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Balneotherapy refers simply to soaking in warm natural spring water (at least 68 [degrees]F/20 [degrees]C and usually about 93 [degrees] F/34 [degrees] C) that contains at least 1 gram of mineral per liter, according to a literature review by M. E. Falagas and Greek colleagues. The water's mineral content varies according to its natural source, with sulfur, mineral salts, and silica being most common. While most people in the US have never heard of balneotherapy, it is very popular in Europe for relieving pain and to treat various disease - particularly in Eastern Europe, Turkey, and Russia.


The 2009 Falagas-led review found that "balneotherapy may be truly associated with improvement in several rheumatological diseases." (This review did not include any studies written in Russian.) According to some studies, patients with rheumatologic diseases and chronic low back pain reported having pain relief for at least three months after treatment ended. The review contains studies from a variety of spas (using different natural springs) as well as simple balneotherapy. Future research needs to pinpoint the factors - such as water temperature, mineral content, and location - that provide the most benefits for specific conditions.

Several small studies (n < 50) have investigated balneotherapy's effect on people with fibromyalgia. A 2002 randomized controlled Turkish study, led by D. Evcik, reported "statistically significant differences in numbers of tender points, Visual Analogue scores, Beck's Depression Index, and Fibromyalgia Impact Questionnaire (FIQ) scores" in the group (n = 22) that received a 20-minute bath, five days per week for three weeks. The number of tender points, Visual Analogue scores, and FIQ still showed improvement from baseline six months later.

In another Turkish study, researchers compared balneotherapy with hydrotherapy and to a control. All 58 patients in this study had fibromyalgia and received physical therapy treatments consisting of transcutaneous electrical nerve stimulation (TENS), ultrasound, and infrared exposure. I could not tell the specific differences between balneotherapy and hydrotherapy from this study's abstract, but hydrotherapy usually refers to water's physical properties (e.g., buoyancy) and does not employ minerals. The researchers assessed pain, depression, respiratory symptoms (dyspnea and spirometric measurements), and quality of life. While people in all three groups experienced less pain and less depression on the scales after three weeks of treatment, only the groups receiving hydrotherapy and balneotherapy showed improvements in respiratory function. The balneotherapy group's improvement was significantly higher; and, unlike the hydrotherapy group, those receiving balneotherapy "had significant improvements for dyspnea scale and spirometric measurements at six month follow up." Balneotherapy has also decreased prostaglandin E2, interleukin-1, and leukotriene B4 in people with fibromyalgia, according to a study led by F. Ardic.

From the studies accessible to English-speakers, balneotherapy apparently benefits people with rheumatic conditions and fibromyalgia. I'd love to gain access to translations of Russian studies that examine the use of this very old therapy.

Ardic F, Ozgen M, Aybek H, Rota S et al. Effects of balneotherapy on serum IL-1, PCE2 and LTB4 levels in fibromyalgia patients [abstract]. Rheumatol. Int. March 2007;27(5):441-446. Available at Accessed October 5, 2011.

Balint GP, Balint PV, Bender T. A brief history of spa therapy. Ann Rheum Dis. October 2002;61(10):949.

Evcik D, Kizilay B, Gokgen E. The effects of balneotherapy on fibromyalgia patients [abstract]. Rheumatol Int. June 2002;22(2): 56-59. Available at Accessed September 13, 2011.

Falagas ME, Zarkadoulia E, Rafailidis PI. The therapeutic effect of balneotherapy: evaluation of the evidence from randomized controlled trials. Int J Clin Pract. 2009;63(7):1068-1084. Available at Accessed September 24, 2011.

Kesiktas N, Karagulle Z, Erdogan N, Yazicioglu K, et al. The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia [abstract]. J Back Musculoskelet Rehabil. 2011;24(1):57-65.


