Author: Stems From The Gut

  • Gut Recovery After Antibiotics or PPIs: A Gentle UK Guide

    Gut Recovery After Antibiotics or PPIs: A Gentle UK Guide


    Finished a course of antibiotics and now your digestion feels “off”? Or maybe you’ve been on omeprazole (or another PPI) for a while and something just doesn’t feel quite right: more bloating, looser stools, constipation, or just a general sense that your gut isn’t behaving as it used to. Well, you’re not imagining it! Both antibiotics and acid-suppressing medications can shift what’s happening inside your digestive system. The reassuring news is that for most people, things settle over time, and there are gentle, practical ways to support that process without expensive supplements or dramatic diet overhauls.

    If you’re looking for practical support with gut health after antibiotics, this guide will help you rebuild gently and steadily. This guide is written with sensitive digestion in mind, including those of us managing fibromyalgia, ME/CFS, or chronic stress patterns where “just eat more fibre” can be the fastest route to feeling worse.

    Quick takeaways

    Why antibiotics and PPIs can upset your gut

    Antibiotics do exactly what they’re designed to do: kill bacteria. The difficulty is that they don’t always distinguish between the bacteria causing an infection and the bacteria that normally help your gut work smoothly. So for a while, your microbiome can become less diverse, and that can leave room for gas-producing or “opportunistic” microbes to flare up. That’s why some people notice bloating, looser stools, constipation, cramping, or food sensitivity during (or after) a course. PPIs (proton pump inhibitors) such as omeprazole and lansoprazole work differently. They reduce stomach acid, which is helpful for reflux and ulcers, but stomach acid also acts as a “gatekeeper” that influences which microbes make it further down the digestive tract. Lower acid levels may shift the microbial balance over time, and in some people, this links with changes in digestion, nutrient absorption, or infection risk. That doesn’t mean PPIs are “bad”; many people genuinely need them. It just helps to understand why your gut might feel different while using them, especially long-term. If you’d like the basics of how the microbiome works, start here: What is the gut microbiome?

    How long does gut recovery take?

    This varies far more than most articles admit. Some people feel back to normal within a few days of finishing antibiotics. Others notice changes for weeks and occasionally longer, especially after repeated courses, strong antibiotics, or if their gut was already sensitive.

    Recovery time can be influenced by the type and duration of antibiotic used, your baseline gut health, stress levels and sleep quality, how stable your eating pattern is, and whether you’ve been unwell or undernourished during treatment. With PPIs, gut shifts can be slower and more gradual. If you’ve been on one for months or years, it may take time for things to settle even after changes are made. The key point: most guts do recover, but it’s often a slower, gentler process than “do this for 3 days and fix it.”

    Gut health after antibiotics: what actually helps (evidence-informed and low-risk)

    These steps are designed for gut health after antibiotics, but they can also help if you’ve been using PPIs and your digestion feels unsettled.

    1) Go gentle with food first

    One of the most common mistakes after gut disruption is trying to “fix” things quickly, suddenly increasing fibre, adding lots of raw vegetables, or piling in fermented foods. For sensitive guts, that often backfires with more bloating, wind, discomfort, or urgent stools. Why it matters: your microbiome needs time to recalibrate. Throwing a huge amount of fermentable food at a system that’s unsettled can feel like adding fuel to a fire. A gentler starting point: begin with foods you already tolerate and keep portions moderate. Think steady nourishment, not a gut overhaul. Once you feel more stable for a few days, you can widen the variety slowly. If you’d like a step-by-step approach, we’ve written this specifically for sensitive guts: How to increase fibre without bloating

    2) Add prebiotic foods gradually (the “start tiny” approach)

    Prebiotic foods provide fuel for beneficial gut bacteria, but you don’t need powders, complicated protocols, or extreme diets to get started. A gentle place to begin is with one small change, such as a small bowl of oats (porridge or overnight oats), a slightly underripe banana (often gentler than very ripe ones for some people), or cooled potatoes or rice (a simple source of resistant starch). If that settles well, you can expand gradually. Other gentle options include cooked leeks/onions, barley in soups, or a small amount of lentils stirred into a meal, but the key is slow and steady, especially if you’re prone to IBS-type sensitivity or post-viral gut fragility. If you want the full explanation of what counts as prebiotic vs probiotic, this guide helps: Prebiotics vs probiotics vs postbiotics

    3) Fermented foods: helpful for some, not essential

    Fermented foods are often marketed as “gut healing must-haves”. In reality, they’re more personal than that. Some people feel noticeably better with them, some notice no change, and others feel worse at first (especially if bloating is already an issue). If you want to try them, the most gentle approach is to start very small, for example, a few spoonfuls of live yoghurt, a teaspoon of sauerkraut from the fridge section, or miso stirred into warm soup (not boiling water). If kimchi feels too strong, or kombucha feels too fizzy or acidic, skip for now. Fermented foods aren’t required for recovery; they’re just one tool, and only if your gut tolerates them. You can also read our full SFTG guide here: Fermented foods for gut health

    4) Probiotics after antibiotics — what the evidence actually says

    Some evidence suggests certain probiotic strains may reduce the risk of antibiotic associated diarrhoea (AAD) when taken during and shortly after antibiotics. But probiotics aren’t a guaranteed fix, and different people respond very differently. There’s also research suggesting that high dose probiotics may delay natural microbiome recovery in some cases, which is why we avoid blanket advice. If you choose to try a probiotic, the SFTG approach is to choose a product that names specific strains (not just “probiotic blend”), trial it for 2–4 weeks, then reassess, stop if it makes symptoms worse, and don’t chase “more CFUs” higher isn’t always better.

    Important: probiotics are usually safe for most people, but if you’re immunocompromised or seriously unwell, speak to your GP or specialist before using them. We’ll cover this in detail in our upcoming guide: Microbiome tests and probiotic supplements

    5) A “food + rhythm” reset (where recovery often accelerates)

    Your gut doesn’t only respond to what you eat. It responds to timing, sleep, stress load, and nervous system state. When stress is high, sleep is disrupted, and eating is irregular, digestion can become more sensitive, even if your diet looks “perfect” on paper. A few gentle resets can make a surprising difference: eating meals at roughly similar times each day, getting morning daylight (even briefly), a calmer evening wind down (dim lights, less screen glare), and gentle movement within your limits (especially important if you have ME/CFS or fibromyalgia). Think of it as creating conditions your gut can trust again: steady, predictable, and not demanding.

    6) Supporting the gut lining (without magic claims)

    You’ll see a lot of products promising to “heal your gut lining” or “seal leaky gut”. Some of that marketing is exaggerated. But supporting gut barrier function through basic nutrition is sensible and low risk. Helpful foundations include adequate protein across the day (your gut lining renews constantly), omega-3 fats (e.g., oily fish, walnuts, flax), polyphenol-rich foods (berries, olive oil, green tea, dark chocolate), and hydration, especially if you’ve had diarrhoea. This isn’t about curing chronic illness by “fixing your gut”. It’s about giving your body what it needs while it does its own repair work.

    7) If constipation is the problem

    Not everyone gets diarrhoea after antibiotics; some people become constipated, especially if their appetite has been low, their routine changed, or motility was already sluggish. Gentle options that often help include two green kiwis daily, prunes (start small and adjust), a warm drink in the morning, light walking if you can manage it, and a small amount of soluble fibre introduced slowly. If constipation persists, is painful, or is new and unexplained, it’s sensible to speak with your GP.

    8) If diarrhoea or urgency is the problem

    Loose stools and urgency are common during and after antibiotics, and for most people, they settle in days to a couple of weeks. In the meantime, focus on comfort and hydration: sip fluids regularly, consider an oral rehydration sachet if needed, use gentle binding foods temporarily (plain oats, rice, bananas), and avoid obvious triggers (alcohol, very fatty/spicy foods, artificial sweeteners). The goal here isn’t perfection, it’s keeping you stable and supported while your gut resets.

    A gentle 7-day rebuild plan (no strict rules)

    This isn’t a rigid protocol; instead, it’s a calming structure you can lean on. Days 1–2: settle + hydrate. Stick to foods you tolerate well. Rest counts as recovery. Days 3–4: add one gentle fibre source (oats/banana/small flax). Keep portions modest. Days 5–7: introduce one new prebiotic option (cooled potato, cooked leeks, small lentil portion). Optional: tiny fermented “taster” if you want to try it. Beyond: widen variety gradually. Small steps repeated calmly beat big swings every time.

    What to avoid (or be cautious with)

    Be cautious with “detox” supplements (often unnecessary and sometimes harsh), megadosing probiotics (more isn’t always better), forcing raw vegetables or huge salads too quickly, aggressive fasting while symptomatic (most people do better with gentle nourishment), and consumer microbiome tests marketed as “actionable” (often interesting, but rarely useful for recovery).

    When to speak to your GP

    Speak with your GP (or seek urgent care) if you have severe abdominal pain that doesn’t settle, high fever, blood in your stool, signs of dehydration (dizziness, confusion, very dark urine), symptoms lasting more than 2–3 weeks without improvement, symptoms getting worse rather than better, or persistent watery diarrhoea after antibiotics with cramping/fever (possible C. difficile).

    Bringing it together

    Gut recovery after antibiotics or PPIs doesn’t require perfection. It doesn’t require expensive supplements or dramatic changes. What it usually needs is time, gentle consistency, and a steady routine your gut can adapt to, especially if you’re already managing fatigue, pain, or sensitive digestion. Start where you are and keep it simple. Build slowly because your gut is resilient, and given the right conditions, it can recalibrate.

    Frequently asked questions

    How long does it take for gut bacteria to recover after antibiotics? For many people, recovery begins within days to weeks, but full recovery can take longer, especially after repeated courses or if your gut was sensitive beforehand. Focus on stability first, then gradually widen variety.
    Should I take probiotics after antibiotics? Some strains may reduce antibiotic associated diarrhoea risk, but probiotics aren’t essential for everyone. If you try one, choose a product that lists specific strains and assess after 2–4 weeks. Stop if your symptoms worsen though.
    What should I eat to restore my gut after antibiotics? Start with tolerated foods, then slowly add gentle prebiotic fibres like oats, cooked vegetables, and cooled potatoes. Fermented foods can be optional and introduced very slowly if tolerated.
    Can PPIs like omeprazole affect gut bacteria? Yes. PPIs reduce stomach acid, which can influence which microbes thrive in the gut. Many people do well on PPIs, but if symptoms develop over time, it’s worth discussing with a clinician.
    Why am I bloated after antibiotics? Antibiotics can temporarily reduce microbial diversity and shift fermentation patterns in the gut. This often improves over time, especially with steady eating, stress reduction, and gradual fibre increases.
    When should I worry about diarrhoea after antibiotics? Seek advice if it’s severe, persistent beyond two weeks, involves blood, fever, significant pain, or signs of dehydration. Persistent watery diarrhoea after antibiotics can sometimes indicate C. difficile infection.

    References (plain-English sources + key studies)

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  • Fermented Foods for Gut Health: A Gentle Guide

    Fermented Foods for Gut Health: A Gentle Guide

    Fermented foods can support gut health for some people, but they’re not essential, and they’re not a cure. Start with tiny amounts (1–2 teaspoons or a few sips) of something you tolerate (live yoghurt/kefir, miso, small amounts of sauerkraut). If bloating/IBS symptoms flare, pause and focus on basics like regular meals and fibre you can tolerate.

    This is a gentle guide to fermented foods for gut health — what may help, what to try first, and how to start without flaring symptoms.

    Key takeaways

    • Fermented foods may support gut health for some people, but responses vary.
    • Start low and go slow: 1–2 teaspoons (or a few sips) is a sensible starting point.
    • “Best” options are the ones you tolerate: live yoghurt/kefir (if dairy is OK), small amounts of sauerkraut/kimchi, miso, tempeh, or live-culture pickles.
    • If you have IBS-type symptoms, watch for histamine, FODMAP triggers, and carbonation (kombucha can be a common culprit)
    • If you’re dairy intolerant, you may still tolerate live yoghurt better than milk (lower lactose), or use non-dairy live yoghurt—but check it contains live cultures
    • No need to ferment at home to benefit—shop-bought can work if it’s unpasteurised/live

    Fermented foods for gut health have been part of human diets for thousands of years, long before anyone used the word microbiome. Sauerkraut in Germany, kimchi in Korea, kefir in the Caucasus, miso in Japan. These weren’t wellness trends. They were practical ways to preserve food and, as it happens, to eat something that often agreed with the gut.

    Fermented foods for gut health: what they can and can’t do

    Today, fermented foods are having a moment. Supermarket shelves are stacked with kombucha, “gut shots”, and fermented everything. Some claims are sensible. Others are wildly overstated. If you have sensitive digestion, bloating, or IBS-type symptoms, it can be hard to know what’s worth trying and what’s just marketing noise.

    This guide is here to help you understand what fermented foods for gut health can realistically do, how to choose an option that might suit your body, and how to start gently without making symptoms worse.

    For a UK-based overview, the British Dietetic Association has a clear guide to fermented foods and how to include them safely.

    Let’s start with the evidence, because there’s a lot of overpromising in this space.

    Some fermented foods contain live microorganisms, and research suggests that regular intake may support gut microbiome diversity in some people. One of the most widely cited studies is the Stanford fermented food trial, which compared a high-fermented-food diet with a high-fibre diet over ten weeks. The fermented food group showed an increase in microbial diversity and changes in some inflammatory markers. (Wastyk et al., 2021)

    That’s genuinely interesting. But it doesn’t mean fermented foods are a cure for anything. People respond very differently. What works beautifully for one person might trigger bloating or discomfort in another.

    Fermented foods won’t “reset” or “detox” your gut. Your gut doesn’t work like that.

    It can help to think of fermented foods as one supportive tool, not a magic fix. If you already eat a varied diet and your digestion feels steady, you might notice very little change. If your gut is sensitive, the effects could go either way, which is why going slowly matters.

    What “counts” as fermented (and why labels matter)

    Fermentation is a process where bacteria or yeasts break down sugars in food, producing acids, gases, or alcohol. This changes flavour and texture and can create useful compounds during the process.

    The confusing bit is that not all fermented foods still contain live cultures by the time you eat them. Many foods are fermented during production but then baked, pasteurised, or heat-treated. Sourdough bread is a good example: fermentation is involved in making it, but baking kills live microbes. Similarly, some sauerkraut in jars is pasteurised to make it shelf-stable. It can still taste great, but it won’t contain the same live cultures as a chilled, unpasteurised version.

    If you specifically want live cultures, labels matter more than marketing words like “gut-friendly”. Look for phrases such as “live cultures”, “live and active cultures”, or “unpasteurised”. Refrigerated products are often more likely to be “live”, but it’s the label that tells the truth. Stanford Medicine has a useful explainer on recognising fermented foods and what still counts as “live”. (Stanford Medicine, 2021)

    Best fermented foods for gut health: what to try first (especially if you have IBS)

    If you’re new to fermented foods, start with the option that feels most realistic for your body and your kitchen. You don’t need to try everything; you’re looking for one small thing you tolerate well.

    For many people, bio-live yoghurt is the gentlest place to begin. It’s mild, widely available, and doesn’t come with the intensity of spicy or strongly flavoured ferments. Choosing a plain version and adding your own fruit can keep things simple and easy to tolerate. Kefir is another dairy option that some people love, and it often contains a wider range of microbes, but it can feel sharper and more tangy. If you try it, start with a small amount rather than a full glass.

