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.
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Another great post, thank you! I am just curious, since you bring up SIBO.
Low FODMAP is recommended to help SIBO, which includes some grains. Then thinking about the GAPS/SCD diets I am assuming grain = bad for autoimmunity. So you think work on SIBO resolution and autoimmunity would follow possibly?
What are your thoughts on the SBO’s in Prescript Assist while breastfeeding?
My mother was diagnosed with fibromyalgia and chronic fatigue syndrome when it first became known about, around 25 years ago. She was so happy that a name was finally given to her symptoms. I really, honestly believe what she had was overweight. I urged her for years to stop the wheat based diet and use more natural, unprocessed foods in her diet but she said she could not live without crackers (really, she said that). About 5 years ago she decided that she was tired of being overweight and went on a whole foods diet, minimizing processed foods and she lost a lot of weight and also all of her symptoms of fibromyalgia and chronic fatigue. Again she’s decided that she can’t live without certain foods and has gained most of the weight back along with all of her symptoms. She’s now on very strong pain meds and would rather eat the food she wants to than feel better without meds. I guess that’s her decision to make. sigh.
just to be clear – fibromyalgia cannot be cured with a change in diet or weight loss. Your Mother was obviously misdiagnosed and she never had FM.
I am considering investing in a women focused clinic as my job plan and Canada’s medical is very limited with regards to holistic medicine.
I’m perimenopause, nearly a year without a period. Should I deal with correcting my hormones or leaky gut? I’ve been getting increasing amounts of joint and muscle pains along with broken sleep, day and night sweats and poor muscle recovery from activities. These pains are worse in the morning and dissipates during the day if I keep moving. But the pain ebbs back if I don’t move.
This clinic uses the salivary test and for an additional hefty fee will do a more accurate urine test for hormonal imbalance.
Should I invest in these tests? Do I deal with hormonal issues or leaky gut issues?
Thanks for the very informative article and for the many valuable comments by your readers.
Chris, have you seen the Stanford research published on the efficacy of low dose naltrexone in the treatment of Fibromyalgia, and if so, what are your opinions on the matter seeming as you frequently mention LDN?
Anyone suffering from fibromyalgia, IBS, Crohns, other autoimmune diseases, I encourage you to research the use of low dose naltrexone (LDN) as an off-label treatment that shows great promise.
I started on it 2 weeks ago and can’t believe the difference it has made in my life!
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/
http://www.ldnresearchtrust.org/about-the-ldn-research-trust
http://www.cortjohnson.org/blog/2014/04/15/low-dose-naltrexone-inflammation-pain-different-approach-fibromyalgia/
A recommendation to consume plenty of fermentable fibres makes absolutely no sense, or is contra-indicated as any patient with SIBO will have compromised carbohydrate digestion and not be able to digest disaccharides so eating these foods will only compound the problem by feeding the unwanted bacteria the patient is trying to get rid of. All starches are OUT, and only homemade yogurt culturing for AT LEAST 24 hrs is recommended. Other cultured foods may cause additional problems until the gut is well healed.
Yes, Ed, fermented vegs made me feel more achy, and I had been making my own yogurt, Viili, but the natural sugar in the milk was still too high and had the same effect. Another reason I think I have candida overgrowth is I can eat only some nuts…almonds and pecans, but if I grab a handful of macadamias or cashews, walnuts or peanuts, the body aches increase dramatically for about 1/2 an hour, and I will get sores in my tongue that will last a couple days.
Riboflavin deficiency can cause canker sores also. Perhaps your gut issues are interfering with your B vitamins assimilation.
Thanks PJ, but I only get the sores when I consume a food that specifically feeds candida. Obviously I avoid those foods, but when I’m starving and the bag of macadamias or cashews are right there, I sometimes give in, thinking maybe I won’t react this time. Wrong. It doesn’t happen if I’m eating 100% anti-candida. However, the body aches are 50% better than they were in November when I started the paleo-type diet hardcore, but whatever overgrowth I have has not been completely killed or starved to death. I’m using berberine and pau d’arco on a regular basis, but caprylic acid gives me diarrhea, which is supposedly similar to the effect diflucan has on the gut. There really is no protocol anywhere online to follow to kill pathogens when you’re not really sure which pathogen you have. I’m going to do another stool test soon, but if I can’t find complete resolution to this 10 year problem, I’ll hire Chris Kresser. It’s rather depressing not to have anyone in the world understand the gut and ever hear of my exact symptoms. At least I have the coil machine, and that has made a world of difference in killing off what causes my body aches. They just seem to regrow. A lot of people with Lymes use the machine as well, as it only kills bacteria. I’ve used it on my cat for chronic ear infections and my pig who gets roundworms from eating grass & dirt. This is way too long of a story. Sorry. There isn’t anywhere else to tell it!
