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Obesity Compounds Pain in Fibromyalgia

As blogged before, overweight and obese patients frequently present with fibromyalgia, characterized by chronic pain, fatigue and depressed mood. A paper by Akiko Okifuji from the University of Utah, Salt Lake City, just published in the Journal of Pain, examines the relationship between fibromyalgia and obesity in pain, function, mood, and sleep. The study examines the impact of obesity on hyperalgesia, symptoms, physical abilities, and sleep in 215 fibromyalgia patients, who also underwent tender point examination, physical performance testing, and 7-day home sleep assessment. Almost 50% of participants were obese and an additional 30% were overweight. Obesity was positively related to greater tender point sensitivity, reduced physical strength and lower-body flexibility, shorter sleep duration, and greater restlessness during sleep. The results confirmed that obesity is a prevalent comorbidity of fibromyalgia and the authors suggest that weight management may need to be incorporated into treatments. In the paper, Okifuji and colleagues also discuss several potential mechanisms linking obesity to fibromyalgia including alterations in the endogenous opioid system, the endocrine system, and systemic inflammation, whereby adipose-tissue derived cytokines may enhance central sensitization. Clinicians should be aware of the relationship between excess weight and fibromyalgia, which can often pose an important contributor to weight gain and a major barrier to weight management. AMS Edmonton, Alberta Okifuji A, Donaldson GW, Barck L, & Fine PG (2010). Relationship Between Fibromyalgia and Obesity in Pain, Function, Mood, and Sleep. The journal of pain : official journal of the American Pain Society PMID: 20542742

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Fibromyalgia and Nutrition

Recently, I blogged about the rather close association between excess weight and fibromyalgia. A paper by Laura-Isabel Arranz and colleagues from the University of Barcelona, Spain, published in the latest issue of Rheumatology International, reviews the role of nutritional factors in patients with fibromyalgia. While their analysis of the literature confirms the high prevalence of overweight and obesity in fibromyalgia patients and the rather sparse data suggesting that weight loss may improve symptoms, they also note that many patients with fibromyalgia may have other nutritional deficiencies which may or may not be related to this disorder. Rather limited evidence supports that notion that vegetarian diets may have some beneficial effects, perhaps due to an increase in antioxidant intake. They also note that although numerous food supplements have been studied, there is very little data to support their use in improving symptoms in patients with fibromyalgia. Clearly, the relationship between obesity, nutritional factors, and fibromyalgia warrants further study. AMS Edmonton, Alberta

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Does Muscle Fibre Type Determine Dietary Weight Loss?

Skeletal muscle, even when it is not active, is an important determinant of energy expenditure, making up 15-20% of resting metabolic rate. But not all muscle is created equal – it is made up of varying amounts of slow Type 1 and faster Type 2 fibres, the former being more dependent on oxygen consumption and capable of endurance exercise, the latter being more capable of non-oxidative activity as in short sprints or lifting weights. People tend to differ in the make up of their muscle fibres, which explains why some people are better at running marathons while others excel at the 100 meter dash. But does this difference in muscle composition also affect the response to dietary weight loss? This question was addressed by Martin Gerrits and colleagues from the University of Ottawa, in a paper just released online in the Journal of Lipid Research. The researchers studied 26 otherwise healthy obese women who were either in the top (diet-sensitive) or bottom (diet-resistant) quintile of weight loss during the first six weeks of a medically supervised 900 kcal/day low-calorie diet program. All participants were highly compliant with the diet (meaning that they only ate 900 kcal/day) and did not differ in levels of physical activity. Subjects were matched for both age and initial BMI. While the diet-sensitive group lost 11.4 kg, the diet-resistant group lost only 7.5 kg during the first 6 weeks. This translates into an almost 25% or 350 kcal/day lower caloric deficit in the diet-resistant group. Following program completion and weight stabilization, skeletal muscle biopsies showed a higher proportion of oxidative Type 1 fibres in the diet-sensitive compared to the diet-resistant women. Gene expression analysis also showed upregulation of genes involved in oxidative phosphorylation, glucose and fatty acid metabolism in the diet-sensitive group. Thus, these data support the notion that the rate of weight loss in response to dietary caloric restriction may very much depend on your muscle composition. Clinically, this would mean that people who are better at aerobic (endurance) exercise may find it easier to lose weight than people who are better at anaerobic exercise (sprints or lifting weights). Perhaps the reason that people who combine diet with endurance exercise tend to lose more weight than people who prefer resistance training has more to do with their muscle composition than with their choice of exercise (or the calories burnt doing it). AMS Edmonton, Alberta

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Obesity and Fibromyalgia: a Painful Barrier to Weight Loss?

