From Gut Health to Fibromyalgia: The Role of SIBO

Jun 02, 2024By Functional Medicine Consulting
Functional Medicine Consulting

Understanding Fibromyalgia

Fibromyalgia (FM) is a disease characterized by skeletal muscle hyperalgesia (muscle pain), fibrous tissue pain (fibrous connective tissue is found in tendons connecting muscles to bones), and ligament pain (which connect bones to bones). The term fibromyalgia is an amalgam of three Latin roots: fibro means “fibrous tissue,” myo means “muscle,” and algia means “pain.”

Fibromyalgia may result from a combination of factors, such as genetics, infections, and physical or emotional trauma. Individuals with a genetic predisposition may be more susceptible to the condition, while others might develop it following a severe illness or injury. Additionally, emotional stress is known to trigger symptoms of fibromyalgia.

Throughout the past century, the symptoms now associated with fibromyalgia have been known by various names, including muscular rheumatism and neurasthenia. The condition has been considered a type of osteoarthritis or an autoimmune disorder. However, one aspect has consistently persisted: the diagnosis of fibromyalgia remains contentious.

The term fibromyalgia was coined in the late 1970s. However, the American College of Rheumatology did not develop diagnostic criteria for FM until the 1990s. The symptoms of fibromyalgia and chronic fatigue vary slightly. The differences lie in the “where” of the symptoms. 

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Individuals with fibromyalgia complain of widespread pain and debilitating fatigue, especially at specific tender points in the body. Chronic fatigue sufferers chiefly complain of extreme fatigue. Various additional symptoms and diagnoses accompany fibromyalgia and chronic fatigue syndrome, such as irritable bowel syndrome (IBS), depression, and anxiety.

Symptoms of Fibromyalgia

According to the CDC, fibromyalgia is a disorder of unknown cause characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue, and often psychological distress. 

Individuals with fibromyalgia may also suffer from a range of additional symptoms, such as:

• Stiffness in the morning
• Tingling or numbness in hands and feet
• Various types of headaches, including migraines
• Symptoms of irritable bowel syndrome (IBS)
• Cognitive challenges, commonly known as "fibro fog"
• Decreased energy production
• Fatigue
• Sleep disturbances
• Depression and anxiety

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Small Intestinal Bacterial Overgrowth (SIBO) and Fibromyalgia

Many studies have shown that SIBO often precedes fibromyalgia, suggesting a significant link between the two conditions. For example, in one study, a positive lactulose breath test was found in 100% of patients with fibromyalgia compared to controls and patients with irritable bowel syndrome (IBS). 

Results: 3/15 (20%) controls had a positive SIBO breath test compared with 93/111 (84%) subjects with IBS (p<0.01) and 42/42 (100%) with fibromyalgia.

Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in the population of bacteria in the small intestine. Normally, the small intestine has relatively low levels of bacteria compared to the large intestine. However, when SIBO occurs, excessive bacterial growth in the small intestine disrupts normal digestion and absorption of nutrients. This can lead to symptoms such as bloating, abdominal pain, diarrhea, and malnutrition.

SIBO can be caused by various factors, including low stomach acid, impaired intestinal motility, and structural abnormalities in the gastrointestinal tract. It is often diagnosed through breath tests that detect elevated levels of hydrogen (H2) and methane (CH4) produced by the overgrown bacteria in the small intestine. Effective management typically involves dietary changes, antibiotics, antimicrobial agents, or probiotics to restore a healthy balance of gut bacteria.

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SIBO presents with a complex interplay of bacteria-derived toxins that can significantly impact various physiological processes, potentially linking to fibromyalgia. Among these toxins is lipopolysaccharide (LPS), a potent immune system stimulator that triggers systemic inflammation, which is implicated in the pathogenesis of fibromyalgia. 

Certain bacteria found in SIBO release D-lactic acid, a substance known to induce symptoms commonly observed in fibromyalgia, including muscle pain, fatigue, and cognitive dysfunction, often referred to as "brain fog." 

Another toxic byproduct is hydrogen sulfide (H2S), which can slow or halt mitochondria (the cellular energy-producing factories) function and processes; excessive hydrogen sulfide (H2) can also lead to muscle fatigue, cognitive impairment, and an elevation of symptoms consistent with fibromyalgia. 

