A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about Fibromyalgia: nearly half of the general public (45%) has never heard of Fibromyalgia, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).

1. FIBROMYALGIA CAN BE RESOLVED
BY MEDICAL HERBALISM
A talk by Morwenna Given
Medical Herbalist
www.medicusherbis.com
03/12/2014 © 1

2. WHO AM I?
I am
MORWENNA GIVEN
BA MA ( Oxon ) BSC m.OHA BHG RH
A Medical Herbalist practising in downtown
Toronto treating a variety of disease from
constipation to cancer
I trained in the UK in university, hospital & clinic
environments on an evidence base basis
03/12/2014 © 2

3. TRAINING
Training Medical
Herbalist
vs. Medical
Doctor
vs. Naturopath
Degree Yes Yes Yes
Prof.body Yes
1542
Yes
1540
Yes
c.1901
Hospital training Yes Yes No
Surgery No Yes No
Evidence
Yes Yes No
based
Specialist Yes Yes No
A medical herbalist only uses plants & professional supplements to treat holistically
A medical herbalist has 2-3 times more training than an MD in Both conventional
drugs and plant medicine Drug interactions & contraindications & Dosage
Nutrition and preventive medicine 03/12/2014 © 3

4. What is Fibromyalgia?
• Fibromyalgia, an illness characterized by
chronic, widespread pain and tenderness, is
estimated to affect about 5 million U.S. adults.
Fibromyalgia was formerly classified as an
inflammatory musculoskeletal disease but is
now considered to be an illness that primarily
affects the central nervous system.
( Medscape 2008 )
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5. MEDICAL STUDENT TEACHING 2011
• Fibromyalgia (FM) is a common, idiopathic, chronic musculoskeletal pain condition
associated with widespread pain, tenderness in various anatomically defined
tender points on the body, fatigue, sleep abnormalities, and common
comorbidities with psychiatric and medical disorders (Arnold, Bradley, Clauw,
Glass, & Goldenberg, 2009). An estimated 6 million (2% of the US population)
men, women, and children have been diagnosed with FM (Krypel, Rospond, &
Chen) with the overwhelming majority being middle-aged women (7:1) (Lawrence,
Felson, & Helmick, 2008). Although FM is the most common presentation of pain
in general medicine and rheumatology (Perrot, Dickenson, & Bennett, 2008), it
continues to be under-recognized and misunderstood. The lack of understanding
of the pathophysiology of FM has made this condition frustrating for patients and
clinicians alike (Harris & Clauw, 2009). A recent public awareness survey by the
National Fibromyalgia Association illustrates a significant lack of understanding
about FM: nearly half of the general public (45%) has never heard of FM, many
people who are knowledgeable about the disorder incorrectly believe that nothing
can be done to manage it, and nearly half (48%) of all healthcare providers are
reluctant to diagnose a patient with the condition (National Fibromyalgia
Association, 2007).
• Medscape 2011
03/12/2014 © 5

6. MERCK
• Pain on 11 out of 18 points on the body
• Widespread pain for 3 months minimum
• Pain widespread in axial skeleton and right
and left of the body on deep palpation.
• Pain gradual diffuse and achy
• Co morbidities
• As described in the Merck Manual 18th Ed.
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7. DOES NOT FIT
• In other words this is a disorder which
conventional medicine cannot neatly classify as it
is multi aetiological in origin requiring multi level
resolution
• Conventional medicine is organised vertically in a
system in which specialists ignore each other
creating further problems with no suitable drugs
for chronic auto immune disease and where
surgery is inappropriate
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8. NOTHING NEW
• Fibromyalgia is not a new disease
“First recorded as far back as the 16th century, medical literature contains
descriptions of clinical manifestations of musculoskeletal pain. In 1904, Sir William
Gowers, coined the term "fibrositis": the idea that there were changes in the
muscular beds and connective tissue that represented inflammation. Those changes
were never found, so that is 1 reason we no longer use the word "-itis.“ In 1975, the
first objective findings that were ever associated with the disorder were discovered by
Dr Harvey Moldofsky, a Canadian psychiatrist working in sleep medicine and suggested
that FM be reclassified as a nonrestorative sleep syndrome. Today there are still
parties who believe that FM is a primary sleep disorder.”
• The current post war WW2 organisation of conventional medicine based
on acute disease with single action drug mechanisms
• The current construct cannot deal with chronic disease and there are no
drugs for lifestyle
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9. epidemiology
• Not present in any significance in the 3rd world
• A chronic disease of the western world but
not new – dis/ease of excess
• Women 7:1 Men
• Some evidence to suggest overweight lower
socio-economic groups more susceptible and
BRICK countries now showing the syndrome
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10. HOMEOSTASIS
• As a medical herbalist which treats
wholistically and aims to return the body to
homeostasis I understand syndromes such as
fibromyalgia as I operate on a the
physiological multi cellular level inter relating
with all aspects of the body. Our biochemical
training allows us to understand how the
differing aspects of this syndrome actually
relate to the symptoms of dysbiosis and of
which pain is merely a symptom
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11. Treatment by Conventional Physicians
• Muscle biopsy studies do not conclusively show abnormalities specific for
FM, moth-eaten fibers, ragged red fibers, and type II fiber atrophy indicate
that muscles are often involved in the pathogenesis of FM. One of the
most important findings is that the regulation of deep tissue
microcirculation is abnormal in FM, which may result in sensitization of
intramuscular nociceptors. Abnormalities may lead to lowered pH during
mild to moderate muscle load sufficient for activation of muscle
nociceptors. Altogether, this may result in peripheral sensitization of
afferent pain pathways, which then provides impulse input to central
pathways resulting in central sensitization.
• A better understanding of peripheral and central pain mechanisms in FM
will aid in the development of new and effective therapies for patients.
Some of the clinical implications include pharmacological and
nonpharmacological therapies that modify peripheral and/or central
mechanisms operant in FM.
03/12/2014 © 11