The last thing a person suffering with the pain of fibromyalgia (FM) probably wants to hear is a recommendation to exercise. Yet exercise improves FM symptoms, according to a 2007 Cochrane Review. Researchers are still investigating which combination of aerobic exercise, strength training, and flexibility exercise benefits them the most. One movement intervention unfamiliar to most US researchers is Biodanza, a system that engages body, mind, and spirit. Biodanza uses expressive movement exercises, group interaction, and music (both popular and classical) to elicit feelings and an intense experience of being in the here and now. Chilean medical anthropologist Professor Rolando Toro Araneda, who died in 2010, developed Biodanza in the 1970s as a tool for encouraging integration with self, others, and the universal, and thereby to promote "a sense of renewal." Although largely unknown in the US, Biodanza is a recognized therapy in many South American countries and has spread to Europe and South Africa.

In 2010, a Spanish research team, led by Ana Carbonell-Baeza, PhD, enrolled 59 women with fibromyalgia in a controlled study to compare the effects of Biodanza with "usual-care." Those in the usual-care group were asked to maintain their medications and usual activity level throughout the 12-week study. The Biodanza participants (n = 27) took part in a two-hour Biodanza session once a week. Each session consisted of a 35- to 45-minute period during which participants shared experiences and feelings that arose from earlier sessions and then 75 to 80 minutes of "fairly light exertion" movement/dance, as directed by the facilitator.

All participants underwent a pre- and postintervention assessment that included pain measurements, physical function tests (e.g., 6-minute walk test, chair sit and reach, back scratch, handgrip strength), body fat composition, and several psychological assessments including the Fibromyalgia Impact Questionnaire (FIQ), Vanderbilt Pain Management Inventory, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale. After three months of weekly Biodanza sessions, pain and FIQ scores improved. Patients in the Biodanza group also walked about 30 meters farther in the 6-minute walk test.

Although Biodanza research is just beginning, this intervention has some similarity with dance movement therapy, which has been used in the US for decades. Both interventions use music and movement to affect psychosocial expression. Recently, researchers have begun to investigate these interventions through the lens of neuroscience. For example, a 2005 Korean study showed that plasma serotonin concentration rose and dopamine levels fell after adolescents with mild depression had 12 weeks of dance movement therapy. Biodanza produced a significant increase in antibody IgA levels in a 2009 study. Dr. Marcus Stuck, the lead author of this study, told Chris Bateman, "... the biggest psychological benefits were reductions in stress and psychosomatic complaints, and improved social abilities, 'especially the ability to enjoy all activities of social life.'" I suspect that the healing effects of movement and music on physiology and neurohormone response will gain more recognition as researchers pursue the psychoneuroendocrinologic interplay.

Bateman C Can we dance towards health? SAM. February 2004;94(2): 76-7. Available at Accessed September 24. 2011.

Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL Exercise for treating fibromyalgia syndrome [abstract]. Cochrane Database Syst Rev. October 17, 2007;(4):CD003786. Available at Accessed October 5, 2011.

Carbonell-Baeza A, Aparicio VA, Martins-Pereira CM et al. Efficacy of Biodanza for treating women with fibromyalgia. Altern Complement Med. 2010;16(11):1191-1200. EBSCOhost. Doi 10.1089/acm.2010-0039. Accessed September 24, 2001

A definition of Biodanza [Web page]. August 6, 2008. Accessed October 1, 2011.

Music for Biodanza exercises [blog entry]. Learning lo dance with life. June 2011. Accessed October 2, 2011.

Stuck M, Villegas A, Bauer K, Terren R, Toro V, Sack U. Psycho-immunological process evaluation of Biodanza. / Pedag Psycho/ SiCNUM TEMPORIS. September 20G9-/2UV.99-113. Available at = 99. Accessed October 2, 2011.

Young-la Jeong, Sung-Chan Hong, Myeong Soo Lee, Min-Cheol Park, Yong-Kyu Kim, Chae-Moon Suh. Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression [abstract]. Int I Neurosci. 2005; 115(12):1711 -1720. Available at Accessed October 2, 2011.

Brain Connectivity in Fibromyalgia

Pain, a notoriously subjective complaint, has long flummoxed medical researchers who study it. Why do some people merely experience discomfort during a saline injection, for example, while others feel excruciating pain? Is the pain that people with fibromyalgia complain about as bad as they say, or it is "all in their heads"? For the first time, a 2010 study has provided objective evidence that brain activity in peopie with fibromyalgia differs significantly from that in healthy controls. The researchers used functional magnetic resonance imaging (fMRI) to observe intrinsic brain connectivity, which is the continuous minimal neural and metabolic activity present during rest.

