Meaning they cant master what they already have at their disposal. Or what are your thoughts about just adding in some bismuthor something like thatto your approach to treating SIBO, generally speaking, based on the fact that we cant measure hydrogen sulfide right now, and you dont know youre dealing with it? The hyperlinked study conducted in 1939 (ya, its been a while) on sulfur content present in foods further describes the specific amount of sulfur in given food products:The Sulfur Content in Food. And most importantly, they treat, and guess what? BONUS: SIBO Research Breakthrough Updates SIBO Research Breakthrough Updates The test tells you whether your IBS was caused by food poisoning from anti-cdtb and anti-vinculin antibodies. It doesnt matter what were talking about. Bacteria found in your mouth and gastrointestinal tract produce hydrogen sulfide from decomposing materials that contain vegetable or animal proteins. Im an independent laboratory. The prevalence of this are going to be different. However, it is essential to note that bacteria within the colon can also consume gases, particularly hydrogen, to release gases like methane and certain sulfur-containing gases like hydrogen sulfide that account for the foul odor we associate with gas. DrAS: Well, actually let me jump in here. But if we dont have enough of it, one theory is that the body encourages overgrowth of H2S producing bacteria to compensate. But unfortunatelyafter cleaning up so many of these patients who have been jumped to the new and novel with their providerIve come to realize that we have to start with what we know works first. Its a series of secondary questions. Ultimately Hydrogen SIBO will be treated by a GI with Rifaximin. Lemongrass oil has been shown to exhibit an antimicrobial effect on sulfur-reducing bacteria through its active ingredient, citral, inseveral studies. I thought it would help with confirmation. Yes. This isn't a long-term solution, but if you do have hydrogen sulfide-producing SIBO, it will likely help alleviate symptoms. 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? SIBO, Small Intestine Bacterial Overgrowth, is an overgrowth of bacteria in the small intestine that typically produces an excess of either hydrogen or methane gas, or both. DrAS: Yeah. (The characteristic rotten egg smell is due to sulfur.). If youre experiencing any issues with sulfur metabolism, the absorption of sulfate through the skin can be a really good therapy to try. And I was going to add that, for the benefit of the listeners, its absolutely working out. Its not that long of an ask! The movement of these gases does not cause us any pain or discomfort, and will eventually be released in small amounts. Its exciting, and hopefully therell be more useful here to come. And what I was thrilled to learn from Gary is that as hes been sharing ithe talks to lots of clinicianshes finding its ringing true. Now I found out I have H2s. Generally speaking, if you eat, youre feeling these symptoms. Symptoms of hydrogen sulfide SIBO are similar to those of regular SIBO, except that they also are, One interesting diagnostic approach, aside from a flat line in regular SIBO testing, is Pepto Bismol. A hundred patients that go through their center are different than a hundred patients off the street. Hydrogen sulfide has emerged as an important 'gasotransmitter' that regulates several bodily systems including: the cardiovascular, digestive, immune, hormonal, and nervous systems. The clinician might treat. This week's podcast: Does Salt Affect Your Blood Pressure? Dosing is 10 drops up to several times daily. Small intestine aspirate and fluid culture. Sulfate plays an important role in a number of daily processes that occur within our body, such as maintaining the viscosity of the blood and lining our connective tissues. We have to be very careful with that though, because that can aggravate. Do you then almost reflex to those questions to determine whether or not you should go that way, since the testing hasnt caught up with us yet? The best practice for Epsom salt baths is to take a hot bath with 4 cups of Epsom salts for 7 days in a row, and then continue to take these baths a few times a week to maintain sulfate levels in the body. Today well be talking about hydrogen sulfide SIBO, what we can do in regards to treatment and testing, and what we may want to be cautious regarding. 