12. Treatments (2)
• These treatments may consist of cognitive-behavioral
therapies, treatment with antidepressants (particularly
serotonin-norepinephrine re-uptake inhibitors) and
antiepileptic drugs, just to name a few. At this time,
stress reduction, restful sleep, and exercise are known
to positively affect FM pain mechanisms.
• NO ADDRESSING OF CAUSES, NO EVALUATION OF
DEFICIENCES WITHIN THE BODY, or LIFESTYLE ISSUES
03/12/2014 © 12

13. drugs
• Commonly prescribed drugs are:
• Tricyclic anti depressants and SSRI’s
• Non opioid analgesics
• Opioids
• NSAIDS
• Muscle relaxants
• ALL HAVE SERIOUS SIDE EFFECTS & THEY JUST
DEAL WITH SYMPTOMS
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14. Side effects
• Addiction
• Ulcers
• Incontinence
• Insomnia/nightmares
• Weight gain
• Impaired hepatic function
03/12/2014 © 14

15. Conventional drugs
• Benzodiazepine tranquillisers e.g. Xanax side
effects as below + ataxia, rashes, libido decreased
• Anti depressants:
• SSRI’s – Prozac
• Sleeping drugs -
• Amitriptyline e.g. Venflaxamine, Elavil – weight
gain dry mouth/eyes, constipation, decreased
perspiration & arrhythmias, addictive, impact
normal muscle function
03/12/2014 © 15

16. Drugs (2)
• Muscle relaxants – anti spasmodics and similar
to anti depressants in pharmacological
mechanism.
• Pain – opioids, NSAIDs, CABA (tramadol)
• All the drugs have very limited effectiveness,
only treat the symptoms and cause major side
effects over short and long term
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17. Aetiologies
• Genetic
• Psychogenic & social causes
• Nutrition
• CFS & other co morbidities
• Environmental toxins
• Neuroendocrine
• Stress
• HPA axis
• Hypothyroidism ( especially
in Ontario
• Immune deficiencies
• Hormone deficiencies
• Physical trauma
• Whiplash
• Neuroplasticity
• Cerebral circulation
• Phosphate deficiency
• GH & impaired Calcium
metabolism
03/12/2014 © 17

18. Typical symptoms
• Muscle stiffness &
aching
• Tender points
• Disturbed sleep
• Fatigue
• Sensitivity to temperature
• Bruxism
• IBS/ Digestive disturbance
• Reproductive hormone im-balance
• Genito/urinary issues
• Sensory overload
• Brain fog
• Depression
• Dry mouth and eyes
• Headaches
• Rhinitis – sinus issues
• Skin, hair, nail problems
03/12/2014 © 18

19. Drivers
• Hyperstimulation of the CNS with raised levels of
glutamate, low tryptophan serotonin
• Increased levels of IL6 and other prostaglandins –
immune dysfunction
• Hyperstimulation of peripheral pain receptors
• Relationship to beta estrodiol & women’s hormones
• Thyroid malfunction / hormone imbalance GH
• Ca metabolism impaired, Vit D deficiency,
03/12/2014 © 19

20. How do I treat
• Each patient is an individual and assessed accordingly in a 2
hour consultation – Symptoms and causes addressed - and
given a bottle of tincture ( medicine ) to take as directed and a
tea, supplements if relevant. A physical examination may be
applicable and blood pressure taken. Bloodwork may be
requested.
• Exercise is discussed and recommended including:
• CBT, Yoga ,Tai Chi ,Aerobic exercise which have all shown to be
beneficial
03/12/2014 © 20