    If dairy doesn’t suit you, you can still explore fermented foods through miso or tempeh. Miso is usually used in small quantities, stirred into warm water or added at the end of cooking, which makes it a gentle entry point. Tempeh is fermented soy in a firm block; once cooked, it can be easy to digest for some people and adds protein without being overly “gut trendy”.

    If you’re drawn to vegetable ferments, it’s often kinder to start with plain sauerkraut rather than kimchi. Kimchi can be brilliant, but it’s typically spicier and more likely to contain garlic and onion, which can trigger IBS symptoms for some people. With either option, a teaspoon alongside a meal is enough to begin with; you’re testing your tolerance, not chasing a target.

    How much fermented food per day is sensible?

    There’s no official UK guideline for how much fermented food you “should” eat.

    Some research trials use amounts that don’t reflect everyday life. In the Stanford study, fermented foods were gradually increased over time, and the end amounts were more than many people naturally eat day to day. (Wastyk et al., 2021)

    A more practical approach is to start with a small amount regularly and see what your body does with it. That might be a few spoonfuls of yoghurt, a small cup of miso broth, or a teaspoon of sauerkraut with dinner. If that feels fine after several days, you can increase slowly. If it doesn’t feel fine, you can step back without feeling like you’ve “failed”.

    Some people prefer fermented foods with meals rather than on an empty stomach, because the rest of the meal can buffer the effect. Others like them as a snack. There’s no perfect rule, only what your gut tolerates.

    If fermented foods make you bloated (or you have IBS)

    Fermented foods can be a little bit “too lively” for some guts, especially at the beginning. There are several reasons you might feel more bloated after trying them.

    Sometimes it’s simply the fizz. Kombucha and some kefirs are naturally carbonated, and if you’re already prone to bloating, adding gas can make you feel uncomfortable. In other cases, it’s the ingredients. Kimchi, for example, is often made with garlic, onion, and other fermentable carbohydrates that can be difficult for IBS guts. Monash University’s FODMAP resources note that tolerance varies by product and portion size, which is why one person can thrive on a food that another person struggles with. (Monash University, 2023)

    Histamine is another possible piece of the puzzle. Fermented foods can be higher in histamine, and some people are more sensitive than others. If you notice headaches, flushing, itchy skin, or feeling unusually “wired” after fermented foods, histamine intolerance is worth discussing with a clinician or dietitian rather than pushing through. (Comas-Basté et al., 2020)

    If fermented foods have caused symptoms before, the gentlest approach is to restart with amounts so small they feel almost ridiculous — a teaspoon of yoghurt, a tiny forkful of kraut, or even just a bit of the brine mixed into a meal. Introduce only one fermented food at a time, give it a few days, and only increase when things feel settled.

    If you want to build your baseline first, you might also like our guide on how to increase fibre without bloating.

    When to be cautious

    Fermented foods are safe for most people, but there are situations where extra care is sensible.

    If you’re immunocompromised or taking immunosuppressant medication, it’s worth speaking to your doctor before regularly eating unpasteurised fermented foods. Live bacteria are generally beneficial for healthy people, but the risk-benefit balance changes if your immune system is severely weakened.

    It’s also worth keeping an eye on salt. Sauerkraut, kimchi, and miso can be high in sodium, especially in larger servings. If you’re managing blood pressure or you’ve been advised to reduce salt, small portions are usually the best fit.

    And if fermented foods consistently make you feel worse rather than better — even in tiny amounts — that’s information worth respecting. They’re not essential, and you can support your gut health in other ways, including through overall dietary variety and fibre tolerance over time.

    If you’d like the broader picture, our article on prebiotics, probiotics, and postbiotics explains how these different concepts fit together without hype.

    A quick way to tell if this is working for you

    If fermented foods suit you, the signs are usually subtle rather than dramatic. You might notice steadier digestion, a bit less discomfort after meals, or simply that your gut feels calmer over time. If they don’t suit you, you’ll usually know fairly quickly: worsening bloating, more pain, looser stools, or feeling “off” in a way that seems linked to the food.

    The goal isn’t to force yourself into fermented foods. The goal is to test gently and see if they help you.

    Frequently asked questions

    Do all fermented foods contain live cultures?

    No. Some are baked or pasteurised after fermentation, which kills live microbes. If you want live cultures, look for “contains live cultures”, “live and active cultures”, or “unpasteurised”. (Stanford Medicine, 2021)

    How much fermented food should I eat per day?

    There isn’t a fixed amount. A small portion most days is a sensible starting point, and you can adjust based on how your body responds. (Wastyk et al., 2021)

    Can fermented foods cause bloating?

    Yes, especially when you first introduce them. Carbonation, portion size, ingredients like garlic/onion, and individual sensitivity can all play a role. (Monash University, 2023)

    Are fermented foods safe for IBS?

    Sometimes, but tolerance varies. Many people do best with gentler options and smaller portions. If you’re following a low-FODMAP approach, it can help to work with a dietitian. (Monash University, 2023)

    What’s the gentlest fermented food to start with?

    Bio-live yoghurt is often the easiest entry point. If dairy doesn’t suit you, a small amount of miso in warm broth can be a gentle alternative. (British Dietetic Association, 2023)

    If you’re exploring fermented foods for gut health, the best approach is consistency in small portions rather than big doses.

    References

    British Dietetic Association (2023). Fermented foods.
    Comas-Basté, O., Sánchez-Pérez, S. and Veciana-Nogués, M.T. (2020). Histamine intolerance: The current state of the art. Nutrients, 12(9), 2734.
    Monash University (2023). Fermented foods and FODMAPs (Monash FODMAP resources).
    Stanford Medicine (2021). Fermenting the Facts / How to recognise fermented foods.
    Wastyk, H.C., Fragiadakis, G.K., Perelman, D., et al. (2021). Gut-microbiota-targeted diets modulate human immune status. Cell, 184(16), 4137–4153.

    If you’d like to keep building your foundations, you may also find these helpful:
    What is the gut microbiome?
    Microbiome tests & probiotic supplements: what’s worth it?

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  • High Fibre Foods UK: 15 Easy Picks (Without Bloating)

    High Fibre Foods UK: 15 Easy Picks (Without Bloating)

    High fibre foods in the UK can be a game-changer for digestion, but only if you add them in a way your gut can tolerate. If you’re searching for high fibre foods UK options that won’t leave you bloated, you’re in the right place. You know the advice: eat more fibre. It’s good for digestion, good for your gut, good for everything.

    So you do what most people do… you buy bran cereal, add lentils, swap to wholegrain everything…

    …and suddenly your stomach feels like a balloon.

    If that’s you, you’re not failing at healthy eating. You’re just doing what many of us do: adding too much, too fast, without giving your gut time to adjust.

    If you’re also exploring fermented foods, here’s our gentle guide to fermented foods for gut health.

    This guide will give you a UK-friendly list of high fibre foods, the difference between soluble fibre, insoluble fibre and resistant starch, and a gentle, realistic way to increase fibre without bloating.

    Because the goal isn’t “maximum fibre overnight”. It’s steady fibre your body can actually tolerate.

    What is fibre (and why does it matter)?

    Fibre is the part of plant foods that your body can’t fully digest. Instead of being absorbed like fats, proteins or carbohydrates, fibre travels through your gut and helps with regular bowel movements, stool softness and bulk, and feeding the bacteria in your gut (your microbiome).

    In the UK, adults are advised to aim for around 30g of fibre per day, but most people fall well short of that.

    And here’s the important bit: if you suddenly go from “not much fibre” to “loads of fibre”, your gut bacteria get a surprise feast. As they ferment all that new fibre, they can produce extra gas, which often means bloating, discomfort and that frustrating “why did I bother?” feeling.

    So if fibre makes you bloat, it doesn’t always mean fibre is “bad for you”. It often just means you’ve increased it faster than your gut can adapt.

    The 3 types of fibre (and why your gut may react differently)

    Not all fibre behaves the same way. Knowing the difference helps you choose foods that feel gentler and still support digestion.

    Soluble fibre (often the gentlest starting point)

    Soluble fibre absorbs water and forms a soft gel in the gut. It tends to be slower-moving and often feels calmer for sensitive digestion.

    Common soluble fibre foods include:

    • porridge oats
    • barley
    • chia seeds
    • ground flaxseed
    • psyllium husk (small amounts)
    • apples and pears (especially stewed)
    • carrots and parsnips (cooked)

    If your digestion is unpredictable (constipation one week, loose stools the next), soluble fibre is often the safest place to begin.

    Insoluble fibre (helpful, but go steady)

    Insoluble fibre adds bulk and helps keep things moving. It can be very useful for constipation, but some people find it more irritating if they’re prone to bloating or cramping.

    Common sources include:

    • wholemeal bread
    • wheat bran (including some bran cereals)
    • brown rice
    • wholegrain pasta
    • vegetable skins and seeds

    If this kind of fibre sets you off, don’t panic, you don’t have to avoid it forever. It often just needs a slower build-up. One easy adjustment is switching from lots of raw veg and bran to gentler options like soups, stews and roasted vegetables.

    Resistant starch (a quiet gut-helper)

    Resistant starch is a type of carbohydrate that “resists” digestion in the small intestine and reaches the large bowel, where gut bacteria ferment it.

    Fermentation can produce short-chain fatty acids (SCFAs) compounds linked with gut health processes, including supporting how the gut lining functions. This isn’t a cure-all, but it’s one reason some fibres are considered especially gut-friendly.

    Resistant starch sources include:

    • lentils, chickpeas and beans
    • oats
    • cooked then cooled potatoes
    • cooked then cooled rice
    • slightly green bananas

    Resistant starch can be brilliant, but it can also cause gas if you overdo it. Small portions first is the key.

    For more on how gut bacteria use fibre, see: Prebiotics vs Probiotics vs Postbiotics

    High fibre foods UK: simple, realistic options

    Let’s keep this practical. Below is a simple high fibre foods UK list you can actually use day-to-day. The kind of fibre foods you can actually buy in UK supermarkets and use in normal meals.

    High fibre breakfast ideas

    • Porridge oats (an easy soluble fibre win)
    • Chia or ground flaxseed stirred into yoghurt
    • Raspberries or blackberries (high fibre for their size)
    • Wholemeal toast (if tolerated)
    • Weetabix-style cereals (go steady and add fluids)

    If bran cereal makes you bloat, don’t force it. Oats are often a calmer daily staple.

    High fibre lunch and dinner choices

    • Lentils, chickpeas and beans (start with 2–3 tablespoons)
    • Sweet potato (skin on if tolerated)
    • Cooked vegetables like carrots, peas, spinach and broccoli
    • Wholegrains like quinoa, bulgur wheat or brown rice
    • A gentle upgrade swap: half white + half wholegrain pasta or rice

    A lot of people find “half-and-half” is the sweet spot: you get the benefit without the blow-up.

    High fibre snacks that won’t feel like punishment

    • Pears, apples, oranges
    • A small handful of almonds or walnuts
    • Hummus with oatcakes
    • Plain popcorn
    • Berries with yoghurt

    Snacks are a great way to build fibre slowly without making meals feel heavy.

    Quick reference table

    Food groupUK examplesGentle starting portion
    Grainsporridge oats, wholemeal bread1 small bowl / 1 slice
    Legumeslentils, chickpeas, baked beans2–3 tablespoons
    Vegetablescarrots, peas, broccoli, sweet potato½ cup cooked
    Fruitberries, pears, apples1 portion
    Nuts/seedsalmonds, chia, flaxseed1 tablespoon

    How to increase fibre without bloating (the gentle method)

    This is the part most people miss.

    They hear “eat more fibre” and change everything overnight, then spend the next few days uncomfortable.

    A calmer approach works better.

    Fibre comfort rules (simple, but powerful)

    • Start low, go slow — increase fibre over 1–2 weeks, not overnight.
    • Spread fibre across the day — a little at breakfast + a little at lunch + a little at dinner is easier than one mega-fibre meal.
    • Increase fluids alongside fibre — fibre pulls water into the gut; without enough fluid, constipation and bloating can worsen.
    • Start with softer fibres first — oats, chia, cooked veg, stewed fruit.
    • Cook vegetables if you’re sensitive — raw veg can be harder work for digestion. Soups, stews and roasted veg are often better tolerated.
    • If constipation is part of the picture — fibre alone isn’t always enough. Many people do best with warm drinks in the morning, a consistent routine, and gentle movement.

    7-day gentle fibre ramp (no drama)

    Days 1–2:

    Add one new fibre habit (porridge oats OR berries)

    Days 3–4:

    Add a small resistant starch portion (2–3 tablespoons lentils or chickpeas)

    Days 5–7:

    Add one extra portion of cooked veg AND one half-and-half wholegrain swap

    If your gut complains at any stage, hold steady for a few more days. That is still progress.

    Read more: NHS guide to getting more fibre into your diet

    Sensitive gut or IBS? Here’s the gentle version

    If you have IBS (or a gut that flares easily), fibre can still help — but it needs more care.

    Many people do best starting with soluble fibres (like oats or psyllium) and going slower with highly fermentable fibres (like large bean portions).

    If symptoms are unpredictable, the safest approach is:

    • one change at a time
    • cooked foods over raw
    • smaller portions more often

    If you’re unsure, a registered dietitian can help tailor fibre increases safely.

    Quick UK cheat list: What foods are high in fibre?

    If you take one thing from this guide, let it be this: go gently, and choose high fibre foods UK options your gut tolerates.

    Here’s a quick fibre rich foods list you can screenshot:

    • porridge oats
    • baked beans
    • lentils and chickpeas
    • raspberries and blackberries
    • pears and apples
    • broccoli and carrots
    • sweet potato
    • wholemeal bread
    • chia seeds and ground flaxseed
    • almonds
    • popcorn
    • bran cereals (only if tolerated)

    What are the best high fibre foods for constipation?

    Foods that combine fibre with good hydration often work well. Prunes, pears, and kiwi fruit have evidence supporting their use for constipation. Oats and ground flaxseed can also help. Increase fluids alongside any fibre increase, and give changes a week or two to take effect.

    What if fibre makes me gassy?

    Some gas is normal when you increase fibre — it’s a sign your gut bacteria are adapting. If it’s excessive, you may be increasing too quickly. Slow down, focus on gentler soluble fibres (like oats or chia), and spread fibre across the day. For most people, this settles within a few weeks.

    What is the best fibre for a sensitive gut?

    Soluble fibre sources like oats, chia seeds, psyllium, and cooked carrots are often better tolerated. Start with small portions and build gradually. Cooking vegetables well and avoiding large bean portions in one sitting can also help reduce bloating.

    How long does bloating last when increasing fibre?

    For most people, bloating improves within two to four weeks as gut bacteria adjust. If bloating persists, worsening discomfort can be a sign you’re increasing too fast — slow down and hold steady for a few more days. If symptoms are severe or ongoing, speak to a healthcare professional.

    How much fibre should I eat per day in the UK?

    The UK recommendation is around 30g of fibre per day for adults. But if you’re currently eating much less, it’s better to work up gradually rather than trying to hit 30g immediately. Consistency matters more than speed.

    Is it OK to increase fibre if I have IBS?

    It can be, but it needs extra care. Some people with IBS do better with soluble fibre, while others may react to certain highly fermentable or high-FODMAP fibres. A slow, gentle approach is best, and if you’re unsure, a registered dietitian can help tailor the right plan.

    What are signs I should slow down?

    Excessive bloating, cramping, sudden changes in bowel habits, or persistent discomfort can mean you’ve increased fibre too quickly. Pause where you are, reduce slightly if needed, and move forward more gradually.

