29: Fibromyalgia: What If Everything You Know Is Wrong? with Rashpal Rai [ASK DR. ANNA]

Fibromyalgia is one of the most misunderstood and debated conditions in medicine — but for the millions of people living with it every day, the suffering is very real. In this episode of ASK DR. ANNA, Dr. Anna sits down with Rashpal Rai, a fibromyalgia patient from the UK who turned her own painful journey into a thriving community support group for others living with the condition.

Together they break down what fibromyalgia actually feels like from both a medical and lived experience perspective, why the diagnosis is so often missed or dismissed, and what a realistic, hopeful path forward actually looks like.

Listen in to learn:

• What widespread pain, deep fatigue, brain fog, unrefreshing sleep, and sensory sensitivity really feel like day to day
• Why fibromyalgia is best understood as nervous system sensitization — the pain volume turned all the way up, not a sign of weakness
• Common conditions that often accompany fibromyalgia including obesity, IBS, headaches, and mental health challenges
• Why movement gets harder, how flares happen, and how to avoid the crash and burn cycle
• The role of depression, grief, identity loss, and trauma — and how to find the right therapy fit
• A realistic multimodal plan combining medication and non-medication tools that can evolve over time
• Gentle movement options including yoga, tai chi, swimming, walking, stretching, and physical therapy
• The 80% rule for pacing yourself and building strength without triggering setbacks
• How Mediterranean-style eating supports diet quality, digestion, and sustainable weight management
• Low energy food strategies using frozen and canned whole foods, simple meals, and knowing when to ask for help

Check out Rashpal's community on YouTube  @fibrowellbeing-club and Dr. Anna's resources linked below — and if you know someone living with fibromyalgia, this episode could make a real difference for them.

👉 Join my next FREE WEBINAR: https://www.annapleetmd.com/live-webinar1

🎙️ Follow the Podcast from wherever you listen:
• YouTube: https://www.youtube.com/playlist?list=PLZ2sK9BzXjBajuP3hLURBrGqroEMj9ECy
• Spotify: https://open.spotify.com/show/7zfUrIJaq9xNEv0Ym1cKK5
• Apple Podcasts: https://podcasts.apple.com/us/podcast/ask-dr-anna-weight-loss-after-50-made-simple/id1878834328
• Amazon Music: https://music.amazon.com/podcasts/fb6cde97-8c99-4278-a94f-df544a38905d/ask-dr-anna-%E2%80%94-weight-loss-after-50-made-simple

💫 Free Downloads:
• Get your FREE copy of The Perfect Meal Formula E-Book here [PDF Download]: https://annapleetmd.kit.com/pmf
• Get your FREE copy of The Grocery Shopping Guide here [PDF Download]: https://annapleetmd.kit.com/grocery
• Get your FREE copy of 100+ PMF Meal & Snack Ideas Guide here [PDF Download]: https://annapleetmd.kit.com/100ideas

💫 Free Masterclass:
• Watch the FREE Masterclass: RECIPE ANALYSIS - Learn if ANY Recipe Is Good for You : https://annapleetmd.kit.com/getrecipemasterclass

💫 Connect With Me:
• YouTube: https://www.youtube.com/channel/UCapta3PYCN2V4NQetFDnm-A
• Facebook: https://www.facebook.com/annapleetmd
• TikTok: https://www.tiktok.com/@annapleetmd
• Instagram: https://www.instagram.com/annapleetmd/

Tags:
#annapleetmd #mediterraneandiet #weightloss #weightlosstips #weightlossdiet #weig...

Transcript

Why Fibromyalgia Is Debated

SPEAKER_00 0:00

If you feel pain all over your body, muscles, joints, even your skin, or you're exhausted no matter how much you sleep, or you have constant headaches or gut issues that no one can fully explain, well, you may have heard of the word fibromyalgia, or maybe your doctors haven't used that word at all. Now, here's what's interesting: fibromyalgia is one of the most debated diagnoses in medicine. Some doctors are skeptical, it's even a distinct condition. But here's what isn't debated: the symptoms are real. They are debilitating. And for the people living with them, answers are really hard to come by. Now, I recently sat down with Rajpal Rai. She's a fibromyalgia specialist in the United Kingdom. And what struck me most was how central lifestyle is to managing this. Sleep, movement, stress, nutrition, the things I talk about on this channel every single day. So whether you have a fibromyalgia diagnosis yourself or you're just someone whose body is in pain constantly and no one has given you a clear answer for it, I think this conversation will give you a framework and honestly, a lot of hope. Listen in.

Meet Rashpal Rai And Dr Anna

SPEAKER_01 1:07

I'm really happy to say that today I'm joined by Dr. Anna Pleat. Dr. Anna, would you like to introduce yourself?

SPEAKER_00 1:13

Sure. Thank you, Rosh Val. This is an exciting day. We're gonna have a good conversation about fibromyalgia and what it means for people in their health overall. I'm a medical doctor. I practice in the US. I was trained over in Italy, and primarily what I do is I work with adults over the age of 50 on whole health, especially targeting healthy weight loss. And I work with people in all aspects of other diseases that they're dealing with. But my focus and my specialty really is in medical nutrition. I got a nutrition degree before I started my medical career. And it is a big passion of mine. So, Roshpa, when you reached out to me that you wanted us to have a conversation about the healthy approaches to fibromyalgia, I was thrilled because this is a big topic that people don't really know that much about. So we're gonna have a great time today. And Rashbal, um, because I'm also sharing this as well with my audience, I want you to please introduce yourself to those who don't know you.

