Your Guide to Metabolic Health
Your Guide to Metabolic Health
IN THE LAST CHAPTER, WE wrote that you must identify the symptoms you want to free yourself fromthe symptoms you suspect your slow metabolism is causing. After identifying them, you must estimate their intensity at intervals. How often you estimate the intensity of your symptoms will depend on your intention.
If youve never eaten a wholesome diet, taken nutritional supplements, or exercised to tolerance, you may want to first measure how much these practices alone reduce the severity of your symptoms. Monitoring the severity blood pressure with an instrument (called a sphygmomanometer), however, shows that it is indeed high. Without the knowledge gained from measuring, Dr. Reichman wouldnt know to adjust his patients treatment so that her blood pressure becomes normal. And without a record that shows the course of his patients blood pressure over time, Dr. Reichman couldnt intelligently guide the patient in her treatment.
Consider this example: Janes blood pressure was 144 over 98 until she stopped putting salt on her food. A week after she stopped the salt, her pressure went down to 135 over 95. The next week it dropped to 128 over 90. Since then, its been 118 over 78. From this description, we know that Janes blood pressure went down. But we dont have a clear picture of how it happened. Now, compare your impression of the improvement in Janes blood pressure with what you get from the line graph in Figure 1. The line with the symbol shows the changes in her systolic blood pressure during each of the six weeks. The line with the symbol shows the diastolic pressure during each week. The two lines are what we call trend lines. Looking at the trend lines gives us a clear view of Janes improvement over the six-week time frame.
The clear view that line graphs provide can have quite an impact on helping you to solve a health problem. Well illustrate how in the example below.
A TYPICAL HYPOTHYROID PATIENT
Here well describe the use of scoring and graphing by a hypothetical patient as she goes through metabolic rehab. Well call her Mary, although her story is a composite of several patients experiences. Mary is hypothyroid. Her main symptoms are depression, disturbed sleep, and widespread pain. One doctor told her that her depression was the cause of her other symptoms. But a year of treatment with several different antidepressants didnt improve any of her symptoms, including her depression. Another doctor diagnosed her pain as fibromyalgia, but six months of treatment with amitriptyline and cyclobenzaprine didnt help at all (see Chapter 11, section titled Antidepressants as Sleep Aids).
Finally, Mary came under the care of a naturopathic doctor in her hometown in New Hampshire. At the same time, she consulted me (GH-L) long distance at our Boulder, Colorado Center for Metabolic Health. I agreed to work long distance with her and her naturopathic doctor. I diagnosed hypothyroidism, and her naturopathic doctor agreed to prescribe desiccated thyroid and to examine her at intervals. I taught Mary to make her own graphs to help guide her therapy. I also advised her to find a chiropractic doctor or therapist to evaluate her for physical sources of pain, such as trigger points or spinal subluxations.
Mary had tried for years to overcome her symptoms with lifestyle practices. She maintained a wholesome diet, took a wide array of nutritional supplements, and exercised regularly. Because she was already doing these metabolism-regulating practices, I expected her to have an uncomplicated recovery by using the desiccated thyroid.
Mary got her baseline symptom scores and posted them to her line graph before she began to take desiccated thyroid. Then she started taking 1 grain (60 mg) of desiccated thyroid at the beginning of the second week of her self-monitoring. Figure 2 shows what her graph looked like at the end of the first month.
The trend lines suggest that after her third week taking the thyroid hormone, all three of her major symptoms (depression, disturbed sleep, and widespread pain) were improving. She was keeping a diary of her subjective feelings about her symptoms, and the diary reflected what the trend lines showed. She said she felt a little less depressed, was sleeping a little better, and that her pain wasnas severe.
At the end of the fourth week, Mary increased her dose of desiccated thyroid to 2 grains (120 mg). She continued to assess her symptom severity with her three symptom scales, and she continued posting the scores to her graph. Her 2-grain (120-mg) dose apparently was effective for her.
Marys graph suggests that by the end of eight weeks (see Figure 3), she had made substantial improvement. The trend line of her pain scores, however, suggests that the severity of her pain had reached a plateau. But a temporary leveling off of a trend line isnt unusual. When I asked Mary about physical treatment, she said she hadnt yet been able to find a doctor or therapist to evaluate her.
She promised to diligently search for one.
