screen there. Put yourself on mute. We offer the ability to look at the body, and then what we can do is focus on the Inbody. We can assess that. Can you zone in on the first page of the Inbody report there? Kenna, go ahead. Yes, right there. We see the ability to determine how much muscle mass, weight, and inflammatory dynamics are going on in the body. It seems kind of complex if we go over this. Can you take me to the second page, where we show our initial report along with the anthropometric measurements of body mass? But we also look at the weight of water and how much water the body has. Now, one of the things that we’re very keen to look at is visceral fat, and visceral fat tends to produce its hormones and cause a different array of changes within the body, so that inflammatory state causes haywire with hormones. It disrupts estrogen. It disrupts insulin. It causes us to be insulin resistant. All these things make us feel bloated of which Ana was discussing. So Ana, why don’t you go ahead and queue yourself up for the conversation here? I want to talk about precisely how you look at that inflammatory dynamics and those changes. So if you can get yourself on the screen there, I can go ahead and show exactly what’s going on now; from my practical point of view, we have to put a team together when we have these inflammatory dynamics. We have to figure out not only what your predispositions are, what your labs are, what your bloodwork does, but we also have to kind of come up with a team approach because it does not bode well when one particular type of doctor tries to handle this multifaceted multi-organ system dynamics that’s called fibromyalgia. It affects many things, from the brain to the gut to the synapses, to deal with abnormal pain sensations. This is really crazy, but the disorder causes so much pain that it touches turns into sharp pain burning. So it does adapt. So we if we can get to the dye component and understand through anthropometric measurements that you do have these issues well, we can start guiding you better and formulating a diet plan that is most effective for you. So Ana, go ahead and tell us a little bit about what’s going on there.

The Anti-Inflammatory Diet

[00:35:16] Ana Paola: Well, that’s true, and that is something that has a lot to do with dropping some weight and intervening with this anti-inflammatory diet. So one of the things that the anti-inflammatory diet has brought to fibromyalgia studies is that it can lower the patients’ weight. And with that, we are particularly thinking about reducing the amount of fat your body has, particularly in the visceral area at the visceral fat. That’s precisely what is going to affect, bringing benefits to this treatment. And the main reason why is because adipose tissue can relieve pro-inflammatory cytokines. And that’s precisely what you want to do with an anti-inflammatory diet to reduce that kind of pro-inflammatory milieu that is going on with people that have a high percentage of body fat.

[00:36:27] Dr. Alex Jimenez DC*: You mention that Ana, and as you do that, we understand that the world of inflammation, specifically when it comes down to the dynamics of cytokines, that’s a word that’s made its name in the public cytokine storm, specifically the COVID people that have a high BMI, they are more pro-inflammatory. So that even affects the dynamics of fibromyalgia. I am optimistic that we will find out that people who have fibromyalgia or are in a chronic state of severe pain and suffer from the COVID infection may find studies that affect their ability to respond and recover from that cytokine storm Ana is reflecting. Please continue, Ana, about this diet?

