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Misunderstood Symptoms of SIBO: Fatigue, Brain Fog, and More

Written by Michael Ruscio on October 17, 2020

Heidi Turner

Written by Michael Ruscio on October 17, 2020 — Reviewed by Heidi Turner Heidi Turner

SIBO, Fatigue, and Your Gut Health

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Small intestinal bacterial overgrowth (SIBO) is known to cause many digestive symptoms. But did you know that SIBO may also cause non-digestive symptoms like fatigue, brain fog, poor mood, headache, joint pain and much more?

If you struggle with fatigue and other unexplained SIBO symptoms, gut treatments like probiotics and diet might not be top of mind. However, they can be very helpful. 

Let’s take a closer look.

What is SIBO?

SIBO is an overgrowth of bacteria in the small intestine, a location that normally has low levels of bacteria. A glucose or lactulose breath test is used to diagnose SIBO.

Symptoms of SIBO

sibo fatigue: SIBO definition and list of SIBO symptoms

SIBO symptoms can vary from person to person. While some may have digestive symptoms, others have no symptoms at all. 

More frustrating for SIBO patients is the long list of non-digestive symptoms they may experience. Some symptoms of SIBO (fatigue, poor mood, brain fog and “lack of well-being” for example) can seem vague with no evident cause. However, they often originate in the gut.

Here’s an overview of the broad range of possible SIBO symptoms.

No Symptoms

Some patients test positive for SIBO and have no symptoms at all. In this case, there is no need for SIBO treatment.

Digestive Symptoms

More often, patients who test positive for SIBO have symptoms similar to irritable bowel syndrome (IBS), which include bloating, distension, indigestion, cramping, reflux, flatulence, diarrhea and/or constipation.

Research suggests strong associations between IBS and SIBO, which means IBS symptoms aren’t uncommon in SIBO:

  • A meta-analysis reviewed 50 studies and found that IBS patients were nearly five times more likely to test positive for SIBO compared to healthy controls 1.
  • One clinical trial diagnosed SIBO in up to 85% of IBS patients, although other trials found lower (but still significant) rates. According to the meta-analysis, more than one-third of IBS patients tested positive for SIBO across 50 studies 2.

This research suggests that SIBO is the cause of some, but not all, IBS cases.

Research also suggests associations between SIBO and inflammatory bowel disease (including colitis and Crohn’s disease). Associations between SIBO and celiac disease/non-celiac gluten sensitivity have also been found.

  • In a meta-analysis of 11 studies, researchers found that IBD patients were more likely to have SIBO than healthy controls. Overall, the rate of SIBO in IBD patients was 22.3% 3.
  • A systematic review found a higher rate of SIBO in patients with celiac disease. Overall the rate of SIBO in celiac patients was 20%. However, this rate increased to 28% for celiac patients who did not experience relief following a gluten-free diet 4.
  • A research review identified non-celiac gluten sensitivity as one possible cause of chronic, watery diarrhea 5.

Fatigue

Of all the symptoms of SIBO, fatigue is often the most debilitating and frustrating.

There’s plenty of anecdotal evidence to suggest that fatigue is common for SIBO patients — I observe this in the clinic all the time. But, it’s important to always check clinical observations against science. Unfortunately I haven’t found any studies that investigate whether SIBO causes fatigue, so there is simply a lack of research information in this area.

However if we look at studies into other gut conditions, some associated with SIBO 6 7, we see a clear pattern of fatigue across gut conditions.

For example, one study found fatigue was very common in patients with irritable bowel syndrome (IBS), and it was associated with poor quality of life 8. A meta-analysis of 17 studies found more than 50% of IBS patients have fatigue symptoms 9. 

A very large study into non-celiac gluten sensitivity found lack of well-being and tiredness were reported as the most common symptoms after bloating and abdominal pain 10. Sixty-eight percent of gluten sensitive individuals reported lack of well-being, and 64% reported tiredness.

Fatigue is also a symptom in nearly 50% of patients with inflammatory bowel disease (IBD) according to another review 11. This includes patients with Crohn’s disease and ulcerative colitis. One survey of IBD patients found lack of energy was more burdensome than digestive symptoms 12.

Gut treatments have also been shown to help with fatigue: 

  • Treating leaky gut reduced fatigue and other symptoms in patients with chronic fatigue syndrome 13. 
  • A low FODMAP diet improved fatigue in patients with IBS and fibromyalgia 14. 

Again, my clinical experience is very similar — patients often tell me they got their energy back after improving their gut health.

So, while we wait for more research specific to SIBO, fatigue can be associated with gut conditions in general.

Mood Disorders

Once again, we lack research regarding the connection between SIBO and mood. However, we can look to other studies for insights about depression, anxiety, and gut health.