The research team, led by Vitaly Napadow, PhD, decided to focus on two intrinsic connective networks: the default mode network (DMN) and the executive attention network (EAN). DMN refers to interactive brain regions that appear to relate to a sense of self and subjective experience (i.e., self-referential thinking). "In normal individuals, activity in the DMN is reduced during nonself-referential goal-directed tasks, in keeping with the folk-psychological notion of losing one's self in one's work" (Sheline). EAN, located in the frontoparietal area, oversees attention control and working memory. Cognitive dysfunction relating to attention and working memory is a common symptom of fibromyalgia. The researchers used the medial visual network (MVN), which has to do with vision, as a negative control. Visual symptoms are not characteristic of fibromyalgia.

This study involved 36 female participants: 18 patients with fibromyalgia (FM) and 18 age-matched healthy controls. Before the first fMRI scan, patients gauged their pain on a visual analog scale of 0 (no pain) to 10 (the worst pain imaginable). The researchers then collected six minutes of resting-state fMRI data on each participant. By comparing data from the two groups, the researchers learned that patients with FM, unlike healthy controls, "have greater intrinsic DMN connectivity to several brain regions that are outside of the DMN but are known to process evoked pain (the left anterior insula and left middle insula). ..." In addition, the women with fibromyalgia showed more connectivity in the right EAN, particularly to the intraparietal sulcus. Higher pain scores correlated with "increased intrinsic connectivity between both the DMN and right EAN and insular cortex." Depression levels among the patient group, however, showed no correlation to activity in these networks. Left EAN and MVN activity in those with fibromyalgia and in the healthy controls did not differ.

In addition to have greater connectivity, people with fibromyalgia may have hyperactive links between the DMN and the posterior insula, which manages sensory intensity. Proton magnetic resonance spectroscopy studies have indicated that people with FM have elevated concentrations of the excitatory neurotransmitter glutamate in the posterior insula that directly correlate to self-reported pain levels.

Napadow v, LaLount l_, Park K, As-banie b, uauw UJ, Harris RE. Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity. Arthritis Rheum. August 2010;62(8):2545-2555. Available at Accessed September 24, 2011.

Sheline Yl, Barch DM, Price JL et al. The default mode network and self-referential processes in depression. PNAS. February 10, 2009; 106(6): 1942-1947. Available at Accessed October 7, 2011.

CAM Cost Minimization Analysis

A team of researchers, led by Bonnie K. Lind, PhD, at the University of Washington (Seattle), recently published a cost minimization analysis that compared users of complementary and alternative medicine (CAM) with nonusers. This study looked at cost only; it did not evaluate health outcomes or patient satisfaction. All participants in the analysis had health insurance and lived in Washington State. (By state law, insurers must cover treatment by licensed CAM practitioners.) The researchers used 2000-2003 enrollment and claim data from two Washington insurance companies to find 26,466 CAM users with back pain (n = 18,343), fibromyalgia (n = 3722), or menopause symptoms (n = 4401). Patients with these difficult-to-treat chronic conditions often seek alternative therapies. CAM users were defined as those who consulted a chiropractor, naturopathic physician, acupuncturist, or licensed massage therapist for one of the three conditions during the study year.

Since CAM use was self-selected rather than randomly assigned, the researchers matched CAM patients with nonusers who had consulted a conventional practitioner for one of the three indexed conditions during the study year. (The researchers apparently assumed that no conventional providers were practicing integrative medicine or using CAM therapies.) The nonusers were matched to CAM users according to condition, gender, 10-year age group, total allowed expenditures, and disease burden (high, medium, or low) at about a 2:1 ratio (13,025 nonusers). The researchers did not match for income, education, or race.