    Final takeaway

    You don’t need to hit 30g of fibre overnight.

    The best fibre plan is the one your body can tolerate consistently.

    Start with one small change this week — oats at breakfast, a few spoonfuls of lentils at dinner, or one extra portion of cooked veg — then build slowly.

    For more gut-friendly basics, explore:

    Medical disclaimer: This article is general information, not medical advice. If you have severe symptoms (blood in stool, unexplained weight loss, persistent or worsening pain), please seek medical advice.

    Sources

    • NHS – How to get more fibre into your diet
    • British Dietetic Association (BDA) – Fibre and healthy eating resources
    • Scientific Advisory Committee on Nutrition (SACN) – Carbohydrates and Health report
    • Mayo Clinic – Dietary fibre: essential for a healthy diet
    • Cleveland Clinic – High-fibre foods and soluble vs insoluble fibre
    • Harvard T.H. Chan School of Public Health – Fibre and the gut microbiome
    • Monash University – Fibre and IBS guidance

  • Prebiotics vs Probiotics vs Postbiotics: 7 Simple Truths

    Prebiotics vs Probiotics vs Postbiotics: 7 Simple Truths

    Prebiotics vs probiotics vs postbiotics can sound confusing at first, but the differences are simpler than most supplement labels make them seem.

    When Every Supplement Feels Like a Gamble

    In this guide to prebiotics vs probiotics vs postbiotics, we’ll keep it simple, flare-aware, and focused on what actually helps sensitive guts.

    If you live with fibromyalgia, ME/CFS, or chronic primary pain, you’ve probably noticed that your gut has opinions. Strong ones.

    You might have tried a probiotic that a friend swore by, only to spend three days bloated and exhausted. Or perhaps you read that fibre is “essential for gut health” and ended up with symptoms that set you back a week.

    Meanwhile, the wellness industry keeps adding new words: prebiotics, probiotics, postbiotics, and synbiotics. Each one promising transformation. Each one another thing to research when you’re already running on empty.

    Here’s the reassurance: you don’t need to master all of this. You don’t need expensive supplements. And you certainly don’t need to overhaul your diet overnight.

    What helps most people with sensitive systems is something far quieter: small, consistent, tolerable changes with clear stop rules if things flare.

    30-Second Definitions: The Simple Version

    Think of your gut microbiome as a garden. These three terms describe different ways of tending it:

    Prebiotics = Fuel for your existing microbes. These are types of fibre and plant compounds that feed the bacteria already living in your gut. You don’t digest them, your microbes do.

    Probiotics = Visiting microbes Live bacteria (or yeasts). These you consume, usually through fermented foods or supplements. They pass through your system and may have temporary effects, but most don’t take up permanent residence.

    Postbiotics = Helpful by-products. When your gut microbes break down prebiotics, they produce compounds like short-chain fatty acids (SCFAs). These by-products may support the gut lining and are involved in immune and gut–brain signalling. Some supplements now sell these directly, but your body can make them from fibre.

    What We’re Actually Aiming For

    It’s tempting to think the goal is a “perfect” microbiome, some ideal balance you can test and optimise your way towards. But that’s not how it works.

    The research suggests what matters more is resilience and tolerance: a gut environment that can handle small challenges without overreacting, and that sends steadier signals to the rest of your body (including your nervous system and immune function).

    For people with fibromyalgia, ME/CFS, or chronic pain, this is especially relevant. Many of us have heightened sensitivity not just in muscles and joints, but in the gut too. The aim isn’t to force dramatic change. It’s to gently expand what your system can tolerate, without triggering flares. Consistency beats intensity. Always.

    If you’re prone to flares, think micro-doses and slow build-ups, not “fixes.”

    Decision Tree: What Should I Try First?

    If you’re flare-prone, the safest approach to prebiotics vs probiotics vs postbiotics is to start with micro-doses and build slowly. Here’s a sensible order of priority:

    Step 1: Food-Based Prebiotics in Tiny Doses (Default Starting Point)

    This is where most people should begin. It’s the lowest risk option, requires no supplements, and works with what your microbes already do.

    See the Prebiotics section below for how to start.

    Step 2: Fermented Foods. Only If Tolerated Though!

    If you already eat yoghurt, kefir, sauerkraut or kimchi without issues, continue. If you’ve never tried them, introduce one at a time in small amounts.

    If fermented foods cause bloating, headaches, or flares, skip this step entirely. It’s not essential.

    Step 3: Probiotic Supplements But Only With a Clear Reason

    Probiotics aren’t a general “health boost.” Evidence for their use is strain-specific and often temporary. Consider a short trial if:

    • You’re recovering from a bout of gastroenteritis
    • You’ve recently finished antibiotics (as an optional supportive measure)
    • You have a specific pattern your GP has suggested probiotics might help with

    Otherwise, there’s no rush. Many people do fine without them.

    Step 4: Postbiotic Supplements. Usually Not Needed Early!

    These are newer to the market and often expensive. For most people, supporting your microbes with gentle prebiotic fibre achieves the same outcome more affordably.

    If you’re curious, see the Postbiotics section, but this isn’t a priority.

    Prebiotics: Feeding What’s Already There

    Prebiotics are specific types of fibre and plant compounds that your gut bacteria ferment. When they do, they produce short-chain fatty acids (SCFAs), particularly one called butyrate, which helps support the gut lining and may influence immune and gut–brain signalling.

    This is one of the most evidence-supported ways to nurture your gut microbiome. But there’s a catch.

    Why Prebiotics Can Cause Bloating

    When gut bacteria ferment fibre, they produce gas. That’s normal. But if you increase fibre too quickly or your system is already sensitive, the result can be bloating, cramping, or altered bowel habits.

    This doesn’t mean prebiotics are wrong for you. It usually means the dose was too high, too fast.

    Micro-Dosing Plan: Gentle Starter Steps

    Week 1: Add one new prebiotic food in a tiny amount, think half a teaspoon of cooked, cooled oats, a few slices of banana, or a small portion of cooked carrots. Have it once daily, ideally at the same mealtime.

    Week 2: If tolerated, either slightly increase the portion or add a second food on alternate days.

    Ongoing: Build up over weeks, not days. There’s no deadline.

    Gentle Food Sources

    • Oats (cooked and cooled if possible as this increases resistant starch)
    • Bananas (slightly underripe have more prebiotic content, but ripe is fine)
    • Cooked and cooled potatoes or rice
    • Leeks, onions, garlic (in small amounts; cook well to soften)
    • Asparagus, Jerusalem artichokes (start very small as these are potent)

    Stop Rules

    • If bloating becomes uncomfortable or persists beyond 3–4 days, reduce the amount or pause entirely.
    • If you notice a clear flare pattern (fatigue, pain increase, brain fog), stop the new food and wait a week before reconsidering.
    • One change at a time makes it easier to identify what’s helping or hindering.

    Probiotics: Visitors, Not Residents

    Probiotics are live microorganisms, usually bacteria, sometimes yeast, that you consume through food or supplements. The idea is that they confer a health benefit while passing through your gut.

    But here’s what the research actually shows: effects are strain-specific and often temporary. A probiotic that helps one condition may do nothing for another. And most strains don’t colonise your gut permanently, they visit, do their work (or don’t), and leave.

    Who Might Consider a Trial?

    • After antibiotics: Some evidence suggests certain strains (like Saccharomyces boulardii or specific Lactobacillus strains) may help reduce antibiotic-associated diarrhoea. This is optional, not essential.
    • Specific diarrhoea patterns: If your GP has suggested trying a probiotic for IBS-D or a similar pattern, a time limited trial with a single strain makes sense.
    • Traveller’s diarrhoea prevention: Some people find certain strains helpful before travel.

    Who Should Be Cautious or Seek Advice First?

    • Anyone who is immunocompromised
    • People with central venous catheters
    • Those with serious gut conditions (e.g., short bowel syndrome, recent gut surgery)
    • Anyone unsure whether a probiotic is appropriate for their situation

    If in doubt, ask your GP or pharmacist before starting.

    How to Trial Safely

    1. Choose one product with a clearly labelled strain (not just “Lactobacillus” — look for the full name, e.g., Lactobacillus rhamnosus GG).
    2. Start with a lower dose if the product allows.
    3. Trial for 4 weeks maximum before assessing.
    4. Keep everything else constant, don’t start a new food or supplement at the same time.
    5. If symptoms worsen significantly in the first week, stop.

    Do Probiotics Help Fibromyalgia?

    The honest answer: we don’t know yet. Some early studies suggest gut microbiome differences in people with fibromyalgia, and a few small trials have explored probiotics, but the evidence is too limited to make recommendations. Anyone claiming a specific probiotic “treats” fibromyalgia is overstating the science.

    Postbiotics: Helpful By Products (With a Marketing Problem)

    “Postbiotics” is a newer term, and it’s become a bit of a marketing magnet. The basic idea is sound. When gut bacteria ferment fibre, they produce beneficial compounds, particularly short-chain fatty acids like butyrate, acetate, and propionate. These compounds may support the gut lining and are involved in immune and inflammatory signalling.

    The Confusion

    Some supplement companies now sell postbiotics directly, essentially bottling what your microbes would produce if you fed them well. This isn’t necessarily wrong, but it’s worth asking: do you need to buy what your body can make for free?

    For most people, consistently eating tolerable amounts of prebiotic fibre achieves the same outcome. The gut produces these compounds naturally when you give it the raw materials.

    When Might Postbiotic Supplements Make Sense?

    • If you genuinely cannot tolerate any prebiotic fibre (even in micro-doses) and want to experiment cautiously.
    • If a specific product has been recommended by a healthcare professional for a particular reason.

    Otherwise, this is low priority. Spend your energy (and budget) elsewhere first.

    Lowest Risk. Two Week Starter Plan

    This plan is designed for sensitive systems. It assumes fatigue, flares, and limited capacity. Adjust timing to suit your energy patterns.

    Days 1–4: Observation

    Don’t change anything yet. Simply notice your current baseline energy, digestion, pain levels, and sleep. Jot down a few words each day if you can.

    Days 5–7: Introduce One Micro-Dose

    Choose one gentle prebiotic food (e.g., 1–2 tablespoons of cooked, cooled oats or a few slices of banana). Have it at the same meal each day.

    Days 8–10: Assess

    How do you feel? Any increase in bloating, discomfort, or fatigue?

    • If fine: Continue at the same dose.
    • If mild bloating: Reduce portion slightly; stay here longer before progressing.
    • If clear worsening: Pause and return to baseline for a few days.

    Days 11–14: Optional Small Increase

    If all is well, either slightly increase the portion or add a second prebiotic food on alternate days. Continue observing.

    After 2 Weeks

    You now have a baseline. From here, you can:

    • Continue building slowly (one change per week maximum)
    • Stay at your current level if it feels sustainable
    • Consider adding a fermented food if curious (same micro-dose approach)

    There’s no rush. Progress measured in months is still progress.

    Red Flags: When to Get Help

    Speak with your GP or seek medical advice if you experience:

    • Unintended weight loss
    • Blood in your stool
    • Persistent vomiting
    • Severe or worsening abdominal pain
    • New symptoms that concern you
    • Any significant change that doesn’t resolve within a few days of stopping a new food or supplement

    Trust your instincts. If something feels wrong, it’s worth checking.

    FAQs

    Do probiotics help fibromyalgia?

    There’s not enough evidence to say. Some research explores gut–brain links in fibromyalgia, but no specific probiotic has been proven to help. Be wary of products making bold claims.

    Will prebiotics make bloating worse?

    They can if you increase fibre too quickly. The key is starting with micro-doses and building slowly. Most people can improve their tolerance over time, but it takes patience.

    Are fermented foods the same as probiotics?

    Not exactly. Fermented foods contain live microbes, but the strains and quantities vary widely. A pot of yoghurt isn’t equivalent to a standardised probiotic capsule. Both can be part of gut support, but they’re different tools.

    Are postbiotics worth buying?

    For most people, no at least not early on. Your gut makes these compounds when you eat prebiotic fibre. Supplements may have a niche role, but they’re not a priority.

    Should I do a microbiome test?

    These tests are interesting but not yet clinically useful for most people. Results can vary between labs, and we don’t have clear guidance on what to do with the findings. Your money is probably better spent on food.

    Can I take prebiotics and probiotics together?

    Yes, this is sometimes called a “synbiotic” approach. But if you’re sensitive, introduce them separately so you can identify what’s helping or causing issues.

    How long before I notice a difference?

    Gut changes happen slowly. Some people notice shifts in digestion within a few weeks; broader effects on energy or wellbeing may take months. Consistency matters more than speed.

    What if I can’t tolerate any fibre at all?

    Start smaller than you think possible, even a teaspoon. If that’s still too much, speak with a dietitian who understands sensitive guts. There may be underlying issues worth exploring.

    Where to Go From Here

    If you’re new to thinking about gut health, start with tiny changes and give yourself permission to go slowly. Your system has been through a lot. It doesn’t need a dramatic intervention; it needs steady, tolerable support.

    Related reading:

    References (Suggested Sources)

    • NHS: Probiotics overview
    • NICE guidelines: Irritable bowel syndrome in adults (CG61)
    • British Dietetic Association: Fibre food fact sheet
    • World Gastroenterology Organisation: Probiotics and prebiotics guidelines
    • Gibson & Roberfroid (1995) — original prebiotic definition (Journal of Nutrition)
    • International Scientific Association for Probiotics and Prebiotics (ISAPP): Consensus statements on pre-, pro-, and postbiotics
    • Peer-reviewed review articles on the gut microbiome in chronic pain/fibromyalgia (early-stage, mixed findings)

  • What Is the Gut Microbiome? A Simple Beginner’s Guide (and Why It Matters)

    What Is the Gut Microbiome? A Simple Beginner’s Guide (and Why It Matters)

    Everyone’s talking about gut health these days. Your Instagram feed promises that fixing your microbiome will solve everything from bloating to brain fog. Your GP might mention it during an IBS appointment. Your friend swears by a probiotic that changed their life. But what actually is the gut microbiome, and why does it matter?

    Here’s a straightforward, evidence-led guide that cuts through the noise—no miracle cures, no scary claims, just clear information to help you make sense of it all.

    Please note: This article is for information only and doesn’t replace personalised medical advice. If you have persistent symptoms or health concerns, speak with your GP or healthcare provider.

    Quick Answer

    The gut microbiome is the community of microbes—mostly bacteria, plus fungi and viruses—that live mainly in your large intestine. They help digest fibre, produce helpful compounds like short-chain fatty acids, and interact with your immune system and metabolism. A healthy microbiome is more about diversity and resilience than having one “perfect” mix.

    What it is / what it isn’t

    • Is: A community of microbes living mainly in the large intestine, performing helpful functions
    • Isn’t: A “toxin” problem you can fix in a weekend with a cleanse or detox
    • Isn’t: A standalone diagnosis for symptoms (having bloating or fatigue doesn’t mean you have a “microbiome problem”)

    Key takeaways

    • Your gut microbiome is trillions of microbes (mostly bacteria) living in your digestive tract
    • It helps digest fibre, supports your gut lining, and interacts with your immune system
    • There’s no single “perfect” microbiome—diversity and function matter more
    • Small dietary changes (more plant variety, gradual fibre increases) can support it
    • You don’t need expensive tests or dramatic changes to look after your gut health

    What is the gut microbiome? (Explained simply)

    Your gut microbiome is essentially an ecosystem of tiny organisms living inside your digestive tract. Think of it as a bustling community—trillions of microbes, mostly concentrated in your large intestine (colon), working away at jobs you might not even notice.

