Typically, the air that is swallowed will remain in the stomach until it gradually moves through the digestive system by peristalsis. I also have H2S. Is it helping hydrogen sulfide? Just because something is new doesnt mean its better, and doesnt mean its going to be helpful. But certainly, you do a great job there. And that seems to me to be really the best way to go about this. It manufactured and distributed the pink liquid. It depends on if the prep was done right, the appropriate laboratory work was done right, the right devices. They have the mycin on the end of the name of them. But it is tenable to say that almost any symptom could be driven by a problem in the gut. Personalizing SIBO treatment by assessing hydrogen sulfide with Dr. Mark Pimentel. 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. Aerodiagnostics, again, is my go-to SIBO lab. 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. Now, before I go on, let me just say that I uniformly saw constipation in my hydrogen sulfide patients. gas. I have started to take berberine and it is also suggested to take Allicin along with it. Id like to thank Aerodiagnostics, my favorite SIBO lab, for making this podcast possible. But my point with this is, flat is flat, and I would not disagree whatsoever with Dr. Siebecker that its highlighted in lactulose tests. If there is a deficiency of molybdenum in the body, this can further contribute to ineffective sulfur metabolism. 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-). 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. Well, I did try that for many years on many patients and I personally found it to be unsuccessful. Is it the air from the room? 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. Number one, with regard to the flat line, lets start there. People use that word toxic like an adjective. So this is a non-validated test and a patient told me about it. EXCESS HYDROGEN SULFIDE . Ive seen them all work and Ive seen them all fail. Youll have to do it in the office of the provider, which makes it significantly less convenient, because now you have to hang out for three hours at a doctors office. Lets go through the checklist that Gary has made, to make sure before you decide its hydrogen sulfide, etc. They have found that patients who perhaps may otherwise be negative for SIBO may be positive for hydrogen sulfide. The studies right now with fecal transplants in IBS patients have not shown good results and can make someone worse. Then we do this right and we get enough of these therapies integrated in sequence together. Additionally, although meat contains a large number of amino acids, such as cysteine and methionine, which contain sulfur, most people have been shown to tolerate meat well in normal portion sizes. Its not going to be effective until its just as widespread as hydrogen and methane testing. They offer accounts for clinicians and direct-to-consumer testing. So heres what I gathered. What can patients and clinicians do with the resources available? We havent even been able to test for a third gas. So I think thats probably where everyone is getting excited. We dont answer them. GS: Absolutely. We might not have a rise in the colon with lactulose because they were on elemental diet. In people with SIBO, there is usually an overproduction of certain types of gases like hydrogen, methane, and hydrogen sulfide in the small intestine. And so all that hydrogen is going to hydrogen sulfide. Ready to get started? Now we go back to the clinician and say, do we have the chronic postprandial symptoms? And then one other one I want to mentionempirical, clinicalis nitazoxanide. 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. If you need a refresher on what exactly SIBO is and how its linked to IBS see the overview here. 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. 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. 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? I mean, it could be celiac. So what you could do, as we look at this whole process, is first verify that your test was done correctly. Learn more about Pepto-Bismol . Thanks for all the great information youve provided here, But yeah, that could make sense. So what would that be? But theres this new gas which may be able to be tested, to tell about a different type of SIBO: hydrogen sulfide SIBO. It damages nerves and mitochondria. And the way that that occurs is, a patient presents and they have chronic postprandial symptoms. And overall they feel sicker than other SIBO patients. One interesting diagnostic approach, aside from a flat line in regular SIBO testing, is Pepto Bismol. Epsom salt baths are a good way to circumvent the gut and raise the blood levels of sulfate via skin absorption. And those came from Dr. Jacobis research. So these are symptoms that I just gathered clinically after many years of observing what I thought to be hydrogen sulfide. And then we have the herbs that we separate out. But whats interesting about SIBOand many a gut conditionis were now understanding that imbalances in the gut can also manifest extra-intestinally. And why is this important? Any suggestions? Its by Priority One, I think. We might get a 20% gain from one and then another 20% gain from another. And it doesnt matter if you eat a hamburger or if you eat a pancake or if you eat something else. 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. So they go for the new and novel, at the expense of what we already know can work. In any case. 