This study looked at overall health costs for the study year as well as the costs of just treating the indexed conditions. Overall, CAM users had higher outpatient expenses than nonusers but lower inpatient (hospitalization) and imaging/laboratory costs, resulting in a lower average for the study year ($3797 vs. $4153; p - 0.0001). "Given the expected $356 lower expenditure for each CAM user," the authors state, "we would expect an overall $9.4 million lower expenditure in a group of 26,466 CAM patients with these medical conditions compared to a similar group of CAM nonusers of equal size." When they analyzed costs tied solely to an indexed condition, the researchers found that "total average expenditures were slightly higher among CAM users ($588 versus $554, p = 0.04)" compared with nonusers. However, fewer CAM users were hospitalized as part of their treatment for the condition.

This study shows that CAM use for these three conditions actually saves insurers money. Now, researchers need to find a way to track CAM efficacy and patient satisfaction as well.

Lind BK, Lafferty WE, Tyree PT, Diehr PK. Comparison of health care expenditures among insured users and nonusers of complementary and alternative medicine in Washington State: a cost minimization analysis. J Altern Complement Med. 2010;16 (4):411-417. EBSCOhost. Doi: I0.1089/acm.2009.026l. Accessed September 24, 2011.

CAM Interventions for Chronic Pain

When I came across a 2007 review of CAM therapies for chronic pain, conducted by NIH and Department of Veterans Affairs, I expected the usual "needs-more-research" conclusions. Instead, I was pleasantly surprised to find several rated "Efficacious" or "Probably Efficacious." (The reviewers used the Clinical Psychology Division of American Psychological Association guidelines on treatment efficacy to rate the therapies.) Despite the perception that reviews (including Cochrane reviews) provide a reliable overview of a treatment's effectiveness, systematic reviews require subjective judgments throughout the review process. The first hurdle is to decide which databases to search.

For this review, the researchers searched MEDLINE, PsychINFO, CINAHL, and the Cochrane Library for studies published between 1966 and July 2006 that dealt with pain and a specific CAM treatment (e.g., acupuncture, Reiki, supplements). I know that in those earlier years, many CAM researchers struggled to design studies to test treatments for the often unique and individualized modalities characteristic of CAM. They didn't know how to fit acupuncture needling into a placebo-controlled study. Early homeopathy trials, conducted like drug trials, produced lackluster results or failed outright; these trials often failed to use a complete picture of a patient's symptoms, which is the hallmark of homeopathy. Since its beginning in 1998, the NIH National Center for Complementary and Alternative Medicine (NCCAM) has urged practitioners to submit best case studies. Case studies often initiate new avenues for productive research. The agency recognized the difficulty and expense of designing and conducting a randomized, placebo-controlled study - especially for a nonpatentable treatment.

For this CAM review, the researchers included only meta-analyses, Cochrane reviews, and controlled human studies (in English) that used pain severity and/or functional disability as their primary outcomes: "Only those CAM modalities and chronic pain conditions that were the subject of at least one controlled trial were included. ..." Three treatments listed on NCCAM's website - transcutaneous electrical stimulation (TENS), cognitive-behavioral therapy (CBT), and relaxation therapy - were not reviewed "since they are widely used and no longer considered CAM by practitioners." I found the evaluations of two treatments particularly interesting: pulsed electromagnetic fields and hypnosis.

High-powered pulsed electromagnetic field (PEMF) generators, such as a Diapulse Model 103, appear to be very helpful for migraine headaches (but not tension headaches), according to the review authors. Unlike the lower-powered battery-run PEMF generators that can be used throughout the day, the higher-powered generators are usually aimed at each inner thigh for half an hour each (totally one hour per day). The reviewers identified small but impressive studies that support the use of PEMF to relieve migraine headaches. A study involving 11 people with chronic migraines reported that headache incidence decreased from 4.03 per week during the two-week baseline period to 0.43 (during a two-week follow-up) after receiving two to three weeks of exposure to PEMF for one hour per day, five days per week (Sherman, Robson, et al.). A crossover study, conducted by the same researchers, failed because all but one of the people receiving active treatment experienced so much improvement that they refused to cross over (Tan et al.). A 1999 double-blind, placebo-controlled study followed 42 people with migraines for a one-month baseline, two weeks of PEMF or sham exposure, and at least a one-month follow-up. At the first month follow-up, 73% reported having fewer headaches; 45% of them rated it a "good decrease," and 14% rated the decline an "excellent decrease." Ten of the 22 who received PEMF treatment agreed to undergo another two weeks of treatment. All 10 reported fewer headaches: 50% good and 38% excellent (Sherman, Acosta, et al.). A 2001 German double-blind, placebo-controlled study reported that 76% of 41 patients who received PEMF "experienced clear or very clear relief of their complaints" (Pelka et al.). "None of the studies reported negative side effects," say the review authors. "PEMF has now been in use for more than 3 decades and no negative side effects have been reported."

