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SIBO and Methane – What’s the Connection?


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Revolution Health Radio podcast, Chris Kresser

A lot of people might not be familiar with the term methanogen, but it is something that people should be aware of, especially if you have SIBO or suspect you may have SIBO.  We’ve talked about SIBO a lot.  For people new to the show or new to this work, this stands for small intestinal bacterial overgrowth.  It’s defined as a pathological increase in bacteria in the small bowel.  As a reminder, we have a lot of bacteria in our gut.  In fact, the bacteria and other organisms in our gut outnumber human cells by 10 to 1, but the location of that bacteria is really important. 

Note: The Prescript-Assist supplements discussed in this article are no longer available. Please click here to learn more about a substitute, the Daily Synbiotic from Seed.

In this episode, we cover:

1:29 What Chris had for breakfast
4:44 The role archaea play in gut health
7:50 What’s the big deal about methane?
14:38 How to address SIBO in methane-producing patients
23:56 Gut healthy treatment recommendations

Jordan Reasoner:  Hi.  Welcome to another episode of the Revolution Health Radio show.  The show is brought to you by ChrisKresser.com.  Steve is off today on a meditation retreat.  I’m your guest host Jordan Reasoner, from SCDlifestyle.com.  With me is integrative medical practitioner, healthy skeptic, and New York Times bestselling author, Chris Kresser.  Chris, welcome.

Chris Kresser:  Jordan, I’m happy you’re here.  And I’m happy Steve’s off walking the talk.  It will be interesting to hear about his experience when he gets back.

Jordan Reasoner:  I’m excited.  He’ll be back tomorrow, so I’m looking forward to it.

Chris Kresser:  This was his first 10-day Vipassana, is that right?

Jordan Reasoner:  Yeah, it’s his first one.

Chris Kresser:  It should be really interesting to hear about.

Jordan Reasoner:  All of our friends are just coming back from Burning Man, and Steve’s coming back from a meditation retreat.

Chris Kresser:  Yeah, other side of the spectrum.  Hopefully, you haven’t been getting any text messages from him in the last 10 days.

Jordan Reasoner:  No.  It’s been radio silence.

Chris Kresser:  Good, good.

Jordan Reasoner:  So he’s been a good boy.

Chris Kresser:  All right.  Cool.

Jordan Reasoner:  Before we dive in, let’s talk about your breakfast, because I know we always get a lot of flak from the listeners if you don’t tell us about your breakfast, right?

What Chris Ate for Breakfast

Chris Kresser:  Okay.  So let’s see, I had some chorizo. We buy half a pig from a local rancher a couple of times a year, and then a butcher in Santa Rosa, Willowside Meats, butchers it and gives us a whole bunch of different cuts.  One of the things they do is make this really amazing chorizo.  So we had some of that, some scrambled eggs, some sauerkraut, beet kvass, and some plantains fried in expeller-pressed coconut oil.  That’s pretty standard breakfast around here.  It’s a good one.  Sylvie loves it.  We all like it.  It’s pretty easy to make.

Jordan Reasoner:  I love your breakfast because it always has like five to seven parts to it.

Chris Kresser:  It’s all about the diversity, right?

Jordan Reasoner:  Yeah, exactly.

Chris Kresser:  Feed those gut bugs.

Jordan Reasoner:  You grew up on Lucky Charms.  It’s a nice transition, right?

Chris Kresser:  Thankfully, I didn’t grow up on Lucky Charms.  As I get older, I have more and more appreciation for my parents, and the way that my mom fed us when we were young.  I mean, certainly, she wasn’t feeding us Paleo.  That wasn’t really part of the understanding at that point.  But she fed us, really, a pretty healthy diet overall, so I’m happy about that.  We have a good question today from Simas I think it is.  I’m not sure how to pronounce it, but I think that’s the right way.  Let’s give it a listen.

Simas:  Hi, Chris.  I just wanted to ask, what would be the best way to deal with methanogens in people with SIBO?  I know Dr. Siebecker says that it’s best to use allicin, but it seems that I have a negative response, extreme fatigue and things like that, after taking it.  Thanks.

Chris Kresser:  All right.  So let’s jump in here.  That’s a great question.  A lot of people might not be familiar with the term methanogen, but it is something that people should be aware of, especially if you have SIBO or suspect you may have SIBO.  We’ve talked about SIBO a lot.  For people new to the show or new to this work, this stands for small intestinal bacterial overgrowth.  It’s defined as a pathological increase in bacteria in the small bowel.  As a reminder, we have a lot of bacteria in our gut.  In fact, the bacteria and other organisms in our gut outnumber human cells by 10 to 1, but the location of that bacteria is really important.  They should mostly be in the colon, the large intestine.  We do have small amounts of bacteria all the way through the digestive tract, from the mouth to the anus, but the majority of the bacteria should be in the colon.  Very little should be in the small intestine, because the small intestine is where we digest and absorb food.  If you have a lot of bacteria growing in the small intestine, that’s going to interfere with the assimilation of nutrients from food, which is one of the major adverse effects of SIBO.

The Role Archaea Play in Gut Health

So most of the research that you’ve probably heard about has focused on the role of bacteria in the gut, but recent evidence suggests that archaea also play a role.  That’s A-R-C-H-A-E-A.  Archaea are actually a completely different class of organism than bacteria.  They’re pretty ancient, single-celled organisms with no cell nucleus and no membrane-bound organelles.  They were originally classified as bacteria, but they’re now classified as prokaryotes, which again are a completely different class.  They’re considered totally unique from the other two major domains of life, which are bacteria and eukaryotes.  Some of the archaea that you might have heard of in the news, in the mainstream media are halophiles and thermophiles.  So these are archaea that live in extreme environments like salt lakes or hot springs.  But we now know that archaea are present in pretty much every habitat where you see biodegradation of organic compounds occurring, and that includes animal guts and human guts.

When you go to get a breath test for SIBO—which is one of the major ways of testing for SIBO that we talked about—they’re going to measure the presence of, and the production of, methane and hydrogen gases at baseline.  Then they’re also going to measure the increase in hydrogen and methane production that occurs after you drink a sugary solution that they give you as part of the test procedure.  So typically, if you have a significant increase in hydrogen or methane after drinking the sugary solution, it means you have an overgrowth of bacteria in your gut.  To be more specific, when you have an increase in methane after drinking this solution, or if you just have high levels of methane at baseline, that indicates an overgrowth not of bacteria, but of these methane-producing archaea.  Unlike bacteria, which primarily produce hydrogen, the archaea are what produce this methane, and they do this actually not by fermenting carbohydrates.  So bacteria produce hydrogen and the way they do that is by fermenting fibers.  The methane production works differently.  The archaea consume the hydrogen that’s produced by the hydrogen-producing bacteria, and then they produce methane as a by-product of that process.  So this is actually one of the ways that excess hydrogen in the gut gets metabolized, is by these methanogenic archaea converting that hydrogen into methane.  And another way that hydrogen gets dealt with is by bacteria that convert hydrogen into sulfites.  That’s probably a little more detail than you needed, but it’s kind of interesting to see how this all works.