SPEAKER_01 2:12

Okay, yeah. So my name's Rashpal, and I'm a certified well-being coach with nearly 20 years experience supporting people to improve their quality of life despite the challenges that they're living with. But personally, I've also lived with fibromyalgia and asthma, and I've lived with those conditions for decades. So that has really informed a lot of my well-being work because I can see it from the inside. I understand what it's like to manage symptoms every single day of your life, the problems it can cause, and the opportunities that come up with that as well. So my YouTube channel focuses on helping people live well with fibromyalgia and chronic fatigue syndrome, and not just manage symptoms, but I showed them how I showed people how to build a good life that actually works around the conditions as well.

SPEAKER_00 3:03

That's amazing. And I'm so glad that we're able to have this conversation because you're not only a practitioner of this topic, you have the lived experience. And that is something very unique and precious in the health space that people are both teachers of their own experience. And you can bring an angle to this conversation, I think, that very few people can.

SPEAKER_01 3:25

So absolutely, that's right. Yeah, because there aren't many people who are also coaches or have got that professional experience of training people on how to keep themselves well on YouTube. There are many channels that are run by doctors and many that are run by people who struggle with the conditions, but it's difficult to find something with both. And I think in your case as well, it's difficult to find a doctor who's so open to alternative approaches and looks closely at dietary nutrition as well. So that's going to be really interesting for us to look at

Pain Fatigue Brain Fog Explained

SPEAKER_01 3:55

today.

SPEAKER_00 3:55

Let's talk about fibromyalgia in general, because I think it's safe to say not everybody knows exactly what that means. Maybe they've heard the term and it's kind of a fancy sounding word. But for those of you listening who are curious about fibromyalgia, you're not really sure what it is, Roshwell, I guess start us off by telling us what people typically experience who have fibromyalgia. Like what is it like to have this condition?

SPEAKER_01 4:20

Okay, so fibromyalgia, the dictionary or the medical definition, is it's a long-term condition, which currently has no cure. Um, so the condition itself, the main symptoms are pain, and that can be all sorts of different types of pain. It can be aching, sharp pains, it can be tendon pains, and that pain can come and go and move around the body. There's also deep fatigue that doesn't really go away with rest. Um, also, you can experience brain fog, so that's difficulty concentrating or focusing. Sometimes your body can be quite active and have energy in it, but your brain just cannot think. So, and often sleep isn't restorative. So, those are the main symptoms that come with fibromyalgia, so widespread pain, sleep, um, deep fatigue, brain fog, poor sleep, and then this sensitivity as well, which is one that not many people talk about. And that sensitivity to everything around you, it can be sensitivity to foods, it can be sensitivity to noise, to light. So, basically, when you become fatigued, you become very sensitive to whatever is happening around you. So, say for example, if I wanted to go to the shops, I would go at the quietest time possible because if I went at a busy time, I'd be overwhelmed in minutes. I have to wear earbuds and maybe dark glasses, just to keep myself okay enough to be able to move around in a public place like that. Some days are better, some days are worse. And that is one of the most difficult parts of fibromyalgia, is that it's so unpredictable. You don't know when you get up in the morning, probably fatigued, you don't know how that day's going to go. So you could have had a fantastic day yesterday, and you wake up the next morning and you're riddled with pain and fatigue. And it's the unpredictability that makes it very difficult to live with, and it can really impact your moods as well. On a day-to-day basis, what it feels like is when you do something, you feel more tired than you would have done before. And maybe you are talking to someone, and just having that conversation is absolutely exhausting. You're fine during the conversation, but when you leave it, you just want to close your eyes and sleep. You could be having aching pains one day, a sharp pain the next day, or you can go several days with one particular pain in one place, but it just comes and goes, and you can't put it down to anything. That's the difference with fibromalgia pain. You can also experience headaches on some days, and your eyes often want to close. So that's when I know I'm getting very tired, or I've done something that might have overexerted myself. I just want to close my eyes. Your motivation and focus, because of all of these symptoms and this daily experience, your motivation just goes out of the window. You can plan your day, the day ahead, and you wake up and it just you can't do anything, you can't function that day. So that can be very difficult to live with when you can't plan your life as well. So your moods can dip. Some people with fibromalgia do struggle with depression, and I have struggled with it on and off as well, quite a bit. So that's basically what fibromalgia feels like to live with. And then there are a whole set of other symptoms that, again, nobody talks about, which will be unique to you. At its core, fibromalgia has been shown to be a nervous system problem now. Research has now pinned that down to say that our nervous systems are sensitized. So it's not that they are sensitive, it's just that they've been through so much and they react quickly and more extremely to anything that happens around us. So if somebody shone a light in your eyes and you haven't got fibromalgia, you'd be fine for a moment. But if they shone it in my eyes, I'd feel it a lot more. Probably a better example is a pain that someone without fibromalgia might rate a four out of ten, I would feel as a seven or eight out of ten. And again, that's not me being weak or someone with fibromalgia being weak. It's just that our nervous system is more sensitive in the first place. And that's a really important thing to know because for many years people thought fibromalgia wasn't a real condition. I've had doctors and professionals tell me that it's depression, it's not five, it's not a real disease. But now it's been proven to be a real disease as well. And fibromalgia can have a real impact on your day-to-day life. It can impact your income, it can impact uh what you can do. For example, I couldn't work, so I had to create my own business so that I could have flexible hours around that.

SPEAKER_00 9:23

Roshpal, thank you for sharing your experience. I I'm sure it's actually not that easy to talk about because these are sensitive things that you've experienced in your life. But what you said hits really the nail on the head. It really covers the entire array of what somebody with fibromyalgia is going to experience.

