Is Fibromyalgia Caused By SIBO and Leaky Gut?

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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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Comments Join the Conversation

  1. emma says

    I was diagnised with fibro about a year ago i seem to be taking it rather hard to get used to so many new things keep apearing i never really no what to do i suffer heart palpitations everyday nearly that make me rather scared but all seems to come back normal when tested and today i got results back from my bacteria test in the stomache and its possitive not to sure if thats anything to do with having fibro or is seperate thing ive been given two different kinds if antibiotics to take for the next 10 days. Then return to do another test in two months time can anyone tell me if its caused by the fibro

    • prioris says

      Fibromyalgia is separate disease. I would suggest you try minocin and borax protocol.

      For heart palpitation, try 1 tablespoon Plaintation Blackstrap Molasses. it can be found in supermarket.

      • emma says

        Thank you for your answer first i will say that when i was talking about the bacteria test yes i meant the breath test . Could i ask when you say to take a spoon of plantation blackstrap molasses is that everyday or just the oncei would like to try i have been to the hospital and they connected me to a 24 hour heart machine that read my heart rate all the time and it came back normal also had an xray and blood test all came back normal

        • says

          If the issue is related to magnesium, 1 tbsp of molasses will supply about 48 mg of magnesium. That’s not a lot when you consider the US RDA for women is over 300 mg daily. If one is magnesium deficient, more than one dose daily would probably be required. The thought occurred to me that molasses is mostly sugar, about half of which is fructose. It might not be the best choice for someone with SIBO. I’m sure it depends on the individual, though, and which bacteria are involved in the overgrowth.

          • emma says

            Thank you for your answer so quickly maybe i will wait to try it untill i have more information on my stomache problem then as i still havent been informed of what it actually is , my doc only told me that i was in need for antibiotics shes never very helpfull on information that is why i am soo lost in my fibromialgia problems as i dont really no anything about it only what i have read on the internet thank you for your advise

            • prioris says

              i know molasses contains iron but that is besides the point.

              based on many anecdotal reports, you will likely know whether molasses will work for you in a short time to calm down your heart, it seems to work for a lot of people. you should be able to do a quick test to see if it works. take 1 or 2 tablespoons and see what happens.

    • says

      If the test you’re referring to was the breath test for SIBO, the gibromyalgia is more likely caused by the bacterial overgrowth, not the other way around. The antibiotics might help, but you might need probiotics, diet modification, etc. to keep the overgrowth from returning. There’s some good info on this site and elsewhere.

      Magnesium deficiency is fairly common in fibromyalgia patients, and it’s also a possible cause of heart palpitations, though certainly not the only one. You can try supplementing a well-absorbed form of magnesium (like glycinate, malate, or taurate). If your absorption is poor, which is a possibility with SIBO, then you might need to get some magnesium from Epsom salt baths and from topical magnesium chloride. If the palpitations persist, please get that checked out by a qualified medical practitioner.

      • Emma says

        Hello again im looking for a bit Morel information somthing slightly different first question I have a horrible burning feeling in my mouth mainly on the tounge thats makes it painfull and uncomfotable to eat and drink I see nothing when I Look in the mirror it looks normal what could this be?? Any ideas on how to ease These symptoms ??

  2. says

    Hi, I’m from South Africa. My mom has been diagnosed with Fibro as well as with RA. She constantly has digestive problems and certain foods make her instantly sick. She can have a salad with vinegar on and instantly feel her stomach start to complain and her RA acting up. I’m definitely studying your material on cleaning out the gut; joining my mom on this journey and hoping this would heal her. She’s been given Chemo-pills and I feel these are making her feel worse. Desperately looking for a natural solution for her, so you have given me hope! Thank you!

    • prioris says

      cleaning out the gut won’t address the root problem.

      there is mycoplasma systemic infection

      I used minocin to cure my FMS.

      I used borax to cure my RA

      I would strongly suggest using the Borax protocol. it takes 3 weeks to work.

      also read arthritistrust.org section on healing

  3. Michael Hertz says

    I have a host of symptoms, none of which I had until August 2013 when I got turista followed by a significant amount of antibacterial medications in November and December 2013. Symptoms include: abdominal clenching, bloated abdomen, GERD, dry mouth, sensitivity to heat and sunlight, increasing neuropathy in feet and hands. The IBS and GERD now go on daily and for most of the day. Stool is loose (no diarrhea). Not sure if the pain I feel qualifies as fibromyalgia. My gastro doctor has me taking an expensive probiotic (VLS #3) and lansoprazole (for GERD). Having been doing this for two weeks with no results as of yet. I am 70 and was in great health until this started. Suggestions? Ideas? Thanks very much.

    • Margo says

      You sound like me. I’m 23 and I was in good health until 3 years ago. I have a lot of symptoms like that. I’m getting tested for Lyme disease now.

    • John Es says

      Michael,

      I sorry your treatment is not working. In one short paragraph, you’ve told a classic story that happens all too often.

      I’m afraid PPIs are used as a diagnostic tool (Let’s Try THIS!). I don’t know if that is happening in your case, but, if it is, I’d expect the choice of probiotic is also just a guess.

      You might want to find a practitioner that will treat you based on good testing. I am planning to work with such a pro. I’m pretty sure she uses the Genova GI Effects Stool Profile, which is based on multiple samples. It’s purpose is to provide an accurate profile of the beasts living in the gut to determine what needs to go, and what is missing.
      https://www.gdx.net/product/gi-effects-comprehensive-stool-test

      A urine organic acids test is also needed to detect certain pathogens.

      These tests are typically done by practitioners of functional medicine. I don’t think they are likely to prescribe proton pump inhibitors.

      Most people do not produce excess stomach acid, especially at age 70. I’m not in a position to say that your prescription was inappropriate. But, these drugs were not intended for long-term use, and likely have significant side effects when used as such.

      The reduction of stomach acid could potentially be making a more friendly environment for pathogens. I believe this was the case for me. I actually got some relief when I increased my stomach acid.

      Please make sure your treatment is the result of a thoughtful diagnosis. There is no standard answer.

  4. Janet says

    I’m new to this whole era of fibromyalgia. Two years ago, I was on 4 different antibiotics and 2 steroids in three months time. I had a wicked sinus infection that just would not clear up. After I was done with all of that, I started getting night time stomach issues. My stomach would just bubble and well, ferment for lack of a better word, and I was all bloated. Suddenly, I could not eat spinach, then beets, then coconut, etc. The list kept of growing of foods I had to eliminate. Then this past year, I started getting tendonitis in the left side joints of my body. First my shoulder, then my wrist, now my ankle, etc. I was prescribed steroids each time. April of this year, I somehow got an intestinal issue (ecoli) from eating bagged vegetables from the grocery store. My husband and I both got ill. Yet, while he got better, I suddenly could not eat squash or any raw vegetables. I got severe cramping an hour after I ate them. I lost 10 pounds in three weeks. I went to a wonderful gastroenterologist at the Cleveland Clinic. She did an MRI and endoscopy. She found diverticulosis in my small bowel. She said I had SIBO and I started on the treatment for that (Rifaximin). Within three days of taking that, all my aches went away as well as my bloating and stomach issues, however, I still could not eat raw food. When I finished the medication my symptoms stayed away for about a month. Then the tendonitis came back in my wrist as well as fatigue, bloating, full body aches and insomnia. I went back this past week and we are trying the Rifaximin again and I am going to see a dietician at the Cleveland Clinic to see if we can take my diet to zero and begin again. We both think I have leaky gut caused by all the medications I was on. The last dosage of steroids were right before the ecoli illness and I do believe the double whammy of those has made me worse. My question to you now is, will taking my diet to zero (like bland foods and bone broth soup) then slowly adding back in foods help to heal my gut? I know there is no time frame for any gut healing and no one can tell me when to add foods back, but just how do I know when to add the raw food back?

    • says

      Janet,

      Cutting your diet back to the basics will help but it’s just one part of the solution. You also need to get the nutrition into your system that your body is so lacking. I started my journey to recover from fibro with juicing, high quality supplements and basic foods like bone broth. You also will need to at some point do a candida cleanse but I recommend to my clients that we get their diet figured out first. Once you start feeling better then you should start adding foods in one at a time to see how your body reacts to them. Each new food that you can eat for a few days with no reaction can be added to your ok to eat list of foods. It’s a process and takes a while but it will be so worth it in the end! Feel free to contact me if you want any support during the process. It can be a frustrating time. It took me a year to start finding relief although now at 1.5yrs I’m so grateful that I committed to it!

  5. prioris says

    The problem with fibromyalgia is that

    1) there is no objective way to diagnose it except by primitive and subjective means.

    2) it may be more than one disease that is being talked about

    3) May have similar profile to people with CFS, GWS, Lyme etc hence indistinquishable

    All three make diagnosing correctly very difficulty

    Garth Nicolson points to mycoplasma as a cause.

    In regards to 2), I don’t recall the the “stiffness” as being the problem but the inflammation especially all around the rib cage. the early mornings would be very painful. stiffness implies a pain similar to someone who over exercises where muscles get sore when creatine gets depleted. stiffness and soreness are two entirely different things. it makes me wonder if every FMS person is on the same page.

    I had costochondritis also. 70 percent of people with FMS have this but it seems odd that it is left out of the FMS diagnosis criteria or hardly mentioned by people and treated as something separate.

    i was shocked on the way they diagnose it. some doctor presses a spot and say if that hurts. they add up the number of spots and come to a conclusion. that is a pretty subjective thing when your entire body is hurting in so many areas, For me, it is a waste basket diagnosis.

    I also am diagnosed with CFS.

    I had FMS for over 35 years. I finally got rid of it within a week by taking minocin. It dissipated within a week or so. Never came back. I should note that most generic minocycline was ineffective. this is a problem for people looking for a cheaper alternative. Some do work but you have to research it.

    I would also try the borax protocol since that also is suppose to help against mycoplasma. I wouldn’t waste my time testing for it since not all strains are tested for or may not be detected. Just try the antidote. It is why all those Lyme tests are a waste of time most of the time.

    This FMS is like a tangled mess. Many people will place the tag FMS on themselves but each may not be on the same page as the others. This makes finding solutions very difficult.

    It’s really down to whether you are going to address it as an infection or non infection or both, If you have inflammation, you have some type of infection.

    The gut/colon is where a large part of the immune system is so working it from that end seems justified but you may need to do a lot more than that.

    It should be noted that mycoplasma has been implicated in Rheumatoid Arthritis also. It is well known that one can’t defeat RA unless other infections in the body are addressed. Systemic fungus may prevent the curing of RA with borax or minocin. So will other infections. So all the infections need to be addressed and be removed in layers. The same may be true of FMS.

  6. Dawn says

    I am dairy/egg free, and have been striving for gluten free. I just saw registered dietitian who uses “alternative” approaches and she wants me on the low FODMAP diet! So, NO dairy, ‘gut fermentation’, no brassicas … does this mean no wasabi, saurkraut, water kefir etc..? where will I get ‘good’ bugs from?

  7. says

    This was absolutely a HUGE issue flaring up my fibromyalgia! I changed my diet and lifestyle and was on the right track but I was never able to progress past a certain point. That’s when I went to a naturopath and I told him that I believed that I had leaky gut and SIBO issues and he helped me resolve the issues. Within a month of doing a proper cleanse, adding in good probiotics and cutting out sugar to stop feeding the bad bacteria I finally progressed to a new level of healing!

    Because I believe so strongly that this is an issue in many if not all fibromyalgia patients, I have all of my clients complete a gut healing cycle or two. It’s amazing how much better they feel after the first month! If you have fibromyalgia then you really should work on any SIBO or leaky gut issues immediately!

  8. Brenda says

    I came across this site and I can hardly read the I formation through my tears of elation!!!! My life took a drastic turn for the worse 2 years ago and I have been in and out of the hospital ever since. It started with stomach issues, In a very short period of time I had lost a significant amount of weight and could no longer do anything, work, take care if my children – NOTHING. I laid around my house all day and night in constant pain – an endoscopy revealed massive irritation but with no known cause – I myself thought I had SIBO but the doctor didn’t even give it a second thought – this is now almost 2 years ago – I met with several specialists over the past 2 years and was also eventually referred to rhuematology as new symptoms seemingly unrelated began. I started to think I had just all of a sudden become THE most unhealthy person on the planet. My life has been absolutely miserable for 2 years. Some autoimmune things were suspected but nothing confirmed – eventually fibromyalgia was my diagnoses at least for rhuematology – I continued to have terrible stomach issues and was in pain CONSTANTLY – nothing brought relief – I had every test and scan possible – finally last week I suggested SIBO again but to my new GI – she said she was happy to prescribe the antibiotic rifaximin and I started it yesterday at 5pm – I have taken 3 doses out of 42 total and I feel like I is working – I am on heavy duty pain meds and have been able to go for longer between taking them – EVERYDAY I wake up – when I can even sleep properly – I wake up feeling like I am dying, as if I have been poisoned – today I woke up feeling just ill instead of dying and trust me that is an upgrade!!!!!! I am SOOOOOOOOOOOO hopeful about the antibiotic and coming across this site and seeing the connection between fibromyalgia and stomach issues – oh I was also finally diagnosed with IBS – seeing the connection that no on ever told me about is amazing!!!!! I had had so many tests, so much blood work, so much everything – if this antibiotic works I will walk around the world like Forest Gump. I am HAPPY to talk to anyone else about their experiences and it share my test results and more extensive med history as well. Thank you so much for this site!!!!!!!

