Hydrogen Sulfide SIBO: Symptoms, Diagnosis, and Treatment

What is Hydrogen Sulfide SIBO?

Hydrogen Sulfide Small Intestinal Bacterial Overgrowth (SIBO) is a digestive disorder characterized by an overgrowth of bacteria in the small intestine, resulting in the production of hydrogen sulfide gas. Unlike traditional SIBO and IMO, which are commonly detected through breath tests measuring both hydrogen and methane gases, hydrogen sulfide (H2S) SIBO presents unique challenges due to the inability of standard testing to identify this specific gas in most countries. More on the trio-smart test below.

Who is at Risk for Hydrogen Sulfide SIBO?

While SIBO can affect anyone, certain groups may be more predisposed. Individuals diagnosed with Irritable Bowel Syndrome (IBS) or Ulcerative Colitis are at higher risk for developing SIBO, including the Hydrogen Sulfide variant. Notably, less than 5% of all SIBO cases are attributed to hydrogen sulfide overgrowth, making it relatively rare.

Symptoms of Hydrogen Sulfide SIBO

Typical symptoms of Hydrogen Sulfide SIBO are the same as the other types of SIBO and include diarrhea, constipation, abdominal pain, bloating, and flatulence. Additionally, some patients may experience sulfur-like, rotten egg smell in their gas, along with other symptoms such as nausea, rashes, and pain. The smell is often a tell-tale sign that hydrogen sulfide producing bacteria could be at play.

Diagnosing Hydrogen Sulfide SIBO

Diagnosing hydrogen sulfide SIBO can be challenging due to the limitations of standard breath tests, which primarily detect hydrogen and methane gases. The Trio-Smart test is currently the only test that measures Hydrogen Sulfide (H2S) gas, and it is only available in the United States, or in Canada if you have a doctor’s referral. However, even if you can’t access this test, we can still do some detective work to assess if you could have this type of SIBO. For instance, a “flat line” on a standard SIBO Breath Test, meaning all gases are at 0, can indicate Hydrogen Sulfide production.

Functional health practitioners can employ a comprehensive approach, considering symptoms, medical history, and specialized gastrointestinal tests like the GI-MAP to identify bacterial overgrowth, including hydrogen sulfide-producing bacteria.

It is estimated that H2S SIBO accounts for approximately 1-5% of SIBO/IMO cases. However, if a breath test yields negative results, it's crucial to explore other potential medical conditions. These include inflammatory bowel disease (ulcerative colitis or Crohn’s disease), collagen-based disorders like Ehlers Danlos Syndrome, Celiac disease, parasitic infections, Small Intestinal Fungal Overgrowth (SIFO), post-infectious IBS, Helicobacter pylori infection, and more. These conditions should ideally be ruled out before diagnosing IBS.

Bacteria Strains and Hydrogen Sulfide Production

The bacteria Klebsiella, Citrobacter, E. coli, Proteus, Desulfovibrio piger, Fusobacterium varium and Pseudomonas aeruginosa are amongst those commonly associated with digestive issues and hydrogen sulfide production.

To thoroughly assess their presence and potential impact on your digestive health, I suggest doing a GI-MAP test or any other type of Complete Microbiome Mapping. These tests provide comprehensive insights into the composition of your gut microbiome, aiding in the identification of specific bacteria and their potential implications for your digestive function.

Treatment Options for Hydrogen Sulfide SIBO

Allopathic treatment for SIBO typically involves antibiotic therapy to eradicate the overgrowth of bacteria in the small intestine. Natural approaches also exist; with a focus on a holistic treatment plan, incorporating higher-dose herbal supplements, biofilm disruptors, and dietary modifications tailored to each patient's health history and laboratory results.

In my practice I exclusively work with herbals but can work in tandem with your doctor if you prefer to use antibiotics. The most common substances used are Bismuth, Uva Ursi and the antibiotic Rifaximin.

There is also clinical evidence for the use of High-dose MSM, which I wrote an article about.

Dietary Considerations

A low-sulfur food plan is often recommended for individuals with hydrogen sulfide SIBO, as traditional diets like low-FODMAP may not effectively address sulfur overproduction. By reducing sulfur-containing foods, patients can often temporarily alleviate symptoms associated with hydrogen sulfide SIBO. This won’t address the overgrowth, however. Note that these types of diet are meant for short-term use only. I do not recommend going longer than 2 weeks on a low-sulphur diet. If you need more information on this, you can reach out to me.

Potential Complications and Prevention

Complications associated with testing and treatment for hydrogen sulfide SIBO include die-off reactions, digestive symptoms exacerbation, and the need for multiple treatment adjustments. However, proactive management strategies, such as regular follow-up evaluations and personalized dietary plans, can mitigate these risks and optimize long-term outcomes.

Hydrogen sulfide SIBO presents unique challenges in diagnosis and management, requiring a comprehensive approach that addresses individual patient needs and underlying factors contributing to bacterial overgrowth. By working closely with a knowledgeable health practitioner, patients can achieve symptom relief, restore gut health, and improve overall wellbeing.

Schedule a consultation today to get help in resolving your SIBO.