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 . It can be compounded. That would be rifaximin for the diarrhea type or rifaximin plus neomycin or metronidazole for the constipation type. And why do we test? And then number two, do they have chronic postprandial symptoms? Its not going to be effective until its just as widespread as hydrogen and methane testing. I care about answering your questions and sharing my knowledge with you. If youve tested for SIBO and your test is negative or its a flat line or at least in early 2020. Again, I dont need to see any kind of lab evidence of hydrogen sulfide SIBO to trial a low-sulfur diet. Disclaimer: (1) The information provided on this website is for educational purposes only and is not intended to diagnose or treat any disease. Supplementing with molybdenum, which is a mineral that helps in sulfur metabolism, can also be very helpful. Well, Gary, Allison, thank you for this roundtable. And then one other one I want to mentionempirical, clinicalis nitazoxanide. And this is something hes actually been talking about for many, many years and reported on for many years. But if Im seeing flat with glucose, I have to ask the same questions. Side effects are generally mild and can include a . Written by Dr. Michael Ruscio, DC on If you are utilizing a generated prep that you didnt validate The only validation Ive ever seen is chicken, fish, eggs, white rice sometimes, and white bread. GS: Right. Hydrogen sulfide is a colorless gas that has a characteristic smell of rotten eggs. 2020 SIBO Surivor | All Rights Reserved. And I felt strongly because I wouldnt offer it if I didnt feel it was good. But you do need to have a lactulose breath test, not a glucose. Bismuth subsalicylate may be useful in the prevention of . I see people after theyve seen other doctors. 34:42 Treatment for hydrogen sulfide SIBO. GS: Yeah. And I think it was about three years ago I started bringing it in. Hear what the research says about their effectiveness. So then as I read some more, I saw that bismuth can also be used. Things that have helped me are ginger, resolor, and eliminating lots of garlic in the diet. DrMR: And this is one of the nice things, Gary, about the way your lab operates. Dr. Mark Pimentel tells us more about this new test and how it can help to personalize SIBO treatment. But certainly, you do a great job there. However, that comes with salicylic acid, which can be damaging to the stomach lining. . In fact, it can sometimes look like a flat line on a lactulose or glucose SIBO test. Theyre seeing the sickest of the sick. So those are some things to think about. Sulfur is critically important in the body. But well come back to that in more detail in a moment. Alternatively, 1048 mg to 1050 mg may be given orally every hour not to exceed 4 doses in any 24 hour period. It works by helping to slow the . We want to know whether or not were dealing with it from a hydrogen and methane perspective. And then when I started going out to our normal time framesa minimum of two weeks, if not a monthand usually a month, then we were starting to see better results. One interesting diagnostic approach, aside from a flat line in regular SIBO testing, is Pepto Bismol. Again, not to bring this back to the same concept over and over again, but Ive been absolutely shocked at these cases that come in and say, Well, Im a chronic case, and theyve seen a few conventional doctors, a few alternative doctors, but oftentimes the approach has had huge gaps. However, clinicians must warn travelers about blackening of the stool or tongue when taking this drug. So what Ive actually seen work, my own self, is nitazoxanide, high-dose oregano. Pepto Bismol normally colors your tongue and stool black. 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. Probably not. That would just be so speculative that the margin for error on that would be very high. But we dont want to confuse these patients. Now its also not to say that everything new we should be looking at incredibly circumspectly. I understand it but I think if I didnt feel strongly, I wouldnt offer it as a laboratory owner. raise the blood levels of sulfate via skin absorption, Anti-Aging Benefits of Glucosamine and MSM, Remove obstacles to cure and give your body the building blocks it needs to heal in just 6 weeks. Its possible that SIBO just isnt the causeit might be some other form of dysbiosis, or overgrowth of pathogenic bacteria, in the colon. When we consume food products that contain sulfur, they go through a series of steps where they react with the oxygen that is naturally present in our body to form sulfate (SO2-). The herb Sparga also helps the body to break down sulphur. Heres what I think this breaks down to. Pepto-Bismol is used to treat diarrhea and relieve the symptoms of an upset stomach. Number one, with regard to the flat line, lets start there. So a lot of them have this. And I think I had one patient report it from burping. Bismuth is also effective at reducing symptoms of Hydrogen Sulfide SIBO. So if you prep with that and that food makes it to the colon, you could have gas, but its colonic gas. And we can use technologies to augment what were currently using, as long as it works. Because they had diarrhea that flushed it out. Ive done it before, and so have many clients of Dr. Mike T. Nelsons. Your information is safe and will never be shared. Nirala Jacobi: Theyre drawing folks in for that purpose and thats whos seeking them out. Now, we can begin discussing treatment options. Pepto-Bismol works as an antacid to reduce excess stomach acid and so eases discomfort. And in the meantime, while were waiting, there are the points that youve all been making and that Ive been making too. Learn more about SIBO and its variations here. But Clindamycin has a very high C. diff rate. 