Nervous System Sensitization And Comorbidities

SPEAKER_00 9:41

So to think about what's the technicalities of this. So, medically speaking, we start, we've started to understand a little bit more of what is leading to somebody having a diagnosis of fibromyalgia. But deep down, is there a specific cause that has been absolutely determined? No. And that's what makes this really difficult for people. How we classify somebody who has fibromyalgia is the following. It can be starting from anywhere, spreading to anywhere. It can be issues with their sleep, as Rashpa was telling us, and excessive fatigue. That's pretty much the criteria that most physicians around the world are going to use to diagnose someone with fibromyalgia. And the challenging thing, as Rashpa, you were telling us, is that there's a lot of other aspects of our health that are affected by fibromyalgia, and that fibromyalgia will affect. So what are we talking about? Well, it's all these comorbidities. Like you were talking about, there are often people who have other areas of their health that are going to get affected. So it's not just all of the symptoms, but what I've realized through my medical work is that people with fibromyalgia often don't just have fibromyalgia. And actually, what's crazy is the research completely backs this up. I was looking this up before our conversation. The most recent data that I could find is that more than 80%, and this is around the whole world, more than 80% of fibromyalgia patients have at least three other physical comorbidities, meaning other conditions or diseases that they get diagnosed with. And almost half, so nearly 50%, have at least three mental comorbidities. So what you're already dealing with, if you're sitting here saying, I have fibromyalgia, or I think I might ask yourself as well, what else is going on in my health? If there's a lot of other stuff going on that is actually pointing towards it, this might be happening for you. Now, which comorbidities are we talking about? And this is the part of the conversation that I'm really most excited to dig into today with you, Rush Bell, because I think this is not addressed. It's not just that you have any random comorbidity, meaning you don't just have any random other diagnosis that comes your way. There are some specific ones that we see over and over, primarily obesity. And there's a lot of reasons for this. So data, I looked this up as well, the most recent I could find. In the people who have fibromyalgia, about 35.7% of them also have obesity. And in my country, the United States, it tends to have even higher rates than in other countries around the world. Now, you might be listening to this thinking, hmm, how does that compare to in general how many people have obesity? Well, that is a higher rate than the general population. And the tricky thing is, it is not clear if obesity is a cause of fibromyalgia or a consequence. It's easy to paint the picture, and I'm sure Rashpal, you can understand you're in a community of people, or really you've created a community of people who have this condition and you're able to interact with them all the time. I'm sure many of your listeners on YouTube are dealing with being overweight or obese. And there's lots of classic consequences of that in and of itself, like having joint pain. And so if you have a condition that causes pain, and then being overweight or obese can worsen pain, that's like a double whammy. So that can make it really, really, really tough for someone to then target some of the things they need to do to help treat this, which we're going to talk about later, things like exercise.

SPEAKER_01 13:24

You raised some really good points there, because I have at least two other physical conditions as well as a couple of mental health conditions as well. So I absolutely agree with that. And part of that is the burden of living with a chronic health condition in the first place. So not just with fibromyalgia, I think that other chronic illnesses like RA, arthritis, etc., you can also develop other illnesses.

Mobility Loss Overdoing It And Flares

SPEAKER_01 13:48

With fibromyalgia specifically, your movement does become greatly impaired. So you might have been someone who goes to the gym and suddenly you're exhausted every single day and you can't even get up someday. So the movement and your routines have suddenly changed completely. When I first was diagnosed with fibromalgia, I was bedwicking for almost three months, and I had so much pain in my body that I literally could not move my arms and legs and I'd crawl to the bathroom once a day. So, but and it can be that experience for a lot of people. And you can just imagine now if you're bedround for any period of time, your muscles are going to weaken as well, and you are going to really struggle with your mobility when you try to start moving again. So, this is one of the reasons when you're first diagnosed and you don't know what's going on. We tend to think I've got pain, therefore I must rest my body. So, and that's perfectly normal, but then you start to realize actually this pain isn't going away. And that's when doctors will start looking at kind of the cause for that pain. So, yeah, movement is a real issue. The other part of movement for people with fibromalgia is that we if we over-exercise, we can flare. And a flare is something where it's a time or a couple of days or maybe a few weeks where your all your symptoms suddenly rise and they're more extreme. So when you have fibromalgia, you're constantly worried about flaring. So the exercise, if you try to exercise, and we have all the will in the world that we want to do these things, and we try them, and then we feel terrible for the next day, and it can take us weeks to recover from that. So there's a lot of uh parts to the movement piece of how fibro affects you.

SPEAKER_00 15:40

That is so tricky because the thing that you know overall will probably make you feel better in in the short term, might make you feel worse, and that's going to be a big barrier for a lot of people. What's very tricky about fibromyalgia, and this is what I see clinically, kind of on the more diagnostic side, is it might first show up as a specific pain condition that doesn't necessarily point towards full fibromyalgia. So it can present, like some people might have digestive issues. So IBS, we see this really commonly, different types of headache disorders, tension type headaches or migraines, chronic low back pain, it could look like. It could be pelvic pain, especially in women. There's a lot of different organs in our pelvic region, especially our reproductive organs, that often can lead to pain in other aspects, uh, whether you're still in your reproductive years, whether you've already gone through menopause. So it can actually be tricky to diagnose. So if you're going to your doctor and you feel like you have a lot of different types of pains and they're kind of coming up at different time points and you don't know if they're related, it can be just as tricky for your doctor to figure it out, right? So it's it's also about us trying to connect all the pieces together. And that is why when we think about the treatment stuff, which we'll talk about at the end, we have to think really holistically. We have to think really full body when we try to start addressing some of these things. So before we even get to any of that treatment stuff, I want to spend a couple more minutes, Rosh

Depression Trauma People Pleasing Perfectionism

SPEAKER_00 17:14

Bell. And I know you'll be able to talk in a lot more detail about the mental health side of it. Because people think of fibromyalgia, I think at first, as a physical condition, because you physically have all this pain, you physically have all this fatigue, you have the sleep disturbances, but there's such a strong connection between depression and fibromyalgia. I've seen this as well in my clinical work. Depression is definitely the most common mental comorbidity. So I'm hoping you can just talk a little bit about that part.

