A Guide to Treating Hydrogen Sulfide SIBO

What is Hydrogen Sulfide SIBO?

You may have heard more about “Hydrogen Sulfide” SIBO lately. For example, there’s a test available to detect this kind of SIBO.

But what is hydrogen sulfide SIBO? How do you know if you have it? And how should you treat it if you do?

Although there isn’t as much information or research about hydrogen sulfide SIBO as methane or hydrogen SIBO, more information is becoming available all the time. I’ve collected some useful information about hydrogen sulfide SIBO below, so read on for more!

The hydrogen sulfide molecule

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There are Three Kinds of SIBO: Hydrogen Sulfide, Hydrogen and Methane.

The bacteria found in our intestines produce three kinds of gases: Hydrogen Sulfide, Methane, and Hydrogen. Bacteria produce these gases by eating the food that we digest.

Different types of bacteria produce different gases. For example, the types of bacteria that produce methane are different types than the kinds that create hydrogen. Desulfovibrio, Bilophila wadsworthia, and Helicobacter are bacteria that are common culprits of hydrogen sulfide production.

So depending on the type of bacteria and the gas it gives off, SIBO can be categorized as “Methane SIBO,” “Hydrogen SIBO,” “Hydrogen Sulfide SIBO,” or some combination. For example, I had (and possibly still have) an overgrowth of methane and hydrogen producing bacteria.

So, if you have an overgrowth of bacteria that create hydrogen sulfide when they digest your food, you have hydrogen sulfide SIBO. You might have methane and/or hydrogen producing bacteria overgrowths as well.

What are the Symptoms of Hydrogen Sulfide SIBO?

Different symptoms are associated with each kind of SIBO. For example, hydrogen SIBO tends to cause diarrhea, while methane SIBO generally results in constipation.

An overgrowth of hydrogen sulfide producing bacteria appears to be strongly associated with diarrhea. But that’s not the only symptom associated with hydrogen sulfide.

Other hallmark symptoms of hydrogen sulfide SIBO are:

• Excessive gas that smells like rotten eggs or sulfur
• Diarrhea
• Excessive belching
• Reaction to foods high in sulfur
• Visceral hypersensitivity (abnormally high abdominal pain or discomfort)
• Bladder pain
• Rashes

What’s interesting is that your body actually needs hydrogen sulfide in very small amounts. At the proper level, hydrogen sulfide fights inflammation and provides other benefits. But when bacteria produce large amounts of the gas in the small intestine, it becomes problematic. That causes the unpleasant symptoms above.

Diagnosing Hydrogen Sulfide SIBO

Until recently, the lactulose breath test used to diagnose SIBO only measured hydrogen and methane. An overgrowth of hydrogen sulfide producing bacteria wouldn’t show up on the test. This prevented people with hydrogen sulfide SIBO from receiving a proper diagnosis and treatment.

In fact, sometimes a breath test of a patient with hydrogen sulfide SIBO won’t show any methane or hydrogen SIBO either. This is because hydrogen sulfide producing bacteria compete with methane producers to consume hydrogen gas. The hydrogen sulfide producers gobble up all the hydrogen gas, leaving the methane producers without enough hydrogen gas to eat. This ends up falsely making the test appear negative.

Thankfully, earlier this year researchers at Cedars Sinai created a breath test for diagnosing hydrogen sulfide SIBO. Although the test was supposed to be released this year (2019), it doesn’t appear to be available yet. Hopefully this test will raise awareness of hydrogen sulfide SIBO.

Bottom line: until the breath test becomes widely available, there isn’t a good way to get diagnosed. Your doctor will likely just have to rely on symptoms for a diagnosis.

Treating Hydrogen Sulfide SIBO

Treating hydrogen sulfide SIBO is trickier (and different) than treating hydrogen or methane SIBO.

To make it easier, I’ll break it up into different aspects of treatment: diet, antibiotics, and supplements.

Diet

First, what is the best diet for treating hydrogen sulfide?

According to SIBO naturopathic doctor Nirala Jacobi, the low FODMAP diet may not be the best diet for hydrogen sulfide. She claims that hydrogen sulfide producing bacteria thrive off high-fat diets, and when patients take supplements that encourage bile production. However, this is just her clinical experience and opinion. As far as I’m aware, there aren’t any studies confirming this.

Dr. Jacobi also recommends a low sulfur diet for hydrogen sulfide patients. You can find her handout on the low sulfur diet here. Generally, you’ll want to avoid or limit high-sulfur foods. Some examples of high sulfur foods include:

• eggs
• meat, particularly red meat
• beer
• red and white wine
• milk
• vegetables containing allium (i.e. onions, leeks, garlic, shallots)
• dairy, except butter
• fish
• cabbage
• broccoli
• kale
• almonds
• peanuts

You can find another list of foods high in sulfur here. Dr. Jacobi recommends trying a low sulfur diet for a week to see if it helps reduce symptoms.