[00:37:13] Ana Paola: Well, that is actually true. Something funny that I found about reading a little more about the dietary interventions is that they don’t focus on weight loss, even though most people are concerned about that. The main concern about the dietary interventions is to provide anti-inflammatory relief, so that is something vital that you’re telling here right now. So I think one of the most critical anti-inflammatory agents that have been proposed for the treatment of fibromyalgia is turmeric or curcumin, where we kind of know about, well, we can use it interchangeably. So this is an inhibitor of all pro-inflammatory pathways starting from the NF2 pathway to the NF Kappa 2 pathway. So this is something essential, and it has to do a lot as an anti-inflammatory agent, and at the same time, it can act as an analgesic and has potential. So this is very important because when turmeric inhibits those pathways, it can eventually affect the synthesis of the pathos gland. Eventually, that would affect one thing that Kenna mentioned, which was PRTV2; I think that was the one she said, and right here, we have like a family member of that same code, and it will lower the chain penalized from the body. So that is one thing that you need right here. Another thing that is very helpful in the anti-inflammatory process is that the dietary approach of treating fibromyalgia is omega-three fatty acids. Women say that omega-three fatty acids, EPA, and NHA are essential anti-inflammatory agents. But in the same way, they are very important antioxidant players right here. So an additional thing that you have to know is that they actually can diminish the inflammatory post that people might get from the glutamate from their diet. So actually, I think that with diet, the main thing that you have to do is that you have to mix and match a lot of antioxidants and many anti-inflammatory agents in order for it to work. Still, as you say, the most important thing about that is that it has to be practical. This combination and all of the mix and match that I just mentioned is bad; for example, some of the excitatory processes with fibromyalgia have a lot to do with that excess glutamate that is going inside the brain through that. Well, because there is permeability in the blood-brain barrier. So this is very important. Once the glutamate levels go up like a little bit higher in the brain, it would have that effect, and the pain will be more excessive.

[00:41:19] Dr. Alex Jimenez DC*: You know, I’d like to touch on that subject matter because one of the things that we’ve learned is that glutamate is a potent neurotransmitter, and we need it. However, what we’re talking about here is when it goes awry, when there’s too much when we have our microglia cells mandating through their activities, activity from the astrocytes that produce the neurotransmitter. It just goes awry, and it’s too much. It’s super sensitive. It becomes a part of that central sensitization dynamically. It’s not that it’s incorrect to have it, but too much of it is. So the load, yes, the load is high. So curcumin has a history of decreasing inflammation and omega fatty acids. So I love that because what we need to understand is that what we’re getting at in; I think what we’re trying to express is that it’s a multifaceted treatment protocol where you can’t just throw a pill at it, and you say, we’ve got to work at it, and we have to have a team that follows you through the dynamics. So go ahead.

[00:42:23] Ana Paola: Yes, sure. So maybe we’re talking about including supplementation and spices like curcumin that you might like to add to your diet. But in fact, that’s a big part of the dietary approach to stop fibromyalgia sentences to diminish and some other type of foods, for example. And as you might hear about it, there is a lot of MSG in Chinese food. Well, there’s a lot of them in Mexican food. Yeah. Like the little cubes we use in chicken soup or anything, they have a lot of MSG. And the thing about MSG is that it has glutamate, so you might like to stay away from them at the end. It’s simple. Just add more onions, carrots, and celery to your soup, and you can stay away from those cubes. So that would be like an easy way to stay away from them from your diet. Another thing is that the same way that glutamate in excess can affect other patients with fibromyalgia, aspartame can do the same thing. And while glutamate and aspartame are both amino acids. But this thing, or what I’m trying to say, is that you might want to stay away from that aspartame sweeteners, and that’s like the way that you can provide a little bit more relief to this patient. Another thing is that the sweeteners containing aspartame might be linked to the same inflammation most of these patients have. So I mean, there’s like a lot of clues right there about the things that you might want to stay away from your diet and the ones you want to include in your diet. And they can work both ways. You can take some things away and add them to keep up with the flavor in your diet.

Know Your Body

[00:44:55] Dr. Alex Jimenez DC*: Ana, when you mentioned that this would be hard, the first thing it conjures up. However, it’s not today with modern technology. We have the ability to kind of help individuals through the modern-day. Just take pictures of your food, and we can help you. So by monitoring these food dynamics as we see what you eat, we can make additional recommendations. The thing that we need to get in this process is that fibromyalgia is since it’s so multifaceted, it doesn’t have an answer. And very few times, do you have the first sure shot at the bullet to treat it? However, we throw what we can at it, and we adapt. We adapt to the changes as we make those changes. You need a team member and someone to discuss that with, so how hard is that to monitor? Well, it’s kind of complex if I have to write it down each time, everything I write, everything I eat, today’s date modern technology makes it, which, as you can see, I have my phone with me at all times. And what you certainly can do is take a picture and have a team member that understands precisely what’s going on. We have Kenna and our nutritionist, Ana Paola, who can help you adapt to those changes because that’s critical. Whether you go, you got to go to a doctor who’s got a good nutritionist or someone who can sit with you and understand precisely what you’re eating because that is what triggers these disorders. And if we can start working through that, we can start lowering the inflammatory load, so to speak, the oxidative state. We can help the mitochondria. We can help the biomes in your intestines restore to normal. And that helps us in that process. So I know that you were talking a bit of grain, and there’s been a lot in public about grains. Please tell us what you’re talking about, specifically about these ancient grains.

