I have a patient with an extreme amount of muscular pain. She has to watch the way she sits, moves, walks in order to avoid pain. Every time she tries to build up her weak muscles, she has to deal with very bad cramping and muscle soreness that can last up to a week after training. It can only be resolved by the use of NSAIDs. She feels very fatigued and virtually permanently suffers from brain fog. Unfortunately, she can’t afford testing. Medication she’s taking is very likely affecting her gut but can’t be discontinued at this point. Also, her menstrual cycle is off, although regular hormone testing through her gynecologist has come back normal. Her diet is spotless and I rather suspect an HPA issue, but where would you start in this case?

Chris Kresser:  Those are tough cases. If a patient can’t afford testing, your hands are tied somewhat. I mean just looking at this information, you provided a number of possibilities come to mind. This sounds a lot like a chronic infection. Patient can present, it sounds a lot like a CIRS or biotoxin type of illness. Patient can present certainly GI inflammation, can lead to muscular pain. It’s a known extra-intestinal symptom of inflammatory bowel diseases like Crohn’s disease or ulcerative colitis. Certainly SIBO or any of the GI issues that we talk about can cause this kind of problem. Muscular pain can also be caused by anemia, inadequate oxygen deliverability, nutrient deficiency, or autoimmunity of course. So something like lupus needs to be on your radar when you see someone that presents with polysite muscular pain. So and then food intolerances, another potential cause, and maybe that’s something that you could do. She could try an autoimmune Paleo. I’m just trying to think of things you could try with absolutely no testing at all, which is certainly not ideal in this case.

Autoimmune Paleo is something that she could try if she hasn’t already as a means of seeing if there is something in her diet which otherwise sounds very good that could be contributing. Especially because some of her symptoms definitely seem consistent with autoimmunity. You could also see if she can get testing for autoimmune disease just through her conventional doctor that’s covered by insurance for lupus or just like a general screen for autoimmunity might be helpful in this situation. And then really, and sometimes you have to ask these patients if there’s anyone they could borrow money from or get support from in order to be able to get the testing that needs to be done to identify these problems, and hopefully our healthcare system will change in the future to where that’s less of an issue and insurance actually supports this stuff. But as you all know, that’s, we’re not there yet.