Is Fibromyalgia Caused By SIBO and Leaky Gut? | Chris Kresser

Is Fibromyalgia Caused By SIBO and Leaky Gut?

by Chris Kresser

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sibo and fibromyalgia, fibromyalgia and gut health
Fibromyalgia is a debilitating condition that may be influenced by gut health. Jupiterimages/Pixland/Thinkstock

Note: The Prescript-Assist supplements discussed in this article are no longer available. Please click here to learn more about a substitute, the Daily Synbiotic from Seed.

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.

310 Comments

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  1. My wife had terrible Fibro, so bad around five years ago she asked that I just “let her die”! Obviously, that just broke my heart.
    I’m a technical recruiter and amateur researcher. Can’t say I understand every science study I read but I buried myself in research for around six months, all while she was going through agonizing pain. Traditional docs suggested Opioids and Gabapentin. She refused either one, thank goodness.
    Long story short, she’s 90% better now. She looks amazing and we’re back to enjoying life. I attribute it to several things, but I’ll post just a few in order of importance.
    Go Pur gluten free first. That is vital. No cheating.
    Eat a WFPB diet (whole food plant based). Don’t agree at all that Paleo is best for Fibro.
    Get tested for food allergies. She had a massive Cow Dairy allergy. We eliminated dairy for two years completely and are now doing limited sheep and goat cheese.
    Take a good quality Methyl B complex. Pure Encapsulation makes some great ones.
    Crank up the Omega3s and Astaxanthin or Krill Oil.
    Take a natural Antibacterial like Oregano Oil, AHCC, Monolaurin or Caprylic Acid. This is huge too. There are also SIBO pills too. Grape Seed Extract is also good.
    Lots of Polyphenols
    Get sleep, avoid chemicals. Get off computers at night!

  2. I was diagnosed with FM about 18 years ago. At the time it was more fatigue than pain that bothered me. However in 2015 I had to have chemo for breast cancer. following that anti hormonal pills. Since then my pain is excruciating and I am wondering if the anti hormonal pills are causing the FM pain to be worse or is this pain unrelated?

  3. I was finally diagnosed with fibromyalgia in 2012. I cannot take anything for it, as I was horribly constipated by a 1/2 dose of Cymbalta (transitioning off of Paxil), Gabapentin (Neurontin) BURNT the mucosal lining of my stomach, and Lyrica was never an option because I suffer from severe depressive disorder. I even respond badly to THC, so though plentiful where I live, I cannot use cannabis products. I have IBS, and now seem to have motility issues – peristalsis seems to have stopped. I’m at a loss here. If fibro is caused by shunts in the palm and blood flow, affecting the nervous system, dealing with possible “leaky gut” may well be a problem for me, too. I hate this disease. Flares can keep me homebound and in bed for days.

  4. Right now I’m angry at “typical western medicine doctors” who refuse to think outside the box. I’ve had the fibromyalgia diagnosis since I was in my 40’s, but noticed symptoms long before this. As far back as high school I knew my energy level just wasn’t right. The past year I’ve had a “rash”, and saw four doctors (2 dermatologists, 1 allergist and a rheumatologist). After a multitude of tests I was eventually told the only thing that made sense was my low thyroid was causing my symptoms. Upped my dose of synthroid and no improvement. I’ve always suspected I had candida, and the more I read, I suspected I had SIBO as well. Thank god my internet is “progressive”. She proscribed Nystatin at my request, and within a week, I was seeing an improvement in my skin. Finally got in to see an OD, and she is formally testing me for both candida antibodies, and has ordered the breath test for SIBO. So, I saw four of the supposed best minds in medicine (at a very large medical center in California), but I was the one who figured out my diagnosis. Thank god I’ve learned to advocate for myself. But what about all the others who can’t? I know this is really just the beginning of my struggle. This stuff is hard to treat, from what I’ve read. But at least I have hope. For so long I did not. Thanks for letting me vent. A year of my life spent going from doc to doc, and no progress had left me with a very hopeless feeling. I am also being advised to purchase an “earthing sheet” to sleep on. The new DO I’m seeing has lots of good suggestions. I have hope! Something new for probably many of us who have spent years struggling with what seems to be such a basic concept – if the gut isn’t working, little else is gong to work the way it should. Thanks for listening. And for anyone wondering what direction to go, seeing an integrative medical doc/ DO is finally giving me some hope after years of struggle, frustration, pain and lost time, wages, and even a relationship that did not survive this condition/s.

  5. Because of my illness, fibromyalgia I have been wanting a colonic irrigation for a long time with the mindset that the build up of toxins in ones body contribute to your overall health and well being. Reasons of not going ahead with one is not only the cost of them but I have heard they can be very uncomfortable and also embarrassing so to find a product that can work just as well is brilliant. I have been taking the Lady Soma Detox (two a day) for the last week and I have to say I can feel a big difference in my body. Not only am I less bloated I feel like I have more energy and not as lethargic as I usually am. Make sure you take it with plenty water a sit works better. I HAVE noticed a difference, my pain is not as intense and I do believe this is because slowly but surely I am ridding my body of the harmful toxins.

