Fibromyalgia and leaky gut

Fibromyalgia: What’s Your Gut Got to Do With It?

If you have fibromyalgia and also experience digestive issues, your gut problems may be more than a coincidence.

“There’s a definite correlation between gut health and fibromyalgia,” says R. Swamy Venuturupalli, MD, a rheumatologist in Beverly Hills, California, whose practice focuses on treating autoimmune and inflammatory diseases. Though researchers vary in their estimates, “there’s a higher incidence of irritable bowel syndrome (IBS) in people with fibromyalgia,” Dr. Venuturupalli says. “Some reports say approximately 60 percent of people with fibromyalgia have IBS, and conversely, 60 or 70 percent of people with IBS also have fibromyalgia.” And, he notes, a study published in March 2015 in the journal Medicine found that people with fibromyalgia were 1.5 times more likely than others to have IBS, the symptoms of which include chronic abdominal pain, constipation, diarrhea, and nausea.

In addition to IBS, fibromyalgia has been linked to small intestinal bacterial overgrowth (SIBO), a condition with similar symptoms in which the small intestine is colonized by colon bacteria. According to Bharat Kumar, MD, an assistant professor of internal medicine at University of Iowa Health Care in Iowa City, while some studies have linked SIBO with increased pain in fibromyalgia, “the evidence linking the two diseases is still a little weak.” He points, however, to a study in which 42 of 42 participants with fibromyalgia “had tests that were strongly suggestive of SIBO.” The big question, Dr. Kumar says, “is can these findings be generalized to the larger population of people with fibromyalgia? The answers aren’t quite there yet.”

Venuturupalli observes that the study Kumar references, which was done by researchers at Cedars-Sinai Medical Center, involved very sick people with fibromyalgia who were tested for SIBO, so the sample was likely skewed. Venuturupalli hasn’t found so high a percentage in his clinical practice, but he agrees that people with fibromyalgia and gut symptoms often have SIBO, estimating it occurs 20 to 30 percent of the time.

A Connection Between Fibromyalgia and ‘Leaky Gut’?

Kumar points to another study that indicates having SIBO increases fibromyalgia pain in areas outside the gut. This may happen due to a somewhat controversial condition called leaky gut. “The gut is a barrier between the outside world and our inner organs,” explains Kumar. “In SIBO, this barrier becomes leaky, so chemicals that are released by or processed by bacteria get into our bloodstream. While the research is still very preliminary, it’s thought that these can activate the immune or nervous systems. This may lead to the symptoms that people with fibromyalgia often relate to their doctors.”

According to Venuturupalli, leaky gut remains a theoretical concept that’s not widely accepted in Western medicine. The theory, he says, promoted largely by alternative medicine practitioners, is that allergens cause a leakage of proteins, which in turn cause inflammation that transcends the gut to other parts of the body. It hasn’t been proved without a doubt, says Venuturupalli. “Having said that,” he adds, “conceptually, it makes some sense.” Hypersensitivity to certain foods can trigger inflammation, but the exact way that happens is unknown. It’s not unlikely, he says, that it could give rise to fibromyalgia symptoms.

“Fibromyalgia can be thought of as a central pain sensitization disorder,” says Kumar. “When there’s chronic pain, due to any reason, the brain starts to rewire itself in a way that prioritizes pain. It’s believed this was originally a survival mechanism to alert the brain about injuries, but that was when people lived very short lives and there was no such thing as chronic pain. The link between poor gut health and fibromyalgia adds a wrinkle to this. Maybe the fibromyalgia related to poor gut health is because of that same survival mechanism alerting the brain that there’s something going on with the gut.”

RELATED: Gut Health and Rheumatoid Arthritis: What You Need to Know

Venuturupalli acknowledges the connection. In his practice, he’s seen people whose fibromyalgia symptoms flair when their gut symptoms flair. “That’s a known phenomenon, but it’s not across the board,” he says. “There are probably subsets of people for whom gut health plays a role in causation of the fibromyalgia, and treatment needs to be directed there. There may be other types for whom fibromyalgia may not be due to the gut.”