I recommended that she contact Richard Finn, Director of the Pittsburgh School of Pain Management in Pennsylvania to get a referral to a certified myofascial trigger point therapist (see Resources). Richard referred her to a therapist who practiced twenty miles from her. Fortunately, the therapist practiced in the same clinic as a chiropractic doctorthe therapists wife. Unfortunately, both of them were on vacation, but Mary made an appointment for two weeks in the future.
At the end of the two weeks, but still before her appointment (look at weeks 9 and 10 in Figure 3), the trend lines show something weve often observed. Weve seen it so often that weve described it in publications on fibromyalgia. When a patient has a physical problem thats causing pain, and she doesnt get effective physical treatment to relieve the problem, her pain scores wont improve beyond a certain leveleven though her metabolic treatment is improving her other symptoms. In addition, her other symptoms will improve only to a certain level; then the improve ment levels off and wont get any better. But as youll see below, when the patient gets appropriate physical treatment, her pain and other symptoms continue to improve under the influence of the metabolic treatment.
At the end of the 10th week, the trigger point therapist and the chiropractic doctor evaluated Marys muscles and spine. The therapist found multiple trigger points in the muscles of Marys neck and upper back, and he began treating these. The doctor found subluxations in Marys cervical and thoracic spinal areas and she adjusted them.
After the combined treatments, Mary felt immediate and profound relief from both pain and tension. She underwent the combined treatments three times a week for the next two weeks. The benefits are reflected by the trend lines in her graph over the next four weeks (weeks 11, 12, 13, and 14) shown in Figure 4.
At the end of the 15th week, Mary increased her dose of desiccated thyroid hormone to 2.5 grains (150 mg). She did this because her symptom status, although dramatically improved, had leveled off again, and the extra grain (30 mg) was calculated to be enough to totally relieve her symptoms. This indeed happened, and she was released from treatment after 18 weeks. Its now been two years, and Mary continues to maintain her full recovery.
More Than Graphing
Marys line graph was instrumental in helping her fully recover. Had she not seen the leveling off of her trend line for pain, she might not have appreciated the importance of getting physical treatment. And without seeing her three trend lines level off after the 12th week, her substantial improvement may have caused her to mistakenly think she had improved as much as she could. She obviously had more improvement to come, and she got it with a slight increase in her thyroid hormone dose.
What we said in the previous paragraph bears repeatingthat Marys graph was instrumental in helping her fully recover. This is what graphs are supposed to do: help. The trend lines in the graphs shouldnt alone dictate what treatment decisions the patient and her doctor make. The patient and her doctor should also calculate their subjective judgments into their treatment decisions. Just as Marys naturopathic doctor made progress notes on her status each time he saw her, Mary also made notes in her diary. And, she recorded the dates that she wrote the notes. Its important for all patients undergoing metabolic rehab to maintain diary notes.
This is because its too easy for a patient to forget exactly how she felt even a couple of days ago, a week ago, and especially further back in time. Usually, the patients subjective judgment of how shes doing corresponds pretty closely to what her graphs show. Unfortunately, the patientlike all of uswill occasionally have a bad day. On that day, shes likely to misjudge how much progress shes made since she began treatment. In fact, some patients who are nearly well will swear on bad days that they havent improved a bit! Looking at the graphs and reviewing ones diary notes can effectively bring ones judgment closer to reality.
In summary, heres the process you need to follow to guide yourself to recovery:
Select the symptoms of slow metabolism you want to eliminate.
Label a severity scale with the name of each symptom (see Forms).
Decide how often youre to reassess your symptoms.
Post your symptom scores to a line graph (see Forms).
Decide what metabolic therapies and lifestyle practices you must include in your regimen of metabolic rehab. Read the chapters on the different therapies and lifestyle practices so that you understand them and can use them effectively.
Commence your treatment program and reassess the severity of your symptoms at regular intervals.
If the trend lines in your graph descend, indicating improvement, and your diary notes reflect the improvement
indicated by your graph, continue with your current treatment regimen.
If the trend lines dont indicate improvement, and this corresponds to your diary notes, troubleshoot your treatment regimen to figure out why youre not improving.
Re-read any chapters about therapies and lifestyle practices that you may not fully understand or may not be
If youre stumped, see Chapter 15, Troubleshooting. If you decide you need help, well be happy to hear fromyou and help get you on the right track. In most cases, we can do this through long-distance consulting ( see Resources).
# For extensive information on monitoring metabolic status and
using graphs to guide treatment, see Chapter 5.2, titled Treatment Protocol, pages 937-979 in The Metabolic Treatment of Fibromyalgia.