🧠 Fibromyalgia & IBS: What's the Connection?

Hi Friend

I hope you are well and had a good week.

If you live with fibromyalgia, chances are you’ve also experienced digestive issues. Bloating, cramps, diarrhoea, constipation — sound familiar?

You're not alone. Up to 70% of people with fibromyalgia also meet the criteria for IBS (Irritable Bowel Syndrome). But why do these two seemingly different conditions so often go hand-in-hand?

🧩 Shared Roots: The Gut-Brain-Pain Axis

Fibromyalgia and IBS are both considered functional disorders, meaning symptoms are real and disabling but don’t always show up on standard tests. What they share is dysregulation in how the brain processes pain and stress.

This is part of what’s called the gut-brain axis — a two-way communication system between your digestive system and your nervous system. In fibromyalgia, the brain becomes hypersensitive to pain; in IBS, the gut becomes hypersensitive to normal digestion processes. In both, the nervous system is in a state of overdrive.

🔬 The Science Behind the Overlap

• Visceral hypersensitivity: People with fibromyalgia have an amplified response to pain. This extends to the gut, where even mild gas or movement can feel painful.

• Small fibre neuropathy: Some studies show small nerve fibre damage in both conditions, which may help explain the widespread symptoms.

• Mast cell activation: Both conditions may involve mast cells releasing histamine and inflammatory chemicals that irritate nerves — especially around the gut lining.

• Autonomic dysfunction: Many with fibromyalgia have dysautonomia (POTS, poor vagal tone), which can slow or disrupt gut motility, contributing to IBS symptoms.

🥦 Does Diet Help?

Yes — for many people, modifying diet can reduce IBS symptoms, which in turn may reduce overall fibromyalgia flare-ups. Some approaches that show promise:

• Low FODMAP diet: Reduces fermentable sugars that cause gas and bloating.

• Anti-histamine diet: If MCAS is suspected, reducing histamine-rich foods may help.

• Gluten-free or dairy-free: Helpful for some, especially if there’s co-existing intolerance or leaky gut.

🧘‍♀️ Soothing Both Gut and Brain: Evidence-Based Treatments

Because fibromyalgia and IBS share overlapping mechanisms — such as heightened pain sensitivity, nervous system dysregulation, and possible immune activation — treatments that support nervous system regulation, gut motility, and inflammation control can benefit both conditions.

1. Nervous System Regulation

• Vagal Nerve Stimulation Techniques

  • Slow, deep breathing (especially prolonged exhale)

  • Humming, gargling, or chanting

  • Cold exposure to the face

  • Somatic practices like TRE (Tension & Trauma Releasing Exercises)

• Cognitive Behavioural Therapy (CBT) Shown to reduce both IBS and fibromyalgia symptom severity.

• Gut-directed hypnotherapy Proven in multiple RCTs to significantly reduce IBS symptoms.

• Mindfulness-Based Stress Reduction (MBSR) Meditation, yoga, or tai chi can help reduce central sensitisation.

2. Targeting Inflammation and Mast Cells

• Antihistamines and Mast Cell Stabilisers H1 and H2 blockers like loratadine; natural stabilisers like quercetin.

• Low Histamine Diet Avoid aged, fermented, or histamine-rich foods.

• Omega-3 Fatty Acids & Curcumin Anti-inflammatory and neuroprotective.

3. Improving Gut Motility and Microbiome Health

• Low FODMAP Diet Short-term use can reduce symptoms; reintroduce carefully.

• Probiotics & Prebiotics Strains like Bifidobacterium infantis or Lactobacillus plantarum.

• Magnesium Glycinate or Citrate Helps with muscle relaxation, sleep, and bowel regularity.

• Peppermint Oil Capsules Reduces IBS pain via smooth muscle relaxation.

4. Additional Therapies

• Acupuncture May modulate pain and improve autonomic balance.

• Amitriptyline / Nortriptyline (Low Dose) Off-label use for pain, gut motility, and sleep.

• SSRIs / SNRIs Useful where anxiety/depression coexists with chronic symptoms.

I hope this was useful for you. As mentioned in my previous email the research project into fibromyalgia will be starting next week so keep an eye for invites to the group sessions! Really looking forward to all your input.

As always stay well

Regards

Dr Ahmed