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. In This Episode Breath Testing 00:03:56 We have patients that have heavy doses of laxatives that can sometimes flush. They could have your standard SIBO symptoms. Its most important, of course, to find the root cause. That would just be so speculative that the margin for error on that would be very high. It can be compounded. To recap, hydrogen sulfide SIBO is a type of SIBO that can now be diagnosed with a lab breath test. So youll have these, and it doesnt matter if its Monday morning, Thursday afternoon, or Sunday evening. If you tend to not do well on lots of meat and lots of vegetables, and you feel better when you have some carbs, some starch, maybe some rice, that indicates to me, okay, lets do a one-week trial on a low-sulfur diet. Some bismuth-containing products that may be useful includeDevrom,Thorne Pepti Guard,andBiotics HPF. We want to know whether or not were dealing with it from a hydrogen and methane perspective. So, what exactly is this gas composed of? But what you will notice is that this main SIBO breath test is not able to detect hydrogen sulfide gas yet. We have things we can do right now. Reducing your intake of sulfur-containing foods, for even a small amount of time, can help your body detox from a clogged sulfur pathway. And I think he even presented a case at one of our symposiums like that, and I just never got success trying that. In summary, testing a low sulfur diet combined with daily Epsom salt baths for 7 days is a great place to start. Generally speaking, if you eat, youre feeling these symptoms. Both can cause deficiency in molybdenum, a cofactor for the enzyme sulfite oxidase, which produces sulfate. Well, first off, I didnt know what to do all those years ago. The three most important and abundant elements within our body, in order, are calcium, phosphorus, and sulfur. Its so simple. *Inquiries relevant to the practice only. Lets use the flat line. Those would be separate. nausea. 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. Our body needs a constant supply of sulfate to function properly. However, when there is an excessive amount of H2S produced by the body, as in the case of H2S SIBO, a number of issues can occur. The symptoms are resolving. DrMR: Hey, everyone. Then: 2 months biocidin 2/day followed by 2 weeks Pepto Bismol 3/day. So I think you have to be careful not to hold this out as, every case who is negative on a SIBO breath test has hydrogen sulfide as the cause. A rapid rise in exhaled hydrogen or methane may indicate bacterial overgrowth in your small intestine. So its new. In particular fatigue, brain fog, and gas associated with this type of overgrowth can be very frustrating to deal with. And then some of these patients would have worse food intolerances all together. And the reason why is because were not yet testing for hydrogen sulfide. So were missing a majority of these people. So were seeing it. And I was also using another test that at the time was very inexpensive, way back then. So Ive seen that work. 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. But what I think happens all too oftencertainly the majority of the timeis a clinician or a patient overlooks tried and true therapies. The next thing that logically comes to mind is, okay, how do we treat hydrogen sulfide any differently? Could be mold. And bismuth, either alone or in combination. He sold his invention directly to other doctors. Can a fecal transplant cure the dysbiosis imbalance causing hydrogen sulfide SIBO that causes debilitating diarrhea? If this isnt working very efficiently, there may be too much unusable sulfur (leading to sensitivities) and not enough usable sulfur (at the same time leading to deficiencies). Bismuth has also been shown to reduce hydrogen sulfide gas in afew studies. So its truly toxic. Gary, anything that you want to close with? Learn more about SIBO and its variations here. Patients are resolving. As always, make sure to talk with your doctor to determine the best protocol. Meaning they cant master what they already have at their disposal. Guests Dr. Allison Siebecker, Gary Stapleton, and I discuss the testing methods available to assess and validate your likelihood of hydrogen sulfide SIBO, and their experiences in the clinic and in the lab, respectively. Its just talk. And thats the case for absolutely everything Ive ever used to treat SIBO. And were going to have to do them for quite a few years. But the problem is its so brand new, hasnt even hit the market yet commercially. GS: Yes, I absolutely agree with that. Have you had the IBS Smart blood test? This does come back to a philosophy of improving ones gut ecology. Im doing it out of memory! Please do not apply any of this information without first speaking with your doctor. 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. 60% of the time (Ive done 34,000 tests), its because the patient did not consume the glucose or lactulose. So, brain fog, fatigue, potentially high cholesterol and weight gain and higher blood sugar, joint pain, skin lesions. Learn more about breath testing here. Sometimes its easier to say, Ooh, look at this new thing, and jump to that thing. So those are some things to think about. And if thats really helpful, then we can continue forward with that. It comes back with the specimens. Theres a study that used it and it had a very successful rate of treating it. TypicalSIBO antibiotics, such as Xifaxan, Neomycin, Berberine, Neem, and oregano, can also be effective in treating H2S symptoms. Bismuth is one that comes up. Dosage. It is also used to treat diarrhea and help prevent travelers' diarrhea. I remember trying devrom last year along with neem, Berberine and allicin and got worse. Unfortunately, there is not as much research on this type of overgrowth and it can be challenging to manage and treat it effectively. 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 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. It might be yeast overgrowth. So we get a flat line hydrogen methane breath test. Unfortunately the Thorne one has a lot of other of their mucilaginous polysaccharide herbs that sometimes can aggravate SIBO. Dr. Allison Siebecker, ND: Diarrhea and constipation. Hydrogen-dominant SIBO causes diarrhea. In the case of hydrogen sulfide dominance however do you think this would be a bad option. But really, you could just add it to whatever you were doing. This isn't a long-term solution, but if you do have hydrogen sulfide-producing SIBO, it will likely help alleviate symptoms. Gary Stapleton: Yes, thank you, Dr. Ruscio. A great product that is recommended to test out isBiotics Mo-Zyme Forte. And when the technology and the validation of that technology has proven itself, then well incorporate that and hopefully even improve further where were at. This can also be used as a simple diagnostic tool to determine whether H2S is playing a role in your symptoms. Ultimately Hydrogen SIBO will be treated by a GI with Rifaximin. And then number two, do they have chronic postprandial symptoms? However, clinicians must warn travelers about blackening of the stool or tongue when taking this drug. 