For those who have been following my health journey since the beginning, you know that hydrogen sulfide SIBO has always been something on my radar. For a period of time, I suffered from intolerance to sulfur/thiol foods. Luckily, this eventually went away when I was introduced to the high-potency probiotic VSL#3 (one of the few probiotic formulas on the market that has research backing its use for IBS).
I also had other signs of hydrogen sulfide SIBO that made both myself and my doctor at the time convinced it was the explanation for me. But there wasn’t a breath test for hydrogen sulfide to confirm our suspicions. What we did know was that I had elevated hydrogen gas (instead of methane), despite suffering from constipation as one of my main complaints (hydrogen is the gas typically associated with diarrhea-type IBS/SIBO). Additionally, I had the characteristic sulfur/rotten egg flatulence that is believed by some to be one of the telltale clues that hydrogen sulfide is in the picture.
So inevitably, my ears perked up real big when (at the NUNM SIBO Symposium 2017- June 3rd/4th) Dr. Mark Pimentel began discussing updates regarding hydrogen sulfide SIBO. And I knew I had to share it with you guys- my loyal audience counting on me to share what I know about this topic that is full of so many unanswered questions.
Hydrogen Sulfide SIBO Updates
Here’s what Dr. Mark Pimentel shared:
- Preliminary research has been conducted at Cedars-Sinai Medical Center in Los Angeles, CA involving a sensor for detecting hydrogen sulfide (H2S) gas in the breath.
- The preliminary research involved 127 patients (this is a small sample size), but the next step is to do a more extensive study. Individuals receiving breath tests at Cedars-Sinai are now being invited to consent to having hydrogen sulfide levels checked in addition to the standard hydrogen & methane gases.
- Preliminary research also indicates that hydrogen sulfide tends to be associated with diarrhea, not constipation. Higher levels of hydrogen sulfide seemed to correlate with having more diarrhea.
- The organisms that produce hydrogen sulfide (called sulfate-reducing bacteria) compete with methanogens (the ones that produce methane). This is because the production of both hydrogen sulfide and methane require hydrogen as “fuel”. It takes 4 hydrogens to create one methane and it takes 5 hydrogens to create one hydrogen sulfide.
- A flat line breath test (when methane and hydrogen are zero across the entire breath test, but hydrogen sulfide is not measured) has been believed to be an indication that hydrogen sulfide is present.
- At this time, there is not information on how to proceed with treating hydrogen sulfide SIBO.
- Keep in mind that because the sample size is small for the preliminary research, further data may show the preliminary evidence to be misleading.
Your Story
Now, I want to hear from you! Do you suspect you have hydrogen sulfide SIBO? Why do you think that? Do you lean more toward constipation or diarrhea? What have you found that works for you?
P.S.
I hope to share more updates from the NUNM SIBO Symposium in the near future. The best way to be notified of new articles is to follow Bridgetown Nutrition on Facebook. Please leave a comment if you have questions or would like to know if a particular topic was discussed at the symposium.
If you would like to watch the symposium, you will be able to purchase presentation recordings in a couple of weeks.
Thaks Riley!
But what if one flatlines methane and no hydrogen?
Could that also indicate hydrogen sulfide or is that something else? I’ve heard it mentioned a couple of times , as “another kind of SIBO” or something like that… it’s like Siebecker and the others really dont know what it indicates?
//. Patrik
Hi Patrik, I am not sure I understand you question. My understanding is that “flatline” implies zeros across the test for both hydrogen & methane and that it has been believed to indicate hydrogen sulfide (only theory at this point, of course).
Hi!
Hmm. Ok. Maybe I’ve misunderstood something then. I’ve believed it meant when the numbers stay the same from the beginning to the end of the breathtest? My mistake then.
// Patrik
Based on the words “flat” and “line”, I could definitely see how that makes sense!
Riley, I was wondering when did you introduce VSL#3 into your SIBO treatment…during or after and if after, how long after you finished your treatment? There is so much conflicting info out there as to whether someone should even take probiotics if have SIBO so just curious when you started taking it and how much. Also, did you introduce any “fermented” type foods into your diet during or after your SIBO treatment? Lastly, do you still pretty much eat low FODMAP or “SIBO” specific foods now that you are healed or have you branched out into more foods…grains, occasional deserts like ice cream, etc?
Thanks for sharing your experience and all the latest info on SIBO.
