Brain and Systemic Inflammation Found in Fibromyalgia

Monday, May 08, 2017
By: Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

Fibromyalgia patients often hear the words “You look so good. How can you be ill?” Or maybe the insensitive words “fibromyalgia is all in your head”.  Ongoing and recent research; however, validates the reality of this invisible illness. This information allows individuals with fibromyalgia and other similar invisible illnesses to press on beyond doubt and find validation for their complex illnesses. Even more important, understanding recent research helps provide direction and identifies natural choices for healthy pain management with fibromyalgia. 

[Jump to: Nutritional Options]

Neuroinflammation and Systemic Inflammation Relates to FKN and Chemokines

Recent findings published in the Journal of Pain Research, March 2017, identified solid evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients.  Using state-of-the-art technology, researchers compared 92 inflammation-related proteins found in the cerebrospinal fluid and blood stream of adult fibromyalgia patients and healthy controls. The results demonstrated significant elevations of several inflammatory chemicals in the cerebrospinal fluid and blood stream of fibromyalgia patients. The most notable elevated inflammatory signals included fractalkine (FKN) found in the spinal fluid and chemokines/cytokines such as IL-8 found in the blood stream and spinal fluid. Elevated signaling in the cerebrospinal fluid (CSF) provides a clue into what is happening in the central nervous system. CSF is the fluid that surrounds the brain and spinal cord and is suggested to mirror the conditions of the brain.  This means that if markers are elevated in the CSF, they are also likely elevated in the brain.

FKN, Fructose, and Curcumin

Fractalkine/ FKN is compound that acts like a busy traffic cop directing traffic communication signals back-and forth with nerves and microglial cells. Microglial cells are part of the brain’s immune system that regulates inflammation. FKN needs to be in balance as it does its regulatory job. In just the right amounts, it provides protective function managing nerve and microglial cell communications. When out of balance like a broken stoplight, it leads to neurodegeneration, increased microglial cell activation and a crowded highway of inflammation.

High level fructose intake was shown to provoke a FKN tipping point in managing neuroinflammation in fibromyalgia and other inflammatory disorders. The November 2016 Journal of Brain Behavior and Immunology found that animals fed a high fructose diet, experienced elevated levels of FKN, which provoked neurological inflammation. High fructose intake caused dysregulation with fractalkine, which provoked neuroinflammation in critical brain structures, the hippocampus and hypothalamus. To counteract and buffer the pro-inflammatory fructose effect on fractalkine, they tested curcumin’s effect against inflammation. This powerful spice and antioxidant, curcumin, was found highly beneficial, as it protected the sensitive brain tissue and kept the FKN in its protective state, which resulted in less neuroinflammation.

Chemokine Elevations in Fibromyalgia

Chemokines/cytokines are substances produced by nerves and glial cells in the brain in response to injury. These neuroimmune chemical messengers indicate brain inflammation and are often found elevated in fibromyalgia. Chemokines are also in the blood stream and reflects inflammation found in tissues outside of the brain. Elevated levels of chemokines/cytokines IL-8 IL-6, and IL-1RA, and IL-10 are the most often found in fibromyalgia patients. The two most troublesome chemokines in fibromyalgia appear to be IL-6 and IL-8. Elevated IL-6 and IL-8 create synergistic pain responses that perpetuate chronic pain in fibromyalgia and correlate with the severity of symptoms. Considering this research, scientists feel that labeling fibromyalgia as idiopathic or psychogenic was definitively outdated. The mentality or even diagnostic approach “it’s all in your head/you’re a hypochondriac” should not be even entertained, as fibromyalgia is real and has objective biochemical inflammatory changes in the blood stream and cerebrospinal fluid.

