Research and Online Consumer Pricing Guide
by Samuel K. Yue, M.D
Clinical Medical Director, HealthEast Pain Clinic
HealthEast Bethesda Lutheran Hospital & Rehabilitation Center, St. Paul, Minnesota
May, 1999
I have noticed that many of my patients with fibromyalgia suffer from leaky gut, irritable bowel, spastic colon, and chemical sensitivities. For patients with fibromyalgia, I think these three conditions can be interrelated and caused by a deficit of the hormone relaxin. My article on disautonomia in patients with fibromyalgia discusses the role of relaxin deficit in stomach, bowel, and colon problems. In this article I will focus on the role of relaxin deficit in the chemical sensitivity of patients with fibromyalgia.Chemical sensitivity often involves the mucosa of the nose and the lungs through the aerial diffusion of chemicals. Other non-chemical stimuli such as light, sound, and smell can induce similar reactions in some patients. The skin is another source of potential sensitivity, although the thickness of the skin layer usually prevents severe reactions in most people. In general, orally ingested chemicals or inhalants cause chemical sensitivity. Although the mechanism of chemical sensitivity is similar whether the stimulus is inhaled or ingested, I will focus on the effect of orally ingested stimuli on the mucosa of the GI tract.
Recently, various researchers have hypothesized that leaky gut syndrome is the real culprit in chemical sensitivity to foods and medications. According to this theory, the mucosa becomes leaky because the junction between cells is somewhat open. Protein antigens (with larger molecular weight) diffuse through the mucosa directly into the body and elicit an antigenic response. Most explanations blame the exogenous food substance for the changed response. However, I believe that the mechanism of chemical sensitivity works somewhat differently for patients with fibromyalgia.
I have noticed that many patients with fibromyalgia do not initially react to a new medication; that is, one tablet causes little or no response, the second tablet causes some response, and the third tablet may cause a violent reaction. Or, the patient may tolerate 10 mg of a medication, but 20 mg causes a deleterious response. Some patients say if they eat one egg or other food, they have no problem, but a second or third serving causes a reaction. Other patients explain that a sudden sensitivity to a particular food they have eaten for years has caused them to eliminate the food from their diet. If the exogenous compound is the problem, the first tablet, egg, or other food should cause the reaction, not the second, third, fourth, or 2000th.
Some of my female patients who have eaten shellfish or seafood all their lives develop an allergic response during menopause, a reaction commonly attributed to the changes in the hormonal environment. Other female patients report that during their menstrual periods they react to a food that is safe to eat during the rest of the month. I believe that it is significant that these two situations almost always coincide with the rapid decline of relaxin in the body.
Relaxin affects the integrity of collagen, which makes up the mucosa, which acts as a sieve to filter nutrients. I believe that mucosa integrity is compromised by relaxin deficit, so that the mucosa may leak or shut down completely. In healthy patients, the ability of the mucosa to filter nutrients stays constant. For patients with fibromyalgia, the mucosa may a) shrink in size so that few or no nutrients are absorbed or, b) open so completely that protein molecules of middle or larger molecular weight improperly leak into the rest of the body. This “all or nothing” response, called disautonomia, can affect other areas of the body besides the mucosa.
For example, disautonomia can affect blood circulation in patients with fibromyalgia. The smooth muscles may contract, causing circulation to the GI tract to decrease during digestion so that the nutrients that do pass through the mucosa may not be conducted to the rest of the body. However, if the mucosa is too open so that the larger proteins pass through the mucosa and the enteric blood flow is high at the same time, the patient may experience a severe reaction. At first the patient may be sensitive to only one type of food because the extreme opening of the mucosa and the dilation of the blood vessels are not quite synchronized. If these two functions become synchronous, the patient will find that almost every food causes an extreme response.
When the smooth muscles and mucosa are contracted at the same time that the smooth muscles affecting the circulation are relaxed, fluids from the mucosa rapidly flow into the GI tract causing the immediate evacuation of food from the body. Many current explanations of leaky gut, including those of Dr. Jeffrey Brand, do not take into account that at times patients do not absorb at all. After eating a certain amount of food, patients with irritable bowel immediately dump all the food from the GI tract. Of course, not all fibromyalgia patients have spastic colon, irritable bowel, and chemical sensitivity. Patients may have a genetic tendency toward either chemical sensitivity with allergic tendencies or problems related to the GI tract. Unfortunately, some patients have inherited both problems.
The deficit of relaxin associated with fibromyalgia also compromises the regulatory functions of the liver. To complicate matters further, some patients with fibromyalgia have inherited the tendency to produce excessive amounts of some enzymes and deficits amounts of others. These congenital variations in enzyme production, exacerbated by compromised liver function, account for the fact that patients with fibromyalgia are sensitive to different substances.
In summary, chemical sensitivity involves several factors. First, the mucosa, which is also governed to some degree by the relaxing and contracting of the smooth muscles, either shuts down or opens completely. Second, the enteric blood flow is also increased or decreased in response to the relaxing and contracting of the smooth muscles. Third, the degree of synchronization between the mucosa and the blood vessels will determine how fast the allergens are circulated to the rest of the body, resulting in an allergic response. Fourth, enzyme excess and deficit, the result of genetic predisposition, affect which substance causes reactions and which do not. Fifth, the conductivity of the nerve endings throughout the autonomic nervous system will affect the relaxation of the smooth muscles in the GI tract.
I believe that chemical sensitivity in patients with fibromyalgia is directly related to relaxin deficit. Relaxin affects the collagen integrity of the mucosa, the regulatory effects of the liver, the relaxing and contracting of the smooth muscles, the conductivity of the nerve endings, and the increase or decrease of enteric blood flow. Because relaxin does affect the entire body, relaxin replacement therapy may help patients who have developed reactions to foods and medication that they have tolerated in the past. Unfortunately for patients with fibromyalgia who also suffer from Crohn’s disease or ulcerative colitis, relaxin therapy cannot reverse the effects of the disease. It may minimize the impact of these diseases on the GI tract and decrease the symptoms associated with these diseases.
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| 1. | Chemical Sensitivity in Patients with Fibromyalgia |
| 2. | Relaxin: Its Role in the Pathogenesis of Fibromyalgia |
| 3. | Relaxin Induces Healthy Blood Vessels |