Fibromyalgia and Gut Health

Fibromyalgia and Gut Health

By: Dr. Mary Rondeau

Fibromyalgia is a syndrome that is characterized by widespread pain, tenderness, sleep disturbances, fatigue and commonly problems of memory or thinking.  Currently there are no lab tests available for fibromyalgia.  Diagnosis is made by finding 11 of 18 tender points in the absence of any other disease to explain the pain.  The prevalence of fibromyalgia is estimated at 2%-4% worldwide with women being more affected than men (9:1 ratio).

Many theories of what causes fibromyalgia have been explored, but neither the etiology nor pathophysiologic mechanisms are known.  Some theories include genetic/familial factors, sleep disturbance, neuroendocrine dysfunction, abnormal pain processing and decreased pain inhibition. Likely it is a combination of several of these categories.

In 2004, a study published in Annuals of the Rheumatic Diseases reported that inappropriate colonization of small bowel with colonic bacteria has been reported in patients with fibromyalgia.  This study also demonstrated that the severity of colonization of the small bowel correlated to the intensity of pain felt in fibromyalgia patients suggesting a pathophysiological role in the disease process.

In 2008, a study published in Rheumatology demonstrated higher rates of intestinal permeability in patients with fibromyalgia compared to healthy volunteers.  This finding in addition to the study mentioned above may indicate that fibromyalgia could be associated with leaky gut syndrome. Dr. Goebel et al. measured permeability in both the gastroduodenal and small bowel in males and females with fibromyalgia.  Out of the 40 fibromyalgia patients tested, 13 had gastroduodenal permeability and 15 had small bowel permeability.  As compared to the healthy volunteer group where 1 person was found to have increased intestinal permeability. This is significantly higher than healthy control volunteers. The study also noted that fibromyalgia patients had reduced mRNA expression for anti-inflammatory cytokines which could be contributing to the increased inflammation seen in these patients. In addition, many patients report that their symptoms began after an intestinal infection. This study demonstrated that of the 40 fibromyalgia patients tested 11 tested positive for antibodies to Helicobacter pylori and 9 had antibodies for Campylobacter jejuni or Yersina enterocolitica. These are pathogenic organisms which can lead to the formation of ulcers and food poisoning respectively. These finding suggest that these infections could be contributing to the intestinal permeability. Dr. Goebel states that there is evidence that restoration of normal intestinal permeability may improve the disease in certain individuals.

In our intestines, our cells are held together by tight junction.  These tight junctions maintain a barrier between what is suppose to be absorbed in our intestines and what is not suppose to be absorbed.  Increased intestinal permeability means that these tight junctions have become relaxed and do not function properly allowing larger molecules and molecules that would have not otherwise been able to cross the intestinal lining to cross.  The passage of these larger molecules is seen as invaders by the immune system and can trigger an immune reaction with the formation of antibodies to these otherwise harmless molecules.  When this happens, a person can become hypersensitive to environmental factors or develop foods allergies or sensitivities to which they previously were not sensitive.   Interestingly, some of these particles can even cross the blood brain barrier which can lead numerous mental symptoms.  Intestinal permeability can be triggered by many factors including infections (current or previous), improper diet, exposure to chemicals/toxins, emotional trauma, and medications.

These studies further validate that the health of our intestines is crucial to maintaining and restoring health. Fortunately, there are several tests that can be done to determine the degree, if any, of intestinal permeability.  Fibromyalgia is one condition that has many contributing factors, improving intestinal health may be an avenue to help reduce pain in these individuals. Improving intestinal health will also help with absorption of critical nutrients to restore the body back to health.

References:

Annals of the Rheumatic Diseases 2004;63:450-452

Rheumatology 2008; Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. A. Goebel et. al.