Fibromyalgia - Leaky Gut Syndrome

Complicating the picture for those with fibromyalgia, there is a strong correlation between fibromyalgia, IBS and "leaky gut syndrome" (LGS). LGS, in fact, may well be the major contributory factor in many of the symptoms of fibromyalgia. Here is what happens in LGS. The lining of the intestinal tract is called the intestinal mucosa. The mucosa is responsible for allowing essential nutrients to be absorbed across it into our bodies and also is the barrier which keeps harmful microorganisms, toxins and by-products from digestion from being absorbed. In LGS, there is increased permeability of the mucosa due to damage to something called "desmosomes" which can be thought of as the "glue" that holds the mucosal cells together. This allows larger sized particles that are normally not absorbed to find a passage open to them and to pass through the mucosa and to enter the bodily circulation. This can set up a cascade of events that can cause many of the symptoms present in fibromyalgia. Here are the symptoms known to occur in the person who is known to have increased intestinal permeability:

• Fatigue and malaise
• Arthralgias (joint pain)
• Myalgias (muscle pain)
• Fevers of unknown origin
• Food intolerances
• Abdominal pain
• Abdominal distension
• Diarrhea
• Skin rashes
• Toxic feelings
• Cognitive and memory deficits ("fibrofog")
• Shortness of breath
• Poor exercise tolerance

Certainly many of these symptoms are similar to those of fibromyalgia. The genesis of these symptoms is due to two processes that occur secondary to an increased mucosal permeability. The first is an immune system response. Our immune system recognizes presence of the invading large particles that are absorbed as "non-self". The immune system responds by attacking them by direct contact and also by producing antibodies. Since some of these large particles have the same appearance as our own tissues, this immune response can result in attacks on our "self" through mis-recognition causing an auto-immune reaction and condition. The second way that increased permeability adversely affects the body is by the stress that the abnormally absorbed particles place on the liver.

The liver is responsible for removing these macro (large) molecules and also to oxidize toxins that enter in the LGS setting because all these substances as well as normally absorbed nutrients are first carried to the liver via the portal vein. This can result in placing an overload on the liver's capacity of detoxification and removal of harmful particles, further accentuating the symptoms produced by increased permeability, by causing hepatocyte (liver) cell damage, excess free radical production and increased strain on an already dysfunctional immune system.

A paradox in LGS is that not only are harmful particles allowed though the incompetent intestinal mucosa but essential nutrients are not absorbed adequately. How can this seeming inconsistency occur? Here is what happens and why. Nutrient absorption is achieved by transportation though the intestinal mucosal cells and depends on the integrity of these cells being maintained. However, disruption of mucosal cells results in disruption of the effectiveness of certain carrier proteins that transport minerals such as magnesium and zinc.

Therefore, a total body magnesium deficit is often seen in fibromyalgia even in those who are using supplementation of this essential mineral due to the fact that it is present in the intestinal lumen but can't be absorbed across the mucosal cell. The same can be true for zinc. The end result in LGS is a vicious cycle of harmful particles being inappropriately absorbed by going around the mucosal cells and essential nutrients not being absorbed because they can't get through.