Treating Digestive Symptoms to Help With Fibromyalgia

If you have fibromyalgia and also have gut symptoms, Venuturupalli advises making your doctors aware of this connection and requesting a consultation with a gastroenterologist, particularly one with some expertise in SIBO. “Working on gut issues is good for overall health, and I recommend that for all patients,” Venuturupalli says.

Kumar doesn’t recommend that everyone get tested for SIBO, however. “Up to 20 percent of the general population may have abnormal lab tests, and this might lead to overtreatment. Antibiotics, which are used in treating SIBO, have their own side effects and should be used very carefully,” he says.

And is the reverse also true? Should people with SIBO and IBS investigate whether they have fibromyalgia? Kumar believes that they should be evaluated by primary care physicians. “Fibromyalgia is treated largely through physical therapy and addressing the root causes for the central pain sensitization,” he says. “Identifying fibromyalgia can make treatment plans more focused and guided.”

Treatment of gut issues may improve digestive symptoms. “Because there are many different reasons for having SIBO, working with doctors to craft a comprehensive and personal treatment approach is essential,” says Kumar. “While it may not necessarily improve the other symptoms of fibromyalgia, by reducing the abdominal pain, SIBO treatment may improve the quality of life for people with concomitant fibromyalgia.”

RELATED: Fibromyalgia Treatment

The Role That Diet and Eating Habits May Play

Kumar advises patients to discuss diet, which he says is extremely important, with their physicians. “The food we eat not only nourishes our bodies but also the millions of bacteria that live in our gut,” he says. “So the types of food that you eat can make SIBO better or worse.” Eating yogurt with live active colonies, he says, is supported by research as helpful for SIBO.

“I also recommend a low-FODMAP diet to people who have irritable bowels,” says Kumar. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are carbohydrates that are naturally present in foods and “are particularly appealing to bacteria that can overgrow and cause SIBO,” he explains. Talk to your doctor before beginning a low-FODMAP diet, he cautions, to determine whether it really may be helpful. The concern, he says, is that you could excessively or unnecessarily restrict your diet, preventing you from obtaining needed nutrients. And dietary changes, he warns, need to be maintained over the long term or SIBO is likely to reoccur.

RELATED: Fibromyalgia: What to Eat, What to Avoid

Don’t Ignore the Connection Between Gut Health and Chronic Pain

“Fibromyalgia is more than just chronic pain,” says Kumar. “Although there’s a lot left unknown about it. We are now understanding that it’s more than just a muscle and joint illness. It can be affected by any number of other organ systems, like the gut.”

If you have fibromyalgia and suspect you may have gut issues, or vice versa, you may have to be your own best advocate. “People with fibromyalgia are sometimes not taken very seriously by doctors when there may be other issues complicating the diagnosis,” says Kumar. “The growing recognition of a link between SIBO and fibromyalgia is a great example of this.”

Fibromyalgia Linked to Gut Bacteria for First Time

Scientists have found a correlation between a disease involving chronic pain and alterations in the gut microbiome.

Fibromyalgia affects 2-4 percent of the population and has no known cure. Symptoms include fatigue, impaired sleep and cognitive difficulties, but the disease is most clearly characterized by widespread chronic pain. In a paper published today in the journal Pain, a Montreal-based research team has shown, for the first time, that there are alterations in the bacteria in the gastrointestinal tracts of people with fibromyalgia. Approximately 20 different species of bacteria were found in either greater or are lesser quantities in the microbiomes of participants suffering from the disease than in the healthy control group.

Greater presence or absence of certain species of bacteria

“We used a range of techniques, including Artificial Intelligence, to confirm that the changes we saw in the microbiomes of fibromyalgia patients were not caused by factors such as diet, medication, physical activity, age, and so on, which are known to affect the microbiome,” says Dr. Amir Minerbi, from the Alan Edwards Pain Management Unit at the McGill University Health Centre (MUHC), and first author on the paper. The team also included researchers from McGill University and Université de Montréal as well as others from the Research Institute of the MUHC.

Dr. Minerbi adds, “We found that fibromyalgia and the symptoms of fibromyalgia – pain, fatigue and cognitive difficulties – contribute more than any of the other factors to the variations we see in the microbiomes of those with the disease. We also saw that the severity of a patient’s symptoms was directly correlated with an increased presence or a more pronounced absence of certain bacteria – something which has never been reported before.”

