There are a few types of SIBO and each type of SIBO is different.
To accurately diagnose and treat SIBO, you need to know the difference between Hydrogen Dominant SIBO, Methane Dominant SIBO and Hydrogen Sulfide Dominant SIBO.
Let me break down the characteristics of each type for you.
What is SIBO?
SIBO is a hot new gut issue, especially for people with irritable bowel syndrome (IBS).
Small Intestinal Bacterial Overgrowth, also known as SIBO, is an overgrowth of bacteria in the small intestine due to impaired defense mechanisms.
When bacteria overgrow in the small intestine, digestion and absorption are impaired, leading to gas, diarrhea, and constipation. This can cause malnutrition and weight loss, as well as a host of other symptoms.
Doctors often use breath tests to diagnose SIBO. These tests measure hydrogen and methane gases in the gut.
Once they know what type of bacteria is overgrowing, they can pick the right antibiotic. Antibiotics can clear out the bacteria, but many people still have symptoms after treatment.
A low FODMAP diet may help some SIBO symptoms by reducing carbs that feed bad bacteria. But please don’t think that dieting will clear SIBO.
Let me explain SIBO so you understand how it impacts gut health, and why dieting alone is not enough to diagnose and treat it.
The Three Main Types of SIBO
SIBO comes in many forms and is primarily classified by the type of gas it produces.
You can have Hydrogen Dominant SIBO, Methane-Dominant SIBO (also called Intestinal Methanogen Overgrowth) or Hydrogen Sulfide Dominant SIBO.
Each type of SIBO is associated with different bacteria and the way they produce gas.
It is good to understand the differences between the 3 types of SIBO in order to treat SIBO effectively.
The most common type of SIBO is Hydrogen Dominant SIBO. With Hydrogen Dominant SIBO, the bacteria in your small intestine produce hydrogen gas.
There are three main types:
- Hydrogen-Dominant SIBO: Excess hydrogen production causing bloating and diarrhea.
- Methane-Dominant SIBO (IMO): Archaea that feeds hydrogen and carbon dioxide and produces methane, causing constipation dominant SIBO symptoms.
- Hydrogen Sulfide-Dominant SIBO: Bacteria that produce hydrogen sulfide gas, causing diarrhea dominant SIBO symptoms.
Hydrogen-Dominant SIBO
Hydrogen-Dominant SIBO is characterized by excess hydrogen production causing bloating and abdominal pain.
A hydrogen breath test is used to diagnose hydrogen-dominant SIBO by measuring hydrogen levels after consuming a sugar-containing liquid.
Antibiotics such as rifaximin are often prescribed to treat hydrogen-dominant SIBO, however a comprehensive approach that includes diet and probiotics is necessary for healing.
Methane-Dominant SIBO (IMO)
Methane-Dominant SIBO occurs when archaea, such as Methanobrevibacter smithii, feed hydrogen and convert it to methane.
This type of SIBO is often constipation dominant and commonly seen in IBS-C patients. Breath tests are used to diagnose methane dominant SIBO, however it requires a different antibiotic protocol as the methane bugs are resistant to many antibiotics.
A combination of antibiotics such as rifaximin and others may be necessary to treat methane-producing organisms.
Hydrogen Sulfide-Dominant SIBO
Hydrogen Sulfide-Dominant SIBO is caused by bacteria that produce hydrogen sulfide gas. This is the least common form of SIBO, affecting only about 10% of SIBO patients, however it can cause very severe symptoms including diarrhea.
Diagnosing hydrogen sulfide dominant SIBO was previously difficult however new and improved breath testing is making it easier to identify.
Common Symptoms of SIBO
SIBO can cause a wide range of gastrointestinal symptoms that can significantly impact your quality of life. Symptoms of SIBO include:
- Bloating
- Gas
- Abdominal pain
- Diarrhea and/or constipation
The intensity and nature of these symptoms may differ from person to person.
Especially when hydrogen sulfide-producing bacteria are involved, persistent diarrhea stands out as a significant symptom.
What causes SIBO?
Several conditions can increase your risk of developing SIBO including:
- Low stomach acid, allowing bacteria from the colon to migrate into the small intestine.
- Structural abnormalities in the intestine such as diverticulosis.
- Conditions such as diabetes, hypothyroidism and IBS.
Once you know the reasons why you might be getting SIBO, you can start figuring out how to prevent it and how to treat it.
SIBO Testing
Primarily, SIBO is diagnosed with breath tests that measure hydrogen and methane gases.
The Trio-Smart test is unique because it measures hydrogen, methane and hydrogen sulfide all at once to give you a full picture of the extent of overgrowth.
An increase in these gases shown on the breath test means you have SIBO and helps to differentiate between the types of SIBO. Non-invasive breath tests are used to diagnose SIBO, inform treatment and track progress.
Natural SIBO Treatment
Natural SIBO treatment focuses on reversing bacterial overgrowth. Here’s how to take back control of your health:
Diet: Reduce FODMAPs. This is not a long term solution, but it can help you feel better. Think of it as a bridge diet.
Herbs: Use herbal antimicrobials. Oregano oil and berberine are two of the most effective herbs to use against SIBO.
Lifestyle: Eat a plant based diet and avoid processed foods. These small changes can help heal your gut and prevent SIBO from coming back.
Diet Therapy for SIBO
Diet is a must for beating SIBO. An elemental diet can be helpful in providing predigested nutrients to give your gut a rest and starve out bad bacteria.
However, be careful with this diet. It’s not suitable for Hydrogen Sulfide-Dominant SIBO because it’s high in sulfur amino acids.
Low Sulfur is best for Hydrogen Sulfide-Dominant SIBO. Low FODMAP is best for everyone else.
Herbal & Supplements
Natural antibiotics like oregano, berberine, neem and allicin are great for SIBO. The Elemental Diet is helpful for Methane-Dominant SIBO.
Atrantil is a specific herbal formula for Intestinal Methanogen Overgrowth.
Herbal antibiotics are usually taken for 4-6 weeks.
If you’re constipated, osmotic laxatives like magnesium can help. Just remember, oregano and garlic are not just for flavor, they have antimicrobial properties that can help you beat SIBO.
These steps can help you heal your gut!
How to Prevent SIBO from Recurring
To prevent SIBO from coming back, you need to address diabetes and hypothyroidism.
There are medications called prokinetics that can help along with natural herbs like ginger or Iberogast that stimulate your digestive system.
Digestive enzymes are also really helpful because they break down food and decrease the bad bacteria that ferments.
Stimulating your vagal nerve and doing visceral manipulation can also help with digestion and decreasing stress.
I recommend spacing out your meals to 4-5 hours apart and fasting for at least 12 hours over night.
This helps stimulate a strong migrating motor complex (MMC) which is what prevents SIBO.
Note: I recommend consulting a Doctor if you’re experiencing persistent SIBO symptoms or any other health issues. I do not advise using any product without a doctor’s prescription.
Bottom Line
SIBO is not SIBO. There are different types and they require completely different approaches to testing and treating.
You can’t treat SIBO with one protocol, you need to approach it based on what kind of gas you produce: Hydrogen-Dominant, Methane-Dominant or Hydrogen Sulfide-Dominant.
Once you know what kind of SIBO you have, you can start addressing the underlying causes and preventing it from coming back.
With the right knowledge, you can heal your gut and keep SIBO at bay.