    Most of these microbes are bacteria, but the community also includes fungi, viruses, and other microscopic organisms. Far from being harmful, many of these microbes are incredibly helpful. They’ve evolved alongside us, performing tasks our own cells can’t manage on their own.

    When people talk about “gut bacteria” or “gut flora,” they’re usually referring to this same community. The terms are often used interchangeably in everyday conversation, though scientists use slightly more specific language.

    Microbiome vs microbiota—what’s the difference?

    You might hear both terms and wonder if they mean the same thing. Here’s the simple distinction:

    Microbiota refers to the actual organisms themselves—the bacteria, fungi, and other microbes living in your gut.

    Microbiome is a broader term that includes the microbiota plus their genes, the compounds they produce, and the environment they live in.

    In practice, most people (including many health professionals) use “microbiome” to mean both. Don’t worry too much about getting the terminology perfect—understanding the concept matters more than memorising definitions.

    Why does it matter?

    Your gut microbiome isn’t just sitting there doing nothing. It’s constantly active, and research suggests it plays several important roles in your overall health. Here are four core functions we understand fairly well:

    1. Digestion of fibre You can’t digest dietary fibre on your own—your body doesn’t make the right enzymes. But many gut bacteria can. When they break down fibre, they produce helpful by-products called short-chain fatty acids, which your gut lining cells use for energy.

    2. Gut barrier support Your gut lining acts as a selective barrier, letting nutrients through whilst keeping harmful substances out. Some gut microbes help maintain this barrier by supporting the cells that line your intestine. (You might have heard claims about “leaky gut”—the science here is still developing, so it’s wise to be cautious about dramatic claims.)

    3. Immune system signalling A huge proportion of your immune system lives near your gut, and your microbiome constantly “talks” to it. This communication helps train your immune system to tell the difference between actual threats and harmless substances. It’s an interaction, not a one-way control—your microbiome doesn’t run your immune system, but it does influence it.

    4. Metabolism and appetite signalling Gut microbes can affect how your body processes food and even influence signals related to hunger and fullness. This is a rapidly developing area of research, but it’s still early days for many of these findings.

    It’s important to remember that microbiome research is fast-moving but still relatively young. Many exciting findings are based on early-stage studies or animal research. We know associations exist between the microbiome and various conditions, but that doesn’t always mean the microbiome is the cause—or that changing it will fix the problem.

    What affects the gut microbiome day to day?

    Your gut microbiome isn’t fixed. It changes in response to various factors, some within your control and others less so. Here’s what can influence it:

    Diet pattern, especially fibre diversity The types of fibre you eat feed different bacterial strains. A varied diet with different plant foods tends to support a more diverse microbiome.

    Medications Antibiotics are the most obvious example—they’re designed to kill bacteria, so they inevitably affect your gut microbiome too. Proton pump inhibitors (PPIs for heartburn) may also have an effect, though you shouldn’t stop prescribed medication without discussing it with your doctor.

    Sleep and circadian rhythm Your gut microbes follow daily patterns, influenced by when you eat and sleep. Disrupted sleep or irregular meal times might affect this rhythm, though we’re still learning exactly how significant this is.

    Stress Chronic stress can influence your microbiome through various pathways, including changes to gut movement, immune function, and the gut lining. The gut-brain connection works both ways.

    Illness and infection Gastroenteritis or other infections can temporarily disrupt your microbiome. It usually recovers, though sometimes this takes time.

    Age and hormones Your microbiome changes naturally throughout life. Hormonal shifts (like menopause, which we’ll cover in separate articles) can also play a role.

    Movement and general wellbeing Physical activity is associated with microbiome changes, though it’s hard to separate exercise from other healthy lifestyle factors. Gentle, regular movement as part of overall wellbeing is sensible—there’s no need to push yourself hard in pursuit of “perfect” gut bacteria.

    What does a “healthy” microbiome actually mean?

    Here’s something that might surprise you: there is no single perfect microbiome.

    Two people with completely different microbial communities might both be perfectly healthy. What matters more is how well your microbiome functions and how resilient it is to disruption.

    Diversity is often mentioned as a marker of microbiome health—having lots of different bacterial species tends to be associated with better outcomes. But context matters enormously. Someone with a chronic condition might have lower diversity not because their microbiome is “broken,” but because their body is responding to illness.

    Having symptoms doesn’t automatically mean you have a microbiome problem, and you certainly can’t diagnose microbiome issues based on how you feel alone. The relationship between symptoms and specific microbial patterns is far more complex than social media might suggest.

    How to support your gut microbiome (6 realistic ways)

    You don’t need expensive tests, fancy supplements, or dramatic diet overhauls. Here are gentle, evidence-informed approaches that most people can try:

    1. Increase fibre slowly (especially if you have IBS or bloating) Fibre feeds beneficial gut bacteria, but adding too much too quickly can cause discomfort. If you’re sensitive, start with small amounts and build up gradually over weeks. Cooked vegetables and peeled fruit are often gentler than raw.

    2. Aim for plant diversity across the week (not perfection) Different plant foods contain different types of fibre. Try including a variety of vegetables, fruits, wholegrains, nuts, seeds, and legumes over the course of a week. Don’t stress about hitting a specific number—gentle variety is the goal.

    3. Include legumes and wholegrains if tolerated (start small) Lentils, chickpeas, oats, and brown rice are excellent for gut bacteria—if you can tolerate them. If you have IBS or find these foods difficult, start with tiny portions (literally a tablespoon) and see how you go.

    4. Fermented foods: optional, start low Live yoghurt, kefir, sauerkraut, and kimchi contain beneficial bacteria. They might help some people, but they’re not essential for everyone. If you know you react to fermented foods, start very small or skip them entirely.

    5. Prioritise regular sleep and meal timing Eating at roughly consistent times and getting adequate sleep supports your body’s natural rhythms, including those of your gut microbes. This is about gentle routine, not rigid scheduling.

    6. After antibiotics: focus on food first When you’ve taken antibiotics, the microbiome often shifts back over time, though recovery varies by antibiotic type, dose, and the individual person. Eating well with adequate fibre and variety supports this natural process. You don’t automatically need probiotics—save your money and focus on food.

    A gentle starter plan

    If you’re not sure where to begin, try this:

    • Week 1: Add one tablespoon of seeds (ground flaxseed or chia) to porridge or yoghurt, plus one extra piece of fruit.
    • Week 2: Add one small portion of legumes (a few tablespoons of lentils in soup, or chickpeas in a salad).
    • Week 3: If you’re feeling good, try one fermented food (a couple of spoonfuls of live yoghurt or a small serving of sauerkraut).

    Go at your own pace. If something causes discomfort, scale back and try again later. There’s no deadline.

    A note for people with fibromyalgia, ME/CFS, or chronic fatigue: Go especially slowly with any dietary changes. Prioritise what feels manageable for your energy levels, and don’t push through if something doesn’t feel right. Supporting your microbiome is about gentle, sustainable habits—not adding more demands to an already exhausted system.

    Common myths (quick myth-busting)

    “You need a microbiome test to know what to do” Not usually. Most commercial microbiome tests aren’t clinically validated, and they won’t necessarily tell you anything actionable. For most people, focusing on a varied, fibre-rich diet is more helpful than expensive testing.

    “Probiotics fix everyone” Probiotic benefits are strain-specific and condition-specific. Some work for certain digestive issues, but they’re not a universal cure. You definitely don’t need them just because you’ve heard they’re good.

    “Detox teas cleanse the gut” Your liver and kidneys handle detoxification just fine. “Detox” products are mostly marketing, and some can be genuinely harmful or cause unpleasant side effects.

    “If you bloat, fibre is bad for you” Bloating often happens when fibre is introduced too quickly or in large amounts. It’s usually about dose, speed, and type—not that fibre itself is harmful. Go slower, try cooked rather than raw, and be patient with your body.

    When to see a GP (red flags)

    Whilst making dietary changes is generally safe, some symptoms need medical attention. See your GP if you experience:

    • Unintentional weight loss
    • Blood in your stool or black, tarry stools
    • Persistent fever
    • Severe or persistent diarrhoea (especially with dehydration)
    • A new change in bowel habit that lasts more than a few weeks
    • Unexplained anaemia
    • Severe abdominal pain
    • Symptoms that wake you at night

    These red flags don’t mean you definitely have something serious, but they do warrant proper investigation. Don’t try to self-manage significant or worrying symptoms—get them checked.

    FAQ

    What is the gut microbiome and why does it matter? The gut microbiome is the community of microorganisms (mostly bacteria) living in your digestive tract, particularly your large intestine. It matters because these microbes help digest fibre, produce beneficial compounds, support your gut lining, and interact with your immune system and metabolism.

    What’s the difference between gut microbiome and gut flora? “Gut flora” is an older term that essentially means the same thing as gut microbiome. Both refer to the community of microorganisms in your digestive system. “Microbiome” is the more current scientific term, but both are widely understood.

    How long does it take to improve the gut microbiome? Some changes to microbial populations can happen within days to weeks—for example, switching from a low-fibre to a high-fibre diet can shift bacterial populations fairly quickly. However, what that means for symptoms is less predictable. Building a resilient, stable microbiome is more about long-term habits than quick fixes. Consistency matters more than speed.

    Do I need probiotics? Not necessarily. Most healthy people don’t need probiotic supplements. They may help for specific conditions (like antibiotic-associated diarrhoea or IBS), but the benefits are strain-specific. Focus on eating well first—food-based approaches are usually more effective and better value.

    What are the best foods for gut bacteria? Foods rich in different types of fibre are excellent: vegetables, fruits, wholegrains, legumes, nuts, and seeds. Fermented foods like live yoghurt, kefir, and sauerkraut can also be beneficial. Variety is more important than any single “superfood.”

    Can gut health affect mood? There’s emerging research suggesting associations between the gut microbiome and mental health, often called the “gut-brain axis.” However, this research is still early. Whilst the gut and brain definitely communicate, we can’t yet say that changing your microbiome will reliably improve mood. It’s one piece of a much larger puzzle.

    The bottom line

    Your gut microbiome is fascinating and important, but it’s not a magic solution to all health problems. You don’t need expensive tests, dramatic diet changes, or cupboards full of supplements to support it.

    Small, consistent changes—more plant variety, adequate fibre (added gradually), regular sleep, and manageable stress—are usually enough. Be patient with yourself, especially if you have chronic symptoms or food sensitivities. What works for someone else might not work for you, and that’s completely normal.

    Start gently, pay attention to how your body responds, and remember that there’s no such thing as a perfect gut microbiome—only one that works well for you.

    Next up in our gut microbiome series

    Ready to dive deeper? Here’s what’s coming next:

    Browse more articles in our Articles section, or learn about our evidence-based approach to health information.

    Sources

    This article draws on information from reputable medical and academic sources:

    1. Harvard T.H. Chan School of Public Health – The Microbiome (general overview and dietary influences)
    2. Cleveland Clinic – Gut microbiome: What it is, what it affects, and how to improve it
    3. NHS Inform – The gut microbiome and health
    4. Thursby E, Juge N (2017). Introduction to the human gut microbiota. (Comprehensive review of gut microbiota structure and function)
    5. Valdes AM, Walter J, Segal E, Spector TD (2018). Role of the gut microbiota in nutrition and health.
    6. British Dietetic Association – Food fact sheets on gut health and probiotics
    7. Patient.info – The gut microbiome

    These sources provide evidence-based, balanced information without overclaiming about microbiome interventions.

    Disclaimer: This content is for informational purposes only and does not constitute medical advice. Always consult your GP or healthcare provider for personalised guidance, especially if you have existing health conditions or persistent symptoms.

  • PEM-safe sleep tools for fibromyalgia and ME/CFS insomnia

    PEM-safe sleep tools for fibromyalgia and ME/CFS insomnia

    If you live with fibromyalgia or ME/CFS, you’ll know that sleep problems aren’t just about struggling to drift off. You might finally fall asleep at 3am only to wake feeling like you haven’t slept at all. Or you collapse into bed exhausted, yet your body refuses to switch off that frustrating “tired but wired” state that so many of us recognise. The sleep disturbance in these conditions runs deeper than ordinary insomnia, and it’s tangled up with pain, nervous system dysregulation, and the ever-present threat of post-exertional malaise.

    Here’s what can make things worse: well-meaning advice designed for otherwise healthy people with insomnia. Standard sleep programmes often encourage restricting time in bed, pushing through daytime tiredness, and increasing activity to “build sleep pressure.” For someone with post-exertional malaise (PEM), following that advice can trigger a crash that sets you back for days or weeks. If you’ve ever felt worse after trying to fix your sleep, you’re not imagining it, and you’re certainly not alone.

    In this guide, we’ll walk through a set of PEM-safe sleep tools that work with your body’s limits instead of against them.

    For a deeper look at how fibromyalgia affects sleep, see What is fibromyalgia? (and what it isn’t).

    This guide takes a different approach. We’ll explore PEM-safe sleep tools that work with your body’s limits rather than against them. You’ll find gentle adaptations from evidence-based insomnia therapies, nervous system calming techniques that don’t require energy you don’t have, and honest information about sleep aids. Nothing here promises a cure, but these supports can make difficult nights a little more manageable.

    Key takeaways

    • PEM changes the rules: Standard insomnia advice assumes you can “push through” tiredness to build sleep drive. With fibromyalgia and ME/CFS, this approach can trigger crashes and worsen symptoms, so everything here is adapted with that in mind.
    • Pacing comes first: Protecting your energy envelope throughout the day is the foundation of better sleep. You can’t optimise nighttime rest if you’re already in energy debt.
    • Borrow gently from CBT-I: Cognitive Behavioural Therapy for Insomnia has helpful elements, particularly the cognitive tools and sleep environment work, but its sleep restriction component isn’t safe for people with PEM.
    • Low-risk supports exist: Nervous system calming techniques, environment adjustments, and certain supplements may help, though evidence varies and nothing works for everyone.
    • Know when to seek help: Persistent sleep problems, suspected sleep disorders, or worsening symptoms warrant a conversation with your GP or specialist.

    Why standard insomnia advice can backfire with PEM

    Cognitive Behavioural Therapy for Insomnia (CBT-I) is the gold-standard treatment for chronic insomnia in the general population. It works remarkably well for many people, and understanding why helps explain why it can be problematic for us.

    Standard CBT-I has four main components. Sleep restriction therapy limits time in bed to match actual sleep time, deliberately inducing mild sleep deprivation to increase “sleep pressure.” Stimulus control asks you to get out of bed after 15-20 minutes of wakefulness and only return when sleepy. Cognitive restructuring addresses unhelpful thoughts about sleep. And sleep hygiene covers the usual advice about caffeine, screens, and bedroom environment.

    The conflict lies primarily with sleep restriction and stimulus control. These techniques require you to intentionally build up tiredness and push through daytime sleepiness to consolidate sleep. For someone without PEM, this creates a temporary dip in daytime function that resolves as sleep improves. For someone with ME/CFS or fibromyalgia with PEM, sleep deprivation is a known crash trigger.

    The 2021 NICE guideline for ME/CFS (NG206) explicitly warns against any programme based on “fixed incremental increases” in activity, and emphasises that rest is “part of all management strategies.” The guideline recognises that people with ME/CFS need daytime rest periods, the opposite of what strict stimulus control demands. Getting in and out of bed repeatedly when you can’t sleep may itself use energy that triggers symptoms.