Are bacteria simply the markers of the disease?

At this point, it’s not clear whether the changes in gut bacteria seen in patients with fibromyalgia are simply markers of the disease or whether they play a role in causing it. Because the disease involves a cluster of symptoms, and not simply pain, the next step in the research will be to investigate whether there are similar changes in the gut microbiome in other conditions involving chronic pain, such as lower back pain, headaches and neuropathic pain.

The researchers are also interested in exploring whether bacteria play a causal role in the development of pain and fibromyalgia. And whether their presence could, eventually, help in finding a cure, as well as speed up the process of diagnosis.

Confirming a diagnosis and next steps towards finding a cure

Fibromyalgia is a disease that has proved difficult to diagnose. Patients can wait as long as 4 to 5 years to get a final diagnosis. But this may be about to change.

“We sorted through large amounts of data, identifying 19 species that were either increased or decreased in individuals with fibromyalgia,” says Emmanuel Gonzalez, from the Canadian Center for Computational Genomics and the Department of Human Genetics at McGill University. “By using machine learning, our computer was able to make a diagnosis of fibromyalgia, based only on the composition of the microbiome, with an accuracy of 87 per cent. As we build on this first discovery with more research, we hope to improve upon this accuracy, potentially creating a step-change in diagnosis.”

“People with fibromyalgia suffer not only from the symptoms of their disease but also from the difficulty of family, friends and medical teams to comprehend their symptoms,” says Yoram Shir, the senior author on the paper who is the Director of the Alan Edwards Pain Management Unit at the MUHC and an Associate Investigator from the BRaiN Program of the RI-MUHC. “As pain physicians, we are frustrated by our inability to help, and this frustration is a good fuel for research. This is the first evidence, at least in humans, that the microbiome could have an effect on diffuse pain, and we really need new ways to look at chronic pain.”

How the research was done

The research was based on a cohort of 156 individuals in the Montreal area, 77 of whom suffer from fibromyalgia. Participants in the study were interviewed and gave stool, blood, saliva and urine samples, which were then compared with those of healthy control subjects, some of whom lived in the same house as the fibromyalgia patients or were their parents, offspring or siblings.

The researchers’ next steps will be to see whether they get similar results in another cohort, perhaps in a different part of the world, and to do studies in animals to discover whether changes in bacteria play a role in the development of the disease.
This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.
Reference: Minerbi, A., Gonzalez, E., Brereton, N. J. B., Anjarkouchian, A., Dewar, K., Fitzcharles, M.-A., … Shir, Y. (2019). Altered microbiome composition in individuals with fibromyalgia. PAIN, Articles in Press. https://doi.org/10.1097/j.pain.0000000000001640

A Functional Medicine Approach to Fibromyalgia

September 23rd, 2019

• Free eBook: 35 Gut Recovery Recipes

It is estimated that fibromyalgia affects nearly 6 million or 1 in 50 people, causing chronic pain, particularly muscle pain, fatigue, sleep disturbances, brain fog, or cognitive impairment, depression and painful tender points throughout the body.

Not surprisingly, conventional medicine focuses only on managing symptoms through pain medications and antidepressants.

Functional medicine, on the other hand, looks to find the root cause of fibromyalgia and other chronic diseases, treating the problem at the root level in order to restore the patient to health. As a functional medicine physician, I have helped many patients recover from fibromyalgia. Below are the top ten root causes of fibromyalgia I see in my clinic.

10 Root Causes Of Fibromyalgia

Gluten Intolerance:

Gluten has been liked to more than 55 diseases and is often called the ‘big masquerader’. The reason for this is that the majority symptoms of gluten intolerance are not digestive in nature but rather neurological such as pain, cognitive impairment, sleep disturbances, behavioral issues, fatigue and depression.

Candida Overgrowth:

Candida is a fungus or yeast, and a very small amount of it lives in your intestines. However, when overproduced, candida breaks down the wall of the intestines and penetrates the bloodstream, releasing toxic byproducts into your body causing a host of unpleasant symptoms such as brain fog, fatigue, digestive issues, and pain. Virtually every one of my patients with fibromyalgia have had Candida overgrowth.