SPEAKER_01 17:48

Yeah, and sometimes people might come to fibromyalgia through depression because they mirror a lot of the symptoms as well. So you can get pain and fatigue and that feeling of not being able to rest properly with depression as well. So, from a point of view of getting fibromalgia, obviously, when you're living with that condition, what happens is you're over overnight almost, once you learn what fibromyalgia is, and once you learn that there's no cure, first of all, your hope is taken away. And there's almost like a grieving process that everyone goes through. So you realize that I can't live the life I used to live, I can't do the things I used to do. Who am I now? So there's a big loss of identity peace, and that impacts anyone's uh mental health. But when you're dealing with the day-to-day difficulties and discomfort as well, and your mood drops and your energy drops, it's much easier for your hormones and your brain chemicals to all work differently, and you're just not getting the serotonin that you would normally get, you're just not um finding the joy in life that you would be able to find normally, because life is pretty depressing, especially when you're first diagnosed. Once you've been living with it for a while and you, I almost want to say used to the condition, you understand that this is your life now, and that's when you start adapting. So that's when things start picking up again. And that's what I try to talk about all the time how we can get to that stage more quickly. But with mental health, I actually had depression before I had fibromyalgia. So there is a certain personality type that tends to come with fibromyalgia. And it's not 100% for everybody, but generally people with fibromyalgia tend to have had some sort of trauma, particularly in their younger life. They tend to be people who think about others a lot, to the verge of to the point of um being people pleasers and or perfectionists, we tend to be overworkers as well. So if that sounds like you, it may be something that you know you might be leaning towards fibromyalgia as well. So that's been researched and proven that there is a certain personality type, but it's not 100%. So, but with most of the people I've talked to, that's what I have found as well. We've always been able to track back. So I realized that my mental health was a big factor that was impacting my physical health. I had fibromalgia, but one of the things that was keeping it going and making it worse was my mental health and my stress levels. So early on, I tried some therapy, and this is really a life journey because you what your first experience of therapy is at one level, and then years later I went through another experience of therapy, and that went a little bit deeper. Uh, I'll be honest, a couple of years ago I went through therapy against CBT, and it actually made things a little bit more difficult for me. And that can happen with therapy, you need to find what works for you. But I do recommend getting some sort of therapy, especially if you have had some trauma in your past or are currently going through a difficult, stressful life. And again, after that round of therapy, I had trauma therapy, and that was the thing that really changed me. I think with when I mentioned the personality type, it got me out of breaking those habits of wanting of wanting to please people, wanting to think about others all the time, and I got to really focus on myself. Now, bear in mind I've had this condition for 26 years, and I've been working on my wellness throughout. But that mindset shift of really saying that actually I'm really important, I'm worth focusing on, and I'm worth looking after. And if I don't do that, everybody around me is not gonna be great either. That shift really only just happened two years ago, and it was life changing for me. My anxiety disappeared. My depression calm down slowly. I have to full disclosure, I am on antidepressants, and I will keep taking them because they are enabling me to live my life uh well and function well and maintain my physical health. So these are things that we need to look into. One, because the condition is difficult to live with anyway, and two, because there might have been something going on before you actually got the condition that would mean that your mental health needs to be looked at.

SPEAKER_00 22:29

Roshwell, thank you for sharing your experience. And um, you know, I think you're sharing from a place of trying to help enlighten other people who are suffering as well. And it's it, I can feel that there's such a goodness in your heart with why we're talking about this today.

Hope Through Adaptation And Priorities

SPEAKER_00 22:45

Um and that's a perfect segue into us, I think, thinking now about, you know, is this all doom and gloom? Well, no, we wouldn't be wasting your time if we were trying to just tell you it's all bad news. Um I like we want to share some of the the good things too.

SPEAKER_01 23:01

The good news. I think it's just about saying this is the reality. And if you are feeling like that, it's not a great place to be. But this is why I'm here, and this is why I share my story because there is hope. How I lived in 2020 when I first got diagnosed is completely changed now. And I'm at a place where I'm really happy in my life. Okay, so for me, when I first started in 2020 with this, yes, I could barely leave the house. Um, and then eventually I got to the point where I was looking after myself, looking after my family. I started moving again. Then I started started running a business. I became CEO of a business, and we ran that for 10 years and won national awards. And and again, this isn't about bragging, but this is about I ended up living a life because of fibromyalgia that was better than any life that I could have imagined for myself. So I'm a great believer in adversity brings us what we need as well. Um, and I think with having fibromyalgia, I really prioritize what is important to me and what I want to do with my time. Yes, it's not all doom and gloom, but you do need to be aware of what the symptoms and signs are of fibromyalgia at the beginning, particularly. But there is hope. My life has completely changed over the years as I've learned, learned more about myself, learn more about the condition, and things are a lot better now. There is a lot more understood about fibromyalgia. We have an actual cause, which was something we've not had for decades as well. So there is hope, and your life can improve. You can also learn to build the life that you really want and prioritize yourself. So it becomes a truer life to you as a person. So it's definitely there is some hope on the horizon. And I do want to make sure that I haven't uh pop anybody off and made them think it's all doom and gleam.

SPEAKER_00 24:54

No, that that's so helpful. Um, so perfect transition. Let's

Combining Medication With Lifestyle Changes

SPEAKER_00 24:59

now pivot and I think talk about what the strategies are to actually start making people feel better. Um and Roshmael, you actually already touched on so many of them. Um, but to kind of give it in a more organized way, if you're listening to this and you're thinking or you know that you have fibromyalgia, and you're starting to realize that there's a lot more that you need to consider. The best approaches, at least from a medical standpoint, and then Rashpal, you can fill in as well with your work and you what you know people in your community are dealing with. It seems like the best practice really is a combination of medication and non-medication approaches. So, in other words, pharmacologic and non-pharmacologic. And Rashpal, you already touched on that. There are some medications that it sounds like have been life-changing for you. And I see this all the time, but that's not to say that's the only thing we need to be thinking about. It's not just about taking pills for the pain or taking antidepressant medication. There's so much more that we need to be supporting people in, which is healthy lifestyle factors. And we'll break those down one by one. Um, Rashma, if there's something else you want to kind of say off from the big picture.

