by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT
In Part 1 of this 3-part series on FM, we looked at what FM is and what the root causes are thought to be, according to both the research and Functional Medicine. These include abnormalities in the central nervous system, genetic factors, psychological variables, and environmental factors (1). In Functional Medicine, we will also look at gut issues, toxic burden, chronic infections, insulin resistance and hormone and/or neurotransmitter imbalances.
Here, In Part 2 we cover the gut as a root cause, the triggers and risk factors for FM. We will also touch on the treatment of FM, which we will then explore in much greater depth in Part 3 of this series on FM.
Could FM be related to the gut?
One environmental (or epigenetic) factor that has been looked at is gut health. It is possible that gut health is a contributing cause of FM, although this has not yet been proven. However a number of studies have linked FM to gut dysbiosis, infections and other gut conditions. Many of the studies correlate FM with GI symptoms, Irritable Bowel Syndrome (IBS) and dyspepsia (7). Other studies have associated FM with Small Intestinal Bacterial Overgrowth (SIBO) and leaky gut (8). Finally one study found that FM symptoms improved in fibromyalgia patients who treated and resolved their SIBO condition with antibiotics. In this same study, no improvement was seen in the patients who took a placebo or who still tested positive for SIBO after the antibiotics. (7). This suggests that SIBO plays a causal role in fibromyalgia for at least some patients.
Although gut health is not a defined known cause of FM, we mention it here because it is a distinct possibility and there are indications that this may be an avenue for further research. It is also worth highlighting because improving gut health is something that everyone can work on, whether they have FM or not. If FM is in a person’s family history, then it may be even more relevant to work on gut health.
We suggest finding a good functional medicine doctor and testing for gut issues like SIBO (lactulose breath test) and other bacterial / parasite / fungal issues (comprehensive stool test).
What are the triggers of FM?
There is often a trigger of the onset of FM. It can be triggered by various factors such as:
- stress and/or a major life event such as divorce or the death of a spouse
- trauma, whether it is emotional, physical or in the form of an accident
- an infection or virus of some sort
- repeated injuries
What are the risk factors for FM?
There are certain risk factors that contribute to the likelihood of developing fibromyalgia. These include:
- Gender: 80-90% of patients with FM are women between 30 and 50 years of age (9). The reason for this isn’t known.
- Family history: As mentioned above, a family history of the condition may increase the risk of developing FM
- Disease: Although fibromyalgia isn’t a form of arthritis, having a rheumatic disease like lupus or rheumatoid arthritis or osteoarthritis may also increase risk.
- Inflammation (from one or more of the causes we discussed and/or inflammation from poor diet)
How is FM diagnosed?
FM is difficult to diagnose. There is currently no available imaging technologies or analytical tests for an objective diagnosis (1). FM is now defined as chronic widespread pain, persisting for more than 3 months, without any obvious wound or lesion. FM is commonly accompanied by additional symptoms, as mentioned above, such as joint stiffness, fatigue, sleep disturbance, cognitive dysfunction, and depression. Diagnosis tends to be subjective based on the symptoms and how the patient describes them to their doctor. Diagnosis also includes ruling out other possible diseases such as Rheumatoid Arthritis, depression, Multiple Sclerosis or other autoimmune conditions. Although debate on the concept of FM has continued ever since the classification criteria for diagnosis were first published, FM is now better understood and is generally recognized as a disorder.
How is FM treated?
There is no clear-cut treatment plan for FM and no one treatment alone gives strong relief of symptoms. The current conventional medicine approaches seek to manage the condition and manage the pain. Conventional medicine typically uses analgesic medications (OTC pain relievers like ibuprofen, or prescription drugs like tramadol), antidepressants, and anti-seizure drugs (which are sometimes helpful in reducing certain types of pain).There are, however, a number of things that can be done that have shown promise or that have worked in specific studies. We will mention a few natural dietary approaches for which there is promising research.
Functional medicine doctors will look for root causes of inflammation and resolve those root issues. We have seen many people with FM have complete recovery in our clinic from working out inflammatory root causes.
What are specific treatment ideas for FM?
Diet is increasingly thought to be a factor in FM. There is growing evidence that diet may contribute to symptoms, with strong evidence for how specific foods may lead to abnormal neurotransmission and continue the process of central sensitization (of pain) (10).
In our clinic, we use a variety of dietary approaches that are specifically tailored to the root causes we find on lab testing. Unfortunately, there is not one diet that works best for everyone with FM. Many times we have patients do one diet for a period of time and then switch diets if we’re not getting results. We also are combining diet with specific supplement and herbal protocols all based on root cause. All this to say that we cannot give one diet that will work for everyone. What we can do is give some general principles that can be helpful guides to consider as part of your dietary plan.
Many with FM do well avoiding gluten and sometimes even all grains. Avoiding refined sugar is also often helpful. Some have success with Paleo diets, others do well with Autoimmune Paleo, others do well with Ketogenic diets, and still others do well with Mediterranean diets (usually gluten-free). There are a few more specifics that can be helpful that will be covered in the next sections.
Please stay with us and read Part 3 of our FM series. In Part 3 we will cover the specific dietary and other action steps to take if you have FM.
1. Park DJ, Lee SS. New insights into the genetics of fibromyalgia. Korean J Intern Med. 2017; 32:984-995.
2. Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative Review: The Pathophysiology of Fibromyalgia. Ann Intern Med. 2007; 146:726-734.
3. Flodin P, Martinsen S, Löfgren M, Bileviciute-Ljungar I, Kosek E, Fransson P. Fibromyalgia is associated with decreased connectivity between pain- and sensorimotor brain areas. Brain Connect. 2014; 4:587-94.
4. Cook DB, Lange G, Ciccone DS, Liu WC, Steffener J, Natelson BH. Functional imaging of pain in patients with primary fibromyalgia. J Rheumatol. 2004; 31:364-78.
5. Kwiatek R, Barnden L, Tedman R, Jarrett R, Chew J, Rowe C, et al. Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami. Arthritis Rheum. 2000; 43:2823-33.
6. Mogil JS. Pain genetics: past, present and future. Trends Genet 2012; 28:258–266.
7. Wallace DJ, Hallegua DS. Fibromyalgia: the gastrointestinal link. Curr Pain Headache Rep. 2004; 8:364-8.
8. Goebel A, Buhner S, Schedel R, Lochs H, Sprotte G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology (Oxford). 2008; 47:1223-7.
9. Carranza-Lira S, Villalobos Hernandez IB. Prevalence of fibromyalgia in premenopausal and postmenopausal women and its relation to climacteric symptoms. Prz Menopauzalny. 2014; 13: 169–173.
10. Holton K. The role of diet in the treatment of fibromyalgia. Pain Management. 2016; 6.
11. Smith JD, Terpening CM, Schmidt SO, Gums JG. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother. 2001; 35:702-6.
12. Lattanzio SM, Imbesi F. Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy. Front. Med. 2018 | https://doi.org/10.3389/fmed.2018.00094
13. Donaldson MS, Speight N, Loomis S. Fibromyalgia syndrome improved using a mostly raw vegetarian diet: An observational study. BMC Complement Altern Med. 2001; 1: 7.
14. Rodrigo L, Blanco I, Bobes J, and de Serres FJ. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease. BMC Gastroenterol. 2013; 13: 157.
15. Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. J Pain Res. 2011 ;4:189-201.