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Richard Podell, MD, on Reversing Eight Vicious Cycles that Block Fibromyalgia and Chronic Fatigue Syndrome Healing

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Richard Podell, MD, is a clinical professor at New Jersey’s Robert Wood Johnson Medical School. He has special interests in chronic fatigue syndrome, fibromyalgia, stress-related disorders, and clinical nutrition. Dr. Podell has offices in Springfield and Somerset, New Jersey. For more information, see DrPodell.org.

People with any chronic illness tend to develop a set of self-defeating vicious cycles, which conventional medical approaches too often overlook. My practice places high priority on reversing these self-defeating cycles, as they are major obstacles to healing.

Vicious Cycle #1: Non-restorative Sleep

Both Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) disrupt sleep quality. Poor sleep, in turn, worsens physical and mental stamina. Poor sleep also increases sensitivity to pain. These, of course, further disrupt sleep. [See Dr. Podell’s lecture on “Improving Sleep Quality Despite Fibromyalgia or Chronic Fatigue Syndrome” – which includes a discussion of 13 principles that should be considered in approaching sleep problems for people with FM and CFS.]

Vicious Cycle #2: Disordered Breathing Rhythms

More than half of our patients with FMS or CFS develop a disordered pattern of breathing. They take very small rapid breaths using the small muscles of their chest instead of slow, deep breathing with the large muscles of the abdomen. These changes are subtle and most people who “hyperventilate” in this manner don’t realize that their breathing pattern is out-of-synch.

Shallow chest breathing makes people feel tense. Slow, deep abdominal breathing creates feelings of calmness. Disordered breathing can also cause a broad array of frightening symptoms including mental fog, dizziness, irritability, chest pain, feeling numb and more. Worsening symptoms then disrupt breathing further.

Vicious Cycle #3: Inactivity Leads to Progressive Loss of Physical Fitness (De-conditioning)

People with FMS and CFS often feel too ill to exercise, and if they push themselves, they get worse. However, not exercising at all is also a mistake. With inactivity, fitness fades. This increases a patient’s vulnerability (i.e., it takes less and less exertion before you’re pushed beyond your limits). This leads to less activity, which, in turn, leads to lower blood pressure and blood volume. Blood sugar becomes unstable. Disruptive stress hormones increase (e.g., adrenalin and cortisone). People feel worse, so they can do even less. And the cycle repeats itself.

Vicious Cycle #4: Magnesium Loss in the Urine

Both physical pain and mental distress cause magnesium loss through the urine. Low magnesium, in turn, turns up pain volume and also heightens vulnerability to stress. This brings about further magnesium loss.

Vicious Cycle #5: Hormonal Imbalances

Both physical and mental distress trigger the release of hormones such as cortisol that promote tissue breakdown. At the same time, distress depresses the output of hormones that promote growth (e.g., DHEA growth hormone). Thyroid and sex-hormones may also be affected. These hormonal disturbances undermine healing, which then leads to further hormone disruption.

Vicious Cycle #6: Blood Sugar Instability

The five vicious cycles just discussed all have adverse effects on the body’s blood sugar and insulin system. Blood sugar tends to rise higher after eating carbohydrates, and then falls rapidly lower, which is the “hypoglycemic” reaction. Actually, low blood sugar per se is not the direct cause of symptoms. Rather, falling blood sugar causes “stress hormones” to surge, including adrenalin and cortisol. These disruptive hormones are actually the cause of most “hypoglycemia” symptoms. These symptoms include: mood instability, depression, light-headedness, foggy brain, fluid retention and fatigue.

[See also Dr. Podell’s discussion of “Hypoglycemia Symptoms and Alternative Hypoglycemia Treatments”.]

Vicious Cycle #7: Mind/Body Tension

Feeling bad for so long makes people “tighten up,” both literally in their muscles and figuratively in their mind. Muscle tension increases pain and stiffness. Mental tension creates feelings of anxiety, and a sense of not being in control. This causes more physical and mental tension, reinforcing the illness.