    This doesn’t mean we should dismiss CBT-I entirely. The cognitive elements addressing anxious thoughts about sleep and reducing the pressure we put on ourselves can be genuinely helpful. The key is knowing what to adapt. We can borrow the gentler tools whilst protecting ourselves from the components that could cause harm. For more on how sleep disruption interacts with symptom flares, see our guide to fibromyalgia sleep flares and PEM.

    PEM-safe sleep tools: foundations for better rest

    These PEM-safe sleep tools for fibromyalgia and ME/CFS insomnia respect your energy limits whilst creating conditions that make sleep more likely.

    Protect your 24-hour energy envelope

    The energy envelope is a core concept from ME/CFS management, now reflected in NICE guidelines. It means staying within your available energy rather than spending more than you have. When you exceed your envelope during the day, you’re more likely to be both exhausted and wired by bedtime and more likely to experience PEM that disrupts sleep for days afterward.

    Practical pacing for better sleep includes planning rest periods throughout the day rather than saving all your rest for nighttime. It means stopping activities before you feel exhausted, and recognising that cognitive and emotional activities use energy too not just physical ones. On days when you’ve had unavoidable exertion, adjusting expectations rather than trying to “catch up” with extra activity can help protect your sleep.

    NICE NG206 recommends agreeing “a sustainable level of activity as the first step, which may mean reducing activity.” This isn’t about being lazy it’s about preventing the boom-and-bust cycles that wreck both daytime function and nighttime rest. Your energy envelope fluctuates, and learning to read your own limits is part of living well with these conditions.

    A softer wind-down routine

    A consistent evening routine signals to your body that sleep is approaching, but with fibromyalgia or ME/CFS, the routine itself needs to be low energy.

    About two hours before bed, begin dimming lights and reducing screen exposure. Blue light suppresses melatonin production by up to 85%, so switching to lamps, candles, or low lighting helps your body’s natural sleep signals emerge. If you need screens, blue light blocking glasses or night mode settings can reduce the impact.

    About one hour before bed, settle into a simple sequence of calming activities. This might include listening to gentle music or an audiobook, very light stretching only if tolerated, a warm drink (not caffeine), or simply sitting quietly. The key is consistency; the same activities in roughly the same order help your nervous system recognise the pattern.

    Avoid anything stimulating during this window: work tasks, difficult conversations, distressing news, or physically demanding activities. Even seemingly passive activities like watching an intense television drama can activate your stress response. Think “boring and gentle” rather than “engaging and interesting.”

    Make the sleep environment kinder

    Your bedroom environment can either support or sabotage sleep. Small adjustments can make a meaningful difference, particularly when you’re managing pain alongside insomnia.

    Temperature matters more than many people realise. Research suggests 15-19°C is optimal for most people, though fibromyalgia can cause temperature sensitivity in both directions. Aim for neutral, neither too hot nor too cold, with layered bedding you can adjust during the night. Breathable natural fibres help regulate temperature better than synthetic materials.

    Darkness supports melatonin production. Blackout curtains, blinds, or a sleep mask can help if light pollution is an issue. If you need to get up during the night, use dim nightlights rather than bright overhead lights to avoid suppressing melatonin.

    Sound management might mean white noise to mask disruptive sounds, earplugs for noise sensitivity, or simply ensuring your bedroom is as quiet as possible. Whatever approach you choose, consistency helps, as the same sounds (or silence) each night builds a sleep association.

    Bedding for pain deserves careful thought. A mattress that provides pressure relief whilst supporting your spine, pillows appropriate for your sleeping position, and positioning aids like a pillow under the knees for back sleepers can all reduce nighttime pain. Weighted blankets have some evidence for calming the nervous system, though they’re not right for everyone.

    Calm pain and symptoms before bed

    Managing pain before bed can prevent it from keeping you awake or waking you through the night. If you take pain medication, timing it appropriately (with your prescriber’s guidance) so it’s working when you’re trying to sleep makes sense.

    Non-pharmacological options include heat or cold therapy for localised pain, getting into a comfortable position before you settle rather than lying awake shifting, and using relaxation techniques (covered below) that can indirectly reduce pain perception. The goal isn’t eliminating pain for many of us; that’s not realistic, but reducing it enough to let sleep happen.

    Borrowing gently from CBT-I without triggering crashes

    We’ve established that full CBT-I isn’t appropriate when PEM is a factor. But several elements can be safely adapted.

    Cognitive techniques are perhaps the most transferable. Many people with chronic illness develop unhelpful thoughts about sleep: catastrophising about the consequences of a bad night, putting pressure on themselves to fall asleep, or lying awake worrying about symptoms. Working on these thought patterns, perhaps with support from a psychologist familiar with chronic illness, can reduce the mental arousal that keeps us awake.

    Sleep environment optimisation translates directly. Creating positive associations between your bedroom and rest, keeping the room dark and cool, removing distracting electronics, and reserving the bed primarily for sleep and rest (not work or screens) are all compatible with pacing.

    Gentle stimulus control requires significant modification. Rather than getting out of bed and staying active until sleepy, you might simply roll over and rest without pressure, practice breathing exercises whilst lying down, or do a gentle body scan. The goal shifts from “only associate bed with sleep” to “associate bed with rest and calm” recognising that lying quietly has value even without sleep.

    What to avoid: Any fixed schedule that ignores symptom fluctuation. Any instruction to reduce time in bed or push through daytime tiredness.

    For more on how sleep disruption interacts with symptom flares, see our guide to fibromyalgia sleep flares and PEM.

    Any approach that treats rest as something to eliminate. The 2021 NICE ME/CFS guideline is clear that sleep management should be “personalised” and must “take into account the need for rest in the day.”

    If you work with a sleep therapist, explain your condition and PEM clearly. A good practitioner will adapt their approach; one who insists on standard protocols despite your concerns may not be the right fit.

    Nervous-system soothing that respects PEM

    The “tired but wired” state common in fibromyalgia and ME/CFS reflects genuine nervous system dysregulation. Research shows that people with these conditions often have higher sympathetic (stress) activation even during sleep. Calming the nervous system isn’t just about relaxation, it’s about shifting your physiology toward rest.

    Extended exhale breathing is perhaps the most accessible technique. Simply making your out-breath longer than your in-breath activates the parasympathetic (rest and digest) nervous system via the vagus nerve. Try breathing in for 2-4 counts and out for 4-8 counts, whatever feels comfortable. Five minutes of this whilst lying in bed requires minimal energy and can genuinely shift your state. If counting feels effortful, simply focus on a slow, gentle exhale.

    Grounding techniques interrupt anxious thought loops by bringing attention to present moment sensation. The 5-4-3-2-1 technique asks you to notice five things you can see (or remember seeing in your room), four you can feel (the weight of blankets, the pillow beneath your head), three you can hear, two you can smell, and one you can taste. This can be done with eyes closed, entirely from bed, and requires no physical effort.

    A worry pad by the bed gives racing thoughts somewhere to go. When worries surface, jot them down briefly and promise yourself you’ll address them tomorrow. This simple act of externalising concerns can reduce the mental effort of trying to hold onto them and can break the cycle of rumination that keeps the stress response active.

    Self-compassion practice may feel uncomfortable at first, but evidence links self-compassion directly to better sleep. When you notice self-critical thoughts (“Why can’t I just sleep like a normal person?”), try placing a hand on your chest and offering yourself kindness: “This is hard. I’m doing the best I can.” Research shows this kind of supportive self-talk triggers parasympathetic activation and reduces cortisol, the opposite of the stress response that keeps us wired.

    The key with all these techniques is gentleness. If any practice feels like effort or creates frustration, it’s not helping. Start with just one approach, practise it consistently for a few weeks, and add more if it’s working without draining you.

    What about melatonin, magnesium and other sleep aids?

    People with fibromyalgia and ME/CFS often explore supplements and sleep aids, hoping to find something that helps. The evidence is genuinely mixed, and it’s important to approach this area with realistic expectations.

    Melatonin has the most promising evidence for fibromyalgia specifically. Several small studies have found improvements in sleep quality, pain, and quality of life. For ME/CFS, the picture is less clear. A 2021 review found insufficient evidence to recommend it. Some research suggests people with fibromyalgia may have altered melatonin production, which could explain why supplementation helps some people. However, melatonin interacts with numerous medications including anticoagulants, antidepressants, and sedatives, and quality varies between products since supplements aren’t tightly regulated.

    Magnesium has theoretical benefits; it’s involved in muscle relaxation, nervous system function, and sleep regulation, and some studies have found lower levels in people with fibromyalgia. However, the evidence specifically for sleep improvement is limited. Different forms of magnesium have different absorption and effects, and high doses can cause digestive upset. If you’re considering magnesium, discussing it with your GP or pharmacist is sensible, particularly regarding interactions with other medications.

    Other supplements marketed for sleep (valerian, 5-HTP, L-theanine, CBD) have varying and generally weaker evidence. 5-HTP in particular carries significant risks if combined with antidepressants due to the possibility of serotonin syndrome; this combination should be avoided without specialist guidance.

    Pharmaceutical sleep aids require careful consideration. The 2021 NICE guideline for chronic primary pain (NG193) notes that opioids and standard hypnotics are not recommended for fibromyalgia. Low-dose amitriptyline is sometimes prescribed for fibromyalgia with sleep disturbance and may help some people, though it comes with side effects. Any medication decision should be made with your prescriber, considering your full picture.

    The honest summary: no supplement or medication reliably fixes sleep problems in fibromyalgia or ME/CFS. Some people find some things helpful. Many of us are medication sensitive and need to start any new approach at low levels. Nothing replaces the foundations of pacing, environment, and nervous system support, but these additional tools may offer modest benefit for some people when used cautiously.

    When to talk to your GP or specialist

    While this guide offers self-help tools, some situations warrant professional input.

    Consider speaking to your GP if:

    • Your sleep problems persist despite trying these approaches for several weeks
    • You suspect an underlying sleep disorder such as sleep apnoea (loud snoring, gasping awake, excessive daytime sleepiness beyond your usual fatigue)
    • You have symptoms of restless legs syndrome (uncomfortable leg sensations and urge to move, particularly at night)
    • Your sleep difficulties are worsening significantly or affecting your ability to function
    • You’re considering prescription sleep medication or have questions about supplements and interactions
    • You’re experiencing worsening depression or anxiety alongside sleep problems

    Your GP or specialist may offer:

    • Assessment for sleep disorders (potentially including referral for sleep studies)
    • Review of current medications that might be affecting sleep
    • Discussion of medication options appropriate for your conditions
    • Referral to a psychologist experienced in chronic illness for adapted CBT-I
    • Referral to ME/CFS or pain specialist services

    Remember that NICE guidelines emphasise personalised, multimodal approaches. There’s no one-size-fits-all solution, and finding what works often requires patience and professional support.

    Key resources and references

    Disclaimer

    This article provides general information about sleep and chronic illness for educational purposes only. It is not intended as medical advice and should not replace consultation with your GP, specialist, or other qualified healthcare professional. Everyone’s situation is different; what helps one person may not suit another, and some approaches may not be appropriate for your circumstances. Always discuss new supplements or significant changes to your sleep approach with a healthcare provider, particularly if you take other medications or have additional health conditions. If your symptoms are worsening or you’re concerned, please seek professional support.

    Written by Stems From The Gut

    This article was written by someone who lives with fibromyalgia, chronic pain, and gut issues. At Stems From The Gut, we believe in plain-English, evidence-aware information that respects the reality of living with chronic conditions—no toxic positivity, no “just push through” attitudes, and no pretending that simple solutions exist for complex problems. We do our best to align with current clinical guidelines whilst acknowledging their limitations. For more about our approach, see our Authors & Medical Stance page.

  • Fibromyalgia body clock

    Fibromyalgia body clock

    If you live with fibromyalgia, it can feel as though your body clock has a mind of its own. Many people talk about a “fibromyalgia body clock” that runs on a completely different timetable to everyone else. Not very helpful when your body seems to be running on a completely different timetable to everyone else.

    This is not another generic list of sleep tips. Instead, we are zooming in on your body clock, your circadian rhythm, and looking at how timing (when you sleep, wake, move and see light) can gently support pain, fatigue and brain fog alongside everything else you are already doing. We will also be honest about what the research actually shows, and where we are still making educated guesses.

    What you will take away from this

    Fibromyalgia seems to mess with the body clock in ways that matter. When your sleep and wake rhythms get disturbed, pain, fatigue and mood often spiral. The strongest signal from the research is not about magic gadgets or expensive supplements; it is about regularity. When you wake up and the difference between your daytime and nighttime patterns seems to matter more than chasing perfect sleep.

    Tools like CBT-I (cognitive behavioural therapy for insomnia), morning light and low dose melatonin can help some people feel more in control, but they sit alongside everything else. They are adjuncts, not cures.

    If you also have ME/CFS or clear post exertional malaise, pacing and energy envelope management stay front and centre. Any timing tweaks need to work around that reality, not override it.

    Here is the reassuring bit: you do not need perfect routines. Tiny, sustainable shifts in timing can still make a difference when you are working with what your body can actually manage right now.

    Meet your body clock (and why it matters for fibro)

    Deep inside your brain, in a tiny cluster of cells in the hypothalamus, sits your master clock. It keeps roughly twenty four hour time, responds to light (especially in the morning), and helps coordinate hormones like cortisol and melatonin. It also influences body temperature, gut motility, immune signalling and even how you process pain.

    Most people’s internal clocks naturally run a touch later than twenty four hours. Without something to anchor them, they gradually drift later and later. For many of us, that anchor is morning light plus a fairly consistent wake up time.

    In fibromyalgia and related pain conditions, several studies have noticed a familiar pattern. People are more likely to prefer evenings, describe themselves as “night owls”, show bigger day to day swings in when they fall asleep and wake up, and have altered rhythms of melatonin and cortisol. That does not prove cause and effect, but it fits what many people with fibromyalgia describe: days and nights gradually sliding out of sync, pain and fatigue flaring when sleep becomes chaotic.

    What research actually says about the fibromyalgia body clock

    The evidence base is still small, but a few themes are emerging that can help us make better informed guesses.

    Morning light and a fixed wake time

    In one four week trial, people with fibromyalgia were divided into two groups. One group had bright morning light therapy, the other dimmer light. Both groups were also given a stable wake up time and some simple advice about bedtime.

    Both groups improved. Pain, mood, day to day function and sleep quality all got better, and the bright light group did not clearly outperform the dim light group. The researchers concluded that regular sleep and wake timing was probably doing most of the heavy lifting, rather than the intensity of the light itself.

    Melatonin: modest help, not a miracle

    Some older trials in fibromyalgia, and newer work in mixed chronic pain groups, suggest melatonin can modestly improve sleep quality and slightly reduce pain scores for some people, especially over the first few weeks. The effects often fade after about six weeks, though. Doses and formulations vary wildly from study to study – anywhere from one to ten milligrams, immediate release or slow release. We still do not have clear long term safety data or a single “best” dose.

    There is also one small trial in ME/CFS that used one milligram of melatonin plus zinc over sixteen weeks and found improvements in fatigue and quality of life. Promising, but not yet replicated.

    Melatonin is not suitable for everyone, particularly if you take several other medicines or live with epilepsy, bipolar disorder or more complex health conditions. It can cause morning grogginess, vivid dreams and, less commonly, mood changes. In the UK it is usually prescription only, which is another reason to talk it through with your GP or pain clinic first rather than experimenting on your own.

