This article is based on scientific evidence, written by experts and fact checked by experts. This does come back to a philosophy of improving ones gut ecology. So its not like youre going to do things vastly differently. But I mean it medically. Im an independent laboratory. And oregano is a standard combination I use. It takes 30 minutes to an hour for Pepto-Bismol (bismuth subsalicylate) to start working and help relieve diarrhea, upset stomach, and nausea. It doesnt matter what were talking about. And I tried that on a lot of patients, and what I found is, it would just immediately come back and I could perceive it just wasnt long enough. The original formula was developed by a physician to treat severe diarrhea brought on by cholera. Typically, the air that is swallowed will remain in the stomach until it gradually moves through the digestive system by peristalsis. In addition to colon bacteria, people with SIBO can have too much bacteria in the small intestine (where there should only be a small amount) which can ferment carbohydrates and also produce these gases. Pepto-Bismol works as an antacid to reduce excess stomach acid and so eases discomfort. And there are many listeners that are clinicians that, unfortunately in the United States, dont have access to lactulose. Is it the air from the room? Getting more specific when someone has hydrogen sulfide issues it is usually correlated with diarrhea and sometimes rotten egg smelling gas, although Ive also seen constipation in people with h2s issues. And guess what the number one reason is for a flat line test? Ultimately Hydrogen SIBO will be treated by a GI with Rifaximin. And the reason why is because were not yet testing for hydrogen sulfide. Sometimes that would make them worse. 60% of the time (Ive done 34,000 tests), its because the patient did not consume the glucose or lactulose. However, we are, by and large, diagnosing SIBO based on the tried-and-true, time-tested, globally utilized hydrogen and methane breath testing, where we validate that from a gas perspective. I just started molybdenum by itself and plan to do the Epsom salts. DrAS: Sure. Which is, yes, we need to help weed out some of the things that we dont want there, but we also have to support the gut ecosystem, if you will, to encourage balance. Bismuth is also effective at reducing symptoms of Hydrogen Sulfide SIBO. I believe we discussed this on the podcast a while ago, that for suspected hydrogen sulfide SIBO, you could add in bismuth to synergize with antimicrobials. But what if your breath test shows no excess of hydrogen or methane, yet you have all the symptoms? It also works to protect the stomach and lower part of your food pipe (esophagus) from stomach acid. However, clinicians must warn travelers about blackening of the stool or tongue when taking this drug. So how do you get bismuth? I would start it slow, be careful. And most of the lactulose in the United States is a syrup. In any case. Bacteria found in your mouth and gastrointestinal tract produce hydrogen sulfide from decomposing materials that contain vegetable or animal proteins.3. Ive seen so many various prep guidelines out there. The clinician might treat. And one other thing I didnt say, that I always like to say as a disclaimer, Ive also seen all of those thingsthat I just said Ive seen worknot work in hydrogen sulfide patients. And I often point patients to Dr. Siebeckers site and Dr. Jacobis site, trusted, well-valued across the board, and to Dr. Ruscios podcast for information. BONUS: SIBO Research Breakthrough Updates SIBO Research Breakthrough Updates Thats why its flat. Any suggestions? They were both saying, you just treat it the same way you would have before, you treat the presentation, meaning constipation versus diarrhea. Excess hydrogen sulfide is a condition that is the result of the overgrowth of hydrogen sulfide-producing organisms. (specifically Target Up&Up brand if you are in the U.S. - a cleaner version of Pepto/bismuth) 3.) Thanks for all the great information youve provided here, And I just monitor Instagram periodically, but I replied on this one and said, Really? So I think thats probably where everyone is getting excited. GS: Can I just ask a question? Sulfur is critically important in the body. Its going to take years to do two things, validate it clinically, which is the point that I think Gary was really great in making. Regarding support, if youre not highly proficient in reading SIBO labs, Gary definitely offers the best clinical support Ive ever come across. That would be rifaximin for the diarrhea type or rifaximin plus neomycin or metronidazole for the constipation type. DrAS: Yes, its siboinfo.com and its a free educational website. Pepto-Bismol is bismuth. And I really want to underscore that point. Part of which are the ones that Dr. Siebecker highlighted for all of us, and thank you to her. So it makes sense that these people present generally sicker. 