The Hidden Cause of Fibromyalgia. You Probably Don’t Know

Fibromyalgia is one of the most common pain syndromes, affecting 2-4% of the population. (1) Unfortunately, it is also one of the least understood.

The hallmark of fibromyalgia is pain. There is pain in places we carry stress: the neck, shoulders, hips, and low back. Then there is chronic pain in the arms, thighs, chest, and rib cage.

The medical community does not yet know what causes fibromyalgia or agree on how to remedy it.

Currently, if you are diagnosed with fibromyalgia, you may be told to exercise, think positive thoughts, and take an anti-depressant or muscle relaxant.


Several studies now tie fibromyalgia back to the gut. There is a strong relationship between fibromyalgia and bacterial overgrowth in the small intestine, a condition known as SIBO, or small intestine bacterial overgrowth. (2)(3)

One study that was published in Annals of the Rheumatic Diseases in 2004 found a 100% correspondence of fibromyalgia with SIBO. (4)

Researchers have finally linked fibromyalgia to the health of the gut! One study showed a 100% connection between fibromyalgia and small intestine bacterial overgrowth, the direct result of an imbalanced inner ecosystem.


In a double blind study, participants were asked to take a lactulose breath test, the gold standard when it comes to measuring overgrowth in the small intestine, which checks the breath for the presence of hydrogen. Bacteria produce hydrogen gas or methane as they feed.

Researchers at the Cedars-Sinai Medical Center found that 100% of the participants with fibromyalgia had abnormal test results. They also found that the more abnormal the test results, the more pain a fibromyalgia volunteer was in.

The degree of bacterial overgrowth in the small intestine has a direct relationship with the severity of fibromyalgia.

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When bacteria overrun the small intestine, whether good or bad bacteria, problems quickly arise. This is because the small intestine is meant to smoothly shuttle food from one end of the digestive tract to the other.

How things can go wrong:

  • Enzymes play an important role. If there are not enough of the right enzymes in the small intestinal tract, which are known as brush-border enzymes, food slows its transit time, and bacterial populations begin to grow.
  • Diet also matters. When we eat a carb-heavy meal, or if we are unable to break down certain plant fibers, this feeds resident bacteria.
  • The wrong kind of bacteria starts to grow. Whether its food poisoning or a small, resident populace of disease-causing microbes, these bad bugs can actually secrete an opiate-like substance that will slow down the wave-like motion of the small intestine. This gives food a chance to rot and microbial communities the opportunity to grow.
  • Diabetes and hypothyroidism affect digestion. In both diabetes and hypothyroidism, something known as the migrating motor complex slows down. The migrating motor complex (MMC) is a set of wave-like movements that keeps food and bacteria moving. Oftentimes, bacteria from the large intestine creep up into the small intestine. With a robust MMC in place, this is usually not a problem. When the MMC weakens or slows down, these bacteria are given the opportunity to proliferate.<

Communities of bacteria in the small intestine and throughout the intestinal tract are normal and expected. It is only when these communities get out of control that problems arise. In any healthy ecosystem, balance is key.


Once our inner ecosystems reach a state of imbalance, the intestinal lining can become “leaky,” or permeable. This becomes a problem because bacteria produce their own toxins and waste products.

These are toxins like:

Lipopolysaccharide (LPS): Otherwise known as endotoxin, this molecule gives structural support to certain bacteria. It also elicits a strong response from our immune system.

Endotoxins contribute to inflammation in the body. We also know that in fibromyalgia patients, it leads to increased pain. (5)

Tryptophanase: Another by-product of some bacteria is an enzyme that degrades tryptophan, called tryptophanase. Tryptophan is an amino acid that may sound familiar. That is because it gets quite a bit of attention as a precursor to serotonin. Without tryptophan, serotonin (our happy brain chemical) could not be made. And without serotonin, it is pretty difficult to manufacture melatonin (our sleepy brain chemical).

Serotonin helps us feel relaxed and happy. It is also important for gut motility, the migrating motor complex that we mentioned earlier. Serotonin deficiency contributes to pain, carbohydrate cravings, and fatigue.

Melatonin helps us fall asleep easily. It also helps to reboot our energy on a cellular level.

When large amounts of the enzyme tryptophanase are busy breaking apart tryptophan, the body no longer has the building blocks that it needs to make enough serotonin and melatonin. This contributes to fibromyalgia syndrome.


Once we know what causes a group of symptoms, we can do something about it.

Luckily, scientists have already done the research showing that SIBO has a direct relationship with fibromyalgia.

While there is not a universal cause-and-effect relationship, we know that bacterial overgrowth can show up as fibromyalgia. If you have been diagnosed with fibromyalgia:

1. Request a lactulose breath test. This can help to determine if you have SIBO.

2. Follow The Body Ecology Diet. Even if your breath test comes back normal, it is essential to remove anything that may reduce your pain threshold. Since studies show that leaky gut and bacterial toxins can contribute to pain, use your diet to protect your gastrointestinal tract and nervous system.

3. Supplement brush-border enzymes. Assist Full Spectrum Enzymes contains brush-border enzymes that help move things along in the small intestine, reducing your chances of developing SIBO.

4. Optimize the beneficial bacteria in your gut by eating fermented foods and drinking probiotic beverages. These foods will not only improve digestion, they will also help assist in repopulating the healthy flora in the intestines.



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