Fibromyalgia SIBO

Hello Everyone,

I haven't posted for quite sometime, but I wanted to share something that I learned recently. It was suggested sometime ago here on the forum that probiotics may exacerbate small intestine bowel overgrowth, and because this seemed to be true in my case (I also have symptoms of fibromyalgia), a few days ago I contacted Dr. Pimentel, who conducted the research in the article which I am posting. He and his team feel that probiotics DO exacerbate this problem, especially lactobacillus. So if you suspect that SIBO is an issue for you, then be careful with probiotics.

The following article is not new, but maybe some newcomers have not read it:

Small Intestinal Bacterial Overgrowth: A Possible Association with Fibromyalgia

J of Musculoskeletal Pain, Vol. 9(3) 2001, pp. 107-113

Mark Pimentel, Evelyn J. Chow, David Hallegua, Daniel Wallace,
Henry C. Lin

Mark Pimentel, MD, is Assistant Clinical Director, GI
Motility Program, and Clinical Instructor of Medicine, UCLA.
Evelyn J. Chow, BA, is affiliated with the GI Motility Program, UCLA.
David Hallegua, MD, is affiliated with UCLA.
Daniel Wallace, MD, is Clinical Professor of Medicine, UCLA.
Henry C. Lin, MD, is Director, GI Motility Program and Section of
Nutrition, and Associate Professor of Medicine, UCLA.

Address correspondence to: Mark Pimentel, MD, Cedars-Sinai Medical
Center, 8635 West 3rd Street, Suite 770 W, Los Angeles, CA 90048 [E-mail:
mailto:mark.pimentel@cshs.org].
Submitted: January 3, 2001.
Revision accepted: February 6, 2001.

ABSTRACT.

Objectives: Subjects with fibromyalgia [FMS] frequently have nonspecific
bowel complaints similar to subjects with small intestinal bacterial
overgrowth [SIBO]. The aim of this study was to test whether 1. SIBO is
prevalent in FMS and 2. If treatment of SIBO reduces bowel symptoms.
Methods: Of 815 subjects undergoing lactulose hydrogen breath testing for
assessment of SIBO, 123 patients had FMS. Those with SIBO were treated
with antibiotics. At the initial and follow-up visits, subjects were
asked to rate their symptoms. Symptom scores before and after treatment
were compared.

Results: Of the 123 subjects with FMS, 96 [78%] were found to have SIBO.
Returning subjects reported a 57 � 29% overall improvement in symptoms
with significant improvement in bloating, gas, abdominal pain, diarrhea,
constipation, joint pains, and fatigue [P < 0.05].
Conclusions: 1. Small intestinal bacterial overgrowth is associated with
FMS, 2. Eradication of SIBO improves intestinal symptoms in FMS.

KEYWORDS. Bacterial overgrowth, fibromyalgia

INTRODUCTION

Fibromyalgia [FMS] is a chronic condition resulting in soft tissue
hyperalgesia. The American College of Rheumatology defines FMS as a
history of widespread pain affecting the right and left side of the body
for a minimum duration of three months in the setting of 1 I out of 18
predefined tender points (1). While FMS is defined by these soft tissue
findings, the association of FMS with intestinal symptoms is well known.
The common intestinal complaints in FMS include excessive gas, bloating,
abdominal pain, and altered bowel habits (2). Some of these symptoms are
consistent with irritable bowel syndrome [IBS] so that the lifetime
incidence of IBS in subjects with FMS is as high as 52% (3). At the time
of presentation, 17% of patients with FMS are already labeled with IBS
and 81 % of subjects reported irregular bowel habits (2,4). However, even
with such strong associations there is no known cause of FMS and its
associated intestinal symptoms towards which diagnosis or treatment can
be directed.

Small intestinal bacterial overgrowth [SIBO] is a condition where colonic
aerobic and anaerobic bacteria are expanded into the small intestine.
Since the symptoms of SIBO overlap with the intestinal symptoms of FMS,
we tested the hypothesis that SIBO is associated with FMS using a symptom
database of patients undergoing a lactulose hydrogen breath test [LHBT].
We also tested the hypothesis that the treatment of SIBO reduces the
gastrointestinal symptoms of patients with FMS.

[Copies of the complete article are available for a fee from The Haworth
Document Delivery Service: 1-800-342-9678. E-mail address:
mailto:getinfo@haworthpressinc.com Website: http://www.HaworthPress.com ]

� 2001 by The Haworth Press, Inc. All rights reserved.

Best wishes for a safe and peaceful holiday season, and a healthier New Year for us all.


Thanks for posting this, Mary G. I've had fibro for many years, and take Natren's Healthy Trinity daily, which contains lactobacillus as well as bifidum. Without it, I seem to develop leaky gut symptoms, but with it, my gut works pretty well. However, lately, I've developed fibro pain (neurological type pain) in my left hand, which seems to correlate to whatever's going on in my gut. When a bowel movement is imminent, for example, the hand pain really flares, then subsides afterwards. If I eat something that my gut doesn't appreciate, the hand pain starts up again. Not sure I understand yet what all this means, except that there's very definite link between bowel & fibro. Maybe I should try restricting my probiotics to only bifidum & see what happens?

Thanks again,



Madge, Natren's makes a good bifidus product. I always used the powder.

MG


That's really interesting.. I have been diagnosed with fibromyalgia as well, and the interesting thing is that my symptoms began after two rounds of Diflucan, one round of antibiotics, (followed with me loading up on probiotics).

Very interesting..


I definitely had intestinal dysbiosis (bacterial overgrowth and candida) but I never had the lactulose breath test that Dr. Pimentel used in his research, so I was never sure if the small intestine was involved. I did notice a change for the worse, however, whenever I took probiotics (except for bifidus). Bifidus actually seemed to help. I had been curious about it for a long time and that's why I decided to ask his professional opinion. As I mentioned in my previous post, according to the research team, the lactobacillus especially seems to be a real problem in cases of SIBO.


Lactobacillus acidophilus makes D-lactic acid, which logically could be a problem in fibromyalgia. However, there are other lactobacillus strains that don't make D-lactic acid. I wonder why these are such a problem?


Polly, perhaps Dr. Pimentel could answer this question. I admit that I don't know the answer.