Is Fibromyalgia Caused By SIBO and Leaky Gut?

Fibromyalgia is a disorder that causes muscle pain and fatigue. People with fibromyalgia often experience tenderness at certain points on their body when pressure is applied.

Fibromyalgia sufferers also experience other symptoms, including:

  • Insomnia or difficulty sleeping
  • Morning stiffness
  • Headaches
  • Numbness or tingling in the hands and feet
  • Menstrual irregularities and pain
  • Difficulty concentrating (i.e. “brain fog”)

According to the most recent statistics, about five million Americans (roughly 1 in 50) suffer from fibromyalgia. It’s the second most common musculoskeletal ailment behind arthritis, and it affects females far more often than males (it is seven times more common in women).

As anyone with fibromyalgia will tell you, it’s a debilitating condition that affects every aspect of life. For example:

  • People with fibromyalgia are three to four times more likely to suffer from depression.
  • 50% of fibromyalgia sufferers have difficulty performing daily activities.
  • 30–40% of people with fibromyalgia have to quit work or change jobs.
  • People with fibromyalgia are hospitalized once every three years on average.
  • The average fibromyalgia patient uses three or four drugs daily to control symptoms.

What is the conventional approach to fibromyalgia?

There is no laboratory test to diagnose fibromyalgia. Instead, patients are diagnosed based on their symptoms and history, and after excluding other diseases that may present with similar symptoms, such as rheumatoid arthritis, major depressive disorder, multiple sclerosis, and other autoimmune diseases.

There is no consensus in the medical community on what causes fibromyalgia. However, the current theory is that it may involve a variety of factors, including:

  • Genetics. Fibromyalgia runs in families, so there may be genetic mutations that make people more susceptible to it.
  • Infections. Some viral or bacterial infections appear to trigger or aggravate fibromyalgia.
  • Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Because the cause of fibromyalgia is unknown, conventional treatment is focused on managing symptoms. Common medications prescribed include analgesics (OTC pain relievers like ibuprofen, or prescription drugs like tramadol), antidepressants, and anti-seizure drugs (which are sometimes helpful in reducing certain types of pain).

An alternative theory on what causes fibromyalgia

For many years I’ve suspected that fibromyalgia is caused by gut dysfunction. I noticed that the vast majority of my patients with fibromyalgia also had digestive problems, and when I started to run tests on them, I discovered that many of them had gut infections, dysbiosis, small intestinal bacterial overgrowth (SIBO), and leaky gut.

Could an unhealthy gut be the cause of fibromyalgia?

Then I decided to look into whether this connection had been explored in the scientific literature. Sure enough, there were several studies connecting fibromyalgia with problems in the gut. For example:

  • 73% of patients with fibromyalgia reported GI symptoms, compared with 37% of those with osteoarthritis. (1)
  • Irritable Bowel Syndrome (IBS) is present in 30–70% of fibromyalgia patients. (2)
  • 33% of IBS patients meet the diagnostic criteria for fibromyalgia, compared to just 4% of control subjects. (3)
  • Up to 50% of patients with fibromyalgia have functional dyspepsia, which is a fancy term for “indigestion” with no known cause. (4)

While I was intrigued by these correlations, they are just that—correlations. What’s more, like fibromyalgia, IBS and functional dyspepsia are simply diagnoses based on symptoms, so these papers didn’t shed much light on what actually might be causing both the fibromyalgia and the IBS/indigestion.

In functional medicine, we’re always concerned with finding the underlying mechanism or cause, because addressing that is what will lead to the most effective and long-lasting treatment.

So I kept digging through the research, and I hit the jackpot. I found several papers associating fibromyalgia with specific mechanisms of gut dysfunction. For example:

  • A study in 2008 found a relationship between alterations of the intestinal microbiota (i.e. “gut flora”) and fibromyalgia. (5)
  • Researchers at Cedars-Sinai Medical Center in Los Angeles found that 100% (42/42) of fibromyalgia patients they studied had small intestinal bacterial overgrowth (SIBO). This is astounding. (6)
  • A study of 40 patients with fibromyalgia, 28 (70%) had intestinal permeability (i.e. leaky gut). Importantly, 12 of the 28 patients with leaky gut had no gut symptoms. I believe this is one reason the gut is often overlooked as a potential underlying cause of fibromyalgia. (7)

Are gut problems the cause—or effect—of fibromyalgia?

Of course, one might ask “Are these gut problems causing fibromyalgia, or is it the other way around?”

At least one study has directly addressed this question. A group of patients with fibromyalgia that were positive for SIBO were split into two groups. One group received antibiotics to treat the SIBO, and the other group received a placebo. Significant improvement of fibromyalgia symptoms was observed in the patients that achieved eradication of SIBO with antibiotics, whereas no improvement was seen in patients who took placebo or who still tested positive for SIBO after the antibiotics. (8) This suggests that SIBO plays a causal role in fibromyalgia for at least some patients.

A new approach to treating fibromyalgia

If GI problems such as SIBO, dysbiosis, infections, and leaky gut are the underlying cause of fibromyalgia, it follows that healing the gut is the key to long-term improvement for fibromyalgia sufferers.

I’ve written extensively about how to do that elsewhere on my blog (this free eBook on gut health is a great place to start), but here’s a brief summary of the most important steps:

  • Avoid foods, medications (e.g. antibiotics), and chemicals (e.g. BPA) that irritate the gut.
  • Eat plenty of fermentable fibers (starches like sweet potato, yam, yucca, etc.).
  • Eat fermented foods like kefir, yogurt, sauerkraut, kim chi, etc..
  • Consume bone broth and glycine-rich foods (e.g. tougher cuts of meat like beef shanks, oxtail, brisket, and chuck roast).
  • Consider taking a probiotic (I prefer soil-based organisms like Prescript Assist) and/or a prebiotic supplement (like PreBiogen).
  • Treat any intestinal pathogens (such as parasites) that may be present.
  • Manage your stress (with mediation, mindfulness practice, biofeedback, etc.).
  • Get at least 7–8 hours of sleep each night.

Now I’d like to hear from you. Have you been diagnosed with fibromyalgia? If so, do you also have digestive problems? Have you noticed any improvement in your fibromyalgia symptoms after taking steps to heal your gut? Please share your experience in the comments section.

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