Although we still don't understand why it works, hypnotic treatment - usually consisting of 4 to 10 sessions with a trained hypnotherapist - can relieve chronic pain for months. In addition, hypnotherapists usually teach clients self-hypnosis techniques for controlling pain. The review authors rated hypnosis as being efficacious, saying: "Clinically, hypnosis and hypnotic analgesia has been greatly underutilized. Hypnosis is almost always a benign treatment with very little likelihood of negative side effects. In fact, the 'side effects' that occur appear to be overwhelmingly positive and include a greater sense of control over pain, as well as increased overall well-being and decreased tension, stress, and anxiety."

I suspect that many of the CAM interventions discussed in this review will eventually - like TENS, CBT, and relaxation therapy - become "widely used and no longer considered CAM."

Pelka RB, Jaenicke C, Gruenwald J. Impulse magnetic-field therapy for migraine and other headaches: a double-blind, placebo-controlled study [abstract]. Adv T/ier. May-June 2001;18(3):101-108. Available at Accessed October 8, 2011.

Sherman RA, Acosta NM, Robson L. Treatment of migraine with pulsing electromagnetic fields: a double-blind, placebo-controlled study [abstract]. Headache. September 1999;39(8):567-575. Available at Accessed October 8, 2011.

Sherman RA, Robson L, Marden LA. Initial Exploration of pulsing electromagnetic fields for treatment of migraine [abstract]. Headache. March 1998;38(3):208-213. Available at Accessed October 8, 2011.

Tan G, Craine MH, Bair MJ et al-Efficacy of selected complementary and alternative medicine interventions for chronic pain. J Rehab Res Dev. 2007; 44(2):195-222. CINAHL Plus with Full Text. Accessed September 17, 2011.

Cognitive-Behavior Therapy and Hypnosis

Hypnosis increases the ability of cognitive-behavioral therapy (CBT) to treat pain, fatigue, mood, and functional symptoms associated with fibromyalgia. CBT is regularly used in combination with exercise, medication, and education to treat fibromyalgia. CBT for fibromyalgia employs a number of techniques, including relaxation training, cognitive restructuring therapy, problem solving, behavioral goal setting, communication and assertiveness training, and education about pain perception. Unfortunately, it can take months or longer to see the benefits.

A Spanish research team led by Antoni Castel decided to combine hypnosis, a recognized therapy for chronic pain, with CBT to treat people with fibromyalgia. They designed a pilot study that compared CBT with CBT plus hypnosis and with a control of standard medication management. The small study recruited 47 patients from the university pain unit in Tarragona, Spain. All 47 received standard medication management involving analgesics, antidepressants, sedatives, and muscle relaxants, as needed. The CBT group also took part in 12 90-minute CBT treatment sessions that included 20 minutes of relaxation training. Participants in the CBT-hypnosis group also received CBT, but instead of relaxation training, they had 20 minutes of group self-hypnosis training. As part of the hypnosis therapy, these participants were given the suggestion of "a liquid or blue 'analgesic' stream that filtered through the skin and reached different parts of the body (including muscles, joints, bones, internal organs). The liquid was said to soothe any discomfort in the most affected areas, eliminate tension and create feelings of well-being." The hypnosis group could practice self-hypnosis at home with the aid of an audio CD.

While the results were not statistically significant (possibly because of the small participant number), members in both CBT groups - unlike the control group - showed a decrease in pain intensity compared with baseline pain questionnaires. Participants in the CBT-hypnosis group were the only ones to report a statistically significant reduction in pain. Pain relief measurements in the CBT group were lower but not significantly different from the CBT-hypnosis group. The authors discussed several limitations with this pilot study: the small sample size, the limited range of hypnotizability in the CBT-hypnosis group, the high dropout rate in the control group (8 out of 14), and the lack of long-term follow-up assessments. Nonetheless, this study introduces the possible benefits of combining two do-no-harm therapies.