Vicious Cycle #8: Losing Perspective, Losing Hope

People who are chronically ill tend to lose optimism and also their sense of perspective and proportion. Small set backs feel like catastrophes. Dips feel like they are taking forever. Anger suppresses immune function. A patient experiencing these lows may lose hope and stop trying. This heavy burden adds to the illness.

What tools do we have to reverse these vicious cycles?

• For sleep quality, we have many options including behavioral training, nutritional supplements, herbs and medicines.

• For disordered breathing, we teach how to restore rhythmic breathing. This can be mastered in just two or three training sessions.

• To improve physical fitness, the Goldilocks Principle applies – not too much exercise and not too little, but just the right amount. Within a few months this usually improves fitness, function and symptoms.

• For low magnesium, we offer a specialized test of magnesium status, and aggressively replace deficiencies.

• For hormone imbalances, we measure relevant hormones and consider the pros and cons of hormonal supplements.

• We treat blood sugar instability with the traditional anti-hypoglycemia diet plus several important new wrinkles.

• To reduce physical and mental tension, we teach a broad set of practical relaxation skills.

• There are also techniques for regaining perspective and realistic hope without long-term psychotherapy. Cognitive Behavioral Therapy (CBT) is a brief educational technique that teaches you how to “reframe” practical problems so that you deal with them more effectively.

Our strategy is to first reverse one vicious cycle, then the next and the next. This removes obstacles that perpetuate illness, thereby strengthening the body’s natural abilities to heal.

Richard Podell, MD
The Podell and King Medical Practice
105 Morris Avenue, Suite 200
Springfield, NJ 07081
http://www.drpodell.org

Tel: 973-218-9191

Somerset, NJ office: 732-565-9224

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Note: This information has not been evaluated by the FDA. It is for general information purposes only and is not meant to prevent, diagnose, treat, or cure any condition, illness, condition, or disease. It is very important that you make no change in your healthcare plan or regimen without researching and discussing it with your professional healthcare team.

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12 thoughts on “Richard Podell, MD, on Reversing Eight Vicious Cycles that Block Fibromyalgia and Chronic Fatigue Syndrome Healing”

  1. sherrillynn says:

    I got to this link through the article: http://www.drpodell.org/fibromyalgia-disability-medical-expert-witness.shtml.

    I thought it was an excellent site, especially the parts about the FCE Exam not being an accurate test of FM. I was recently forced to resign from my job as Program Assistant for the Georgia Department of Juvenile Justice. I filed a discrimination claim on the basis of disability and in their response the DJJ repeatedly stated that I refused to submit to a FCE exam. Like most of what they ascertained, this wasn’t true, but it sure was validating to read what I knew was going to be true about any FCE: that it would be painful and no indicator of what is wrong with me.

    Sherril Johnson

    1. applepansy says:

      Dr. Podell wrote:
      “People who are chronically ill tend to lose optimism and also their sense of perspective and proportion. Small set backs feel like catastrophes. Dips feel like they are taking forever. Anger suppresses immune function.”

      I know many patients with FMS and those who have had it long term do not lose their sense of optimism or their sense of perspective and proportion. It’s just different than people without FMS.

      I would suggest that Dr Podell try to recreate FMS symptoms in himself for a year and then readdress these issues. When there is so little you can successfully do without causing a flare or putting yourself back in bed for days, then it stands to reason that your prespective and proportion will be different than someone who can still work 8 hours or more a day and then go home and do laundry, fix dinner, help kids with homework, and still have sex with hubby.

      Small set backs have never been catastophes for me or for many others I talk to. What they are is big, because what we’re trying to do is all we can do. So often not being able to do something because of a flare is a great disappointment because that’s all we have had to look forward to for several days or weeks.

      Also, what was the size of the group he studied? I believe in the 18 years I’ve had FMS, researched and taught others about FMS, including the 10 years online talking to 10s of thousands have given me a different view than Dr. Podell’s. I agree that patients newly diagnosed do lose perpective and hope, but perspective is changed and hope comes back when they educate themselves and they find a compassionate doctor who will truly treat the pain. Also, support groups live or online help a lot.