Want to learn more about what causes Candida Overgrowth and how to eliminate it? Download my FREE Candida Control Resource Bundle!

Thyroid:

More than half of the people with thyroid issues have no idea they have one and 90% of these have hypothyroidism, or an underactive thyroid gland. It is vital that your doctor check six different blood markers to measure your thyroid gland’s function, and it’s imperative that your doctor use the optimal levels rather than the standard reference range when assessing and diagnosing thyroid disorders. Getting my patient’s thyroid levels into an optimal range, typically alleviates their fatigue, brain fog, sleep disturbances and depression.

Vitamin Deficiencies:

Magnesium, vitamin D and B12 deficiency are the most common vitamin deficiencies I see in those who have been diagnosed with fibromyalgia. I have had several patients completely reverse their fibromyalgia symptoms with magnesium alone. The best way to measure magnesium is a red blood cell (RBC) magnesium level, which can be ordered by your conventional doctor and tested through any conventional lab.

Small Intestine Bacterial Overgrowth (SIBO) and Leaky Gut:

There are more bacteria in us and on us then there are of our own cells. When these bacteria get out of balance through use of antibiotics or a sugar-rich diet we can lose our ability to digest and absorb nutrients, particularly B12. Gluten can cause SIBO and leaky gut and SIBO and leaky gut can lead gluten and other food intolerances. It’s a catch-22 and a vicious cycle. You must ‘fix the gut’ first in anyone with fibromyalgia or any chronic illness.

Adrenal Fatigue:

Adrenal fatigue is a result of the chronic stress whether real or perceived. Chronic pain is a stress to the adrenal glands, though typically not the initial adrenal stressor. The initial stressor is usually something such as food intolerances, Candida, mercury toxicity, vitamin deficiencies, or mycotoxins. My goal is to support the adrenals with adaptogenic herbs while we search for the root cause of the stress and correct it.

Mycotoxins:

Mycotoxins are very toxic substances produced by toxic molds. Only about 25% of the population carries the genes to be susceptible to the effects of mycotoxins. Conventional environmental mold testing only tests for levels of mold spores and does not test for mycotoxins. I use a urine mycotoxin test in my clinic to determine if someone has been exposed to toxic molds.

Mercury Toxicity:

I recommend that all my patients find a biological dentist and have their mercury amalgam fillings removed. Mercury is toxic to our bodies and can be one piece of the puzzle for those with fibromyalgia and other chronic illnesses such as chronic fatigue syndrome, autoimmune diseases, neurological disorders and cancer. I then recommend heavy metal testing using a pre and post DMPS urine challenge test.

MTHFR Mutations:

This is a genetic test you can get though any conventional lab. The more mutations you have at the MTHFR gene the less able you are to methylate and detoxify, particularly toxins such as mercury and lead. The more mutations you have at this gene the higher your requirements for methyl-B6, methyl-B12 and folinic acid in order to keep your detoxification pathways working properly.

Glutathione Deficiency:

Glutathione, a molecule, is the most critical part of our body’s detoxification system. Glutathione gets recycled in our body unless our toxic burden gets to high or we lack GSTM1 and GSTP1, the enzymes needed to recycle and produce glutathione. Taking a glutathione supplement or the precursors (NAC, alpha lipoic acid, milk thistle) often help my patients dramatically with fatigue.

As you can see from the above list, many of these causes are interrelated and often there is no one single root cause to fibromyalgia or any chronic illness. It is a combination of several or possibly all of the above. Because getting to the root cause can be complex, I recommend that you find a functional medicine physician in your area to help uncover the root cause for you. You do not need to suffer needlessly or mask your symptoms with pain medication and antidepressants. There are doctors like myself who can help you.

Gut bacteria associated with chronic pain for first time

Fibromyalgia affects 2-4 percent of the population and has no known cure. Symptoms include fatigue, impaired sleep and cognitive difficulties, but the disease is most clearly characterized by widespread chronic pain. In a paper published today in the journal Pain, a Montreal-based research team has shown, for the first time, that there are alterations in the bacteria in the gastrointestinal tracts of people with fibromyalgia. Approximately 20 different species of bacteria were found in either greater or are lesser quantities in the microbiomes of participants suffering from the disease than in the healthy control group.