What’s the Big Deal about Methane?

Methane production begins at about three years of age.  You don’t see any methane production in infants, for example.  This suggests that methane production has everything to do with how the gut is colonized initially, because there are no archaea initially in the gut.  And it peaks at about 10 years of age, when adult levels are reached.  So by the time a child is 10, they’re typically producing the adult amounts of methane that they would produce for their whole life.  But here’s the thing—not everybody produces methane.  Depending on the studies that you look at, the numbers I’ve seen range from 30 percent to 50 percent of adults being methane producers.  So anywhere from a third to half of people have significant amounts of archaea that produce detectible amounts of methane.  That’s something important to understand—this is not an issue that affects everybody.

So what’s the big deal about methane?  Simas’s question, “Is the presence of methane different?  Does it require a different approach?”  I think the answer is yes.  For what we see in the research and then what I’ve seen in my clinical experience working with patients.  Methane is a colorless, odorless, inert gas.  For a long time, it was thought that it didn’t really have any impact on human health, except for maybe causing a little bit of bloating and distention, if you had high levels of it.  But more recent evidence actually has linked methane production to various disease states.  And it’s still somewhat unclear whether that’s because of the level of methane itself, or whether it’s because of the removal of hydrogen from the bowel that happens when that hydrogen is converted to methane by archaea.  But we do know from studies that methane-producing archaea are present in 45 percent of people with SIBO.  In other words, a substantial percentage of people with SIBO have methane-producing archaea.  And the amount of methane that’s produced is significantly higher in patients with SIBO, compared with patients with fructose and lactose malabsorption, which are other gut issues.  So if you’re looking at a breath test, the presence of methane, to consider yourself a methane producer, you would have baseline methane levels of over 3 parts per million.  And I can tell you, from running a lot of these tests, that that’s quite common.  It’s more than 50 percent, I would say, in my patient population.  Then again, I’m testing people that mostly have SIBO and other gut issues, so it’s not necessarily a representative sample.

Jordan Reasoner:  Now Chris, if I’m a patient and I’m experiencing problems, I think it’s SIBO and I’m not looking at a test, are there symptoms that are different in somebody who is predominantly going to have methane-producing bacteria versus non-methane-producing?

Chris Kresser:  Yeah.  That’s a good question.  And it takes us right into the next section, which is, the answer to that is constipation.  Constipation, of course, can be caused by many things.  So it’s not to say that methane-producing archaea are the only cause of constipation.  But methanogenic flora, or archaea that produce methane, are significantly associated with chronic constipation in the scientific literature.  The amount of methane produced is correlated with colonic transit time.  So the more methane you have, the slower your transit time is.  In one study, if a breath test was positive for methane, they saw a 100 percent association with constipation-predominant IBS.

Jordan Reasoner: Wow.

Chris Kresser:  So yeah, it’s pretty strong in terms of association.  In other words, to put it in plain language, everyone who is positive for methane had constipation-predominant IBS in that study.  In contrast, the prevalence of methane was very low among patients with inflammatory bowel diseases like Crohn’s and ulcerative colitis, which typically present with diarrhea.  So you see that it’s much more common in people with constipation than it is in people with diarrhea.  I’ve also seen this correlation in my work with patients, people who have the really chronic, intractable constipation that doesn’t tend to respond well to a lot of different interventions.  I will often see really high baseline levels of methane and/or an increase in methane production after the challenge test.  A few other things you’ll see clinically are methane producers can have a higher prevalence of rectal hypersensitivity compared to non-methane-producing patients.  So sometimes, pain in that area or just a feeling of urgency can signal methane production.  This is not something that patients will be aware of, but if you’re looking at test results in constipated patients, the average pH of the colon will be significantly lower in patients with methane-producing flora.  So if you see a low pH on a stool test, it might be one potential sign of methane production.  Also, I think the other thing that’s important to know is that methane production seems to be much more common in women than it is in men.  That’s the only real demographic characteristic I’ve been able to find.  It seems there’s no age-specific distribution, other than the fact that you don’t get methane production until three years of age, as I mentioned before, and it will be lower in kids up to 10 years of age typically.  But other than that, the only significant association I found is that it’s more common in women than it is in men.

Jordan Reasoner:  In your research, have you seen any associations between being breastfed or vaginal birth versus C-section?  Have you seen any associations around that?

Chris Kresser:  No, I haven’t.  I don’t think that that means there aren’t any, but there are only a handful of studies on this topic.  Most of them are pretty recent; most of them were done by Dr. Mark Pimentel’s group.  He, as many people know, has been a pioneer in research on SIBO and has a research clinic at Cedars-Sinai down in LA.  It does a lot of great work.  So I think there’s still a lot to be learned about this.  My guess is there is possibly an association, Jordan, but we don’t really know for sure about that.

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How to Address SIBO in Methane-Producing Patients

Jordan Reasoner:  Chris, before we move on, what do I do about this in general?  If I’m somebody who, I find with a practitioner that I have more of these methane gases in my body, and I’m that type of a person with small intestinal bacterial overgrowth, how does that change your approach as a practitioner?  And how does that change what I do, as somebody who’s trying to recover from this?

Chris Kresser:  So it could change the medications that you take for SIBO, if you are going to take medications, and may change the way you treat it overall.  The first thing, taking even a step back before we get into that, is to determine—so far, we’ve been talking about associations between methane and constipation, but that doesn’t necessarily tell us that methane is causing the constipation.  It could be that constipation is causing the high methane levels.  There is actually some research that suggests that might be true.  There are studies showing that treatment with laxatives and bowel cleansing, like a colonic, can reduce or eliminate methane production in some patients.  So that would suggest that constipation, at least to some extent, may increase—methanogens may favor a slow transit type of environment, and when you’re constipated, you might get an increase in methane-producing species.

