Small intestinal overgrowth (SIBO) is a common gut health issue characterized by bacterial overgrowth in the small intestine. It is normally diagnosed through a breath test identifying hydrogen or methane produced by the overgrown bacteria. The problem is that this breath test is unable to detect a less talked about form of small intestinal overgrowth, hydrogen sulfide SIBO.
The good news is that working with a functional medicine practitioner, you can find out if your symptoms are due to hydrogen sulfide SIBO and if so, treat it naturally through a low-sulfate diet.
In this article, you will learn what SIBO and hydrogen SIBO are. You will learn how they are different, what are their symptoms, and how to diagnose them. I will explain why a low-sulfur diet is the best solution for hydrogen sulfide SIBO and how to follow a low-sulfur food plan.
You will also understand how working with a functional medicine doctor, like myself, can help you overcome hydrogen sulfide SIBO.
What Is SIBO
Small intestinal bacterial overgrowth (SIBO) is a gut health condition that affects the small intestine. It happens when certain bacteria, normally grown in other areas of your gut, start growing in your small intestine leading to overgrowth.
Symptoms of SIBO
If you have SIBO, there are a variety of symptoms you may experience. These SIBO symptoms may include:
- Stomach pain
- Feeling of fullness and quick satiety
- Weight loss
What Is Hydrogen Sulfide SIBO
If your doctor is suspecting SIBO after going through your symptoms, health history and performing a physical exam, she or he will use a breath test that can detect hydrogen and methane in your breath. Since excess bacteria in your small intestine can lead to the release of these gases, this certainly makes sense and helps to identify most forms of SIBO. However, it doesn’t take hydrogen sulfide SIBO into account.
Hydrogen sulfide is a third form of gas that is commonly present among patients with SIBO. The problem is that hydrogen sulfide cannot be measured with a SIBO breath test. Hydrogen sulfide is produced by a very specific type of bacteria that can overgrow in your small intestine.
The interesting thing about hydrogen sulfide is that in small amounts, it can be beneficial and anti-inflammatory. However, when it occurs in high amounts due to a bacteria overgrowth in your small intestine, it becomes very problematic. High amounts of it in your large intestine can also result in health problems. Therefore to handle this overgrowth and to resolve your symptoms, we have to bring the healthy balance back to your small intestine, your whole gut, and body.
Diagnosing Hydrogen Sulfide SIBO
Since SIBO breath tests are not looking for hydrogen sulfide, you may wonder how can you know if you have hydrogen sulfide SIBO. That’s a great question. Let’s see how functional medicine doctors, such as myself, can help to diagnose hydrogen sulfide SIBO.
As you’ve already learned, breath tests only look for hydrogen and methane, not hydrogen sulfide, and can only diagnose traditional SIBO, not hydrogen sulfide SIBO. One study has found that people with traditional SIBO also have a higher risk of hydrogen sulfide SIBO.
However, another study has found that people who test negative for the SIBO breath test have a higher likelihood of having hydrogen sulfide SIBO. This is why it is important that you are working with a doctor who is familiar with hydrogen sulfide SIBO and is willing to dig deep to find the root causes of your symptoms and gut health issues. Working with a functional medicine doctor, like myself, is a great option.
First, your doctor will go through your symptoms. Symptoms of hydrogen sulfide SIBO may be different than the symptoms of SIBO. Sulfur-like, rotten egg smelly gas or belching are generally a good indication that you are dealing with hydrogen sulfide SIBO. You may also be more likely to experience diarrhea and nausea. You may also have other symptoms as well, such as rashes and pain. Once your doctor understands your symptoms, they can run some more complex GI tests other than the breath test to look for bacteria overgrowth and other gut imbalances. Lastly, if going on a low-sulfur food plan helps to relieve your symptoms, it is a good indication that hydrogen sulfide SIBO was the culprit behind them.
Low-Sulfur Food Plan for Hydrogen Sulfide SIBO
Traditionally, people with SIBO are often recommended to follow the low-FODMAP diet.
However, research has found that low-FODMAP is actually not beneficial for hydrogen sulfide overproduction. If you have hydrogen sulfide SIBO, a low-sulfur diet is a much better idea.
When you eat sulfur-containing food, they go through a process to naturally occurring sulfate in your body. While in a small amount, sulfate is good for you, too much becomes a problem. If you are dealing with hydrogen sulfide SIBO, following a low sulfur food plan can help your body regain its balance and get rid of your symptoms.
What to Eat and What Not to Eat on a Low Sulfur Food Plan
Vegetables to avoid:
- Bok choy
- Brussels sprouts
- Daikon radish
- Collard greens
- Swiss chard
- Split peas
Fruits to avoid:
- Dried fruits
- Dried coconut
Dairy and dairy alternatives to avoid:
- Cow, sheep, and goat milk
- All cheese
- Cottage cheese
- Coconut milk from a carton
- Soy products
- Animal protein to avoid:
- Red meat
- Poultry white meat
Legumes to avoid:
- All legumes, including beans, lentils, bean sprouts, soy, etc.
Herbs to avoid:
Other things to avoid:
- Lemon and lime juice
- Frozen potatoes and french fries
- Wheat germ
Supplements to avoid:
- Bromelain and papain
- Milk thistle
- Dairy source acidophilus
- All squash
- Bell pepper
- Water chestnut
Fruits allowed (up to ½ cup a day):
- Bay leaves
Other foods allowed:
- Almond, rice, and hemp milk
- Nuts, including almonds, cashews, and macadamia
- Seeds, including pumpkin seeds, sesame seeds
- Gluten-free bread
- Beet, corn, or parsnip chips
- Basmati and jasmine vinegar
Hydrogen sulfide is the third most common gas in those with SIBO, yet, there is less research on it making diagnosis and treatment more difficult. If you have hydrogen sulfide SIBO, I recommend that you try a low-sulfur food plan, and notice a reduction in symptoms within a couple of weeks.
If you suspect that you have SIBO or hydrogen sulfide SIBO, I recommend that you contact a functional medicine doctor, like myself, for diagnosis and treatment. I can help you to address the underlying causes of your hydrogen sulfide and other types of SIBO, as well as other gut health issues using a system-oriented approach and engaging both patient and practitioner in a therapeutic partnership. As an experienced functional medicine doctor with integrated expertise of both Western medicine and traditional Eastern practice, I can assess all the factors, including diet, lifestyle, stress, toxicity, allergies, sleep habits, and medication, that may affect your gut health. Then I will prescribe a personalized and effective plan to improve your gut health condition, repair your body, and regain your health and well-being.
If you would like to get more information about hydrogen sulfide SIBO and gut health treatment or to schedule a functional medicine consultation, please call my office at 212-696-4325.
March 2021 Update:
There is currently an experimental test available to confirm the diagnosis of H2S SIBO. You can request this test HERE and bring the results to your functional medicine practitioner for proper interpretation and treatment.
Elena Klimenko, MD