What foods trigger fibromyalgia pain. How can diet impact fibromyalgia symptoms. Which nutritional choices may help alleviate fibromyalgia discomfort. What dietary adjustments can potentially reduce fibromyalgia flare-ups.

Understanding Fibromyalgia and Its Relationship with Diet

Fibromyalgia is a complex condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, memory issues, and mood changes. While the exact cause remains unknown, researchers believe it involves abnormalities in how the brain processes pain signals. Although there’s no cure, various treatments, including dietary modifications, can help manage symptoms.

The foods we consume can significantly impact inflammation levels in the body, which in turn affects fibromyalgia pain. By making informed dietary choices, individuals with fibromyalgia may be able to reduce flare-ups and improve their overall quality of life.

The Inflammation-Pain Connection in Fibromyalgia

Inflammation is a key trigger for pain in fibromyalgia. How does inflammation exacerbate fibromyalgia symptoms? When the body is in a state of chronic inflammation, pain receptors become more sensitive, potentially amplifying the pain signals sent to the brain. This heightened sensitivity can lead to increased pain perception, a hallmark of fibromyalgia.

Foods to Avoid with Fibromyalgia

Certain foods have been identified as potential triggers for fibromyalgia symptoms. By eliminating or reducing these foods in your diet, you may experience a decrease in pain and other associated symptoms.

Sugar and Simple Carbohydrates

Why are sugar and simple carbohydrates problematic for fibromyalgia sufferers? Research indicates that consuming foods high in sugar can increase fibromyalgia pain by putting excess stress on the body, contributing to inflammation, pain, and obesity. Simple carbohydrates, such as those found in white rice, bread, and pastries, are quickly digested, causing rapid spikes and drops in blood sugar levels. These fluctuations can exacerbate fatigue and pain associated with fibromyalgia.

Processed Foods and Unhealthy Fats

Processed foods often contain high levels of sugar, unhealthy fats, and artificial additives that can trigger inflammation and food sensitivities. Unhealthy fats, particularly those found in vegetable oil, safflower oil, peanut oil, and corn oil, may worsen fibromyalgia symptoms due to their inflammatory properties. This effect is especially pronounced when these oils are used for frying foods.

Alcohol and Caffeine

How does alcohol consumption affect fibromyalgia? Alcohol can trigger inflammation in the body, potentially exacerbating fibromyalgia symptoms. Additionally, combining alcohol with certain medications used to treat fibromyalgia can lead to adverse side effects. Caffeine, found in tea, coffee, soda, and chocolate, may also negatively impact some individuals with fibromyalgia, particularly those who experience sleep disturbances.

Specific Foods to Consider Eliminating

• Aspartame
• MSG and nitrates (food additives)
• Red meat
• Yeast and gluten
• Dairy products
• Eggs
• Nightshade vegetables (potatoes, tomatoes, bell peppers)

It’s important to note that food sensitivities can vary from person to person. Keeping a food diary and working with a healthcare professional can help identify specific trigger foods for individual cases of fibromyalgia.

Beneficial Foods for Fibromyalgia Management

While certain foods may exacerbate fibromyalgia symptoms, others can potentially alleviate discomfort and improve overall health. Incorporating these foods into your diet may help manage fibromyalgia more effectively.

Fruits and Vegetables

Why are fruits and vegetables beneficial for fibromyalgia sufferers? Fruits and vegetables are typically low in calories, high in fiber, and rich in antioxidants and phytochemicals. These properties make them excellent choices for maintaining a healthy weight, managing irritable bowel syndrome (a common comorbidity with fibromyalgia), and supporting overall health. Fresh or frozen produce is generally free from additives that can aggravate fibromyalgia symptoms, making them a safer choice for sensitive individuals.

Omega-3 Fatty Acids

How can omega-3 fatty acids help with fibromyalgia symptoms? Omega-3 fatty acids, found in cold-water fish, nuts, and seeds, are believed to have anti-inflammatory properties. While research on the direct connection between omega-3s and fibromyalgia is ongoing, these healthy fats are generally considered beneficial for overall health and may help reduce inflammation-related pain.

Whole Grains

Whole grains provide complex carbohydrates that are digested more slowly than their refined counterparts. This slower digestion helps maintain stable blood sugar levels, potentially reducing fatigue and pain fluctuations associated with fibromyalgia. Examples of whole grains include brown rice, quinoa, oats, and whole wheat bread.

Lean Proteins

Incorporating lean proteins into your diet can help maintain muscle mass and support overall health. Good sources of lean protein include chicken, turkey, fish, legumes, and tofu. These proteins provide essential amino acids without the potentially inflammatory effects of red meat.

