How to deal with Hydrogen Sulfide SIBO (H2S)
Have you heard of the third type of Small Intestinal Bacterial Overgrowth (SIBO): Hydrogen Sulfide (H2S) SIBO? Hydrogen sulfide SIBO has unique characteristics and treatment approaches that are pivotal for those suffering from gut health issues.
What is SIBO?
SIBO, or Small Intestinal Bacterial Overgrowth, is a condition where an excessive amount or abnormal type of bacteria are present in the small intestine, where their numbers should be relatively low compared to the large intestine. (The large intestine houses the highest number of bacteria). These bacteria in the wrong place can interfere with normal digestion and absorption of food by fermenting carbohydrates and fibers and creating byproducts, like gases (methane, hydrogen, hydrogen sulfide). The overgrown bacteria can interfere with normal digestion and nutrient absorption.
This process can lead to symptoms like:
- Chronic bloating that tends to get worse by the end of the day,
- Changed bowel movements involving constipation and/or diarrhea or alternating bowel movements
- Abdominal pain,
- Nausea,
- Burping,
- Fatigue,
- Muscle or joint pain,
but it can also impact your skin, hormones, and other areas of the body. (1)
SIBO is a complex condition with various root causes, including impaired gut motility, anatomical abnormalities, and a compromised immune system.
What about Hydrogen Sulfide SIBO?
Hydrogen sulfide SIBO occurs when an overgrowth of bacteria in the small intestine produces excessive amounts of hydrogen sulfide gas. This type of gas can have unique and potentially more severe impacts on the body's systems.
This type of SIBO is notorious for:
- rotten egg smelly gas,
- diarrhea or constipation,
- bloating,
- belching, acid reflux,
- brain fog,
- body pain (mostly abdominal pain, bladder, and joint pain),
significantly impacting gut health and overall well-being.
The production of hydrogen sulfide in the gut is a natural process. Still, the excess is often due to a combination of dietary choices, slow intestinal motility, impaired detoxification pathways, and an imbalance in gut flora. These factors create an environment where sulfur-reducing bacteria thrive, leading to Hydrogen sulfide SIBO.
The research found that Fusobacterium and Desulfovibrio spp are two predominant hydrogen sulfide-producing bacteria. (2)
Hydrogen sulfide gas can cause inflammation and interfere with mitochondrial function in excess. This type of gas has been associated with gastrointestinal disorders such as ulcerative colitis, Crohn's disease, and irritable bowel syndrome. (3)
Testing for Hydrogen Sulfide SIBO
Diagnosing Hydrogen sulfide SIBO has historically been challenging due to limitations in testing for hydrogen sulfide. However, advancements have led to the development of specific tests, namely the TrioSmart breath test, at least in the United States, that can directly measure hydrogen sulfide levels in the breath, offering a more accurate diagnostic tool for identifying this subtype of SIBO. The TrioSmart test can measure all three types of gases: hydrogen, methane, and hydrogen sulfide. (4)
Reducing Hydrogen sulfide in the gut
The treatment for Hydrogen Sulfide SIBO may involve conventional and natural strategies to reduce hydrogen sulfide production and address the root causes of overgrowth.
The conventional approach for Hydrogen sulfide SIBO
The conventional approach often includes antibiotics (Rifaximin with Flagyl or Neomycin) specifically targeted to reduce bacteria that produce hydrogen sulfide. (5)
Natural approaches for Hydrogen sulfide SIBO
Hydrogen Sulfide SIBO Diet
Generally, a low-sulfur diet is recommended, although it is still questionable whether it truly helps this condition as the research is currently limited. The low-sulfur diet means a reduced intake of foods high in sulfur, such as:
- eggs,
- dairy products (cow/ sheep/goat milk, cheese, yogurt, cottage cheese, etc.)
- red meat,
- dried fruits,
- legumes (beans, lentils, soy)
- Vegetables: cruciferous vegetables like broccoli, cauliflower, cabbage, arugula, daikon radish, horseradish, spinach, split peas, turnip, watercress, etc.
- Certain fruits: grapes, papaya, and pineapple
- garlic, onion, leek
You can always try a low-sulfur diet for a short period, 1-2 weeks, to see if it reduces your symptoms, but it is not a long-term approach.