  9. Pauline Tait says

    So your article has startled me and disappointed me nothing you have done I was hoping I didn’t have FM I have the brain fog symptoms (but I am also on morphine) I have tender points aching joints etc etc and thought I had FM as a result of Physical or emotional trauma BUT when I had FM I also had IBS it went away for 3 years (after prayer I’m a Christian) then in January 2014 I was diagnosed with an impacted bowel from a com-plication of weight loss surgery the IBS came back soon to be followed by classic symptoms of FM sigh

  10. Aidan Walsh says

    Histamine Intolerance now seems to be a diagnosis being found now in cfs/fibro/lyme…Also hyperparathyroid issues in some with even normal calcium levels called normocalcium parathyroid :) DAO low enzyme in cfs/fibro/lyme :) Time will tell if any of these are true or just more b.s. hype dignosis!! Excluding also hypoparathyroid issues is a must, remember cfs/fibro is only ever given after all exclusions of illness are met and elimination must be at the forefront of diagnosis which is not being done which causes decades of human sufferings including deaths :)

  11. Aidan Walsh says

    Histamine Intolerance now seems to be a diagnosis being found now in cfs/fibro/lyme…Also hyperparathyroid issuse in some with even normal calcium levels called normocalcium parathyroid :) DAO low enzyme in cfs/fibro/lyme :) Time will tell if any of these are true or just more b.s. hype dignosis!!

  12. Aidan Walsh says

    Histamine Intolerance now seems to be a diagnosis being found in cgf/fibro/lyme…Also hyperparathyroid issuse in some with even normal calcium levels called normocalcium parathyroid :)

  13. Laurie Van Den Beldt says

    Quick question so I can avoid reading all posts, is acidophilus okay as a probiotc?

  14. mari herman says

    I was diag. with FM after a work injury 10 years ago. I also have lupus and hypothyroid. I know that hypothyroid can cause the gut to slow down but I do have IBS with constipation. It seems I am always battling a “bad belly.” I have had H-pylori twice. I am now back to eating a fiber One bar daily and probiotics, yogurt every morning. It has been a week and the belly slight better. The FM pain is bad in the mornings but once I get going it is better.
    Thanks for the article.

  15. Molly says

    Hi,

    I had a horrible intestinal infection about 5 years ago, and then tested positive for SIBO afterwards. In the past 6 months I’ve been diagnosed with fibromyalgia and told I have IBS since stomach issues still bother me, such as bloating and gas. A GI doctor in St. Louis who has been studying muscle and gut connection (I no longer live there but my dad asked him after I was diagnosed with fibro) thought I likely had SIBO again. Turns out I tested positive and I’m currently starting antibiotics. Since I had a huge hit to the gut a while back caused by sinus antibiotics, I know my gut problems started first and very excited to see if the SIBO treatment helps my fibro pain. Fingers crossed!

  16. Keri Fulmore says

    HI Chris, Thank you for a wonderful article. I do have a quick question. I believe i have SIBO and was wondering if you have a link to a book that effectively treats SIBO. Perhaps you have one?

    Thanks.

  17. Carol says

    Yes I have IBS and Fibromyalgia, it took quite some years to diagnose, I have recently heard that a lack of magnesium may be the problem, I have started to take magnesium and a probiotic each day along with Endep at night which helps me to sleep, I must say I am starting to feel like I have more energy and do not have the aches I used to have 24/7.
    I still on occasions have hot flushes which are quite different to menopause flushes. One strange thing I also have is my blood count has low white cell count, neutrophils and lymphocytes. Kind of wonder if it is my blood that is causing the problem ????

  18. Cheryl says

    Bron, I’d take her off all grains immediately rather than wait to hear from someone to see if they have seen success. Just do it, and mark the progress, if any.

  19. Ann Kent says

    Thank you for the interesting information. I wonder how this can be applied to chronic lyme disease patients. Many believe that fybromyalgia and chronic fatigue syndrome patients are underdiagnosed and many have lyme. That was certainly the case in our family with 3 diagnosed as CFS and finally were diagnosed with lyme. As i read the symptoms of many of the commenters they are all under the lyme umbrella. Can you comment on your experience with chronic lyme patients?

  20. Kelley Nielsen says

    I was diagnosed with fibromyalgia about 11-12 years ago. I found out about it through my own research and asked my PCP to verify it for me. I had already been diagnosed with IBS. It set in during the last few months of my osteoarthritis, before my joint replacement surgery, when the stress of trying to lead a normal life with it overwhelmed me. (My osteoarthritis was undiagnosed and untreated; the doctor I sought help concluded that it was an attention seeking ploy, on the assumption that patients in their 20s did not get arthritis, and told me not to bring it up again for at least 20 more years.)

    Right now, I’m trying to heal my gut and keep myself sane in the meantime. I got great relief from my digestive symptoms by first abandoning vegetarianism and then switching to a meat based diet. I still have neurological symptoms, such as muscle aches, depression, and an exaggerated startle response. I’m also struggling with weight loss, and have a few digestive symptoms here and there.

    (I did the Marshall Protocol for a few years–don’t worry, I take cod liver oil now, which has been a huge help against the constant cold and bugs I used to suffer from).

    I’m eating paleo pretty well now, except for occasional lapses surrounding social events where grain based foods are served. I eat homemade sauerkraut every day and bone broth most days, plus I take magnesium glycinate, dulse, cod liver oil and fish oil, vitamin K2, phenibut, and since the past few days, phosphatidylserene. I’m gradually doing better overall (although with big setbacks dominated by depression), and I presume that my gut focus is part of it although it can be hard to keep it all straight.

    • Cheryl says

      Hi Kelley, you poor thing! I can’t believe how your doctor treated you! Although I’m not trained in health, I’ve read thru my own research that extreme startle responses are adrenal related, and supporting your adrenals is essential for that as well as helping with depression. I learned at StopTheThyroidMadness.com a lot about adrenal support as far as taking lots of B vitamins, Ashwaganda, higher doses of vitamin C, some Raw Adrenal extract, Holy Basil, and getting plenty of sleep by going to bed earlier. The other things you take are helpful too. My adrenals are so much better now and my sleep is wonderful. Plus I’m not as jumpy.

  21. Jacquie Lee says

    I have been diagnosed firstly with B12 deff and now fibromyalgia…I have pain, brain fog, irritable bowel (although saying this I can eat very hot spicy food and am fine but anything else even a glass off water or price of salad sometimes can set my gut off and I end up on the toilet within 30 mins). And many more symptoms.

    • John Es says

      I think the standard advice to avoid spicy foods can be misleading. My gut is certainly compromised to some degree, but, I enjoy eating spicy foods, and even experience a soothing feeling in my gut after eating them.

      I think I am also sensitive to the insoluble fiber in salad greens. I had quite a setback after eating a big dandelion green smoothie (cheap blender!). I am considering eating greens cooked and pureed, and combined with some soluble fiber, like cooked winter squash.

      I *do* avoid some spicy food, not because of the heat, but, because they are nightshades, and might be contributing to intestinal permeability (and autoimmunity).

  22. Pete says

    Thanks Chris for your wonderful work, you have helped me greatly!

    I’m not a medical pro but I am a SIBO experiencer and I attended the SIBO Symposium at the National College of Natural Medicine in January 2014. Please check this out.

    http://sibosymposium.com/

    It was excellent and included some very advanced new info that I will attempt to briefly share.
    Researcher and speaker Dr. Mark Pimentel presented his discovery of a causal link between SIBO and wider autoimmune disease. Dr. Weinstock presented his research and work successfully treating several enigmatic maladies from RLS to Parkinson’s and many other diseases through addressing SIBO.
    Many treatment protocols were addressed by Dr. Pimentel,MD, Dr. Weinstock, MD, Dr. Allison Siebecker ND, and Dr. Sandberg-Lewis, ND.

    The amazing discovery is as follows – please pardon my stating of the known and obvious for context:

    SIBO occurs when the function of the ileocecal valve has been undermined (there are many known causes of this) and bacteria that belong in a healthy colon manage to migrate into the small intestine. They consume carbs there and give off gas.
    Hydrogen produced by them feed their buddies, the methane producers. These methanogens also produce a cytolethal extending toxin – an antigen which mimics vinculin resulting in the immune system’s production of anti-vinculin antibodies (bad!).
    Vinculin is a cytoskeletal protein that plays a unique and irreplaceable role in cell adhesion and motility. In the gut, the interstitial cells of Cajal govern constriction of the intestines (peristalsis). Damage to the ICC vinculin and thus to the nerve function there results in cramping and constipation: disrupting motility and allowing the bacteria to hang around and continue the process
    .
    But the role of vinculin is critical throughout the body. And as these SIBO caused anti-vinculin antibodies become present in the bloodstream they assault everything.

    At the Cedars-Sinai Medical Center where Dr. Pimentel is director of the GI Motility Program, the presence of methanogens in the small intestine, SIBO, can be confirmed through a simple blood test for anti-vinculin antibodies. I look forward to the wide use of this procedure in diagnosis.

    I believe SIBO is a core civilization disease.

    Your life is like a boat floating you down a stream of health. When the stream is full the trip is smooth but when the stream gets low you begin to encounter rocks and irregularities that interrupt your journey. Some of us may snag on various diseases depending on the features of our own stream bed. We are not “genetically programmed” to get some disease, we are variously susceptible according to our individual stream bed but the main thing is that we only get sick when the stream is low! As the health streams of our culture get lower and lower, different people begin to strike different problems first. The lower the streams, the more problems will occur.

  23. Joe says

    My wife 61 has had Fibromalgia symptons since 2011. This intense pain resulted over a matter of a few weeks time and is a way of life now. I know because I pay close attention to anything that affects my physical relationship with her. Because of her lack of blood clotting, she is unable to take any medications that would thin her blood like (aspirin, Ibuprophen etc.) It doesn’t leave much for relief. History: 2010 we went to Mexico for our honeymoon. A couple of weeks latter at home, she became very sick, vomiting with intense diarrhea. Her Doctor gave antibiotics which helped but the diarrhea varied in intensity over several more months. She was tested for Lyme and some other things which were all negative. The diarrhea eventually went away. About a year later in 2011 after having some woman’s surgery and also esophagus/stomach problems that is when the Fibromalgia pain appeared. She was given Nexium for her stomach which she is still on to this day because they cannot operate on her esophagus. After reading this article about the Fibromalgia maybe being linked to stomach bacteria, I am curious that maybe the Nexium might be messing up the natural chemistry which keeps many things in order in the stomach, or she may have contacted a bacterial infection from Mexico that has raised its ugly head again causing this pain. If anyone has ever had a cut that got infected and remembers the pain when touched they can appreciate that maybe Fibromalgia is also some kind of bacterial infection that is infecting the whole body. Just a thought?

    • Pete says

      Your wife’s case sounds just like a number of cases discussed at the symposium referred to in my comment below. Montezuma’s revenge is found by Dr. Weinstock to be a very common precursor to the many of the SIBO related disorders he is currently working with. He has vast clinical and research experience around this.