Hi Michele,
I introduced VSL#3 after I had treated with Rifaximin followed by about a year where I couldn’t seem to get off herbals without relapse. I knew taking herbals wasn’t sustainable so I was desperate to try something I viewed as more sustainable (even though I had been previously recommended to stay away from probiotics by a SIBO doc). VSL#3 ended up being exactly that sustainable option for me and I have since tried and tweaked other things to continue seeking optimal health. I experimented with some fermented foods- kombucha, sauerkraut, fermented carrots, fermented beets, enjera. I seem to do mostly okay with them, but I don’t find them to be therapeutic for me. I do not eat strict low FODMAP and definitely not SIBO specific, but I do maintain a somewhat “FODMAP-conscious” lifestyle when I notice symptoms creeping in. For a better idea what my life with food looks like, check out my instagram account. I must say though that I post more of my low FODMAP meals than ones I eat that do contain FODMAPs, but I eat dairy-free ice cream a couple times a month and enjoy dark chocolate and other desserts too.
Thanks for the info, Riley. My husband had 2 flatlined Breath tests, but experienced all the symptoms of SIBO so went on the assumption that he had it…possibly the Sulfide one. He does experience constipation, but he never has had the sulfur smelly gas that seems to be common for Hydrogen-Sulfide SIBO. He’s done Rifaximin 3 times with no success. He just recently finished doing 2 wks Elemental. He said it helped 50-60%, but still not better. His diet has been low FODMAP/SIBO for 1-1/2 yrs now. I want to experiment with more food, but he’s never without some discomfort so it never seems like a good time to try, plus I think he’s afraid to try new foods, although he’s so tired of eating same ol’things. He gets a lot of what I call indigestion; a burning feeling under his ribs all the time. Gets so bad it wakes him up early AM and can last most of day. Sometimes eating helps, but then he’ll get cramping & bloat when he eats. Seems like a vicious cycle!..,we’ve read “Breaking the Vicious Cycle” book, but didn’t seem to apply too much to SIBO. Sorry for the long post, but did you 1) Experience any indigestion like this?, 2) Did you take anything to help with constipation?, 3) Did you take a Prokenetic anytime during this process and if so, what?and 4) What do/did you eat for Breakfast?…we’re so tired of eggs! Thank you so much!
Hi Michele,
Here are my answers to your questions:
1) I have never personally experienced the problem with indigestion/burning under ribs. This may be a silly question, but has your husband been evaluated by a gastroenterologist? The burning under the ribs makes me think of a few possible things to have a doctor rule out- H pylori, stomach acid issues (Heidelberg test), hiatal hernia syndrome.
2) That’s a complicated question because I have taken different things at different stages of my healing journey. Might be better suited for a phone consult. Currently, I utilize diet, a prokinetic, probiotics, and lifestyle factors as my primary means of controlling constipation.
3) Yes, I have taken a prokinetic since being treated in 2014. I have tried many different ones along the way- Resolor, low dose erythromycin, low dose naltrexone, ginger, iberogast.
4) I don’t tolerate eggs very well, but I can definitely understand how eggs would get old and I do have some alternative suggestions! I have a recipe for “Italian Pork Sausages” on my website and I will sometimes make it with ground chicken or turkey for a leaner meat and to switch things up. I also sometimes do smoked salmon. Smoothies are a regular weekly item for me- I’ve got several recipes on my website. I eat certain gluten-free grains also so that expands my options- quinoa or rice porridge are some of my go-to items.
Hope that helps!
Thanks Riley for answering all my questions. Yes, my husband has seen 3 Gastroenterologists, has had all the tests that a GI does (except Heidelberg) and they haven’t uncovered anything.
Also, none of them feel there is such a thing as not enough acid. One of them had him on PPI’s for a few months and if anything it’s probably what contributed to SIBO. Its been so frustrating. I appreciate you taking the time to answer my questions. I will definitely check out your recipes. If we decide to do a consult, I can’t think of anyone else we’d rather have one with…someone that’s been through it! Thanks again!
Akk! I feel your frustration! So sorry you have not had a good experience with the medical world.
Hi Riley, when(empty stomach or with meals, morning, evening), and how often were you taking the VSL # 3 before you got your symptoms in control. Im ready to try it this week. Thanks again, James.
Hi James,
I still take VSL#3 at times and do not follow any particular schedule, but instead listen to my body. I haven’t noticed it make much of a difference as to timing in relation to meals. When I first started it, I began with 2 capsules per day and experimented with up to 8 capsules per day (per my doctor).
P.S. Please be aware that VSL#3 is designed to be taken under the care of a physician due to its potency. Although probiotics do tend to be safe, there are certain circumstances where they are contraindicated. I recommend that you speak with your doctor before trying VSL#3.
