The Underlying Condition Present In Almost All Fibromyalgia Patients (And What to Do About It)

Laura D’Itri MSOM LAc is a certified Functional Medicine Practitioner who helps women recover from adrenal fatigue and Chronic Fatigue Syndrome (CFS) to get their health and their lives back. Laura’s personal journey with fatigue has allowed her to understand functional medicine from multiple angles. Her original background in Traditional Chinese Medicine has given her the ability to utilize various methods of treating the whole person through both ancient and new systems of medicine. Laura has her certification in functional medicine from the Kalish Institute of Functional Medicine and currently works with women all over the U.S. She lives in Los Angeles with her husband and two dogs.

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Fibromyalgia is disorder that causes chronic, widespread musculoskeletal pain in specific locations. Other symptoms include fatigue, headaches, sleep problems, numbness and tingling in the hands and feet, “stimulation overload,” and often digestive disturbances as well. Fibromyalgia used to be greatly tied to Chronic Fatigue Syndrome/CFS, although now I see that connection less often. As another “mystery illness,” it can present similarly to CFS but often includes the “tender points” of pain as well.

If you’re reading this, you may know exactly what fibromyalgia is already. You might have it or know someone that does. Fibromyalgia can be frustrating, confusing, and can make you feel completely hopeless at times. 

As a functional medicine practitioner, I know how valuable it can be to look at the root cause of disease. I know fibromyalgia, just like Chronic Fatigue Syndrome, always has an underlying cause. And likely has multiple underlying causes.
Fibromyalgia can be triggered by a traumatic event, extreme stress, a physical injury, or an illness. Once one body system is affected, others tend to follow suit.

The Causative Factor of Fibromyalgia
The most likely causative factor of fibromyalgia has much less to do with the actual muscles, and much more to do with the digestive system.r Studies have shown that Small Intestine Bacterial Overgrowth a.k.a. SIBO is present in 78 – 100% of fibromyalgia patients. 

Keep in mind that just because two conditions appear together doesn’t mean they cause each other, but because we know exactly how SIBO affects the body, we can reasonably assume SIBO is a huge underlying factor in the development of fibromyalgia. 

The first causative link is that SIBO can cause oxidative stress in the cells. This decreases mitochondrial function and therefor cellular energy production. Decreased cellular energy production due to mitochondrial damage has been found in the muscle biopsies of fibromyalgia patients. 

The second causative link has to do with serotonin. Serotonin is made from tryptophan, an essential amino acid we get from food. Just like us, the bacteria in SIBO take tryptophan out of the food we eat. By the time they’ve used up this important amino acid, there is little left for us to absorb. When we don’t get enough tryptophan, we can’t produce serotonin. We often think of serotonin as the “happy” hormone, but it’s also incredibly important in regulating pain. When we don’t have enough serotonin, pain can be incredibly apparent and intense.

What To Do About SIBO
We know SIBO likely plays a huge role in the development of fibromyalgia. Here are a few things you can do to get rid of SIBO and manage your pain and fatigue in the meantime:

1.    Support Your Serotonin
As we learned, serotonin is so important in fibromyalgia. Follow these tips to support healthy serotonin production in your brain:

•    Eat tryptophan-rich foods. Walnuts, dark chocolate, and potatoes are all high in tryptophan.
•    Avoid aspartame. Aspartame can make it hard for serotonin to reach the brain
•    Go outside in the sun. Natural sunlight exposure may increase serotonin in the brain.
•    Exercise regularly without overdoing itRegular exercise has been shown to increase serotonin production in the brain and help ease fibromyalgia symptoms. Don’t exercise so much that you’re more fatigued afterwards, but gentle exercises like yoga can be extremely beneficial and even energizing.

2.    Decrease Oxidative Stress    
We know that SIBO can cause oxidative stress and mitochondrial damage, and reversing this damage will likely go a long way towards reversing fibromyalgia. 

•    Get your antioxidants in. Antioxidants counter oxidation (it’s all in the name). When there’s oxidation at the cellular level, we need the antioxidants form fresh and colorful fruits and vegetables to offset it. Don’t forget to eat the peel when you can – the highest level of antioxidants in plants are in their peels!
•    Consider taking a CoQ10 supplement. CoQ10 is a powerful antioxidant which has been shown to be specifically helpful in fibromyalgia patients.

3.    Get Rid Of The Bacterial Overgrowth
Last but not least is of course getting rid of Small Intestine Bacterial Overgrowth itself. SIBO is always a direct result of slow motility, meaning your digestive tract isn’t moving as quickly as it should be. The bacteria that are supposed to stay constrained to the large intestine start creeping up into the small intestine, where it shouldn’t be!

•    Try intermittent fasting. If the SIBO doesn’t have anything to eat, theoretically it will starve. I’ve found intermittent fasting to be extremely helpful in some, but a bit more burdensome in others. Intermittent fasting usually means fasting for around 12-16 hours every evening and into the next morning. This strategy doesn’t work for everyone, and I do NOT recommend it if you also have adrenal fatigue a.k.a. HPA axis dysregulation… but it can be powerful when it does.
•    Take herbal antibiotics. The most tried-and-true herbal antibiotics to kill off SIBO are garlic, oregano oil, berberine, grapefruit seed extract, and olive leaf extract, among others.
•    Avoid high FODMAP foods. FODMAP stands for Fermentable Oligo-, Di-, Monosaccharides And Polyols. They’re specific types of carbohydrates that are often the perfect food for the actual bacteria in SIBO. Our goal is to starve these guys, so sticking to low FODMAP foods can greatly reduce SIBO and therefore fibromyalgia symptoms.
•    Increase your motility. Make sure you’re having a bowel movement daily. Magnesium citrate, apple pectin fiber, and regular exercise are all great options if you aren’t. If those aren’t working, Iberogast is a natural product that has been scientifically studied to increase motility.

SIBO and fibromyalgia can get mixed up in the greater issues of immune dysfunction, viruses like Epstein-Barr, persistent Lyme disease, and adrenal fatigue. Functional medicine can work to look at all these layers and use a targeted approach based on your symptoms and health goals. As with all chronic conditions like fibromyalgia, seek help from a medical professional for any symptoms you experience. 

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