Just before Christmas a friend of mine shared a Facebook post from a news website that discussed some newly published research about Fibromyalgia syndrome (FMS). Initially I intended to just share this directly to my own Facebook page, but I wanted to see if I could find the published study first to check what I was sharing. As anyone who reads medical journal articles knows, getting more than just the abstract for free for a recent article is about a rare as hen’s teeth, so when I found that Elsevier had made it available in full, I was over the moon. I printed it out and sat down with my yellow highlighter and started to go through the article.
It would be fair to say that my first reaction was an emotional one. Here, in front of me, was more evidence that fibromyalgia syndrome had a physical manifestation that could actually be measured and was the possible reason for the symptoms experienced. For years people diagnosed with FMS have had to rely on whether or not their physicians “believed” in FMS – and let me tell you from experience, many didn’t. So, it has taken me a little while to get over the “wow, no way!” reaction and get to writing the blog post !
The journal article is titled “Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation” Albrecht, D., Forsberg, A., Sandstrom, A., et al (2018). I know that sounds like a load of medical jargon. In plain English it means that a type of brain scan using positron emission tomography (PET) found that cells called glial cells are more active in people with fibromyalgia.
Although this is a relatively small study with 31 participants with FMS and 27 healthy participants, there are two things that I like about it:
- It is on living humans (in vivo), not mice or rats and not on cells in a lab (in vitro).
- The Massachusetts General Hospital, USA and the Karolinska Institute, Sweden collaborated on the study with groups of people from both countries.
The study focused on levels of a translocator protein (TSPO) which has been found in to be upregulated in the glial cells of people who experience chronic pain.
Now before I lose part of my audience, here are some definitions for my non-medical readers:
- Glial cells are a group of cell types found in association with nerve cells, but are not nerve cells and do not make synaptic connections. They provide support to the nervous system. The studies discussed here refer to microglia – which are part of the body’s clean-up crew, aka macrophages. They are attracted to and remove debris created by injuries, inflammation or general cell renewal.
- Translocator Protein (TSPO) – is a protein that is found on the membrane of the mitochondria inside your cells. It is involved in a number of processes that I won’t go into here, and is also expressed/activated when inflammation is present, so is a good indicator of an inflammatory process going on in areas of the body where it is active in high densities. TSPO activity is also implicated in heart disease and, most importantly for FMS people, the production of neuroactive and reproductive steroid hormones which impact on mood, pain and cognition – starting to sound familiar anyone? It can also be easily scanned in PET imaging, as was done in these studies.
- Serotonin Transporter 5-HTT – aka SERT is a protein that regulates the amount of serotonin that is available for nerve cells to use by releasing it into the gap between cells (synaptic cleft) and then recycling (reuptaking) it. The way this functions is related to the genetic polymorphism, or variant, of the gene that codes for 5-HTT that you carry.
An equally interesting and earlier study by Kosek, K., Martinsen, S., Gerdle, B., et al (2016), also from the Karolinska Institute and on 126 real live people, found a link between some of the polymorphisms, of the gene that codes for TSPO, and the level of pain experienced by people with FMS. It found that people with FMS who had a genotype for high affinity binding TSPO reported greater severity of symptoms, including pain, than those with mixed and low affinity TSPO binding. They also looked at serotonin transporter 5-HTT polymorphisms and found that people who had high levels of TSPO expression AND had high levels of 5-HTT expression (leading to higher levels of serotonin) reported the highest levels of pain.
In a “things that make you go hmmm” kind of way I wonder if the reason that the popular supplement 5-HTP is helpful for some people with fibromyalgia and also anxiety, but causes increased levels of anxiety in others, is related to the 5-HTT polymorphism that people carry.
There was also a comment that TSPO upregulation has an association with higher levels of another inflammation indicator interleukin 8 (IL-8), which has also been recorded as elevated in cerebral spinal fluid in FMS people.
As usual, more research is required, but this is great to know and means that there is tangible evidence to start working with.
How can we make this knowledge work for us?
Reducing inflammation is likely to be a key to any wellness plan for someone with FMS.
Like so many health conditions, inflammation appears to be at the heart of the symptoms that people with FMS experience. While medication and supplements that suppress inflammation may bring about symptom relief and can help to get through the worst times, it is akin to taking the batteries out of the smoke alarm – it stops the irritating noise but doesn’t put out the fire. Inflammation and symptoms are a warning that there is something that is triggering the smoke alarm. For those of us with FMS our alarm systems are more sensitively tuned than other people. By identifying and avoiding the things that trigger a flare up we can reduce stress signals to our cells and reduce the over expression of the genes that bring on the symptoms related to inflammation.
