Small Intestinal Bacterial Overgrowth & How It Relates To Fibromyalgia

Published: // Updated: March 13, 2021

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Studies show that small intestinal bacterial overgrowth (SIBO) occurs in 90 to 100 percent of fibromyalgia patients. This post explains what SIBO is, what the symptoms are, and how to treat small intestinal bacterial overgrowth.

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Our intestines consist of two major subdivisions: the small intestine and the large intestine. The small intestine is much smaller in diameter but is much longer and more massive than the large intestine. The intestines are an important part of the immune system, especially the small intestine.

Normal bacteria that are part of the small intestine help protect against bad bacteria and yeast that are ingested. They help the body absorb nutrients, and also produce several nutrients and vitamins.

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Research has revealed that gut bacteria perform a host of useful functions. These include interacting with the immune system, producing vitamins such as vitamin K, stimulating the release of hormones involved in the storage of fats and influencing mood and our feeling of well-being.

What Is Small Intestinal Bacterial Overgrowth?

Small Intestine Bacterial Overgrowth is a chronic overgrowth of bacteria in the small intestine. SIBO is not caused by a single type of bacteria. It is an overgrowth of various types of bacteria that should normally be found in the colon (large intestine).

Bacteria overgrowth interferes with normal digestion, the absorption of food and leads to damage of the lining of the intestine. Eventually, the bacteria enters the bloodstream and cause problems with the immune system. The immune system’s reaction to the bacteria causes fatigue, body pain and burdens the liver.

Finally, the bacteria excrete acid, which in high amounts causes neurological and cognitive symptoms.

Symptoms Of SIBO

The main symptoms of SIBO are those of Irritable Bowel Syndrome (IBS):

  • Abdominal gas and bloating
  • Abdominal pain and cramps
  • Constipation, diarrhea or both
  • Mucus in the stool

Other symptoms may include:

  • Heartburn, acid reflux
  • Nausea, vomiting
  • Vitamin and mineral deficiencies
  • Food sensitivities
  • Headaches
  • Joint pain
  • Fatigue
  • Brain fog
  • Skin rashes or eczema
  • Respiratory symptoms such as asthma
  • Depression and/or anxiety

SIBO may be an underlying cause or a major factor in all of the following diseases: acne rosacea, anemia, autism, celiac disease, cystic fibrosis, chronic fatigue syndrome, diabetes, diverticulitis, fibromyalgia, GERD (gastroesophageal reflux disease), hypothyroidism/Hashimoto’s thyroiditis, IBD (inflammatory bowel disease) such as Crohn’s and ulcerative colitis, IBS (irritable bowel syndrome), muscular dystrophy, rheumatoid arthritis and many others. You can see a full list of associated diseases at SIBO Info.

Diagnosing SIBO

The most common way to diagnose SIBO is with a breath test. The breath test involves drinking a prepared glucose or lactose solution, then measuring the presence of methane and hydrogen gasses. There is a 24-hour preparation period before taking the test. The first 12 hours require a specific diet and the last 12 hours require a fasting period. After drinking the solution, the patient produces breath samples every 20 minutes over a 3-hour period. The test is performed in a doctor’s office, hospital, clinic or with an at-home test kit.

SIBO Treatment

Treatment involves reducing the bacteria, healing the intestinal lining and preventing relapse.

  1. Antibiotics – The most commonly prescribed antibiotic used to kill SIBO is Rifraximin. However, using antibiotics can also have a negative impact on the good bacteria in the gut. With that in mind, many people choose to try an herbal antibiotic such as enteric-coated peppermint, garlic, oregano, and goldenseal.
  2. Diet – Bacteria primarily feed off of sugars and starches in the diet (both refined sugars and natural sugars). So it is essential to eliminate all refined sugars from the diet and most starchy foods. Keeping your diet low in carbohydrates will starve the bacteria. Established SIBO diets are:
    • Specific Carbohydrate Diet (SCD) – The Specific Carbohydrate Diet is a group of foods which are grain-free, sugar-free, starch-free, and unprocessed. The diet is an all-natural way to break this cycle of bacteria and yeast overgrowth by eliminating the food sources they feed on. This book, Breaking the Vicious Cycle by Elaine Gottschall can help you understand the diet.
    • Gut and Psychology Syndrome Diet (GAPS) – The GAPS diet is based on the Specific Carbohydrate Diet. 85% of everything you eat daily should be made out of meats, fish, eggs, fermented dairy, and vegetables. Baking and fruit should be kept out of the diet for a few weeks, and then be limited to snacks. Homemade meat stock, soups, stews and natural fats are the main staples of this diet. Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride can help fully understand the GAPS Diet before you start. Starting the diet incorrectly may lead to unnecessary diarrhea or constipation.
    • Low FODMAP Diet – FODMAPs is an acronym referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are the names for a collection of molecules found in food, that can be poorly absorbed by some people. The Low FODMAP diet has two phases. The first phase restricts all high FODMAP foods for 6 to 8 weeks. The second phase is where the type and amount of FODMAPs are identified so that the longer-term diet can be established.