Antibiotics

First, you’ll want to consult your doctor about any antibiotics you take for hydrogen sulfide SIBO.

Second, you’ll want to be well informed yourself so you can tell if your doctor is knowledgable about SIBO. If your doctor doesn’t seem to know what antibiotics are most useful for SIBO, or prescribes something you haven’t heard of, make sure to question your doctor about why he or she is choosing that treatment. Ask what evidence supports that drug being effective for SIBO. Don’t be afraid to take notes of what your doctor says and ask again about anything that doesn’t make sense. Remember, your doctor is a service that YOU are paying for!

Unfortunately because research about hydrogen sulfide is in its infancy, there isn’t much information about what antibiotics work best for this particular kind of SIBO. Generally, it appears that Rifaximin in combination with other antibiotics like Neomycin or Metronidazole might be the most effective at killing hydrogen sulfide producing bacteria.

Supplements

Several supplements might help treat, or at least control the symptoms of, hydrogen sulfide SIBO.

Green tea extract

Green tea has so many benefits…especially for controlling the symptoms of hydrogen sulfide SIBO! Taking a green tea extract removes around 30% of hydrogen sulfide gas. Unlike a lot of treatment recommendations for hydrogen sulfide, this one is backed by studies which show green tea extract reducing hydrogen sulfide.

It’s important to recognize though that green tea extract doesn’t appear do anything to treat or cure SIBO. It just helps control symptoms and make life more bearable, while you pursue other methods to treat the root cause of SIBO.

Taking green tea extract should reduce gassiness and the intestinal discomfort it causes. Because hydrogen sulfide SIBO so often produces excessive, smelly gas, this can be hugely helpful!

You can get green tea extract on Amazon. Keep in mind that most green tea extracts (like this one) contain naturally-occurring caffeine, which can irritate the digestive system. Therefore, you might want a decaffeinated green tea extract like this one.

Codonopsis Root (Dang Shen)

Codonopsis root is an herb, also called “Dang Shen,” traditionally used in Chinese herbal medicine. This herb can reduce some of the hydrogen sulfide producing bacteria (such as can desulfovibrio and alistipes). Supposedly it also can help increase beneficial bacteria such as Bifidobacterium, Akkermansia, and Lactobacillus.

You can purchase Codonopsis root on Amazon, either as a pill or an alcohol-free liquid.

Dang Shen roots look like this: 

Bismuth Subsalicylate

Bismuth subsalicylate is something you’ve probably heard of – it usually goes by the name Pepto-Bismol! It’s usually used as an antacid medication. 

But, Bismuth subsalicylate has also been shown to substantially reduce gas in the intestine caused by hydrogen sulfide. Bismuth subsalicylate binds to hydrogen sulfide in the colon, which reduces the hydrogen sulfide gas. In this study, doses of bismuth subsalicylate reduced hydrogen sulfide gas by 95%! That is impressive. In this study, the patients took 524 mg four times a day for 3-7 days.

If you’ve ever taken the liquid Pepto-Bismol you’ll probably feel, like I do, that drinking it is gross. Do yourself a favor if you go this route and just get the tablets. They are way easier to take. 

Please note that it isn’t safe to take Pepto-Bismol long term! Chronic use can cause Salicylism. Salicylism is toxicity caused by excessive intake of salicylic acid or salicylates. Symptoms include tinnitus (ringing ears), nausea, vertigo, and vomiting.

Molybdenum

Molybdenum is an essential trace mineral, which is a fancy way of saying it’s something we need small amounts of to survive. What does it have to do with hydrogen sulfide SIBO though? 

Molybdenum helps the body produce sulfate. If you don’t have enough Molybdenum, then your body won’t be able to produce enough sulfate. Hydrogen sulfide is a source of sulfate for the body, so if you aren’t getting enough sulfate from your diet, the body might encourage hydrogen sulfide producing  bacteria instead. Of course, over-producing hydrogen sulfide bacteria is hydrogen sulfide SIBO! 

Some practitioners recommend making sure your body is getting enough dietary sulfate by supplementing with Molybdenum. Some sources say no more than 150mcg twice per day. 

The brand I’ve seen most recommended is Biotics Research Mo-Zyme Forte, available online. 

Hydrogen Sulfide SIBO is tricky, but we now know more than ever before. 

Hydrogen sulfide SIBO might be the trickiest type of SIBO to deal with. 

The only good part is that we are rapidly learning more about it. One good resource I’d recommend is this video of an interview with Dr. Nigh about Hydrogen sulfide SIBO.

Have you found anything that helps your hydrogen sulfide SIBO? Please let us know what’s working, or not working, in the comments!

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