  • In a survey of 160 IBS patients, depression and anxiety were found to be common symptoms 15.
  • Another study surveyed patients with both IBS and a mood disorder. Two-thirds of this population experienced IBS before they had mood symptoms 16. This implies gut disturbances may be a source of anxiety and depression.
  • Individuals with non-celiac gluten sensitivity also reported anxiety (39%) and depression (18%) 17.

Can gut treatments help with mood disorders? A meta-analysis of 10 clinical trials showed probiotics are effective for treating mild to moderate depression 18. In a systematic review of 21 anxiety studies, more than half of the subjects saw improvements in anxiety symptoms when diet and/or probiotics were used to support microbiome health 19.

Finally, additional research suggests that a gluten-free diet may improve mood of those with celiac disease, IBS, and non-celiac gluten sensitivity 20.

Rosacea

One compelling study links SIBO and rosacea 21, an inflammatory condition of the blood vessels most often seen on the face.

Researchers in this study found a much higher prevalence of rosacea in SIBO patients when compared to healthy controls. What’s very exciting is 93% of rosacea patients with SIBO saw complete elimination or significant improvement in rosacea lesions after SIBO treatment 22.

Restless Leg Syndrome

Restless leg syndrome (RLS) has also been connected to both SIBO and IBS. 

One study found SIBO and IBS are common in patients with RLS 23, with 59% of RLS patients testing positive on a SIBO breath test. Another small study treated 13 patients with both RLS and SIBO 24. Ten of the 13 patients achieved at least 80% improvement in their RLS symptoms.

Joint Pain

Another common complaint I see with gut patients is sore joints. So, it’s interesting to see one small study successfully used a two-week elemental diet (a gut therapy often used for SIBO patients) to improve joint stiffness and pain in patients with rheumatoid arthritis 25. 

Headache

SIBO patients may also suffer with headaches. Once again, this symptom is commonly seen in other gut conditions.

Research suggests migraine patients may be more likely to have IBS 26. In a survey of gluten-sensitive individuals, 54% identified headaches as a symptom 27.

In one small study of patients with non-celiac gluten sensitivity, dietary changes significantly reduced the impact of migraine on patients’ daily activities 28.

Why Does SIBO Cause So Many Different Symptoms?

SIBO, like many other gut conditions, falls under the broad term of digestive tract dysbiosis. Dysbiosis simply means an imbalance of bacteria, fungus, and other digestive system organisms.

When you understand the connections between your gut health, your immune system, inflammation, and nutrient absorption, it’s easier to understand how a condition like SIBO can lead to a wide array of health problems.

Immune System

The health of your digestive tract and the health of your immune system are closely linked. Unbalanced gut bacteria activates your immune system. In fact, your small intestine contains the greatest density of immune cells in your body 29. A chronically over-activated immune system leads to inflammation and immune reactions 30 31.

Inflammation

As a result of gut dysbiosis, your over-reactive immune system produces inflammation. Chronic inflammation is now understood as the root cause of many health conditions 32, both minor and life-threatening. The long list includes rosacea 33, cardiovascular disease 34 35, and Parkinson’s disease 36 — conditions that have been associated with SIBO in research 37 38 39.

Nutrient Absorption

Chronic inflammation leads to digestive tract lining damage 40. This can impair nutrient absorption. Severe cases of SIBO can lead to malabsorption of fats and carbohydrates, nutritional deficiencies (vitamin B12, A, D, E, K, and iron), and, for some, weight loss 41.

Added up, gut dysbiosis, inflammation, immune reactions and nutrient malabsorption can lead to a wide array of symptoms and chronic health conditions.

SIBO Treatment

sibo fatigue: treatment plan

SIBO treatment is best done through a combination of research-backed tactics that address intestinal dysbiosis and improves overall digestive health. Depending on the patient, this may include probiotics 42, diet 43, fasting 44, digestive supports 45, herbal antimicrobials 46, and/or an antibiotic drug such as Rifaximin.

Poor Gut Health May Be the Root Cause of Your Fatigue

If you struggle with symptoms like fatigue, brain fog, poor mood, headaches and other unexplained symptoms, I encourage you to pay attention to improving your gut health. Don’t let inflammation and immune dysregulation wreak havoc on your health. An experienced practitioner can help you diagnose SIBO through breath testing and guide you through treatment options. On the other hand, there is much you can do to improve your gut health on your own. My book, Healthy Gut, Healthy You, provides a step-by-step process for better gut health and fewer burdensome symptoms.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

➕ References

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  2. Chen B, Kim JJ, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. PMID: 29761234.
  3. Shah A, Morrison M, Burger D, Martin N, Rich J, Jones M, Koloski N, Walker MM, Talley NJ, Holtmann GJ. Systematic review with meta-analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease. Aliment Pharmacol Ther. 2019 Mar;49(6):624-635. doi: 10.1111/apt.15133. Epub 2019 Feb 8. PMID: 30735254.
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