21. “ Let food be thy medicine and
medicine thy food – Hippocrates”
• Diet is key in any chronic auto immune disease and is believed to be
part of the aetiology
• FRUITS AND VEGETABLES ,
• basic principles & Palaeolithic diet
 Altern Ther Health Med. 2011 Mar-Apr;17(2):36-44.
A program consisting of a phytonutrient-rich medical food and an
elimination diet ameliorated fibromyalgia symptoms and promoted
toxic-element detoxification in a pilot trial.
Lamb JJ, et al.Dept. of Molecular and Cellular Biology, MetaProteomics
LLC, Gig Harbor, Washington, USA.
03/12/2014 © 21

22. Reduce the drivers
• Chemical imbalances in the brain corrected
• Inflammation reduced
• Immune system modulated
• Hormonal imbalances corrected
• Environmental issues addressed
03/12/2014 © 22

23. Solution!
• PLANTS ARE MULT FACETED AND MULTI
FACTORIAL OPERATING ON BIOCHEMICAL
PATHWAYS WE ARE ONLY BEGINNING TO
UNDERSTAND capable of treating CHRONIC
DISEASE WITH NO SIDE EFFECTS.
• ' Everything man needs to maintain good
health can be found in nature - the true task
of science is to find these things ' Paracelsus
03/12/2014 © 23

24. Plants
• Muscle stiffness & Pain:
• Alteratives, anti inflammatories, circulatory stimulants,
connective tissue tonics, analgesics
• Devils claw, Prickly Ash Bark, Celery seed
• Kava black cohorsh scentella lobelia
 J Pharmacol Sci. 2003 Nov;93(3):367-71.
Harpagophytum procumbens suppresses lipopolysaccharide-stimulated expressions of cyclooxygenase-
2 and inducible nitric oxide synthase in fibroblast cell line L929.Jang MH et al. Department of
Physiology, College of Medicine, Kyung Hee University, Seoul, Korea.
03/12/2014 © 24

25. Plants
• Pain and lack of sleep:
• Analgesics, hypnotics, neurotransmitter regulator
• Valerian, passionflower, Jamaican dogwood , anemone,
Skullcap, wild lettuce, Californian poppy, meadowsweet
 Evid Based Complement Alternat Med. 2011:403591. Epub 2011 Apr
26.Selective Interactions of Valeriana officinalis Extracts and Valerenic Acid
with [H]Glutamate Binding to Rat Synaptic Membranes.Del Valle-Mojica
LM, et al. Ortiz JG. Department of Pharmacology and Toxicology, School of
Medicine, University of Puerto Rico-Medical Sciences Campus,
03/12/2014 © 25

26. Plants
• Connective tissues:
• Regenerator of muscles and tissues:
• Scentella, hawthorn, horsetail, fo ti, bilberry,
• Plantain, comfrey
BMC Plant Biol. 2011 Jul 29;11:112.
New insight into silica deposition in horsetail
(Equisetum arvense).Law C, Exley C.Lennard-Jones
Laboratories, Keele University, ST5 5BG, UK.
03/12/2014 © 26

27. Plants
• Muscle relaxants:
• Cramp bark, prickly ash bark, willow, paeony
J Med Food. 2011 Apr;14(4):434-40. Epub 2010 Dec 27.
Anti-acetylcholinesterase and antioxidant assets of the major
components (salicin, amentoflavone, and chlorogenic acid) and the
extracts of Viburnum opulus and Viburnum lantana and their total
phenol and flavonoid contents.
Erdogan-Orhan I, Altun ML, Sever-Yilmaz B, Saltan G.
SourceDepartment of Pharmacognosy, Faculty of Pharmacy, Gazi
University,
03/12/2014 © 27

28. Plants
• Lack of Energy:
• Siberian ginseng, liquorice, verbena, ginger
• Nettle, schizandra
• Nettle and alfalfa contain between them
nearly all the micro nutrients the body needs.
03/12/2014 © 28

29. More Plants
• Digestive issues – carminatives, anti
spasmodics, bitters
• Peppermint, chamomile, milk thistle,
marshmallow, ginger
• Excretion
Anti spasmodics Diuretics and liver herbs
03/12/2014 © 29

30. And so on……
• Brain fog:
• Cerebrovascular stimulants and HPA
• Rosemary gingko, periwinkle, scentella
• Anxiety/depression:
• Neurotransmitter balance and HPA
• Arctic rose, rose, verbena, St John’s wort,
passionflower,
03/12/2014 © 30

