Abstract
Fibromyalgia syndrome (FMS) is a chronic, complex, and heterogeneous disorder of still poorly understood etiopathophysiology associated with important musculoskeletal widespread pain, fatigue, non-restorative sleep, and mood disturbances. It is estimated to afflict 2–3% of the worldwide population, with clean prevalence among women. The objective of this paper is to propose a novel treatment for symptomatic remission of FMS, grounded in biochemistry and consisting in the withdrawal from the diet of molecules that can indirectly trigger the symptoms. The hypothesis develops from the evidence that low serotonin levels are involved in FMS. Serotonin is synthesized starting from the essential amino acid tryptophan. The presence of non-absorbed molecules in the gut, primarily fructose, reduces tryptophan absorption. Low tryptophan absorption leads to low serotonin synthesis that triggers FMS symptoms. Moreover not-absorbed sugars could also produce a microbiota deterioration activating a positive feedback loop: the increasing microbiota deterioration reduces the functionality of absorption both of fructose and tryptophan in the gut, entering a vicious circle. The therapeutic idea is to sustain serotonin synthesis allowing the proper tryptophan absorption. The core of the cure treatment is the exclusion from the diet of some carbohydrates and the marked reduction of some others. The main target is the limitation of total dietary fructose as marked as possible. It could be an effective strategy to get the remission of symptoms acting on the impaired biochemical pathways. The straying from the treatment is expected to cause the reappear of the symptoms.
Highlights
Fibromyalgia Syndrome (FMS) is a chronic, complex, and heterogeneous disorder (1, 2) of still poorly understood pathophysiology (1, 3, 4) associated with important musculoskeletal widespread pain, fatigue, and mood disturbances (1, 2)
Fructose Malabsorption “Fructose malabsorption is characterized by the inability to absorb this molecule efficiently
It is important to stress that the efficiency of fructose absorption can be much variable among subjects and influenced by several condition: among them, the amount of total ingested fructose, GLUT5 is a low and saturable transporter (30); the concurrent presence of glucose, which activates the GLUT2 co-transporter (28); the expression of the transporter
Summary
Fibromyalgia Syndrome (FMS) is a chronic, complex, and heterogeneous disorder (1, 2) of still poorly understood pathophysiology (1, 3, 4) associated with important musculoskeletal widespread pain, fatigue, and mood disturbances (1, 2). The majority of patients has one or more pain co-morbidities or associated disorders: among them lower back pain, specific regions of localized tenderness, non-restorative sleep and sleep disturbances, irritable bowel syndrome (IBS), restless leg syndrome and leg cramps, headache, migraine, visceral. Often co-morbidities and associated disorders are managed with additional treatments (8), demonstrating the lack of understanding of the real source of the abnormal nervous system sensitization. FMS diagnosis and management is still a substantial challenge for patients, physicians (1), and society as a whole for its associated economic burden (9)
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