Digestive disturbances

Many people with ME/CFS and FM find they have food sensitivities and various digestive problems. Some patients develop acid reflux disorder or might experience bowel irritability, abdominal cramping, and/or changes in bowel movements.

Digestive enzymes can help to break down food which makes it easier to digest and absorb nutrients. These enzymes can also help to reduce bloating, gassiness, and heartburn. 

GERD and stomach acid problems

Sometimes heartburn or acid indigestion (especially if frequent) may be symptoms of a larger problem called Gastroesophageal Reflux Disorder (GERD), a digestive disorder in which partially digested food and stomach acid and enzymes will back up into the esophagus. Sometimes, these secretions can travel all the way into the throat, which is then referred to as laryngopharyngeal reflux. The problem is usually caused by the lower esophageal sphincter muscle failing to close properly after food has passed into the stomach.

Certain medications, like NSAIDS, some asthma, blood pressure, tranquilizer and other pain medications cause this muscle to over-relax while some medications can irritate the GI lining. Food allergies, especially dairy, certain deficiencies, but also chronic immune disorders can also contribute to development of GERD. The standard treatment is to use medications which will either reduce stomach acid or suppress it from being made (from Rolaids to Tagamet or Pepcid (histamine H2-blockers) to proton pump inhibitors, like Prilosec or Nexium).

Though reducing or suppressing stomach acid may provide relief, it is important to realize the stomach needs a certain amount of stomach acid with which to sterilize food before it goes into the intestinal tract and to keep other bacteria in check, including yeast overgrowth. Plant enzymes and multi-strain probiotics are just a few of the digestive aids one might want to consider and review with his/her doctor. 

There are non-invasive things one can also do, like following a general anti-reflux diet, not laying down for 3 or 4 hours after eating, not bending at the waist after eating, elevating head of the bed by 4 to 8 inches, and taking extra measures to maintain regular bowel elimination.

Irritable Bowel Syndrome

One of the most commonly used treatments of Irritable Bowel symptoms is probiotics (which are actually dietary supplements containing beneficial bacteria or yeasts which can help to offset the overproduction of other (bad) bacteria). There are numerous formulas on the market but one particular formula containing B infantis was studied in FM patients and found to be especially effective. It is called Align and can be ordered from two of the leading drugstores.

Xifaxan (rifaximin) is an antibiotic which is sometimes prescribed to kill off small intestinal bacterial overgrowth (which can be checked for via a lactulose breath test) and to treat diarrhea. This particular medication has been used to treat travelers' diarrhea and is used in many countries. There were two other medications marketed for treatment of diarrhea and abdominal pain in women, but these have been withdrawn by the FDA (though one, Alosetron (Lotronex), is occasionally used in very severe and resistant cases and can only be prescribed by doctors registered with the company).