      I think the problem with his premise is his perspective.

      Other than that I think his article was good.

      Alison aka applepansy

    2. happyy says:

      HELLO SHERILL. I HAVE FIBRO TOO FOR 5 YEARS NOW, AND LET ME TELL YOU THAT ON MY FIRST TERM-PERIOD OF DISSABILITY MEANS THE SHORT TERM THRU MY JOB, THEY WAS ACCEPTING ONLY MY MEDICAL RECORDS OK. BUT AFTER 1 YEAR THEY SENT ME THRU MAIL AN SPECIAL APPOINMENT TO SEE THEIR OWN DOCTORS I WAS SUPPOSED TO TAKE A SPECIAL TEST FOR 2 COMPLETED DAYS, TRAVELING FROM MY TOWN TO THEIR TOWN AND WITH ALL EXPENSES PAID, BUT BY THE FIRST DAY THEY STARTED GIVING ME THE TEST THEY FOUND OUT THAT I WASN’T ABLE TO HANDLE ONE MORE DAY IN THE TEST, SO THEY ASKED MY DAUGHTER NOT TO BRING ME BACK THE NEXT DAY I PROVED TO THEM THAT MY CONDITION WAS REAL.SO KEEP YOUR FAITH AND KEEP YOUR POSITIVE ATTITUDE, BECAUSE ANY DAY THEY WILL FIND OUT THAT YOU ARE A REALL SUFFER. GOOD LUCK.

    3. happyy says:

      HELLO, SHERILL. THANKS FOR REPLY TO MY E-MAIL. AND I WANT TO ANSWER YOUR QUESTION.. WELL AFTER A PERIOD OF TIME OF 1 YEAR THE DISSABILITY INSURANCE THAT I HAVE THEY ASKED ME TO HAVE THIS SPECIAL TEST DONE, I HAAD TO TRAVEL FROM SPF.MA TO ANOTHER TOWN THAT IS AN HOUR AWAY FROM HOME, BUT I HAD TO TAKE THIS SPECIAL TEST, THEY NEED TO MADE SURE THAT I WAS A REAL FIBRO- PATIENT, THE TEST CONSIST IN LIFTING, CARRYING, QUESTIONS… I DIDN’T NEED TO WRITE ANYTHING IN PAPPER, BECAUSE EVERYTHING WAS IN A COMPUTER, THEY JUST ASKED ME THE QUESTIONS I ANSWERED AS MUCH AS I COULD, AND THE COMPUTER WAS TELLING IF IT WAS CORRECT WHAT I ANSWER, BECAUSE MY ANSWER WAS NEED TO BE TRUE AS THE SAME WAS THE COMPUTER. AND THE OTHER PART OF THE TEST WAS FOR THEM TO BE ABLE TO FIND OUT HOW MUCH I WAS ABLE TO DO LIFTING AND CARRYING, AND THE COMPUTER WAS LETTING THEM KNOW IF WAS ABLE TO DO IT OR KNOW, I HAD TO USE SPECIAL BELT THAT THEY GAVE MY DAUGHTER TO PUT IT ON ME AROUND MY CHEST. THIS ALL I CAN REMEMBER I WAS IN A LOT OF PAIN, AND ALSO WITH MY MEDS ON MY SYSTEM, IF YOU WANT TO WRITE TO ME, CARMEIG@MSN.COM. GOOD LUCK AND HAVE A GOD DAY.

    4. happyy says:

      HELLO SHERILL. IS BEING A LONG TIME I DON’T HEAR FROM YOU. I JUST WANT TO KNOW HOW ARE YOU DOING? WELL TODAY IS HORRIBLE ONE FOR ME IS RAINING SO MUCH AND VERYYYYYYYYYYY COOOOOOLLL OUTSIDE MY PAIN LEVELS ARE VERY HIGH, BUT I WILL TRY TO REST AND DO THE BEST I CAN FOR MYSELF… YOU ALWAYS HAVE A FREIND AND THAT FRIEND IS YOU, ALWAYS BELIEVE IN YOU AND THINK POSITIVE TO YOURSELF. HAVE A GOOD DAY.