The Role of Antioxidants in Fibromyalgia Management

Antioxidants play a crucial role in fighting free radicals and reducing oxidative stress in the body. How do antioxidants benefit individuals with fibromyalgia? By neutralizing free radicals, antioxidants may help reduce inflammation and alleviate some of the oxidative damage associated with fibromyalgia symptoms.

Foods Rich in Antioxidants

• Berries (blueberries, strawberries, raspberries)
• Dark leafy greens (spinach, kale, collard greens)
• Nuts and seeds
• Green tea
• Dark chocolate (in moderation)

Incorporating these antioxidant-rich foods into your diet may help support your body’s natural defense mechanisms against inflammation and oxidative stress.

Hydration and Fibromyalgia

Proper hydration is essential for everyone, but it can be particularly beneficial for individuals with fibromyalgia. How does staying hydrated impact fibromyalgia symptoms? Adequate hydration helps maintain proper muscle function, reduces the risk of headaches (a common fibromyalgia symptom), and supports overall bodily functions.

Hydration Tips for Fibromyalgia Patients

1. Aim to drink at least 8 glasses of water per day
2. Infuse water with fruits or herbs for added flavor without sugar
3. Incorporate hydrating foods like cucumbers, watermelon, and zucchini into your diet
4. Limit caffeine and alcohol intake, as they can contribute to dehydration
5. Consider herbal teas as a soothing, hydrating alternative to caffeinated beverages

Implementing Dietary Changes for Fibromyalgia Management

Making significant changes to your diet can be challenging, especially when dealing with a chronic condition like fibromyalgia. How can you successfully implement dietary changes to manage fibromyalgia symptoms? Here are some strategies to help you transition to a fibromyalgia-friendly diet:

Gradual Implementation

Instead of overhauling your entire diet at once, consider making small, incremental changes. This approach can help you adjust to new eating habits without feeling overwhelmed. Start by incorporating one or two new healthy foods into your diet each week while gradually reducing your intake of trigger foods.

Food Journal

Keeping a detailed food journal can help you identify specific trigger foods and track how dietary changes affect your symptoms. Record what you eat, when you eat it, and any symptoms you experience. Over time, patterns may emerge, allowing you to make more informed decisions about your diet.

Meal Planning and Preparation

Planning and preparing meals in advance can help you stick to your new dietary goals, especially on days when fibromyalgia symptoms are more severe. Consider batch cooking and freezing meals for easy reheating on low-energy days.

Seeking Professional Guidance

Working with a registered dietitian or nutritionist who has experience with fibromyalgia can provide personalized advice and support. They can help you develop a balanced meal plan that addresses your specific needs and preferences while avoiding potential trigger foods.

The Importance of a Holistic Approach to Fibromyalgia Management

While diet plays a significant role in managing fibromyalgia symptoms, it’s important to remember that it’s just one piece of the puzzle. A holistic approach that combines dietary changes with other treatment modalities can offer the most comprehensive management of fibromyalgia.

Complementary Strategies for Fibromyalgia Management

• Regular exercise, including low-impact activities like swimming or yoga
• Stress management techniques such as meditation or deep breathing exercises
• Adequate sleep hygiene to improve rest quality
• Physical therapy to improve mobility and reduce pain
• Cognitive-behavioral therapy to address the psychological aspects of chronic pain
• Medications prescribed by a healthcare provider to manage specific symptoms

By combining these strategies with a fibromyalgia-friendly diet, individuals may experience a more significant improvement in their overall quality of life and symptom management.

Emerging Research in Fibromyalgia and Nutrition

The field of fibromyalgia research is continually evolving, with new studies exploring the relationship between nutrition and symptom management. What are some recent developments in fibromyalgia and nutrition research?

Gut Microbiome and Fibromyalgia

Recent studies have begun to investigate the potential link between gut health and fibromyalgia symptoms. Some researchers hypothesize that imbalances in the gut microbiome may contribute to inflammation and pain sensitivity in fibromyalgia patients. This area of research suggests that probiotics and prebiotic-rich foods may play a role in future fibromyalgia management strategies.

Nutrient Deficiencies and Fibromyalgia

Ongoing research is exploring the potential impact of specific nutrient deficiencies on fibromyalgia symptoms. Some studies have found correlations between low levels of certain vitamins and minerals (such as vitamin D, magnesium, and coenzyme Q10) and increased fibromyalgia symptoms. While more research is needed, these findings suggest that addressing nutritional deficiencies may be an important aspect of fibromyalgia management.

Personalized Nutrition Approaches

As our understanding of fibromyalgia and individual variations in symptom presentation grows, researchers are beginning to explore personalized nutrition approaches. These tailored dietary interventions take into account an individual’s unique genetic makeup, lifestyle factors, and symptom profile to create more targeted and effective dietary recommendations.

