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

SIBO, Fatigue, and Your Gut Health

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.

SIBO fatigue: Illustration of man looking defeated

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

sibo fatigue: man holding his stomach in pain

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 Trusted SourcePubMedGo to source].
  • 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 Trusted SourcePubMedGo to source].

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 Trusted SourcePubMedGo to source].
  • 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 Trusted SourcePubMedGo to source].
  • A research review identified non-celiac gluten sensitivity as one possible cause of chronic, watery diarrhea [5 Trusted SourcePubMedGo to source].

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 Trusted SourcePubMedGo to source, 7 Trusted SourcePubMedGo to source], 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 Trusted SourcePubMedGo to source]. A meta-analysis of 17 studies found more than 50% of IBS patients have fatigue symptoms [9 Trusted SourcePubMedGo to source]. 

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 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].

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 Trusted SourcePubMedGo to source]. 
  • 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 Trusted SourcePubMedGo to source].
  • Another study surveyed patients with both IBS and a mood disorder. Two-thirds of this population experienced IBS before they had mood symptoms [16 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].

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 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source].

Rosacea

middle-aged woman with Rosacea

One compelling study links SIBO and rosacea [21 Trusted SourcePubMedGo to source], 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 Trusted SourcePubMedGo to source].

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 Trusted SourcePubMedGo to source], with 59% of RLS patients testing positive on a SIBO breath test. Another small study treated 13 patients with both RLS and SIBO [24 Trusted SourcePubMedGo to source]. 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 Trusted SourcePubMedGo to source] . 

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 Trusted SourcePubMedGo to source].

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

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

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 Trusted SourcePubMedGo to source, 38 Trusted SourcePubMedGo to source, 39 Trusted SourcePubMedGo to source].

nutrient absorption

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.

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 Trusted SourcePubMedGo to source], diet [43 Trusted SourcePubMedGo to source], fasting [44 Trusted SourcePubMedGo to source], digestive supports [45 Trusted SourcePubMedGo to source], 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.

➕ References
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