Could probiotics help with fibromyalgia?
Fibromyalgia (FM) is a 'pain disorder', and patients present with multiple areas of pain, that are sensitive to pressure, as their over-riding symptom. Additionally however, they may also experience a combination of the following symptoms: IBS, other bowel complaints, mood disorders (such as depression), sleep problems, fatigue, muscle stiffness, brain ‘fog’ and problems with memory and concentration.
The cause of FM is still unknown, although the onset of the condition can often be traced back to a physically or emotionally stressful event, such as childbirth, an accident, a relationship breakdown or death of a loved one etc. It is thought that the condition affects as many as one in twenty people to some degree or other.
Intestinal symptoms affect the vast majority of FM sufferers, with 81% reporting irregular bowel habits, and 32% of sufferers being diagnosed with IBS1. Dysbiosis (see Probiotics Learning Lab for more glossary definitions) has often been suggested as a trigger for Fibromyalgia, and in 2004 Pimentel et al2, studied 42 patients with the condition and found (through Lactulose Hydrogen breath testing) that all 42 had an overgrowth of bacteria in the small intestine, as opposed to only 20% of healthy controls.
With that in mind probiotics could potentially be helpful in a number of different ways, including that they have been shown to: inhibit pathogens, strength gut barrier function, modify the inflammatory response of the intestine and reduce hyper-sensitivity in the GI tract 3,4,5,6.
Mood disorders and poor sleep patterns
Sufferers of Fibromyalgia have been shown to have low levels of serotonin. Serotonin is a neurotransmitter that helps us to feel happy and relaxed, and therefore low levels are often seen in depressed patients. Serotonin is also used as a building block for our main ‘sleep hormone’, melatonin. So, without enough serotonin a patient often feels both depressed and suffers with insomnia or irregular sleep patterns.
So, you may ask, what links this to the microbiome and probiotics? Well, certain strains of bacteria are known to produce an enzyme (tryptophanase) that degrades tryptophan, which is the amino acid that serotonin is made from. Without enough tryptophan to convert to serotonin we are unable to make enough of this vital neurotransmitter, and deficiency symptoms arise. 90% of our serotonin is made in the digestive tract, and therefore having a healthy microbiome is crucial to balancing neurotransmitter levels (to read more about probiotics and sleep, you may like to read my earlier blog here, over in the Probiotics Learning Lab).
In addition to helping with our emotional health, serotonin is also involved in gut motility. The wave-like movements that keep food moving down the GI tract are slowed down considerably when serotonin levels are low, and our faecal transit time increases which can lead to a build up of gases and bloating in the bowel.
Brain fog is a common complaint for FM patients. The cause is not really understood by most ‘mainstream’ physicians, but looking at it from a more naturopathic viewpoint, brain fog is often linked to dysbiosis and especially an over-growth of Candida albicans in the gut. Many pathogens, including Candida albicans produce a lot of toxins that increase inflammation in the gut. It is this inflammation that is thought to lead to brain fog. Probiotics can help to re-dress the balance of microbes in the GI tract, and the probiotic yeast Saccharomyces boulardii has been shown in trials7 to produce anti-fungal acids that can inhibit its proliferation.
Looking to the future
It's important to note that at this stage, this is all theoretical. Gold standard trials need to be run to see if probiotics can indeed help with the symptoms of Fibromyalgia. If they are found to be of therapeutic benefit, then further trials will be needed to analyse the best strains to be used.
My own ‘gut feeling’ (forgive the pun) is that probiotics will, in the future, have a valuable role to play in managing FM symptoms, and making life a little easier for sufferers.
1. Triadafilopoulos 1991
2. Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, et al. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Annals of the Rheumatic Diseases 2004 Apr;63(4):450-2.
3. Preidis 2009
4. Quigley 2006
5. Quigley 2007
6. Spiller 2008
7. Capric Acid Secreted by S. boulardii Inhibits C. albicans Filamentous Growth, Adhesion and Biofilm Formation. Anna Murzyn, Anna Krasowska, Piotr Stefanowicz, Dorota Dziadkowiec, and Marcin Łukaszewicz,