    CBT-I for insomnia

    For people with fibromyalgia who also have clear insomnia, CBT-I – a structured talking therapy focused on sleep patterns, thoughts and behaviours around sleep tends to outperform generic “sleep hygiene” advice. It also does better than standard CBT for pain when the main target is broken sleep.

    Improvements in pain and mood tend to be smaller than the sleep gains, but they can still be meaningful for some people.

    NICE does not currently recommend melatonin or light boxes specifically for fibromyalgia because the evidence is limited. Instead, guidance leans towards multimodal care: pacing, gentle movement within limits, psychological support where appropriate, and CBT-I for those with true insomnia.

    The big idea: give your body clock a daily anchor

    The most realistic change most of us can make is not fancy or expensive. It is about giving your fibromyalgia body clock a few consistent time signals every day, so it knows what counts as day and what counts as night.

    Those anchors might be getting up at roughly the same time most days, seeing natural light not too long after waking, keeping most of your eating, movement and social contact in the daytime, and making your evenings visibly and sensibly “quieter” with softer light and less stimulation.

    You do not need to hit all of these. Even one or two clear anchors, done gently and consistently, can start nudging your system in a kinder direction.

    Step 1: Choose a realistic wake up window

    For many people with fibromyalgia, especially those without post exertional malaise, the single most powerful shift is choosing a regular wake up time and sticking to it on most days.

    If your current pattern is all over the place, it is usually unhelpful to suddenly decide you will get up at seven every morning. Instead, look back over the last week and notice when you naturally wake if nobody is forcing you. Use that as your starting point. If you tend to wake somewhere around half past eight or nine, choose a half hour window in that range and aim to be out of bed within that window on most days.

    If you also live with ME/CFS or clear post exertional crashes, your anchor might need to be softer and later. The aim is gentle regularity, not dragging yourself out of bed in the middle of a crash just to “protect your rhythm”. You can always experiment with edging your window earlier by fifteen or thirty minutes once things feel more stable.

    Step 2: Use light as your “on switch” gently

    Light is the main signal for your master clock, but you do not need specialist equipment to begin with. If you can, open the curtains soon after you wake and spend ten to twenty minutes near a window with a drink. On better days you might manage to step outside, even if it is just onto a balcony or front step.

    If mornings are your worst time and you tend to wake very late, start from where you are rather than where you think you “should” be. If you usually first see daylight at one in the afternoon, aim to see it at half twelve for a week, then experiment with shifting that earlier in small steps – only if your body tolerates it.

    Some people use a bright light box, particularly in winter. These can be helpful in conditions like seasonal affective disorder. In fibromyalgia, though, the best evidence so far suggests that having a regular morning light routine mattered more than hitting a particular brightness. You can treat any gadget as a possible helper, not a cure.

    If you have a history of bipolar disorder, significant eye disease or you take medicines that make your skin or eyes more sensitive to light, speak to your doctor before using a light box.

    Step 3: Create quiet cues for “night mode”

    Evenings are about giving your brain clear signals that it is time to wind down. This does not require a long complicated routine, it is more about drawing a line between “day” and “evening”.

    That might look like switching from the main ceiling lights to lamps about an hour before bed, choosing lower stimulus activities such as an audiobook, podcast, familiar television or a paper book instead of fast scrolling, and keeping your largest meals earlier in the evening so you are not trying to sleep on a very full stomach.

    Some people with insomnia find blue blocking glasses helpful for a couple of hours before bed, especially if they use screens a lot. Most of the research for these is in general insomnia rather than fibromyalgia specifically, but they are relatively low risk and not usually expensive if you want to try them. Using the night mode or warm colour settings on your phone, tablet or laptop is a simple, free step in the same direction.

    If you already have a basic wind down routine, you do not need to add lots of extra steps. The main thing is that your brain can tell, most nights, when day has ended and night has begun.

    What about melatonin, light boxes and other circadian “hacks”?

    For adults, small doses of melatonin, often in the one to three milligram range, can shift the body clock slightly earlier if taken at the right time, usually one to two hours before your intended bedtime. In some fibromyalgia and chronic pain studies, this has led to better sleep and modest reductions in pain in the short term.

    At the same time, it is not a cure for fibromyalgia, and it is not right for everyone. It can cause grogginess, vivid dreams and occasionally changes in mood, and it can interact with other medicines. Because melatonin is prescription only for adults in the UK, it is best thought of as something to explore with your GP or pain team as a time limited trial, not something you put yourself on indefinitely.

    Bright light therapy boxes sit in a similar category. They can be helpful in certain circadian rhythm disorders and seasonal affective disorder, but in fibromyalgia the clearest message so far is that a regular morning routine matters more than a particular lux number. For people with ME/CFS we do not yet have strong evidence that bright light therapy improves post exertional symptoms or core fatigue, and it is not a specific NICE recommendation. If you do experiment, it is wise to start gently and keep an eye on boom and bust patterns, where a brief improvement leads to a big uptick in activity and then a crash.

    Blue blocking glasses and software night modes fall into the “low risk helper” category. They can make it easier for some people to fall asleep and stay asleep, especially in our very screen heavy evenings, but they are unlikely to transform fibromyalgia on their own.

    If you live with PEM or ME/CFS as well as fibro

    Many people reading this sit somewhere on a fibromyalgia ME/CFS Long Covid overlap. You might recognise delayed crashes after effort, have very limited energy to spare, or face days when getting out of bed at all feels like climbing a mountain.

    In that context, pacing and energy envelope management remain non negotiable. Any body clock work needs to be gentle enough that it does not trigger post exertional malaise. It is completely fine if your wake window is later than average, if it has to flex on crash days, or if family, caring roles or appointments mean your timing is far from textbook.

    A useful way to picture this is to imagine body clock work as sandpaper rather than a hammer. You are smoothing out a few rough edges, not remodelling the whole structure. If any suggestion in this article feels as though it would tip you into a crash, it is simply not the right step for you at the moment.

    Making this doable when you are already exhausted

    When you are dealing with chronic pain, fatigue and brain fog, even small changes can feel like a lot. It helps to treat this as a series of tiny experiments rather than a big lifestyle overhaul.

    You might begin with one simple anchor, such as opening the curtains within fifteen minutes of waking most days, or sitting in your usual spot by a window with a drink for ten minutes. Set a reminder on your phone, or leave a note where you will see it, so you do not have to hold it in your head.

    On more difficult days, the only realistic goal might be to keep today’s wake time within an hour of yesterday’s, if that is possible. If you share a home, you could ask a partner, family member or housemate to help with easy cues, opening the curtains or switching to lamps in the evening at an agreed time.

    If a week or two goes off track, that is not failure. It is simply information about what your body and life are like at the moment. You can always restart from where you are, not where you were.

    When to talk to your GP or specialist

    Self help changes can be useful, but they are not a substitute for proper assessment. It is worth speaking to your GP or specialist if you have had very little sleep for months despite trying basic changes, if someone has noticed loud snoring, gasping or pauses in your breathing at night, if you wake unrefreshed with morning headaches, or if your mood has dropped very low or you are having thoughts of self harm.

    It is also sensible to get medical advice before using melatonin or bright light therapy if you have a history of bipolar disorder or psychosis, or if you are already taking several medicines that make you drowsy.

    In that appointment, you can ask about referral options for services that offer CBT-I, whether melatonin might have a role in your specific case, and whether any of your current medicines might be making your body clock later or your sleep worse.

    Next read: Pain and crashes fit together; have a look at our guide to fibromyalgia and sleep.

    Key resources and references

    If you would like to read more or share information with your GP, these are good starting points:

    NICE guideline NG193 on chronic primary pain in over sixteens, which includes fibromyalgia.

    The Royal College of Physicians guidance on diagnosing fibromyalgia.

    The Burgess trial on morning light and stabilising sleep and wake timing in fibromyalgia.

    The DREAM-CP trial led by Galley and colleagues, looking at modified release melatonin in severe chronic pain.

    Recent reviews of CBT-I in people who have both fibromyalgia and insomnia.

    Disclaimer

    This article offers general information about fibromyalgia, sleep and circadian rhythms. It is not a substitute for individual medical advice. If you are experiencing chronic pain, fatigue or other worrying symptoms, please speak with your GP or a relevant specialist. Everyone’s situation is different, and what helps one person may not be right for another.

    Written by Stems From The Gut

    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about how we use evidence on the Authors and Medical Stance page.

  • Fibromyalgia Sleep and Flares: How Bad Nights Turn Up Pain and PEM

    Fibromyalgia Sleep and Flares: How Bad Nights Turn Up Pain and PEM

    You know the pattern if fibromyalgia sleep flares are part of your life. A night spent tossing and turning, staring at the ceiling, or waking every hour. Then morning arrives, and with it comes pain that feels sharper, brain fog that is thicker, and a flu like exhaustion that sits heavy in your bones. It is not your imagination, and it is not weakness. There is a real, measurable connection between broken sleep and the worsening of fibromyalgia symptoms.

    This post builds on an earlier piece about why sleep itself feels so disrupted when you have fibromyalgia. Here, we’re looking at fibromyalgia sleep flares, what happens after a bad night, why pain and fatigue spike, how this connects to post-exertional symptom worsening, and what you can do to navigate the next day without making things worse.

    The reassuring news is that you are not imagining the link between rough nights and rough days. Research shows that poor sleep leaves the nervous system more sensitive to pain, and for people with ME or CFS or Long COVID overlap, inadequate rest can be one of the triggers that tips you into post exertional malaise. Understanding this cycle can help you approach bad nights with self compassion rather than self blame.

    Why a Bad Night Can Make Fibromyalgia Sleep Flares Worse

    When you do not get enough good quality sleep, especially deep, restorative sleep, your nervous system does not get the chance to reset properly. Think of it like a smoke alarm that has become too sensitive. It starts going off at the smallest whiff of toast, not because there is a real fire, but because its threshold has been turned down too low. That is essentially what happens with pain processing when sleep is disrupted.

    In fibromyalgia, this is part of something called nociplastic pain or central sensitisation. Your nervous system has become over protective, and it amplifies pain signals that might feel mild or even go unnoticed in someone without chronic pain. It is not all in your head. It is your alarm system working overtime, trying to keep you safe but actually causing more distress. Poor sleep makes this hypersensitivity worse, because sleep is when the nervous system usually does its housekeeping and turns down the volume on threat detection.

    The good news is that a few bad nights usually cause a temporary spike in symptoms, not a permanent worsening. Your pain threshold might drop for a day or two, making everything feel more intense, but this does not mean you have lost ground forever. Your body is responding to a stressor, in this case lack of sleep, and once you get a bit more rest, things often settle back towards your baseline. It is uncomfortable and exhausting, but it is not a sign that you are failing or that your condition is spiralling out of control.

    Sleep, Flares and PEM or PESE: When Exhaustion Becomes a Crash

    In fibromyalgia, people often talk about flares. These are periods when pain, fatigue, brain fog and other symptoms ramp up significantly and stick around for days or even weeks. They are not random. They are usually triggered by something, whether that is physical over exertion, emotional stress, illness, or broken sleep. A flare can feel like your body has suddenly turned the difficulty dial right up on everything.

    For people who also have ME or CFS or Long COVID, there is an additional layer called post exertional malaise, also called post exertional symptom exacerbation. This is when symptoms get noticeably worse after doing too much. It is not just feeling tired in the moment, but experiencing a delayed crash that can last for days. Too much does not only mean exercise. It can include mental effort, emotional stress, travel, or simply not getting enough sleep for several nights in a row.

    This is where it gets tricky. Broken sleep can act as one of several stressors that push you over the edge into a flare or a PEM episode. Imagine your energy and symptom tolerance as a budget. You might cope reasonably well with one stressor, such as a bad night, or a busy day, or an argument with a friend. When two or three pile up, you hit your limit. A fibromyalgia sleep flare up followed by trying to keep up with your normal routine can be the combination that tips you into a crash.

    It is important to understand that taking care of your sleep is one supportive pillar among others. Pacing, managing stress and supporting your nervous system are also important, but sleep on its own is not a cure. Improving your sleep will not make fibromyalgia or PEM disappear, but it can help reduce the frequency and intensity of flares by keeping one major stressor more under control.

    Planning for After a Bad Night: Pacing, Not Punishment

    After a terrible night, the instinct is often to push through. You feel as if you have lost time, so you need to catch up. There is a to do list staring at you, responsibilities that will not wait, and a nagging voice saying you should be able to manage if you just try harder. But here is the truth. Pushing through after a bad night is one of the quickest ways to trigger a worse flare. Your body is already running on empty, and asking it to perform at full capacity is like trying to sprint on a sprained ankle.

    A more sustainable approach is to think of your days using a simple traffic light system.

    On red days, when you have had a very bad night and feel dreadful, you go into a gentler mode. This means fewer tasks, more rest breaks, and letting go of anything that is not essential. It is not giving up. It is strategic energy management.

    On amber days, when you have had an ok night and feel wobbly but functional, you keep the essentials but drop the non essentials and add extra breaks throughout the day.

    On green days, when you have had a better night, you can consider doing a little bit more, but still within your limits. It is not about making up for lost time.

    Scaling down your plans after a bad night is not laziness or failure. It is wise self management. You are working with your body rather than against it, and that gives you the best chance of avoiding a full flare or a PEM crash. The goal is not perfection. It is to avoid the boom and bust cycle where you overdo it, crash hard, recover a little, then overdo it again.

    Tiny Tweaks That Help You Survive the Day After

    You do not need a long list of complicated strategies to get through the day after a bad night. Pick one or two small adjustments that feel realistic for your life, and be gentle with yourself. Perfection is not the goal. The aim is to get through the day without making things worse.

    If you wake up feeling wired and exhausted, a quieter, lower stimulation morning can help. This might mean softer lighting, less noise and simpler tasks that do not demand much decision making. Your nervous system is already overwhelmed, so you do not need to add more demand first thing.

    Gentle movement or stretching can help if it feels tolerable, with the emphasis on gentle. This is not about making up for lost time or forcing yourself through a workout. It is about moving in a way that feels supportive, such as a slow walk around the house or some careful stretches in bed. If movement makes you feel worse, rest is absolutely fine too.

    Steady meals and snacks can make a real difference. When you are exhausted, it is tempting to skip meals or survive on sugar and caffeine, but this can leave you even more shaky and foggy. Easy, nourishing food, nothing fancy, can help stabilise your energy without adding to your load.

    It also helps to think realistically about naps. For some people, a short nap earlier in the day, perhaps twenty to thirty minutes before mid afternoon, can take the edge off without ruining night time sleep. For others, naps make falling asleep at night harder. If naps do not work for you, quiet rest or just lying down with your eyes closed can still give your body some recovery time. There is no single right way here. It is about noticing what your body responds to.

    Protecting Future Nights Without Perfectionism

    The goal here is not perfect sleep every single night. That is not realistic for anyone, especially for people living with fibromyalgia or ME or CFS. The aim is to gently shift the odds in your favour, so you have fewer bad nights and the bad nights you do have feel a little less intense.

    Gentle and realistic sleep protecting habits can help. A wind down routine that does not require lots of energy, perhaps dimming lights, putting your phone away and doing something calm, can signal to your nervous system that it is time to move towards rest. Roughly regular bedtimes and wake times, when life allows, can help stabilise your body clock. The key word is roughly. It has to be flexible enough to allow for the realities of chronic illness.

