Over the past couple years, I have received increasing inquiries about Hydrogen Sulfide (H2S) Small Intestine Bacterial Overgrowth (SIBO). This interest comes from patients who have struggled with recurrent SIBO and are actively seeking new information. They’ve discovered that H2S is an emerging indicator of bacterial overgrowth, adding a new dimension to SIBO diagnosis and treatment.
What is H2S SIBO
Let’s delve into what we know about H2S SIBO, its symptoms, and the available treatment options.
Traditionally, SIBO has been diagnosed using a lactulose breath test that measures the production of Hydrogen (H2) and Methane (CH4). Recently, attention has shifted to H2S, a gas that was not available for commercial testing until five years ago.
Gas is a byproduct of metabolism, created by all living creatures.
Plants release O2, while animals emit CO2. H2S is a gas produced by humans, bacteria, and yeasts. A moderate level of H2S is beneficial, possessing anti-inflammatory properties that aid in safeguarding and mending the gastrointestinal tract lining. While H2S plays a beneficial role in the body by being anti-inflammatory and aiding in GI tract repair, excessive levels are toxic, particularly to the nervous system and mitochondria.
The challenge lies in determining how much H2S is too much and how to measure it accurately.
Currently, the only test that measures H2, CH4, and H2S is TrioSmart by Gemelii Biotech. Patients perform a two-hour breath test at home by drinking lactulose, which the body doesn’t digest well, leaving it to bacteria and yeasts to ferment.
If the H2S level exceeds 6, the test is considered positive, indicating a likely bacterial or yeast overgrowth. Levels below 2 suggest a low likelihood.
Common symptoms of H2S SIBO include:
- Diarrhea
- Bowel urgency
- Abdominal pain
- Heartburn
- And visceral hypersensitivity.
Potential symptoms can also include:
- Constipation
- Bladder irritation
- Body pain
- Numbness
- Tingling in extremities
- And histamine intolerance
These symptoms may worsen with sulfur-rich foods like wine, dried fruits, meats, eggs, dairy, cruciferous vegetables, onions, and garlic.
Treating H2S SIBO
Treating H2S SIBO involves three main options: an elemental diet, antibiotics, and herbal antibiotics.
The elemental diet involves a nutrient formula that is quickly absorbed in the upper small intestine, starving bacteria in the lower sections. Antibiotics like Rifaximin, Neomycin, and Amoxicillin-clavulanic are used, along with herbal options such as bismuth compounds, oregano, uva ursi, pomegranate, silver, prebiotics, probiotics, molybdenum, and butyrate. An anti-biofilm protocol may also be necessary for effective treatment.
If you suspect you have H2S SIBO, it’s crucial to seek professional guidance rather than self-treat. Many health conditions mimic SIBO, and interpreting breath test results can be complex. Proper diagnosis and treatment are essential for effective and efficient recovery.
Ready to learn more? Feel free to schedule a consultation with the providers at Naturopathic Family Health if you have any questions.
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Dr. Sherry Su, ND, FABNG
Naturopathic Doctor San Jose
408-356-1364
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