However, there are also a lot of other studies that suggests that methane directly causes the constipation in the first place.  For example, in animal models, they directly infuse methane into the small intestine.  You’ll see a reduction in transit time of 60 percent, compared to just infusing normal room air.  They suspect, right now, that this effect may be mediated by serotonin, which is a neurotransmitter—as I’m sure most people know—that is present in the gut in about 400-fold higher concentrations than is present in the brain.  So serotonin really, more than anything else, is a gut neurotransmitter, and it’s thought to affect intestinal motility.  Studies have found that methane producers have lower post-meal serotonin levels than people who produce primarily hydrogen.  So I think it is pretty reasonable to assume that methane does play a causative role in constipation.  Then there are also studies that show that the elimination of methane in treatment correlates very closely with symptom improvement.  That’s where your question comes in, Jordan.  So if you treat SIBO and you don’t address the methane production, even if you get rid of the hydrogen, the patient is probably not going to improve to the extent that they should, because you’re not getting rid of the methane.

So here’s the tricky thing—rifaximin, which is the drug that is typically used to treat SIBO, is not very effective against methane-producing species on its own.  For example, in a study with patients who all had baseline levels of methane above 3 parts per million—which established them as methane producers—10 days of rifaximin alone led to a clinical response about 56 percent of the time, so roughly half the time.  But it only led to a negative result on the breath test 28 percent of the time.  So about 70 perecent of the time, rifaximin was not clearing the methane from the breath test, and about half the time, it wasn’t leading to any clinical improvement at all.  Now, 10 days of another drug that’s often used to treat SIBO on its own, called neomycin, led to a clinical improvement in 63 percent of cases, which is a little bit better than rifaximin on its own.  And it led to a negative breath test result 33 percent of the time, which is again, a little bit better than 28 percent for rifaximin.  But it’s not great, right?  We’re still talking about two-thirds of the time that it’s not working.  But if you combine rifaximin with neomycin together and take them for 10 days, that led to a clinical improvement 85 percent of the time, and a negative breath test result 87 percent of the time.  So now we’re talking about some real treatment efficacy numbers here.  Actually, they don’t really understand why the combo of rifaximin and neomycin works better than either of these two drugs alone, but there are other examples where this happens.  For example, the H. pylori treatment, right?  That requires two different antibiotics, and if you use one alone, or the other alone, you don’t get the same efficacy than if you use the two antibiotics together.  So there is a precedent for this kind of thing happening.

The other thing to be aware of is that outside of rifaximin and neomycin, most methanogenic archaea are resistant to the majority of the antibiotics that are typically used against gram-positive and gram-negative bacteria.  So your ciprofloxacins and Flagyls and things like that that a lot of practitioners would use to clear out bacterial infection are probably not going to work for these types of archaea.  And in my mind, this is another reason why botanical treatments can really make a lot of sense.  We talked on a previous show about a study that showed that botanical treatments were as effective, or more effective, than antibiotics for SIBO, and had far fewer side effects.  One of the reasons for this is that botanicals, herbs, plant substances, have a really broad spectrum of activity.  And it’s far less likely that organisms will be able to develop resistance against a botanical, because within each single herb, there are many different active compounds, instead of just one active compound that’s in an antibiotic.  So it’s much harder for the organism to adapt to that.  And typically, herbs or botanicals are used in formulas, where you have many different herbs together.  You’ve got many different herbs, each with multiple compounds, and then they form together to create synergistic compounds.  It starts to become exponentially more diverse, complex, and more difficult for organisms to develop resistance to.  I think given some of the research we have on the efficacy of botanical treatments, given the increasing problem of antibiotic resistance, and possibly these archaea developing resistance to rifaximin and neomycin eventually, given the fact that studies show that about one out of two people who have SIBO and are treated successfully for it will relapse in the future, which is kind of a depressing statistic.

Jordan Reasoner:  Yeah.

Chris Kresser:  I mean, not to get too far off on a tangent, but I bet a lot of people in those studies aren’t doing low-FODMAP, Paleo type of diets or SCD type of diets.  They’re only just taking the drugs, and then they’re going back to eating the same crappy diet that led to the problem in the first place.  In my population, the relapse rates are not that high.  But given all that stuff, it’s possible that people will have to get treated more than once.  That’s what I’m getting at.  And I’m much more comfortable with the idea of someone doing multiple botanical protocols and using probiotics that secrete antimicrobial peptides—which probably may work against methanogens—and food-based treatments, like removing FODMAPs, which are the certain class of carbohydrates that feed the bacteria which produce hydrogen, which feed the archaea.  So if you starve the bacteria, you’re reducing the hydrogen levels.  That, in theory, would reduce the levels of substrate that are available to the archaea for producing the methane.  So the food-based treatments still work there.  I did mention, when we talked about the causal relationship with methane, that some studies show that a bowel lavage, a colonic, or a laxative kind of thing, can lower or even eliminate methane production.  But I would be careful with that, because colonics, while they do wash out some of the bad gut flora, they also wash out a lot of the good gut flora.  They’re also pretty invasive.  I think it’s probably best to try to treat with herbs, diet, and other antimicrobial nutrients than it is to use laxatives or colonics.

Jordan Reasoner:  One of the common objections that I always hear with somebody that follows Dr. Pimentel’s work, they’re very familiar with this type of thing, and they’re going to end up on this combo of neomycin or rifaximin, people freeze.  That’s because we’re all really afraid to use antibiotics now almost in this health community, right?

Chris Kresser:  Mm-hmm.

Jordan Reasoner:  One of the most common things I get asked is, “What can I do before, during, and after this protocol to not totally set me back and destroy all my good gut flora?”

Gut Healthy Treatment Recommendations

Chris Kresser:  That’s a valid question.  The good news is that rifaximin and neomycin are narrower in spectrum than ciprofloxacin or some of the really broad-spectrum antibiotics, and they’re not going to wipe out your gut flora to the extent that some of those other antibiotics will.  They’re also not absorbed systemically, that’s another advantage to those drugs.  I think rifaximin, 99.8 percent stays in your gut and doesn’t get absorbed, so it’s not going to affect flora in other parts of your body as much.  So they are safer than a lot of other antibiotics.

My strategy is to start with the botanical protocols, and use antimicrobial botanicals like olive leaf extract, uva ursi, cat’s claw, yerba mansa, coptis, artemesia, sida, et cetera.  Then use soil-based organisms that secrete antimicrobial peptides—Prescript-Assist, which I sell in my store.  It’s available in my store, because I’ve just had such great success with it in just about everybody, which is rare with probiotics.  You know, a lot of people don’t respond to probiotics very well.  Then we have nutrients like Lauricidin or lauric acid, which are antimicrobial, which may be helpful in this kind of situation.  So I like to start a protocol with a whole bunch of natural things like that, and see how they do.  I only really recommend the rifaximin and neomycin combo if a couple of rounds of this initial protocol aren’t successful.  Then I would definitely suggest patients take things like Saccharomyces boulardii or other probiotics while they’re doing the protocol and after the protocol.  Then ironically, prebiotics often are a big part of the healing process.  This is where it gets tricky, because prebiotics are the fiber that feed the bacteria, which then produce hydrogen, which feed the archaea.  You have to make sure you reduce the levels of those bacteria and archaea first, and then come in with the prebiotics to rebuild a healthy gut flora that will make it less likely that you’ll develop this problem again in the future.  So it’s a pretty involved process, there’s a lot to it, and it has to be timed right.  But it’s definitely possible, and it works.  It just takes more time, in some cases, than people expect.  Generally, with SIBO, and especially if it’s a recalcitrant case and the levels of methane are really high, I tend to tell patients that this is going to be a 6- to 12-month process to fully deal with it, and that’s what we’re seeing in the clinic.

