The Fibromyalgia Puzzle – Another Piece Fits into Place

Published: November 5, 2018
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Puzzle Pieces

More and more pieces of the fibromyalgia puzzle are coming together to give us a bigger picture, and this new one can help treatment in two major ways!

A recent study showed something we already knew. That serotonin (the "happiness molecule") is low in people with fibromyalgia. Not surprisingly, low serotonin is also associated with poor sleep, increased pain, and feeling blue.

Fortunately, raising serotonin is easy to do, and can be done without medications. Simply taking 5-HTP (200-400 mg at bedtime) can markedly improve mood, comfort, sleep, and even help weight loss. Many people find it helps them feel significantly better after just six weeks of use. That said, you should be careful if you try taking 5-HTP while also taking serotonin-raising antidepressants, such as Prozac. Though it happens only rarely, the combination can raise serotonin levels too high, which can cause anxiety-like symptoms. So if you are on antidepressants, limit your 5-HTP intake to 200 mg a day.

A Remarkable Observation

We already knew that serotonin is low in fibromyalgia, so this aspect of the study was nothing really new. But without knowing it the study authors shed light on a much more important and poorly understood area in treating fibromyalgia — the relevance of enlarged blood platelets in fibromyalgia.

Enlarged blood platelets can offer clues as to what needs treatment in fibromyalgia, and a simple $10 blood test (called "Complete Blood Count" or CBC) can detect the presence of this. In fact if you've been working with a physician you've very likely already had this test — though it's also likely that your doctor, not knowing the significance of this marker, may have simply ignored it.

I've seen for decades that people with fibromyalgia often show enlarged platelets in their blood counts (called "Mean Platelet Volume" or MPV). Though I wasn't sure why, I've often suspected this was not just coincidence.  The new study is the first I've seen that confirmed a connection between elevated platelet size and fibromyalgia.

The researchers speculated that this was simply a result of the low serotonin. I don't believe this is the case. So, I decided to explore what causes elevated platelet size. Here's what I found.

What Causes Increased Platelet Size (MPV)?

Platelets are the blood cells that cause blood clotting. When these cells are activated (turned on), they get larger.

The surprise is that blood clotting isn't the only reason platelet activation can occur. It can also be a marker of issues that reflect specific conditions associated with fibromyalgia (yet one more puzzle piece adding to the evidence that fibromyalgia is a physical and real condition!). These include:

  1. A marker for autonomic dysfunction, which can lead to a blood-flow disorder called POTS (a treatable condition characterized by lightheadedness upon standing), or excessive adrenaline release and exhaustion. Both of these conditions are associated with fibromyalgia (learn more about POTS and adrenal issues in FMS).
  2. A marker for immune system activation, which can be inflammation from many causes. In fibromyalgia, it raises the suspicion of underlying infections, which can also help guide treatment.

So, this is good news! There's a simple, cheap, blood test that's most likely covered by your insurance and that most of you have probably already had (even if your doctor missed its significance) that can hold all kinds of clues relevant to your fibromyalgia, and can help guide you with your recovery.

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