Castel A, Salvat M, Sala J, Rull M. Cognitive-behavioural group treatment with hypnosis: a randomized pilot trial in fibromyalgia. Contemp Hypn. 2009;26(1):48-59. EBSCOhost. doi: 10.1002/ch.372. Accessed September 23, 2011.

Questions About Glyphosate (Roundup)

In January 2011, plant pathologist Don Huber, PhD, emeritus professor at Purdue University, sent a letter to US Secretary of Agriculture Thomas Vilsack asking him to postpone approval of Roundup Ready (RR) alfalfa. RR alfalfa is genetically modified to withstand the herbicide Roundup. Huber's concern is not the genetic modifications, but rather the increased use of glyphosate, Roundup's active ingredient, which accompanies RR crop production. Most herbicides combine with one necessary mineral, making the nutrient unavailable to the plant for key enzyme processes. Glyphosate, however, attaches to and immobilizes several important nutrients, including zinc, calcium, magnesium, copper, iron, manganese, and nickel. By depriving plants of vital minerals, glyphosate cripples their immune systems, leaving them vulnerable to invasion from soil-borne bacteria and fungi. Crops genetically modified to survive glyphosate have alternate enzyme pathways. Still, GM crops absorb glyphosate and store the herbicide in their roots, shoots, legume nodules, and reproductive sites - just like normal plants. The use of glyphosate affects the nutritional status of RR soybeans, according to a 2010 study led by Brazilian Luiz Henrique Saes Zobiole in which Huber took part, reducing both total micronutrients and macronutrients. Given the widespread use of glyphosate in animal feed and human food, a decrease in mineral nutrients is troubling.

Unfortunately, glyphosate's ability to immobilize necessary nutrients is only a fraction of the problem that concerns Huber. As he explains in letters to Vilsack and to EU President Jose-Manuel Barroso and members of the European Parliament, "... we are experiencing a large number of problems in production agriculture in the US that appear to be intensified and sometimes directly related to genetically engineered (GMO) corps, and/or the products they are engineered to tolerate - especially those related to glyphosate (the active chemical in Roundup herbicide and generic versions of this herbicide)."

Huber is particularly concerned about the spread of Goss's wilt of corn, sudden death syndrome of soybean, and "an increasing frequency of previously unexplained animal (cattle, pig, horse, poultry) infertility and spontaneous abortions." While glyphosate is not directly responsible for these problems, Huber hypothesizes that widespread use of the herbicide has allowed a "newly-recognized" microorganism to infect crops and, in turn, animals that eat them. He asserts in these letters and in an interview with ACRES U.S.A. that veterinarian researchers, using Koch's postulates, have tracked previously unexplained livestock infections to a microorganism present in soy and corn feed.

The scientific community has castigated Huber because no published data about this microorganism exist. Huber told AC Professional contributing editor Jim Ruen, "My credibility may take a blow, but I felt the situation was serious enough that I didn't have a choice but to ask for help. ... Alfalfa has a bacterial wilt also, and if the relationship with glyphosate, the new pathogen and Goss's wilt holds up, it could be devastating for alfalfa producers and livestock producers alike. ..." He is working with a group of scientists to gather data that support or negate his hypothesis.

In addition to immobilizing mineral nutrients and opening the door for microbial crop invasion, glyphosate use has several other negative effects. It is toxic to earthworms and to soil organisms that help plants absorb nutrients. It reduces photosynthesis and increases the plant's susceptibility to drought. Glyphosate accumulates in soil and plants. It is not biodegradable, but it can be rendered inert with the addition of soil cations such as calcium, cobalt, copper, iron, magnesium, manganese, nickel, and zinc. Huber's informative article "AG Chemical and Crop Nutrient Interactions - Current Update" gives a good picture of current knowledge about glyphosate's effects.