Supplements and nutrients:
Herbal antimicrobials like oil of oregano may work to help reduce the overgrowth. Oregano oil contains compounds such as carvacrol and thymol, which have been shown to possess broad-spectrum antibacterial activities. These compounds can disrupt the cell membranes of bacteria, leading to their death or inhibition of growth. In the context of Hydrogen sulfide SIBO, oregano oil could potentially help by targeting the specific bacteria responsible for producing hydrogen sulfide gas. By reducing the population of these bacteria in the small intestine, oregano oil may help decrease hydrogen sulfide production, thereby alleviating some of the symptoms associated with H2S SIBO. (6)
It's important to note that while oregano oil has promising antibacterial effects, its use should be cautiously approached. High doses can irritate the gut lining, and it should not be taken for prolonged periods without the supervision of a healthcare provider.
Another great herb is Uva Ursi (bearberry leaf), well-known for its antiseptic and antibacterial properties, particularly in treating urinary tract infections. Its primary active component, arbutin, is metabolized into hydroquinone, a compound with antimicrobial effects. Uva Ursi can exert antibacterial effects and possibly help modulate bacterial populations in the gut, potentially impacting the bacteria responsible for hydrogen sulfide production.
However, it's important to approach Uva Ursi cautiously due to its potent effects and potential toxicity at high doses. Specifically, the hydroquinone produced from arbutin can be toxic, necessitating careful dosing and, ideally, supervision by a healthcare provider. Its use is typically recommended for a short period of time. (7)
Supplements such as bismuth subsalicylate (the active ingredient in Pepto Bismol) can bind to hydrogen sulfide, reducing its presence in the gut. It has antimicrobial and anti-inflammatory properties, making it effective in combating certain types of bacterial infections in the gastrointestinal tract. (8) (9)
Molybdenum is an essential trace mineral that also acts as a cofactor for enzymatic reactions and may help break down sulfites into sulfates. Many patients reported their brain fog disappearing. Dr. Greg Nigh recommends Mo-Zyme (from Biotics)—it is best to chew it.
Many people fear prebiotics in SIBO, but galacto-oligosaccharides (GOS) may benefit SIBO warriors by stimulating the growth of beneficial bacteria in the gut. Prebiotics like GOS support a healthy microbiome by providing food for probiotic bacteria, such as Bifidobacteria and Lactobacilli, which can enhance gut health and function. In the context of hydrogen sulfide SIBO, the potential effects of GOS could be beneficial; by promoting the growth of beneficial bacteria, GOS might help outcompete sulfur-producing bacteria, potentially reducing hydrogen sulfide production. It can also be a great addition if you are working on eliminating harmful bacteria with antibiotics or antimicrobials so you can help preserve the presence of beneficial gut flora.
If you are a tea drinker, I have good news! Research has shown green tea extract can help reduce levels of hydrogen sulfide because green tea polyphenolic antioxidants can oxidize hydrogen sulfide. (10) (11) Other polyphenols like resveratrol, quercetin, and curcumin may also help inhibit these bacteria.
As with all types of SIBO, it is crucial to support gut motility. Prokinetics are medications or supplements that can help stimulate the muscles of the gastrointestinal tract to move contents along more efficiently. (12) Natural prokinetics include ginger and artichoke, while prescription options might include low-dose naltrexone or prucalopride. (13) (14)
Conclusion
The treatment for hydrogen sulfide SIBO quite differs from other types due to its unique cause and effect on the body. Successfully managing SIBO, including its hydrogen sulfide variant, necessitates a comprehensive, individualized strategy that addresses the condition's multifaceted nature. Dietary adjustments, lifestyle changes, addressing the root causes, targeted supplementation, gut motility support, and bacterial balance are essential for effective management.
Remember, healing your gut is a journey. Incorporating these recommendations can significantly reduce hydrogen sulfide levels, improve symptoms, and enhance your quality of life. Always consult a healthcare professional to tailor these suggestions to your health needs.
This post is only for informational purposes and is not meant to diagnose, treat, or cure any disease. I recommend always consulting your healthcare practitioner before trying any treatment or dietary changes.
