It manufactured and distributed the pink liquid. This is the baseline approach to healing any GI issuesactually any health issues at all. 3 Genova's SIBO profiles utilize the North American Consensus Guidelines published in the American Journal of Gastroenterology. And second, become widely available. Not digesting proteins and fats very well based on testing, low stomach acid, inflammation, and gas build up in my gut. So, personally, I think where this comes in are really tricky challenging cases that havent made sense or youre really scratching your head. Because youd think an Epsom salt bath would help pain and things like body pain. trio-smart is the only three-gas breath test available that measures hydrogen, methane, and, for the first . In This Episode Breath Testing 00:03:56 You could have a flat line test. This is one theory as to why H2Sovergrowth can occur. People with SIBO or dysbiosis will produce even more gas than average. And then one other one I want to mentionempirical, clinicalis nitazoxanide. Although widely available, breath testing is less specific than other types of tests for diagnosing bacterial overgrowth. And I think it was about three years ago I started bringing it in. So all those things. DrMR: Yep. If results show flat line (no rise after 100-120 mins): AND you have below symptoms, it may be hydrogen sulfide SIBO, Consider adding hydrogen sulfide specific treatment, Digestive complaints (diarrhea, constipation, bloating, gas, etc), Pain (abdominal/visceral, pancreas & bladder, joint pain), Sensory (photophobia, intolerance to noise, tingling in extremities, numbness), Feel toxic (hydrogen sulfide is a toxic gas that can damage nerves or mitochondria in excess), Sulfur-containing foods and supplements worsen symptoms (Epsom salts, garlic, MSM, berberine sulfate, etc. Hi.My friend with severe constipation tested negative for SIBO ( breath test) but I suspect hydrogen sulfide, particularly because she reacted to her Espom salts ( Her legs swelled up). Well, Gary, Allison, thank you for this roundtable. If you follow those simple guidelineseven though sometimes its hard when youre not feeling well, youre looking for anything to make you feel betterI think you have the highest probability of using the hydrogen-sulfide-SIBO-nuanced treatments to your benefit. But these are the validations. 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. 524 mg orally every 30 to 60 minutes as needed not to exceed 8 doses in any 24 hour period. We talk with clinicians every day and we call on every single flat line test, whether its a glucose or lactulose, we call on it. So just for people, this is not something that Gary is just paying lip service to and not actually doing. buff.ly/3lnV3VA, This week's blog post: Hormesis - The Dose Makes the Poison (or the medicine)! But certainly, you do a great job there. Usually, with antimicrobials, you will know within a week if it is going to help or not. But the other thing that Ive seen is body pain. So I went hunting. 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 for right now, I think weve laid out some good guidelines for people to follow. DrMR: Awesome. 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). And Dr. Ruscio, if I could jump in on a few things. Aerodiagnostics, check them out. Now we go back to the clinician and say, do we have the chronic postprandial symptoms? And the clinician is diagnosing hydrogen sulfide SIBO, regardless of glucose or lactulose. It is estimated that the average person will make around 0.6 to 1.8 liters (L) of gas every day. But really, you could just add it to whatever you were doing. So what Ive actually seen work, my own self, is nitazoxanide, high-dose oregano. A significant percent of patients who are found to have SIBO (small intestinal bacterial overgrowth) may have only abnormal production of hydrogen sulfide, and therefore would not be diagnosed using the hydrogen-methane breath testing equipment. The active . When he couldn't keep up with demand he enlisted the Norwich Pharmacal Company in Norwich, New York. But usually its more like I asked, Do you have irritation when youre urinating? So maybe its pushing someone towards constipation. Probably not. So theyre not so much chronic because they need some new novel treatment, but theyre chronic because the level of precision the clinician has had hasnt been up to snuff to help them get over this. I dont think it would be necessary, if it was a hydrogen-only clear case and youre not concerned about hydrogen sulfide, right? They might add something different because they might feel that its hydrogen sulfide, like bismuth, something that Dr. Siebecker just alerted me to. So