  24. VALERIE LIPOWSKI says

    WHEN DIAGNOSED OVER 25 YEARS AGO WITH FIBROSITIS, WHICH IS NOW KNOWN AS FIBROMYALGIA, I FOUND IT HARD ADAPTING. BUT I LEARNED THAT I EXPERIENCED “LESS MUSCLE PAIN” WHEN I STAYED ACTIVE…..GOING TO THE GYM, WALKING, STRETCHING, & OF COURSE TAKING NAPS.
    MY MEDICAL HISTORY INCLUDES BEING BORN WITH A HEART MURMUR (WHICH REQUIRES ANTIBIOTICS EVERY TIME I HAVE A DENTAL APPOINTMENT) HYPOTHYROIDISM, HASHIMOTO’S DISEASE, PARKINSON’S DISEASE, PULMONARY HYPERTENSION, COLITIS, POOR IMMUNE SYSTEM, CHRONIC GASTRITIS, GASTROPARESIS, HIGH BLOOD PRESSURE, AND GLAUCOMA.
    BOTH MY SON AND HIS WIFE ARE CHIROPRACTORS AND LIVE A VERY HEALTHY PALEO LIFESTYLE. THEY HAVE INTRODUCED ME TO PALEO, BUT I HAVE TO BE HONEST AND SAY “IT’S HARD TO TEACH AN OL’ DOG NEW TRICKS”! :)
    I AM CONVINCED THERE’S SOMETHING VERY POSITIVE ABOUT PALEO, SO I’M DETERMINED TO LEARN ALL I CAN TO HAVE A BETTER QUALITY OF LIFE.
    CURRENTLY MY BIGGEST ISSUES ARE WITH THE GASTROPARESIS AND INABILITY TO EAT AT ALL.
    MY DAUGHTER-IN-LAW HAS TOLD ME ABOUT THE PALEO BONE BROTH FOR GUT PROBLEMS AND I’M TRYING TO SNEAK-UP ON THAT RECIPE. I DID GO OUT AND BUY A SLOW-COOKER AND PLAN TO MAKE IT THIS WEEKEND……….ESPECIALLY SINCE I’VE RUN OUT OF EXCUSES TO TELL HER WHY I HAVE NOT MADE IT YET!
    I ENJOY ALL OF CHRIS’s ARTICLES AND LOOK FORWARD TO THEM ALL!

  25. says

    I definitely think that one of the contributing factors to Fibro is gut issues – I for one have fibromyalgia and I know I have a leaky gut – I have both gluten sensitivities, sensitivities to various other foods (nightshades and almonds for the most part), and also a dairy allergy. And all were improved by eating a diet designed to heal the gut.
    But I don’t think that gut-issues are the only problem – both from my own experience with my own body and experience from many of my patients who have fibro (I am a massage therapist), musculo-skeletal issues are also a huge part of this condition – I suspect that trigger-points in muscles are a leading cause of pain that many fibro patients suffer.
    I know that when I suffer any pain and I get one of my colleges to release the trigger-points, my pain goes away or is at least dramatically lessened.
    I also suspect that nutritional deficiencies are a major part – whether these are as a result of the damaged gut/poor digestion or simply because of a poor diet I do not know.
    I do think that this is a condition with multiple factors though…

    • Cheryl says

      Sal, it’s so interesting how we are all different and have different intolerances! I’ve NEVER had the trigger point thing. I do get tension headaches with knots in my back, but those only occur during ovulation and menstruation. My food intolerances are specific to what feeds candida bacteria according to the lists of foods in books and websites on candida. It’s not mind over matter either. I though eggplant was approved, started eating a nice plate of it, then felt the body aches raging…..no, eggplant was on the unapproved list. I’m not bothering with lentils, even though there is a discrepancy as to whether or not they will feed candida.

  26. Becky says

    I have been doing research on diets and specifically insulin resistance, which a good number of Americans have.
    I have been diagnosed with fibro, after lifelong heart trouble. Immune systems seem to play a role. I got off the usual western diet if processed foods and went while, limited carbs but wholesome. Throw in exercise daily, even if just stretching, and I feel so much better. Not entirely gone but much better.

  27. Joel T says

    Little confused – you mentioned that one study found that 100% of fibro patients showed signs of SIBO, and in the title hint that it could be a causal factor.

    But, aren’t the starchy foods that you recommend (sweet potatoes/etc), and also even fermented foods, shown to exacerbate SIBO to some degree?

  28. Vicky says

    Great, informative postings! One other consideration is chronic or late stage Lyme disease. The other already mentioned is hypothyroidism and Hashimotos disease.

  29. Diana says

    Thank you so SO much for posting this article Chris! I’ve had chronic diarrhea that has persisted for the past 3 years in spite of numerous diet (very strict autoimmune/semi-wahls protocol, no sugar, no caffeine) & lifestyle changes (my early twenties have not been so fun, I spend most of the time sleeping). To think that SIBO is probably the underlying issue behind my hypothyroidism and fibromyalgia as well is earth shattering.

    Quick question, are there any functional physicians/practitioners that you could recommend for SIBO treatment & adrenal issues on the East Coast (or anywhere in the USA)? Do you know of any integrative endocrinologists or holistic gastroenterologists?
    I would love to have you as a practitioner (just signed up on your wait list!) but wanted to know where I should turn in the meantime. Best wishes, health & happiness.

  30. Tom says

    I have undiagnosed fibro-type symptoms – insomnia, stiffness and pain especially in the neck and the shoulders, headaches, brain fog, fatigue. And I have SIBO. And candidiasis. And high mercury, arsenic and lead (revealed in DMSA provoked urine tests). And calcification issues. Magnesium helps but I cannot get enough of it into my cells without getting diarrhea. You may assume this is a sign of intestinal malabsorption but mercury also blocks cellular ion gates so possibly my tissue fluids are saturated with magnesium (I have very high salivary pH) but its not getting into my cells. 5-HTP helps. Probiotics (even ones with no fermentable substrate except for a small amount of cellulose) and even cellulose powder (in quantities large than in supplements) make things much worse for me.
    Antibiotics massively helped me sleep – but yeast got much worse and SIBO soon returned. I eat meat, fish, and a few olives, and the veg I can tolerate I have in juice form because I can’t deal with the cellulose. FODMAPs foods are out, even in juices (FOS is water-soluble). I can tolerate one carrot juice a day and would feel better if I could have more CHOs to protect my thyroid. The antibiotics I took were for parasites. Stool tests on the NHS (the medical service here in the UK) showed I had giardia in 2005. I took metronidazole twice, since I still had symptoms. Then sleep deteriorated over the next 5 years, skin lesions appeared on my hands and feet every winter and when I put my hands in the soil. I got CFS, did a stool test (Genova CDSA with parasitology) and discovered blastocyctis hominis, dientamoeba fragilis, three yeast species and 5 unusual bacteria species in my gut. Doxycycline and paramomycin killed off the parasites according to a follow-up CDSA some months later. And I slept well for a few days!!!
    Now I am looking for root causes of SIBO – reasons why the Migrating Motor Complexes (cleansing intestinal waves between meals) may not be happening as efficiently for me. One reason is yeast (effects neurotransmitters, vagus nerve, ileo-caecal valve etc). Another is the heavy metals – either because they support yeast or through other more direct mechanisms such as macromineral imbalances and their effect on neurotransmitters and their affinity for nervous tissue. Another I am considering with the winter eczema, cold intolerance, poor immunity and very high calcium to potassium ratio in a hair mineral analysis, is thyroid issues, possibly due to mercury and/or yeast. Low thyroid slows gastrointestinal motility – and I imagine therefore MMCs too, and reduces stomach acid. I need to run myself a thyroid panel with antibodies.
    I guess what I am saying with giving you all this detail is that there are many possible interlinking mechanisms at play here for me, and for other SIBO/fibro sufferers, but for me certainly the SIBO and fibromyalgia – if that’s what it is – are clearly connected since I slept normal hours after antibiotics – for a short period of time.

  31. Holli says

    I’m really surprised that very few medical professionals have made the connection to one the strongest causes of fibromyalgia….flouroquinolone antibiotics (Cipro, Levaquin, Avelox). I believe from personal experience that fibromyalgia is a direct effect of the damage they do to our CNS, intestines, muscles, joints, eyes, etc. I am living proof of what those drugs can do to the body. I went through all of the normally reported fibro symptoms after only 3 days on Cipro for a UTI. Wonder why fibro affects women more? Women are treated for UTI’s more often than men and they take these powerful drugs, especially if they report a penicillin allergy like I did. Chris, I do agree with you that to heal fibro you have to focus on the gut. The antibiotics wiped out the good bacteria and therefore the intestinal disturbance. This also makes gluten sensitivity higher and also blood sugar imbalances. These antibiotics should never be given with NSAIDS or steroid drugs because they basically make the damage worse. They don’t tell you this in the clinic because very few medical professionals have even studied these drugs. There is now a black box warning on Cipro that says it can cause permanent peripheral neuropathy. I have peripheral neuropathy and I was an active, 38 year old mother of 3, who could run marathons and now I am limited on what activities i can do. The biggest healing for me has come from treating this condition with pure foods and organic animal products. If you eat non-organic meats and dairy you are basically giving back the body a dose of the drug that caused the problem in the first place. Animals are treated with antibiotics and that’s why so many fibro sufferers have issues with meat. The meat they used to eat has now become inflammatory because the body is reacting to the antibiotics in them. The issue with wheat and other grains is because the cellular mitochondria have been damaged, therefore a slower response to breaking down glucose is in effect. While the excess glucose load piles up on the exterior of the cell membrane, the body slows down to compensate the work load on the body. This brings about the extreme fatigue after meals and the reported crash that many fibro sufferers feel. I have spent 2 years researching this correlation and have much data to back my findings. I am an anatomy, health and biology teacher so my background has lead me in this search for a cure and a better understanding of how to treat fibromyalgia as naturally as possible. I haven’t taken one pill or anything synthetic in two years and I’m getting good results. Can’t say that I’m 100% the old me but any improvement is welcome after months of suffering. I just wish countless others didn’t have to go through what I did because of the needless use of class 4 antibiotics. This country is in a crisis. If doctors don’t stop handing out antibiotics like candy and saturating our food supply with them it will only get worse. I’m tired of hearing fibromyalgia being called the “mystery disease”. It’s no mystery to me.

  32. Sonia says

    I was diagnosed with FM in the late 90’s. I thought I had a death defying disease. It was so painful and so many symptoms I was ready to accept that I was about to die. Anyhow to make, a long story short – I ended up finding something natural that really helped me & I’m, I would say a good 70% better. My doctor (he is an MD but treats 95% with natural things) did a bunch of test and besides a number of other findings found that the level of aluminum in my body was extremely high. He didn’t and still hasn’t related this finding to me having FM but I remember comparing my levels to another friend with FM and her levels of aluminum were high also, but what’s interesting is that about a year ago (early 2013) I read an article on the internet that said that people with FM have high levels of this toxic metal. Hmm I only wonder where these toxic levels are coming from because since the early 90’s I haven’t even used anything aluminum to cook or even to cover my foods, nor even use underarm deodorant (I’ve used baking soda for some time now) anyone I started to wonder since this has become an epidemic starting possibly in the late 80’s early 90’s if the theory is really true about the “chem trails” and that some of the spray is aluminum. I just wonder if this is what’s causing that problem along with the other epidemic proportions of illnesses

  33. Nell says

    Diagnosed with FM and Chronic fatigue 24 years ago, and because of anemia, Celiac disease 9 years ago and am still having inflammation and gut issues today. Gluten free/ milk free made me feel somewhat better. Tried the Paleo diet and was not able to sleep at night. I know that my main issues are gut related but there are certainly no simple answers.

  34. Mike says

    Cured SIBO with enteric coated peppermint oil and lactoferrin. Lactoferrin is a biofilm disruptor and peppermint oil has been proven to stop SIBO in some small studies. I decided to put the two together.

    It certainly helped me a great deal.

    Dealing with candida after that has returned my digestion to where I was when I was in college – just left a movie theatre where I ate some garbage popcorn and a diet drink- yeah, bad for me but I’m not bowling over in pain and will eat right for at least the next week to be on the safe side.

  35. Gen says

    Another great post, thank you! I am just curious, since you bring up SIBO.
    Low FODMAP is recommended to help SIBO, which includes some grains. Then thinking about the GAPS/SCD diets I am assuming grain = bad for autoimmunity. So you think work on SIBO resolution and autoimmunity would follow possibly?
    What are your thoughts on the SBO’s in Prescript Assist while breastfeeding?

  36. Karen B. says

    My mother was diagnosed with fibromyalgia and chronic fatigue syndrome when it first became known about, around 25 years ago. She was so happy that a name was finally given to her symptoms. I really, honestly believe what she had was overweight. I urged her for years to stop the wheat based diet and use more natural, unprocessed foods in her diet but she said she could not live without crackers (really, she said that). About 5 years ago she decided that she was tired of being overweight and went on a whole foods diet, minimizing processed foods and she lost a lot of weight and also all of her symptoms of fibromyalgia and chronic fatigue. Again she’s decided that she can’t live without certain foods and has gained most of the weight back along with all of her symptoms. She’s now on very strong pain meds and would rather eat the food she wants to than feel better without meds. I guess that’s her decision to make. sigh.

    • Christopher says

      just to be clear – fibromyalgia cannot be cured with a change in diet or weight loss. Your Mother was obviously misdiagnosed and she never had FM.

  37. Mirian says

    I am considering investing in a women focused clinic as my job plan and Canada’s medical is very limited with regards to holistic medicine.

    I’m perimenopause, nearly a year without a period. Should I deal with correcting my hormones or leaky gut? I’ve been getting increasing amounts of joint and muscle pains along with broken sleep, day and night sweats and poor muscle recovery from activities. These pains are worse in the morning and dissipates during the day if I keep moving. But the pain ebbs back if I don’t move.