While these areas of research are promising, it’s important to note that more studies are needed to fully understand the complex relationship between nutrition and fibromyalgia. Always consult with a healthcare professional before making significant changes to your diet or treatment plan based on emerging research.

In conclusion, while there is no one-size-fits-all diet for fibromyalgia, making informed dietary choices can play a crucial role in managing symptoms and improving overall quality of life. By avoiding trigger foods, incorporating anti-inflammatory options, and working closely with healthcare professionals, individuals with fibromyalgia can develop a personalized nutrition plan that supports their well-being and helps manage their condition more effectively.

Foods That Could Worsen Fibromyalgia

Foods That Could Worsen Fibromyalgia

SEMGeeks2020-10-22T15:51:12-04:00

Fibromyalgia is a condition characterized by widespread musculoskeletal pain, along with fatigue, trouble sleeping, memory problems and mood issues. While the exact cause of fibromyalgia is unknown, researchers believe that the condition has to do with how the brain processes pain signals. 

There is no cure for fibromyalgia, but there are various medications, therapies and lifestyle changes that can improve symptoms. One we’re going to talk about today is diet. The foods you eat affect the inflammation in your body, so there’s some foods to avoid and some to add to your diet. 

What Types of Foods Should I Avoid with Fibromyalgia? 

Inflammation is a trigger for pain, so the goal of a fibromyalgia diet is to avoid inflammatory foods. By replacing these foods with anti-inflammatory options like berries and leafy greens, it’s possible to prevent flare-ups. Here are some food types to avoid: 

• Sugar. Research shows that eating foods high in sugar can increase fibromyalgia pain because they put excess stress on the body, contributing to pain, obesity and inflammation.
• Carbohydrates. Refined carbohydrates (white rice, breads, pastries) are digested quickly, causing blood sugar levels to spike. But this doesn’t last long. Blood sugar levels then drop and you’ll feel hungry again, making pain and fatigue worse.
• Processed foods. Sugar and unhealthy fats are common in processed foods, and these can increase inflammation. Also, processed foods contain flavorings and preservatives that can trigger food sensitivities. 
• Unhealthy fats. Vegetable oil, safflower oil, peanut oil and corn oil can worsen fibromyalgia symptoms because they are inflammatory, especially when used to fry foods. 
• Alcohol. Drinking alcohol can also trigger inflammation, so it’s best to drink in moderation, if at all. Also, combining some medications with alcohol can lead to adverse side effects. 

Worst Foods to Eat When Suffering from Fibromyalgia Pain

Now that you know the types of foods you should stay away from when are diagnosed with fibromyalgia, let’s look at some specific foods you should start cutting from your diet right away: 

• Aspartame 
• MSG and nitrates (food additives) 
• Simple carbohydrates 
• Red meat 
• Caffeine, including tea, coffee, soda and chocolate 
• Yeast and gluten 
• Dairy products 
• Eggs 
• Nightshade vegetables (potatoes, tomatoes, bell peppers)

Contact Jersey Rehab for More Ways to Treat Fibromyalgia Pain 

To manage your symptoms, it’s best to eat a balanced diet that includes plenty of fresh fruits and vegetables. These foods contain vitamins and antioxidants that fight free radicals and keep the body normalized. Other foods to add to your diet include whole grains, healthy fats and lean proteins.  

If you feel that your symptoms are still not managed with a healthy diet and medication, contact Jersey Rehab for an appointment. We have three convenient locations and can schedule your appointment within 24 hours. 

Fibromyalgia: Foods That Help, Foods That Hurt

When you have fibromyalgia, following a healthy diet that reduces sugar and processed carbs may provide some much-needed relief.

Medically Reviewed

Eating whole foods may help ease fibromyalgia symptoms.

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While no magic food will prevent every person’s fibromyalgia flare-ups, a few dietary improvements can make a world of difference and may help control even the most daunting symptoms.

“With fibromyalgia, one of the most important things is to improve your overall health and well-being,” says Lynne Matallana, founder and former president of the National Fibromyalgia Association. Following a nutritious diet is a big part of that.

Find out which foods can offer relief — and which should have a less prominent place on your table.

Enjoy Fruits and Vegetables in Abundance

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Fruits and vegetables are typically low in calories, high in fiber, and rich in antioxidants and phytochemicals. That’s good news for anyone who is working on maintaining a healthy weight, is living with irritable bowel syndrome, or has an autoimmune disorder — all common among people with fibromyalgia, according to the Mayo Clinic. As an added plus, fresh or frozen fruits and vegetables generally don’t contain the additives that can aggravate fibromyalgia symptoms.