Hi I’m a little disappointed when i realized the VSL#3 contains milk. I fully avoid dairy products. I recently did a SIBO breath test and came back positive with hydrogen. 22 at 90mins 42 after 135mins. Ive started a round of xifaxan plus hydrogenated guar gum with Fodmap diet. My question is does xifaxan kill off the hydrogen sulfide SIBO too? I’ve been struggling with fibromyalgia, extreme brain fog, fatigue, depression and irritability. I do have very bad reactions to garlic, onions and eggs. I’m strongly believing I also have the sulfide SIBO too
Unfortunately, there is not currently research indicating whether Xifaxan is effective against hydrogen sulfide SIBO. Personally, it helped me (although the results were temporary, not long-term). I know it can be alarming to see supplements with dairy. I am highly sensitive to dairy (even a bite of cheese would cause me to have acne the next day), but had no issues with VSL3. Where did you see that VSL#3 contains milk? On their website, I found an article showing that it was reformulated in 2016 to be dairy-free.
Hi Riley,
Thank you for all of the information you have shared, especially about the Hydrogen-Sulfide type of SIBO.
I was diagnosed with Hydrogen-Sulfide SIBO after flatlining on a breath test 3 years ago. Of all the treatments I have tried, taking Rifaximin, two prokinetics, D-lactate free probiotics, and Nystatin, followed by 6 months of Biosolve PA was the only treatment that helped all my symptoms for any length of time. The Biosolve PA is not approved for long term use, though, and after discontinuing it my symptoms have returned.
Since you seem to have had such good luck with it, I am considering trying the VSL#3 after I get current symptoms under control.
Like many of your other readers, I am struggling with what to eat. Also, I have found that Betaine with Pepsin and digestive bitters cause inflammation. Do you think this is because of the bad bacteria? Or is the sulfur issue separate from the bacterial issue?
I would love to have a consultation with you, but notice you are scheduling at 7 weeks out. If I schedule an appointment is there a list to be notified if anything becomes available sooner?
Thank you!
Stephanie
Hi Stephanie,
Thanks for reaching out! I’m sorry to hear that you are struggling with symptoms. I would be happy to chat more and will definitely add you to the wait list. Perhaps you should go ahead and schedule for 7 weeks out so I have all your contact info and then can easily reschedule it to sooner in my system.
Regarding the inflammation with betaine, pepsin, digestive bitters, the first thing that pops into mind is potentially having high stomach acid? Alternatively, I could see it being related to high sulfur ingredients in those supplements causing issues.
I think that in many cases the sulfur is a direct result of the bacterial issue. However, there are other theories that we can discuss more when we chat.
Thank you,
Riley
What is the best treatment for Hydrogen Sulfide SIBO at this point? I am deciding between Xifaxan and elemental diet and am not sure which would be best or if either…
Hi Stephanie,
I am not aware of any research available to date that compares treatment options for those with hydrogen sulfide. Testing for hydrogen sulfide is currently in its infancy and therefore research regarding treatments is not yet available. Since sulfur-containing foods can be problematic for those with SIBO and an elemental diet is still rich in sulfur-containing amino acids (which are necessary for health, but may be problematic in large quantities when sulfate-reducing bacteria are overgrown), I would think Xifaxan would be more helpful for those with hydrogen sulfide SIBO. Just my theory though.
All the best to you in your healing journey!
Riley
Hi Riley,
Thank you for the information and sharing your experiences. I am certain and have been for a while that I have hydrogen sulfide sibo die to my food sensitivities and symptoms. So happy that its beginning to get attention.
I’m interested which herbals were you taking before the VSL3 probiotics that seemed to help you?
Also, have you learned of any new treatments or research regarding HS sibo?
Thank you,
Thanks for your comment! I am so glad it is getting better attention as well! I hope that means there will be more clear treatment strategies. You’re testing my memory a little with which herbals I took before VSL3 🙂 I think I tried Neem Plus by Ayush Herbs (worked best), Allimed (too sulfury for me), and Berberine Complex by Integrative Therapeutics (worked for a short period of time).
I know there is a lot of talk lately about bismuth as both a diagnostic and treatment strategy for H2S. However, it can be dangerous if administered incorrectly, so I would definitely make sure you use it under a doctor’s care who is familiar with it and feels comfortable using it safely. Personally, I have only tried it as part of a biofilm disruptor formula and it exacerbated my symptoms (which biofilm disruptors are supposed to do)- but that made it so I didn’t stick with it long term because I’ve got a life to live and symptoms don’t quite fit in with that 😉
Hey Riley,
Thank you for this article. I think I have Hydrogen Sulfide SIBO even though my breath test showed elevated hydrogen gas levels. My issues are: constipation, iron deficiency (even though I eat a well-rounded diet), gas, aggressive belching, bloating, white tongue, bad breath. The bad breath is my biggest complaint because it’s not normal bad breath. It has been described as smelling like rotten eggs and sewage and it can actually fill a room. In the morning it’s the worst, but it’s even more repulsive after eating or drinking certain items. For example, if I eat ice cream or have an alcoholic beverage, an odor emits within a minute or two. This happens on both an empty stomach or full stomach (after a meal). I also have this outcome with lemon water, ginger root tea, dandelion root tea, anything very cheesy, fried foods, and lentils. What’s odd is that i cannot smell the odor but I have been repeatedly asked by various people if I have passed gas. It’s such a socially crippling experience , I literally want to crawl in ball. Another strange thing is that when I’m sick with a virus or sinus infection, the odor is at its absolute worst (I get the most verbal reactions when I’m sick, even when I’m across the room). Well, I’m on day 3 of my 2 week Xifaxan prescription. I’m really hoping that it will cure this awful situation. Do you have any advice on what I can do? Thank you I’m advance for your time.
