Fibromyalgia – A Functional Medicine Approach

Welcome to my blog post ‘Fibromyalgia Testing – A Functional Medicine Approach ‘.

Although chronic fatigue syndrome (CFS) has been defined as a separate syndrome to fibromyalgia (FM),

up to 70% of patients with fibromyalgia are also diagnosed with CFS and 35-70% of patients with CFS have also been diagnosed with fibromyalgia.

Thus studies of patients with CFS may have clinical relevance to fibromyalgia.

Listen to Dr. Myhill Discuss CFS And Gut Health

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What Is Fibromyalgia?

Fibromyalgia is a condition that causes widespread pain and extreme tiredness. Like chronic fatigue syndrome it can be argued that it is a ‘diagnosis of exclusion’, meaning conventional tests have come back negative and you meet the criteria (a list of symptoms) for the condition. This, in my eyes, is incredibly frustrating as it doesn’t;t help us understand what might be at the root of the condition.

Fortunately our understanding of fibromyalgia is improving and we have several functional tests that may help us understand how we can support someone with the condition. This blog will summarise some of this research, and highlight the relevant tests available for each of these factors.

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Fibromyalgia Symptoms

Symptoms vary significantly and can often fluctuate but include:

  • Chronic pain
  • Issues with sleep
  • Fatigue
  • Headaches
  • Brain fog
  • Irritable bowel syndrome: bloating, constipation, diarrhoea, and abdominal pain

What Causes Fibromyalgia?

There is no one definitive cause of fibromyalgia, but we do know there are numerous things that may contribute to it. I discuss these below, and also highlight the appropriate tests that can be considered.

How To  Test For Fibromyalgia?

Every patient with chronic widespread pain requires at the first medical evaluation a complete history, and some laboratory tests to screen for metabolic or inflammatory causes of chronic widespread pain:

complete blood count, C-reactive protein, serum calcium, creatine phosphokinase, thyroid stimulating hormone, vitamin D

SIBO, Testing, And Fibromyalgia

Investigators found small intestine bacterial overgrowth in 100% of 42 patients with FM.

SIBO stands for small intestine bacterial overgrowth and is thought to be the most common cause of irritable bowel syndrome. It is tested for via a breath test.

Interestingly not only is SIBO found in a high percentage of those with fibromyalgia but studies have shown that the degree of somatic pain in fibromyalgia correlated significantly with the hydrogen level seen on the breath test – i.e the worse the bacterial overgrowth the more pain was experienced.

In a well known study run by Dr. Pimemtel 100% of fibromyalgia participants were found to have SIBO.

Interested In Testing For SIBO?

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Recommended Test: SIBO Breath Test

Leaky Gut, Testing,  And Fibromyalgia

Leaky gut has also been detected in patients with Fibromyalgia – which isn’t surpassing since we know approximately 50% of people with small intestinal bacterial overgrowth have leaky gut.

Recommended Test: Healthpath Leaky Gut Test.

The Gut Microbiome And Fibromyalgia

Imbalances in the gut microbiome have also been detected in those with fibromyalgia. The below quote comes from a paper published in 2019 in the journal pain

Targeted serum metabolite analysis verified differences in the serum levels of butyrate and propionate in FM patients

Butyrate is produced by certain bacteria in the large intestine and has a key role to play within maintaining a healthy gut lining. It is literally the food for our colonocytes – cells that line the colon.

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Mitochondrial Dysfnction And Fibromyalgia

Increased ROS (unstable molecules that cause cellular dysfunction) in Fibromyalgia, resulting in impaired mitochondrial function and reduced ATP in muscle and neural cells, might lead to chronic widespread pain. Therefore, antioxidants and mitochondrial support could offer a solution for the chronic pain in these patients.

In another study the authors concluded that there results lead to the hypothesis that:

inflammation could be a mitochondrial dysfunction-dependent event

Recommended Test: An organic acid test which will evaluate nutrient status, mitochondrial function, gut health and more.

Thyroid Hormones & Fibromyalgia

We found a high prevalence of autoimmune thyroid disease among 207 patients with clinically defined FMS, with TRAb being especially prominent among these patients.

Three studies have found thyroid autoantibodies to be in greater percentages in subjects with Fibro compared with controls, in spite of normal thyroid hormone levels.

Recommended Test: Comprehensive thyroid blood test.

Cortisol And Fibromyalgia

A significant difference in the night time serum cortisol level was observed among the patients and control groups. It could be concluded that there is an abnormality in circadian secretion of cortisol in those with fibromyalgia.

Emotional trauma has been associated with fibromyalgia and may lead to the reactivation of previously controlled infections

Recommended Test: Cortisol 24 hour saliva test.