Jordan Reasoner:  Well, Chris, I think we answered Simas’s question pretty in-depth today.

Chris Kresser:  All right.  Great question.  Keep them coming, everyone.  It’s really fun to hear your questions.  Of course, we don’t have the chance to answer them all.  We try to choose ones that we think will be of greatest interest to the greatest number of people, and kind of spread out the topics.  Keep them coming and we’ll see you next week.

Jordan Reasoner:  If you want to get more info about what Chris is researching in-between all these show recordings and all the studies that he’s sharing, head over to Facebook.com/ChrisKresserLAc and Twitter.com/ChrisKresser.  Thanks, everyone.

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Join the conversation

  1. “They were originally classified as bacteria, but they’re now classified as prokaryotes, which again are a completely different class.”
    Hmm slightly off, I think. Yes, they were originally lumped in with bacteria, but now they’re classified as archaea. So “prokarya” have now been broken down into “bacteria/monera” and “archaea”, not “bacteria” and “prokarya” (which bacteria would belong to).

  2. Thanks again Chris for your podcast and responses, and also all others who have posted comments/questions. This info has been a revelation for me. Just looked at the high FODMAP food lists for the first time…WOW! Over the past few years I’ve had bad GI reactions to a short list of foods, but didn’t know until now that they are all high FODMAPs!!! Most notably: butternut squash, beets, cherries, and dried fruits, especially in large servings. Now I have something concrete to work with!

    I’d also like to learn more about the antimicrobials that Chris mentioned. Perhaps the combinations and doses need to be customized to each patient, so a generic recommendation from Chris may not be feasible?

  3. With autoimmune disease, I find that treating my SIBO with antimicrobials can easily cause serious flares of my immune system. How can I prevent this from happening? I haven’t tried the antibiotics yet, just some of the recommended antimicrobials.

    Typically I have a positive response at first, but after a few doses or a few days, my immune system flares up and I regress. Since we believe SIBO is one of the main causes of my autoimmune disease, how can I treat it safely without these nasty side effects?

    Many practitioners, even the holistic or functional ones are unfamiliar with the specifics of autoimmune disease, and can offer little help.

    • Did anyone address your question? I’d love to hear/read the answer. Thanks for responding to my question about Allicin.

  4. I had a consult with Dr. Whitney Hayes, ND, a colleague of Dr. Siebeckers. She told me that she and Dr. Siebecker compared the results of their hydrogen/methane breath tests from Commonwealth and from other laboratories using Quintron machines and find that Commonwealth’s tests tend to under-report methane. This means that if you have a Commonwealth breath test, your methane results could be higher than what the test actually shows. It was frustrating to learn this as Dr. Siebecker still lists Commonwealth on her list of labs to use for breath testing, so I paid for a test with results that may be inaccurate. I’m posting this here so that others will know and will NOT use Commonwealth for their SIBO testing.

    • Nadira,

      So interesting to hear this about Commonwealth. It definitely fits with my experience. I was tested in February (via Commonwealth) and showed high hydrogen but NO methane (which did not make sense because I have IBS-C). I have been working with Dr. Keller and experienced quite a lot or relief from my treatment. I was convinced that I had gotten rid of the bugs! I just retook the test a couple of weeks ago (this time through NCNM Lab) and while my hydrogen had gone down, methane now appeared (not super high, but still a high enough level to indicate it was a problem).

      • Hey Riley!
        I have the same case as you (IBS-C), and super curious to read that your treatment gave a lot of relief. What did you do? 🙂

        You probably always had methane producers and it just didn’t get picked up in the Commonwealth lab? From what I’ve been told it’s the methane producers that cause constipation. But sounds like you already knew that since you were also confused by the lab results. That is strange!

        • Hi Marianne,

          It is hard to know what helped the most between my first and second tests because I did several treatments and was reluctant to retest. I work with Dr. Keller at the NCNM SIBO Center. I have done 2 rounds of Rifaxamin, high dose neem for over a month after that, then started a prokinetic (I have used resolor and low dose erythromycin- separately) then allimed and neem combo (this is supposed to be the most helpful when you have IBS-C and/or methane- Dr. Keller recommended it based on my symptoms). I also get nutrient IVs every couple of weeks. During all of this I have followed a pretty strict low FODMAP, no fruit, Autoimmune Paleo diet. The diet I was following was too low carb though and made me exhausted. I started adding more carbs in (white rice, sweet potatoes, winter squash) which made my brain work sooo much better, but I may have overdone it because my SIBO seems to be creeping back a little bit since my last breath test.

          • Hi Riley,

            Thanks so much for your answer, I really appreciate it. That’s really interesting, I didn’t try Rifaximin, but I did try all the other things (except the prokinetics) and they surprisingly didn’t work for me either. I’ve never heard of resolor so I’ll have to read about it. I’m always looking for something to help with regularity, seems like nothing ever really works or only works for a short while.
            Funny, I had the same problem with going too low carb! I was super strict for about a year and a half but lately I started adding more fruit (low FODMAP) and oatmeal, although I think I also am overdoing it :S I can tell.
            My doc recommended two antimicrobial products that were shown in a study to be as effective as the antibiotics, which are actually different than the many herbal protocols I tried before, they’re called Biotics FC Cidal and Dysbiocide. They need to be taken in conjunction with EDTA (as a chelator) or an enzyme to improve their efficacy. I haven’t been able to try it yet bc I moved to Germany in July and everything gets confiscated that is shipped here 🙁 I’m trying to work something out..
            But once I try it, if it works I’ll let you know! It’s been already such a long long process, I just can’t accept that we can’t beat this! Best of luck,


            • Marianne- The prokinetic has been a lifesaver in terms of keeping me regular. I don’t want to be on it indefinitely though, which is why I am trying to figure out and treat my root cause as well. In the meantime, the prokinetic keeps me sane and detoxified. Best of luck!