2: Laxatives, stool softeners, stool bulking agents (Ex-Lax, Colace, Metamucil, Fibercon) . And in terms of sulfur types of foods or supplements, a lot of them are worse from an Epsom salt bath, because thats magnesium sulfate. And why? Can a fecal transplant cure the dysbiosis imbalance causing hydrogen sulfide SIBO that causes debilitating diarrhea? And were going to have to do them for quite a few years. So were seeing this really play out. Sometimes theyd be taking allicin which comes from garlic, and thats sulfur-containing. buff.ly/3JsH0FZ. And the way that that occurs is, a patient presents and they have chronic postprandial symptoms. We might get a 20% gain from one and then another 20% gain from another. In this study the ability of bismuth subsalicylate, a compound that binds H 2 S . The movement of these gases does not cause us any pain or discomfort, and will eventually be released in small amounts. So yes, there are things that may be more active against hydrogen sulfide. But we dont want to confuse these patients. It wont hurt to test it out and see how your body reacts to it. Lets say the technology does come out, but its only in office and its not something that offices want to buy because of the cost of the technology. And then we further validate on the research that Dr. Siebecker did, that Dr. Ruscio is going to supply, and theyll talk about this in a moment. Again, Aerodiagnostics is the SIBO lab I use in my clinic. GS: Absolutely. In your interview with Greg Nigh you mention you were able to get past your hydrogen sulfide issues. It manufactured and distributed the pink liquid. DrMR: Awesome. He goes over labs in detail and offers insight analysis and really goes above and beyond. This is invaluable! So were seeing it. So thats light and noise intolerance. Never did feel quite sure it really did help methane, but Ive had a couple of cases where the hydrogen sulfide was successfully treated with high-dose oregano. DrMR: Okay. So thats always the kind of thing thats going to happen. So, what exactly is this gas composed of? They might add something different because they might feel that its hydrogen sulfide, like bismuth, something that Dr. Siebecker just alerted me to. Hydrogen sulfide is a colorless gas that has a characteristic smell of rotten eggs. Hydrogen sulfide is a new gas being studied as a cause of SIBO Specific hydrogen sulfide test not available as of August 2019 (in development) Current Method to Detect First, test for SIBO using a breath test Second, verify the test was performed correctly: did you drink the solution, lab prep, etc. And second, become widely available. Patients are resolving. If you are someone who has always had a mysterious case of SIBO or dysbiosis, your tests are inconclusive and/or show a flat line, or you know that you have recognized that your symptoms or the smell of your gas are linked to sulfur, then hydrogen sulfide overgrowth might be an issue. Thats just to name a few. Pepto Bismol (bismuth subsalicylate), a popular antidiarrheal drug, binds hydrogen sulfide and removes it from the gastrointestinal tract therefore minimizing sulfur burps and gas. Bismuth has also been shown to reduce hydrogen sulfide gas in afew studies. There was another work by Lin and Massey showing 48% of people with positive glucose hydrogen breath tests at 90 minutes had a rise after that with glucose. Also at the same time guarding against not getting pulled into a gutter of therapies that have no relevance to your gut, and maybe even spinning your wheels. But these are the validations. ), Rare: gas smells like sulfur (or rotten eggs), Remember other healthy gut foundational practices like diet & probiotics, You may not need to overly specialize on hydrogen sulfide treatment, Bismuth with other SIBO treatments (herbs, antibiotics), Antibiotics with -mycin (ex: Clindamycin, but does have C. diff risk Dr Siebecker prefers herbals), Healthcare providers looking to sharpen their clinical skills, check out the. A multi-focused approach works best to treat SIBO and biofilm. I think it was originally for blastocystis. Two, if your test is negative, consider hydrogen sulfide. Were not just trying to kill stuff, were also trying to help repair, and make the soilfrom which these organisms either grow or dont growthe most favorable that it can be. The other thing thatat least for right now until we have better dataI just want to again remind the audience of is, a good gut-focused or SIBO-focused clinician should be able to help you navigate this. Allison, will you remind people of your website, in case people wanted to hear more from you? So is it a I have a positive SIBO, Im just going to check on the hydrogen sulfide symptoms, the tingling of the hands and feet, the photophobia and intolerance, all the things that youve already reviewed? Because you will most likely need an experienced clinician or a good program to work through to rebuild your gut health, which would include things other than just, Okay, were going to use bismuth plus high-dose oregano.. Bismuth subsalicylate- 'Pepto-bismol', follow label dosing, short term use Possible side effects: constipation, blackened stools and/or tongue, Tinnitus Imodium, follow label dosing Avoid/careful with fats (ex. Side effects are generally mild and can include a . We havent even been able to test for a third gas. I utilize a branded device and branded kits because theyre the best that Ive come across. Green tea is well documented with research showing it reduces hydrogen sulfide gas by 30%. For more information on how to become a patient, pleasecontact our office. But what