“Preservatives and coloring tend to have a negative effect on a person with fibromyalgia,” Matallana says. “Eating more natural foods is very important.”

Seek Out Foods That Contain Omega-3 Fatty Acids

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The “good fat” found in cold-water fish, nuts, and seeds is believed to have anti-inflammatory properties, according to Jeffrey Thompson, MD, a physiatrist and sports medicine specialist at the Mayo Clinic in Rochester, Minnesota. While research on the connection is not definitive, there is growing evidence for omega-3’s anti-inflammatory benefits, notes the American Heart Association. And while omega-3s may not offer pain relief across the board, they’re a worthy addition to any diet: “Just for heart health, it’s not a bad idea,” Dr. Thompson says.

Include Lean Protein Sources in Your Meals

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Packing more healthy protein into your diet can keep blood glucose levels from fluctuating, which can trigger fatigue. “One thing we recommend is the Mediterranean diet, because it helps people avoid those sugar rushes,” Matallana says.

Consuming adequate protein is necessary for good health generally, and choosing mainly lean proteins — such as lean meat, skinless poultry, fish, legumes, tofu and edamame, nuts and seeds, and low-fat dairy products — can help keep your saturated fat intake low, which in turn helps keep blood cholesterol in a healthy range.

Pay Attention to the Effects of Caffeine

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Fatigue is one of the most common symptoms of fibromyalgia, but using caffeine to combat this symptom may backfire. “What we tend to do when we get into that exhaustion phase is self-medicate with caffeine,” Matallana says. “You give yourself a boost, but then you have that drop-off.”

While a moderate amount of daily caffeine may have no negative effects for individuals with fibromyalgia, a high intake can interfere with sleep patterns, which can further perpetuate fatigue, and can also trigger headaches if a person suddenly consumes less than normal. The important thing is to be aware of how your caffeine intake is affecting you, mentally and physically.

Avoid Processed Foods and Refined Carbohydrates

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Processed foods (which include many frozen dinners, breakfast cereals, and snack foods) and refined carbohydrates (such as white rice and baked goods made from white flour) typically provide a temporary surge in energy followed by a crash. And as Thompson explains, people with fibromyalgia often experience general hypersensitivity — and that can translate into increased sensitivity to blood sugar highs and lows.

At the same time, processed foods often contain added sugar and are typically missing the fiber and micronutrients that are naturally present in unprocessed foods. While in the short term they may provide psychological comfort, in the longer term they tend to be less satisfying than whole foods.

Avoid Artificial Sweeteners

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While reducing sugar intake can be beneficial, you may also want to steer clear of artificial sweeteners, which tend to be even sweeter than sugar. Artificial sweeteners have not been shown to help with weight loss or reduce the risk of chronic diseases. And some people find that the sweetness of low-calorie sweeteners makes them crave more sweetness, not less.

Instead of turning to sweetened foods, try curbing your sugar cravings by eating moderate portions of fresh fruits and sweet vegetables like sweet potatoes, winter squash, or carrots.

Keep a Fibromyalgia Food Diary

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The benefits of eating or avoiding specific foods are different for everyone, so keeping a food diary may help you identify which foods appear to trigger pain for you and also which foods make you feel good. It may be a process of trial and error, but rest assured that improving your diet is unlikely to backfire.

“People have to realize that it may not be an overnight fix,” Matallana says. “But by eating healthy, you’re working toward a better quality of life, because you’ll be healthier overall.”

Editorial Sources and Fact-Checking

• Fibromyalgia: Symptoms and Causes. Mayo Clinic. October 26, 2021.
• Could Fish Oil Fight Inflammation? American Heart Association. December 12, 2019.

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Fibromyalgia secret found in microbiome

07/24/2022 19:14

Fibromyalgia secret found in microbiome

9000 4

Some differences in microbiome composition and bile-metabolizing bacteria are exclusively associated with fibromyalgia

Affecting up to four percent of the population and mostly women, fibromyalgia is a syndrome that causes pain, fatigue, and cognitive problems. This poorly understood condition has no cure and is difficult to diagnose. Now, thanks to the work of a team of scientists from the McGill University Medical Research Center, the University of Montreal, and the Institute of Pain Medicine at the Rambam Medical Campus in Haifa, Israel, that hope of a cure is on the horizon.

After Fibromyalgia was first shown in 2019 to be associated with changes in the gut microbiome, this group of researchers has taken an important step towards better understanding the link between gut bacteria and the syndrome. In a new study, they provide the first evidence that patients with fibromyalgia have different numbers and types of bile-metabolizing gut bacteria, as well as different concentrations of bile acids in the blood compared to healthy people. They also show that some of these differences correlate with symptom severity. These findings, published in the scientific journal Pain, could pave the way for the development of diagnostic and therapeutic tools for people with fibromyalgia.