Greater presence or absence of certain species of bacteria

“We used a range of techniques, including Artificial Intelligence, to confirm that the changes we saw in the microbiomes of fibromyalgia patients were not caused by factors such as diet, medication, physical activity, age, and so on, which are known to affect the microbiome,” says Dr. Amir Minerbi, from the Alan Edwards Pain Management Unit at the McGill University Health Centre (MUHC), and first author on the paper. The team also included researchers from McGill University and Université de Montréal as well as others from the Research Institute of the MUHC.

Dr. Minerbi adds, “We found that fibromyalgia and the symptoms of fibromyalgia — pain, fatigue and cognitive difficulties — contribute more than any of the other factors to the variations we see in the microbiomes of those with the disease. We also saw that the severity of a patient’s symptoms was directly correlated with an increased presence or a more pronounced absence of certain bacteria — something which has never been reported before.”

Are bacteria simply the markers of the disease?

At this point, it’s not clear whether the changes in gut bacteria seen in patients with fibromyalgia are simply markers of the disease or whether they play a role in causing it. Because the disease involves a cluster of symptoms, and not simply pain, the next step in the research will be to investigate whether there are similar changes in the gut microbiome in other conditions involving chronic pain, such as lower back pain, headaches and neuropathic pain.

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The researchers are also interested in exploring whether bacteria play a causal role in the development of pain and fibromyalgia. And whether their presence could, eventually, help in finding a cure, as well as speed up the process of diagnosis.

Confirming a diagnosis and next steps towards finding a cure

Fibromyalgia is a disease that has proved difficult to diagnose. Patients can wait as long as 4 to 5 years to get a final diagnosis. But this may be about to change.

“We sorted through large amounts of data, identifying 19 species that were either increased or decreased in individuals with fibromyalgia,” says Emmanuel Gonzalez, from the Canadian Center for Computational Genomics and the Department of Human Genetics at McGill University. “By using machine learning, our computer was able to make a diagnosis of fibromyalgia, based only on the composition of the microbiome, with an accuracy of 87 per cent. As we build on this first discovery with more research, we hope to improve upon this accuracy, potentially creating a step-change in diagnosis.”

“People with fibromyalgia suffer not only from the symptoms of their disease but also from the difficulty of family, friends and medical teams to comprehend their symptoms,” says Yoram Shir, the senior author on the paper who is the Director of the Alan Edwards Pain Management Unit at the MUHC and an Associate Investigator from the BRaiN Program of the RI-MUHC. “As pain physicians, we are frustrated by our inability to help, and this frustration is a good fuel for research. This is the first evidence, at least in humans, that the microbiome could have an effect on diffuse pain, and we really need new ways to look at chronic pain.”

How the research was done

The research was based on a cohort of 156 individuals in the Montreal area, 77 of whom suffer from fibromyalgia. Participants in the study were interviewed and gave stool, blood, saliva and urine samples, which were then compared with those of healthy control subjects, some of whom lived in the same house as the fibromyalgia patients or were their parents, offspring or siblings.

The researchers’ next steps will be to see whether they get similar results in another cohort, perhaps in a different part of the world, and to do studies in animals to discover whether changes in bacteria play a role in the development of the disease.

Fibromyalgia Linked To Nearly 20 Different Kinds Of Gut Bacteria

People with fibromyalgia (FM) have different quantities of certain types of gut bacteria than those without the disease, according to a new study published in the journal PAIN. It’s the first time differences in the gut microbiome have been linked to the disease, and the researchers say their work may lead to better diagnostic tools and treatment options.

Fibromyalgia is one of the most common forms of chronic widespread pain, affecting as much as 4 percent of the population. It is characterized by pain, physical exhaustion, sleep problems, and cognitive symptoms that affect a person’s overall quality of life. The source and cause of the disease are largely unknown and it’s difficult to diagnose, in some cases taking up to five years to do so.