SPEAKER_01 26:15

Absolutely. I think with medication, a lot of people with fibromyalgia struggle with medication because, again, your nervous system is sensitive. That almost means your entire body is sensitive, your gut can be more sensitive. So suddenly you might find, and these are some of the lesser-known symptoms, suddenly you might find that foods that you used to eat are more difficult for you to digest, or medication that you've always taken, you're now reacting to. So it really is a conversation with your doctor about what is going to work best for you. Medications are normally around painkillers and uh nerve blockers or almost uh things to help you calm your nervous system down as well, because you can get things like pins and needles, itchy skin, feel like it's ants crawling up and down your skin as well, especially when you're in a fleb when everything is sensitive. So, medication, I would say take it for when you are at the worst. Don't ignore medication and keep trying. It's very important with fibromyalgia. If one medication, one therapy, one lifestyle change doesn't work, try another one. Because it will, something will fall into place eventually.

SPEAKER_00 27:25

That's exactly the point, and very important for people to keep in mind. Fibromyalgia, because it is so individualized in terms of what your body is going to be dealing with when you have this. And at different points in time, your symptoms are going to come and go and change, and you might get new ones and ones you used to have go away forever. You have to have a very open-minded approach, I think, to not just from the doctor's standpoint, the patient, like having that back and forth conversation with your healthcare provider that, hey, we need to change things up. What used to work is no longer working, which is always, I think, the best way to approach anything in our body because as we get older, things evolve. Um, this is a lot of what I am always promoting when it comes to even just something like weight loss, which is a huge cornerstone of fibromyalgia treatment. You can't have a tunnel-visioned approach thinking that there's one best solution for everyone all the time. That's never true. You have to experiment a little bit. And so, with that flexibility in mind, I think let's break down um kind of piece by piece. So um we talked a little bit about medication. I don't want to us to go too far into it because again, this is not medical advice. That's that's not this conversation. Instead, what we're doing here is we're laying all the pieces on the table. We're putting all the puzzle pieces together, so to speak. Um, everything has its role. So we have our medications and then thinking through some of the approaches that are not just medication. Um, I guess let's break this into a few sections. We have our whole wheelhouse of lifestyle, which is the stuff that addresses our physical health and our mental health. Some of them overlap. Um, we can start with, I think, kind of the big topics that are going to be top of mind. So being what can we do to specifically calm down the nervous system, right? And do things like reducing stress.

SPEAKER_01 29:32

Yeah. So with fibromyalgia, again, um, this is one condition where you really are the expert on the condition and yourself. So I I do know a lot of people get frustrated with doctors, but then the doctor doesn't he know the general symptoms of fibromyalgia, but he doesn't know he or she don't know how you are experiencing it. So you really have to become uh very self-aware. And again, this is one of the things I teach on how to do that, and there's little systems and uh forms and things I've could I've created so that you can work through that and learn more about yourself. But yes, you are the expert on yourself and learning about yourself is the first step. But then, as far as lifestyle is concerned, for me, that is the biggest uh thing that will impact your fibromalgia. Your medication can have a little bit of impact, your movement can have a little bit of impact, but you've got to look at the way you're living day to day. So, for example, any but a healthy person out there, we're all being told you've got to exercise, you've got to eat well, have your five a day or seven a day, whatever it is, and um have some social time and make sure you're not too isolated. And that all implies applies extra to people with chronic conditions, any chronic conditions. So those are the things that we have to look at. We have to look at our connections, we have to look at our movement, and we have to look at our diet and our nutrition very closely. And we have to almost work harder on it than anybody else would have because it makes a real difference to our day-to-day life when we focus on those things.

SPEAKER_00 31:14

And the main thing that people need to realize is that when you do these lifestyle approaches, and we're gonna run through what some of these examples are of how you can start making your body feel better, it doesn't just affect one aspect of what you might be experiencing. And that's why it's so powerful. It is so much more than following a specific protocol to check off the boxes of, okay, this thing is gonna address the pain part and that thing is gonna address the sleep part. It that's what lifestyle can give us that really medications cannot. And I'm a huge advocate for doing a what's called a multimodal approach in my patients, using both medications and lifestyle to target all the aspects. Now, in terms of the specific lifestyle things, one thing that is very clear, and all the research tells us this is that, and this is the hard part, and we alluded to this at the beginning.

Gentle Movement Yoga Tai Chi Walking

SPEAKER_00 32:06

One of the most important parts of the lifestyle is to keep your body moving, to get enough movement in. In other words, exercise, right? But if you're dealing with a lot of pain, that might feel like the impossible thing. And so you might be wondering, how am I even going to get that process going? If it's the thing I need to be doing to feel better, but it hurts, which kinds of movement? So, what research has been showing for several years is that the gentle movements, things like yoga, tai chi, pilates, swimming, things that don't put pressure on our joints, is usually the best place to start for most people. And that makes a lot of sense. Those types of activities, they're not only like moving your joints and getting what some people call the juices flowing. It's not just about strengthening your muscles and getting more flexibility and all the things we want to do from getting exercise types of activities. These things actually, things like yoga and tai chi specifically, are going to actually address the nervous system aspect of fibromyalgia and any other nervous condition. A lot of people who have multiple sclerosis as well are really recommended to do these types of activities. Why? Because they literally put our nervous system into a more calm, the technical term for this is parasympathetic mode of being that shifts the chemistry that happens in our body to going away from a stress response and towards a calm response, which literally can affect how much pain our body feels. It also is going to help improve digestion, which, as we talked about in the beginning, one of the classic manifestations in some folks of fibromyalgia is something like irritable bowel syndrome, which basically is really bad digestive issues, bloating, gas, cramping, could be diarrhea, constipation. Um, those things are very much connected to our nervous system. And we know fibromyalgia is a nervous system condition at a lot of its crux. So we want to be thinking about the approaches to movement that target the nervous system, that help address the stress response in the body, which ultimately is going to impact the amount of pain you feel because it literally affects the chemistry of your body. It is so powerful. Like, I can't recommend enough to my patients to do movement activities throughout every single day, like as frequently as possible. And I think Roshpa, you and I spoke about this when we were prepping for this talk about you don't have to just bang out an hour, right? Like, what could a movement routine look like for someone with fibromyalgia?

