Gut Health: Fibromyalgia and SIBO

Fibromyalgia

Fibromyalgia & SIBO: The Gut-Pain Connection

At first glance, fibromyalgia and gut health might seem like separate conversations — one rooted in chronic pain and fatigue, the other in digestion and bloating. But more and more research is uncovering an important connection between these two areas, suggesting that for many people, healing fibromyalgia may begin in the gut. Spoonies (an affectionate term for people with fibro- counting their energy units in “spoons”) out there, listen up!

Understanding Fibromyalgia. So Much More Than Just Pain

Fibromyalgia (FM) is a complex, multifactorial condition that affects an estimated 2-4% of the population — mostly women. It’s characterised by chronic, widespread musculoskeletal pain, unrelenting fatigue, non-restorative sleep, and cognitive symptoms often referred to as fibro fog. Muscle stiffness, sensitivity to touch, headaches, and digestive problems frequently accompany these symptoms. What’s particularly challenging is the fluctuation of symptoms – some days are manageable, others can feel nearly impossible.

Despite its growing recognition, fibromyalgia remains difficult to treat using conventional methods alone. That’s where a naturopathic lens can offer valuable insights, especially when we consider what’s going on in the gut.

The Fibromyalgia-Gut Axis: What the Research Is Telling Us

Many people with fibromyalgia experience significant digestive symptoms — often diagnosed as Irritable Bowel Syndrome (IBS). In fact, up to 70% of FM patients meet criteria for IBS. But a growing body of evidence suggests we should look deeper than IBS alone.

Enter Small Intestinal Bacterial Overgrowth – better known as SIBO.

SIBO occurs when bacteria, normally found in the large intestine, migrate up into the small intestine where they don’t belong. This can cause a wide array of symptoms: gas, bloating, constipation or diarrhea, nausea, fatigue, and nutrient malabsorption. Alarmingly, some studies have found SIBO present in up to 100% of fibromyalgia patients tested – a connection that’s hard to ignore.

How SIBO May Worsen Fibromyalgia Symptoms

One proposed mechanism linking SIBO and fibromyalgia is increased intestinal permeability, or “leaky gut.” This allows bacterial components like lipopolysaccharide (LPS) to enter the bloodstream, where they trigger systemic inflammation. LPS is known to activate microglia in the brain — cells involved in central sensitization, the neurological mechanism behind chronic pain in FM. It’s also been linked to:

TLDR;, an unhealthy gut can feed a pain-promoting cycle that spirals outward through the entire body.

Supporting the Gut Naturally: A Naturopathic Approach

When SIBO is present, it’s not just about reducing bacterial overgrowth – it’s about healing the gut as a whole and restoring balance. Here’s how we can approach this holistically:

1. Break the Biofilm

SIBO bacteria often hide behind protective biofilms, making them resistant to treatment. Using proteolytic enzymes can help disrupt these layers:

This makes antimicrobials more effective and helps break the cycle of relapse.

2. Antimicrobials & Herbal Medicine

Gentle, targeted herbal antimicrobials can support the body in rebalancing the gut microbiome:

These botanicals may also support reduction in abdominal pain, bloating, and irregular bowel habits common in both SIBO and FM.

3. Address Hypochlorhydria & Digestive Weakness

Low stomach acid can predispose to SIBO by reducing the natural barriers to bacterial overgrowth. Support may include:

4. Heal the Gut Lining

A compromised gut lining needs care. Use of mucilaginous herbs and nutrients that promote tissue repair can be central:

These support mucosal integrity, reduce inflammation, and help seal a “leaky gut.”

5. Mindful Use of Probiotics

Probiotics can be tricky in SIBO. While certain strains may be helpful, others can worsen symptoms — especially in methane-dominant cases. Studies have shown that:

For this reason, probiotic therapy must be highly individualised.

6. Bind & Clear

For patients experiencing high gas, toxin release, or die-off reactions, binders can offer relief by absorbing and carrying out microbial byproducts:

Testing for SIBO – Is It Always Necessary?

Breath testing (measuring hydrogen and methane levels) is the gold standard for diagnosing SIBO. It can be a helpful tool to track progress or confirm clinical suspicion, but it’s not always essential. Treatment decisions can often be made based on clinical presentation.

Final Thoughts. Whole – Body Healing Starts with the Gut

For those living with fibromyalgia, digestive issues may seem like just one more thing to deal with – but they could hold the key to broader healing. Addressing gut dysfunction, particularly SIBO, may help reduce systemic inflammation, modulate pain, improve energy, and even clear the dreaded fibro fog.

The body has an incredible capacity to heal when we support it at the root level. If you’re dealing with fibromyalgia and suspect your gut health may be playing a role, consider speaking with a naturopathic practitioner experienced in complex, overlapping conditions.

You don’t have to live with chronic pain — and your gut may be the place to start.

My name is Ash, and I am a naturopath in Kalamunda, Perth Hills. Fibro and SIBO are no strangers to me – I suffered with them in the past and corrected them through naturopathy and diet. So I understand the challenges and emotional turmoil that these conditions cause. If you are interested in having chat or addressing your health, get in touch. Perhaps my Digestion Restoration Package is for you, or book in for a consult!