You can follow one or a combination of these diets.

Conclusion

Several studies have connected fibromyalgia with the gut, emphasizing a strong relationship between fibromyalgia and bacterial overgrowth in the small intestine.

Researchers discovered that the degree of bacterial overgrowth detected in the small intestine has a direct relationship with the severity of fibromyalgia. Some even suggest small intestinal bacterial overgrowth may lead to fibromyalgia.

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Since small intestinal bacterial overgrowth can contribute to pain, your diet can help alleviate FM symptoms and protect your gastrointestinal tract and nervous system.

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16 thoughts on “Small Intestinal Bacterial Overgrowth & How It Relates To Fibromyalgia”

  1. Great article Sue – dysbiosis is such a major issue with ME/CFS/Fibromyalgia and a really important aspect to address for recovery. Personally, not so keen on anti-biotics as they gut is already so unbalanced, but of course it always depends on the individual. Thanks for sharing this great article. 🙂

    Reply
    • Hi, Dan. I agree with you on the antibiotics. I think the over-use of antibiotics has done way more harm than good. I watched your videos and added your book: CFS Unravelled to my wish list just a few days ago. So I was pleasantly surprised to see you left this comment on my blog. Thank you.

      Reply
      • I have had Fibro for years now and aparently a SIBO issue even longer, and first time when I felt better with Fibro pain was when my doctor prescribed me a different antibiotic than I have taken before for another reason than my gut (I don’t recall the name of it right now). It was very mild on the stomach, I had no pain or any other unwanted symptom from taking it as I always do with others. It was the first time in years that I felt better in my body pain wise. I also started a low carb and no sugar diet soon after, and my overall pain went from 7-8 daily to 1-2 now, with flare ups, which don’t happen often. And now, whenever I have sugar, the pain in the body and headache return (I don’t have a diabetes, my sugar levels are normal).
        I also spoke to a friend recently, who has had Fibro for over a decade, who also mentioned taking some antibiotic recently for something and noticed her Fibro pain went down considerably.
        I have been going between specialists for a while now to figure out the cause of Fibro, and they can’t identify the cause. My immune system is compromised to the point that I have developed severe intolerance even to any leafy greens and to most other foods. So I eat meats, some fish, soups, stews, and broth, which seem to be the only foods I can tolerate without side effects these days.
        The closest I have come to any pain relief is cutting carbs, sugars, going off all my Fibro meds, as they were causing severe side effects like all over body burning, severe short term memory problems, etc. So now I am going to give a try to SIBO diet and see about that antibiotic I had before , and see what heppens after. I really hope this is going to be a more permanent fix to Fibro!

        Reply
        • Hi, Lexy. I haven’t been eating the best diet for a while. Your comment reinforced what I already knew, I have to cut the sugar out of my diet again. I was feeling so much better until I started eating sugary foods again. There may be more foods that I can’t tolerate anymore so I know I should go on an elimination diet. I have been putting it off for too long. Good luck on the SIBO diet. I hope you find relief.

          Reply
  2. Thank you for this. I’ve been doing tons of research and I’m glad to see that there is more than one way to skin the proverbial cat. I’m so tired and in so much pain, though. I think that is why so many continue to suffer. The solutions require more energy than the sufferer can manage. I just wish there was a food service (like Nutrisystem) that was affordable and specifically for sibo sufferers so that people that are too tired and in too much pain to cook could actually get better.

