The key to successfully treat hydrogen sulfide SIBO is to first understand the underlying mechanisms causing an increase in hydrogen sulphide production in the first place. Considerations include slow motility, a sulphur deficiency, an unhealthy diet, and also fast motility in the large intestine.
You may also like to read:
- Hydrogen Sulfide: The good, the bad and the misunderstood
- What Causes Hydrogen Sulfide SIBO?
- The Ultimate Guide To IBS
- SIBO: What Causes It
What Is Hydrogen Sulfide SIBO?
Hydrogen Sulfide SIBO is the term used when someones SIBO breath test results come back with extremely low levels of both hydrogen and methane gas, throughout the three hours of the test.
How Do You Test For Hydrogen Sulfide SIBO?
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There are two options to consider when seeking to understand the cause of symptoms associated with IBS and poor gut health:
- A SIBO Breath Test
- A comprehensive stool test
There are times when additional testing is essential.
One of the most important things to understand about gut health is that there are times when your gut symptoms (bloating, diarrhoea etc) aren’t caused by issues in the gut. This is where other tests can be helpful and this could range from something as ‘basic’ as a thyroid test (poor thyroid function can cause constipation) to a mycotoxin test (various mycotoxins are known to cause gastrointestinal issues).
There is a breath test, only available in the U.S, that looks at methane, hydrogen and hydrogen sulfide. Unfortunately it is not available in the UK. Healthpath have tried to bring it to the UK without success.
A sample of a SIBO breath test is shown above. In stool testing, we can assess the levels of sulphate-reducing bacteria and thus understand whether hydrogen sulfide, via this mechanism, might be contributing to symptoms. An example is shown below from Healthpath’s ‘Advanced Gut Health Test‘:
You can see in the middle of this page of the report the sulphate reducing bacteria (categorised under ‘H2S production’). However there are many other bacteria that have been discussed in the research to contribute to hydrogen sulfide levels. Read my blog Hydrogen Sulfide: The good, the bad and the misunderstood to learn more.
How Do I Treat Hydrogen Sulfide SIBO?
The key to successfully treat hydrogen sulfide SIBO is to first understand the underlying mechanisms causing an increase in hydrogen sulphide production in the first place. Considerations include suboptimal digestion of proteins (due to low stomach acid or issues in the small intestine), a sulphur deficiency, an unhealthy diet, and also fast motility in the large intestine.
So, I apologise guys. I have no fancy perfect answer for you. I am not going to tell you that I have an exact answer and if you follow this process in this order you will be fine. It just doesn’t work like that.
Firstly then, the key is to try and understand the mechanism that caused the imbalance in the first place.
We need to take a personalised approach, alongside considering some of the more general interventions that can be considered.
Sometimes hydrogen sulfide issues can be caused by something as simple as someone whose been on a high protein low fibre diet for too long. Other times, based on Dr. Greg Nigh’s theory, it can be related to glyphosphate toxicity, there really is no one cause for this specific imbalance in the microbiome.
What Diet Is Best To Treat Hydrogen Sulfide SIBO?
I honestly don’t think there is one diet that will successful treat hydrogen sulfide SIBO scenarios in all cases (no matter what you might read!). Options you will find discussed include:
- A low sulfur diet.
- A low FODMAP diet.
Both diets can help in certain circumstances, but it’s important to appreciate that they are both symptom management techniques rather than actual treatment strategies. This doesn’t mean they aren’t important, but it is important to understand much more than the diet is needed to restore a healthy gut.
One study showed that increased consumption of Brassica vegetables was linked to a reduced relative abundance of sulphate reducing bacteria, and therefore may be potentially beneficial to gastrointestinal health. Sulphate reducing bacteria are the bacteria which product hydrogen sulfide. The high-Brassica diet consisted of six 84 g portions of broccoli, six 84 g portions of cauliflower and six 300 g portions of a broccoli and sweet potato soup. This is an interesting study as many will talk about brassica vegetables being a significant source of inorganic sulphate in the diet, and thus it conceivable that diets rich in these vegetables may encourage the growth of sulphate reducing bacteria. This doesn’t seem to be the case.
A low protein diet, or certainly if you’re going to consume a moderate-high protein diet a high intake of fibre is also needed to offset it. In both human and animal studies, a high protein diet results in fecal microbiota changes that increase H2S production and decrease SCFA production.
High carbohydrate availability in the colon, as noted above, promotes microbial groups able to utilise carbohydrate substrates, but also affects other aspects of microbial metabolism and especially impacts protein degradation. The addition of fermentable fiber to healthy human faeces in an in vitro setting drastically reduces H2S production from any source (e.g., cysteine, sulfate).
Lower pH associated with microbial carbohydrate fermentation also leads to inhibition of dissimilatory aromatic amino acid metabolism. Interestingly, stool pH is lower in vegan and vegetarian individuals relative to omnivores, consistent with greater abundance of carbohydrates in the proximal colon, faster colon transit, and higher delivery of SCFA to the distal colon. This finding underscores the importance of overall diet composition when considering the relative proportions of different end-products of microbial metabolism.