I think happens all too oftencertainly the majority of the timeis a clinician or a patient overlooks tried and true therapies. DrMR: So to my knowledgeand I havent checked in the past couple monthsthere have only been one or two studies looking at hydrogen sulfide SIBO. A great product that is recommended to test out isBiotics Mo-Zyme Forte. trio-smart is the only three-gas breath test available that measures hydrogen, methane, and, for the first . There have been days when Ive been like, Boy, Im getting another call from Gary or an email. And your customer service is sometimes almost hard to keep up with, because you are that thorough. This is just theory. Its just getting the available therapies to work takes time, thought, follow-up, personalization. Honestly Ive stopped using it because it became more expensive and Im not so sure about that test. Guess what? (The characteristic rotten egg smell is due to sulfur.). A new SIBO breath test assesses hydrogen sulfide, which is directly related to diarrhea and abdominal pain. We might not have a rise in the colon with lactulose because they were on elemental diet. So thats Alinia. August 14, 2019. I understand it but I think if I didnt feel strongly, I wouldnt offer it as a laboratory owner. DrAS: I think its very reasonable. Different underlying hydrogen sulfide issues (SIBO, LIBO, and sulfur-sensitivity) Different diagnostics (flat line, Trio Smart, or symptoms) Different symptoms (headaches, brain fog, sulfur gas, etc), and . Some bismuth-containing products that may be useful includeDevrom,Thorne Pepti Guard,andBiotics HPF. Bismuth subsalicyclate (BSS) has been shown to provide up to 65% protection against TD when taken as 2 tablets 4 times per day for a maximum of 3 weeks. Blood Covenant Origins: Biblical Retellings, But what if your breath test shows no excess of hydrogen or methane, yet you have all the symptoms? So I would see that, and also supplements like MSM. But, Bismuth subsalicylate has also been shown to substantially reduce gas in the intestine caused by hydrogen sulfide. We really dont know. Although widely available, breath testing is less specific than other types of tests for diagnosing bacterial overgrowth. And the noise level about hydrogen sulfide right now is confusing them. The test tells you whether your IBS was caused by food poisoning from anti-cdtb and anti-vinculin antibodies. At the same time, it has antibacterial activity that may kill off both the unfriendly bacteria and the biofilms they live in. And so is intolerance to noise. GS: Yes, I absolutely agree with that. I recently had the opportunity to sit down with Dr. Greg Nigh a Naturopathic doctor fromPsoriasiswho was able to clearly explain this process, as well as provide some insight as to why he believes that sulfur metabolism plays a role in H2S SIBO. The flat line hydrogen and methane breath test, if prep was done correctly and if you have chronic postprandial symptoms Why do I keep saying this about prep and chronic symptoms? (2) The Ruscio Institute is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. It might be yeast overgrowth. This is commonly known as Pepto Bismol. If you use highly absorbable foods, that hasnt been tested. As always, make sure to talk with your doctor to determine the best protocol. So, I feel like its essential in a basic way. Background & Aims: Hydrogen sulfide is one of the main malodorous compounds in human flatus.This toxic gas also has been implicated in the pathogenesis of ulcerative colitis.Therefore, a treatment that reduces colonic H 2 S levels could be clinically useful in the treatment of flatus odor and of ulcerative colitis. When I see zeros, ones, twos, threes parts per million with glucose, were picking up the phone. I have to underscore this. And this is something hes actually been talking about for many, many years and reported on for many years. In small amounts, hydrogen sulfide is actually a vital molecule that is needed for living organisms to survive. Unfortunately the treatment for Methane and HS is Rifaximin and Neomycin in combination. One interesting diagnostic approach, aside from a flat line in regular SIBO testing, is Pepto Bismol. The studies right now with fecal transplants in IBS patients have not shown good results and can make someone worse. I usually use two herbs at once when Im treating SIBO. 1, 2 Experts suggest non-invasive breath testing for the diagnosis of SIBO. Each tablespoon or chewable tablet contains 262 mg, and it aggressively soaks up hydrogen sulfide and pulls it out of your body (by turning the hydrogen sulfide into bismuth sulfide). Id like to thank Aerodiagnostics, my favorite SIBO lab, for making this podcast possible. Now, before I go on, let me just say that I uniformly saw constipation in my hydrogen sulfide patients. If you need a refresher on what exactly SIBO is and how its linked to IBS see the overview here. And then we think its hydrogen sulfide. Although if Im remembering some of the details correctly, you oftentimes see an overlap between being traditional SIBO-positive and hydrogen-sulfide-SIBO-positive. They have the mycin on the end of the name of them. So many of the chronic cases, sadly, appear to be chronic because the provider hasnt had the requisite knowledge in how to really