    This clinic uses the salivary test and for an additional hefty fee will do a more accurate urine test for hormonal imbalance.

    Should I invest in these tests? Do I deal with hormonal issues or leaky gut issues?

    Thanks for the very informative article and for the many valuable comments by your readers.

  38. Mr.Bacon says

    Chris, have you seen the Stanford research published on the efficacy of low dose naltrexone in the treatment of Fibromyalgia, and if so, what are your opinions on the matter seeming as you frequently mention LDN?

  39. homebody says

    Anyone suffering from fibromyalgia, IBS, Crohns, other autoimmune diseases, I encourage you to research the use of low dose naltrexone (LDN) as an off-label treatment that shows great promise.

    I started on it 2 weeks ago and can’t believe the difference it has made in my life!

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/

    http://www.ldnresearchtrust.org/about-the-ldn-research-trust

    http://www.cortjohnson.org/blog/2014/04/15/low-dose-naltrexone-inflammation-pain-different-approach-fibromyalgia/

  40. Edward says

    A recommendation to consume plenty of fermentable fibres makes absolutely no sense, or is contra-indicated as any patient with SIBO will have compromised carbohydrate digestion and not be able to digest disaccharides so eating these foods will only compound the problem by feeding the unwanted bacteria the patient is trying to get rid of. All starches are OUT, and only homemade yogurt culturing for AT LEAST 24 hrs is recommended. Other cultured foods may cause additional problems until the gut is well healed.

    • Cheryl says

      Yes, Ed, fermented vegs made me feel more achy, and I had been making my own yogurt, Viili, but the natural sugar in the milk was still too high and had the same effect. Another reason I think I have candida overgrowth is I can eat only some nuts…almonds and pecans, but if I grab a handful of macadamias or cashews, walnuts or peanuts, the body aches increase dramatically for about 1/2 an hour, and I will get sores in my tongue that will last a couple days.

      • PJ (RightNOW) says

        Riboflavin deficiency can cause canker sores also. Perhaps your gut issues are interfering with your B vitamins assimilation.

        • Cheryl says

          Thanks PJ, but I only get the sores when I consume a food that specifically feeds candida. Obviously I avoid those foods, but when I’m starving and the bag of macadamias or cashews are right there, I sometimes give in, thinking maybe I won’t react this time. Wrong. It doesn’t happen if I’m eating 100% anti-candida. However, the body aches are 50% better than they were in November when I started the paleo-type diet hardcore, but whatever overgrowth I have has not been completely killed or starved to death. I’m using berberine and pau d’arco on a regular basis, but caprylic acid gives me diarrhea, which is supposedly similar to the effect diflucan has on the gut. There really is no protocol anywhere online to follow to kill pathogens when you’re not really sure which pathogen you have. I’m going to do another stool test soon, but if I can’t find complete resolution to this 10 year problem, I’ll hire Chris Kresser. It’s rather depressing not to have anyone in the world understand the gut and ever hear of my exact symptoms. At least I have the coil machine, and that has made a world of difference in killing off what causes my body aches. They just seem to regrow. A lot of people with Lymes use the machine as well, as it only kills bacteria. I’ve used it on my cat for chronic ear infections and my pig who gets roundworms from eating grass & dirt. This is way too long of a story. Sorry. There isn’t anywhere else to tell it!

  41. Lynn says

    Have recently been diagnosed with fibromyalgia. Have been trying to heal my gut.
    Four years ago, my life was almost ended with a bowel situation. Was very fortunate that a surgeon stepped in to do an exploratory on me much to the ER attending’s dismay. He was releasing me because my symptoms were “only gas”. After the exploratory surgery, 18″ of my bowel was extracted because it was SEPTIC.
    Had a history of IBS for over 30 years (hospitalized on five different occasions), but never realized the severity. Would like to releave the aches and pains of fibromyalgia, but more importantly I must figure this out, because my 24 year old is daughter is repeating history.
    Thanks for the info. Will be following for relief!

  42. Debbie says

    PS: I see the Core digestive product is out, so I’ll wait until it’s in to order that, the Flex and the prebiotic formula.

  43. Debbie says

    I have never been diagnosed with F. but have experienced extreme fatigue and muscle/joint ache when my weight is lower than a certain number. I lost 80 pounds 25 years ago, and for years maintained a “low weight” – in the 120s – and basically could barely move. But I hung onto that weight. It is crystal clear that I feel incredible energy when my weight is higher – in fact, recently I gained 8 pounds without realizing it, which put my weight at 142 (I’m 5′ 1″), and thought it was my wonderful diet changes – red meat, coconut oil, sweet potato – that were making me feel so fantastic, have a zip in my step, able to walk for miles easily – but then I faced the truth.

    I cut back on my protein, since I was simultaneously – for the first time ever – feeling repulsed at the sight of turkey or a burger. I lost some of the weight, started getting bruises on my legs again, and today felt that same horrible fatigue. I could barely walk up the subway stairs. I’d like to think I’m low on salt, or iron – but I have a feeling it’s the weight.

    My digestive tract is improved, as the constipation I had is gone using Dr. BG’s SIBO cure drink. Drink homemade kefir and eat cultured vegetables. Probably weight about 135 – not skinny! I’m so frustrated! After all these years I still can’t figure out how to eat and feel good – and not be so chunky!

    I am wondering if it’s time to try Chris’s new digestive aid products. Does anyone have any thoughts? Thanks in advance.

  44. Kevin Power says

    I have had all the classic symptoms of FM for20 years and have had no positive help from the medical profession. I get relief by eliminating gluten and taking pain killers. My symptoms change severity almost daily and I believe stress doesn’t help it seems to bring the symptoms on stronger. My most noticeable symptoms are muscle pain, brain fog, indigestion, gluten intolerance, food chemical intolerance (preservatives), lack of concentration, headaches, itchiness especially after sleeping even for a short nap. Mornings are often worse and some mornings brain fog is so bad I can’t see properly. I continue a normal life but with a lot of pain and perseverance. Thanks for the article it might help.

    • Debra Power says

      Hey Kevin,
      Its actually funny… that is my 20 yr old sons name. :) but I wanted you to know some information I found out. I have a Histamine allergy and that itchiness that you describe is a symptom of that. You may want to go to an allergist and see if you have a histamine allergy. Read up on it, you will be surprised at what you learn. Since changing my diet to exclude the things that set off a histamine response I no longer get as many headaches, acid reflux, heartburn, itchiness and my brain fog has lifted. Also other symptoms I had was ringing in the ears, insomnia and my heart would jump out of rhythm. Check it out.

  45. Angela Nagele says

    I am looking for information on fibromyalgia and considerable weight gain possible tissue resistence

  46. says

    YES! I was diagnosed with Fibromyalgia in 2012 and have also had undiagnosed CFS since childhood. I finally became extremely ill at the beginning of last year after taking steroids and antibiotics following a surgery – the drugs almost killed me. It was a blessing, however. I ended up finding out that I had a Candida Overgrowth and everything you mention in this article. I changed my life and my diet and Fibromyalgia is almost non-existent in my life now. I stopped eating wheat/gluten/grains, dairy, sugar, processed foods and much more of those icky food items. It’s unbelievable how much a perfect diet helps. I could barely even walk last year due to severe inflammation in my body, but now I exercise and am very active all day long! Food is medicine if you give it time and be patient. I didn’t heal overnight, and I want to make it clear to anyone who might be reading this. If you think you’ve “tried everything” to heal your Fibromyalgia and/or your gut – try harder and do it 100% with no cheating. I just passed a year of being on my awesome diet and I still have another year until I’m all the way “normal” again. I’ve also removed a lot of toxins from my life from the water I drink to not using aluminum foil and saran wrap. All of the bad stuff can really add up and make a major impact on our health – it’s so worth it to change your life in a drastic way! :)

  47. says

    Hi everyone,
    I am holistic aromatherapist and I systematically rebalance the gut (via treating dysbiosis) of my client before starting any approach. To me, this is the basics. I don’t know any sick person with a clean, healthy gut. Fibromyalgia is just another example of how important it is to start with gut balance when we want to restore immunity, nervous system and proper regeneration. Vital points in treating fibromyalgia!

  48. Raza says

    Hi Chris,
    If you can kindly suggest me that what is the best food for me to eat as my body is reacting to all histamine containing foods, salicylates and also lectins, I am right now eating only fresh chicken and potatoes but worried about nutrient and vitamin deficiencies as can’t tolerate most of the supplements.
    I believe that my Gut is still Leaky, I am using only Klaire Labs products as most of them are Salicylates and allergens free.
    I have cleared my Gut from all bad microbes with the help of natural anti-bacterial, anti-fungal and biofilm breakers.

  49. john says

    Chris-I have been reading your book and accessing your bonus chapter in a random manner,but have not run across the botanical protocol.Could you possibly direct me to the chapter?

  50. Rebecca says

    I found your website 3 years ago because of steroid induced diabetes. The helpful information you provided on the paleo diet bought me back to health and I was full of energy and vitality once again. Then I had to go on 5 courses of antibiotics 18 months ago for a tooth infection and have been having gut problems, depression, chronic fatigue and all over body aches ever since. I definitely believe the drastic, almost overnight change after the antibiotics was the cause of my gut problems and fibromyalgia like body aches.

  51. Greg says

    Hi

    So how do you get rid of SBIO?

    Peppermint Oil? Grapefruitseed Extract? How do you destroy it.

    And do the compounds you are killing it with, do they effect the probotics that you take like the soil probiotics?

  52. Raza says

    Hi Chris,
    your posts are very helpful.
    I hope you must have some advice for me also, I was diagnosed with Leaky Gut 3 years back but unfortunately in my country there is no understanding and awareness regarding Leaky Gut so I consulted different doctors and naturopaths and followed their diet plan but for some reason I could not heal myself and now my body is reacting to salicylates, histamines and lectins also.
    I have done all the tests and now there is no bad bug in my Gut but I can’t touch any grain, dairy, vegetables, fruits and red meat due to salicylate sensitivity and histamine intolerance, eating fresh chicken and potatoes only but I guess even fresh meat is also causing inflammation.
    Kindly advice me how can I heal my Leaky Gut when I can’t eat 90% of the foods.

  53. Wayne says

    Chris,
    Your mention of leaky gut as the underlying cause of fibromyalgia, true as it may be, is still a symptom. You have provided some excellent solutions to heal leaky gut, but I wonder if it is enough to help with eradicating the fibromyalgia.
    An iodine group that I belong to seems to be chattering quite a bit about iodine supplementation focusing on thyroid health as a successful method of alleviating and even eliminating many symptoms of fybromyalgia. Perhaps the cure to this disease is a bit more multifaceted, and requires a more synergistic approach to achieve success.
    We have failed to recognize iodine deficiency as a critical nutritional deficiency that is leading to the development of modern diseases on a massive scale, fibromyalgia included.

    • Chris Kresser says

      I’ve not seen research indicating that iodine deficiency is at the root of leaky gut, if that’s what you’re suggesting.

      Leaky gut is both a cause and a symptom. It can cause numerous problems, including fibromyalgia; but it is usually a “symptom” of another problem, like SIBO, fungal overgrowth, parasites, dysbiosis, etc.

  54. says

    Chris,

    I would love to see you look into the research on low Melanocyte Stimulating Hormone (MSH), leaky gut and infections. It could be that MSH helps to pull together your evolving picture of how multifactorial disease conditions arise in connection with the gut.

    Based on the work of Dr. Ritchie Shoemaker the mechanism seems to be:
    1. Infection or other health issue decreases MSH
    2. Low MSH leads to leaky gut
    3. Multi-symptom and varied conditions appear such as fibromyalgia etc.

  55. Debra says

    I have had health problems all my life and have been diagnosed with IBS, Migraines, Fibromyalgia, ect. However, the most helpful thing that I found is a Histamine allergy.

    It turns out that I am like the poster child for Histamine allergy and this allergy can present with the same type of symptoms. The discovery was made purely by accident though, I was in the hospital after gallbladder surgery. My surgery had gone bad, an artery was cut causing me to bleed out. Luckily, they saved me, but it put me in the hospital for 7 days on heavy IV’s (multiple)

    The interesting thing was that all the IV’s flushed my system because I was not allowed to eat for the entire time. By day three in the hospital, I felt AMAZING (day 5 or 6 without food, I was so sick prior to surgery I couldn’t eat). I kept asking my doctors … why do I feel so good … this makes no sense… I’m not in any physical pain …even with 17 staples and a few other slices across my abs. I felt incredible. SO I went home, btw no headache, no muscle pain NOTHING! But by day 3 of being home and going back onto home cooked food prepared by my mom, who only cooks real foods, I was feeling sick. Then a migraine, then insomnia, then body aches…. you see where I’m going. Within 3 months I was right back to where I started. Chronic pain.