Infections & Fibromyalgia

Viral infections associated with fibromyalgia have included hepatitis C, hepatitis B,  human immunodeficiency virus (HIV) and human T cell lymphotropic virus type I.

Mycoplasmal infections have been identified in 52 – 70% of CFS patients compared with 5 to 10% of healthy subjects in North America and Europe (Belgium).

Recommended Test: Comprehesnive viral profile.

Neurotransmitters And Fibromyalgia

Autoantibodies to serotonin were identified in 74% of 50 patients with fibromyalgia compared with 6% of 32 healthy controls. Notably, serotonin levels were normal in 90% of the fibromyalgia patients indicating serotonin receptor involvement.

Inflammation And Fibromyalgia

Many of the above factors we know can contribute to chronic systemic inflammation. And this has indeed been seen in those with fibromyalgia:

Normal-weight patients showed higher levels of C-reactive protein (CRP) indicating systemic inflammation is present.

Neurological health

There is converging data in favour of a dysregulation of pain processing in the central nervous system of Fibro patients, particularly associated with an increase in cerebral glutamate levels. Furthermore, there is evidence to support an association between increased glutamate levels and an increase in symptoms (Pyke et al., 2016).


Meditation awareness training may be a suitable treatment for adults with fibro and appears to ameliorate symptoms and pain perception by reducing attachment to self (Gordon et al., 2017).

Music listening in daily life improved perceived control over pain in female patients (Linnemann, 2015)

Fibromyalgia And Vitamin D

Ultimately nutrition recommendations are going to vary depending  on what we feel is the underlying cause(s). For example if SIBO is detected a FODMAP diet trial may recommended. However there is a little research on nutrition in fibromyalgia:

This study indicated that antioxidant protection from bioactive compounds present in fruit and vegetables could have an adjuvant role in fibromyalgia treatment (Costa de Miranda et al., 2017)

Vitamin D replacement treatment in patients with nonspecific chronic widespread pain has provided improvements in musculoskeletal symptoms, level of depression and quality of life of patients. Patients with chronic widespread pain should be investigated for vitamin D deficiency.

Fibromyalgia and B Vitamins

Dose-response relationship and long-lasting effects of vitamin B12/folic acid support a true positive response in the studied group of patients with ME/fibromyalgia

Conclusion Of ‘Fibromyalgia Testing – A Functional Medicine Approach’

We can conclude quite simply with this quote:

Investigation of potential triggers of chronic immune activation needs to include sources of underlying infection, unresolved physical or emotional trauma, toxins and food sensitivities.

In my experience there is often a combination of things have accumulated over the years and culminated in a diagnosis in Fibromyalgia. As a result a program to recover from Fibromyalgia needs to be staggered with treatment layered in a sequential method.

Resources For ‘Fibromyalgia Testing – A Functional Medicine Approach’

Check out this book on Fibromyalgia, and the books I recommend in my library, such as Mindfulness For Health.

References For ‘Fibromyalgia Testing – A Functional Medicine Approach’:

  1. Breeding et al., (2012) Integrative model of chronically activated immune-hormonal pathways important in the generation of fibromyalgia, click here.
  2. Hauser et al., (2017) Management of fibromyalgia: practical guides from recent evidence-based guidelines, click here.
  3. Pyke et al., (2016) Measuring Glutamate Levels in the Brains of Fibromyalgia Patients and a Potential Role for Glutamate in the Pathophysiology of Fibromyalgia Symptoms: A Systematic Review, click here.
  4. Nishioka et al., (2016) High prevalence of anti-TSH receptor antibody in fibromyalgia syndrome, click here.
  5. Van Gordon et al., (2017) Meditation awareness training for the treatment of fibromyalgia syndrome: A randomized controlled trial, click here.
  6. Costa de Miranda et al., (2017) Polyphenol-Rich Foods Alleviate Pain and Ameliorate Quality of Life in Fibromyalgic Women, click here.
  7. Yilmaz et al., (2016) Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency, click here.
  8. Reginald et al., (2015) Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia, click here.
  9. Gobble et al., (2008) Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome, click here.
  10. Linnemann et al., (2015) The effects of music listening on pain and stress in the daily life of patients with fibromyalgia syndrome: click here.
  11. Rush et al., (2016) Nitric Oxide, Inflammation, Lipid Profile, and Cortisol in Normal- and Overweight Women With Fibromyalgia, click here.
  12. Fatima et al., (2013) Circadian rhythm of serum cortisol in female patients with fibromyalgia syndrome, click here.
  13. Meeus et al., (2013) The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients: peripheral and central mechanisms as therapeutic targets? click here.
  14. Cordero et al., (2013) Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia? click here.
  15. Gut microbiome: pertinence in fibromyalgia: click here
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