[00:46:40] Ana Paola: I think this has to do much about the fact that each patient has to be tested the right way, and I mean, as you said before, don’t be dogmatic, don’t just stay away from the grain because you have fibromyalgia. No, get tested and be aware of your symptoms. Get to know your body. Maybe you just don’t have this overlapping symptom uploaded that comes after gluten or maybe gluten-based foods. So that’s like a disclaimer. You have to be very aware of your symptoms before just taking them all the way from your diet. And in this case, this particular case might be gluten-free diet has been part of the dietary approach to fibromyalgia. Still, it’s because of the overlapping symptoms within IBS and the celiac disease or non-celiac disease. So you have to be very aware of your symptoms and what you are eating, first of all, instead of just taking it all out. So I’m going to talk specifically about this ancient grain product called Khorasan. And Khorasan is just a word that was previously used to describe Afghanistan. I’m sure that’s like the word, but they have seen that it has a lot of micronutrients and macro elements with a lot of fiber. It has by the 56 percent that we need on a daily dose, so that’s fantastic. It has a lot of magnesium, phosphorus, potassium, selenium, and zinc. As Kenna mentioned, we can determine the amount of zinc and magnesium that you might need or that you might be missing. But in previous studies in fibromyalgia, patients are very deficient in this kind of microalgae. And so Khorasan can be used as regular wheat products like, let’s say, bread or anything. It showed some improvement, so maybe this could be an extra inclusion to your diet instead of just taking the wheat out of your diet. You can bring back the Khorasan wheat and products. You can have a better response to your fibromyalgia symptoms. So it showed some improvement right here. But I think you have to be aware, first of all, and make sure that you have Khorasan products surrounding your local market because that is how you want to make it possible for the patients to introduce this to your diet.

[00:50:06] Dr. Alex Jimenez DC*: In terms of other dietary changes, what kind of other dietary changes, in general, are a good approach?

[00:50:15] Ana Paola: A good approach? I was amazed that the intervention with different Lactobacillus was not really important in this kind of patient. I was really amazed because it is clear that the microbiome has something to do with the symptom and fibromyalgia. But it did impact how people may like a rapid response. It’s like they feel overwhelmed and make very bad decisions. That was the main thing that they were very helpful with. So eventually, it has to do something with fibromyalgia and depression. Still, the Mediterranean diet or the intervention with the Mediterranean diet and the supplementation of tryptophan and magnesium were the most effective in this kind of condition. So, yeah, this could be something that could be added to, or you can add this to your diet, many foods mentioned in the Mediterranean diet. But yeah, that was like the most impactful diet approach that could be used. And can help lower the weight of some patients; it was related to a lower concentration, pro-inflammatory cytokines. So that’s something that you want to have around when you’re dealing with fibromyalgia.

Sleep Is Very Important

[00:51:57] Dr. Alex Jimenez DC*: You know, I notice that you have a big title up there, a psychological and sleep effect. It appears that sleep is critical in understanding, even like COVID, the treatments and the susceptibility, but it’s also important in fibromyalgia patients. What do you notice about the sleep importance in terms of individuals with fibromyalgia?

