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.
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.
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
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.
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
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.
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.
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.
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
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!
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.
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.
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
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.
What test should I get to determine if I have SIBO?
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.
Yes. And, not to be confused with the glucose breath test, which may be more popular with conventional gastroenterologists. The right test and the right practitioner seems critical in getting the right treatment.
Lots of great information on SIBO here:
http://www.siboinfo.com
Robb Wolf’s latest podcast with Dr. Michael Ruscio has a few gems, too:
http://robbwolf.com/2014/06/10/episode-227-dr-ruscio
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
Great article. Just wondering do you use antibiotics in your practice to treat SIBO?
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.
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.
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.
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.
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.
How is SIBO different from candidiasis?
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.
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).
Yes, I think the connecting factor is disruption of the gut microbiota. That can predispose toward both histamine intolerance and FM.
Could that be attributed to people who have dysautonamia ot Potts/itts/tachyhardia? Also people with constant dis ended stomachs
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.
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.
Hello, regarding your familial dysautonomia, I was researching tocotrienols and came across the info below:
Tocotrienols reverse IKAP and monoamine oxidase deficiencies in familial dysautonomia. http://www.ncbi.nlm.nih.gov/pubmed/16125677
Maybe this info can help out.
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!!
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.
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.
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.
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?
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.
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.
Alison, where do you get these specific supplements?
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.
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.
Just a little addendum to my thyroid/FM conundrum. Since taking thyroid hormone I can work and not experiencing that crashing leg-locking exhaustion.
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.
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.