get in there and use the available tools appropriately. So the problem is not on the clinicians, not on the patients. However, as Dr. Ruscio clearly pointed out in the introduction, we need to be cautious that we dont jump from an approach that weve used in large part to actively deal with patients suffering from SIBO globally, to newer technologies that may be very exciting and new in research situations, but have not been necessarily tested, nor has the technology been validated to really lead us. Its a series of secondary questions. Genetic tests can come with a cost, and not only to your wallet. And it was like they had both histamine and salicylate intolerance on top of their SIBO food intolerance. Learn more about SIBO and its variations here. And what prokinetic did you use and possibly still using? indigestion. And now the exciting opportunity iswhen the technology becomes available and when its not in research mode, when its actually been a large-scale study across multiple geographies and anatomies across the globeis it standard? The Future of Functional Medicine Review: Elemental Heal (Gut Healing Meal Replacements), Future of Functional Medicine Review Clinical Newsletter, gut related disorders such as SIBO, leaky gut, Celiac, IBS, An Effective, Gut-Friendly Meal Replacement Shake, The Two Most Effective Supplements For Your Gut Microbiome, Spotting a Hashimotos Misdiagnosis and Treating The Real Cause, The Truth About Genetic Testing For Your Health, Hydrogen sulfide is a new gas being studied as a cause of SIBO, Specific hydrogen sulfide test not available as of August 2019 (in development). But by and large, were having a lot of success based on everything that weve discussed. It is also used to treat diarrhea and help prevent travelers' diarrhea. A low sulfur diet enables the overworked enzymes to play catch-up. Pepto-Bismol has been around for more than 100 years. Sulfur is also part of the cellular stress response, improving ATP (energy) productionso that cells can carry on normal functions even when under stress. So theyre not so much chronic because they need some new novel treatment, but theyre chronic because the level of precision the clinician has had hasnt been up to snuff to help them get over this. I continued to workout and sweat often. One interesting diagnostic approach, aside from a flat line in regular SIBO testing, is Pepto Bismol. Even if you kill the overgrown bacteria and restore normal sulfur levels, if the reason sulfur dropped in the first place is due to toxicity, then identifying and, SIBO, Small Intestine Bacterial Overgrowth. Our Disclaimer and Privacy Policy. But Allison, any particulars that youre looking to? TypicalSIBO antibiotics, such as Xifaxan, Neomycin, Berberine, Neem, and oregano, can also be effective in treating H2S symptoms. And as with many that are listening (and those here on this podcast), we always look forward to new technologies, new approaches to evaluating SIBO, and whether or not there are applications to that in treatment. In summary, testing a low sulfur diet combined with daily Epsom salt baths for 7 days is a great place to start. The prevalence of this are going to be different. We need to validate, is this bacteria in the small intestine where it doesnt belong, or is it not? Its most important, of course, to find the root cause. Im not even going to share any more about that. 25 It is usually well tolerated in young healthy adults. This is what we do. Were working one-third blind here and were in the middle of an age of discovery here in SIBO. Ive said that many times before. I have started to take berberine and it is also suggested to take Allicin along with it. I also have H2S. All rights reserved. Then there are some herbs that we could use. So to your point, Dr. Ruscio, it could be a large amount of people would be handled very well by that. Theyve been sick for so long. There are also some supplement products that have bismuth in there. Gary Stapleton: Yes, thank you, Dr. Ruscio. Nirala Jacobi: Small intestine aspirate and fluid culture. But really, you could just add it to whatever you were doing. I will never share, sell, or publish your email address. I asked Dr. Weinstock about that, and he said that approach had been very successful in his experience. Its going to say, any time I feed itdoesnt matter if its morning, afternoon, evening, it doesnt matter what type of foodgenerally speaking, its going to ferment. Hydrogen sulfide is a colorless and odorless gas that is produced both by our own cells, and, by bacteria in the large intestine. And I appreciate that both Dr. Ruscio and Dr. Siebecker are participating in this conversation. And what wed like to do is level set what we know today. A breath test can help you determine if your symptoms are caused by treatable conditions like small intestinal bacterial overgrowth (SIBO). So thats one thing we can do. Honestly, it really just depends. Is it helping hydrogen sulfide? And so I asked what Dr. Pimentel and Dr. Weinstock were doing. Serving the San Francisco bay area and distance patients via phone and Skype. It damages nerves and mitochondria. A hundred patients that go through their center are different than a hundred patients off the street. We talk with clinicians every day and we