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Is Fibromyalgia Caused By SIBO and Leaky Gut?


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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

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)

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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 options like the Daily Synbiotic from Seed) and/or a prebiotic supplement.
  • 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.
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Join the conversation

  1. 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.

  2. 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.

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

    • 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.

  4. 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.

    • 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.

    • 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.

  5. 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.

  6. 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.

    • 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.

      • 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.

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

  7. 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.

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

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

      • 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.

      • 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.

      • 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.

        • 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

  9. 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!

  10. 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.

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

    • 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.

      • 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.


        • 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….


          Cheers and welcome any other curiosities!


    • 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.

      • 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.

  11. 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)

    • 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).

  12. 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.

  13. 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.)

  14. 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…?

    • 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?

    • 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.

    • 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.

  15. 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.

  16. 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!

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

      • 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.

        • 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.

  17. 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! 🙂


    • 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.

      • 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

      • 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.

        • 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.

        • 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.

        • 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?

  18. 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.

  19. 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.

    • 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!

      • 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.

        • 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!

        • 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.

      • 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.

        • @ 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?

        • 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

          • 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?

          • 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?

        • 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.

          • 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.


            • 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?

      • 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?

        • 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

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

    • 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.

      • 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…

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