But what are the triggers of inflammation?
The things that trigger ongoing flare-ups can be as varied and unique as the people with FMS but all appear to start with a stress response which in turn activates the immune and inflammatory systems Segerstrom & Miller, (2006). We do know that initial FMS triggering events are reportedly as varied as injuries in car accidents to illnesses or traumatic life experiences. What all these things have in common is they place high stress loading on our bodies. Overwhelming and long-term stress has been shown to alter the way our brains are wired to react to future stress. In particular the pathways that include our Hypothalamic Pituitary Adrenal (HPA) axis and steroid hormone production. It is not uncommon for people with FMS to also be diagnosed with other conditions including auto immune, food intolerances, other digestive issues, hypothalamus dysfunction/adrenal fatigue, PTSD and to have weight issues – all of which are stress related in one form or another.
Finding what works for you - taking ownership of fibromyalgia
There is a large self-help community on the internet, where people share what does or does not work for them. A lot of this is based on people’s own n=1 experimentation with diets and supplements or what they have been told by health professionals. All of this can become quite overwhelming. I recommend that if you are going to try something that you do as much research as you can into it before you start either taking it or doing it and don’t make any other significant changes until you can determine whether it is working for you or not. Some supplements take time to build up in your system, so find out how long it could take to start seeing improvements – patience is the key. Often the recommended dosage for over-the-counter supplements does not contain therapeutic dose levels, so check this out too – preferably with a professional who can take your own circumstances into consideration.
Nutrition for reducing inflammation
The food that you eat and gut health can make a huge difference to inflammation. The best way to identify what may be causing your symptoms (and not just the gut related ones) is to try an exclusion diet. Auto Immune Paleo or GAPs are good options that can help to guide you through the process, which will take several weeks, but they can be so worth the time!
Reducing stress to reduce inflammation
One of the most important things that you can do is to work on reprogramming your stress response. Again, find something that works for you. All our cells have stress related receptors, but they do not know if the stress we are feeling is because we need to run away from a tiger or that we have too much modern living stress on our minds. Here are three easy and cost-effective changes that you can make now:
- Take the time to relax – mineral spas (balneotherapy) have been shown to be helpful for people with FMS. If you don’t have access to a spa then simple Epsom salts baths are a great and inexpensive alternative. Make use of a friend or family members bath if you don’t have one 😉.
- Work on your internal dialogue. The way we talk to ourselves has a major impact on our stress response. When you catch yourself having negative thoughts, actively find something about the situation or just in general to be positive about and grateful for. This may feel difficult and awkward at first, but you will be surprised to find how quickly this becomes a habit.
- In your mind, talk directly to your cells at night as you fall asleep. Tell them that they are safe, they are not in danger, they are nourished, they are loved and that they can relax and heal. This is a great to do after a progressive relaxation exercise where you become aware of each part of your body and feel them relax.
For more ideas to help with coping with stress click here for one of my other blogs.
Stay well 😊
As always, this is general information and not to be taken as direct advice. For a more personalised approach, either click the “Book Now” button to book a consultation with me or contact your local registered Naturopath or other Health and Wellness professional
Ablin, J., Häuser, W., Buskila, D., (2013) Spa treatment (Balneotherapy) for fibromyalgia: A qualitative-narrative review and a historical perspective. Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 638050, 5 pages, 2013. Retrieved from: https://doi.org/10.1155/2013/638050
Albrecht, D., Forsberg, A., Sandstrom, A., et al (2018) Brain glial activation in fibromyalgia: A multi-site positron emission tomography investigation. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0889159118302423
Kosek, K., Martinsen, S., Gerdle, B., et al (2016) The translocator protein gene is associated with symptom severity and cerebral pain processing in fibromyalgia. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0889159116303440?via%3Dihub
Microglial cells. (n.d.) Farlex Partner Medical Dictionary. (2012). Retrieved February 28 2019 from https://medical-dictionary.thefreedictionary.com/Microglial+cells
Segerstrom, S., Miller, G., (2006) Psychological stress and the human immune system: A meta-analytic study of 30 years inquiry. Psychological Bulletin, 130(4), 601-630. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/