[00:52:28] Ana Paola: That it is important. It increased the quality of life in the nation, and it is one part of the question. It’s about the quality of life in every kind of application or clinical application. So yes, it is very important. And actually, there have been fewer studies reported about melatonin use and in fibromyalgia, and they had positive results, but they had no association with the pain score. So maybe they weren’t that important because I said before that patients with fibromyalgia want to keep the pain at bay. So that was the thing that I found that I could find about melatonin and sleep, but that is very important.

[00:53:29] Dr. Alex Jimenez DC*: I want to digress and get Kenna involved in this particular part of the discussion regarding lifestyle changes, Kenna, in terms of things that we can look at in terms of lifestyle dynamics? Maybe you want to get your computer up there and see if we can come up with ways that we have been able to address the lifestyle changes that are so important in an individual with fibromyalgia. For me, sleep is critical. You’ll notice that the individual who has the sleep patterns can adapt. Maybe not so much the pain receptor issue is diminished. However, they can sustain just the barrage of drama associated with this. When we deal with sleep, we’re also, as you can see, we’re talking about inflammation, and at the base of inflammation is immunology. Immunology has its basis on its ability to recover, and for that, sleep is critical to be able to reset the body to sustain those blasts, whatever they may be. Tell me a bit about this, Kenna, in terms of what you look at when you look at lifestyle changes, and also, I want if you wish, Ana, you can chime in on that particular subject matter.

[00:54:53] Kenna Vaughn: So sleep, as you have mentioned before, is how our body repairs itself. It’s crucial for everything; our brain needs rest, and our cells need rest. When you sleep, we take all that good food we’ve eaten throughout the day, burn it, and digest it. And so that’s why it’s important also to make sure like Ana was saying, you’re eating the right foods, you feel your body so that when you sleep, it is restorative. It does help your body. And one way that we can help improve sleep and patients can be as simple as adding meditation to your day. Many fibromyalgia patients do have chronic pain, so exercise might not be there yet when we first start. But one thing that we can do is add in just mindfulness of what we’re eating, what we’re doing, and then adding that meditation, even as simple as five to 10 minutes, has been shown to help relax the body, and it can reduce inflammation throughout the day. It’s just meditation can be such a powerful thing. As well as grounding, grounding is something that you do when you’re barefoot. You go outside, and you just let your body and your feet. You feel the ground; you take deep breaths, you let all of that come in. It might sound silly, but it has been proven to help. And when you just take even small lifestyle changes like that, because we’re not going to go crazy at first, it has to be something that our patients can do. So, just by taking those two things, we can start seeing such positive impacts. And once we get onto those lifestyle changes, we can start switching other ones, such as, you know, the soaps they’re using, the shampoos they’re using, the fragrances in their home, adding some plants to their house snake plants. You only have to water down once every eight weeks. I have to tell you that a lot of my life is about having simple things like that that can start to change our genetics and how we are in our sleep. And it just it’s incredible the small lifestyle changes you can make to improve sleep as well as symptoms.

Changing Your Lifestyle

[00:57:02] Dr. Alex Jimenez DC*: I know we’re going to get in a little more complex of these issues in terms of lifestyle changes. Ana, what have you noticed that the patients do in your experience, specifically lifestyle changes? Because I want to digress. And before we end, I want them to understand a few lifestyle changes and things like yoga, pilates, tai chi things a spirituality that makes an important component in the recovery process of a fibromyalgia patient. What have you seen on Ana?

[00:57:34] Ana Paola: Well, the first thing I have seen is that gratefulness is one of the main things that can help people process what they are feeling. So when you have this kind of chronic situation, when you’re constantly feeling pain, you are aware of that pain, and maybe you just shut down all of the fantastic things you are going through or that things are going around in your life. And one thing that I like about, well, that I link to nutrition and that I link to food and everything is the fact that you have to be very aware of what you’re eating, so every time you sit down and eat, just turn off the TV and just really take the time and take your turn to show your food and think about it entirely. Probably I have right here this chicken curry recipe. Oh, I’m not sharing my screen. I’m sorry. Yeah, even when you’re here, you’re thinking about eating. You need to go through everything that went through that process.