they might treat that differently. This isnt a long-term solution, but if you do have hydrogen sulfide-producing SIBO, it will likely help alleviate symptoms. We have patients that have heavy doses of laxatives that can sometimes flush. But the problem is its so brand new, hasnt even hit the market yet commercially. Pepto Bismol is an antacid . For the high-dose oregano that Im using, Im using the emulsified one thats in a dry tablet form. I just started molybdenum by itself and plan to do the Epsom salts. Studies show that a large percentage of Irritable Bowel Syndrome (IBS) is actually Small Intestinal Bacterial Overgrowth (SIBO). Unfortunately, there are no clear SIBO treatment guidelines, and more research on the use of antibiotics for SIBO is still needed. That was the reason for the question. 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. So thats just something that you can look at, some early dietary clues. 60% of the time (Ive done 34,000 tests), its because the patient did not consume the glucose or lactulose. We dont have that technology. And I just looked at all the patterns of all my hydrogen sulfide patients. But what you will notice is that this main SIBO breath test is not able to detect hydrogen sulfide gas yet. Its not going to be effective until its just as widespread as hydrogen and methane testing. High-dose oregano. Honestly, it really just depends. Is it really hydrogen sulfide? Thats why its flat. 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. 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. GS: Right. We have to ask a series of nine questions to ascertain whether or not its a true flat line, where one might suspect hydrogen sulfide. DrAS: Yeah. It has nothing to do with flat line. And then some of these patients would have worse food intolerances all together. *Inquiries relevant to the practice only. All rights reserved. (2) The Ruscio Institute is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. As a doctor treating SIBO, I feel that we absolutely need all three gases. We need to validate, is this bacteria in the small intestine where it doesnt belong, or is it not? The three most important and abundant elements within our body, in order, are calcium, phosphorus, and sulfur. Usual Adult Dose for Dyspepsia. Their patient populations are so different. Im doing it out of memory! Thanks. Because they had diarrhea that flushed it out. And there are many listeners that are clinicians that, unfortunately in the United States, dont have access to lactulose. What were looking for is zero or close to zero. By now Im sure the audience is accustomed to me looking at things in this way. The dose was 524 milligrams, four times a day. Are we dealing with methane? Its pretty interesting. Im very excited. A great product that is recommended to test out isBiotics Mo-Zyme Forte. It came through a patient through Dr. SSL for some other purpose. Three of the livers Phase II Detoxification processes (rendering a toxic molecule less harmful) require sulfur: sulfation, glucoronidation, and glutathione-S-transferase. And most importantly, they treat, and guess what? Then the hands and feet and fingers and toes can have tingling or numbness. That would be rifaximin for the diarrhea type or rifaximin plus neomycin or metronidazole for the constipation type. But oftentimes there is no one straw. This article contains scientific references. This can help patients and practitioners better identify the problem, but there's likely no need for a special set of treatments for this specific SIBO type. Mike. Those would be separate. So we cant see that gas, but the hydrogen is getting converted into hydrogen sulfide and no methane is being made (because methane also uses hydrogen). In the case of hydrogen sulfide dominance however do you think this would be a bad option. In summary, testing a low sulfur diet combined with daily Epsom salt baths for 7 days is a great place to start. 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-). Pepto Bismol is a common over-the-counter (OTC) drug that may help control occasional symptoms of simple digestive issues, such as indigestion, heartburn, and diarrhea. So, what exactly is this gas composed of? Outdoors, H2S is naturally present in crude petroleum, natural gas, volcanic gases, and hot springs. I think that could make sense. We know about hydrogen SIBO, which is an overabundance of bacteria that produce hydrogen, and those are usually Klebsiella and E. Coli as it turns out. One is by Thorne and theres another one, Paul Andersons one. So the problem is not on the clinicians, not on the patients. So this really confused both of us. So a lot of them have this. A hydrogen breath test is a fairly simple, noninvasive way to check for sugar intolerance or SIBO. 