Unique Bile Acid Signature

Human bile acids, secreted by the liver, help the body digest oils and fats and perform many biological functions in other body systems. After being metabolized in the intestines, they are recycled to the liver and blood and become secondary bile acids.

In this study, comparing 42 healthy women with 42 women with fibromyalgia, the researchers found that bile-metabolizing bacteria, which were more abundant in the gut, were not the same in both groups, and that women with fibromyalgia had significant changes in serum concentrations secondary bile acids.

“The change in bile acids that we observed in patients with fibromyalgia in our study is distinct enough to be used as an effective biological marker to identify people with fibromyalgia. This is an important step forward given that diagnosing fibromyalgia is often a lengthy process that requires addressing other conditions that can cause similar symptoms,” says Dr. at McGill University Medical Center (MUHC) to the Rambam Institute of Pain Medicine during the study.

Using artificial intelligence, the team also found that the presence of six specific secondary bile acids was enough to predict, with over 90% accuracy, that a study participant would have fibromyalgia.

“Machine and statistical learning has helped us determine which gut bacteria are abundant and which human bile acids are important causes of disease,” says study co-author Emmanuel Gonzalez , MD, of the Canadian Center for Computational Genomics and the Department of Human Genetics at McGill University. “These approaches have provided an accurate biological signature for fibromyalgia, and while our study population was relatively small, these results are a promising sign that artificial intelligence can significantly improve the accurate diagnosis of the disease.”

Changes related to symptom severity

Researchers collected stool samples from all participants for bacterial microbiome analysis, as well as blood samples for bile acid analysis. To see if there was an association between observed biochemical changes and symptom severity, they asked participants with fibromyalgia to complete questionnaires assessing their pain, fatigue, sleep quality, and cognitive and somatic problems. Patients also described their physical functioning, difficulty at work, morning fatigue, muscle stiffness, symptoms of anxiety and depression.

alpha-muricholic acid

Researchers identified a secondary bile acid called alpha-muricholic acid (αMCA) that was, on average, five times less present in patients with fibromyalgia than in healthy participants. They found that the presence of αMCA was negatively correlated with most of the symptoms of the syndrome, including pain, fatigue, poor sleep, and cognitive complaints.

“If this is confirmed in future studies, we may explore a potential novel mechanism involving one particular secondary bile acid that affects chronic pain,” says study senior author Dr. Yoram Shire of MUHC Alan Edwards Pain Management Unit.

Using DNA sequencing technology and artificial intelligence, the team looked for correlations between serum bile acid concentrations and various clinical variables. The analysis confirmed that at least some of the observed differences in patient microbiome composition and bile-metabolizing bacteria were likely due to fibromyalgia rather than other individual or environmental factors.

“For example, irritable bowel syndrome and depressive disorder are common among people with fibromyalgia, but we were able to demonstrate that changes in specific bile acids associated with fibromyalgia do not correlate with these conditions,” says bioinformatics expert Emmanuel Gonzalez .

Because diet is a factor influencing the composition of the gut microbiome, the scientists also analyzed each participant’s diet and found no correlation between nutrient intake and symptoms.

First report related to bile acid changes in chronic pain

Like the team’s previous study linking fibromyalgia to the gut microbiome (published in Pain in 2019), this new study was conducted as part of the Fibromyalgia Microbiome Project , which was conducted between 2017 and 2018 at the MUHC Alan Edwards Pain Management Unit and the West Island Rheumatology Clinic in Montreal, Canada. Despite the challenges posed by the COVID-19 pandemic, a team of researchers specializing in clinical research, human nutrition, environmental biology and bioinformatics, continued their collaboration and in less than three years were able to publish this new study, establishing the first significant link between blood bile acids and chronic pain.

“Our results show a strong relationship between a patient’s microbiome composition, bile acids, and the severity of fibromyalgia symptoms. Understanding the biological mechanism behind fibromyalgia is critical because it shows that the condition is real and because it moves us closer to developing an effective treatment for these women and men in pain,” says Dr. Shir .

Source : medicalxpress

Some details of the study (regarding the microbiome) see below: 8

from an article in Pain

Study participants

Of the 156 participants selected, 77 were patients with fibromyalgia (group FM ) and 79 were participants in the control group. Control participants included 11 first-line relatives of patients with FM (group RC ), 20 other family members of FM patients (group HC ), and 48 unrelated controls ( UC ).