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 he couldn't keep up with demand he enlisted the Norwich Pharmacal Company in Norwich, New York. Aerodiagnostics, again, is my go-to SIBO lab. And man, I wish we had been recording earlier because I think of all the good stuff we already talked through before we even started recording this call. Ready to get started? If you use an open capture that doesnt have data on it, we dont know what were measuring. 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. So Ive seen that work. They offer accounts for clinicians and direct-to-consumer testing. Although it is normal to produce some amounts of this gas, an excess amount can be an indicator of a certain type of gastrointestinal issue. Uses. Chronic postprandial symptoms mean its not going to be mostly or generally or somewhat I have these issues. And then the last thing Ill say is, when folks are doing studies with regard to hydrogen and methane breath testing, please, please know that if youre doing it right, its all about the prep and the devices used, closed capture devices, and how the laboratory does it. Following an elemental diet is an easy and effective way to give your gut a rest and the key nutrients it needs to heal. And when that happens, then we can really talk. I havent tried them, so I dont know. And if thats really helpful, then we can continue forward with that. So maybe its pushing someone towards constipation. Now, there are some other things that are shown in the research that Ive never tried, like lactobacillus plantarum LP8. Its amazing how far weve come and we have farther to go. DrMR: Well said. No, berberine is not that only or main antimicrobial for h2s. So how do you get bismuth? High-dose oregano. So their actual digestive and all of these symptoms like the neuralgia and the body pain would get worse, which is unique. In this study the ability of bismuth subsalicylate, a compound that binds H 2 S . We have patients that have heavy doses of laxatives that can sometimes flush. This article contains scientific references. Then the hands and feet and fingers and toes can have tingling or numbness. Again, Aerodiagnostics is the SIBO lab I use in my clinic. The study was three to seven days. Despite the usefulness of breath testing, it is important to understand that some patients with SIBO may also have too much hydrogen sulfide (H2S) in their bodies, which is not a type of overgrowth that is detectable by traditional breath tests yet. And thats possibly where youre getting some of these hydrogen sulfides, and still have some gas. So we need to validate a flat line first, then go to the secondary questions. GS: Can I just ask a question? And many GI's are not aware of that and simply prescribe course after course of Rifaximin. In addition to this benefit, Epsom salt baths are also great for reducing stress, which can further help with any symptoms you might be experiencing. If theres newer technology, I would assume that manufacturer and others will come up with it. And they have been exciting. When our body recognizes that we are low in sulfate, it can adapt and grow more H2S producing bacteria, since hydrogen sulfide gas and sulfite can be used to produce sulfate where its needed. So hydrogen sulfide, when its in excess, is a toxic gas, like actually literally toxic. 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. 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? So this conversation is relevant to almost anyone listening. Which are: does the patient suffer from tingling of the hands and feet, do they have photophobia, intolerance to noise, visceral body pain, do they have the odorous gas, that river bed or rotten egg odor? Sulfur is also part of the cellular stress response. So thats Alinia. It should be available maybe in 2019 or at least early 2020. I think it was originally for blastocystis. The large intestine, way more than 10 to the 5. It depends on if the prep was done right, the appropriate laboratory work was done right, the right devices. And then we have the herbs that we separate out. And particularly for hydrogen in the third hour, thats sort of the keynote: we should see the hydrogen rising because theres bacteria in the large intestine. So, I feel like its essential in a basic way. Download Episode (Right click on link and Save As). You could have a flat line test. So again, we have Allison and Gary here. Hydrogen