Editor’s Note: This is part two of the article. Click here for Part One: Part One
Two Main Digestive Problems
There are two main digestive problems, which affect many fibromyalgia patients: irritable bowel/spastic colon, and leaky gut. The irritable bowel or spastic colons are used to describe the propulsion of food through our GI tract, whereas leaky gut is used to describe the malabsorption of the nutrients within the GI track.
Irritable Bowel/spastic colon
The irritable bowel/spastic colon will be described first. Normally the foods are slowly propelled down the GI tract. Within 24 hours the non-absorbed but digested food slowly accumulates in the colon to be later evacuated. Because of the dysautonomia or the all or nothing type of autonomic response in fibromyalgia patients, the bowel behaves strangely and in extreme. The bowel either is too tight or too loose, resulting in constipation alternating with diarrhea. Initially the bowel may be too tight as in constipation, but the organ signals to the ANS (afferent impulses) is delayed until finally the threshold is reached and the signal is sufficiently strong to be recognized by the ANS.
The parasympathetic response from the ANS will be initiated (efferent impulses) which stimulates the bowel to relax maximally resulting in diarrhea. Once the diarrhea begins the bowel and the ANS will attempt to reverse this condition, which over a few days revert back to constipation. Irritable bowel syndrome describes these yo-yo effects of constipation alternating with diarrhea together with the malabsorption difficulty.
Dysautonomia in Relation to Bowel Dysfunction
Dysautonomia in this instance describes the inability of the ANS to control and balance the bowel’s function so that it behaves in both extremes instead of optimal functions. Constipation is related to higher sympathetic flow, which is more typical in fibromyalgia patients, so constipation part of this yo-yo cycle predominates. Most fibromyalgia patients experience longer period of constipation alternating with a few days of diarrhea. This diarrhea phase is usually more welcomed before the constipation phase begins anew. However, on those fibromyalgia patients where diarrhea predominates, malabsorption is further exaggerated which will be discussed later.
Those fibromyalgia patients who constitutionally have a problem with their bowels rarely experience diarrhea. The sympathetic outflow is high congenitally and coupled with the disease which increases this outflow further. This constant state of constipation alternating with occasionally short brief or no period of looser bowel movement is called spastic colon. The autonomic nervous system lost the ability to regulate the bowel and to revert the excessive sympathetic outflow. Once a day bowel movement is rare in these patients, they may evacuate their bowel on a weekly basis. Stool softeners and other bowel movement aids are often needed just to initiate a bowel movement. Many of them have become dependent on these aids for any bowel movement.
Leaky Gut Syndrome
Irritable bowel/spastic colon often aggravates the leaky gut syndrome. The leaky gut syndrome describes how our body absorbs nutrients. The mucosa (lining of the bowel) reacts to the nutrients within the bowel through the autonomic nervous system. It acts as a sieve to filter the necessary nutrients into the blood stream so that the body can utilize them. The closing and opening of the sieve to allow the passage of nutrients is directly related to the autonomic nervous system (sympathetic Vs parasympathetic).
Because of dysautonomia, fibromyalgia patients close or open maximally these sieves on the mucosa at the inappropriate time. Poorly digested foods and the breakdown nutrients are either completely passed over or not absorbed by the closed mucosa or maximally absorbed by the opened mucosa. When undigested small foreign proteins are passed from the maximally opened mucosa into the blood stream, allergic reaction begins. The degree of reaction depends on the amount of foreign proteins absorbed. Severe anaphylactic reactions may occur which at times may lead to death of the individual.
It is interesting to note that many fibromyalgia patients related to the fact that they have been eating the same “allergic” food their entire life only to discovery that the allergy develops when fibromyalgia condition progresses. The allergy results from the bowel’s inability to digest food properly and the absorption of foreign undigested protein into the body secondary to dysautonomia.