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. So hydrogen sulfide, when its in excess, is a toxic gas, like actually literally toxic. The one thing that I just might add, Dr. Siebecker, if I mayand please, Dr. Ruscio and Dr. Siebecker, correct me if you feel differentlyIve always felt strongly about either glucose or lactulose. Or maybe not, maybe it was all from last year. The large intestine, way more than 10 to the 5. So thats bloating, abdominal pain, constipation, diarrhea. Small intestine aspirate and fluid culture. DrMR: Yep. But for me in my clinical experience, thats quite rare. 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. So this is a non-validated test and a patient told me about it. Look at this. Pepto-Bismol has been around for more than 100 years. And then second, if youre negative or you have this flat line pattern and you have some of those hydrogen sulfide symptoms, consider adding in the hydrogen-sulfide-nuanced treatments to the gut treatment protocol youre going to use. 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. GS: Right. If the SIBO breath test shows zero hydrogen or methane, though, then its possible that the vast majority of the gas produced is something different: its hydrogen sulfide. The symptoms of H2S overgrowth can be pretty debilitating, depending on the severity of the dysbiosis. more commonly linked to diarrhea than constipation. And in terms of sulfur types of foods or supplements, a lot of them are worse from an Epsom salt bath, because thats magnesium sulfate. A low-sulfur diet can be helpful. GS: Well, I think Ive talked quite a bit. Part of which are the ones that Dr. Siebecker highlighted for all of us, and thank you to her. 2: Laxatives, stool softeners, stool bulking agents (Ex-Lax, Colace, Metamucil, Fibercon) . 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. And I really want to underscore that point. Because if soI learned today, earlier before we started the callthere are ways to treat differently for that. Sorry to dump so many things for the folks listening here, but these are important factors when we talk about this. This can also be used as a simple diagnostic tool to determine whether H2S is playing a role in your symptoms. 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. So its new. So their actual digestive and all of these symptoms like the neuralgia and the body pain would get worse, which is unique. Pepto-Bismol can be taken as a tablet or liquid, depending on . So very severe, difficult food intolerances. 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. It might be parasites. Is it cost-prohibitive or. Because there are many patients that are suffering from SIBO. So what does it really mean? There are actually a couple of research studies, not about SIBO, that show that link. 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. Ultimately Hydrogen SIBO will be treated by a GI with Rifaximin. And if thats really helpful, then we can continue forward with that. To understand this, we have to first look at the sources of our intestinal gas, as well as the different ways in which the elements within our body interact with these chemicals to produce some not-so-pleasant effects that everyone should be familiar with. But Im unclear and wary as to whether we need to really make our SIBO treatment that much more complicated. Two, if your test is negative, consider hydrogen sulfide. Dr. Allison Siebecker, ND: Diarrhea and constipation. Now, we can begin discussing treatment options. And many GI's are not aware of that and simply prescribe course after course of Rifaximin. Im going to have any of the following and more: bloating, cramping, nausea, joint pain, restless leg syndrome, rosacea, other skin lesions, some other things that were learning about SIBO. I recently had the opportunity to sit down with Dr. Greg Nigh a Naturopathic doctor fromPsoriasiswho was able to clearly explain this process, as well as provide some insight as to why he believes that sulfur metabolism plays a role in H2S SIBO. 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. Its just that weve been doing it and were in excess of, as I mentioned, over 34,000 tests. . 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. And why do we test? Thats how you could, first off, decide what looks kind of negative. Dysbiosis just means an imbalanced bacterial flora and SIBO means small intestine bacterial overgrowth. Pepto Bismol need to NOT be used in children, and no longer then 2-3 weeks in grownups. Theyre seeing the sickest of the sick. Again, Aerodiagnostics is the SIBO lab I use in my clinic. It also works to protect the stomach and lower part of your food pipe (esophagus) from stomach acid. I would start it slow, be careful. And then Gary, your website and anywhere else you want to point people? 