University of Texas finds strong link to elevated blood sugar and fibromyalgia pain in metformin trial

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Researchers led by a team from The University of Texas Medical Branch at Galveston were able to almost completely eliminate pain in fibromyalgia patients with a medication that targets insulin resistance ( metformin ), showing a link to elevated blood sugars and the disease.

The study consisted of two groups, one on the standard treatment that involves norepinephrine reuptake inhibitors (amitriptyline, duloxetine or milnacipran) and ‘membrane stabilizing agents’ (gabapentin or pregabalin), and another group that was given the standard treatment plus metformin.

The results were dramatic:

( the I-NPRS was the initial pain assessment. ST-NPRS was the standard treatment group. M-NPRS was the standard treatment + metformin group )

Researchers noted a high degree of correlation to hba1c values and fibromyalgia severity when adjusting or age and gender. Of note, a majority of the patients were hovering in the pre-diabetic range of hba1c:

From the paper:
In view of the substantive research efforts involved in FM, including those from the pharmaceutical industry, we were puzzled that prior investigations had overlooked these simple findings. The main reason for this oversight is that many patients with FM show HbA1c values currently considered to be within the normal range; however, this is the first study to analyze the data in an age-stratified manner. This is important, considering the effect of aging on HbA1c levels [19]. Therefore, a value of 5.5%, for example (considered “normal” by current criteria), may not be so in many young subjects. An additional reason for having missed this association may be as follows: prior studies have established an association between FM and small fiber neuropathy [17, 18]. Although IR is a frequent cause of small fiber neuropathy, work up of this disorder by the investigators of these studies did not include evaluation of HbA1c levels. Instead, other methods were used in some studies [i.e., oral glucose tolerance tests; for example, see [17]]. Our data, if confirmed, may explain not only mechanisms germane to central pain in FM but also, the association between this disorder and small fiber neuropathy.

Our take..

In type 2 diabetes, elevated blood sugar causes systemic inflammation and eventual destruction of nerves (neuropathy) and blood vessels, as well of a host of other negative effects. Type 2 diabetes is the inability of the insulin to divert excess blood sugar, due to insulin resistance. Insulin resistance often forms when the body has perpetually elevated insulin levels, and starts to become numb to insulin’s signal.

It is no surprise to us that fibromyalgia and diabetes share many characteristics – systemic inflammation of nerves and blood vessels induced by excess blood sugar, as well as many other issues diabetics experience, such as brain fog and joint pain.

More research is needed to confirm the blood sugar – fibromyalgia connection, but we think that those who advocate for low carbohydrate and paleo diets as a means to handle the disease might feel vindicated today, as they now have some non-anecdotal evidence to support their case.

For more information, see:
UOT’s press release: https://www.utmb.edu/newsroom/article12083.aspx
Open access report on PLOS ONE: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216079