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. Heres what I think this breaks down to. Long-term use of Pepto Bismol, however, is not recommended, as it contains many adjuvants as well as salicylate, which can be harsh on the gut lining. Because the last thing that we need is a clinician whos just shooting from the hip, in terms of how theyre interpreting a SIBO breath test. And yes, there is some newer information, possibly some newer devices that we could augment to improve it even further. But well come back to that in more detail in a moment. Dosing is usually around 50-150 mg, but not more than 500 mg per day. 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. There are also studies of using bismuth with antibiotics of your choice, really. Most of those are actually aminoglycosides, not all of them. 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? So we need to validate a flat line first, then go to the secondary questions. And thats possibly where youre getting some of these hydrogen sulfides, and still have some gas. Pepto-Bismol is used to treat diarrhea and relieve the symptoms of an upset stomach. essentially gives the patients Pepto-Bismol along with the Rifaximin. Use until diarrhea stops but not longer than 2 days. 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. So it could be that theres methane present at the same time, and methane is usually more dominant than hydrogen sulfide. Epsom salt baths also help and occasional antimicrobial treatment has helped me. And if there isnt a rise there, if we see zero or close to zero, then thats when we call it a flat line or low fixed. Im trying to help patients and providers make as much sense out of this as possible. 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). In fact, it can sometimes look like a flat line on a lactulose or glucose SIBO test. And I think I had one patient report it from burping. People with SIBO or dysbiosis will produce even more gas than average. I tested positive. August 14, 2019. Because youd think an Epsom salt bath would help pain and things like body pain. Antibiotics are used to treat both types of the disease, but along with antibiotics, methane-dominant SIBO may require you to take fiber. And this was not my dosing regimen. DrMR: Sweet. Then we zero in and revisit the chronic postprandial symptoms. Learn exactly what combinations of prescription and herbal antibiotics and supplements are used to treat the 3 main types of SIBO: Hydrogen, Methane, and Hydrogen Sulfide. Pepto-Bismol: Generally given as part of H.pylori treatment, Pepto-Bismol is also known to impact other bacteria. Is it the air from the mouth? Outdoors, H2S is naturally present in crude petroleum, natural gas, volcanic gases, and hot springs. 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. But I mean it medically. Hydrogen sulfide is a colorless gas that has a characteristic smell of rotten eggs. And in this case, they were doing stool testing to find it in the stool. Where should we start this conversation? The original formula was developed by a physician to treat severe diarrhea brought on by cholera. And I just looked at all the patterns of all my hydrogen sulfide patients. At least in my opinion, I dont want to paint this picture that if youre struggling with symptoms, that knowing you have hydrogen sulfide SIBO is going to be the one thing thats going to take you from highly symptomatic to totally fine. But Im unclear and wary as to whether we need to really make our SIBO treatment that much more complicated. Is it colonic gas? Or sometimes Id have patients that thought they were trying to treat their SIBO and theyd bought berberine sulfate, and theyd get worse. Its not really. The herb Sparga also helps the body to break down sulphur. Epsom salt bathsallow your body to soak up sulfate in the form of magnesium sulfate. DrAS: Okay. We respect your privacy. I understand people not reading, people not being patient and being maybe a little bit impetuous. Researchers are working on a new device that will be able to measure all 3 gases and it should be out in the next year or so I believe. Its amazing how far weve come and we have farther to go. I could sit here and name 25 agents: rifaximin, and go down the line. Different versions of the test measure your digestion of different sugars. So we just see nothing or close to nothing. So one of our Instagram posts went out today. There are also some supplement products that have bismuth in there. What Ive found is for patients who have this predilection toward carbsthey like carbs, they like starch, and they dont do that well with meat and lots of vegetablesIve observed that patient type may simply do better on a lower-sulfur diet. This seems contradictory if the whole issue is low sulfur levels, but again, the problem may be that the body is unable to use the sulfur it receives from food. Pepto Bismol (bismuth subsalicylate), a popular antidiarrheal drug, binds hydrogen sulfide and removes it from the gastrointestinal tract therefore minimizing sulfur burps and gas. Now, if you did, in fact, prepare correctly and you are negative for SIBO, you may want to consider hydrogen sulfide as the culprit. 3 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. So thats bloating, abdominal pain, constipation, diarrhea. My guess is the allicin didnt work for me. You could have a flat line test. Third hour represents the large intestine generally. In the colon, there are numerous bacterial species that grow on poorly digested foods such as starches and sugars (carbohydrates).2As the bacteria within the colon ferment these foods, hydrogen and carbon dioxide gases are released during the process. Methane-Dominant SIBO may require you to take fiber remain in the form of magnesium sulfate also... 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