call on every single flat line test, whether its a glucose or lactulose, we call on it. Symptoms of hydrogen sulfide SIBO are similar to those of regular SIBO, except that they also are more commonly linked to diarrhea than constipation. This makes up 60 to 70 percent of flat line. So theyre more challenging cases. And this was not my dosing regimen. Five of those tablets, three times a day for 10 days, and then drop down to three tablets, three times a day for 20 days. So if youre going to treat SIBO more empirically, then you consider adding these in. If so, what is the instrument(s) used for these measurements? That seems to be a little bit better tolerated for a lot of people. These include brain fog, memory issues, redness, fatigue, and other problematic digestive symptoms like diarrhea and constipation seen in IBS. So, just because you have a flat line, it doesnt necessarily mean its hydrogen sulfide. Dosing is 10 drops up to several times daily. Now, if you did, in fact, prepare correctly and you are negative for SIBO, you may want to consider hydrogen sulfide as the culprit. Lemongrass oil has been shown to exhibit an antimicrobial effect on sulfur-reducing bacteria through its active ingredient, citral, inseveral studies. Just because something is new doesnt mean its better, and doesnt mean its going to be helpful. I know theres a preference. It has nothing to do with flat line. I personally dont feel comfortable using it. Its amazing how far weve come and we have farther to go. Antibiotics are used to treat both types of the disease, but along with antibiotics, methane-dominant SIBO may require you to take fiber. Its on the lab. These symptoms can include: heartburn. So it could be that theres methane present at the same time, and methane is usually more dominant than hydrogen sulfide. Well, Gary, Allison, thank you for this roundtable. This isn't a long-term solution, but if you do have hydrogen sulfide-producing SIBO, it will likely help alleviate symptoms. We have to be very careful with that though, because that can aggravate. Glutathione (used by that last one) is also most powerful antioxidant in the body, comprised of three amino acids: cysteine (which contains sulfur), glutamine, and glycine. Is it really hydrogen sulfide? And one lady said, What probiotics do you recommend?. It's used to help diagnose common digestive problems, including SIBO, IBS and lactose intolerance. If they do, then we yield to Dr. Siebeckers work here, and weve been validating that they are hitting on one or more of these. Is Berberine the main natural antimicrobial used for hydrogen sulfide sibo? Unfortunately, there is not as much research on this type of overgrowth and it can be challenging to manage and treat it effectively. And those came from Dr. Jacobis research. Theres a study that used it and it had a very successful rate of treating it. And most importantly, they treat, and guess what? Then, we have methanogens that produce methane, but we are re-thinking that whole diagnosis as more intestinal methanogen overgrowth rather than classic SIBO. Dr. Ruscio is your leading functional and integrative doctor specializing ingut related disorders such as SIBO, leaky gut, Celiac, IBSand inthyroid disorders such as hypothyroid and hyperthyroid. For a while there, I couldnt tell, is it helping methane? The symptoms of H2S overgrowth can be pretty debilitating, depending on the severity of the dysbiosis. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you! 2020 SIBO Surivor | All Rights Reserved. Weve got to see how this pans out, right? And I should add one other thing. We want to see if the patient, number one, did the test correctly. So I dont like the idea of using that long-term at all, personally. Then the hands and feet and fingers and toes can have tingling or numbness. And photophobia is not something that Ive seen, but its in the research. However, the testing for this is not yet available. Steps to Breaking Through Biofilm to Eradicate SIBO: As always, "clean air, clean water, and clean food" should come first. I contacted Dr. De Meirleirs lab, and the lab director sent me a list of antibiotics that could be used, based on the hydrogen sulfide producing organism that you find. If youre exhibiting a lot of these symptoms, that increases the probability that the underlying cause of your symptoms may be this hydrogen sulfide SIBO, which could mean some nuanced changes in how you treat SIBO. It should be available maybe in 2019 or at least early 2020. But the problem is its so brand new, hasnt even hit the market yet commercially. So we have to see how this pans out. These amino acids, of course, are also building blocks for protein, so sulfur is necessary for building proteins in general. Uses. For the high-dose oregano that Im using, Im using the emulsified one thats in a dry tablet form. So, brain fog, fatigue, potentially high cholesterol and weight gain and higher blood sugar, joint pain, skin lesions. For glucoseand Dr. Goldenberg sent me great points, updated points, regarding thisby the Rome working group in 2009 showed a 71.7% accuracy, but more importantly, more newer work like Sellin is showing that 8 out of 25 patients with chronic diarrhea showed rapid transit, and theyre finding glucose absorbed distally.