    Needless to say, I wanted to go back to pain free. I was obsessed to find the answer. It was the only time in my life without pain and I wanted it back. Thru much work, I went to a nutritionist and she did a major blood test called LEAP. Turns out I’m not allergic to everything, however, I’m extremely sensitive and it sets off a histamine response. It causes a T4 cell reaction. ie … migraines, stomachaches, intestinal problems, pain… you get the idea.

    So I am on a seriously limited food diet, safe foods only. I have approximately 40 safe food items and have been on the diet since Sept ’13. I feel better, but not even close to what I felt after getting out of the hospital. Btw I was not on pain meds after surgery because I didn’t need them, I felt awesome.

    With that said, I’m considering going to my doctor and asking if we can try or test the IV therapy idea. In the hospital it completely flushed my system and tissues. It was amazing! Had I known about how many foods set off the histamine response for me and that I am actually ALLERGIC to histamine, which in turn causes my symptoms, I would have been on a clean diet. Most likely my problems would have stayed away longer then a few months. So my theory is IV therapy may flush my system again and with the clean diet I will have better luck.

    At this point, I would be willing to go thru an IV therapy type thing a few times a year if it meant being out of pain. I had read about IV therapy on a website about Histamine allergy. I’m not sure I can convince my doctor to try this, but it wouldn’t take long for me to feel the difference.

    Its my opinion that those with all the gut issues you discuss in this article may have more food problems then they know. I say this because I was trying to go “healthy” FOR YEARS!!! But after testing, I found out that I am so sensitive to things I would have NEVER thought of…. here is just some foods I CANT have… Lettuce, Spinach, pineapple, raspberries, pepper, garlic, onion, zucchini, squash, vanilla, turkey, beef, the ENTIRE Cabbage family of vegies, and the ENTIRE legume family.

    The strangest thing is what I can have… Grains, and milk! which I thought was the problem and had removed from my diet with very little success. I had also removed beef years before the test, but had switched to ground turkey and now I know I am just as sensitive to that.

    In any case, I thought I was “going healthy” but really I was eating histamine on a plate. I have actually heard specialists say that no one should be allergic to vegies, well guess what… I am. I may not have the actual allergy to the vegie, but the sensitivity is so strong it still sets off the same response and therefore I am sick.

    My word of advice… find out what sets you off. Find out allergies, sensitivities, and intolerances. They all matter. I am in the testing stage and I now see the reaction within 3 days. I have still not been able to add to my diet.

    Also, for me environmental triggers set the problems off because of the Histamine allergy. Pollen, dander, mold, dust, chemicals, perfumes, they all cause a histamine response. I’m in the process of stripping my home and adding air cleaners, getting rid of fabrics that collect dust, ripping out the carpet, ect… I hope this long comment will help someone out there and I truly believe we don’t have to live in pain. We just have to find the root cause.

  56. Lisa says

    I was wondering about the recommendation to eat fermentable fibers for SIBO. I just listened to a podcast with Alison Siebecker done in April I believe. She said resistant starch is NOT good for SIBO. Yes it feeds good bacteria, but also the overgrown bacteria. So I’m confused because she seems to be the ‘go to’ person when it comes to SIBO. I guess this same confusion would then apply to the prebiotics. Wouldn’t they also feed the overgrowth? Also wondering what make soil based organisms better than other probiotics.

    • Chris Kresser says

      Read this for another perspective: http://digestivehealthinstitute.org/2014/03/24/resistant-starch/

      Some research suggests that resistant starch “vacuums” bacteria out of the small intestine. If true, then RS could help SIBO patients.

      I can tell you from my work with patients that I believe RS does benefit SIBO sufferers over the long term, but in some cases where SIBO is severe it cannot be used until some improvement occurs because the side effects are too extreme.

  57. says

    Chris,
    I am from Pakistan, i am suffering from fibro and multiple RSI injuries, weak tendons, muscles and i am just 34.
    I am a Web Designer so these pains are hindering my work.

    I have been mostly in my life on rice and chicken, very less vegetables i have taken…

    Yes i do have GUT problems, but they are mostly stomach related
    Can you tell me how to diagnose or any test for SIBO as i read in your article so i wanted to test for it

    There is one thing i want you to write article which is relation of Hepatitis C medicines to sciatica pain and muscle pain
    As i was treated for Hepatitis C with Interferon for 8 months and then with alpha interferon for 8 months again. But after completing my treatment i started heaving disc compression and sciatica pain and after few years i got all this muscle pain….also i started severe stomach problems during my hepatitis C treatment

    Is your book and medicine available on amazon, i will try to order them to one of my relatives in New York….
    Also which medicine do you recommend me

  58. Jill says

    I truly wish a medical doctor who is both popular and open-minded, such as yourself, would do an honest look at the work of Dr. John Sarno and TMS. Surely with so many being cured of fibromyalgia, back pain, etc., for many–not all–the true root is not GI issues, which may or may not be an effect, but tension myositis syndrome. I speak as someone cured of chronic pain by Sarno’s work. I suggest The Divided Mind for an in-depth understanding, or Healing Back Pain for a quicker read. Maybe a few of the fibromyalgia sufferers here would be willing to do a trial run of his method. Good luck and healing to all!

    • Debbie says

      Actually, reading Dr. Sarno’s book, Healing Back Pain, many years ago healed me overnight of carpel tunnel syndrome that had persisted for about two years. It’s the only experience I’ve ever had like that, and it hasn’t “worked” for my other issues, such as a foot problem and the various digestive/energy issues I’ve described in another post. But I think he’s clearly brilliant, and teasing out what the real problem is isn’t easy.

    • matt says

      I’m currently using Dr. Sarno’s method for a herniated disc and sciatica. After 6 months of incredible pain I have had a drastic improvement. The tingling and numbness in my foot has gone away. I’ve done everything else possible and this is the only method that has reduced pain drastically.

  59. Marlana says

    I have had fibromyalgia since 2009. I did not have gut issues up to that point. The digestive issues came later. I think the root cause of my fibromyalgia is adrenal fatigue brought on by financial stress

    • Chris Kresser says

      That is possible, of course. However, as I mentioned in the article 42% of people with fibromyalgia and leaky gut did not have any gut symptoms. Other studies have shown that, in general, 30% of people with leaky gut don’t have gut symptoms. So it’s conceivable that leaky gut was present before the onset of fibromyalgia, but you just weren’t experiencing gut symptoms at that time.

    • Pete says

      Lactulose breath test. You can order a kit which you will be mailing to a lab or better yet do it through an appropriate practitioner: one who is interested in this approach.

      I think the test and lab runs about $150 in addition to any practitioner fees.

  60. suzanne Handsaker says

    I have never been diagnosed with fibromyalgia however my symptoms are consistent with untill 12 months ago I went gluten processed foods free the difference was amazing untill 14 september 2013 when I mistakenly had a huge hit of gluten symptoms came back with a vengeance where I was nearly 100% incapacitated. .I have maintained a strict diet protocol since and I am nearly symptom free absolutely amazing!!
    Regards Suzanne

    • Chris Kresser says

      I always start with a botanical protocol, which is effective the vast majority of the time. When it’s not, I refer out for antibiotics.

  61. says

    I was diagnosed with fibro in my early 40s, and was essentially sent home with no hope. Yet, I found out exactly what you said. I needed to clean up my gut. For me, it was getting off of grains, milk and sugar. I eat mostly Paleo in nature. I still struggle with a low iron and magnesium problem, but I take supplements for this and I now live a normal life. I personally believe that it is based in our gut malabsorption, and causes a lack of proper absorption of nutrients. I also believe that the hormonal shift from peri-menopause to menopause is a factor in fibro as well. I added selenium to my supplements to balance my hormones, and I sleep better and my mood is more balanced. The fibro is no more.

  62. Robert says

    I am male and have had FMS for the past 15 years. There was a time that my gut gave me issues; including acid reflux disease and other stomach pains. However, I have done several gut cleansings, specifically using doTERRA oils and probiotics (PB Assist), and do not feel those gut issues anymore.

    I still have Fibromyalgia, though, and the symptoms seem to worsen as I age. I am skeptical that SIBO is the cause of FMS, and would suggest that, for me at least, it was a symptom of it.

  63. Ray Webster says

    Hi

    I haven’t been diagnosed with fibromyalgia, but I have had IBS for many years and have been suffering from silent reflux for the past two years having previously had H pylori twice and never been right since. I also have cervical osteoarthritis and for many years have felt quite depressed and also experience brain fog, which I have put down to my arthritis as when it is aggravated I suffer from a lack of concentration and coordination. Could it be that my stomach problems, IBS and arthritis could be linked to fibromyalgia as I have also been suffering from fatigue for many years and my doctor hasn’t been able to find out the reason for this.

    • Chris Kresser says

      Yes, I think it’s reasonable to assume that they are linked. Inflammation in the gut is a common underlying cause of joint and muscle pain.

    • Chris Kresser says

      Candidiasis involves an overgrowth of the yeast Candida albicans. SIBO involves an overgrowth of bacteria (that normally resides in the colon) in the small intestine.

  64. Lee says

    This post, coming on the heels of your post on histamine intolerance, makes me wonder if there is a connection between the two. If so, then refraining from conventional probiotics and the like might be indicated for some folks with fibromyalgia (and histamine issues).

    • Chris Kresser says

      Yes, I think the connecting factor is disruption of the gut microbiota. That can predispose toward both histamine intolerance and FM.

    • says

      Yes, i do think so.
      I have been diagnosed POTS/CFS/fibromyalgia/ADD (some of it 15 yeas ago) and recently started the GAPS diet. It’s developped by Dr. Natsha Campbell-McBride. It’s purpose is to heal the gut and restore a healthy microbiome. As it was developped to heal neurological conditions i figured it could help with POTS since it is also a neurological condition (and of course hoping in the mean time to get rid of the other conditions as well because I think they are related). Since then my research has confirmed my way of thinking. (if you want more on the GAPSdiet and POTS look at this extensive pdf.: http://gapsdiet.com/uploads/FAQS_Listing_0114.pdf
      I found out here Dr.NCM answers that POTS it is a condion that can be healed with the GAPSdiet)
      My doctor (a CFS researcher) agrees on POTS being a neurological condition and is very curious what GAPS is going to do to my POTS and CFS.
      So far a few little issues have been solved but I’m still very tired and can’t do without my class3 waits-high compression thights but i keep trying every now and then, especially in summer ;-P

      Thanks Chris, for doing the research and presenting another confirmation along this line of thinking.

      One more thing: Dr. Campbell-McBride’s GAPS diet is mainly the same as you suggest in your atricle except for one thing: no straches because they feed mainly the bad microbes. I’ve asked about the resitant starch (because I wanted their benefits too) but also that has to be avoided until the microbiome (and therefore your body) is in a better condition. If you eat a lot of veggies there are still lots of fermentable fibres.

  65. Liz B says

    I find this article intriguing, as my IBS symptoms definitely came before fibromyalgia symptoms. But I have had hereditary dysautonomia all my life (can’t stand up very long without fainting, can’t sit up for long periods without debilitating fatigue). In the 1960’s, in my pre-teen years, is the first I remember IBS symptoms, and was diagnosed in the 1970’s. In the 1990’s after a very traumatic jaw surgery, I was diagnosed with Chronic Fatigue Syndrome and Fibromyalgia. About 2 years ago, I was having unrelenting abdominal pain that the doctors couldn’t find the cause of. I tried going gluten-free and not only the abdominal pain disappeared, but so did almost all of the IBS symptoms, that I had suffered with for around 50 years! My endoscopy didn’t show any changes consistent with Celiac Disease, but based on symptoms, my gastroenterologist said that I had a gluten-sensitivity. If I even take a bite of bread it doubles me over in stomach pain.

    I am now eating a diet similar to the Paleo/Primal template, based on what foods I find my body best tolerates and eating lots of fermented probiotic foods. I have gotten off all meds after finding out that they caused liver damage and am learning to use foods and herbs as my medicine. I still have fibromyalgia and dysautonomia symptoms, but am able to sit and stand a little longer than before and am so thankful for that and my newly happy gut.

  66. Tiffany says

    This is SUCH an interesting point of view. I have been treating for Lyme Disease the last couple weeks, and after the first week of an increase in symptoms, which my doctor informed me would happen, I started feeling about 60% better. I still have some sensitivity of my trigger points and my morning stiffness is still there but overall I feel a real improvement of my symptoms. More so than I have in a long time. I am very interested in pursuing this further. I’m finally hopeful!!

  67. Catherine Nicewood says

    I was diagnosed with both Fibro and IBS while I was in college back in 1979. Now my naturopath thinks that I have SIBO. I started on the SIBO diet and I am feeling much better other than some diarrhea after a boil water alert in our area.

  68. Angela Nagele says

    Along with the weight gain I am experiencing, my cholesterol has increased and well as the fact that I am headed towards diabetes.