-VL
Hi!
I am so sorry to hear about the negative social repercussions of your symptoms- I know how frustrating that can be! (((Here’s a big virtual hug!)))
Your symptoms of white tongue and iron deficiency raise some red flags for me about yeast overgrowth- have you been tested or tried any treatments for it to see if symptoms improve? And oftentimes chronic sinus infections are related to yeast overgrowth. It sounds like your upper gut is where you experience the most symptoms. If the Xifaxan doesn’t provide adequate relief, I would recommend asking your doctor about antifungal treatments- a naturopath might be most helpful in this situation. Also, have you tried any probiotics?
Hi Riley,
Thank you for the response and the virtual hug 🙂
I have used probiotics, but they made no difference and I stopped once I was diagnosed with SIBO. I plan on using them again once I’m off xifaxan.
My doctor took a swab of my mouth to test for Candida, but I found out today that the results were all negative. Somehow I don’t believe that though.
Keeping my fingers crossed for Xifaxan, so far so good. Thank you again!
Glad to hear the Xifaxan is working so far! Crossing my fingers for you! P.S. yeast can be sneaky when it comes to testing.
Hi Riley,
Just wondering if you suffered from bloating with your SIBO? I seem to have hydrogen sulphide sibo and suffer more bloating from sulphur foods then I do with even some carbs. Whats your thoughts?
Hi Dave,
I didn’t struggle much with bloating- I did have some, but it wasn’t my primary symptom. But that doesn’t mean that hydrogen sulfide doesn’t cause it for some people! I have heard some theorize that bloating is a sign that gas is not being expelled very well. Do you have much gas?
GREAT ARTICLE! I just had a SIBO breath test that was completely flat lined the entire test. It was basically zero. I have a lot of nausea and don’t tolerate sulfur foods. I also am sensitive to what I eat. The nausea is the worst symptom. Did you have that and do you think I could have Hydrogen Sulfide sibo? I’d like a consult with you to talk about it.
I have definitely heard that kind of clinical picture be attributed to hydrogen sulfide SIBO. Unfortunately, I do not currently have any openings for new clients. I have a waiting list if you would like to be added to that to become notified when I begin accepting new clients.
I will do that! Have you seen patients with hydrogen sulfide sibo improve their energy and nausea with a protocol?
Everyone is so different in terms of their symptoms and what helps them feel better! I can’t think of a particular case of someone with those exact symptoms of nausea, low energy, and hydrogen sulfide SIBO, but it doesn’t mean it isn’t out there. I have seen many people experience symptomatic improvement from each of those issues individually.
I was exposed to deathly dangerous levels of Hydrogen Sulfide from the city sewer gasses coming directly into my home sewer system. At a rate of 267ppm, I had a heart attack and my first experience with SIBO. Could the SIBO have been caused from that poisoning? No doctor here in San Diego had any idea how to even test for Hydrogen sulfide poisoning. It took me 8 months to get the SIBO under control, now it has come back with a vengeance. This it the first I had heard about Hydrogen sulfide SIBO. The sewer problem has now been corrected, but I am left with serious health problems.
Fascinating (but scary!!) story. SIBO can occur for so many different reasons, toxic exposure being one of them, so you might be onto something there. Sorry to hear that it came back with a vengeance and that you are suffering from symptoms!
Hi Riley. I have been diagnosed with hydrogen sulphide SIBO based on my flat line breath test and my other typical SIBO symptoms of bloating, belching etc. However I haven’t noticed much of an improvement – Im 2 months into treatment. My practitioner doesn’t seem to have much experience treating this type of SIBO although she was able to identify it. I was wondering if you had any knowledge of any more recent research by the likes of Mark Pimental regarding treatment protocols? Many thanks for taking the time to read my message.
Hi Fin, the last I heard, Dr Pimentel was gathering more research regarding the test and felt that it was too early to provide any treatment suggestions. Perhaps you could ask your doctor about trying something new? Even for two people with the same type of SIBO gas, they may respond very differently to the same treatment. I’m all for tailoring it to the person, not the condition! But that’s just my personal opinion 🙂