  5. Chris said “My strategy is to start with the botanical protocols, and use antimicrobial botanicals like olive leaf extract, uva ursi, cat’s claw, yerba mansa, coptis, artemesia, sida, et cetera.”

    what specific brands of these treatments do you use? All too many of us have to self treat because our doctors have no idea about SIBO.

    • FYI
      one interesting thing about uva utis is that one needs to take 500 mg twice a day with 8 oz of water that has 1 tsp of baking soda in order to release the active component. It requires an alkaline solution. One should not use it longer than 7 days.

    • There are many options. In the study on botanical anti-microbials, one combination they used was Candibactin AR and BR.

  6. I would love to hear doses and more specifics on the herbal/botanical treatments for methane producers as well. Thanks!

    • I had a consult with a colleague of Dr. Siebeckers. Here is what she recommended:

      1) Neem Plus by Ayush Herbs: 1 cap, 3x/day

      2) Berberine Complex by Integrative Therapeutics: 2 caps, 3x/day

      3) Allimed brand allicin: 2 caps, 3x/day. (Note: I found that the capsules of Allimed contain a SIBO-unfriendly filler, but the liquid does not). You’d just have to do a little conversion of the caps to liquid to obtain liquid dosing).

      4) (opt). Monolaurin- I specifically asked about this supplement because it is proven effective against certain viruses, yeasts and parasites in addition to bacteria. The ND recommended:

      a) Ecological Formulas: 1-2caps, 2x/day

      But I chose:

      b) Lauricidin because it’s not in capsules, so no fillers, and I can individualize the dosing per my tolerance. Equivalent dosing would be approximately: 1/4tsp, 2-3x/day. It’s very powerful so if you’re sensitive or have autoimmune issues I’d start out much lower.

      • Wow this is phenomenal. Just to clarify, is this protocol for methane SIBO or Hydrogen? Or Perhaps it doesn’t matter?

        Would you be following this regimen for 30 days and then retest?

        • Yes, this is the protocol for both hydrogen and methane. The Allimed is for the methane.

          Yes, it’s for 30 days, then re-test. Presumably if symptoms are not 80-90% improved! continue treating until symptom improvement and a positive test.

          Another option is to combine Abx treatment with the Allimed to treat methane (instead of taking 2 antibiotics):

          1) Rifaximin, 550mg, 3x/day
          2) Allimed brand allicin: 2 caps, 3x/day (or liquid equivalent).

          Here the Allimed stands in for Neomycin.

          • So the hydrogen protocol would just be

            1) Neem Plus by Ayush Herbs: 1 cap, 3x/day

            2) Berberine Complex by Integrative Therapeutics: 2 caps, 3x/day

            and optionally the Lauricidin.

            • No, there are no other herbal alternatives that are as powerful as the ALLIMED allicin garlic extract. This is according to Dr. Siebecker and her SIBO colleagues.

              I bought mine at optimalhealthusa.com for $80 for a 1oz liquid bottle. Each oz contains 600 drops which is about 12 days on the protocol. So you’ll probably need 3oz at least. If you buy a larger bottle the price per oz decreases. The 4 oz bottle is $55/oz. The bottles must be stored in fridge or freezer.

              I chose liquid over capsules to avoid then maltodextrin in the capsules but caps nay be more convenient if you’re not worried about the maltodextrin.

              • Monopoly by the company that makes “allimed”. Ridiculous. I’d rather take one crushed whole clove of garlic for my allicin, and simply reduce fodmaps elsewhere in my diet to make up for the small amount in that one clove of garlic, than pay $80 to some arrogant “patented” company.

                One clove of garlic can’t have as much fodmaps as the multiple servings of wheat that people indulge in – look at the small size, and much of that small volume is fiber, sulfur, and water.

                If ANYONE cared about human health they would finally test fodmaps levels in reasonable serving sizes of foods, instead of lumping one clove of garlic into lists of “high” fodmaps foods. No lab has ever done this that I’ve ever found.

          • Nadira,

            I am considering using Rifaximin with Allicin together as you mentioned above but I had never heard of anyone using that combination before, so I am worried about its safety etc (just because it is the first time I had seen them suggested together). Could you tell me where you heard that this combination can be used? Thanks 🙂

            • This was suggested to me by a colleague of Dr. Siebeckers who treats SIBO patients. The alternative is taking neomycin with Rifaximin but she wasn’t sure I’d be able to handle the intensity of the dual antibiotic therapy. For others they may handle it better.

              • Nadira, can you tell us how your antibiotic therapies went? I have methane SIBO and am considering Rifaxan (200mg 3x/day) + Allicin. Can Allicin be used alone for methane SIBO?

      • And can anyone shed light on the inclusion of Allicin, a garlic product? Garlic is considered a trigger food in FODMAPs?

          • Do you think allicin is safe for those sensitive to sulfur? I don’t do well with excessive garlic, but because allicin is an extract, maybe it’s fine?

      • Hi Nadira,

        Do you mean you take all the supplements together in a day or rotate them every few days?

        I might have SIBO but I dont have any breath test available in my country and no Naturopaths or natural functional doctors. If the CommonWealth breath test is unreliable what kind of breath test is best used?

        I know about Dr Siebecker but couldnt find an email address to ask her some questions,as I am in Europe and dont know if she can work with me. I contacted NCNM but no reply as well

        Thanks a lot for your help

  7. Hi Chris.

    This may be a silly question but it pops into my mind every time I read anywhere that Rifaximin is not absorbed beyond the gut. How is that possible? And more importantly, what if you have a leaky gut, would it then get through the gut wall and what effect would that have on your system?

    Thank you,


  8. Chris – one of the criticisms I hear in regards to the soil based organisms such as Prescript Assist is that there is not enough evidence yet for their efficacy and safety. What is your response to that?


    • There’s a one year RCT supporting Prescript Assist, which is more than many probiotics have behind them. I can tell you from clinical experience that it’s the single most effective and best tolerated probiotic I have ever worked with.

      • Maybe I missed this in the transcripts and chains, but when in the process do you recommend introducing PrescriptAssist?

  9. I see that this is a VERY complex issue and I also realize that I may have some of the symptoms you describe, Chris. And it probably very difficult to self-treat, isn’t it? Chris, do you have a directory of physicians and other professionals qualified to treat patients with SIBO, etc.? I live in the Washington DC area.
    Thank you very much.

    • Unfortunately, I don’t know of such a directory. You’d want to look for functional medicine practitioners, and then ask if they have experience with SIBO.

      • Is this in reference to treating SIBO while pregnant? I am looking for help myself and am in this boat. I have been doing Paleo and not nuts, eggs nightshades and so on for years… I have not had FODMAPS for about 1plus year and now pregnant and with SIBO at is worst. Any suggestions or is this a 9 month waiting process?