    Doctors don’t seem to have a clue about any of this. I have been working on balancing my thyroid, without success, over a 5 year period.

    • Helen Nock says

      Angela, I gained 24 pounds. It’s coming off slowly since taking NDT. I also have fluid retention issues but moving seems to help those. I wish you luck and the proper with addressing your thyroid.

  69. Angela says

    I have fibromyalgia. With exercise and vegetable based, low carb, small portions of meat, I have been able to keep the muscle aches under control. I have IBS, severe constipation, fatigue, wake up at 3:00 or 4:00 a.m. in the morning. I have gained a considerable amount of weight – upwards of 30 lbs. which diet cannot control. I am taking synthroid and a T3 compound (because fibromyalgia patients sometimes cannot process T3. I have just started taking Prilosec because of indigestion problems not caused by overeating or bad food choices. I had my gallbladder taken out 2 years ago which is unusual for someone who eats little fat or processed food. I have not been tested for SIBO but am considering it. I am not sure what the test entails. I am also beginning to wonder if I am tissue resistant and that is what is causing the weight gain. My metabolism is slower as are all Fibro patients. Does anyone else have the weight gain issue and if so, how did you get your metabolism back on track?

    • Allison says

      Unfortunately many thyroid patients feel worse and have terrible hypothyroid symptoms while on any T4 meds including synthroid. Have a look at stopthethyroidmadness.com and Recovering with T3.

      For some reason, those with complex pictures either make too much reverse T3 or have some sort of tissue resistance.

      I literally felt like death on all T4 meds, I now feel very well on low dose T3-only medication.

    • Allison says

      Also I used get the early morning waking. Phos serine complex (with a mix of phospholipids) has really helped that problem along with good sleep hygiene and salt water before bed. All of these are great for the adrenals.

    • Allison says

      Just reading your posts again – you’re clearly very hypothyroid :( Raised cholesterol, weight gain, fibro – classic hypothyroid. Ensure to get a doctor who will work with you to find the right medication and dose, paying attention to you as a human, not lab numbers. Suggest getting Reverse T3 along with Free T3. Most importantly, signs and symptoms are the true measure of status.

    • Helen Nock says

      Thank very much for this Chris and the very interesting and extremely helpful comment response. I live in the UK, and it seems we are light years behind in both mainstream and functional medicine compared to the US. I was diagnosed fibro nearly two years ago running the whole gambit of symptoms. My latest thyroid test showed hypo/myxoedema but I think that I have been type 2 for years and not being picked up on standard lab tests. I am on a loading/starting dose of 25mcg synthetic T4 but have actually changed early track to NDT without my GP’s knowledge. I will inform him at next consultation. The NDT took a while to work but now I am running between hypo and hyper whilst titrating dose by symptoms and signs…no, I would not recommend this solo approach to anyone – I took the chance because I was desperate..Anyway, since using thyroid meds my significant bowel problems have significantly improved and so have my FM symptoms. It’s a bit of a roller coaster but I’m discovering through others that getting thyroid hormone levels just right seems to be a lifelong art. I will make an effort to follow a better cleaning my gut protocol. I don’t do too bad having already learned that my slow metabolism and resultant CNS symptoms escalated on fast and sugary foods.
      Ultimately changing my diet and taking thyroid hormone has helped hugely in lessening and eliminating bloating and gas, reflux, pale slimy stools and constipation. My stools are a lovely dark brown (liver/bile?) and no wind or foul smells or awful cramping pain …… providing I stay on the wagon. They return very quickly if I fall off. Interestingly, I have had chronic gut issues since childhood.

      • Helen Nock says

        Just a little addendum to my thyroid/FM conundrum. Since taking thyroid hormone I can work and not experiencing that crashing leg-locking exhaustion.

      • JenH says

        There is enough interest in the fibromyalgia/thyroid connection that Stanford is conducting a study focused on the treatment of patients with a fibromyalgia diagnosis using, I believe, T3 (link: http://med.stanford.edu/snapl/t3/). Like a lot of people I have been diagnosed with fibro (at age 27, I’m now 40). Since then, I’ve developed both obvious digestive problems along with a slew of other health issues. I was first dx’d with leaky gut 4+ years ago. I have tried gaps, autoimmune paleo and many other things. The dietary stuff most definitely helps (mostly with regard to pain) but has not really touched the fatigue, insomnia and brain fog. I recently took a break from my active healing quest due to burnout. However, I’m about to move to Portland, Oregon (a place where alternative medicine is almost the norm rather than the exception). Number one on my list of things to do is work with a naturopath who has experience with thyroid and adrenal issue and explore the possibility of hypothyroid as the cause of my fibromyalgia symptoms (the symptoms overlap is considerable, as with a lot of other difficult to treat/understand conditions).

        I’d be very curious to know if anyone else has an established or suspected link between fibro and thyroid.

  70. Maria says

    Hi Chris,
    I’ve had fybromyalgia since I was in 6th grade (11 years old). Although I was not diagnosed until I saw a rheumatoid arthritis dr. in my 20’s. I have managed the pain over the years and luckily the pain is more intermittent (not constant) but I never had any success with any conventional doctors. Now in my 40’s I’m learning more about Paleo way of eating. It’s an interesting perspective; gut/fybromyalgia correlation. I’ve always had gut/intestinal issues even as a kid. It’s all overwhelming and even more so without a doctor to guide me through the process (tests,etc). And the costs are another thing to consider since insurance doesn’t cover much of functional medicine approach (that I’m aware of). Where would one start to determine if I have SIBO or leaky gut? Thanks for all the info you put out and for your great book.

  71. Richard says

    I have been diagnosed with Crohn’s and have been suffering from pain in my feet for several years. While my stomach has responded to treatment, my foot pain has intensified. It has become clear that the foot pain is related to the IBD. Your article is exactly on target.

  72. Peter Jeffries says

    Hi
    I suffer with Chronic long term Polymyalgia. I’ve recently discovered I have a chronic lack of free testosterone. I purchased the cream Tostran 2% after appropriate blood tests. I’ve found although not gone , my PMR is better controlled and my feeling of strength and well being have raised by a significant degree. I want to get off the long term Prednisolone and this could be a way. Early days yet but T has a major effect on body inflammation markers amongst other things. Any man with PMR should get his T levels checked especially if Type 2 Diabetic.

  73. Daziner says

    My wife has Fibromyalgia and a bundle of digestive issues, where do we go to get tested for SIBO and treatment?

    • Chris Kresser says

      A conventional gastroenterologist can test for SIBO, but they will almost certainly prescribe antibiotics. An alternative would be seeking a functional medicine practitioner (could be MD, ND, LAc, DC, etc.) who is familiar with testing for SIBO and treating with botanical protocols.

  74. Fruitbat says

    Very interesting info, thanks!

    If the cause is SIBO I’m curious about the advice to eat sweet potatoes, yams etc given they are disaccharides – won’t they just feed the bad bacteria? I’m coming from a GAPS perspective. I’m currently doing GAPS full diet (have done the intro) and would love to start eating starchy veg again. Am just finishing second protocol for clearing a parasite but my practitioner suspects SIBO too. I’ve been on GAPs for 7 months now and feel I need the starch.

    • Chris Kresser says

      Many of my patients with SIBO tolerate starch without a problem, but of course others don’t. I address it on a patient-by-patient basis.

      One of the challenges in treating SIBO is that over the long term, the key is to re-establish a healthy microbiome. Prebiotics (food or supplements) are an important factor in doing this—but many people with SIBO are sensitive to them. So it’s a delicate balance to keep things moving forward.

    • Natalya says

      Fruitbat….I did GAPS for 18 months, used to be hugely intolerant of carbs. Started adding supplemental and food sources of Resistant Starch 5 months ago, my gut is now so much happier.

  75. JoAnn Johnston says

    I have had fibromyalgia for many years. I was then diagnosed with a gluten intolerance and dairy and had lots of candida.
    I cleaned up my diet and was much improved.
    Almost 2 years ago I also added taking a very high quality liquid vitamin and mineral product with daily high quality EFA’s That totally improved my fibromyalgia. I also take a B12 shot every 10 days. I have relatively no symptons now unless I don’t get enough rest or happen to accidently get gluten or dairy in something I eat. I believe with the gut system has the ability to heal itself if we take care of it. Because I have gut issues I was not getting the nutrients I needed so adding the vitamins and minerals changed my life.

  76. Kimberley Jones says

    I’ve always had digestive issues and take probiotics, digestive enzymes, smoothies, green powders, alkalise etc. For me personally Fibromyalgia is the label I’ve been given for a somatisation of trauma that is exaggerated due to a spiritual crisis I experienced in 1998. By the way when I eat fermented foods I feel worse.
    Best wishes to all with FMS.

    • Cheryl says

      Yes, Kim, I feel worse when I eat fermented foods too, ones I made myself! Very disappointing. I can eat cabbage cooked any way, but when I ferment it, the body aches are worse. Basically everything listed in a candida book or website matches what I can and cannot eat. If I eat it, it also makes my mouth sore. My taste buds get inflamed.

      • Allison says

        Histamine intolerance is a common problem that can cause issues tolerating ferments.

        Histamine intolerance has a few causes – dysbiosis (some bacteria create histamine and other amines), lack of DAO enzyme, poor methylation, lack of co-factors to break down histamine.

      • Aidan Walsh says

        cabbage very high in histamine plus fermented increases histamine ‘histamine intolerance’ histamine blocker may help :) on Amazon histamine blocker works better than histamine sold :)

  77. Teresa says

    I had my first episode of IBS 21 years ago and it had been a chronic issue for many years. Allopathic medicine was not able to help my many issues, and l, indeed, made them worse in most ways ( fibromyalgia, with onset after contracting mononucleosis 26 years ago ).

    I found that eating a low carb diet that excluded all grains helped my digestive system immensely, as well as helping. the fibro symptoms . However, I was perplexed anytime I would attempt to supplement with probiotics. At one point, in an attempt to supplement with a high quality probiotic supplement , I had such excruciating pain and nearly called 911. I also noticed that certain products had a similar affect on my digestive system
    (Chicory root, inulin, and others such as listed “prebiotics”). I was baffled and totally avoided those products.

    That was before I learned about SIBO. When I read studies concerning “small intestine bacterial overgrowth”, written by a fellow Naturopath a few years ago, I felt like it was what I had been struggling with unknowingly for so long. Rather than using conventional antibiotic therapy, I cleansed myself of SIBO with herbal antibiotics.

    I am currently in the process of attempting to “rebuild” my intestinal microbiome. Short of a fecal transplant, this is no small feat. I am continuing to maintain a diligently healthy diet and have added a good probiotic and fermented foods to my regimen. I am continually researching ways to most effectively repair the damage that prolonged antibiotic therapies did to my precious microbiome so many years ago.

    If one does have symptoms of SIBO, I suggest that you read labels carefully and do not use probiotics that have any prebiotic ingredients included in them ( such as inulin or others). It is possible to find some good probiotic products without the prebiotics until you cleanse from your SIBO issue (Pure Encapsulations has a product that I tolerate. I have added prebiotics back in dietary form but not in supplementation yet). The prebiotics will exacerbate your condition greatly until you do a bacterial cleanse for the SIBO. Chris probably references this in his booklet. I am sharing out of personal and professional experience.

  78. Wenchypoo says

    About a decade ago, I remember reading somewhere that a deficiency of magnesium was to blame for fibromyalgia…my, how times have changed!

    • Chris Kresser says

      Might be part of the picture, but what’s the cause of magnesium deficiency? One possibility is SIBO (which decreases nutrient absorption).

      • Sood Faith H says

        Question: why the magnesium deficiency? Answer: evolving microbes deplete nutrients. Antimicrobial substances e,g,, beta lactams, induce microbes (protozoa, bacteria) to produce L-forms, biologically active particles with potential to evolve to original and/or variant forms like mycoplasma – to escalate infection (ONE microbe to MANY L-forms to MANY original and/or variant forms) – deplete nutrients essential to host health and parasite cell wall synthesis. Dry weight of feces is about 48% microbial in a nonvegetarian. Release of sequestered substances, e.g., catecholamines, lipid bound acid, cause IBS.

      • Martha says

        Yes! In my own case, I was taking double doses of even pico-sized liquid magnesium (supposedly it’s near 100% absorbed) to keep leg cramps at bay. Then I went to a naturopath and we started healing my gut which had poor digestion and absorption. Now I barely need my magnesium at all. I guess I am getting it through my food, as one should.

      • karen says

        It seems to me that everything out there is conflicting. I was on life support in Oct. and I know that part of it is an unhealthy gut. Severely high histamines. Not sure what or why, I just want to heal my gut and move forward. Do I take prescript or not. I eat organic no grain, ect.., Should I juice my veggies take supplements or what. One book says one thing the other says another. Ugh just unsure and willing to heal with foods but I can not figure out which way to go.

