Fibromyalgia and the Bacterial Microbiome

A couple of weeks ago, I asked all of you to let me know if there are topics of particular interest to them.  I’ll be covering a number of these suggestions in the next few weeks.  Thanks for all your feedback and keep it coming!

The number one request was for more information on the relationship of the gut biome to fibromyalgia (FM) and chronic fatigue syndrome (CFS).  For once, I was not surprised. For decades, these two overlapping, yet distinct, illnesses were ignored by the medical community and now, so many years later no one has yet figured out how to properly diagnose them, let alone effectively treat either of them.  (Here is a post I wrote about CFS and microbiome, for those interested.)

In one of those coincidences that I love so much, last week, a paper was published in the major medical journal, Pain, entitled, “Altered microbiome composition in individuals with fibromyalgia.”[i]  Can you believe the timing?!

To sum up:  there are distinct differences in the composition of the gut bacteria in those with FM, so much so that it looks like a promising way of accurately and rapidly diagnosing the disease in the not-very-distant future. (I have written a bit about FM and the biome before, like here.) Previous research has shown that the rate of false positive diagnosis of FM (i.e. telling people they have FM when in fact, they are suffering from something else) is between 66-73%!  A reliable way of definitively diagnosing FM is desperately needed.

The justification for the present study:  in CFS, which is closely related to FM, a small amount of research has shown altered gut microbiota, and one small study of those with FM itself showed altered intestinal permeability, and a “…distinct urine metabolomics signature was demonstrated, which could be attributed to gut microbiome alterations.”  This study included 166 participants, 77 with FM and 79 healthy controls.

Highlights of their findings:

1. As mentioned earlier, there were distinct differences in the gut bacterial composition of those with FM versus those without.  These alterations showed a very distinct pattern.  More than that, there was a quantitative association between certain kinds of bacteria and the severity of FM symptoms including pain intensity, pain distribution, fatigue, sleep disturbances and cognitive symptoms.
2. Some of these changes include low levels of the following species: prausnitzii, B. uniformis, P. copri, and Blautia faecis. This latter species, “…is one of the most abundant and well-studied butyrate producing bacteria in the human gut. This species has been reported to be depleted in multiple intestinal diseases and was therefore suggested as a potential marker for gut disorders…. B. uniformis is one of several species that have recently been reported as having altered relative abundance in patients with inflammatory arthritis…” (That said, there are distinct differences in the composition of the microbiota in FM patients versus those with traditional rheumatic diseases.)
3. FM patients had markedly higher levels of bacteria that are known to produce high levels of the short-chain fatty acid (SCFA), butyrate: butyriciproducens, F. plautii, B. desmolans, E. tayi, and E. massiliensis.
4. Higher levels of the SCFAs butyrate and propionate are found in the blood of those with FM versus healthy controls.

The authors conclude that their study provides evidence of a unique bacterial signature for FM, which could, “…offer new insights into the pathogenesis and pathophysiology of FM, and possibly suggest leads to explore the possible effects of trigger events, personal susceptibility, and individual prognosis.”  Certainly this research may, at the very least, provide a way to properly diagnosis the illness.  And over time, I certainly hope it leads to new treatments because, as of now, there are none.  (In fact, I recently wrote about the fact that the science is simply not there yet regarding using probiotics to treat either CFS or FM.)

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[i] Minerbi, A, et. al.  Altered microbiome composition in individuals with fibromyalgia. Pain. 2019:160(11).