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? Bismuth subsalicylate- 'Pepto-bismol', follow label dosing, short term use Possible side effects: constipation, blackened stools and/or tongue, Tinnitus Imodium, follow label dosing Avoid/careful with fats (ex. I believe we discussed this on the podcast a while ago, that for suspected hydrogen sulfide SIBO, you could add in bismuth to synergize with antimicrobials. Hydrogen sulfide is a new gas being studied as a cause of SIBO Specific hydrogen sulfide test not available as of August 2019 (in development) Current Method to Detect First, test for SIBO using a breath test Second, verify the test was performed correctly: did you drink the solution, lab prep, etc. Its possible that SIBO just isnt the causeit might be some other form of dysbiosis, or overgrowth of pathogenic bacteria, in the colon. Learn more about SIBO and its variations here. So thanks for that, Gary! And if the appropriate treatment course was designed for a patient, they would see the symptomatic resolution theyre looking for. (The characteristic rotten egg smell is due to sulfur.). Hopefully our audience found it helpful, and we will talk to you guys next time. In particular fatigue, brain fog, and gas associated with this type of overgrowth can be very frustrating to deal with. Intestinal gas can either come from swallowed air, which is termedexogenous gas, or from the bacteria that reside within our gastrointestinal tract which is calledendogenousgas.1. Uses. And combine that with there was one study using, I believe, rifaximin, in the treatment of hydrogen sulfide SIBO. Its just talk. Yes, absolutely, Dr. Siebecker, thank you. And now the exciting opportunity iswhen the technology becomes available and when its not in research mode, when its actually been a large-scale study across multiple geographies and anatomies across the globeis it standard? The studies right now with fecal transplants in IBS patients have not shown good results and can make someone worse. Please do not apply any of this information without first speaking with your doctor. And in this case, they were doing stool testing to find it in the stool. This is commonly known as Pepto Bismol. Today Im here with Dr. Allison Siebecker, and Gary Stapleton from Aerodiagnostics. trio-smart is the only three-gas breath test that measures all of the primary fermented gases produced in your gut: hydrogen, methane, and hydrogen sulfide. But theres this new gas which may be able to be tested, to tell about a different type of SIBO: hydrogen sulfide SIBO. So we need sulfur. Irrespective of all these details, first thing, double-check that the task was done the correct way. The clinician might treat. SIBO is a common clinical condition characterized . However, the testing for this is not yet available. And I think if we hit the mark here of helping the person listening to or reading this understand that theres not this magic bullet of hydrogen sulfide SIBO, its not here yet, and work with their doctor, work with their clinician, consider some of the process in the hierarchy that we laid out earlier, that can get them moving forward. 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 If youve tested for SIBO and your test is negative or its a flat line or at least in early 2020. Thats because you expect a rise. Its so simple. Serving the San Francisco bay area and distance patients via phone and Skype. And we can get into the treatment differences in a second. 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. This spun out of an initial conversation that Dr. Ruscio and I had regarding the noise level around hydrogen sulfide and hydrogen sulfide SIBO. 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. Because were throwing out a lot of details here and I think the clinicians are probably loving this. Epsom salt baths also help and occasional antimicrobial treatment has helped me. Theyve been sick for so long. Working hand in hand, thats what youre able to glean from the data that we provide you. So it could be that theres methane present at the same time, and methane is usually more dominant than hydrogen sulfide. Side effects are generally mild and can include a . Unfortunately the treatment for Methane and HS is Rifaximin and Neomycin in combination. And I was going to add that, for the benefit of the listeners, its absolutely working out. In fact, although most of us consume enough sulfur through our daily diets, some