Synbiotic Supplementation Improves Stress, Quality of Life in Patients With Fibromyalgia

Published on: 

Patients with fibromyalgia receiving the synbiotic intervention reported decreased levels of anxiety, depression, and stress, as well as improvements in quality of life during daily activities.

Synbiotic nutritional supplements (Gasteel Plus, Heel España SAU) were shown to improve the dysregulated immunoneuroendocrine interaction regarding inflammatory and stress responses in female patients diagnosed with fibromyalgia, particularly for patients without chronic fatigue syndrome (CFS), according to a study published in nutrients.1 The supplements also improved perceived levels of stress, depression, anxiety, and quality of life.

The origin of the conditions is unknown, although certain studies have indicated abnormalities in muscle physiology and immune/inflammatory response could be the main causes. Further, the gut microbiome of this patient population may differ from that of the general population, with patients with fibromyalgia exhibiting higher numbers of enterococci compared with controls.2

“Several food supplements are currently proposed for the improvement of symptoms in fibromyalgia and CFS, among which we can highlight probiotics, as well as synbiotics, the latter being very scarce in the literature,” wrote a team of Spanish investigators. “Probiotic therapy, according to other authors, may change the gut microbiota, enhance mucosal barrier function, reduce pro-inflammatory cytokines and probably have a favorable effect on mood in people who have emotional symptoms and elevated inflammatory immune signals, as well as improvements in cognitive symptoms through neuroimmunoendocrine enhancements.”

Investigators evaluated the effects of the synbiotic via the pro-inflammatory and anti-inflammatory cytokines, interleukin-8 (IL-8) and IL-10, as well as the neuroendocrine biomarkers, cortisol and dehydroepiandrosterone (DHEA), to better understand the interaction between inflammatory and stress responses mediated by the cytokine-hypothalamic-pituitary-adrenal (HPA) axis in addition to mental and physical health. Mental and physical health were assessed using body composition analysis, validated questionnaires, and accelerometry.

Each synbiotic bar contained 1 × 109 colony forming units (CFU) of freeze-dried powdered bacteria in addition to 8.25g selenium, 1.5mg zinc, and .75g vitamin D and maltodextrin. Eligible patients were female patients diagnosed with fibromyalgia, with or without concurrent CFS. A total of 15 patients with fibromyalgia were enrolled, with 7 in the CFS group and 8 patients without a CFS diagnosis. Patients were evaluated at both baseline and after the 1-month intervention.

Patients receiving the synbiotic intervention reported decreased levels of anxiety, depression, and stress, as well as improvements in quality of life during daily activities (P <.05). Depression and stress levels were statistically improved in patients without a concurrent CFS diagnosis (P <.05); however, anxiety, fatigue, and the impact of fibromyalgia statistically improved in patients in the fibromyalgia and CFS cohort (P <.05). Additionally, the synbiotic generated an activation of the HPA axis which was able to compensate the increased inflammatory status, as observed by elevated IL-8 levels, at baseline in this patient population.

No negative changes in sleep parameters or body composition were reported, as well as for most of the activity/sedentarism-related parameters that were assessed by accelerometry. No significant changes in bone mass, total body water percentage, muscle mass, weight, or body fat mass percentage were noted, which indicated that, in addition to maintaining body composition, patients maintained the same diet during the study.

Limitations noted by investigators included the lack of evaluation of the basal level of dysbiosis of patients with fibromyalgia and if the 1-month intervention was enough time to change microbiota. Therefore, they encouraged future studies that measure some of the strain characteristics of these 2 conditions, both before and after synbiotic treatment to confirm whether modification of existing dysbiosis could be responsible for improved immunoneroendocrine regulation.

“The synbiotic seems to have a beneficial effect on the inmunoneuroendocrine imbalance presented by women with fibromyalgia, provoking a clear response of activation of the HPA axis and subsequently a decrease in the inflammatory profile, an effect that only occurs in patients without a previous diagnosis of CFS,” investigators concluded.


  1. Hinchado MD, Quero-Calero CD, Otero E, Gálvez I, Ortega E. Synbiotic Supplementation Improves Quality of Life and Inmunoneuroendocrine Response in Patients with Fibromyalgia: Influence of Codiagnosis with Chronic Fatigue Syndrome. Nutrients. 2023; 15(7):1591.
  2. Madden, J.A.J.; Hunter, J.O. A Review of the Role of the Gut Microflora in Irritable Bowel Syndrome and the Effects of Probiotics. Br. J. Nutr. 2002, 88 (Suppl. S1), s67–s72.