Fibromyalgia, Multi-System Diseases
Impression of the publications on the relevance of the microbiome
In addition to clearly defined diseases, there are various conditions or syndromes that are less clear-cut, but can be very limiting for the patient. These are often referred to as multi-system diseases, and chronic systemic inflammation also plays an important role here. Because of the involvement of the immune system and its interconnectedness with the microbiome, it is not surprising that relationships with a disturbed microbiome are found here as well. Fibromyalgia and ME/CFS are examples of multi-system diseases.
Fibromyalgia
This often highly debilitating condition is characterized by widespread pain, fatigue, and low energy levels (1). Not to be underestimated are the also common mental complaints that are grouped under the term 'brain fog, fibrofog', which make patients unable to focus and forgetful, which often has an even greater impact on the lives of patients than the pain and fatigue (2). There is still a lot of uncertainty about the cause of fibromyalgia, but it is often seen as a disturbed function of the central nervous system, with pain signals coming in much stronger than in healthy people (3). This may sound like something that has little to do with the microbiome, but it should not be forgotten that the nervous system in the gut is very extensive, and that there is a close relationship between the brain and the gut (4,5). It is also striking that a large to very large proportion of fibromyalgia patients (30-75%) also have IBS complaints (6). In addition, there are indications that fibromyalgia patients have bacterial disruption in the small intestine (4,6) and the extent to which this is present is correlated with the intensity of the pain symptoms (7).
Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS)
ME/CFS is related to fibromyalgia, but the focus of the symptom pattern is different. Patients with ME/CFS are often severely fatigued, lack refreshing sleep, and experience fatigue and malaise after physical exertion (8). Because ME/CFS develops after infection in about 80% of cases (9), this condition is further discussed under post-acute infectious syndromes (PAIS).
References
- Clauw DJ. Fibromyalgia: A Clinical Review. JAMA 2014;311:1547.
- Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int 2015; 35:1115–25.
- Clauw DJ, D'Arcy Y, Gebke K, Semel D, Pauer L, Jones KD. Normalizing fibromyalgia as a chronic illness. Postgrad Med 2018; 130:9–18.
- Galland L. The Gut Microbiome and the Brain. J Med Food 2014; 17:1261–72.
- Zhu X, Han Y, Du J, Liu R, Jin K, Yi W, Zhu X, Han Y, Du J, Liu R, et al. Microbiota-gut-brain axis and the central nervous system. Oncotarget 2017; 8:53829–38.
- Othman M, Agüero R, Lin HC. Alterations in intestinal microbial flora and human disease. Curr Opin Gastroenterol 2008;24:11.
- Malatji BG, Meyer H, Mason S, Engelke UFH, Wevers RA, van Reenen M, Reinecke CJ. A diagnostic biomarker profile for fibromyalgia syndrome based on an NMR metabolomics study of selected patients and controls. BMC Neurol [Internet] 2017 [cited 2018 Feb 3];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426044/
- Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Rev Environ Health 2015; 30:223–49.
- Arron HE, Marsh BD, Kell DB, Khan MA, Jaeger BR, Pretorius E. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease. Front Immunol 2024;15:1386607.
Agenda
Knowledge & meetings
Microbiome Center regularly organizes intervisions, webinars and knowledge meetings for doctors and professionals. The sessions are aimed at both healthcare providers who are orienting themselves on microbiome therapy and experienced practitioners who want to deepen their knowledge.