  6. Basically, I believe this to be the result of Candida affecting the “nervous system”. Candida feeds off sugars and yeast in the body… 20 years ago, I had systemic sinus infections, made worse by steroids and antibiotics. I even developed pneumonia because of this. Sinus surgery did not cure the problem, diet and nutritional supplements to rebuild my immune system did over time. Today I have “NO” sinus infections, do not suffer from allergy symptoms and take nothing for sinus or joint related past problems. I was diagnosed with ADHD over 15 years ago. You would be hard pressed to believe that today. I follow the eat for you “Blood Type” diet. I have gotten away from most gluten, I go gluten free, when ever possible and have cut out most starches. One thing about the percentages of who gets this, Estrogen is a source of many problems for women. Progesterone is a healthy hormone, from all the studies I’ve read. Estrogen is not, it has lead to people gaining more weight than those with less Estrogen in their body. This is all about “tissue” swelling. Candida in the heart leads to “Congestive Heart failure due to thickening of the heart muscle. Diabetes is linked to sugar processing in the body.. or lack of it. Try going gluten free and see how you feel!!!

  7. OMGoodness!! As I’m reading each of these comments/posts, I just want to reach out to each person who is suffering and reassure them that there are answers and there is hope! I actually made the post below on an earlier comment, but am doing so again, only in the hope of possibly being able to reach out to and help others. So, here goes. There is help. Just about every issue mentioned is a gut health related issue and the fix is actually overwhelmingly simple. I used to take 12-16 ibuprofen daily for pain, but haven’t taken any…in over 18 months. In fact, I’ve been off of 8 prescription medications (for issues including: depression, anxiety, ADD, cholesterol, thyroid, and acid reflux) and have been Dr visit free…for the same 18+ months. I’m always happy to share with anyone who may benefit, because for the first time in decades, I feel like I’m truly LIVING life!

    • Hi Lisa so you have healed yourself of ADD,depression and anxiety? I’ve just recently started trying to heal my gut but I’m worried I’m wasting my time and money because I might not be doing it right. I’m in my third week and can’t afford organic food because I’ve no job so it could all be a waste of time. How long did it take to see results? Thanks

      • Try doing a Parasite cleanse first. Before I began my journey, I had a systemic yeast infection in my sinuses for 10 months. Modern medicine led to it. Sinus surgery did not get rid of it. I decided to go organic or “natural”. First, I was encouraged to go on the candida diet. Eggs were my only dairy like product I could eat. After one month, my energy lever “doubled”. The next month I took supplements like Beta Carotene, Zinc, Vitamin C, D and E, again my energy level improved. The last step was to take a highly concentrated Garlic tablet. I took it like I’d take an Antibiotic. Tripled the dosage the first 3 days, doubled it for the next 4 and went to normal after that. In 10 or 12 days. My infection was gone.
        – Eliminating sugars and starches will help you have more energy. Candida affects the gut, but causing bloating, When I get some of that I take, HCL caps to break up the gas. Should you go gluten free and as organic as possible, I would believe you’ll be feeling so much better, you would scarcely remember the last time you felt that way.

        • Thanks for the advice. I’m definitely going to do a parasite cleanse because I’ve seen it recommended a lot recently. So could it be a parasite and candida?
          Thanks

    • My daughter has Candida which is so difficult to get rid of.. Now is suffering aches and pain all over her body. Yogurt and probiotics help a little. Please help. The pain is unbearable and she is only 33 years old.

  8. I had eye surgery in 1998 severe pain, this and a thousand other health problems brought me into severe depression. Vaginitis or vulvadynia for four years Lot’s of antibiotics to Severe SIBO I made the mistake of believing in western medicine. I have spent every dime I have and I know have severe Fibromalgia from going over threshold with carbs. I read Dr pimentals book The Ibs solution. It said if you went over threshold Go back on Rifaximin and neomycin. The book also said to eat some carbs to get the archea methane producing bacteria to let go of the small intestine wall. I ate to many carbs and it hit like a bullet. Severe fibromalgia. I’m going on ten days of pain. I am trying neomycin and diet. I am wondering what exactly do I need. Supplements, and or probiotics. When to add the probiotics. I am on shutdown mode. I am pretty mad at myself. and plumb scared. I had to quite my job. I have given up. There is no help in wyoming,

    • Get yourself some kefir grains and make some milk or coconut milk kefir. I think antibiotics cause fibro by wiping out the gut microbes that produce the neurotransmitters (eg GABA) that you need (Cipro appears to be the worst antibiotic but they all mess up your gut), and then candida yeast takes over. Kefir will help to repopulate your gut with those good bacteria. My symptoms are reversing since I started drinking kefir. It takes a long time and a lot of kefir daily. I’m not 100% yet but it really helps.

    • There is help. This is a gut health related issue and the fix is actually overwhelmingly simple. I used to take 12-16 ibuprofen daily, but haven’t taken any…in over 18 months. In fact, I’ve been off of 8 prescription medications (for issues including: depression, anxiety, ADD, cholesterol, thyroid, and acid reflux) and have been Dr visit free…for the same 18+ months. I’m always happy to share with anyone who may benefit, because for the first time in decades, I feel like I’m truly LIVING life!