"Genetic engineering is a tool we may need for specific situations," Huber said in his ACRES U.S.A. interview, "but it's also been easy to abuse. I believe that when we start putting all of our eggs in one basket, it increases our vulnerability and potential risk factors dramatically. I believe we should try to follow scientific principles and use a lot of caution until we understand what's going on in the whole process."

Huber DM. AG chemical and crop nutrient interactions - current update. Proceedings Fluid Fertilizer Forum. Scottsdale, AZ; February 14-16, 2010;27. Available at = 7213. Accessed September 24, 2011.

--. GMOs, glyphosate & tomorrow [interview]. ACR[pounds sterling]S USA. May 201 1;41(5). Available at Accessed October 3, 201 1.

--. Scientist warns US and FU administrations of glyphosate-caused crisis in agriculture. March 31, 2011. Available at Accessed September 24, 2011.

Ruen j. Glyphosate controversy requires research to resolve. AG Professional. April 15, 2011. Available at Accessed October 9, 2011.

Saes Zobiole LH, Silverio de Oliviera R, Huber DM, et al. Glyphosate reduces shoot concentrations of mineral nutrients in glyphosate-resistant soybeans. Plant Soil. 2010; 328:57-69. Available at Accessed September 24, 2011.

Low-Normal Iron Levels and Fibromyalgia

Usually, we associate iron deficiency with anemia. Yet, before anemia appears, other symptoms arise, including fatigue, poor endurance, a depressed affect, and muscle pain. Sounds like fibromyalgia, right? While no one is claiming that a low iron level is the underlying cause of fibromyalgia (FM), a team of Turkish researchers decided to see if the two are linked. In addition to the overlap in symptoms, "iron is essential for neurotransmitter synthesis," O. Ortancil and colleagues write. People with fibromyalgia are known to have lower neurotransmitter concentrations (dopamine and serotonin) in their cerebrospinal fluid. Also, the researchers were inspired by studies that associate low-normal ferritin (iron-containing protein) levels with restless leg syndrome (RLS) - "another disease in which the dopaminergic system is involved." In a small study led by S. T. O'Keeffe, oral iron supplements reduced RLS symptoms in elderly patients who had low normal serum ferritin levels at baseline. The lower the baseline level, the greater their response to treatment.

The Turkish researchers enrolled 46 women with fibromyalgia and 46 age-matched healthy women, who formed the control group. The mean serum ferritin level in the FM group was 27.3 [+ or -] 20.9 ng/ml, compared with a mean of 43.8 [+ or -] 30.8 ng/ml (p - 0.003) in the healthy group. (The normal range at their laboratory is 13-150 ng/ml.) Since RLS and depression have been linked to low ferritin levels in other studies, the Turkish researchers excluded data from 13 patients with Beck Depression Inventory scores greater than 10 and from 6 patients with RLS before performing a second analysis. This time, mean ferritin level in the FM group was 30.8 [+ or -] 20.9 ng/ml. The difference between the FM group and the control group was still statistically significant (p = 0.035). After removing the patients with depression and RLS, the researchers concluded that "having a serum ferritin level <50 ng/ml caused a 5.9-fold increased risk for FMS (P = 0.011)."

While this small trial is certainly not conclusive, it does open the door to the possibility that oral iron supplements might reduce fibromyalgia symptoms. Iron supplementation should be supervised by a physician, because iron can build up in the body and cause organ damage, according to the NIH Office of Dietary Supplements (

O'Keeffe ST, Gavin K, Lavan JN. Iron status and restless legs syndrome in the elderly. Age Ageing. May 1994;23(3):200-203. Available at Accessed October 9, 2011.

Ortancil O, Sanli A, Eryuksel R, Basaran A, Ankarali H. Association between serum ferritin level and fibromyalgia syndrome. Eur J Clin Nutr. 2010;64:308-312. EBSCO. doi 10.1038/ejcn.2009.149. Accessed September 23, 2011.

briefed by Jule Klotter
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Title Annotation:balneotherapy; biodanza, an exercise for fibromyalgia; physiology of fibromyalgia
Author:Klotter, Jule
Publication:Townsend Letter
Geographic Code:1USA
Date:Dec 1, 2011
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