        • Hi! I’m wondering how your pregnancy went, and how your baby is doing? I am pregnant with SIBO and face so many anxieties about the nutritional health of the baby and potential effects of SIBO, and there is so little information! I would love to hear about your experiences and any advice you have for someone just 2 months in…

    • I live in DC area and have some practicioners open to treatments and even have heard of Chris! JHU was useless, and tried treating the very off the charts methane positive with rifaxamin only. Three positive tests and systemic involvement. Now understanding that the actual number of methane level should be looked at to see if the peak methane levels are lower. Please contact me privately to share resources.

      • Green Smoothie –
        Please send me your information on doctors in the Washington DC area who can treat SIBO and related conditions. This listserve hides email addresses. Contact me at
        Grace AT TakomaVillage
        DOT org (Use the proper symbols and leave out the spaces). Thanks

  10. Hi Chris,

    In your professional experience, do methane producing archaea and constipation predominant IBS have any relation to the fecal SCFA levels or n-butyrate levels you see on stool tests?

    After listening to your show I did a quick Google search for archaea and butyrate and came across a study titled “Methanogenic archaea in adult human faecal samples are inversely related to butyrate concentration” Authors: Guy C.J. Abell, Michael A. Conlon, Alexandra L. Mcorist.

    Would increasing butyrate be a way to manage IBS-C or reduce methane producing SIBO, or is it more likely that butyrate levels are only low in these high-methane people coincidentally because of altered diet or some other cause?

    I ask this because I did a GDX GI Effects test in August before a rifaximin-only course and to my surprise I had no microbial imbalances. With the severity of my abdominal cramping and IBS-C symptoms I really didn’t expect that. The only red flags in my results report were low SCFA, very low n-butyrate and low butyrate %. Now I’m wondering whether or not I should try to increase butyrate levels or try some other natural antimicrobial. Not surprisingly, the rifaximin-only course didn’t help to reduce symptoms.

    I was under the impression that RS should be generally avoided along with other fermentable fibers even in methane producing SIBO cases with IBS-C.

    Do you think attempting to increase butyrate levels in people who are methane-positive and have IBS-C is a good or bad idea?

    Thank you.

    • That is very interesting! I hope Dr. Kresser answers your question about increasing butyrate levels.

      I’d like to also write to Dr. Kresser, because I’ve been dealing with SIBO for a couple years.

      I’ve done the elemental diet, all the herbal antimicrobials a couple times for 2 months minimum each, and then taken allimed for 3 months all while over these 2 years on a strict paleo/SCD diet w/o any fruit, carbs or sugars. I still am at the same place I started and I can’t understand why. Still very distended stomach, very constipated. I feel lost and helpless, and all the NDs and FM doctors I’ve been to don’t know what else to do either. I only have turned down the Rifaximin/neomycin combo because I’ve read that many people have a relapse anyway and it costs a ridiculous amount of money for those antibiotics.

      Any help, leads, tips, words for hope would be greatly appreciated!!

      Love your work, thank you for all that you do.



      • @ Marianne,

        I can think of a couple things here…did you take the anti-microbial WITH the Allimed or did you take them during 2 different times? You would need to take Allimed PLUS 2-3 other herbal antimicrobials.

        Did you have a SIBO breath test done? Were the results positive? For both methane and hydrogen, I presume?

        After treatment with the e-diet, the herbals, and the Allimed. Did your symptoms improve but just come back, or did they never improve?

        Another thing to consider is SIYO AND SIVO. (Yeast, Viral). In theory, the herbals used to treat bacterial overgrowth also have antifungal and antiviral properties, so may take care of this. However, personally I find that I need to add in some specific anti- yeast and Lauricidin to make my treatment effective. I mix Caprylic acid, Thorne SF5722, and the Lauricidin. I can tell a big difference with the addition of these supplements.

        Okay, so if your symptoms went away but came back, then you need to find your root cause. Dr. Siebecker has a great list of 7 causes of SIBO and ideas to prevent its recurrence. The #1 reason is lack of small bowel motility. You could try ginger, Iberogast, MotilPro, or LDN, but Dr. Siebecker says usually these aren’t strong enough and low-dose erythromycin may be needed.

        If your symptoms never went away, and assuming you do have SIBO, maybe you weren’t treating intensely enough. With the elemental diet, you may to stay on it 21 days if you’re not much improved by 15. The e-diet can worsen yeast overgrowth, so you may need to do e-diet plus some anti-fungals at the same time. Again, adding in the supps I mentioned above could be helpful as well as increasing dosages of the herbals you were taking, or switching to others that may be more effective for you.

        In addition, you are on a very low-carb SCD, have you also eliminated FODMAPS? This is huge, if you don’t, you will keep feeding the small bowel bacteria. Eliminate them ASAP. Also, if you drink broth or homemade soups, make sure that you do not use any joint material, tissue, collagen, etc. This means only pure meat broth/meat soups. (Ie from stew meat, ground meat, not a whole chx, for example, or from beef bones). However, you can still make these foods- chx broth and bone broth, it’s just a lot more labor intensive. If you’re interested, I can explain how I do it.

        Also, I’m sure you’ve done this, but make sure you’re not accidentally eating any of the starches, gums, fillers, etc, that upset SIBO. Again, the http://www.siboinfo.org has a great listing if these things in the resources section.

        Lastly, if your symptoms have subsided,for a time, but came back, you may need to trial supplements like: zinc, resveratrol, glutamine, colostrum, betaine hcl brush birder enzymes, pancreatic enzymes, and probiotics.

        Hope this helps!

        • Wow Nadine, I can’t thank you enough for taking the time to write so much helpful information!

          I did have a breath test that showed low hydrogen and very high methane. I remember my methane was so high it surprised my doctor (and that was with Commonwealth Labs)

          I unfortunately never saw any improvement with the antimicrobials. I remember I did do both the allimed and berberines together, plus something else and biofilm disruptors an hour just before the antimicrobials religiously. Then in a later round I did oregano, neem and the Allimed (1 cap 4x/day), while at the same time taking NAC and candex. I have also been aware of low FODMAP on all these rounds, and following it.

          In between I did make bone broth, but found out what you mentioned about the mucopolysaccharides so stopped 🙁 I have taken just about everything you listed…

          The one thing I did see improvement with was the elemental diet. My stomach actually looked normal like it has almost all my life! That ended teh day I started to eat food again. I had already read every word on Dr. Siebecker’s website as well when I started all this 🙂 I used her homemade elemental diet because it was healthier but it made me nauseous so I can’t imagine doing it again and for longer than what I did (14 days). Also that diet set me back, the honey caused my candida to come back so I was very upset after all that effort to be even worse overall. I would like to try a version of that diet again but without the sugar.. I just don’ t know how to do it. I heard it’s possible to try a water fast for 14 days with supervision, but that is quite intense. I like it though because it won’t cost me anymore money haha!