  9. I had eye surgery in 1998 severe pain, this and a thousand other health problems brought me into severe depression. Vaginitis or vulvadynia for four years Lot’s of antibiotics to Severe SIBO I made the mistake of believing in western medicine. I have spent every dime I have and I know have severe Fibromalgia from going over threshold with carbs. I read Dr pimentals book The Ibs solution. It said if you went over threshold Go back on Rifaximin and neomycin. The book also said to eat some carbs to get the archea methane producing bacteria to let go of the small intestine wall. I ate to many carbs and it like a bullet. Severe fibromalgia. I’m going on ten days of pain. I am trying neomycin and diet. I am wondering what exactly do I need. Supplements, and or probiotics. When to add the probiotics. I am on shutdown mode. I am pretty mad at myself. and plumb scared. I had to quite my job. I have given up. There is no help in wyoming,

  10. My daughter having had 14 surgeries and over two years on antibiotics for osteomyelitis developed fibromyalgia somewhere in the mix!!

    She has had FMT with Profossor Borody in early March and lives on A paleo/ fermented food diet. So far her mood has improved but I am concerned her pain appears worse than before. Could this be a result of embedding and part of the process?

    I know this can take time but wasn’t expecting worsening symptoms before any possible improvement

  11. Just wondering if anyone here had ever been diagnosed with RSD/CRPS. I have a daughter who has been given this diagnosis as well as mast cell activation disorder. She has had a history of gi problems since birth (she’s only 9) and since finding Chris Kresser and learning so much from him we have changed her diet and she is now doing phenomenal! I totally believe there is a huge connection between the gut and fibromyalgia(which is another term for crps, ive heard)???

    • Yes, Leslie I have crps sinse 22 years and I am certain that it has something to do with candida overgrowth, leaky gut and foodallergies
      This illnes improved when I started with a candida diet and pau d´arco capsules but when I had to take 7 times antibiotics in 2 years time it got worse again
      Unfortunately the pau d´arco doesn’t help anymore because now the yeast in my gut seems to be immune because I took it to long I have started the diet again
      Hopefully more people with crps will react to your mail so we can compare with pother patients
      Forgive me for writing mistakes I don’t live in the UK

  12. Hi Chris. Shoemaker seems to think a lot of fibromyalgia is actually CIRS. Now knowing what you know about mold, would you agree?

    (CIRS certainly caused my SIBO, which I spent a lot of time chasing until I discovered the root cause.)

    And if so, why does diet seem to improve so many cases of fibro?

    • Sarah, did your SIBO improve after you were treated for CIRS? I’m on my 3rd round of SIBO treatment with hardly any improvement. My labs (Shoemaker’s suite of labs) strongly point towards CIRS, and I’m wondering if I should be treating *that* instead if I want to get anywhere with SIBO. Any insight you have regarding the CIRS/SIBO connection would be appreciated. Thanks!

      • Hi Karen!
        You may want to look into treating CIRS at some point, however if you tested positive for SIBO I would recommend searching for a suitable treatment path before turning to treat something else. The antibiotic treatment course doesn’t always work for everyone. I myself am 20 and have had a horrible history with antibiotics. I tried the traditional treatment routes and saw no progress, I started with diet and reputable supplements and have seen such a difference. It’s certainly not a quick fix and can be incredibly difficult but its what i’ve found to work. Good luck!

        • Thanks for your reply. I haven’t done antibiotics for SIBO, just hardcore herbal protocols (allicin, berberine, etc., etc.). My SIBO actually got worse after 2 rounds of treatment, but it might have been because I was also taking 3 different probiotics per my doctor.

        • Thanks for the reply! One more question: Did you find that cholestyramine interfered with bile production? Did it give you digestive symptoms or make digestion more difficult since it binds bile and bile is needed for good digestion? How long do you think it’s safe to stay on CSM?

  13. I have constant joint pain, ibs flares.am totally gluten free/ lactose intolerant, parathyroid disease w 2 surgeries in 3 yrs..ibs keeps me at home. Other pain I can deal with. No meds, have given up my one cup instant cappuccino,and everything I love.. What could stop the ibs const/diaherrea/cramps…gf worked for awhile. I take atenolol long term and have felt awful for 17 yrs. Finally dx w/ fibro/osteoarth/osteop. Help me to rid the ibs. Please.

    • I had to quit wheat and oatmeal and immediately noticed a change in my IBS. I rarely have gas and bloating now. I also take Benefiber twice daily. Also, my diarrhea is gone and I have had normal bowel movements since I quit the grains.

    • You probably have sibo and Need one round of antibiotics meant for the small intestine, Rifaximin and neomycin for both constipation and diarrhea. Neomycin can help fibromalgia by getting rid of methane bacteria in gut. Read The IBS solution by Dr. Pementel and Some of Alice seibeckers books on healing Sibo and IBs. Plus a low fod-map diet or restricted diet maby
      indefently. You may have wicked side efcects like brain fog, a feeling of weakness all around sick, because you are getting rid of the toxins collaborating in small intestine. Then you go on diet and eventually if things start seeming more normal. You then try a good probiotic.

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