FM patients were women (mean age 46 ± 8 years) who were diagnosed with FM on average 7.7 years ago. Most of the participants were Caucasian. The mean generalized pain index in the patient group was 11 (SD 3.2) and the mean symptom severity score was 9.3 (SD 1.8). 2016 FM diagnostic criteria scores and FM Impact scores were significantly higher in patients compared to all controls (Pillai trace P < 0.0001, F = 4.53).

General composition of the gut microbiome

The predominant bacterial phyla among all participants were bacterioids (48%), firmicutes (40%), proteobacteria (4%) and actinobacteria (2%). Of the 349 OTUs annotated at the taxonomic species level, 312 were unique, while 37 had a sequence common to several species. The 10 most common OTUs annotated at species resolution in all samples belonged to 9 genera0087 Bacteroides including Bacteroides dorei, Bacteroides uniformis, Bacteroides stercoris, Bacteroides ovatus and Prevotella copri, Alistipes putredinis and Faecalibacterium prausnitzii .

Figure 1. ( A ) General composition of the microbiome of 156 study participants. Flower diagram of 1620 OTUs, colored by type. ( B ) Taxonomic composition of the gut microbiome at the philological level among patients from the respective groups: FM (n = 77), RC (n = 11), HC (n = 20) and UC (n = 48).

Gut microbiome composition changes in patients with fibromyalgia

Canonical correspondence analysis shows that samples are separated by FM patients and unrelated controls in non-overlapping clusters. Multivariate analysis showed that the intergroup variance was significantly greater than the intragroup variance (P < 0.01) between FM patients and unrelated controls. Family members and first-degree relatives are grouped between FM patients and unrelated controls.

Differential population analysis was performed to compare FM patients (77) with unrelated controls (48) using differential analysis of gene expression based on negative binomial distribution (DESeq2).

note for understanding further information:

DA 099 Taxa DA (DA species) are taxa whose absolute abundance per unit volume of an ecosystem (eg gut) differs significantly depending on changes in the covariance of interest (eg group effect). The DA assay checks for significant changes in cell numbers for each label depending on the conditions. This will show which cell types are being depleted or enriched by processing, which is perhaps as interesting as the changes in expression within each cell type.

Seventy-two OTUs were identified as species DA, 53 higher in FM and 18 higher in unrelated controls. These OTUs included 47 that could be annotated at the taxonomic level of genera or species and included taxa from Firmicutes, Bacteroidetes and Proteobacteria . The largest positive difference in fold change in putative DA species observed in FM patients was obtained from OTUs Parabacteroides_merdae_4 and Clostridium_scindens_1, while the largest negative difference in fold change in an FM patient was in Prevotella_copri_1 and Bacteroides_uniformis_3 (Fig. 2).

Figure 2 .: ( A ) Different number of OTUs between FM patients and unrelated controls. The fold change (FC log2) denotes the relative differences in relative abundance between groups (DESeq2). Species are grouped by type for comparison. ( B ) Diagram of species-level differential abundance of bacteria in FM patients (left) and healthy individuals (right). FM, fibromyalgia; OTU, operational taxonomic unit.

Change in serum levels of fermentation end products in patients with fibromyalgia

Consistent changes in the abundance of bacteria associated with butyrate metabolism were observed: F. prausnitzii and B. uniformis were found in lower relative abundance in patients with FM, while a higher relative abundance was observed for Intestinimonas butyriciproducens, Flavonifractor plautii, Butyricoccus desmolans, Eisenbergiella tayi and Eisenbergiella massiliensis . To explore the possible metabolic effect of these changes, a targeted metabolic approach was used to measure the serum concentrations of butyric acid, isobutyric acid, propionic acid, and lactic acid. Serum levels of butyric acid in FM patients (n = 73) were higher compared to unrelated controls (n = 46, P = 0.005), while propionic acid levels were lower (P = 0.006), and downward trend in isobutyric acid levels (P = 0.056). There were no significant differences in serum lactic acid levels. Multivariate analysis showed a significant difference between the groups (Pillai’s Trace, F = 8.97, P < 0.0001).

Figure 3 . Serum concentrations of butyric acid, isobutyric acid, propionic acid and lactic acid (ANOVA **P<0.01, ˙P<0.1).

The gut microbiome is associated with clinical scores of fibromyalgia

To examine the relationship between abundance of DA taxa and symptom severity of FM, the relative abundance of DA OTUs was correlated with disease-specific and independent variables. Spearman’s rank correlation coefficient demonstrated a statistically significant relationship between the abundance of several taxa and measures of disease severity, including pain intensity, widespread pain index, dyscognition, and fatigue (Benjamini-Hochberg coefficient < 0. 05). The abundance of these taxa showed no consistent association with demographic, anthropometric, or physical indicators of patient activity. Thus, the abundance of some DA taxa may correlate with the severity of FM symptoms.