SIBO's production of LPS, D-lactate and H2S, inhibit mitochondria production of energy, failing to produce energy while building up toxins, leading to pain.

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Other bacteria in SIBO, such as Escherichia coli (E. coli), produce tryptophanase, an enzyme involved in the breakdown of tryptophan. This process can lead to tryptophan deficiency, subsequently causing deficiencies in serotonin and melatonin.

Serotonin deficiency is associated with symptoms like depression and anxiety. In contrast, melatonin deficiency contributes to insomnia, both of which are prevalent in fibromyalgia. Additionally, tryptophan deficiency has also been shown to exacerbate hyperalgesia (heightened sensitivity to pain).

Another way SIBO causes pain is through bacterial translocation, where bacteria move from the gut to other areas of the body where they shouldn't be. When these bacteria relocate, they often die and disintegrate in these new environments. This process releases harmful substances called endotoxins, which are components of the bacterial cell walls.

Endotoxins trigger a strong immune response, leading to inflammation and the release of tumor necrosis factor. This protein causes widespread inflammation and pain throughout the body, contributing to the symptoms of fibromyalgia. Endotoxemia significantly increases the brain's sensitivity to pain and the perception of pain found in FM patients.

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Steps and Remedies to Reduce FM Symptoms Linked to SIBO:

1. Dietary Changes

Low FODMAP Diet: Limiting fermentable carbs like oligosaccharides, disaccharides, monosaccharides, and polyols can alleviate symptoms of SIBO and FM by restricting the nutrients available to harmful bacteria.
Anti-inflammatory Diet: Foods high in omega-3 fatty acids, antioxidants, and fiber can diminish systemic inflammation.
Elimination Diet: Removing foods that provoke symptoms can aid in controlling SIBO and FM.

2. Probiotics and Prebiotics

Probiotics: Introducing beneficial bacteria such as Lactobacillus and Bifidobacterium can rebalance the gut microbiome.
Prebiotics: Non-digestible fibers like inulin and fructooligosaccharides promote the growth of beneficial bacteria.

3. Antimicrobial Treatments

Herbal Antibiotics: Agents such as oregano oil, berberine, and garlic may reduce bacterial overgrowth.
Prescription Antibiotics: Rifaximin is often used to treat SIBO. Always seek medical advice for proper antibiotic use.

4. Digestive Enzymes and Bile Supplements

Digestive Enzymes: These supplements can assist in digestion and alleviate SIBO symptoms.
Bile Acid Supplements: They can aid fat digestion and mitigate bacterial overgrowth for those with bile acid deficiency.

5. Support Gut Motility

Prokinetics: These help maintain proper food and waste movement in the digestive tract, preventing bacterial overgrowth.
Regular Exercise: Enhances digestive health and motility.

6. Nutritional Supplements

Magnesium: Contributes to muscle relaxation and pain relief.
Vitamin D: Its deficiency can worsen pain in FM patients.
Coenzyme Q10 and B Vitamins: Support mitochondrial function and energy production.

7. Stress Management

Mindfulness and Relaxation Techniques: Practices like yoga, meditation, and deep-breathing exercises can reduce stress and alleviate FM symptoms.

Adequate Sleep: Prioritizing good sleep hygiene can help improve overall symptoms of FM.

8. Pain Management

Medications: Over-the-counter pain relievers or prescription medications as advised by a healthcare provider.
Physical Therapy: Tailored exercises can help improve flexibility and reduce pain.

By following these steps and remedies, you can potentially reduce the symptoms of fibromyalgia linked to SIBO. 

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The connection between SIBO and fibromyalgia is rooted in the complex interplay of bacteria-derived toxins that impact various physiological processes. SIBO introduces lipopolysaccharides (LPS), which trigger inflammation, and D-lactic acid, which induces muscle pain, fatigue, and cognitive dysfunction.

Hydrogen sulfide (H2S) from SIBO can impair mitochondrial function, leading to similar fibromyalgia symptoms. Additionally, certain SIBO bacteria produce tryptophanase, leading to tryptophan deficiency and subsequent serotonin and melatonin deficiencies, contributing to depression, insomnia, and heightened pain sensitivity.

Understanding and addressing SIBO may help alleviate fibromyalgia symptoms. If you are experiencing symptoms of fibromyalgia or have been diagnosed with fibromyalgia, testing for SIBO is highly recommended as part of your diagnostic and treatment plan.