Natural Compounds That Modulate Chemokines/Cytokines

The identification of which chemokines/cytokines are elevated can help focus on ways to modulate the pain and neuroinflammation response.  For example, low cellular magnesium levels lead to increased IL-8, which locks-in chronic pain. Restoring tissue levels of magnesium helps balance IL-8 and reduces chronic pain. Glycoaminoglycans (GAGs), which are part of the chondroitin, glucosamine, and hyaluronic acid family of repair nutrients, are known to quench several different inflammatory chemokines, including IL-8, throughout the body. Hyaluronic acid has been found to suppress IL-8 and IL-1beta. Hyaluronic acid is commonly used to help cartilage and joint pain, but may also be helpful for fibromyalgia because of its dampening effect on inflammatory chemokines. The herbal compound, boswellia serrata has positive history of reducing pain producing chemokines, specifically IL-1beta, IL-6, TNF-alpha, and others. 

Brain and Spinal Glial Cell Support

In addition to modulating FKN and chemokines to reduce chronic pain and brain inflammation in fibromyalgia, we want to keep glial/microglial cells healthy. Microglial cells get overactive when FKN and chemokines/cytokines are elevated. Several nutrients are known to help modulate and stabilize glial cell over-activity. Omega-3 fish oil, DHA regulates glial cells and can prevent the over-stimulation, oxidative stress that leads to chronic pain. Grape seed extract, cordyceps, and curcumin are known potent antioxidants for microglial cell protection.

Microglial cells are in the spinal cord too. When overstimulated, it causes oxidative stress resulting in pain. This may be felt as tenderness or a feeling of burning in the spinal column. Curcumin and coenzyme Q10 were found to alleviate spinal microglial cell activation and oxidative stress in disorders other than fibromyalgia. We know that curcumin and coenzyme Q10 are very helpful for other reasons in fibromyalgia. It is likely that curcumin and coenzyme Q10 also alleviate spinal microglial cells over-activation in fibromyalgia, which then leads to reduced pain and sensitivity. 

Fibromyalgia is a real disorder and a very complex one at that. As research delves into things that we cannot see on the surface with this invisible illness, we indeed find hidden brain and systemic inflammation. If the brain is sick with inflammation, it sends stress signals throughout the body. We see that manifesting as other dysregulation within the gut microbiome and leaky gut syndrome, liver detoxification, lactic acid production, hormone imbalances, heart rate variability, and lymphatic congestion that all cause the spiral of the sick get sicker. Drugs like Lyrica, Neurontin, NSAIDs, and antidepressants with toxic side effects are often the mainstay of medical treatment. The brain is the command center of the body. Interventions with the digestive tract, metabolism, and hormones certainly can make a positive impact, but if the brain and the systemic neurological inflammation is not down-regulated, it is an up-hill battle. Several nutrients like curcumin, coenzyme Q10, grape seed extract, DHA, cordyceps, hyaluronic acid, chondroitin, and boswellia demonstrate very promising neuroinflammation modulatory effects of FKN, chemokines/cytokines, and microglial cells activation that are problematic in fibromyalgia. Consider incorporating several of these nutrients into management of this invisible illness. It may just change your tears of pain to tears of joy and relief.

Nutritional Options

Curcumin – This Indian spice is the go-to nutrient for many different types of inflammation throughout the body. Brain and spinal cord inflammation, glial cells, FKN, and chemokines were shown to be positively affected by curcumin intake. Curcumin is hard to absorb in therapeutic amounts unless it is accompanied by carrier nutrients like Bioperine.

Grape Seed Extract - Grape seed extract helps stabilize microglial cell inflammation, the brain’s immune cells. Chronic pain causes microglial cells to become over-stimulated and can lead to central sensitization or wind-up, which locks in chronic pain. It may be used synergistically with curcumin, calcium AEP, DHA, and hyaluronic acid etc to help reduce nerve and inflammatory stress.

Hyaluronic Acid – Hyaluronic Acid or HA is well-known for its rejuvenation benefits of skin and cartilage health. It helps protect tissues from inflammation beyond cartilage, as it can help protect against nerve inflammation and peripheral neuropathy.

Coenzyme Q10 – Numerous studies have shown a high need for coenzyme Q10 in fibromyalgia in energy, pain, nerve, and inflammation management. Research shows that it helps stabilize spinal cord glial cells from inflammation and oxidative stress. For chronic and severe concerns, the fat-soluble forms of coenzyme Q10 ubiquinol or coenzyme Q10 with tocopherols will provide the best support. These forms get into nerves and brain tissue the best.

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