SPEAKER_01 34:41

So with fibromyalgia, you do go through different stages. There may be times where you are well enough to even attend a gym. But I tried doing that when I was feeling a bit better, but I couldn't consistently consistently maintain that because fibromyalgia is a nervous system condition. Anything that's going on in your life is going to put extra strain on you and then flare up the condition as well. It may do, it may not do, but nine times out of ten it will. So, for example, you're going through a life change. We're moving home at the moment. So I've got that on top of my fibromyalgia. So, what I've done is I've reduced my activity level right down to the basics. So we have to make those sorts of adjustments, and we need to have a whole list of different types of movement that we can do. The most basic movement I would say is make sure you're not sitting for too long. So just getting up every hour or every half hour. So if you're really in pain and you're struggling or you're extremely fatigued, at least just get up out of bed or off the sofa, walk to the bathroom or walk to get yourself a drink, and then come and sit down again. I'm not saying to you you've got to push yourself into exercise when you're in that fault. Going on from that, the next level is something I do every single morning is I have a basic set of stretches that I do. And that's the equivalent to the yoga and the taichu. And it's a set of exercises that I do where I literally just move every joint, every part of my body, and just you know, really flex it. And I go through each part of my body gradually, focusing on your breath at the same time. And these, Dr. Annie, you're absolutely right, these are the best types of exercises because they calm our nervous system down as well. Going on from the gentle stretches, I try to walk every day. If I'm going through a flare and I really can't, I will still always do my stretches. Because once you just stretch out every part of your body, that initial fatigue you have when you get up in the mornings with fibromyalgia, it just loosens everything out and it does get the blood flowing a little bit. So I really recommend that. But then absolutely, what you said, Dr. Anaro, about walking, swimming, whatever you can do. Swimming is great if you can do it. Again, if you've become very weak, it might be difficult, but just getting in a pool and walking even within a pool will give you some exercise and it will minimize the pain that comes up with it. So, um, so those are the things I go through uh for exercise. A few years ago, there was a big push for people with fibromalgia or chronic fatigue syndrome to do resistance exercise. And again, this can be dangerous, but it can be very rewarding as well. So, what I have a set of very light weights because I think if you try and lift 10 kilos in one hand or something, you're gonna struggle and you're gonna be in so much pain for the rest of the week. So, what I do is I take it right back to the beginning and I go from one kilo to two kilos to three kilos, and I never go over. With movement, and with most things with fibromyalgia, I would say stick to 80% of what you can do, which is better than nothing. The danger with fibromalgia always is that you flare and you push yourself back a few more weeks, and it's not comfortable for you, and you shouldn't be in that position. But if you monitor your movement and you keep it just below your extreme level, then you will be okay with doing some exercise and some movement. It does get better in the summer as well. I think all of us struggle in the winter a little bit, so it does feel easier to do in the summer, I have to admit. Is there anything else that you could suggest on movement, Dr. Anna, that you think might help people with um pain, particularly?

SPEAKER_00 38:31

Yeah, I I think you really touched on a lot of the elements that need to be said, which are don't overdo it. And this is where we have to be thinking about avoiding injury. Injury is one of the worst situations, whether you have fibromyalgia or not. Um and so that being said, I it might be different in the UK for you, Roshpal, at least in the United States, physical therapy is a really common thing that us doctors are going to basically prescribe for patients, where you're sitting basically with, you're sitting with a physical therapist. In some countries, they're called physiotherapists, and they are monitoring and being kind of therapeutic about how they're going to suggest you move certain parts of your body depending on what you have going on. So, for example, if you're having an acute flare, you should not necessarily do the same things that you would if you were not having a flare. And I think, Roshavel, you you touched on that by talking about the concept of resistance training, it works best if you're not dealing with an injury and you're not dealing with a flare, right? But you have to be extremely careful when you're in a state of acute pain. And really, that means you're in a state of acute inflammation. So we we need to be careful that we're not injuring ourselves. So whether you want to select any of the above types of exercise that we've talked about, that we mentioned yoga, tai chi, walking, swimming, Pilates, gentle, light weights, any of those things, it's more important, I think, to think about is this the best thing for you in this moment in your health or in this moment in your situation of symptoms in the constellation of whatever you're experiencing in your body at the time. Because any of them are good options. It's not like one is better than another. You just work with your healthcare provider to see what's safe for you at the time and listen to your body. It really comes down to that. Like, we don't need our doctor to tell us every little thing. Like at the end of the day, every each of us has wisdom in our own body. We are the ones who've been living in our body our whole life. We have the experience from the past. Some things will work for you at times, other times that same thing will not work for you. And you just have to know when you're at that point. And I think you brought up what I know a lot of people refer to as the 80-20 principle, which is very wise for anybody, whether you're dealing with fibromyalgia or not, that always go not till the absolute end of your ability because there's a risk that you're gonna go over your threshold and deal with something like an injury. Now, for someone who's not dealing with pain, this might be a little bit different. Like if you're a professional athlete, you the whole game that you're playing is that you want to push your body to your limits. We're not talking to those people. Like, that is not what we are speaking to today. Instead, we are speaking to people who are dealing with these symptoms, things like fibromyalgia symptoms. So understand the context of what we're saying. Now, let's transition beyond movement and exercise. There's