To anyone regularly dealing with overweight and obese patients, the frequent association between excess weight and chronic musculoskeletal pain is no secret. This association is particularly true for the rather enigmatic syndrome of fibromyalgia, characterised by the presence of generalized pain in muscle and joints, often associated with fatigue, poor sleep, and depression. Patients typically present with exquisite tenderness over discrete anatomical points, commonly referred to as tender points.  While there is still much debate around the exact etiology or even the exact diagnostic criteria (e.g. number of tender points) for fibromyalgia, there is no doubt that the presence of this syndrome can prove a major barrier to weight management. Indeed, it is not at all clear whether there may in fact be an etiological link between fibromyalgia and obesity. As outlined in a paper by Akiko Okifuji and colleagues from Salt Lake City, UT, published last year in Clinical Rheumatology, 70% of fibromyalgia patients in their study were overweight or obese and presented with elevated levels of IL-6, catecholamines, cortisol, and CRP, all of which are common findings in obese patients. Furthermore, the patients with fibromyalgia, as do obese patients, presented with reduced sleep duration and efficiency. Based on these commonalities, Okifuji and colleagues concluded that excess weight and obesity may well play a role in fibromyalgia and related dysfunction.  Interestingly, in 2008, Alan Saber and colleagues published an article in Obesity Surgery describing a significant improvement in pain score and points of tenderness in patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass surgery. Based on these findings, the authors suggested that weight loss may be an important treatment modality for severely obese patients with this syndrome. Whether or not less drastic approaches to weight management can provide benefits remains to be seen. Nevertheless, there have been reports of limited response to education, exercise, and psychological interventions. Thus, currently accepted non-pharmacological treatments for fibromyalgia remain rather limited. Recently, a Cochrane review concluded that duloxetine is efficacious for treating pain in fibromyalgia and another systematic review found evidence that gabapentin and pregabalin can also reduce pain in these patients.  Nevertheless, fibromyalgia continues to be a common but largely undertreated problem in overweight and obese patients and can often pose a significant barrier to increasing physical activity or modifying ingestive behaviour.  As blogged before, assessment for muskuloskeletal pain should be a regular and essential feature of any assessment for overweight and obesity.  I very much look… Read More »

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Is Belly Fat Bad For Bones?

Regular readers of these pages are well aware that when it comes to health risks, not all fat is bad. We now know that for many conditions like diabetes and heart disease, increased fat deposits inside your abdomen and in organs like the liver, heart or skeletal muscle are the real problem. In contrast, there is increasing evidence that fat deposits under the skin (particularly on hips and thighs) may actually reduce the risk of these conditions. Simply put, it appears that there is good and bad fat – which is why obesity is not all the same and BMI alone is not a good measure of health. It now seems that the same ying-yang of visceral and subcutaneous (sc) fat may also apply to the relationship between obesity and bone health. This notion is supported by data just published in the Journal of Clinical Endocrinology and Metabolism by Vicente Gilsanz and colleagues from the University of Southern California, Los Angeles, USA. Gilsanz and colleagues studied the relationship between sc and visceral adiposity and the cross-sectional dimensions and other characteristics of the femur (thigh bone) in 100 healthy women between 15 to 25 years. After multiple adjustments for leg length and thigh musculature, both sc and visceral fat had strong and independent associations with femoral cross-sectional area, cortical bone area, and various other measures – but in opposite directions! Whereas sc fat had a strong positive relationship to all femoral bone characteristics, visceral fat had a strong negative effects on these parameters – or in other words – sc fat good, visceral fat bad. Although the authors can only speculate on the reasons for this paradoxical relationship between fat depots and bone health, the data clearly suggests that as for diabetes and heart disease, when it comes to the relationship between fat and bone health, the old real estate mantra applies: location, location, location. AMS Edmonton, Alberta

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