References:
- Achufusi, T. G. O., Sharma, A., Zamora, E. A., & Manocha, D. (2020). Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods. Cureus, 12(6), e8860. https://doi.org/10.7759/cureus.8860
- Villanueva-Millan, M. J., Leite, G., Wang, J., Morales, W., Parodi, G., Pimentel, M. L., Barlow, G. M., Mathur, R., Rezaie, A., Sanchez, M., Ayyad, S., Cohrs, D., Chang, C., Rashid, M., Hosseini, A., Fiorentino, A., Weitsman, S., Chuang, B., Chang, B., Pichetshote, N., … Pimentel, M. (2022). Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes. The American journal of gastroenterology, 117(12), 2055–2066. https://doi.org/10.14309/ajg.0000000000001997
- Singh, S. B., & Lin, H. C. (2015). Hydrogen Sulfide in Physiology and Diseases of the Digestive Tract. Microorganisms, 3(4), 866–889. https://doi.org/10.3390/microorganisms3040866
- Pimentel, M., Mathur, R., & Chang, C. (2013). Gas and the microbiome. Current gastroenterology reports, 15(12), 356. https://doi.org/10.1007/s11894-013-0356-y
- Gatta, L., & Scarpignato, C. (2017). Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Alimentary pharmacology & therapeutics, 45(5), 604–616. https://doi.org/10.1111/apt.13928
- Xu, J., Zhou, F., Ji, B. P., Pei, R. S., & Xu, N. (2008). The antibacterial mechanism of carvacrol and thymol against Escherichia coli. Letters in applied microbiology, 47(3), 174–179. https://doi.org/10.1111/j.1472-765X.2008.02407.x
- de Arriba, S. G., Naser, B., & Nolte, K. U. (2013). Risk assessment of free hydroquinone derived from Arctostaphylos Uva-ursi folium herbal preparations. International journal of toxicology, 32(6), 442–453. https://doi.org/10.1177/1091581813507721
- Daghaghzadeh, H., Memar, A., Mohamadi, Y., Rezakhani, N., Safazadeh, P., Aghaha, S., & Adibi, P. (2018). Therapeutic Effects of Low-dose Bismuth Subcitrate on Symptoms and Health-related Quality of Life in Adult Patients with Irritable Bowel Syndrome: A Clinical Trial. Journal of research in pharmacy practice, 7(1), 13–21. https://doi.org/10.4103/jrpp.JRPP_17_56
- Suarez, F. L., Furne, J. K., Springfield, J., & Levitt, M. D. (1998). Bismuth subsalicylate markedly decreases hydrogen sulfide release in the human colon. Gastroenterology, 114(5), 923–929. https://doi.org/10.1016/s0016-5085(98)70311-7
- Olson, K. R., Briggs, A., Devireddy, M., Iovino, N. A., Skora, N. C., Whelan, J., Villa, B. P., Yuan, X., Mannam, V., Howard, S., Gao, Y., Minnion, M., & Feelisch, M. (2020). Green tea polyphenolic antioxidants oxidize hydrogen sulfide to thiosulfate and polysulfides: A possible new mechanism underpinning their biological action. Redox biology, 37, 101731. https://doi.org/10.1016/j.redox.2020.101731
- Ben Lagha, A., Haas, B., & Grenier, D. (2017). Tea polyphenols inhibit the growth and virulence properties of Fusobacterium nucleatum. Scientific reports, 7, 44815. https://doi.org/10.1038/srep44815
- Reynolds, J. C., & Putnam, P. E. (1992). Prokinetic agents. Gastroenterology clinics of North America, 21(3), 567–596.
- Ploesser, J., Weinstock, L. B., & Thomas, E. (2010). Low dose naltrexone: side effects and efficacy in gastrointestinal disorders. International journal of pharmaceutical compounding, 14(2), 171–173.
- Mozaffari, S., Nikfar, S., & Abdollahi, M. (2013). Metabolic and toxicological considerations for the latest drugs used to treat irritable bowel syndrome. Expert opinion on drug metabolism & toxicology, 9(4), 403–421. https://doi.org/10.1517/17425255.2013.759558