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The chapters in The Metabolic Treatment of Fibromyalgia are extraordinary. Each contains as much well-organized information and scientific documentation as most entire books on the subject of fibromyalgia. Section I Dr. Lowe opens the book with an overview of the fibromyalgia model that has reigned from the early 1970s until now. That model is the "rheumatology paradigm" of fibromyalgia. According to this paradigm, fibromyalgia results from (1) a serotonin deficiency or (2) a decreased serotonin effect (failure to properly activate serotonin receptors). These serotonin-related abnormalities presumably result in the neuroendocrine dysfunctions of fibromyalgia. Dr. Lowe writes that for many years, this was productive in helping us learn about fibromyalgia. For example, the model gave rise to studies that now enable us to identify fibromyalgia patients and to appreciate many of the biologic abnormalities of the disorder. But weaknesses of the rheumatology paradigm have now given rise to the second fibromyalgia paradigm. According to the second paradigm, fibromyalgia is the clinical effects of impaired metabolism in "fibromyalgia-specific" tissues. Dr. Lowe labels this model of fibromyalgia the "hypometabolism hypothesis." He focuses on a comparison of the two serotonin hypotheses and the hypometabolism hypothesis. In addition to a critical analysis of the serotonin hypotheses, he critiques other hypotheses of the cause of fibromyalgia. These include commonly accepted hypotheses: (1) that fibromyalgia is caused by deconditioning, (2) that it results from disturbances of the hypothalamic-pituitary-adrenal (HPA) axis, and (3) the pseudo-scientific claim that it is a somatoform (psychogenic) disorder. He reviews the evidence writers have used to justify these hypotheses, and he reinterprets that evidence in view of a corollary of the hypometabolism hypothesis. That corollary maintains that all the symptoms and objective abnormalities of fibromyalgia can be adequately accounted for by inadequate thyroid hormone regulation of cell function. Dr. Lowe also includes an extensive chapter on the notion that fibromyalgia is a mental or emotional disorder. He refutes this notion and shows that it is a mixture of metaphysical and pseudo-scientific ideas. He provides evidence that labeling fibromyalgia patients with somatoform (psychiatric) diagnoses from the Diagnostic and Statistical Manual of the American Psychiatric Association is a form of quackery. He notes that most physicians probably use these labels for convenience or out of ignorance. He also argues, however, that some physicians who promote the use of the labels are themselves mentally disturbed and constitute a serious threat to the public welfare. Section II Section II is by itself a comprehensive textbook on clinical thyroidology. Dr. Lowe provides extremely detailed chapters on the basic science aspects of thyroidology, including the cellular and genetic actions of thyroid hormones and thyroid hormone physiology. Also, in separate chapters, he covers the main thyroid-related clinical conditions that are relevant to fibromyalgia. These include the forms and causes of primary and central hypothyroidism, hypometabolism despite normal thyroid hormone and TSH levels (euthyroid hypometabolism), and thyroid hormone resistance. Section III Dr. Lowe devotes Section III to the major symptoms and the objectively verified abnormalities of fibromyalgia. He demonstrates with weighty documentation from the scientific literature that all the features of fibromyalgia can result from inadequate thyroid hormone regulation of cell function. Many patients have expressed gratitude for this section of the book. They say his explanation of their symptoms and signs is the first thing they've ever read that has made sense out of their illness. Physicians have written that this section enlightened them as to the underlying cause of fibromyalgia. Section IV Section IV contains chapters on diagnosis, laboratory testing, the use of patients' symptoms and signs, and the adverse effects of too much and too little thyroid hormone. In the first of these chapters, Dr. Lowe describes how to diagnose fibromyalgia. In addition, however, he explains how to use objective measures of fibromyalgia status. These measures permit the clinician and patient to precisely determine, at any point during therapy, how the patient is responding to metabolic rehabilitation. In another chapter, Dr. Lowe provides detailed explanations of the commonly used laboratory thyroid function tests, and he explains precisely how to properly interpret them. He also discusses their limitations. In still another chapter, he describes how to measure the patient's tissue responses to metabolic treatment. This chapter is a revival of the practical assessment methods used before the advent of laboratory tests of thyroid function. These methods, in contrast to the use of lab tests, enabled clinicians to effectively treat patients with thyroid hormone. And in the final chapter of Section IV, Dr. Lowe thoroughly covers the potential adverse effects from excess thyroid hormone. He presents the scientific evidence that dispels the mythic beliefs of physicians that lead to their denying their patients large enough dosages of thyroid hormone to get well. He also includes the adverse effects of too little thyroid hormone regulation. In Section V, Dr. Lowe first reviews the published studies on other fibromyalgia treatments. He discusses and interprets them in view of the finding that fibromyalgia is a disorder of abnormally slow metabolism. It is in Section V that Dr. Lowe describes in detail the protocol for metabolic rehabilitation. He includes chapter that thoroughly describes the treatment protocol in minutes detail. He also explains the special considerations in the treatment of both hypothyroid and euthyroid patients. He includes chapters on the use of thyroid hormone preparations that combine T4/T3, and he includes a chapter on special considerations in the use of T3 alone. In one of the largest chapters in the section, he describes the complementary methods typically used during metabolic rehabilitation. He groups these complementary methods into those that induce a sustained increase in the patient's metabolism, those that reduce metabolic demand, and those that decrease the flow of noxious sensory signals into the central nervous system. Under these headings, he extensively covers the use of treatments such as diet modification, nutritional supplementation, exercise to tolerance, the judicious use of caffeine, muscle relaxation methods, myofascial trigger point therapy, and spinal manipulation. Section V ends with a chapter on trouble-shooting the protocol. In this chapter, Dr. Lowe describes the most common problems clinicians and patients are likely to encounter and exactly how to handle them. Four Appendices Appendix A of The Metabolic Treatment of Fibromyalgia contains the assessment forms and blank graphs that are needed to evaluate the patient's fibromyalgia (metabolic) status. Chapter 4.1 and Chapter 5.2 of the book contain detailed instructions for scoring the assessment forms. Appendix B
of The Metabolic Treatment of Fibromyalgia contains all of the published studies by Dr. Lowe and his
research group. We have included these because Dr. Lowe believes
that physicians who use the book should have immediate access to
the studies upon which the book is based. Many physicians aren't
aware of the science behind the metabolic rehabilitation of
patients that Dr. Lowe describes in detail in the book. This form of fibromyalgia
treatment has stood the test of the most rigorous scientific scrutiny. In fact, metabolic
rehabilitation, as described in this book, is the only treatment
ever found to be truly effective for fibromyalgia. Appendix D contains an extensive chart of conversions between T3, T4, and desiccated thyroid. | McDowell
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