Sulfide SIBO Protocol update Hi guys :) I'm two weeks in to my treatment 2000mg Bismuth (Brands Combination out of Devrom, Thorne Pepti Guard and Pepto Bismol) 34mg Zinc Acetate (Brand life extension) 300 mcg molybdenum (Brand Biotics, Mo-zyme) Two pills of ADP oregano It was a urine test developed by Dr. De Meirleirwho focuses on hydrogen sulfide in the context of myalgic encephalomyelitis (another name for that is fibromyalgia)in Europe. DrMR: Okay. But, if something happens in the body that is not allowing sulfur metabolism to work correctly and get the body its necessary sulfate, then our body has to come up with a workaround. But by and large, were having a lot of success based on everything that weve discussed. So, just because you have a flat line, it doesnt necessarily mean its hydrogen sulfide. Both can cause deficiency in molybdenum, a cofactor for the enzyme sulfite oxidase, which produces sulfate. And they often actually say, I feel toxic. Its really interesting. And the reason why is because were not yet testing for hydrogen sulfide. 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. Thats how you could, first off, decide what looks kind of negative. Currently, breath tests are the most useful diagnostic test for examining the type and amount of gas produced in the gut. So the problem is not on the clinicians, not on the patients. Do I take my time to do that or take the easy way out and just send the results? Aerodiagnostic offers cash pay and insurance billing options, and they do a terrific job at keeping costs low and billing easy. The dose was 524 milligrams, four times a day. Its important to remember that taking Pepto Bismol for extended periods is not advised. And why is this important? Personalizing SIBO treatment by assessing hydrogen sulfide with Dr. Mark Pimentel. Most of those are actually aminoglycosides, not all of them. It needs to be available, every machine, every lab. DrMR: Sweet. And then the spring again, multiple studies came out, diarrhea. It doesnt offer much in regards to treatment besides letting you know that you probably have an underlying motility issue you need help with, but Id say its great for peace of mind knowing what caused your condition. We havent even been able to test for a third gas. Different versions of the test measure your digestion of different sugars. Measuring hydrogen sulfide to determine excess overgrowth was previously not possible until recent technological breakthroughs in breath testing. Third hour represents the large intestine generally. Im trying to help patients and providers make as much sense out of this as possible. If youve tested for SIBO and your test is negative or its a flat line, the first thing you should do is double-check that you did the test appropriately. And overall they feel sicker than other SIBO patients. Pepto-Bismol can be taken as a tablet or liquid, depending on . Is it the air from the room? But what you will notice is that this main SIBO breath test is not able to detect hydrogen sulfide gas yet. Its just talk. Instead, bismuth can be a short-term remedy for someone looking for some symptom relief. I personally dont feel comfortable using it. Does anyone know of a Dr who could treat all 3 types of sibo successfully?? Guess what? Its rare that I see, for a patient whos pretty ill, that just one thing breaks open the entire case. 2. It is typical for people with an excess amount of hydrogen sulfide gas to have their stools turn black when they take bismuth. Now, before I go on, let me just say that I uniformly saw constipation in my hydrogen sulfide patients. But they only did it for like seven days. There are two other quick things I just wanted to mention, and Dr. Ruscio just hit on it. Would you ever consider just making that part of your herbal regimen in general, or when you have the chronic postprandial symptoms and a flat line? I think where the excitement is coming from for the new technology is that Doctors Pimentel and Rezaietheyre the ones who have invented this technology and are doing the researchhad told me that somewhere between 60 to 70 percent of people who are actually positive for hydrogen sulfide with this new technology are not a flat line. I think it mightve been six or seven years before I even started teaching about hydrogen sulfide in special classes I would do with physicians. 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. I understand people not reading, people not being patient and being maybe a little bit impetuous. To recap, hydrogen sulfide SIBO is a type of SIBO that can now be diagnosed with a lab breath test. So one of our Instagram posts went out today. And he said he was finding bismuth to be successful in cases of methane. Unfortunately the treatment for Methane and HS is Rifaximin and Neomycin in combination. And my position here is primarily with hydrogen sulfide. It's used to help diagnose common digestive problems, including SIBO, IBS and lactose intolerance. 