[00:58:57] Dr. Alex Jimenez DC*: That looks good, by the way.

[00:58:59] Ana Paola: Thank you. This is something that my mom tells me. Like, don’t you ever feel angry about cooking because you have food in your home? So that is very important once you go through getting treatment in every kind of condition. And you bring the food back from your nutritional program, and you have to be thankful that you’re able to provide that food to your body, which eventually will bring some kind of healing to the process.

[00:59:33] Dr. Alex Jimenez DC*: Now, one of the things you mentioned there, just if I may you talk about making the food, the understanding, and you should not feel bad about making it, but how do you feel? How do you personally feel when you can be able to create your own dynamics in your foods? Because I feel that this the creation of the food and making it happen also serves as a kind of a release of dynamic expression.

[00:59:57] It’s an appreciation because you can move, you’re able to cook, you’re able to convert something uncooked to something that was cooked, maybe that’s very simple. But it will ultimately lead to better functioning of your body. So I think that whereas you have to go through that explanation about everything that is going into your dishes and how it will help your condition. So I feel that once the patients go and start making their food, they can fully digest or process that bad a way of thinking, and they can perceive then traditional function, their food a little bit better. So yes, that is very important because, you know, that food is medicine and that food should always be comfortable.

[01:01:58] Dr. Alex Jimenez DC*: Any other ideas in terms of just we will be touching on this matter in a much more intense way because I think it’s important we will probably spend the next month or so discussing fibromyalgia and the dynamics. We’ll be teasing out these supplements and sometimes going down the rabbit hole of, let’s say, acetylcysteine or even the vitamin D complex issues that will be in its podcast and its own presentation. Because it is highly complex and there are many studies, we can’t assume that everyone knows the implications of NAC or homocysteine effect on inflammatory states. We have to understand that it is a complex dynamic, that it requires a team of individuals that actually understand the process of trying to work with a recovery regiment. There’s no pill. There’s no sure shot. There is a dynamic cacophony of things that we can do to change an individual’s lifestyle. I know that Ana, you also did some work in terms of the dietary changes, but tell us a little bit more about the direction you wanted to take this particular podcast in.

[01:02:15] Ana Paola: Oh, this particular podcast and I wanted to take it into the way that Kenna said mindfulness and awareness, I think that it’s like the first thing that you have to take care of, that you have to see yourself with the patient. You have to be aware of everything that you’re feeling and everything that it’s going to for you to be able to go to the doctor’s office or the nutritionist’s office and tell them precisely what it is that you are feeling. Or maybe not exactly. Just tell them how you’re feeling, and that will provide much in that treatment for yourself because you just come in with a diagnosis such as fibromyalgia, which is very extent. Man, then what am I going to do with that? You have to be very aware of what you feel and what you want to do. I ask about what you want to do, and if you’d already been some kind of research, you can go through that and, like, say what you want to be treated as. So yes, that could be something. And there’s a lot of things that could be done when you are talking about the nutritional aspects of fibromyalgia and even the vegetarian diet because you want that gluten-free diet could be one of the FODMAP diets could be one approach or even an elimination diet. The main role of a nutritionist while speaking with some fibromyalgia patients is to leverage and negotiate the treatment because most people want to versus staying in their comfort zone. You have to meet them, have them for you at the beginning, and then they’re going to start moving along with you. So, yeah, the approaches are many, and that’s how you should be. You just can take this like one approach and go with it for the rest of your life. You have to listen to the patient, and you have to listen to the symptoms as they revolve or as they dissolve, or as they continue.