31. THYROID
• A previous slide showed how important the thyroid is in
governing hormones
• In Ontario there is a huge problem of sub clinical
hypothyroidism
• The Thyroid governs all metabolic function if this is out of
balance then hormones will rage!
• Issues include, lack of iodine, bromine in foods
• Lack of exercise
• Withania, nettle, myrrh, reishi, bacopa, coleus,
• Liquorice, melissa, blue flag, motherwort,
03/12/2014 © 31

32. Control of Hormones implicated in
Fibromyalgia
• Thyroid specifically matters in fibromyalgia
Because:
• Growth Hormone, somatostatin, and IL6
• Calcium, calcitonin and muscle function
• Regulated by HPA/thyroid axes
03/12/2014 © 32

33. Consequences of thyroid dysfunction
• Immune dysfunction - Tsh T 3 T4
• Cone flower, milk vetch, skullcap, schizandra,
• Ginsengs, scentella, arctic rose
• Susceptibility to colds, flu other infection
• FMS patients have higher levels of IL2, T helper
cells and alpha interferon which mediates
immune response.
03/12/2014 © 33

34. CASE STUDY
• Female 46 yrs. single, sales administrator
• PMHx: abusive relationship, frozen shoulder,
• Ovarian cysts, endometriosis, frequent earaches,
bronchitis, reflux, dysphagia, recurrent cystitis,
Nasal polyps, rash, sub clinical hypothyroidism
finally ddx fibromyalgia
• Drugs: SSRI’s
• Diet high in pasta low in vegetables
03/12/2014 © 34

35. Case study
• Amended diet and encouraged to exercise
• Compound included:
• devil’s club, marigold, golden seal, verbena,
rosemary, withania, reishi, Poke, skullcap, black
cohorsh, golden rod
• Tea
• Supplements recommended Vit D
magnesium,B12, zinc, fish oils
03/12/2014 © 35

36. OUTCOME
• In 4 months:
• No muscle aches and pains
• Subclinical thyroid becoming normal
• No breast pain, no ovarian pain, no discharge
• Mental fog significantly reduced
• Bowels, digestion normal, no reflux
• No nasal polyps, no ear aches,
• Skin ‘big improvement no longer dry’
03/12/2014 © 36

37. NEW LIFE
Opened new business with partner!
• Gone back to study for diploma
• Sleep normal, sex life normal!
03/12/2014 © 37

38. Vitamin D
• Vitamin D is poorly understood ; currently 8 forms identified - most
common form - Vitamin D3
• Pathogenesis of cancer, hypertension, MS, auto immune, osteoporosis,
osteoarthritis, pulmonary disease, Crohn's, diabetes, thyroid function,
blood clotting, liver function
• Endocr Pract. 2009 Apr;15(3):203-12.Correlation of symptoms with
vitamin D deficiency and symptom response to cholecalciferol treatment:
a randomized controlled trial.( in fibromyalgia Px’s) Arvold DS, et al. St
Luke's Internal Medicine Associates, Duluth, Minnesota 55802, USA.
• Most Canadians deficient.
• Grant W, et.al. An estimate of the economic burden and premature
deaths due to vitamin D deficiency in Canada, Molecular Nutrition and
Food Research, volume 54, Issue 8, p. 1172-1181, août 2010.
03/12/2014 © 38

39. Supplements
• As a rule I do not advocate supplements for
reasons shown in the next slide but some are
useful in Fibromyalgia
• Melatonin, Fish oils, glutathione, bromelain
and NAC; zinc, selenium, B6
• Other symptoms such as anaemia may require
short term supplement use
03/12/2014 © 39

40. Supplement cautions
• Illegal to sell a medically efficacious dose
• Most are not pharmaceutical grade
• No evidence base / extrapolation claims
• Contents /label/marketing claim
• Unnecessary
• No consideration of individual needs
• Failure to address polysupplementation
• Arch Intern Med. 2011;171:1625-1633,1633-
1634.
03/12/2014 © 40

41. References
• I have a large number of references which I
am happy to supply if you would like to email
me at mrsmg@sympatico.ca or leave your
own email address with me today
• www. Pubmed, Science Direct
03/12/2014 © 41

42. Please note :
• PLEASE NOTE IT IS ADVISED, THAT ANY PLANTS MENTIONED IN THIS
TALK ARE ONLY USED UNDER PROFESSIONAL GUIDANCE.
• BOTANICAL MEDICINE AS SUPPLIED BY A PROFESSIONAL IS NOT
AVAILABLE OVER THE RETAIL COUNTER.
• It is not advisable to self treat
• A professional will recognise all the issues within the body and
• Select herbs that will impact positively on these issues without
• Causing problems in order to co exist with orthodox drugs,
03/12/2014 © 42

43. Thank you for listening
Morwenna Given
www.medicusherbis.com 03/12/2014 © 43