Consumption of processed foods expose individuals to additives such as phosphates, nitrates, and emulsifiers, which have been shown to influence the composition of microbiota, mucin layer thickness, and intestinal inflammation.
And in fact another paper (15) concluded that:
These results suggest that the use of dietary interventions alone may be insufficient for rapid therapeutic targeting of SRB
Which may lead us in to the next question arounds supplements to treat hydrogen sulfide SIBO.
Supplements To Treat Hydrogen Sulfie SIBO:
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Molybdenum
Some people do genuinely see significant improvement in their symptoms (particularly diarrhoea) within 24-48 hours of supplementing molybdenum. Molybdenum supports the metabolism of sulfur via the transulfuration pathway.
- Recommended Product (U.K): Molybdenum
- Recommended Product (U.S.A): Molybdenum
Vitamin B6
Along with molybdenum vitamin B6 is a key nutrient required for healthy transsulfuration.
- Recommended Product (U.K): Vitamin B6
- Recommended Product (U.S.A): Vitamin B6
Probiotics
There is no specific probiotic that can be recommended here, but for those that may have slow motility through the large intestine causing their hydrogen sulfide symptoms then this product contains a very well researched strain of bifidobacteria that supports colonic transit time.
- Recommended Product (U.K): Probiotics
- Recommended Product (U.S.A): Probiotic-10
Antimicrobials
- Recommended Product (U.K): oregano oil
- Recommended Product (U.S.A): Oregano oil
Korean Ginseng
Dr. Greg Nigh recommend this as part of his protocols.
- Recommended Product (U.K): Korean ginseng
- Recommended Product (U.S.A): Korean Ginseng
Epsom Salt Baths
The idea here is that you can absorb the sulfur in the bath salts through your skin, bypassing the gut and gut microbiome. Epsom salt baths are something many of us can benefit from a simple strategy to support relaxation, as well as magnesium and sulphur status.
- Recommended Product (U.K): Epsom salts
- Recommended Product (U.S.A): Epsom salts
Prebiotics
Anecdotally I have found prebiotics to be very helpful to treat hydrogen sulfide SIBO. PHGG and GOS are the ones I recommend most frequently as they are generally better tolerated that prebiotics like FOS and inulin.
- Recommended Product (U.K): PHGG or GOS
- Recommended Product (U.S.A): PHGG or GOS (and XOS)
It is important to highlight the most important part of treatment is understanding the root cause – this could be related to a wide variety of factors from poor dietary choices over an extended period of time through to exposure to environmental toxins such as glyphosate. Working with an experienced practitioner to establish this is the only way to return to optimal health.
References For How Do You Treat Hydrogen Sulfide SIBO
- Jennifer Pichette and Jeffrey Gagnon (2016) Implications of Hydrogen Sulfide in Glucose Regulation: How H2S Can Alter Glucose Homeostasis through Metabolic Hormones
- Tomasova et al., (2016) Gut Bacteria and Hydrogen Sulfide: The New Old Players in Circulatory System Homeostasis
- Teigan et al., (2019) Dietary Factors in Sulfur Metabolism and Pathogenesis of Ulcerative Colitis
- Carbinero et al., (2012) Microbial pathways in colonic sulfur metabolism and links with health and disease
- Wallace et al., (2018) Hydrogen sulfide: an agent of stability at the microbiome-mucosa interface
- Wang R. Physiological implications of H2S: a whiff exploration that blossomed
- Fu M, Zhang W, Wu L, et al. Hydrogen sulfide (H2S) metabolism in mitochondria and its regulatory role in energy production
- Yao et al., (2018) Modulation of colonic hydrogen sulfide production by diet and mesalazine utilizing a novel gas-profiling technology
- Suarez et al., (1998) Bismuth subsalicylate markedly decreases hydrogen sulfide release in the human colon
- Webster et al., (2019) Influence of short-term changes in dietary sulfur on the relative abundances of intestinal sulfate-reducing bacteria
- Sing & Lin, (2015) Hs2 in Physiology and Diseases of the Digestive Tract.
- Linden, (2014) Hydrogen Sulfide Signaling in the Gastrointestinal Tract
- Huang et al., (2015) A cardioprotective insight of the cystathionine γ-lyase/hydrogen sulfide pathway
- Consumption of a diet rich in Brassica vegetables is associated with a reduced abundance of sulphate-reducing bacteria: A randomised crossover study (click here)
- Influence of short-term changes in dietary sulfur on the relative abundances of intestinal sulfate-reducing bacteria: click here
Alex is a certified Functional Medicine Practitioner (IFMCP) and has a MSc in Personalised Nutrition. He is also a breathwork facilitator with a background in personal training and massage therapy. He also runs The Resiliency Program - a 24 week program aimed at building physical, mental, emotional, and spiritual resilience.