          I think you had a great point about going back to the causes. I am quite confident my cause is low small bowel motility. I have had constipation issues for years. I even went to a visceral manipulation therapist who said my small intestine is crawling at a snail’s pace. I don’t know how to improve this though. If I don’t get things moving faster, I can kill things off as much as I want but it will just grow back.

          I have tried so hard at this that the past 2 months I stopped all antimicrobial herbs and started Prescript Assist SBO, with taking home made kefir and yogurt (made with VSL3) because my latest stool test still showed NG for the main bacteria. Good news was I totally kicked the fungal infections. However bloating and distended stomach always still the same, plus of course the constipation.

          I’m mostly trying to not restrict myself so much anymore on food (I have been eating some FODMAPs..) and work on the probiotics, with good doses of HCl at every meal and small amount of digestive enzymes. I am about 10% better than I was a year ago in bloating, but I really don’t feel like I’m making any progress still.

          Do you think it would be worth trying another round of antimicrobials? I really feel like I’d be beating a dead horse. If you have any thoughts on a fungal´-safe elemental diet though, I would be very eager to try!

          I also will look into your suggestions for low motility. I did try LDN and it helped only a tiny bit and then wore off. Probably if LDN didn’t work the others won’t (I did try ginger tablets and nothing). I didn’t want to take erythromicin because I try my best to avoid antibiotics.

          Thanks again so much for your post. Means a lot!



          • Marianne, yes, there are several things you could do to avoid a yeast flare up on the e-diet.

            *Make sure you follow the low-sugar version of the homemade diet listed on Dr Siebeckers website, not the high sugar, low-fat one (the Vivonex ratios). Start there.

            *Also don’t use honey it’s way too sweet. Order organic dextrose online -it’s cheap and not very sweet. And just use less sugar and make up your calories in fat if you can. If you can feel it that you really need the sugar for energy, then just add in an antifungal.

            *Make sure that you rest and relax as much as possible – no stress. If you work you may want or need to take off some days or the whole time, depending on how much energy you consume at work. Or try to work from home, part-time. Ideally you need to stay home, sleep as much as possible, read books, nap, take baths, watch tv, etc.

            *Use coconut oil as your sole fat source on the diet. This alone may stop the yeast problem. Take it with your dextrose.

            *Add in an antifungal- Monolaurin, neem, olive leaf, etc., there are many. Start with a small dose bc you don’t want too much die-off. If you still are feeling yeasty then increase the dose SLOWLY, or as you feel comfortable. Take it with your dextrose.

          • Hi, I’m interested to know how you’re doing. You sound like me in terms of symptoms and everything you listed, just about, is what I’d follow, too. But it sounds like it didn’t help you as much as you’d hoped. That is disheartening!

            Curious how you’re doing now. This is overwhelming! But your posts and answers from everyone is very enlightening. Thanks for sharing your journey!

          • Hi Marianne, please try Iberogast. This help things get moving in me for severe constipation.

        • Hi Nadira! I have a couple questions for you if you are willing! Let me know and I will share my email with you.

        • Hi Nadine, I have a couple of questions. Would it be ok if I emailed you?

    • Hey Nathan,

      Thought I’d share my experience with GDX – mine showed no obvious dysbiosis at all even though I had severe overgrowths that other testing picked up here in Australia. I think it often comes down to what specific bacteria are being reported on, these tests really only touch the surface of the numbers of bacterial species in the gut. When I revisited my GDX results, I did see that there were other markers of putrefactive dysbiosis, but the test didn’t show me which bacteria specifically were a problem – the Bioscreen test in Australia was much more useful in that regard.

      None of these tests are infallible unfortunately.

    • I think it’s worth a try. RS is hit or miss with SIBO; some respond well, others don’t. Trial and error is a valid approach.

  11. Chris, are you saying that a breath test reading high methane only (no hydrogen) still considered SIBO?

    I’d been told no by my doctors, yet everything that I’ve read seems ambiguous. But your podcast seems to say that it IS SIBO, which makes sense to me, because otherwise, why test for methane. Other than sudden onset rosacea, I’m told that I don’t have the classic SIBO symptoms (excessive bloating, gas, nor very bad breath). Serum and stool tests negative for h pylori, no parasites or bad bacteria, other than a few commensal e coli. Also, are you saying avoiding FODMAPs could help with the high methane? I haven’t tried that yet. FYI, my hydrogens, including baseline, were 0 (except for a 4 ppm at 20 mins), but methane was 80 at baseline and 56-74 at all other test times.

    Thanks in advance for clarifying this point about SIBO vs not SIBO for me. This would help me try to figure out what to do next.

    • Yes. According to Dr. Piementel, a baseline level of methane over 3 ppm is considered a positive result, regardless of baseline hydrogen or increase of hydrogen or methane after challenge. Whether this qualified as “SIBO” according to the strict definition is debatable, but from a practical perspective it doesn’t matter what you call it. The question is whether to treat, and I’d say yes if symptoms are present.

      • One more thing. Commonwealth, the lab I now use for SIBO testing, also marks methane over 3 ppm at baseline as a positive result. They recently made this change because of what the scientific literature suggests.

        • THANK YOU very much Chris!

          Dr. Jolley (the GE at Baycro in Mill Valley) wrote “Methane Positive” on the report. Since I couldn’t find the answer online, I asked my FM doctor who ordered the tests if that meant I have SIBO; she told me no, that I was just constipated and needed to increase my fiber and exercise (which is silly because both were already very high, and fiber possibly too high).

          Would rosacea (sudden onset 1 year ago), without other typical extreme symptoms, still qualify as “symptoms are present”? For example, bloating isn’t common (never severe) and only mild at that; rare bouts of constipation — generally regular (once a day); chronic bad breath was an issue years ago — not as bad lately, though it could be better.

  12. hey Chris, this podcast is so appreciated , thanks.

    i have been wondering though, if a stool test (doctor’s data) shows little to no beneficial bacteria in the colon (eg. bifido and lactobacillus), is it still possible to have an overgrowth in the small intestines? I have all the symptoms of methane version of SIBO.

    • Seconded. (Same situation: “No Growth” readings for beneficial bacteria and methane SIBO symptoms; additionally, ambiguous breath test results.)