Have recently been diagnosed with fibromyalgia. Have been trying to heal my gut.
Four years ago, my life was almost ended with a bowel situation. Was very fortunate that a surgeon stepped in to do an exploratory on me much to the ER attending’s dismay. He was releasing me because my symptoms were “only gas”. After the exploratory surgery, 18″ of my bowel was extracted because it was SEPTIC.
Had a history of IBS for over 30 years (hospitalized on five different occasions), but never realized the severity. Would like to releave the aches and pains of fibromyalgia, but more importantly I must figure this out, because my 24 year old is daughter is repeating history.
Thanks for the info. Will be following for relief!
PS: I see the Core digestive product is out, so I’ll wait until it’s in to order that, the Flex and the prebiotic formula.
I have never been diagnosed with F. but have experienced extreme fatigue and muscle/joint ache when my weight is lower than a certain number. I lost 80 pounds 25 years ago, and for years maintained a “low weight” – in the 120s – and basically could barely move. But I hung onto that weight. It is crystal clear that I feel incredible energy when my weight is higher – in fact, recently I gained 8 pounds without realizing it, which put my weight at 142 (I’m 5′ 1″), and thought it was my wonderful diet changes – red meat, coconut oil, sweet potato – that were making me feel so fantastic, have a zip in my step, able to walk for miles easily – but then I faced the truth.
I cut back on my protein, since I was simultaneously – for the first time ever – feeling repulsed at the sight of turkey or a burger. I lost some of the weight, started getting bruises on my legs again, and today felt that same horrible fatigue. I could barely walk up the subway stairs. I’d like to think I’m low on salt, or iron – but I have a feeling it’s the weight.
My digestive tract is improved, as the constipation I had is gone using Dr. BG’s SIBO cure drink. Drink homemade kefir and eat cultured vegetables. Probably weight about 135 – not skinny! I’m so frustrated! After all these years I still can’t figure out how to eat and feel good – and not be so chunky!
I am wondering if it’s time to try Chris’s new digestive aid products. Does anyone have any thoughts? Thanks in advance.
I have had all the classic symptoms of FM for20 years and have had no positive help from the medical profession. I get relief by eliminating gluten and taking pain killers. My symptoms change severity almost daily and I believe stress doesn’t help it seems to bring the symptoms on stronger. My most noticeable symptoms are muscle pain, brain fog, indigestion, gluten intolerance, food chemical intolerance (preservatives), lack of concentration, headaches, itchiness especially after sleeping even for a short nap. Mornings are often worse and some mornings brain fog is so bad I can’t see properly. I continue a normal life but with a lot of pain and perseverance. Thanks for the article it might help.
Hey Kevin,
Its actually funny… that is my 20 yr old sons name. 🙂 but I wanted you to know some information I found out. I have a Histamine allergy and that itchiness that you describe is a symptom of that. You may want to go to an allergist and see if you have a histamine allergy. Read up on it, you will be surprised at what you learn. Since changing my diet to exclude the things that set off a histamine response I no longer get as many headaches, acid reflux, heartburn, itchiness and my brain fog has lifted. Also other symptoms I had was ringing in the ears, insomnia and my heart would jump out of rhythm. Check it out.