Mediterranean Code For Weight And Pain

SPEAKER_00 41:38

a lot of other stuff that's really important, especially if we're trying to target weight loss. That will also help our symptoms if we're dealing with fibromyalgia. And so this obviously brings up diet, which is really my wheelhouse. Now, Rajpal, for those in your audience who may not know what I teach, I teach and promote a very whole foods, like well-rounded approach to eating and living with a healthy regimen of food in your in a lifestyle approach. I like to teach the Mediterranean diet and lifestyle, which I really have to say you've probably heard it called the Mediterranean diet. It's not a diet at all. I really like to refer to the principles and how I teach it as a Mediterranean code, including selecting the right foods, creating balanced meals, and building a sustainable or really an eating approach that you like, that you enjoy, that you'll want to keep doing for the long term. That's the game we're playing, is a long-term commitment because short-term weight loss is dangerous for our body. Now, there are there is more than one way to lose weight. And I think a multifaceted approach is the best way. So addressing the diet, addressing the exercise, and getting on medications if that's what works for you. And maybe you're somebody who has done bariatric surgery or you're a candidate and you're curious about it, talk to your doctor. Those are also still options on the table. And there's some literature, and I found some data for fibromyalgia patients specifically, those can all be really smart options, depending on where you're at. But we have to address the diet quality. Like nothing can get away from that. Whether you're interested in something like a GLP one, you're thinking about bariatric surgery, you want to not do it with medications, you want to just deal with the healthiest, you know, lifestyle approaches by themselves, diet quality is paramount. And so what does that mean? And you might be thinking what that means. We're not going to get into a huge conversation about that today. I have a ton more resources that are always linked underneath all of my videos. So underneath this video right now, there are links on my channel for free PDFs. I have a free weight loss webinar that's all teaching these Mediterranean code, what you really need to know. About how to put it together. But Roshwell, I know you've experimented and you've followed some of my content too. Um, yeah, you know, from your standpoint, what's the most important thing for somebody with fibromyalgia to think about when it comes to their diet?

SPEAKER_01 44:16

I think there's the diet as well, but there's also the the difficulty of struggling to lose weight. That's the most important thing for us, I think. So many of us are overweight, and we might not hit the obese category, so we might not qualify, especially in the UK, for some of those strategies. But for us, a lot of us, we might lose a little bit of weight and or but we continuously tend to gain year on year. And a lot of people do as they get older. But what you'll find with people who fibromalgia is we are trying all the time. We're focusing on it all the time. And this is one of the reasons that I wanted to speak with you, Dr. Anna, is because I love your approach. It absolutely mirrors what I have found has worked for me over the years. So it mirrors my approach and it mirrors what I have found has worked to help me feel better, reduce my gut symptoms, and actually help me maintain my weight. And I think that's the first battle. So you're not putting any more on. And that is the combination of the movement and the food you eat. But I agree that the quality of the food is absolutely vital. I mean, I actually started to grow my own food so that I could have organic food. And at the very least, I grow my own leaves, salad leaves. So at least I know I'll be getting some of those every day. They're organic and they are highly nutritious as well. And the other part of the Mediterranean diet that I really like is that it's it's not, you don't feel restricted and you don't feel like you're missing out on food. It's tasty, it's nutritious. Again, with fibromyalgia, you want to avoid any diet that makes you feel restricted, make puts pressure on you, that it's too extreme. So things I've tried in the past are keto, which is very difficult for me because I'm vegetarian. So that wasn't easy. And I just miss my vegetables too much because I've a lifelong vegetarian. So I've tried intermittent fasting. Yeah, intermittent fasting. Um, I've tried, I still do that, so I will fast naturally 16 to 18 hours overnight anyway. Uh helps me sleep a little bit better if I don't eat too close to bedtime. And then uh I've even tried 36 hours of fasts every week, which worked really well to help me lose weight, but it was a pressure on my system, and I started becoming very weak. So the thing with diets is all these extreme diets, any anything that you pick up that's generally called a diet, you're gonna struggle with one aspect or another of it, either the pressure, not getting full nutrition, or you know, just struggling to maintain it. And I think that's the beauty of the Mediterranean diet. You know, I absolutely believe in the least processed foods as you can. Now, this is where one of the issues comes in with fibromyalgia, because there are days we can't cook, we can't even feed ourselves if we're going through a rough flare. So, Dr. Anna, what would your be your recommendation for times like that if someone is really struggling with fatigue?