    What does not help is self criticism. Telling yourself that you have failed at sleep only adds stress to a nervous system that is already overloaded. You are doing your best in difficult circumstances, and some nights will simply be rough whatever you do. That is not your fault. The kinder you can be to yourself about sleep, acknowledging that it is hard, that you are trying, and that progress is not linear, the less emotional stress you add to the physical challenge.

    When to Talk to a Doctor About Your Sleep

    Having fibromyalgia, ME or CFS or Long COVID does not protect you from other sleep disorders, and sometimes what feels like typical fibromyalgia sleep may have an additional, treatable cause. It is worth speaking to a GP or sleep specialist if you notice certain signs.

    Very loud snoring, choking sounds, gasping for air, or long pauses in breathing during sleep can be signs of sleep apnoea, which is surprisingly common and can be treated. Uncomfortable sensations in your legs, such as crawling, tingling or an urge to move, or kicking during sleep, might point to restless legs syndrome or periodic limb movement disorder. Both have treatment options.

    If you are experiencing very low mood, high anxiety or any thoughts of self harm, it is vital to reach out for support. Chronic sleep deprivation can worsen mental health, and you deserve help to navigate that.

    Taking a short symptom diary, even just a few days, can make medical appointments more productive. Note when you go to bed, when you wake, how many times you wake during the night, and how you feel the next day. It does not need to be complicated. Rough notes on your phone are absolutely fine.

    You Are Not Lazy: It Is a Real, Rough Cycle

    Needing a quieter day after terrible sleep is not a character flaw. It is a sign that your body is working incredibly hard to manage a complex and exhausting condition. You are not lazy for resting after a bad night. You are being sensible. You are not weak for struggling with pain and fog when you are sleep deprived. You are human, and your nervous system is behaving in exactly the way science says it will in these circumstances.

    The key idea to take away is this. Bad nights can turn up pain and worsen post exertional symptoms, but you are not powerless. Pacing, tiny adjustments and self compassion can soften the impact over time. You will not eliminate bad nights altogether, and you will not always get it right. But every time you choose to scale back after a rough night instead of pushing through, you are breaking the boom and bust cycle a little more.

    If you would like to explore more about fibromyalgia and sleep, or dive deeper into pacing and energy management, there are other posts on this site that may help. Take what is useful, leave what is not, and remember that you are doing better than you think.

    Next read: What is fibromyalgia? (And what it isn’t)

    Key resources & references

    Written by Stems From The Gut
    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about who we are and how we use evidence on the Authors & Medical Stance page.

  • Fibromyalgia and Sleep: Can Fixing Your Sleep Really Help Pain and Exhaustion?

    Fibromyalgia and Sleep: Can Fixing Your Sleep Really Help Pain and Exhaustion?

    If you’re living with fibromyalgia, fibromyalgia sleep can feel like an impossible puzzle. You’re beyond exhausted. Bone-deep, all-the-time exhaustedYet when you finally climb into bed, sleep won’t come. Or it does come, but you wake every hour, or you sleep through the night only to feel like you haven’t slept at all. Meanwhile, the pain keeps humming away in the background, or gets worse the moment you lie down.

    In this guide, we’ll look at fibromyalgia and sleep, why nights can be so broken, and what genuinely helps. If you’re not sure whether your symptoms fit fibromyalgia, start with What Is Fibromyalgia? (And What It Isn’t).

    If you’re living with fibromyalgia and sleep feels like an impossible puzzle, you’re far from alone. Poor sleep is one of the most common and frustrating symptoms people with fibromyalgia face. And it’s not just about feeling tired. Broken sleep can intensify pain, worsen brain fog, and leave you feeling utterly depleted before the day’s even started.

    Quick takeaways

    • Poor sleep can increase pain sensitivity, fatigue, and brain fog in fibromyalgia
    • Fixing sleep” doesn’t cure fibromyalgia — but it can reduce symptom intensity and improve coping
    • The best improvements often come from gentle consistency, not forcing strict routines
    • If you also experience PEM/PESE, pacing and sleep need to work together (not against each other)

    The good news? While there’s no magic cure, there are evidence-informed strategies that can genuinely help. Improving your sleep won’t make fibromyalgia disappear, but it can ease the pain-fatigue-insomnia cycle enough to give you a bit more breathing room. Let’s look at what’s actually going on with fibromyalgia and sleep, and what you can realistically do about it.

    Key takeaways

    • Fibromyalgia doesn’t just cause pain – it also disrupts how your nervous system regulates sleep, leaving many people “tired but wired”.
    • Poor sleep and fibromyalgia pain fuel each other; improving sleep usually won’t cure fibromyalgia, but it can make pain, fatigue and brain fog easier to live with.
    • The strongest evidence supports a regular wake-up time, morning light, and CBT-I (a structured talking therapy for insomnia).
    • Tools like melatonin, light therapy lamps and sleep hygiene tweaks can be helpful adjuncts, ideally used alongside pacing and nervous-system-friendly routines.

    Why can’t I sleep with fibromyalgia?

    Fibromyalgia affects the way your nervous system processes pain signals. In simple terms, your pain “volume” is turned up too high: signals that wouldn’t normally register as painful get amplified, and signals that are painful feel even more intense. This heightened sensitivity doesn’t just affect pain—it affects your entire nervous system, including the systems that regulate sleep.

    Non-restorative sleep and frequent waking

    Many people with fibromyalgia describe their sleep as “light” or “unrefreshing.” You might spend eight hours in bed but wake feeling as though you’ve had three. Research shows that people with fibromyalgia often spend less time in the deeper, restorative stages of sleep. Instead, sleep is fragmented: you wake repeatedly (even if you don’t fully remember it), and your brain doesn’t get the sustained rest it needs to repair and reset.

    This isn’t just “bad sleep”—it’s a feature of how fibromyalgia affects your nervous system. The same heightened sensitivity that amplifies pain signals can also keep your brain in a state of hyperarousal, making it harder to relax into deep sleep.

    The vicious circle: pain, fatigue, and broken sleep

    Here’s where things get particularly frustrating. Poor sleep makes pain worse. When you don’t sleep well, your pain threshold drops, meaning you feel pain more intensely the next day. That increased pain then makes it harder to sleep the following night. Add in the exhaustion (fibromyalgia fatigue is profound and doesn’t respond to a simple early night), and you’re stuck in a cycle that feels impossible to break.

    Brain fog, low mood, and heightened stress responses all feed into this loop as well. It’s no wonder so many people with fibromyalgia feel utterly trapped by their sleep problems.

    Your body clock and fibromyalgia

    Your circadian rhythm—your internal body clock—helps regulate when you feel alert and when you feel sleepy. It’s driven by light exposure, meal times, activity, and routine. When fibromyalgia disrupts your sleep, it can also throw your circadian rhythm out of sync.

    Irregular sleep and wake times, staying in dim indoor light all day (because you’re too exhausted to go out), and crashing into bed at wildly different times can all confuse your body clock. Once your rhythm is disrupted, it becomes even harder to fall asleep at night and wake feeling rested in the morning—even if you’re desperate for rest.

    What actually helps? Evidence-informed strategies for fibromyalgia and sleep

    There’s no single “fix” for fibromyalgia insomnia, but several approaches have good evidence behind them. The aim isn’t perfection—it’s small, sustainable improvements that ease the cycle over time.

    Sleep-wake regularity: your body clock’s best friend

    One of the most helpful things you can do is work with your body clock rather than against it. This means:

    • A consistent wake-up time, even on weekends. Yes, even when you’ve slept terribly. This is hard, but it’s one of the most powerful tools for resetting your circadian rhythm. Your wake-up time anchors your body clock far more than your bedtime does.
    • Morning light exposure as soon as you can manage it. Natural daylight (even on a cloudy day) signals to your brain that it’s daytime, which helps regulate the release of melatonin later in the evening. If getting outside feels impossible, sitting near a window with your morning tea can help. Light therapy lamps are another option, though it’s worth discussing these with your GP first, especially if you have eye problems, take photosensitising medication, or have a history of bipolar or manic episodes.
    • A wind-down routine in the evening. This doesn’t need to be elaborate—20–30 minutes of dimmer lighting, something calming (reading, gentle stretching, breathing exercises), and stepping away from bright screens can signal to your body that sleep is approaching.

    This won’t work overnight, but over a few weeks, many people find their sleep becomes a little more predictable.

    CBT-I: one of the best-supported approaches for chronic insomnia

    Cognitive behavioural therapy for insomnia (CBT-I) is a structured, evidence-based approach specifically designed to tackle long-term sleep problems. It’s recommended by NICE (the National Institute for Health and Care Excellence) as a first-line treatment for chronic insomnia, including for people living with persistent pain conditions like fibromyalgia.

    CBT-I isn’t about “thinking positive” or forcing yourself to relax. Instead, it focuses on changing the thoughts and behaviours that keep insomnia going. This might include:

    • Stimulus control: retraining your brain to associate bed with sleep (not frustration, scrolling, or lying awake for hours).
    • Sleep restriction (more accurately called “sleep consolidation”): spending less time in bed initially to build up sleep pressure, then gradually expanding your sleep window as your sleep improves. This sounds counterintuitive but can be very effective.
    • Addressing unhelpful thoughts about sleep, such as catastrophising about how awful tomorrow will be if you don’t sleep tonight.

    CBT-I is usually delivered over several weeks by a trained therapist, though online CBT-I programmes (such as Sleepio, available on the NHS in some areas) can also be helpful. It’s not a quick fix, and it requires some effort, but many people with fibromyalgia find it genuinely improves their sleep quality over time.

    Pacing and energy management during the day

    How you manage your energy during the day has a direct impact on your sleep at night. If you push through on a “good” day and do far too much, you’re likely to crash hard afterwards—and that crash often includes worse pain and even more disrupted sleep.

    Pacing means finding a sustainable rhythm of activity and rest that doesn’t tip you into a flare. It’s not about doing nothing; it’s about doing enough, consistently, without overdoing it. Some gentle structure to your day—regular meal times, short rests, a bit of movement within your limits—can also help support your circadian rhythm and make it easier to wind down in the evening.

    There’s no “push through it” here. Pacing is about respecting your body’s limits and working with them, not fighting against them.

    Gentle movement within your limits

    Movement can help with both pain and sleep, but it needs to be the right kind of movement. This isn’t about graded exercise programmes or forcing yourself to hit step targets. For people with fibromyalgia, overdoing exercise often backfires, leaving you in more pain and even more exhausted.

    Instead, think: gentle stretching, short walks, seated exercises, or anything that feels manageable without triggering a flare. Even five or ten minutes of gentle movement during the day can help. Some people find that a bit of movement in the morning supports their body clock, while others prefer a gentle stretch in the evening as part of their wind-down routine.

    The key is listening to your body. If something leaves you feeling worse, pull back.

    Adjuncts and support tools: helpful, but not magic bullets

    Morning light and evening dim lighting

    Alongside a regular wake-up time, getting bright light in the morning and reducing bright light in the evening can help recalibrate your circadian rhythm. You don’t need expensive equipment—natural daylight is best, but if you’re housebound or it’s winter, a light therapy lamp (around 10,000 lux) used for 20–30 minutes in the morning may help. Speak to your GP before starting light therapy, especially if you have eye conditions, take photosensitising medicines, or have a history of bipolar or manic episodes.

    In the evening, dimming the lights and reducing screen time in the hour or two before bed gives your brain a chance to start producing melatonin naturally.

    Melatonin: a short-term adjunct, not a cure

    Melatonin is a hormone that helps regulate your sleep-wake cycle, and some people with fibromyalgia find that a low dose (around 1–3 mg) taken an hour or so before bed helps them fall asleep more easily. Small studies suggest melatonin may also have mild pain-relieving effects in chronic pain conditions, though the evidence is still emerging. Studies in chronic pain, including fibromyalgia, are still small and short term, and in the UK melatonin isn’t usually prescribed specifically for fibromyalgia on the NHS – it’s more of a case-by-case, off-label discussion with your doctor.

    However, melatonin isn’t a cure for fibromyalgia or fibromyalgia insomnia. It’s best used as a short-term tool to help reset your sleep pattern, ideally alongside the behavioural strategies above. It can cause daytime grogginess in some people and may interact with other medications, so it’s important to discuss it with your GP or specialist before trying it.

    Sleep hygiene basics

    You’ve probably heard of sleep hygiene: keeping your bedroom cool, dark, and quiet; avoiding caffeine late in the day; not using your bed for scrolling or working. These things can help, but they’re not usually enough on their own—especially when you’re dealing with fibromyalgia pain at night.

    Still, they’re worth getting right. Small adjustments like blackout curtains, a supportive pillow, or a notebook by the bed (for writing down worries so they’re not spinning in your head at 2 a.m.) can make a difference when combined with the bigger strategies.

    Practical tips you can try: small steps, realistic goals

    If you’re reading this and feeling overwhelmed, start small. Here are a few manageable things you can try:

    1. Pick one wake-up time and stick to it for two weeks, even after a bad night. Set an alarm, get up, and get some light (natural or from a lamp).
    2. Create a simple wind-down routine: 20–30 minutes before bed, dim the lights, put your phone in another room, and do something genuinely calming. Reading, gentle stretching, or listening to an audiobook all work.
    3. Keep a sleep and pain diary for a week or two. Note your bedtime, wake time, how you slept, and your pain levels. Patterns often emerge that can help you spot what’s helping (or hindering).
    4. Pace your daytime activity. Don’t try to “make up for lost time” on good days. Spread tasks out, rest before you’re desperate, and give yourself permission to do less.
    5. Try a “brain dump” before bed: write down anything that’s worrying you or that you need to remember. Getting it out of your head and onto paper can reduce the mental chatter that keeps you awake.
    6. Get outside (or near a window) in the morning, even for five minutes. Your body clock will thank you.
    7. Talk to your GP or a sleep specialist if insomnia is severely affecting your quality of life. CBT-I, referrals to pain management services, or adjustments to your medication may all be options worth exploring.

    Even small improvements in sleep can start to ease the pain-fatigue cycle. It won’t happen overnight, but over weeks and months, many people find that their pain becomes a little more manageable, their energy improves slightly, and the whole picture feels a bit less impossible.

    Bringing it together

    Fibromyalgia and sleep are deeply intertwined. The same nervous system changes that amplify pain also disrupt your ability to get restorative rest, creating a vicious circle that’s exhausting to live with. But while there’s no magic cure, there are evidence-informed strategies that can help.

    Working with your circadian rhythm, exploring CBT-I, pacing your activity, and making small, sustainable changes to your sleep habits can all contribute to breaking the cycle. Adjuncts like morning light, melatonin (if appropriate), and good sleep hygiene can support these bigger strategies, though they’re not enough on their own.

    The goal isn’t perfect sleep—it’s better sleep. And better sleep, even in small increments, can make fibromyalgia a little easier to live with.

    FAQ: Fibromyalgia and sleep

    Why can’t I sleep with fibromyalgia, even when I’m exhausted?
    Fibromyalgia affects your nervous system’s ability to regulate pain, stress, and sleep. Even when you’re exhausted, your brain may be in a state of hyperarousal, making it difficult to relax into deep sleep. Pain at night, heightened sensitivity, and a disrupted circadian rhythm all contribute to this frustrating “tired but wired” feeling.

    Can improving my sleep reduce fibromyalgia pain?
    Yes, to some extent. Better sleep won’t cure fibromyalgia, but it can help reduce pain intensity, improve your pain threshold, and ease other symptoms like fatigue and brain fog. Sleep and pain are closely linked, so working on one often helps the other.