        • karen says

          FYI, I am allergic to aspergillus as high as a reaction as cats and pine trees according to my allergy test. And keflex is what finally had me go into acute respitory failure

  79. Lauren says

    I was diagnosed w/ Fibromyalgia 7 years ago, when I was 18. In between then and now I had multiple yeast infections that otc and prescription medications could not clear up, so I went the homeopathic route and it cleared up. Doctors couldn’t figure out how to diagnose me. Symptoms included fatigue, joint pain, muscle pain, muscle spasms, vertigo, depression, mood swings, brain fog, irregular periods, difficulty sleeping and more. I decided to take matters into my own hands 3 years ago and became paleo. Within 3 months 90% of my symptoms went away and my Fibromyalgia seemed nonexistent and I considered coming off of my muscle relaxers and anti-depressants when all of a sudden my symptoms started to return two months ago. 3 weeks after the onset of my returning symptoms I had a GI infection (stomach pain like sharp glass and bloody stool). I went on Rifaximin for two weeks and now my symptoms are close to being gone again.

    I think that confirms I can connect to this article!

  80. Christine says

    Yes you are right on the money with your description of Fibromyalgia and it’s connection to gut health. I was diagnosed with Fribro and possible Lupus about 15 years ago after having 3 root canals, remarrying with a large blended family, massive exposure to wheat by driving wheat truck to town, and the genetic factor of my Maternal Grandmother who had a thyroid condition. Yup that was the perfect storm. After 10 years of steroid use off and on, Plaquenil, and Celebrex. I went to see nutritionist 3 years ago who through testing found that I am extremely sensitive to wheat, gluten, and casein. It took 3 months off wheat products for the deep muscle pain to begin fading. At 6 month I quite taking all my drug. I also have Hashimotos disease. As a NICU nurse with a strong medical background I really felt angry and betrayed by my doctors. I have remained gluten and milk free following a Paleo diet feeling much better. After reading more about SIBO and leaky gut I feel I am still in trouble and in disagreement with my MD about my thyroid levels. If yo have room in your practice for one more please let me know. Thank you for all the great work you do. As a nurse I love all the research that goes into all your article and book. PS i had the privilege of meeting you in Denver . Soon to be a Boston transplant yup more stress.

    • Lisa says

      Wow, agree with you, as a Nurse with hacking cough, being tested for hashimotos , history of IBS and fibromyalgia
      This amazing!

    • Rob says

      Any thoughts regarding the influence of fascia Chris?

      One example of fascial influence regarding digestion issues that could contribute to poor digestion:

      The fascia in the torso becomes traumatized. It goes from a spacious, gliding state to clamping down on any of the organs in the torso. These unnaturally sectioned or clamped areas can create problems with digestion, elimination and the potential for gut microbes to grow to pathological populations with ease.

      When the traumatized fascia is released, restoration of digestive system commences at a much more rapid rate and adding better results from tandem therapies that may have already been employed.

      • John Es says

        Rob,

        What would be the best kind of practitioner to work with, in this case?

        I saw a Myopractor for hiatal hernia, and he made some remarks that I interptreted to mean my gut components were stuck to my abdominal wall, instead of freely floating around as they should. He was not a great communicator, and seemed like he had never experienced this.

        Do you think we’re talking about the same condition, here?

        Any further information would be much appreciated.

        Thanks,

        • says

          Hi John,

          I’m not familiar with a myopractor.

          The manual therapy I refer to is called the John Barnes approach to Myofascial Release. It is commonly practiced by physical therapists, massage therapists and occupational therapists.

          I do emphasize the John Barnes approach b/c Myofascial Release is an umbrella term in the manual therapy realm.

          I believe this work is right up your alley with opening the stick space in your abdomen. I speak from experience to as a practitioner in this work.

          The website gives further description of fascia’s role and of the therapy….

          http://www.myofascialrelease.com

          Cheers and welcome any other curiosities!

          Rob

    • says

      I am a massage therapist who also practices myofascial release – I agree there could be a fascial link (and a musculo-skeletal one as well). I am convinced that trigger-points in muscles account for a large amount of fibro pain.

      • says

        Hi Salixisme!

        From my Barnes MFR training, we learn that the fascial system is interconnected with all other body systems due to the connective nature and influence of the fascia. In the case of trigger points, I’ve experienced them going away on their own when you release the fascia(local or regional, depending on the individual) that is tugging or pushing on trigger area.

        In the case of fibro, another factor of fascia’s whole body connectedness is with the nervous system. If the fascia is traumatized and is supporting a nerve, it can potentially clamp down on that nerve and create dysfunctional and/or random sensations from that area and distal of it.

  81. José Carrión says

    I was diagnosed as fybromialgic many years ago. All my pain disappeared one month after I adopted an autoimmune diet such as it´s described by C Kresser in his book and web page. Joint and muscle pain, pelvic chronic pain, diarrhea, even my moody character changed. I was intolerant to gluten probably ever since I was born, and my gut is severly damaged now because I didn´t know it. Thus, now I can´t deal with a number of foods including gluten, dairy, soya, high-glycemic foods, additives,… Basically gluten has been poison to me. Upto such extent that I suspect that a recently diagnosed neurological condition (oromandibular dystonia) is connected with gluten intake. Gluten can produce attaxia, so dystonia should not be discarded. In any case, I strongly recommend to avoid gluten to any person with fancy pain, that one conventional doctors tend to think as “psychogenous”. It´s unfair the way conventional medicine has been treating fybromialgia. In my case, YES, that thing called fybromialgia was of gut origin, doubtless.
    Thanks for reading this post (sorry for my English, is odd, I know)

    • 50 and 'newly' celiac says

      Leaky gut is also highly correlated with celiac disease, and anyone who has a history of anemia, or low bone density should also be screened. But keep in mind that if your diet even leans toward Paleo (that is, low in wheat, barley, rye) the serologic tests will be ineffective and you need a biopsy. I was undiagnosed for 49 years with doctors suggesting IBS or fibromyalgia. The symptoms of both overlap with celiac. In my case, lifestyle/diet changes helped with symptoms but weren’t enough to prevent intestinal damage. By the way, not all celiacs have intestinal damage in the same intestinal area, and this can lead to different symptoms, since many of the ‘symptoms’ of celiac are really the result of a variety of nutritional deficiencies that are in turn the result of failure of different parts of the intestine to absorb different types of nutrients. The diagnostic standard is 5 biopsy sites. The most commonly damaged area of the villi is also the area of the intestine responsible for dairy absorption, hence extreme lactose intolerance for most celiacs. For 1 in 133 people, celiac disease is the culprit. If you have anemia and low bone density, it’s more like 1 in 10 (according to my gastroenterologist).

  82. Moongirl says

    YES. I completely fit the profile. IBS sufferer since I was in my teens (now 49). Dairy intolerant since birth. I am a life long anxiety sufferer. My brother and I are both gluten intolerant. I was diagnosed with Fibromyalgia about 5 years ago. I have presumed NSAID sensitivity OR Crohns (GI doc ran full battery of tests and found a few small lesions in my small intestines). In my opinion, my symptoms are presenting more like IBS as I don’t have any of the other major signs of Crohns. I no longer take any pain meds as I’m trying to heal my gut. This can be super challenging as I get pain flare ups and I have no way to treat it. I would be very interested to see what researchers find out regarding gut health and Fibromyagia as the current group of docs, sad to say, have NO clue about this disorder. I even had one doc tell me not to tell any other doctors that I have this because they will think I am crazy. Wow. Sensitive yes, crazy, no.
    I do mindfulness meditation, eat as clean as I can, get the supplements I need and try to carry on with my life despite all the challenges my body hands me. Thanks for all the great information. What you are saying completely makes sense to me.

  83. Ann Deno, RN says

    Confidential: My father married a woman who grew up eating primarily cornmeal. She still prefers carbohydrate dominated meals. To a certain extent, it is a habit of “cost-saving” meal-planning. However, the cost to her health may be extensive. She complains often of fibromyalgia symptoms. {Taking NSAIDS frequently is probably tough on the gut.)

  84. Cheryl says

    I found your article very interesting. I was diagnosed with breast cancer in 2012 and have gone through a double mastectomy, chemo and also was in the hospital for pneumonia for a week while going through chemo. In 2013 through a biopsy with my GI doc I was diagnosed with celiac. Since chemo and my meds- aromatise inhibitors- I have had a lot of stiffness, and bone/joint pain. My oncologist took me off the AI for a period of time to see if the pain would go away and it did slightly but still feel like I am 80 year olds when I am only in my 40’s. I work out and do yoga and that does not help. I also have numbness, tingling in my hands and feet….so I am wondering if it is fibromyalgia and if it is could it be related to my celiac and infections (pneumonia) and cancer…?

    • Sue says

      Do you not think the numbness and tingling in your hands and feet are due to chemo? These are very common side effects.
      Also AIs are only effective with post menopausal women- are you post menopausal in your 40s?

    • Carol says

      With regard to the peripheral neuropathy, I came across an interesting article by the Center for Peripheral Neuropathy with the University of Chicago that links peripheral neuropathy to celiac disease. Its said that the neuropathy can start even before the gastrointestinal symptoms appear. It said that if you had undiagnosed peripheral neuropathy, to be tested for celiac disease.

    • Susan says

      Chemo depletes vitamin B12 and folate so supplementing may help with your symptoms. Being celiac you were already very likely low in many vitamins and minerals, including B12 and folate. Make sure you get your vitamin D checked as well.

  85. Sarah says

    Thank you for this! One of the things I so appreciate about your posts is how you unify and simplify the concepts I’ve got floating around in my head after so much reading and research. I was diagnoses (uselessly) with IBS in my early 20’s. Then with fibromyalgia and adrenal fatigue in the last couple of years. I know intuitively that all are related, and the gut problems started first. But I’m a bit at a loss now as to how to tackle the probable leaky gut, which tests to request from my newly-acquired functional medicine doctor, and what foods to eat/eliminate. It’s overwhelming. I seem to react to salicylates, FODMAPs, gluten, and dairy, and I’m inherently not a meat-lover. So the diet part, which I know is more than half the battle, is perplexing.

  86. says

    I can’t thank Chris enough for passing this info along during his book tour. I met him and told him my symptoms of fibromaylgia. He said it was most likely SIBO/gut related.

    I was nervous to take SBO’s, but this allowed me to finally give Prescript Assist a try. Continuing to eat clean and now adding in Prescript Assist, I was able to knock out the fibro symptoms within a few weeks.

    I couldn’t believe it. I can now tolerate starches, and other foods. I’m certainly on my way to healing my gut. Thanks again Chris!

    • Chris Kresser says

      So glad to hear it. I’ve had great success treating fibromyalgia patients by focusing on the gut.

      • Jody says

        Chris, I was dx’d with fibromyalgia back in ’98. Over the years I’ve simply thought it was misdiagnosed gluten intolerance. Next came MS in 2002 and U.C. in 2003. As I’ve worked on healing my gut the muscle aches have gone away. For me there is a direct correlation.
        Doing well with M.S. in remission for past 7 years on Low Dose Naltrexone (LDN)!
        Any suggestions for getting off of Trazedone? They prescribed back in ’98 for the sleep issues. Haven’t found an alternate that is not a drug.

        • Cheryl says

          Way to go Jody! Although I do know the benefits of LDN, I would have to stop taking my Tramadol for body aches for 2 weeks before switching to LDN. The Tram is what has kept me sane for 10 years, at 50 mg a day. Since starting a strict anti-candida diet, healing my gut, and using the Doug Coil Machine, I have gotten the dose down to 25 mg a day within 2 months. This is a major success. Jody, supporting my adrenals helped my sleep problems. Typing in to a search engine will give you supplement suggestions, like lots of B complex, extra B5, B6, B12, Ashwaganda, Holy Basil, Raw Adrenal Extract, Magnesium Citrate at night, no caffeine after 12 noon, wearing dark sunglasses after 6 pm in the summer to turn on my melatonin, and natural progesterone if your levels are low. And I still use Melatonin at 3 mg. The website StopTheThyroidMadness.com has a lot of adrenal and thyroid info. Sleep is key to health.

  87. Rs711 says

    Fascinating! Speculation of mechanisms via: neurotransmitter depletion? Leaky-gut to nerve-cell specific inflammation? Or nutrient deficiency via poor absorption resulting in sub-optimal myelination?

    Probably a mix. But which of these stands out the most for you? Maybe none! :)

    Thanks

    • Chris Kresser says

      Recent studies have found that central nervous system (CNS) inflammation is part of the pathological picture in fibromyalgia. The gut is a big bundle of nerve tissue; in fact, some have referred to it as the second brain. Gut dysbiosis/permeability > inflammation of the CNS > fibromyalgia.