    5. happyy says:

      WELL EVEN WITH A LOT OF PAIN I HAD TO TRAVEL FOR ABOUT 1 HOUR WITH MY DAUGHTER TO HAVE THE TEST DONE, IT WAS AN EVALUATION TEST, AND I THINK IS VERY IMPORTATNT TO GO THRU THAT BECAUSE THAT WAY YOU CAN PROOF YOUR REAL FIBROMYALGIA, I AM GETTING MY DISSABILITY BENEFITS THRU THE JOB I HAD FOR 5 1/2 YEARS NOW. SO, MY ADVICE TO YOU IS GO THRU THE TEST BECAUSE IS FOR YOUR OWN GOOD. GOOODDDDDDDDDDDDDDDDDDDDDD LUCKKKKKKKKKKKKKKKKK.
      ATT. CARMEN

  2. lsongs says:

    I think whenever we as patients get information regarding this devastating disease, we are greatful. He surely highlighted the most important points, but true…we do not have to lose our hope. Thank you Dr. Podell, for your skill and interest; and you’re not losing hope with patients who have this disease.

  3. happyy says:

    I like very much to read every important article you published in the web, because from every one, I can learn more and more in how to deal with my chronic Fibromyalgia Issue every day of my life. And is true for every of us that suffers from fibro because even some of our family members and friends they can’t understand that we have this invisible illness, so they always trying to humilated us, or, trying to see us as a lazzy person’s. Thanks so much Immune Support because this is a real place where each of us find the Support we really need.
    Keep the good work. Good luck to every Fibro Suffer.

  4. sherrillynn says:

    I wonder how long you were in a fibro flare afterwards, from having to travel to another town, in addition to taking the test?!

  5. sunrise7 says:

    If it is one thing that stands out for CFS-ME persons is that everyone has 3 or more of 7 or 8 major health problems. There are effective protocols, now, for each of these. If you don’t know which you have, everything is a wild guess and many options which work for others may make you worse or not benefit. Whenever possible, and if affordable, run effective tests to determine a starting point.

    That said, Recovery for most of us is not going to be quick or short, and often not easy. Changing our basic attitude and behavior negative patterns won’t get us better but it may certainly take a huge negative stress off our Reptilian Structures, including our immune systems.

    Dr. Podell defines some of those major patterns to consider and reframe. You don’t have to, yet it could be the difference between whether the protocols which could get you to recovery will defeat you or not.

    The article is a good reminder that REAL solutions to complex problems CAN be complex and if we don’t set a firm foundation to build from, we are just planning to fail.

  6. 545 says:

    While I found it useful how Podell broke down the disease into bite-sized elements, I think that he could have tried to conceptualize these “cycles” more efficiently by tieing the article to more research. For instance, in the section on breathing, he says that we “develop a disordered pattern of breathing”, and should try breathing more slowly. While I’m sure his appraisal is correct, he doesn’t consider *why* we might develop slower breathing. Past articles have suggested that we have decreased lung capacity and oxidative stress. I’m not a pulmonary expert, but it would seem like if your lungs and blood cannot handle large amounts of oxygen, breathing more slowly could be somewhat harmful.

    Similar points might apply to other cycles in this article. Even though it is certainly necessary to deal with some of these issues, particularly the ones regarding sleep and losing perspective, vicious cycles are not so easy to turn around, especially when they’re rooted in physical causes. Treating CFS & FM is notoriously similar trying to fix an old leaky faucet: If you tighten one area, another squirts out water.

  7. tonikelley says:

    The first few statements in Podell’s article are offensive to me. He says”we develop self-defeating” behaviors. I would not go to him for help if he were the last doctor on earth.

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