[01:04:43] Dr. Alex Jimenez DC*: As you notice, your approach is one of the things you mentioned as a nutritionist. The health coach also becomes an important kind of contributor in managing the care of a fibromyalgia patient from the types of exercises we do many times that we look at these dynamics and we assess it, understanding what the doctor’s role is, what is the nutritionist role? What is the dietitian’s role? What is the health coach’s role? What is the physical fitness individual that is important in the recovery for how much stretching and exercise is allowable? The individual who connects the dots in those is usually the health coach. Kenna, tell us a bit about how that integration between the fitness nutritionist, the dynamics of treatment, and assessing the issues comes together for you as a health coach, if you may?

[01:05:39] Kenna Vaughn: Yes. So as you’re saying, everything works together; the body is so delicate, so we must find that balance.

[01:05:48] Dr. Alex Jimenez DC*: Ana, stop sharing your screen for a moment.

[01:05:53] Kenna Vaughn: When you incorporate everything, I look at these Inbody results with this inflammation. And we also work with a gym called PUSH. And so we take everything and create a whole personal program and connect with the patients. If the patients have questions about the stretching they should be doing or just anything in general, they can always reach out to us. We have apps available. They can message us on this Inbody app, or they can message on an app called Coach Care that we work with, and we can even set up video consultations just by; one of my roles here is about making sure that our patients always feel seen and heard, and that we’re listening to everything that they’re saying. And so any anything that they have, we just really wrap them around us and take care of every single need, whether it’s what drink they should get at Starbucks that won’t flare up their inflammation all the way to what they should be eating or exercising or stretching or just anything. We are the team for you to help, and my job is connecting you with the doctor and with the nutritionist to make sure that we are getting those right answers for you in a reasonable amount of time and that you’re not just waiting.

Conclusion

[01:07:10] Dr. Alex Jimenez DC*: You know, at going from just the fibromyalgia dynamics to the present issues, we can see that the care of a person suffering from, let’s say, concomitant migraines with fibromyalgia is very complex. Some that just have fibromyalgia, this inflammatory state at the level, the deep to the mitochondria has to be weaned out to the history where we see that the story’s essential. We make complex history assessments to determine exactly where this thing began. Where was where were the clues? What would I call antecedent triggers and mediators of these particular issues? So in terms of what are the causes before this happened, what are the mediators? What are the things that continue this process and keep feeding the fire of inflammation? One of the problems in medicine is that sometimes we don’t get the answer right up front is sometimes the deep histories have to be done in an in-depth way. So and time is incredible and important, but you can’t always get the information right away. So as time progresses, our job is to unpeel the complex onion of an individual and figure out the causes, what the things are, and understand that we can go deep through lifestyle changes and change quite a bit. Sometimes it’s just a tiny tweak. Sometimes it requires a little bit more than a minor tweak. So our team here is designed to be empathetic, understanding, compassionate, and passionate about what we do. So our goal is to understand, clinically evaluate and come up with the standards of what treatment protocols are out there and come up with the best approach for each individual. I hope this has been a bit of useful information for you guys, and we’re going to present much more elaborately. And as we get better and our team gets more dynamic as we do these presentations, we’re going to do more and more so that you can understand the complexities of issues like fibromyalgia. They’re not so simple. And as time goes on, we realize that the magnitude of a disorder that has one diagnosis code affects not only the brain, the effect, the psychosocial, the emotional, the anxiety, the depression. It affects everything, and it does make individuals feel sick. And what I call sickness syndrome. So when they just feel disconnected, things happen due to that. So it’s a very important thing. And though it may seem to start as a musculoskeletal disorder, the implications go far, and the essences are dynamic and changing. So not only when you say, Aha, I figure this out, Eureka, it moves, and we have to adapt within individual’s lifestyle and their changes. So I thank you again, and we look forward to hooking up with all you guys again. So God bless, and we’re here as a team. So thank you, Kenna Lee Vaughn and Ana Paola Rodriguez Arciniega. Thank you so much, guys. You guys have a fantastic day, OK, and I’ll chat with you next week, and we’ll be here next week.

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