      I think there are probably multiple mechanisms, but this is one of them.

      • rs711 says

        Yes this (generalized) pathway is what I have in mind. It’d be interesting to explore whether or not tissue-specific metabolic dysfunction might act as the ‘weak link’, enabling inflammation ‘here’ rather than elsewhere.

        Chris, is there a particular reason why you didn’t mention the possibility of exogenous cannabinoids in treating fibromyalgia?

        It is one of the diseases that best responds to targeted eCB stimulation. Fortunately there’s a decent amount of it in the literature. I’m sure you’re well aware of the anecdotal evidence, which is compelling to say the least.
        Also, CB2 concentrate (topical, oral &/or vaporized) is a safe and effective treatment in the large majority of cases for intractable seizures. It’s particularly interesting for children as they tend to do best with (essentially) non-toxic medication like cannabis* compared to the conventional medication for epilepsy. Also, CB2 is non-psychoactive.

        *cannabis &/or isolates derived from it

        – Anandamide and neutrophil function in patients with fibromyalgia (2008) http://www.ncbi.nlm.nih.gov/pubmed/?term=cb2+receptor+fibromyalgia
        – Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials http://www.ncbi.nlm.nih.gov/pubmed/21426373
        – Care and Feeding of the Endocannabinoid System: A
        Systematic Review of Potential Clinical Interventions
        that Upregulate the Endocannabinoid System http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0089566&representation=PDF (you might find this one particularly interesting for the breadth of connections they make between the eCB system and diet/life-style)

        PS: just ordered PrescriptAssist from you & will be starting yet another N = 1

      • Welner Zuleta says

        Hi Chris,
        What do you think about the fast tract digestion book. You probly haven’t read it but the author talks about not consuming high ferment able foods. At least limiting the amounts of starchy foods because they feed the bacteria in your upper small intestine. Would love to hear your thoughts. The authors name is Robert nobillard.

        • Honora says

          I keep hearing that resistant starch is not broken down in the small intestine, only in the large intestine, so it would probably be OK. It seems to be derived from rice and potato and some people have found consuming potato starch beneficial for this reason.

          Not sure what potato starch is; whether it’s that old-fashioned starch that people used to buy for starching their collars or if it’s something like potato flour.

          The Cooling Information Prof. Ayers says it supports beneficial clostridia species in the colon which encourage proliferation of T Regs to help modulate auto-immunity.

        • John Es says

          I’m sure many people get your meaning, but, I am going to correct you a bit. I believe the author you’re referring to is Norm Robillard. His Fast Tract Digestion books are indeed about reducing undesireable bacteria by reducing your intake of fermentable fiber. Norm corrects at least one error of the Specific Carbohydrate Diet (SCD) and shares some great data in his take, but I see the same basic strategy in these approaches. Dr. Allison Siebecker is another high profile practitioner which advocates a similar approach. She also shares some great info on her site siboinfo.com.

          So, do you starve and / or kill the bad bugs? Or, feed the good bugs to crowd out the bad bugs? I think the majority of successful practitioners would agree to take some action against the bad bugs, when they exist. But, if bad actors don’t exist, or have much of a foothold, nurturing your microbiome is probably the thing to do. This is why I think the DIY approach can be risky when pathogens are likely present. An experienced practitioner has a better chance of evaluating your condition and making the right call.

          It’s surprising to me that more people aren’t willing to part with the out-of-pocket expense to get their problems taken care of. It’s a good investment, IMO, provided one is willing to make the lifestyle changes needed to maintain their health after the treatment.

        • Suzanne says

          I have had wonderful results following the plan outlined in Fast Track Digestion IBS. Nothing else was working for me in controlling my SIBO. I got results in about a week and am mostly good now 6 months later –unless I start thinking I am superman and eat too much of the high fermentable foods. His name is Norman Robillard by the way. I am excited to see a mention of the book as it has helped me so much!!
          I don’t have FM but when I would have a flare of my IBS part of it would include body aches and flu-like symptoms. My son however has chronic fatique and I have often wondered it he could have SIBO without gut symptoms?

  88. says

    This is great information, I do believe there is a link and my instict tells me the gut issues come first! My dad has fibromyalgia and has had IBS symptoms as well as ulcerative colitis in the past and the gut issues came first. I have similar gut issues that have drastically improved since eating paleo, and I’m hoping to avoid all the problems that I believe arise from years of these digestive issues continuing unchecked. Thanks for sharing.

  89. Cheryl says

    Yes, mine definitely is. It’s been a 10 year problem because I’m waiting for mainstream medicine to catch up to what other people have been writing books about for 15 years. Only I’m more inclined to think it’s in my large intestine due to a stool test in 2005 that showed overgrowth of candida and staph aureas (not sure of that spelling). Been on a strict anti-candida diet and OTC herbs for 7 months and feel 50% better, but a Doug Coil machine has made more difference than anything else. I will ask for another stool test from Great Smokies when I see a new doc later this month. May need nystatin, or may not ever truly get it out of my system. Regardless, my diet has still made me healthier now than ever. I’m definitely gluten intolerant as well, and even eliminating that helped. But the flu-like body aches I’ve had for 10 years are absolutely 100% related to my gut health and gut bacteria. And guess what…probiotics make me feel WORSE. But I’ll figure it out eventually.

    • Catherine says

      Yes probiotics make you feel worse because they cause a die-off of the “bad” bacterial overgrowth. They sort of crowd it out. While that’s dying you feel the toxins. Flush with lots of water and support liver function. Tough feeling so sick, I know!

      • Cheryl says

        Thanks, Catherine, but the aches I feel from eating yeast and sugar are identical to the aches I feel from taking probiotics, so I don’t believe it’s a die-off effect.

        • Jody says

          Cheryl,
          The ‘die-off” from taking probiotics may simply effect your muscle tissues in a similar way to being aggravated by yeast and sugar! When I started to take Prescript-Assist, I broke the capsules down into 3 blank capsules, taking 1/3 dose for a week.Then 1/2 dose for a week and gradually building up to a full capsule daily. it can help with the die off symptoms.
          Something to consider…best of health to you!

        • Henderina says

          When the micro organisms die they release the same toxic substances they produce when eating sugars. So die-off can make your normal symptoms worse for a while.

      • Michelle says

        Contrary to popular belief probiotics are not always helpful and can even be harmful for SIBO. “Die off” is not usually a good thing for more than a couple days and usually indicates there is something wrong. The small intestine is not meant to harbour bacteria, good or bad. There is usually something else causing the SIBO such as low stomach acid or dysfunction of the iliocecal valve.

        • C says

          @ Michelle

          I’m very interested in what you’ve said here and wonder if you can direct me to a further elaboration of your points?

        • says

          Hi Michelle,

          Your information is not correct. The small intestine is definitely not sterile. It is meant to ‘harbor’ healthy flora. Think about the small intestine for a minute – this is where the majority of the immune system operates, the lining is one cell layer deep, this is the site of critical nutrient digestion and absorption and this is where food sensitivities are triggered. Matter moves through this area fast, so we don’t see huge colonies of flora here like we do in the large intestine, where matter moves through much more slowly.

          In the duodenum, there are 100-10K cfu/ g, 100,000-10 million cfu/ g in the jejunum and in the ileum there are 10-100 million cfu/ g (this is per gram – this is definitely not an insignificant amount of flora). Lactobacilli are the dominant flora in the duodenum and jejunum and bifidobacteria and lactobacilli are the dominant flora in the ileum.

          SIBO becomes an issue because of stress, antacid use, low stomach acids and dysbiosis of the small intestine. There are two types of SIBO – one is not even a bacteria. The consequences of SIBO gas producing organisms. For those with methane producing issues, this isn’t a bacteria overgrowth, it is another species called Archaea (methanogens). The others produce hydrogen gas and still another produces hydrogen sulfide.

          All of these organisms wreak havoc in the small intestine. They are present because of dysbiosis and a dysfunction of the system as a whole. Replenishing lactobacilli and bifidobacteria is part of the treatment. This should be free of FOS (prebioitics) – simply lactobacilli and bifido. I prefer a powdered probiotic that I titrate up slowly.

          I do not recommend massive doses, broad spectrum probiotics (if you will), spore forming soil probiotics… etc. Feed the gut what it prefers to have in this area to heal the area and address the inflammation that SIBO created. This will only be corrected and prevented from reoccurring when the dysbiosis is addressed. If this is not addressed and antibiotics are used without a replenishment phase, then this is opening the door for immune dysfunction, food sensitivities.. etc.

          A ‘die off’ effect simply means that there is dysbiosis present that needs to be resolved and that addressing this with the correct titration, duration and species of probiotic is going to be a pillar of regenerating the gut.

          Angela Pifer, Functional Medicine Nutritionist
          http://www.CleanAndLeanRevolution.com

          • karen says

            I am working on healing from life support from annaphylatic shock. I tried working on my gut but the results have made me so ill. I can not tolerate prescript yet. It and a few other supplements nearly put me back in the hospital. Not even beef broth. No fermented prod. either. I am trying to heal my gut and had to go back to a low histamine diet. When I add supplements I go extremely slow as I do with anything. Any suggestions?

          • Margo says

            Isn’t it possible to have too much of even “good” bacteria? I’ve read that lactobacillus can deconjugate bile acids and suspect that overdose of lactobacillus supplements has aggravated SIBO and caused fat malabsorption in my case. Any ideas about this?

        • Susan says

          Michelle, Angela,

          My Certified Nutritionist recommends soil based Prescript Assist probiotics for most people, regardless of whether they have SIBO. She says they are safe for people who have SIBO. She says they are also good for my daughter who’s testing indicated she should not have acidophilus.

          As with any probiotic, dividing the capsule and titrating up slowly (for some people very slowly) should prevent potential unpleasant symptoms.

          • says

            Hi Susan,

            I do recommend soil based probiotics for some patients, but not all. Soil-based organisms reproduce differently than other bacteria that are normally part of our flora in that they are spore-forming. Because of these spores, if a person does not have enough of their own healthy gut flora to compete with the SBOs, it opens the door for them to become pathogenic.

            After taking antibiotics and wiping out good flora, taking a spore forming probiotic, that cannot be held in check by beneficial flora colonies, is not a good idea.

            Angela
            http://www.CleanAndLeanRevolution.com

            • says

              That danger would only exist for SBOs capable of living inside humans. Spore productions alone is insufficient to colonize a host. According to Dr. Art Ayers, most of the species in Prescript-Assist are utilized for specific byproducts in industry and are not capable of colonizing the gut. If true, there is probably little danger in taking transient spore producers. Have you seen adverse effects, or are you just being cautious?

      • Greg says

        Hmmm. Exactly which bad bacteria are dying off. Could good bacteria also be dying off with an overload of a few bacteria in a capsule?

        • says

          Hi Greg,
          No we don’t see this- this is offering support to the beneficial bacteria in the gut. This beneficial bacteria that is already in residence blooms up and reestablishes the balance in the gut. When you take lactobacillus strains, this supports the lactobacillus colonies in the gut (best to use strains that have been tested and shown effective). When you take a probiotic, unless you take the specific strain of lactobacilli or bifido that you have in residence, you cannot colonize the area. Studies have clearly shown that probiotic use supports the establish beneficial flora and helps to build them up. They can bring them back to baseline, when taken long enough (6 months to a year) – but, with a history of dysbiosis, it is a good idea to stay on a lose probiotic ongoing.

          Along with probiotics – healing the gut, addressing lifestyle issues – these are all part of the treatment. All of these, when implemented together can evoke lasting change. Just taking a probiotic won’t fix things long term. We need to figure out why the dysbiosis happened in the first place.

          Angela Pifer, Certified Nutritionist
          http://www.CleanAndLeanRevolution.com

    • Babelene says

      Have you all heard of the Body Ecology Diet by Donna Gates? It addresses these issues really well.

    • says

      I always wondered if candida and FMS were linked. I ran a clinical trial on FMS back in 2004-2006 so I am familiar with a lot of the symptoms. I suppose it could be a transglutaminase issue/autoimmune issue. The protein that candida uses to bind to tissues has protein sequences identical to the ones in gluten that cause issues in sensitive people. Candida also loves L-proline and it can liberate it from peptides such as gluten.

      • Aidan Walsh says

        Some patients also diagnosed with the rare form of Systemic Mastocytosis called ‘Mast Cell Leukemia’ he was told he had cfs/fibro since the 80’s which we all know are ‘just labels’ of ‘unexplained syndromes’ Tufts University calls it ‘Spectrum’ with levels of different types of Mast Cell Activation Disorders’, there is no cure and is multi causal with some research saying genetic mutations ‘but’ not in all…

    • Aidan Walsh says

      Systemic Mastocytosis/Mast Cell Activation Disorders…tryptase blood tests/histamine levels…bone marrow/aspiration/24 hour urine collection for histamine/metabolites…

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