Saturday, June 25, 2011

Fibromyalgia's possible biomarker - Dr. Bhatt's lecture

Fibro Notes June, 2011
A summary of the Mishawaka Fibromyalgia Support Group for June of 2011
I was honored to introduce a very special guest speaker and dear friend this evening,Dr. Kumar Bhatt of The Mishawaka Clinic. He is the man who started me on my path of discovery, and pointed me in the direction of my passion. I can never thank him enough!

As you may know we hold our meetings in the lower level of the library, where there are three various-sized meeting rooms. We generally hold our meetings in the “Friends of the Library” room which holds 25 people (as per the fire code). This had always been a sufficient-sized room in the past. It was not so this evening. Kashmira Bhatt did a bit of negotiating with the Library staff and was able to get permission for her husband to speak in the “Spencer Room,” which holds many more people! And so we were able to relocate. Thank you, Kashmira, for your powers of persuasion!

Dr. Bhatt began this evening by telling us the old adage, “When all you have is a hammer, everything looks like a nail.” With Fibromyalgia there is no existing hammer! (Ouch- I’m not certain I like that particular analogy.) For example, it was only in1980 that the medical condition of depression had been recognized as a legitimate medical condition. There had been no hammer for this condition either! There were no regular blood tests, x-rays or obvious physical anomalies (hammers) prior to 1980 that could identify that this was a legitimate condition. So when the medical community had finally found their hammer – or rather, found the biomarkers of serotonin, dopamine and norepinephrine - they found that there really WAS an identifiable cause, and therefore a legitimate condition for a thing called depression. Fibromyalgia had been in the same diagnostic dilemma.

He then gave a list of conditions, where he listed side-by-side their available biomarkers – the diagnostic tools, or specific “things to look for” - with which to identify the particular medical conditions:

Rheumatoid Arthritis-~~->Serum Rheumatoid factor
Osteoarthritis-~~->Joint X-Ray (observation)
Gout-~~- >Serum Uric Acid
BBB~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ BBB
Clinical Depression-~~->Serotonin, Dopamine, Norepinephrine
Fibromyalgia-~~->Substance P, fMRI (functional Magnetic Imaging)

You may notice a difference in the type of testing that is done in these particular conditions. The first three utilize time-honored, long-standing, readily accessible and fairly inexpensive testing on body functions. Simple. Basic. Blood tests and x-rays.

Depression uses testing of neurotransmitters in the brain, and brain function - much more distinctive, complicated, expensive and not always readily available. Here we have crossed the “BBB” – the blood brain barrier. And this manner of testing is not the walk in the park presented by simple blood tests and x-rays. Neurotransmitters, by definition are fast travelers. It took a long time just to discover that they existed and what they did, they’re still not exactly sure how they work – they are electrical in nature and electricity is still a mystery in many ways, especially in the brain.

Fibromyalgia has biomarkers too – Substance P and observation via an fMRI. However, these tests are difficult, can be dangerous, are extremely expensive, and not every medical facility, doctor or patient is up for the task! So for the time being we settle for the other “markers” of Fibromyalgia, 1) at least three months of body pain, along with the typical exhaustion, sleeplessness and depression (simply from being in pain for three months, will do it – and the pain has usually gone on a LOT longer than that) and 2) eleven (more or less) out of 18 tender points test as sensitive. These are the current diagnostic tools that are readily available, inexpensive, and the least painful.

Dr. Bhatt then went on to describe diagnostic criteria for other conditions. The following were once considered diagnostic dilemmas for quite different reasons, and in a strange way, quite similar to our plight.

Tuberculosis-~~->turbecule bacillus
Peptic Ulcer Disease-~~->Helicobacter Pylori
Syphilis-~~->Treponema Pallidum
Pernicious Anemia-~~->Vitamin B12

Each of the above conditions was initially treated symptomatically. That is, each symptom was treated individually for the condition at hand. The root cause of the conditions had been unknown and so this was the only method of treatment. The problem was that in each condition one organ or system would be affected; it would be treated; then symptoms would show up in another system or organ; then that would be treated; and then it would show up somewhere else! In other words, the condition or disease was not treated, only the symptoms.

It wasn’t until a single reason was found – a root cause – for the condition that these began to be effectively treated and even cured! Tuberculosis, for example was found to be caused by a bacteria that was named turbecule bacillus. Once this was found as the cause, an antibiotic could be created to help fight it and even cure it in many cases.

Peptic Ulcer Disease had long been considered a result of anxiety or stress, much like a stomach ulcer. But with more study and research, Peptic Ulcer Disease was found to be the result of a bacterium and again, a specific antibiotic was then developed to deal with the condition and cure it. And the same thing happened with Syphilis until the bacterium was identified and it was found that penicillin as well as other antibiotics could neutralize the bacterium.

Until it was learned that a severe lack of vitamin B12, or the inability to absorb it properly, was the actual cause of Pernicious Anemia, many people died from this condition, as they did from the previously mentioned conditions. Now a simple series of B12 injections (until the B12 level is back to normal) has been found to cure this condition.

All of these listed conditions had been treated piecemeal for many years, and were ultimately considered fatal. The treatments addressed the symptoms, and not the root cause. There had been little else they could do. The symptoms changed or moved around, and even if one part was helped, it broke out in another way, or in another spot. Actually this happens with a lot of conditions, until the root cause is defined in absolute terms, and a successful treatment for that cause is determined.

Right now there is a LOT of well-funded research going on for Fibromyalgia. Some researchers suspect the root cause may have been found. Promising research in the area of serum testing of Interleukin 8 Cytokine (IL-8), an inflammatory mediator, is now under way. Fibro had never been thought to be an inflammatory condition in the past. But now the researchers are not so sure.

