Recently I had the pleasure of treating a very nice, young woman who is suffering from a condition called fibromyalgia. I told her I’m writing a book called “The Biggest Organ.” It’s about how muscle is an organ, and its number one function is to generate energy with the help of mitochondria, the energy powerhouses of the cells. I explained that the main pathology in fibromyalgia is that it is a mitochondrial disorder, that muscles are unable to generate enough energy and therefore cannot ever recover, and that one section in my book was going to cover this. She was very excited and said she couldn’t wait to read it. Unfortunately, I’m so far away from finishing this book that I didn’t think she may ever read it, but that gave me an idea!
I decided I’ll be writing my book in public – on my blog and in emails to you. I’ve already started, but I want to keep it going and see where it takes me.
This will help me to stay current with my patients and research. And it also gives me a chance to interact with the public on my ideas and hear feedback before I put the book out. And of course, putting it out in the public keeps me more honest and responsible.
Let’s get back to the topic. Fibromyalgia is a condition of severe pain in many areas of the body, but specifically in certain trigger points. People with fibromyalgia are more susceptible to pain, fatigue, sleep issues, an inability to handle exercise, stress and they often have brain fog, emotional distress and are very sensitive. The only treatment currently available is management of these symptoms with medications, which help people with fibromyalgia to improve their quality of life, but it’s far from any cure.
So in order to understand what’s going on, we first need to understand mitochondria as it relates to fibromyalgia. As part of my challenge, I’ll try to simplify the information to make it digestible and easily understood, without dumbing it down. This can help people figure out how they can allocate their personal energy and time in the best way for the future of their own health and wellbeing.
As I stated earlier, fibromyalgia is a mitochondrial disorder. Mitochondria’s main job is to make adenosine triphosphate, or ATP. ATP is required for muscle health. It aids in protecting the muscles against damage and in muscle regeneration. But people with fibromyalgia have low ATP. The reason for low ATP is because a switch in the metabolism has occurred; it has moved from aerobic metabolism to anaerobic metabolism. In aerobic metabolism, also known as oxidative phosphorylation (OP), oxygen is present and allows a molecule of glucose to yield 34 molecules of ATP. But with anaerobic metabolism, which fibromyalgia patients experience, there is an absence of oxygen. Without oxygen, glucose is instead being fermented to lactic acid and yields only 2 ATP molecules. So, rather than an efficient production of 34 molecules to burn clean by-products of CO2 and water (in aerobic metabolism), there is a dysfunction where only 2 molecules are producing lactic acid (in anaerobic metabolism.) Lactic acid from anaerobic glycolysis isn’t in itself problematic, because we all produce it during periods of high intensity activities, such as sprinting and working out. However, it becomes problematic when there is an excess of lactic acid, and it becomes a predominant source of energy, such as in fibromyalgia. This is why patients experience a burning feeling in their muscles – there is microscopic muscle damage, which keeps accumulating, leading to muscle pain. Excessive accumulation of lactic acid can cause muscle fatigue, cramping, pain and ultimately muscle damage. This is the reason fibromyalgia patients have little or no exercise tolerance. They are already maxed out on lactic acid, and in a short time it begins to spill over.
Why is this mitochondrial dysfunction happening and how can it be addressed?
First, let’s understand mitochondria a little bit better. ATP, which we know mitochondria produces for muscle health, is a triple (3) phosphate molecule. When one of the phosphate bonds is broken, the energy stored in it gets released and ATP turns into ADP, a double (2) phosphate molecule. ADP is less efficient and can further break down to AMP, a single (1) phosphate molecule. While ADP(2) is a molecule that is produced when ATP(3) is used to produce energy, AMP(1) is a molecule that is produced when ADP(2) is broken down. This all happens in the inner membrane of mitochondria and plays a key role in the body’s energy production. ADP(2) and ADP(2) can combine to make one ATP(3) and one AMP(1). In fibromyalgia, people are chronically low in ATP(3), so ADP(2) is combined with another ADP(2) to make needed ATP(3), and less needed AMP(1). This creates an imbalance of ADP(2) and AMP(1). There will be less ADP(2) than AMP(1). The body will get rid of excess AMP to maintain the correct ADP-AMP ratio.
This decreases mitochondria’s ability to ultimately produce ATP, because it decreases the pool of ATP precursors. So the body then has to build it from scratch. It is very difficult for the body to make brand new AMP or ADP molecules from scratch. Think of this in terms of plastic production. It’s easier to get plastic out of recycling than producing it from raw material. The same can be said for ATP – it’s much easier to get it from recycled AMP and ADP, than to make it from scratch.
Moreover, with the lack of ATP inside the mitochondria, there is going to be an increase in oxidative stress and therefore cell damage, which is well documented in fibromyalgia. Oxidative stress is an imbalance between the production of free radicals and the body’s ability to neutralize them. Free radicals, also known as reactive oxygen species (ROS) are a by-product of normal cellular metabolism and necessary for certain functions such as signaling and defense against pathogens. However, excessive levels of ROS can damage cellular components, including DNA, proteins and lipids. This damage, along with lactic acid buildup, can lead to further dysfunction of mitochondria, which also damages the cells of fibromyalgia patients.
With all these issues you can see how a person with fibromyalgia cannot escape this never ending cycle of breakdown and the inability to recover. By addressing those imbalances and underlying conditions, I truly believe that in the right environment, with the right doctor, given adequate amount of time to allow all the diet, lifestyle changes and supplements time to work, it is possible to break this vicious cycle.
To Your Health,
Arthur Gazaryants, DOM
Arthur Gazaryants is a Doctor of Oriental Medicine, a Naturopathic Practitioner and a Licensed Acupuncturist located in the Los Angeles region of Southern California. Dr. Gazaryants is licensed and has 22 years of experience in acupuncture and functional medicine. He uses a combination of various techniques such as Acupuncture, Electric Stim, Functional Medicine, Nutrition and Supplements, as well as Cupping, Myofascial Release and Active Release Technique to maximize the benefits and to achieve optimum results for his patients. He has busy private practices in Calabasas and Long Beach, treating pain of all sorts, including but not limited to neck, back, shoulder, hip, knee, elbows, wrist, head and many other various types of pain. He’s also successful in treating many complex and chronic conditions such as autoimmune disease, infertility, fibromyalgia, and different chronic degenerative conditions such as diabetes, heart, neurological, digestive diseases. He loves helping athletes and high performance individuals such as CEOs, portfolio and fund managers with their performance, brain function, energy and rehabilitation. Dr. Gazaryants cares deeply for his patients as well as the overall health of individuals and the community.