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. DrAS: Yes, its siboinfo.com and its a free educational website. So were missing a majority of these people. So theyre more challenging cases. And so all that hydrogen is going to hydrogen sulfide. It manufactured and distributed the pink liquid. By now Im sure the audience is accustomed to me looking at things in this way. 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. Since molybdenum is the nutrient cofactor for sulfite oxidase which tends to be low, supplementation is a good idea, especially if levels are found to be low. Studies show that a large percentage of Irritable Bowel Syndrome (IBS) is actually Small Intestinal Bacterial Overgrowth (SIBO). Although widely available, breath testing is less specific than other types of tests for diagnosing bacterial overgrowth. And I have seen cases get better from that. As an Amazon Associate I earn from qualifying purchases. I just want to make sure we dont lose our lay audience, who are saying, Oh my God, all these details are way over my head. So thats how you can think about sequencing these different interventions. Ive been through several treatments and several Drs for methane dominant sibo, including abx, alinia and herbals. I havent tried it yet. Epsom salt bathsallow your body to soak up sulfate in the form of magnesium sulfate. There are also some supplement products that have bismuth in there. And photophobia is not something that Ive seen, but its in the research. It also works to protect the stomach and lower part of your food pipe (esophagus) from stomach acid. This is one theory as to why H2Sovergrowth can occur. Thanks for that. 25 It is usually well tolerated in young healthy adults. Were working one-third blind here and were in the middle of an age of discovery here in SIBO. So I guess what I want you to know is that diarrhea is what the research is showing, and mine and Dr. Jacobis clinical experience is showing constipation. Is there increased frequency? Thats what Ive seen work. And that seems to me to be really the best way to go about this. 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. Capsules, tincture or tea. There are so many symptoms that look like other things. So its new. These large research centers are doing extraordinarily good work. In any case. Start course. *Inquiries relevant to the practice only. Sulfur is also part of the cellular stress response, improving ATP (energy) productionso that cells can carry on normal functions even when under stress. Chew the tab up in your mouth and let it get into your bloodstream via saliva. What can patients and clinicians do with the resources available? So I dont like the idea of using that long-term at all, personally. Your . If your symptoms are severe, certain treatment options that reduce hydrogen sulfide-producing bacteria may also help, as well provide you with some symptomatic relief. Its Biofilm Phase-2 Advanced. 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. These are the types of gases that are measured on a breath test. so that cells can carry on normal functions even when under stress. Can we reproduce the event, where we can measure hydrogen sulfide and detect it? I havent prescribed it, but Ive had patients report to me multiple cases of success with hydrogen sulfide SIBO and that antibiotic. Ive said that many times before. We have things we can do right now. I do not necessarily think all of this was necessary, but this is . essentially gives the patients Pepto-Bismol along with the Rifaximin. Hope you can improve. Although if Im remembering some of the details correctly, you oftentimes see an overlap between being traditional SIBO-positive and hydrogen-sulfide-SIBO-positive. But I think thats a minority ultimately. This is invaluable! GS: So first of all, what Dr. Siebecker was saying I absolutely align with too, and everything you just mentioned. Dr. Michael Ruscio, DC. They have impeccable organization, customer service, test quality, and support. Learn more about breath testing here. But if the problem is low sulfur, then its likely that the overgrowth will recur unless this is addressed. That didnt work for me. I can go on. Hydrogen Sulfide SIBO Treatment. It wont hurt to test it out and see how your body reacts to it. 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. Go to wholehealthdr.com, choose the type of practitioner and/or the specialty you're looking for, and/or your city or zip code! Its a hydrogen sulfide. So we have to see how this pans out. So very severe, difficult food intolerances. And we can get into the treatment differences in a second. Because thats pretty much how we separate out our SIBO treatments, with the diarrhea usually going with hydrogen and the constipation usually going with methane.