Identifying Fibromyalgia Patients Using Microbiome-Based Machine Learning

To explore the utility of gut microbiome composition in identifying patients with FM, machine learning was used using LASSO (least absolute shrinkage and selection operator) and SVM algorithms to determine OTUs, most predictive for diagnosing FM. Full and filtered scoring tables as well as subsets of OTUs (DA and random) were tested to determine the most useful dataset for classification. The DA OTUs data set showed the highest diagnostic accuracy. 10-fold cross-validation (10,000 iterations) yielded 123 sets of DA OTUs with the highest diagnostic accuracy. LOOCV (unit-wise cross-validation) identified a set of OTUs that provided the best overall prediction accuracy. Finally, this set for the best prediction of OTUs was used in the SVM trained on 90% of participants. SVM gave an ROC-AUC prediction accuracy of 87.8% using cohorts of 10% participants (100 iterations).

Discussion

(excerpts)

The overall population structure and diversity of the gut microbiome in patients with fibromyalgia and a comparable cohort of healthy individuals were relatively similar. However, when examined at higher resolution, the composition of the gut microbiome showed significant changes in FM patients. The diagnosis of FM and its clinical features (pain, fatigue, and cognitive symptoms) account for more microbiome variability than any other covariate, including demographic, anthropometric, and dietary variables, as well as comorbidities and medication intake.

A quantitative relationship has been observed between the abundance of several bacterial taxa and the severity of symptoms associated with FM, including pain intensity, pain distribution, fatigue, sleep disturbances, and cognitive symptoms. The abundance of these taxa was selectively correlated with disease-related symptoms but not with disease-independent variables.

Having established that the gut microbiome is altered in FM patients, the LASSO machine learning algorithm showed high accuracy in predicting control patients based only on the individual characteristics of the microbiome. Further studies are needed, including larger cohorts, a larger ethnic sample, and inter-cohort evaluation, before a confident contribution to improving the diagnosis of FM can be made; however, the ability of the model to accurately identify patients with FM in this study indicates that the gut microbiome may potentially contribute to the clinically challenging diagnosis of FM.

When looking at the 19 specific species identified as significantly different between FM patients and unrelated controls, there was a wide range in how well these species were characterized. Those species thought to have been depleted (lower in relative abundance) in the FM group were relatively well characterized and included F. prausnitzii, B. uniformis, P. copri and Blautia faecis . Bacterium F. prausnitzii is one of the most common and well-studied butyrate-producing bacteria in the human gut. This species has been reported to be depleted in numerous intestinal diseases and has therefore been proposed as a potential marker for intestinal disorders. In the gut of F. prausnitzii , has been reported to have antinociceptive as well as anti-inflammatory effects and enhance gut barrier function. As in our observations, the depletion of F. prausnitzii 9 was also reported.0088 in patients with CFS.

B.uniformis is one of several species in which a change in relative abundance has recently been reported in patients with inflammatory arthritis, along with Haemophilus parainfluenzae , P. copri and others. B. uniformis and H. parainfluenzae were found in the synovial tissues of joints affected by osteoarthritis, while P. copri and H. parainfluenzae were found in the synovial fluid of rheumatoid arthritis. It is believed that species P. copri mediates an inflammatory response through Th27 activation and has also been shown to cause arthritis in arthritis-prone mice. In this study, these species were found in lower numbers in patients with FM. Although FM is often considered a rheumatic disease, it appears that at least some of the species previously found at higher abundance in inflammatory rheumatic diseases are depleted in FM.

In contrast to the depletion of butyrate producers F. prausnitzii and B. uniformis in FM patients, a significantly higher relative abundance of a number of other known intestinal butyrate producers was observed: I. butyriciproducens, F. plautii, B. desmolans, E. tayi , and a recently identified E. massiliensis . Changes in butyrate and propionate metabolizing species were further supported by changes in serum levels of these short chain fatty acids. Consistent with this putative shift in the butyrate-producing community in FM patients, a relative abundance of Parabacteroides merdae was also significantly higher in patients with FM. Recently, Olson et al. reported P. merdae as one of 2 key mediators of the antiepileptic effect of the ketogenic diet: in a mouse model, a ketogenic diet can lead to an increase in the abundance of P. merdae , which in turn, through regulation of amino acid γ-glutamylation, leads to an increase in the ratio of γ-aminobutyric acid (GABA) to glutamate in the hippocampus. An increase in the ratio of inhibitory to excitatory neurotransmitters in the brain is thought to protect against seizures. The second key mediator of the effect of the ketogenic diet on seizures reported by Olson et al. was Akkermansia muciniphila , which in our cohort was also found at higher numbers in FM patients, although this observation did not reach statistical significance (P=0.042, Benjamini-Hochberg FDR=0. 27).