When protein is partially digested in the gut, accumulation of certain amount of digested nutrient will cross the threshold, initiates the opening of the sieve within the mucosa to facilitate absorption. Because of dysautonomia and the maximally opened sieve, the undigested or partially digested small foreign proteins that are usually not absorbed is now filtered into the blood stream. When that happens, the body perceives these proteins as foreign substances and mounts an allergic reaction to these proteins. Suddenly the person develops a rash, hives, swelling, high fever and palpitation. It is interesting to note that some patients will remark that, ” I can eat one egg, but if I eat two eggs I will be in trouble.”
It takes a certain amount of digested and undigested protein within the GI tract of high enough concentration to stimulate and initiate the threshold in the mucosa before dysautonomia sets in and the sieve within the mucosa opens maximally. The severity of the leaky gut syndrome is related to the blood supply at that time when the protein leaks into the body (dysautonomia of the blood vessels). If the blood supply is minimal secondary to tightness of the smooth muscle to the blood vessel wall, a relatively small amount of the protein will leak into the blood stream. Allergic reaction is minimal. When the blood vessels open maximally various types of small and medium size foreign proteins that are not supposed to be absorbed are absorbed into the blood stream, moving very quickly to the rest of the body, a severe allergic reaction results.
Fibromyalgia patients also develop multiple “allergies” to many medications. Initially the medications do not seem to work on these patients because they are not absorbed into the body. They are usually instructed to increase their dosage. Unfortunately when the threshold is reached the sieve opens up completely and the medications will be dumped maximally into the blood stream. At this point every single side effect will begin to manifest on this poor patient. These heightened reactions to many medications lead the patients and their physicians to labeled themselves as sensitive or allergic to multiple medicines. So allergy, chemical sensitivity, food intolerance, malabsoprtion and irritable bowel/spastic colon are the result of dysautonomia of the mucosa, motility and blood supply of the GI track.
Digestion is Controlled by the ANS
The whole digestive system is controlled by the autonomic nervous system. When the autonomic nervous system is delayed or has denervation type of effect, the body will exhibit “unusual symptoms” that puzzle many physicians. Western physicians do not seem to pay much attention to this autonomic nervous system whereas classic Chinese medicine places an extremely important role of the autonomic system since it controls the inside of the body and the inside is reflected on the outside of the body. Fibromyalgia patient may have rough or dry skin at all times, rough or brittle nails, and brittle hair. These signs reflect internal problems as in the mucosa dysfunction of the GI track. They may be susceptible to infections. Even the immune system is directly and indirectly affected by the autonomic nervous system.
Many of the nonspecific complaints of fibromyalgia patients can be attributed to dysautonomia. Dysautonomia can be used to explain why the person has a regulatory temperature difficulty resulting in cold feet and hands. It can also be used to explain why people have Raynaud’s Phenomenon on the fingers. Dysautonomia can also be used to explain why patients get dryness of the mouth and dryness of the tear ducts. Glucose intolerance is also a result of autonomic dysfunction. With hyper or hypoglycemia, glucose stimulates the secretion of insulin which is delayed in fibromyalgia. When the sugar reaches a certain threshold, the insulin rushes out to immediately drop the level of glucose. The secretion of insulin, however, overcompensates leading to a low serum glucose, resulting in hypoglycemia. These patients fell hungry and wish to eat and repeat the cycle. Many normal but prediabetic patients also experience this hyper/hypoglycemic cycle. In addition, many other hormonal responses to internal and external stress and menstruation cycle also aggravate the hyper/hypoglycemic state of these patients.
In summary, I believe that many usual and unusual complaints of fibromyalgia patients related to the digestive system can be explained as dysautonomia or “denervation effect” of the nerve endings and its effects on the end organs. These usual and unusual signs/symptoms that are seemingly unrelated, prompt many fibromyalgia patients to seek medical help in various specialties. Since both the patients and the physicians are unaware that the same set of S/Ss are related to fibromyalgia, extensive work up are usually ordered on these patients with mostly negative results. When all results are negative, physicians are at a loss to explain these S/Ss and the patients return home with the most unsettling feeling of their body since these S/Ss are so “real” to them. Addressing the issue of dysautonomia and its effect on these patients will assure these patients that their S/Ss are real and that the S/Ss may be controlled by many therapies: including relaxin replacement, enzymes replacement, food avoidance and good colon hygiene.