Frozen Foods Simple Meals During Flares

SPEAKER_00 47:25

Yeah, this is this is key, right? Ideally, we can all eat a perfect whole foods diet, no processed things at all. Then we think, okay, but we have to chop the vegetables, right? So, quite honestly, what I talk to patients about all the time is like, we live in the modern age now. We're using the principles of the Mediterranean diet that includes a way of eating that often is really a lot of cooking in terms of how it's been going on for hundreds of years. But in the modern era, we have tools that we can use, like frozen and canned things. They're still whole foods. So if you're somebody who's going through a flare, for example, and you're like, I cannot chop anything, you don't have to. Don't feel guilty about buying the pre-frozen broccoli and just microwaving it if you have to. You're still getting nutrition. And by the way, frozen vegetables and canned goods, those are packaged when those vegetables or when those ingredients are at their peak freshness, which also correlates to their optimal level of nutrients, vitamins, and minerals. So use these tools that we have in the modern era, they're there to help you. As well, it might be the case that you have to ask people to help out with your meal preparation. Not everybody has the same resources. So if you are in a community of people, like you're a part of a church, a place of worship, this might be something that you need to look into. It's just asking people to help. Most people are willing to help if they know you're dealing with something. They might not know you're dealing with anything. So if you have family, of course, that's usually the first go-to, but not everybody has family. So that's another thing. I would say dig into your communities and see what can help you. Um, simple meals are best. I have so many resources on my YouTube channel. I have tons of videos about really basic meal structure. I teach something called the perfect meal formula, which is really just the fundamental way to balance a meal. It doesn't need to be an elaborate recipe. And I think this is what people misunderstand about the Mediterranean diet. And I really don't like the term diet because it's not a diet, it's not a protocol. There are not specific ingredients that you need to be eating. You don't have to have fish, you don't have to cook your vegetables from whole forb. You don't have to slave over the stovetop for three hours making a fancy tomato sauce, right? That's what a lot of the recipes include, these kinds of things, but it doesn't have to be what your Mediterranean approach looks like. As long as you're sticking to the Mediterranean code, the core principles of eating as many whole foods as you can, balancing your meals, trying to remove a lot of the very processed ingredients that are not good for our bodies, all of the added sugar, all of the fried foods, uh, the fast foods, the prepackaged things, the things that are meant to be on the shelf for several months at a time, you're going to actually make a huge impact on your body. It can come more quickly than you realize. So, whatever you can do towards practicing and applying the Mediterranean code, you're going to be helping yourself out so much, right? So I suppose at this point somebody has listened to this conversation, right, Roshwell. They have realized how much fibromyalgia impacts the rest of their body, how many symptoms they may or may not feel, how diverse of an array of experiences they're going to have just having this diagnosis, one person to the other might not look the same. One time point to another might not feel the same, even within the same person. And so thinking about how to address all of those different things: the overweight, the fatigue, the physical pain, the debilitation, the sleep disturbances, with both using medications that make sense for them at the time and all of the lifestyle approaches that they have available to them. I suppose what would you say is the most important take-home message for somebody having listened to this conversation that is dealing with fibromyalgia?

Relaxation Breathing Nature Community Support

SPEAKER_00 51:29

What do you want them to really take home from this conversation?

SPEAKER_01 51:32

One of the things that works better for fibromyalgia than anything else is relaxing. Now, relaxing is probably and de-stressing, and relaxing is probably one of the hardest things to do if you are the kind of person who gets fibromalgia, because we are the kind of people who won't sit still. We feel guilty about sitting still. So it's about finding ways in your day-to-day life that you can calm your nervous system all the time. That is the main problem. We're in that constant survival mode, and we need to tell our bodies and our systems we are safe now. And there's so many different ways of doing that. There is through movement, through the practices like yoga, deep breathing, standing outside for a few minutes and just taking a few deep breaths. Nature is a very good therapeutic help as well. And looking at food as a joy, as well as, you know, not just something that's going to make you bigger. And actually eating enough, I wanted to mention as well. You know, you have to eat, so you might just have a cup of coffee and not actually eat much. So it's really important to keep nourishing your body because your nervous system is only going to calm down when it's got everything that it needs. It's got some peace, it's got some nutrition, it's got some exercise, it's got some connection with people around you as well. And I think your idea about church groups is really a great idea. I was actually thinking about this last night because I was wondering if somebody hasn't got the excellent type of support that I've got, what would you do? But it's about finding people in communities. There are fibromyalgia communities everywhere online that you can connect to. Uh, we've got a great community on my channel as well, very supportive of each other. So those are the kind of things that you need to keep in your life. But you have to start at home with yourself and focusing on you. You are worth taking care of. When you are well, everybody around you is well. So if you are looking after yourself as much as possible and looking after your needs and your body's needs first, then that is what's going to keep your life happier in the long run as well and more healthy.

SPEAKER_00 53:42

Fantastic.

Where To Learn More Next

SPEAKER_00 53:43

Rajwa, I think this was such a great conversation for folks. They probably won't hear this from anybody else. How comprehensive the approach really can be and how individualized it should be. And that there's hope for you if you're somebody familiar with this. And there, I really can encourage anyone in my community, please use Rushpal as a resource. If you have fibromyalgia, she is a wealth of information and knowledge and wisdom and a shared lived experience that you might be having. So, you know, please don't hesitate to join her community. I think it's really important that people with fibromyalgia find each other and help support each other.

SPEAKER_01 54:24

Um I think equally it's I would recommend Dr. Anna's channel for my viewers as well, because I find there are lots of easy ways to incorporate healthy eating into your day-to-day life. And all the knowledge she's got around the different aspects of diets and nutrition and different ways of losing weight is very valuable information for us, particularly when we're struggling with a long-term condition. And I think there are resources in the links below for my channel and for Dr. Anna's channel as well. So please do check out each other's channels. And uh I highly recommend Dr. Anna. Not only is she a medical doctor, but she really understands what the struggle is like. And I love the fact that you look at all different aspects of weight loss as well. It's not just about the individual and their wages, about how does it impact the family, how does it impact your shopping list? I think with both our topics, there is so much more detail that we could be talking for four hours, couldn't we?

SPEAKER_00 55:28

Absolutely.

SPEAKER_01 55:28

Yeah, we're not going to keep you on here forever. But yeah, I've really valued this conversation and it's uh it's been very useful, and it's been really nice to explore fibromalgia with someone who understands and listens as well, and to be able to look deeper into the uh Mediterranean diet as well. And uh please do look at Dr. Anna's resources, they are very worth a look at. Uh, I use them myself.

SPEAKER_00 55:56

Thank you, Rashma. I appreciate it. And um so looking forward to meeting any of you over on my channel as well. Um, come join our community. All right, Rashwell. Thanks for such a fabulous conversation. I think um we'll we'll sign off.

SPEAKER_01 56:09

Bye. Yeah, thank you very much, everyone. Be well. Until next, we see you.