    Is CBT-I effective for fibromyalgia insomnia?
    CBT-I (cognitive behavioural therapy for insomnia) has good evidence for treating chronic insomnia, including in people with long-term pain. It won’t work for everyone, and it requires commitment, but many people with fibromyalgia find it improves their sleep quality and reduces the impact of insomnia over time.

    Should I take melatonin for fibromyalgia sleep problems?
    Melatonin can help some people with sleep onset, and there’s early evidence it may have mild pain-relieving effects in chronic pain. However, it’s not a cure and works best as a short-term adjunct alongside behavioural strategies. Always discuss melatonin with your GP first, as it can cause side effects and may interact with other medications.

    Disclaimer: This article is for general information only and is not a substitute for individual medical advice. Always speak to your own doctor or specialist before making changes to your medication, diet, supplements, or activity levels.

    Next read: When you’re ready, learn how bad nights can tip you into crashes in Fibromyalgia Sleep and Flares: How Bad Nights Turn Up Pain and PEM

    Key resources & references

    NHS – Fibromyalgia overview

    NICE guidance on chronic primary pain (NG193)

    NICE guidance on ME/CFS: diagnosis and management (NG206)

    Versus Arthritis – Fibromyalgia

    Fibromyalgia Action UK (FMA UK)

    Written by Stems From The Gut
    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about who we are and how we use evidence on the Authors & Medical Stance page.

  • What Is Fibromyalgia? (And What It Isn’t)

    What Is Fibromyalgia? (And What It Isn’t)

    Why this question matters

    You’ve been living with pain for months, maybe years. It shifts around your body – your neck one day, your hips the next, your hands the day after that. You’re exhausted in a way that sleep doesn’t touch. Your brain feels thick and foggy. You’ve had blood tests, scans, referrals. Everything comes back “normal”.

    And yet you’re not fine. Not remotely.

    Maybe your GP has mentioned fibromyalgia. Maybe you’ve typed “chronic widespread pain” or “what is fibromyalgia” into Google at 2am, trying to make sense of it all. Maybe someone has suggested it’s stress, or that you just need to get fitter, and a small part of you is wondering if they’re right.

    Here’s the thing: fibromyalgia is real. It’s recognised by the NHS, by NICE guidelines, and by pain specialists across the UK. The pain you feel isn’t imagined, it isn’t weakness, and it isn’t your fault.

    So what is fibromyalgia – and just as importantly, what isn’t it?

    What is fibromyalgia? A plain-language definition

    Fibromyalgia is a long-term pain condition where your nervous system becomes oversensitive to pain signals. It’s as if the volume knob on your pain system has been turned up too high. Sensations that wouldn’t usually hurt – a light touch, everyday movement, even the weight of clothing or bedding – can feel painful, uncomfortable or strangely “too much”.

    Medically, fibromyalgia sits under the umbrella of chronic widespread pain. That means pain affecting several parts of the body (both sides, above and below the waist) for at least three months. In current NICE guidance it’s grouped within chronic primary pain – pain that has become a condition in its own right, rather than being explained by obvious joint damage, inflammation or a single injury.

    In fibromyalgia, your brain, spinal cord and nerves process information differently. The alarm system is on a hair trigger. That doesn’t make the pain any less real. It simply means the main issue sits in how the nervous system works, rather than in something that shows up on a scan or a standard blood test.

    This isn’t about “thinking yourself into pain”. The system that’s meant to protect you has become over-protective. Once those pathways are reinforced over months or years, they can be very persistent.

    How fibromyalgia feels in real life

    Fibromyalgia almost never shows up as “just aches”. It usually arrives as a cluster of symptoms that don’t fit neatly into a single box.

    The pain itself often feels deep and muscular, as though you’ve done a tough workout you never actually did. It can feel like joint pain even when the joints themselves aren’t inflamed or damaged. Some people describe burning, shooting or stabbing sensations. Others notice that even a hug, a waistband, or lying on one side in bed feels surprisingly sore. The pattern shifts: shoulders might be worst one week, lower back or hips the next, or sometimes it seems to be everywhere at once.

    Then there’s the fatigue – not just feeling tired, but a bone-deep exhaustion that doesn’t lift with a lie-in. People say it’s like waking every day with only 10% battery, no matter how early they went to bed.

    Sleep itself is usually part of the problem. Many people fall asleep only to wake repeatedly, or sleep through the night but wake feeling completely unrefreshed. Doctors call this non-restorative sleep: your brain never quite drops into the deeper, restorative stages often enough, so you wake feeling as if you’ve barely slept at all.

    “Fibro fog” adds another layer. Losing words mid-sentence. Walking into a room and immediately forgetting why. Reading the same paragraph three times and still not taking it in. Mixing up dates, names or simple tasks you’d normally do on autopilot. It’s frightening, especially when you worry about things like dementia, but in fibromyalgia it’s usually part of the wider picture of chronic pain, poor sleep and a constantly over-busy nervous system.

    Many people with fibromyalgia also notice their senses feel dialled up. Background noise in a café, bright lights in a supermarket, strong smells or changes in temperature can all feel overwhelming. IBS-type gut symptoms, bladder urgency, headaches or migraines, dizziness, restless legs and muscle twitches are common travelling companions.

    Taken together, it can feel as if your whole system is turned up too loud.

    How is fibromyalgia diagnosed?

    There isn’t a single blood test, scan or “marker” that diagnoses fibromyalgia. That doesn’t mean it’s vague or made up – it means diagnosis is based on patterns rather than one lab result.

    In practice, a diagnosis usually comes from three strands woven together:

    Your story and symptoms. Your clinician will listen for pain affecting multiple areas of the body for at least three months, alongside things like fatigue, unrefreshing sleep and brain fog.

    A physical examination. Your GP or specialist will check painful areas, look at how the pain is distributed and make sure there are no obvious signs of joint inflammation, neurological disease or another clear explanation that would point in a different direction.

    Tests to rule out other conditions. Blood tests help exclude things like thyroid disease, inflammatory arthritis, anaemia or vitamin deficiencies.

    Normal blood tests do not mean the pain is “just anxiety” or “in your head”. They simply show that those particular problems aren’t present.

    Some GPs are confident diagnosing fibromyalgia themselves; others refer on to rheumatology or pain clinics. Whichever route you take, a good diagnosis should feel like someone has finally joined the dots with you – not like you’re being dismissed.

    What fibromyalgia isn’t

    Because fibromyalgia doesn’t show up clearly on standard tests, a lot of myths have grown around it.

    It isn’t “all in your head”.
    The brain and nervous system are central to fibromyalgia, but that doesn’t make the pain imaginary. Brain imaging studies show differences in how people with fibromyalgia process pain and sensory information. The pain is real; the wiring just works differently.

    It isn’t classic arthritis.
    Fibromyalgia doesn’t damage or deform your joints or bones. You can absolutely feel joint pain, stiffness and aching, but if you have visible swelling, warmth or deformity in a joint, that needs separate assessment. Some people live with both fibromyalgia and an inflammatory or mechanical joint problem – but they’re not the same condition.

    It isn’t laziness or a lack of fitness.
    Most people with fibromyalgia have pushed through for a long time before anyone names what’s going on. Chronic pain naturally leads people to move less, which can cause deconditioning over time – but that’s a consequence, not the root cause. You didn’t bring this on yourself by being “unfit”.

    It isn’t simply stress or depression.
    Stress and mood absolutely influence pain, and long-term pain feeds anxiety and low mood in very understandable ways. But fibromyalgia isn’t just “stress in disguise”. It’s better understood as a condition of nervous-system sensitisation, sometimes with mood and stress layered on top, rather than as a purely psychological problem.

    Why does fibromyalgia happen?

    The honest answer is that we don’t yet have a single, simple explanation. Fibromyalgia seems to develop from a combination of factors that add up over time.

    There may be a genetic vulnerability – fibromyalgia and related pain conditions run in families. On top of that, many people develop central sensitisation: over months or years, the nervous system becomes more and more protective, until it starts reacting as if everyday sensations are dangerous.

    There’s usually a trigger, or a cluster of triggers. For some people, fibromyalgia appears after a physical injury, an operation, an infection or a period of severe illness. For others, it follows a stretch of intense life stress – bereavement, relationship breakdown, work pressure – or a long spell of poor sleep and burnout. In many cases, several of these threads are tangled together.

    Hormones seem to play a role too. Fibromyalgia is more common in women, and some people notice their symptoms fluctuate with their menstrual cycle or around perimenopause and menopause. That doesn’t mean oestrogen changes are the whole story, but they’re likely part of it.

    There’s also growing interest in gut–immune–nervous system connections. Many people with fibromyalgia also live with IBS-type gut symptoms, and research is exploring whether changes in the gut microbiome and low-grade inflammation might interact with the pain system. At the moment, it’s safer to describe these as possible contributors rather than simple causes or cures.

    What we know with confidence is that fibromyalgia is a real neurobiological condition that emerges from a mix of biology, life events and environment. It’s not about being weak, negative or somehow failing to cope.

    How is fibromyalgia treated? A realistic overview

    There is no quick cure for fibromyalgia. Anyone promising to “fix” it in a month with a single supplement, boot camp or detox is overselling. But that doesn’t mean there’s nothing to be done.

    Most people who find a better balance with fibromyalgia do so through a combination of approaches that gradually turn the nervous system’s volume down and make life more liveable. The aim is “better and more manageable”, not perfection.

    Understanding and validation.
    Simply having a clear explanation – “this is fibromyalgia; this is how it works” – is surprisingly powerful. Knowing that your pain comes from nervous-system sensitivity rather than hidden damage can reduce some of the fear and confusion that automatically dial pain up. Being believed matters too. A GP or specialist who says, “Yes, this is real and it’s tough, but there are things we can try,” makes a huge difference.

    Pacing rather than boom-and-bust.
    Many people with fibromyalgia recognise the boom-and-bust pattern: a slightly better day appears, you rush to catch up on everything, and then you crash hard for days afterwards. Pacing is about stepping off that rollercoaster. It means spreading activity more evenly, building in rest before you’re desperate for it, and working out what feels like a sustainable “baseline” level of activity for you right now. From there, you can experiment with very gentle increases.

    If you notice post-exertional malaise (PEM) – where even modest physical or mental activity makes you significantly worse for a day or more – the approach needs to be especially cautious, more akin to ME/CFS-style pacing than to classic graded exercise. The key is respecting the limits your body currently has, not pushing through them because you “should” be able to.

    Sleep support.
    Non-restorative sleep is such a core piece of fibromyalgia that any improvement here tends to ripple out into pain, fatigue and brain fog. Helpful strategies include keeping a fairly consistent wake-up time (even after a bad night), getting some daylight soon after waking, creating a short wind-down routine in the evening and looking at anything else that might be disrupting sleep – from medication timing and pain to worries that hit hardest at 2am.

    Cognitive behavioural therapy for insomnia (CBT-I) is one of the most evidence-based treatments for long-term sleep problems, and it can be adapted for people with chronic pain. It doesn’t suit everyone, and it does require some effort, but for some people it makes a real difference to sleep quality over weeks and months.

    Movement within your limits.
    Movement helps pain, mood, sleep and general health – but only if it’s done in a way that your system can tolerate. For fibromyalgia, “no pain, no gain” is usually the wrong approach. For some people, helpful movement looks like short, gentle walks, stretches or water-based exercise. For others, especially when symptoms are severe, it might start with very small, structured movements around the house or in a chair.

    The key is to work with your body, not against it: start low, go slow, and watch how your symptoms respond over the next 24–72 hours rather than just in the moment.

    Emotional and psychological support.
    Living with long-term pain is emotionally hard work. Therapies such as CBT or acceptance and commitment therapy (ACT) can help people find ways to live alongside symptoms, reduce the intensity of distress, and make room for things that still matter to them. That doesn’t mean your pain is “just psychological”. It means your brain, body and emotions are all connected – and if one part is under constant strain, it’s helpful to support the others.

    Medication – where it fits, and where it doesn’t.
    Medicines sometimes take the edge off fibromyalgia symptoms, especially when used alongside the approaches above, but they’re rarely a complete solution on their own.

    In NICE guidance for chronic primary pain, the main medicines considered are certain antidepressants, such as amitriptyline or duloxetine. These are used at lower doses than for depression and may help calm overactive pain pathways and sometimes improve sleep.

    Other medicines, such as pregabalin or gabapentin, are generally reserved for people who also have clear nerve-type pain or another neuropathic pain condition, and usually under specialist advice. NICE is cautious about starting these purely for chronic primary pain.

    On the other hand, long-term opioids (like codeine or tramadol), benzodiazepines, and using paracetamol or NSAIDs as stand-alone treatments are not recommended for chronic primary pain in general. They may still have a role for other conditions you might also have – for example inflammatory arthritis – but they’re not good long-term tools for fibromyalgia-type pain on their own.

    Medication is very individual: what helps one person does little for another, and side effects often limit what’s realistic. The goal is to find the smallest effective dose of the simplest regimen that gives you some relief without too many downsides, and to combine that with non-drug strategies.

    Can fibromyalgia get better?

    Fibromyalgia doesn’t follow a single script. Some people find their symptoms are fairly steady over time. Others notice waves and phases – better stretches followed by flares. A smaller group see quite marked improvement over the years.

    It isn’t always relentlessly downhill. With the right mix of pacing, sleep support, movement within limits, emotional support and, where appropriate, medication, many people find that their pain becomes less overwhelming, crashes become less intense or less frequent, and life starts to feel a little more spacious again.

    You may not get back to how things were before fibromyalgia appeared. But it’s entirely reasonable to hope for more good days, shorter flares, and a life that feels more like yours again, rather than something ruled entirely by pain.

    Quick answers to common questions

    Is fibromyalgia real?
    Yes. It’s recognised by the NHS, by NICE, and by pain specialists and researchers worldwide. Studies show measurable differences in how people with fibromyalgia process pain and sensory information.

    Is fibromyalgia an autoimmune disease?
    At the moment, fibromyalgia isn’t classed as an autoimmune disease. Classic autoimmune illnesses involve the immune system directly attacking tissues, which isn’t what we see in fibromyalgia. It’s better thought of as a condition of nervous-system sensitisation, although there may be some immune and inflammatory involvement that researchers are still unpicking.

    Can fibromyalgia be cured?
    There’s currently no cure. But symptoms can be reduced and better managed with the right mix of self-management, medical support and time. The focus is on improving quality of life rather than chasing a complete disappearance of every symptom.

    Will exercise help, or make me worse?
    It depends very much on how it’s done and on whether you also experience post-exertional malaise. Gentle, well-paced movement within your limits helps some people over time. For others, especially where activity reliably causes big delayed crashes, the priority is careful pacing and energy management first, with tiny movement experiments built in very gradually.

    Is fibromyalgia connected to gut health or hormones?
    Both seem to be part of the wider picture. Many people with fibromyalgia have IBS-type symptoms, and hormonal changes (for example around perimenopause) can influence how symptoms feel. Supporting gut health and hormone balance can help as part of a bigger plan, but they’re unlikely to be magic bullets on their own.

    Disclaimer: This article provides general information about fibromyalgia and is not a substitute for individual medical advice. If you’re experiencing chronic pain, fatigue or other worrying symptoms, please speak with your GP or a specialist. Everyone’s situation is different, and what works for one person may not work for another.

    Next read: If you’d like to understand why sleep is such a big deal in fibromyalgia, read our guide to fibromyalgia and sleep

    Key resources & references

    Written by Stems From The Gut
    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about who we are and how we use evidence on the Authors & Medical Stance page.