        • Hi Chris,

          Along those same lines, would a stool test indicating “heavy growth” of non-pathogenic bacteria (both gram negative and positive) be in any way indicative of SIBO (especially if the patient is symptomatic)? I realize the stool tests are only reflective of bacteria in the large intestine, but couldn’t this still mean something?

          Thanks for the fantastic post!

  13. Great article, I am a methane producer, and I have been battling sibo for about 3 years. I believe I am antibiotic resistant now. So my next step is trying to starve out the bacteria by doing an elemental formula (vixonex ten) via NJ tube along with herbal antibiotics (candibactin AR and BR). In this discussion elemental formula was not covered. What are the success rates for getting rid of methane dominant sibo with this protocol? Any reply would be greatly appreciated! I’m desperate and down to my last options, I continually lose weight and fear for my life and health.

    • most antibiotic resistance can be overcome by taking bromelain which removes the biofilm the bateria use to protect themselves. for mrsa, one can use manuka honey.

    • I have not seen any data on the effectiveness of elemental diets for reducing methane-producing archea.

      • At the SIBO Center in Oregan, it is quite the opposite. They see methane levels decrease with the Elemental Diet.

  14. Now I am totally confused. I was told I was negative for SIBO because my methane concentration barely increased from its baseline reading of 3ppm to just 4ppm after 120 minutes.

    Is the takeaway from the podcast that I am merely a “methane producer” but nevertheless one without SIBO? Or should I rethink my diagnosis and seek treatment?

    The part that has me the most confused is that in the study Chris mentioned, it sounds as if the people were treated based on their baseline levels alone. That can’t be true…can it?

    • If I remeber correctly, Dr. Siebecker says that even a baseline methane increase is considered positive. Especially if the symptoms are present, I believe.

        • I too have seen several statements that a high methane baseline level can be considered positive for SIBO even WITHOUT an increase in the subsequent breath samples. It seems logical that a high baseline reading for methane means you are a methane producer, but how is this then associated with the SI? According to the logic of breath testing (time stamps matching up to a specific part of the digestive system as the sample transits through) the SI is indicated by a certain time frame. I have not been able to find an explanation as to why the high methane seen at baseline is produced in the SI rather than the LI.

          • If I remember correctly, doesn’t high baseline mean that the archaea are high up (at the beginning of) the SI? Can’t remember if I heard that from Chris ore elsewhere.

            • The high baseline value for methane is produced by food that is ingested prior to the fasting period (a minimum of 12 hours before the breath test). Surely this food has long since passed through the SI when the baseline breath sample is taken? (Remember the baseline is taken before swallowing the glucose or lactulose sample). I’m sure there is a good reason to associate a high baseline of methane with SIBO, but that reason is certainly not clear in any of the ‘interpreting HBT results’ articles I have read.

              • Well you’re light years ahead of me in understanding the science, so this will probably be a stupid comment/question: since it’s the archaea’s consumption of food that produces the methane (and not actually the food itself), then maybe the existence of the archaea at the beginning of the SI might indicate that they continue to produce methane for a period of time even after the food has passed thru the tract? As a methane SIBO sufferer I’d really like to understand it better myself.

  15. Great article Chris,

    One question, is your treatment protocol outlined in more detail in your book?

    I have 68ppm methane baseline and have been feeling better with 2 months of low fodmap but feel awful with even a small amount of dark chocolate as a test. I’d really like to add in some of the supplements you recommend but would like more detail on dosage and timing.

    Thank you.

  16. I’m sorry if this is a stupid question, but I’ve been unable to find a direct answer to this anywhere:
    If you take the breath test and hydrogen is ~ zero, but the methane is high, does this definitively rule out SIBO? (And I guess the other question is, but does it rule in IBS?)

    My doctors say high methane and no hydrogen means no SIBO, but based on Chris’ explanation, it seems that it could actually mean that I am in fact producing hydrogen, but it’s all being consumed by the archaea, so it’s not showing up on the test.

    In my case hydrogen is 0 at baseline and all other times (except for 4 ppm at 20 min). But methane is 80 ppm at baseline and 53-74 at all other test times.

    Other than sudden onset rosacea, doctors say that I don’t fit the typical SIBO profile, ie, not bloated enough, don’t pass enough gas or have horrible breath (although I feel at times that I do). My h pylori tests (serum and stool) are negative.

    Any clarifications/insights you can provide would be very helpful.
    And thanks for this excellent podcast.

    • I would say this is definitely SIBO based on what I’ve learned from Siebecker class and SIBO symposium! I wonder what doctors are you seeing? Do you have constipation?

      • Simas thanks! It’s a functional MD who’s been thru all of the IFM courses. Constipation is not typical (I’m once a day regular) and actually more regular than I’ve ever been in my life before now. I do get occasional bouts though, often alternating with loose stools. I’ve concluded that when this happens, it’s due to consuming too much insoluble fiber at one meal, and not enough water. Maybe I’m wrong though now — maybe it’s the SIBO or maybe it’s FODMAPs which I’ve never paid attention to before. I did a long drawn out elimination diet several months ago and never found a specific food that causes allergic or distress or any other bad reactions (other than things that cause my face to heat up due to rosacea, like hot peppers or alcohol, or anything thermally warm). Does Siebacker say to avoid FODMAPs?

        • Rosacea + alternating diarrhea with constipation are very typical signs of SIBO. My guess is that your doctor is not very familiar with it.
          FODMAPs is not a condition btw, they are certain compounds in food that can be fermented by bacteria. So you may benefit symptomatically by avoiding them, but I doubt it would solve the problem. I’m not a doctor, but based on extensive reading and conferences I saw, you have most definitely have SIBO.
          Wikipedia has a nice article on SIBO, and it’s link with rosacea. Have a look http://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth#Proposed_link_with_Rosacea

          • Thanks Simas, that’s a great article too. See my post later in this string — I’ve actually had reactions to high FODMAPs foods as it turns out; I just never knew that FODMAPs were the common link between them before now. Yes, I knew about the strong link b/w rosacea and SIBO which is why I insisted that my doctor prescribe the test; the problem was with my doctor’s interpretation of the results.

            Interesting about metronidazole, because all the dermatologists push MetroGel or Lotion at rosacea, which I’ve found completely ineffective. The main oral that they push is Doxy in the low-dose form of Oracea, which I’ve refused to take. I don’t relish the idea, I’m not at all opposed to taking an antibiotic if I know it’s going to help with the root cause, not just the symptoms.

  17. Great podcast! Thanks for answering my question! I have also submitted another question about the various causes of SIBO that I hope could be answered someday. It’s really really interesting, because as far as I know, there’s only one established cause, which is called “post infectious IBS”. But I guess it’s not the only one, and there are other reasons for slowed motility.
    Thanks again!