Clostridium scindens and B. desmolans, 2 bacterial species capable of converting cortisol to androgens through 20α-hydroxysteroid dehydrogenase activity were found at higher numbers in patients with FM. Interestingly, abnormal regulation of the hypothalamic-pituitary-adrenal axis has been reported in patients with FM, although the direction of the dysregulation remains controversial.

Fibromyalgia shares clinical features with several syndromes, including IBS, CFS, and IC. In all of these syndromes (IBS, CFS, and IC), specific changes in the gut microbiota have been reported. Although it has been reported that several taxa found here are so-called. DA taxa under FM, they are DA incl. and in other overlapping syndromes, while other taxa appear to be unique to FM. As an example, C. scindens was found in higher numbers in both FM and CFS. H. parainfluenzae and F. prausnitzii were found to be depleted in FM and CFS, and the latter was also reported to be depleted in IC patients. Several genera, including Bacteroides, Parabacteroides , and Clostridium , have been found in both DA in IBS and FM (regardless of IBS). However, several taxa showed an inverse differential abundance pattern: for example, P. merdae , significantly taller in FM, was reported to be depleted in CFS. In addition, FM is associated with a high incidence of comorbid mental illness, mainly anxiety and depression, affecting 40% to 80% of people. Anxiety, depression, and emotional stress are associated with changes in the gut microbiome, both in the general population and in the context of other specific diagnoses. A recent study by Peter et al. (2018) highlighted the potential importance of mental health as a factor in IBS, suggesting that further interdisciplinary research is needed to fully understand the microbiome differences identified here. Thus, FM appears to share some common microbiome characteristics with several overlapping syndromes while retaining some unique features.

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The results presented in the study demonstrate for the first time the change in the microbiota of the gastrointestinal tract in patients with somatic (non-visceral) pain in general and FM in particular. Several of the DA taxa described here are known to be involved in metabolic pathways whose effect on FM symptoms is biologically plausible. Moreover, there appears to be a quantitative correlation between the abundance of several taxa and the severity of symptoms. Finally, DA taxa in FM patients share some common features with overlapping dysfunctional syndromes—IBS, CFS, IC—while retaining some unique DA taxa.

The results of this study suggest changes in the gut microbiome in FM. Further studies are needed to measure possible microbiome changes in other chronic pain conditions, as well as to explore potential causal correlations between the gut microbiome and FM. Our findings may provide important opportunities to improve our understanding of FM, aid in its diagnosis, and possibly chart future therapeutic options. First, the study of the mechanisms by which the gut microbiota may influence nociception may provide new insights into the pathogenesis and pathophysiology of fibromyalgia and possibly suggest ways to explore the possible effects of trigger events, personal susceptibility, and individual prognosis. Second, microbiome-based machine learning classification accuracy suggests that the microbiome may help diagnose FM in the future. Finally, if a causal relationship between changes in the gut microbiome and FM can be established, the way could be paved for the development of new therapies that target this fascinating community of gut microorganisms.

Retrieved : Minerbi, Amir, et al. Altered microbiome composition in individuals with fibromyalgia / PAIN : November 2019 – Volume 160 – Issue 11 – p 2589-2602

Formerly see: Gut bacteria linked to chronic pain 9000 5

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Fibromyalgia diagnosis and treatment

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Fibromyalgia is a pain syndrome that occurs when soft extra-articular tissues are damaged and the activation of glutamate receptors, an amino acid that ensures the functional activity of the central nervous system, is increased.

Diagnosis of fibromyalgia

Diagnosis and clinical differentiation of fibromyalgia from psychosomatic disorders, myositis, oncopathologies, neurasthenia is based on the results: main complaints, prescription of pain syndrome, concomitant diseases.

Trigger point studies – small foci of tension in the muscles that are activated under certain conditions (inflammatory process, physical activity, trauma).

Causes of fibromyalgia

Practicing rheumatologists associate this pathology with:

• genetic predisposition;
• damage to peripheral nerve trunks in trauma, inflammatory and dysmetabolic processes;
• infectious diseases;
• destructive stress;
• hormonal imbalance;
• vaccination;
• the use of certain pharmacological agents.

Pathogenesis

In the occurrence of fibromyalgia neurotransmitter systems play the leading role – noradrenergic and serotonergic. Excessive excitation of associative neurons located in the posterior horns of the spinal cord provokes a decrease in the level of 5-hydroxytryptophan, an amino acid that is a precursor of the biogenic amine serotonin, in the cerebral fluid.