Dr. Bhatt drew another diagram here, but I confess I haven’t found a way to transpose it to an e-mail or blog where it is actually readable. So I’ll simplify, and pray that I can do him justice.

Omega 6 is a pro-inflammatory essential fatty acid; Omega 3 is an anti-inflammatory essential fatty acid. Our intake of these two essential fatty acids should ideally be 1:1 or 2:1 and yet it is currently calculated at 25:1 by some, and 40:1 by others -far in favor of the Omega 6’s. Soooo much more PRO-inflammatories. Our Western/American diet is absolutely LOADED with Omega 6’s, which is one reason we have so many inflammatory medical conditions running rampant in our country.

Contributors to this inflammation are the Omega 6’s found in fried fatty foods, hydrogenateds, trans fats, prepared and packaged foods with safflower, sunflower, corn oils, etc (vegetable oils). I explain this more fully in my new book Fibromyalgia Basics, so I won’t go into it here. But Dr Bhatt explained the mechanism of inflammation here. [Note: please do not mistake the beneficial antioxidant ALA Alpha Lipoic Acid, with ALA Alpha Linoleic Acid, the Omega 6.)

ALA (Alpha Linoleic Acid = Omega 6) breaks down into
DGLA. DGLA breaks down (using the enzyme delta-5 desaturase) into
Arachidonic Acid, a precursor to pro-inflammatory mediators IL-8.
(The process of inflammation)

However, when the EPA-DHA of Omega 3 is available in equal amounts to the ALA Omega 6, the enzyme delta 5 desaturase becomes neutralized and would not break down the DGLA into the Arachidonic Acid. The EPA-DHA inhibits the delta 5, and so it will not break down the DGLA in this inflammatory direction. Moreover, this means it will not break down even further into interleukin-8 Cytokine (IL-8).

In other words, Omega 3 EPA-DHA anti-Inflammatory inhibits the inflammation that the pro-inflammatory Omega 6’s cause. I know, “Why didn’t I just say so?”

The reason is simple. The promising research now being done is focused on these Interleukin-8 Cytokines – this may very well be the biomarker they are looking for. Researchers are trying to find a more direct route to neutralizing these inflammatory mediators. When they find it, this may well prove to be our “Antibiotic,” or neutralizer. And there we are…looking forward to a positive identification of our biomarker. Getting one step closer!

There was a Q & A period following Dr. Bhatt’s lecture which was lively, to say the least, on a variety of pertinent subjects.

-We discussed pain meds like opioids, which aren’t very effective for many in chronic pain, and Ultram which seems to work for acute pain in some, and Elavil or Amitriptyline which can be used for a longer term without incident or addiction.
-Rheumatologists have a difficult time dealing with chronic pain, due to the fact that this pain is usually originating from the opposite side of the blood brain barrier. And not every prescription for these conditions works for everyone; some prescriptions don’t work at all for some; and it’s almost always a case of trial and error.
-The subject of chemical triggers for our Fibro-flairs was brought up. Things like salicylates, odors like household cleaning chemicals, plastics, rubber, even MSG and Aspartame and more.
-For clarification, Dr. Bhatt explained that the EPA part of Omega 3 is mostly used to neutralize inflammation, and the DHA part of Omega 3 is mostly used to benefit the brain, and conditions of and around the brain such as cognitive functions, memory, eye conditions, hearing, etc.
-The topic of Alpha Lipoic Acid, the antioxidant, came up. We talked of its use for skin sensitivity and pain (neuropathy) and RLS. And that it is often used with CoQ10 because they increase the energy metabolism. And both are excellent free radical fighters – antioxidants!
-We briefly discussed Guaifenesin. One member mentioned that her muscle pain is usually helped when taking Mucinex, which she discovered by accident when she had a cold. Dr. Bhatt stated that the main ingredient in Musinex is Guaifenesin, which is an expectorant, and may or may not help some people. But remember to always tell your doctor of anything you are taking. This medication, like anything else, can react badly with other medications.

[ This is a long article titled “The Truths and Myths of the use of Guaifenesin for Fibromyalgia” or “Guaifenesin: One Medicine, Several Effects” by Mark London at MIT. Note: Mark London has several very interesting articles on Fibromyalgia, Magnesium, and Omega 3, among others.]

-One member mentioned “The White Paper on Fibromyalgia,” put out by Johns Hopkins Medical Center, and she stated that many of the ideas and concepts about Interleukin-8 Cytokines that Dr. Bhatt had talked about was mentioned in the 70 page paper. I am trying to locate this “paper” and will pass along any further information I come across concerning it, or a website.

Dr. Kumar Bhatt and The Mishawaka Clinic is located at:
The Medical Arts Building
303 S. Main St. Suite 212
Mishawaka, IN 46544

Thank you Dr. Bhatt and Kashmira and everyone, for attending the meeting tonight and helping to make it most memorable!

My new book, Fibromyalgia Basics, has now been officially released and can be seen on’s “Look Inside” feature. You can get a signed copy at my website at securely with PayPal, check or money order. You can also go to where you will find the complete version as an E-Book for just $7.99. It is available at, too.

If you already have a copy of Fibromyalgia Basics, Thank You! Please take a minute to go to Amazon and leave a sentence or two in the review area. Librarians all over the country look up books on Amazon to see whether they want to order it for their Library. I would like to have my book in as many libraries as possible, so it is available even for those who can’t afford to buy one at this time. They need the information too! Thanks again! Pati* *J