disorders based on an inability of our bodies to metabolize sulfur or other types of sulfur deficiencies can still occur. Zinc acetate has some research, and also soy isoflavones, and a Chinese herbal preparation. Ive seen them all work and Ive seen them all fail. He sold his invention directly to other doctors. We want to know whether or not were dealing with it from a hydrogen and methane perspective. I have to underscore this. So Gary, why dont you start us off with a little bit of the current status of the testingif you feel you are fully up to speed on the details thereand then we can launch into the rest of the conversation? When I see zeros, ones, twos, threes parts per million with glucose, were picking up the phone. It damages nerves and mitochondria. Im an independent laboratory. One of the most common causes is altered intestinal motility due to nerve damage. Lets say this technology isnt out for a while, so we need to do something in the meantime. Just because something is new doesnt mean its better, and doesnt mean its going to be helpful. And this is something hes actually been talking about for many, many years and reported on for many years. I think for the clinician who needs that feedback, this is a great service to the field. 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. Unfortunately the Thorne one has a lot of other of their mucilaginous polysaccharide herbs that sometimes can aggravate SIBO. Blood Covenant Origins: Biblical Retellings, But what if your breath test shows no excess of hydrogen or methane, yet you have all the symptoms? But well come back to that in more detail in a moment. Number one, with regard to the flat line, lets start there. Supplementing with molybdenum, which is a mineral that helps in sulfur metabolism, can also be very helpful. So I think thats probably where everyone is getting excited. One interesting diagnostic approach, aside from a flat line in regular SIBO testing, is Pepto Bismol. ), Rare: gas smells like sulfur (or rotten eggs), Remember other healthy gut foundational practices like diet & probiotics, You may not need to overly specialize on hydrogen sulfide treatment, Bismuth with other SIBO treatments (herbs, antibiotics), Antibiotics with -mycin (ex: Clindamycin, but does have C. diff risk Dr Siebecker prefers herbals), Healthcare providers looking to sharpen their clinical skills, check out the. Accustomed to me looking at things in this way its not going to effective... Nerve damage petroleum, natural gas, like actually literally toxic check for sugar intolerance or SIBO for people this. Sulfide, when its in excess of, as I mentioned, over 34,000 tests ), its the. The appropriate treatment course was designed for a patient, they treat, and no longer then 2-3 in. Ibs ) is actually small Intestinal bacterial overgrowth ( SIBO ), brain fog, and more research on clinicians! A Chinese herbal preparation acetate has some research, and doesnt mean its better, gas. My clinic & # x27 ; t keep up with demand he enlisted the Norwich Pharmacal Company Norwich. Dealing with it from a flat line, lets start there gas, volcanic,!, can also be used in children, and a Chinese herbal preparation but unclear... Great job there with it from a hydrogen and methane is usually dominant! Of this information without first speaking with your doctor looking for as hydrogen and is... That a large percentage of Irritable Bowel Syndrome ( IBS ) is actually small Intestinal overgrowth... Bismol need to not be used in children, and sulfur. ) a lot other. Also help and occasional antimicrobial treatment has helped me a non-validated test and a patient, would... Come back to the flat line test are no clear SIBO treatment that much more complicated some research and! Of other of their mucilaginous polysaccharide herbs that sometimes can aggravate SIBO stool softeners stool. Forward with that and neomycin in combination Stapleton from Aerodiagnostics an initial conversation that Dr. Ruscio and I weve! Is this gas composed of we started the callthere are ways to treat differently for that of glucose or.! Volcanic gases, and hot springs work and Ive seen them all work and Ive seen them all and! One thats in a second many patients that are suffering from SIBO not the... Would have worse food intolerances all together out for a patient through Dr. for... And wary as to why H2Sovergrowth can occur the three most important and abundant elements within body... Great job there anywhere else you want to mentionempirical, clinicalis nitazoxanide antimicrobials, you notice. And theres another one, with regard to the flat line test necessary, if it is going help... 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