I am looking for information on fibromyalgia and considerable weight gain possible tissue resistence
YES! I was diagnosed with Fibromyalgia in 2012 and have also had undiagnosed CFS since childhood. I finally became extremely ill at the beginning of last year after taking steroids and antibiotics following a surgery – the drugs almost killed me. It was a blessing, however. I ended up finding out that I had a Candida Overgrowth and everything you mention in this article. I changed my life and my diet and Fibromyalgia is almost non-existent in my life now. I stopped eating wheat/gluten/grains, dairy, sugar, processed foods and much more of those icky food items. It’s unbelievable how much a perfect diet helps. I could barely even walk last year due to severe inflammation in my body, but now I exercise and am very active all day long! Food is medicine if you give it time and be patient. I didn’t heal overnight, and I want to make it clear to anyone who might be reading this. If you think you’ve “tried everything” to heal your Fibromyalgia and/or your gut – try harder and do it 100% with no cheating. I just passed a year of being on my awesome diet and I still have another year until I’m all the way “normal” again. I’ve also removed a lot of toxins from my life from the water I drink to not using aluminum foil and saran wrap. All of the bad stuff can really add up and make a major impact on our health – it’s so worth it to change your life in a drastic way! 🙂
Hi everyone,
I am holistic aromatherapist and I systematically rebalance the gut (via treating dysbiosis) of my client before starting any approach. To me, this is the basics. I don’t know any sick person with a clean, healthy gut. Fibromyalgia is just another example of how important it is to start with gut balance when we want to restore immunity, nervous system and proper regeneration. Vital points in treating fibromyalgia!
Hi Chris,
If you can kindly suggest me that what is the best food for me to eat as my body is reacting to all histamine containing foods, salicylates and also lectins, I am right now eating only fresh chicken and potatoes but worried about nutrient and vitamin deficiencies as can’t tolerate most of the supplements.
I believe that my Gut is still Leaky, I am using only Klaire Labs products as most of them are Salicylates and allergens free.
I have cleared my Gut from all bad microbes with the help of natural anti-bacterial, anti-fungal and biofilm breakers.
Chris-I have been reading your book and accessing your bonus chapter in a random manner,but have not run across the botanical protocol.Could you possibly direct me to the chapter?
I found your website 3 years ago because of steroid induced diabetes. The helpful information you provided on the paleo diet bought me back to health and I was full of energy and vitality once again. Then I had to go on 5 courses of antibiotics 18 months ago for a tooth infection and have been having gut problems, depression, chronic fatigue and all over body aches ever since. I definitely believe the drastic, almost overnight change after the antibiotics was the cause of my gut problems and fibromyalgia like body aches.
Hi
So how do you get rid of SBIO?
Peppermint Oil? Grapefruitseed Extract? How do you destroy it.
And do the compounds you are killing it with, do they effect the probotics that you take like the soil probiotics?
Herbal therapies work very well. In fact, they’re superior to antibiotics: https://www.facebook.com/chriskresserlac/posts/744469492271983
Hi Chris,
your posts are very helpful.
I hope you must have some advice for me also, I was diagnosed with Leaky Gut 3 years back but unfortunately in my country there is no understanding and awareness regarding Leaky Gut so I consulted different doctors and naturopaths and followed their diet plan but for some reason I could not heal myself and now my body is reacting to salicylates, histamines and lectins also.
I have done all the tests and now there is no bad bug in my Gut but I can’t touch any grain, dairy, vegetables, fruits and red meat due to salicylate sensitivity and histamine intolerance, eating fresh chicken and potatoes only but I guess even fresh meat is also causing inflammation.
Kindly advice me how can I heal my Leaky Gut when I can’t eat 90% of the foods.
Chris,
Your mention of leaky gut as the underlying cause of fibromyalgia, true as it may be, is still a symptom. You have provided some excellent solutions to heal leaky gut, but I wonder if it is enough to help with eradicating the fibromyalgia.
An iodine group that I belong to seems to be chattering quite a bit about iodine supplementation focusing on thyroid health as a successful method of alleviating and even eliminating many symptoms of fybromyalgia. Perhaps the cure to this disease is a bit more multifaceted, and requires a more synergistic approach to achieve success.
We have failed to recognize iodine deficiency as a critical nutritional deficiency that is leading to the development of modern diseases on a massive scale, fibromyalgia included.
I’ve not seen research indicating that iodine deficiency is at the root of leaky gut, if that’s what you’re suggesting.
Leaky gut is both a cause and a symptom. It can cause numerous problems, including fibromyalgia; but it is usually a “symptom” of another problem, like SIBO, fungal overgrowth, parasites, dysbiosis, etc.
Chris,
I would love to see you look into the research on low Melanocyte Stimulating Hormone (MSH), leaky gut and infections. It could be that MSH helps to pull together your evolving picture of how multifactorial disease conditions arise in connection with the gut.
Based on the work of Dr. Ritchie Shoemaker the mechanism seems to be:
1. Infection or other health issue decreases MSH
2. Low MSH leads to leaky gut
3. Multi-symptom and varied conditions appear such as fibromyalgia etc.