Researchers tested 77 women with FM and 79 control participants in a variety of ways, including extracting DNA from stool samples.

“We found that fibromyalgia and the symptoms of fibromyalgia – pain, fatigue, and cognitive difficulties – contribute more than any of the other factors to the variations we see in the microbiomes of those with the disease,” said study author Amir Minerbi in a statement. “We also saw that the severity of a patient’s symptoms was directly correlated with an increased presence or a more pronounced absence of certain bacteria – something which has never been reported before.”

Fibromyalgia is one of the most common forms of chronic widespread pain, affecting as much as 4 percent of the population. Blurry Me/

Generally speaking, those with and without FM had the same overall population and diversity of bacteria in the gut microbiome, but their levels differed. In all, 19 different species of bacteria – including several that have been linked to gut disorders, inflammatory arthritis, and inflammatory responses – were found in lesser or greater quantities in the gastrointestinal tracts of the study participants with FM.

It’s not clear whether the changes in a person’s gut bacteria are markers of the disease or cause it, but understanding the makeup of the gut microbiome is an important step to understanding how the disease works.

“We used a range of techniques, including Artificial Intelligence, to confirm that the changes we saw in the microbiomes of fibromyalgia patients were not caused by factors such as diet, medication, physical activity, age, and so on, which are known to affect the microbiome,” said Minerbi.

Machine learning was then used to analyze the data and accurately diagnose fibromyalgia 87 percent of the time. As of now, there is no test for FM and its diagnosis is largely based on self-reported symptoms.

The researchers report that their next steps will be to determine whether changes in the gut microbiome affect chronic pain.

by Renee Fabian (The Mighty)

This article originally appeared in Yahoo! Lifestyle

Bacteria inside the large intestine, concept, representation. 3D illustration

The connection between the bacteria in your gut and a wide range of chronic (and even mental) illnesses is one of the trendiest research topics. For conditions like fibromyalgia, which doesn’t have a definitive diagnostic test, a new study linking specific gut microbiome patterns to the condition opens the door to a better understanding of the disease.

Since its official classification as a medical condition in 1990, fibromyalgia eluded many professionals, who preferred to write symptoms off as “all in your head.” As research has improved, experts learned the condition is best described as the result of a hyperactive nervous system, which leads to fibromyalgia symptoms like chronic pain, fatigue and cognitive difficulties like brain fog.

Researchers at McGill University in Canada wanted to see if gut bacteria played a role in fibromyalgia too. To do this, they looked for a difference in the gut bacteria of people with fibromyalgia compared to those without the condition. They compared 77 people with fibromyalgia to 79 healthy controls, including control participants who were related to and lived with patients with fibro to control for genetic and environmental factors. The results of their study were published in the journal Pain on June 18.

Between participants with fibromyalgia and healthy, unrelated control participants, McGill researchers discovered an identifiable pattern of differences in gut bacteria. The authors note they only saw the difference when they looked in more detail at gut bacteria patterns as opposed to first glance. In total, the study found distinct patterns across 19 species of gut bacteria in fibromyalgia patients, suggesting gut bacteria may play a role in the condition.

A write-up of the study points out one such species of bacteria, faecalibacterium prausnitzii, was lower in participants with fibromyalgia. This same bacteria has already been linked with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Another type of gut bacteria lower in people with fibro, bacteroides uniformis, is associated with inflammatory arthritis. Researchers could also determine the severity of classic fibromyalgia symptoms like chronic pain and fatigue.

Study authors note this is the first time research looked at whether or not gut bacteria and fibromyalgia may be related. To measure gut bacteria in this study, researchers used a computer program and machine learning to help identify “microbiome blueprints” associated with fibro. Preliminary results based on this study (though more research is needed) suggest gut bacteria could be one way to get a fibromyalgia diagnosis in the future — and potentially new treatment options.

“By using machine learning, our computer was able to make a diagnosis of fibromyalgia, based only on the composition of the microbiome, with an accuracy of 87 percent,” Emmanuel Gonzalez, Ph.D., a researcher on the study, told New Atlas. “As we build on this first discovery with more research, we hope to improve upon this accuracy, potentially creating a step-change in diagnosis.”

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