Updated: Feb 27, 2020
Fibromyalgia is a common cause of widespread pain for at least three months without an identifiable cause. It is present in 2% to 8% of the population. Medications used for fibromyalgia include antidepressants like duloxetine (Cymbalta), anticonvulsants (Lyrica, gabapentin, etc.), and anti-inflammatory drugs (ibuprofen, naproxen, meloxicam, etc.) The effectiveness of these treatments is slightly better than placebo. The side effects of these medications are quite prominent. Due to the questionable efficacy in the treatment of fibromyalgia with medications, you wonder if something else may be influencing the condition.
The Gut is a crucial area for patients with fibromyalgia. Serotonin, which is a neurotransmitter related to mood issues, is mostly produced in the gut. If the gut bacteria is out of balance or more harmful bacteria are present when compared to beneficial bacteria, then the patient may be prone to be depressed. Several studies have identified that 90 to 100% of patients with fibromyalgia have evidence of an imbalance in the gut. This term, in general, is called dysbiosis or if the infection or imbalance is located in the small intestine then is called Small Intestine Bacteria Overgrowth (SIBO). Some of these harmful bacteria will secrete neurotoxins that are detrimental to brain health and will promote general inflammation in the body. Dysbiosis has been linked to autism, Alzheimer's Disease, and other neurologic disorders. Nutrition is vital for our gut health. Beneficial food like vegetables and fruits can improve the number of good bacteria in your gut. We have to eat food sources that are rich in beneficial bacteria or that promotes the growth of good bacteria. Probiotics are another excellent tool against dysbiosis. Not all probiotics are the same, and you have to select a probiotic with clinical evidence of effectiveness. Antibiotics like Rifaximin or Vancomycin can be helpful in patients affected with dysbiosis. In fact, patients with fibromyalgia and autism have improved with the administration of these agents. Antimicrobial botanicals or herbs like oregano, berberine, and combination products can be useful in dysbiosis. There is a clinical trial that demonstrated that herbal therapy to be at least as effective as Rifaximin. Finally, it is essential that patients with fibromyalgia have a healthy gut environment for the improvement of their symptoms. Nutrition is crucial for the fulfilling of this goal.
David Rivas, RPh, CCN
References: Daulatzai, M. A. (2014). Obesity and gut’s dysbiosis promote neuroinflammation, cognitive impairment, and vulnerability to Alzheimer’s disease: new directions and therapeutic implications. J Mol Genet Med S, 1, 5. Häuser, W., Walitt, B., Fitzcharles, M. A., & Sommer, C. (2014). Review of pharmacological therapies in fibromyalgia syndrome. Arthritis Research & Therapy, 16(1), 201. Mezzelani, A., Landini, M., Facchiano, F., Raggi, M. E., Villa, L., Molteni, M., ... & Marabotti, A. (2015). Environment, dysbiosis, immunity and sex-specific susceptibility: a translational hypothesis for regressive autism pathogenesis. Nutritional neuroscience, 18(4), 145-161. Myers, S. P. (2004). The causes of intestinal dysbiosis: a review. Altern Med Rev, 9(2), 180-197. Pimentel, M., Hallegua, D. S., & Wallace, D. J. (1999). Improvement of symptoms by eradication of small intestinal overgrowth in FMS: a double-blind study. Arthritis Rheum, 42, S343. Pimentel, M., Wallace, D., Hallegua, D., Chow, E., Kong, Y., Park, S., & Lin, H. C. (2004). A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Annals of the Rheumatic Diseases, 63(4), 450-452. Sandler, R. H., Finegold, S. M., Bolte, E. R., Buchanan, C. P., Maxwell, A. P., Väisänen, M. L., ... & Wexler, H. M. (2000). Short-term benefit from oral vancomycin treatment of regressive-onset autism. Journal of child neurology, 15(7), 429-435. Tomova, A., Husarova, V., Lakatosova, S., Bakos, J., Vlkova, B., Babinska, K., & Ostatnikova, D. (2015). Gastrointestinal microbiota in children with autism in Slovakia. Physiology & behavior, 138, 179-187.