    Reply
  3. This is so interesting because I went to see a Dr. to lose weight. He put me on a diet that was highly restrictive. Basically it was no sugar and no carbs. While on this diet, the fibromyalgia pain,which had been debilitating, disappeared almost completely. I basically stayed on this diet for 4 years with no recurrence of th fibro symptoms. Then I went off this diet had added some sugar and carbs back in, not a lot. I got sick and was on two rounds of steroids. I had a huge fibro flare. Because of the steroids I gained some of the weight back. The Dr. recommended the diet again for both the fibro symptoms and the weight gain. As I have started back on the diet, I am already feeling the symptoms start to reside.

    Reply
    • Hi, Janet. Glad to hear you are feeling better. I am being reminded of how important diet is. I have been feeling awful for months and finally realized it was because I started eating sugar again.

      Reply
  4. Hi Sue,
    Thank you so much for writing this article, I found it to be very helpful!
    I’ve had Fibro for as long as I can remember and have had RA for the past 11 years.
    The list of meds I’m on is ridiculous (Humira and Morephine just two name a few) and they just keep adding more every year while Never addressing the root cause! Well, I’ve had enough! I’ve decided to heal myself through diet/nutrition. As a person who has never studied nutrition it’s a very daunting task, as I’m sure you can imagine!
    Your article is pointing me in the direction I need to go, so Thank You, again! I love your Blog! Best wishes, Lynnie

    Reply
    • Hi, Lynnie. I am glad I could help. Diet is the best place to start. A few years ago, I didn’t know squat about nutrition and I remember how overwhelmed I felt. The first thing I did is cut out sugar. That alone, made a big difference. As I cut an unhealthy food out of my diet, I added a healthy one in. It is hard to give up foods you love forever so I set my goal as 90/10. Ninety percent of my diet has to be healthy, nutritious, anti-inflammatory foods. Good luck and thank you!

      Reply
  5. Small intestine bacterial overgrowth can be very harmful if not diagnosed early. The reason behind a bacterial overgrowth in the small Bowel can be anything from diverticulitis to neurological and muscular diseases. The best way to identify the bacterial overgrowth is through SIBO Breath Testing. For SIBO Breath test, you can Visit Biohealth Laboratory.

    Reply
  6. Hello Sue, I just came across your site in my research/advocacy for my battle with diagnosed Fibro and SIBO, along with my chronic IBS. I do have a team of doctors, but due to the snail’s pace of finding answers, and the fact they sometimes scratch their heads at what to do next, I, in the meantime, read and read and read. This article just hit the nail on the head and was kind of an “Ah ha” moment for me. I found this yesterday while in the middle of a several day severe flare up where I could barely get out of bed due to the pain. So I decided to reduce my intake of sugar (in the form of table sugar, as I follow a strict FODMAP diet already), and today I am feeling much better! Now, that could be coincidence, but I have hope. I have a huge sweet tooth, so it will be a difficult challenge…but one I MUST try! As with anyone suffering from chronic health issues, I am desperate to have my life back, and to be my former strong, healthy, happy, vibrant self again…or some semblance of it at least. Life is passing me by, and that is the most difficult part of it all…even worse than the symptoms sometimes. I look forward to reading more of your blog articles…thank you so much for being a warrior for all of us who are desperate for answers. God bless you!

    Reply
    • Hi, Andrea. I have a sweet tooth too. I have managed to give up table sugar and soda completely. I don’t even miss it but Chocolate Paradice ice cream is my downfall. You have reminded me that I really need to pay more attention to my diet. Thanks for that and thank you so much for your kind words. 🙂

      Reply
  7. Diagnosed with SIBO in fall 2019. Insurance denied the antibiotic route (thank god – would have been very compromised when Covid began). Had to go on a very restricted diet and it took about 16 months but things got better for quite awhile. But this is a very difficult way to live. I started adding things back in and it’s a slippery slope. Fibro pain is back – lots of inflammation, sleep disturbance, weight gain, etc. I know I have to go back to some of the things that were working. Primarily gluten free, sugar free, dairy free. But I also had to eliminate nightshade veggies, caffeine, nuts. Really difficult since I’m vegetarian on top of all the rest so taking supplements. At least some of IBS symptoms and reflux subsided. Prayers to all suffering through this challenging diagnosis

    Reply

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