Hydrogen Sulfide SIBO – When SIBO Tests Are Negative but You Have IBS Symptoms

SIBO (small intestinal bacterial overgrowth) often causes the symptoms of IBS: gas, bloating, abdominal pain, constipation, and/or diarrhea. But what do you do if you have IBS-like symptoms but your SIBO test is negative? You may actually have hydrogen sulfide SIBO, which does not show up on standard SIBO breath tests. Let’s discuss exciting news about diagnosing this condition.

If you need help with IBS symptoms, click here.

Hydrogen Sulfide SIBO – When SIBO Tests Are Negative but You Have IBS Symptoms

Dr. Michael Ruscio: Hydrogen sulfide: an overlooked cause of IBS and of SIBO.

Hi, this is Dr. Ruscio, and let’s talk about a very interesting and very impactful study that relates to IBS and SIBO. So what is IBS? And what is SIBO, in case you haven’t heard of either one of these?

IBS is irritable bowel syndrome which includes a constellation of symptoms that typically includes gas, bloating, abdominal pain, and altered bowel function—that may be constipation, it might be diarrhea or loose stools.

And much of IBS, depending on who and what you read, may be caused by underlying SIBO (S-I-B-O), which stands for small intestinal bacterial overgrowth.

And as more people are becoming aware of SIBO and testing for SIBO, there’s a little bit of a quagmire that has formed. Now, SIBO is tested by a breath test. And this breath test typically assesses levels of gas in the breath of hydrogen and of methane.

However, sometimes people will have all of the symptoms of SIBO or IBS, but their breath test is negative. And so it leaves the clinician or the patient scratching their head.

We’ve known about another type of gas called hydrogen sulfide, and this is not able to be tested according to standard SIBO tests. However, a research group just recently developed a breath test for hydrogen sulfide.

And that’s the topic of this study—and I’ll put it up here on the screen—entitled “Hydrogen Sulfide in Exhaled Breath: A Potential Biomarker for Small Intestinal Bacterial Overgrowth.”

So hydrogen sulfide is a different type of gas that can be released by SIBO, or small intestinal bacterial overgrowth, meaning there’s an excess of bacteria in the small intestine.

And here is what the researchers found. Amongst many things, here is what I think is the takeaway, and I’ll quote here: “We found a missing link between breath hydrogen sulfide and SIBO when hydrogen breath tests often fail to diagnose SIBO.”

So essentially what they’re showing is exactly what I said a moment ago. Someone has the symptoms of SIBO or IBS, the typical breath test is negative, and they then found that it was actually hydrogen sulfide that was positive.

So it’s pretty important for those who have either IBS or SIBO and are looking into if they have a bacterial overgrowth as a contributing factor and the standard SIBO breath test has been negative.

Now, what does this mean? Well, what it means is it may still make sense to treat for SIBO if you have IBS symptoms and your SIBO breath test is negative because what you may have is underlying hydrogen sulfide SIBO.

Now, what about doing the hydrogen sulfide test? I don’t believe this test is readily available. We’re currently looking into it. This research group is located in India. I am not sure if their test is something that’s going to be made commercially available or is only locally available or only available for their research purposes at this time.

I’m sure eventually it will be more broadly available, but for right now, it might not be a fruitful endeavor to try to do a hydrogen sulfide test.

There is a hydrogen sulfide test via urine. But its correlation to SIBO and IBS has not been validated, whereas this test has, according to this study, been validated. But accessing this test might be a challenge.

So what you can do or what you can consider, speak with your healthcare provider about, is if you have the symptoms of IBS—gas, bloating, abdominal pain, altered bowel function, loose stools, diarrhea, constipation—and you’ve tested for SIBO and SIBO is negative, you may want to consider a course of treatment for SIBO anyway in case there is actually the hydrogen sulfide SIBO contributing to that.

Now, in terms of treatment options, you may want to start with some of the less invasive treatment options for SIBO, like a low FODMAP diet, which can be helpful, or certain probiotics or herbal anti-microbials that can kill SIBO, or even a liquid elemental diet.

And leave antibiotics as a last resort because we want to try to mitigate any harm if we don’t have a lab test that tells us you definitely need this treatment.

So what I’m suggesting is you treat based upon symptoms. But you have to be a little more careful, a little more conservative with utilization, in my opinion anyway, of antibiotics unless you have laboratory evidence to support the use of antibiotics.

So we can use some of the great tools that we have in natural medicine like low FODMAP, certain probiotics, liquid elemental diets, or herbal anti-microbials.

So if you’re suffering with SIBO or trying to obtain a SIBO diagnosis because you have the symptoms of IBS, hydrogen sulfide might be a key player in that. If you’re working with a good clinician who’s open minded and also willing to go beyond just what lab tests say, you’ll probably be okay. And you’ll probably have this all sorted out.

But in case you’re a little confused and trying to sort out why your lab test and your symptoms don’t match, hydrogen sulfide might be a major contributing factor to that. And that can lead you to, of course, a treatment that you can track to see if it helps you improve your IBS symptoms.

So this is Dr. Ruscio, and I hope this helps you get healthy and get back to your life. Thanks!


If you need help with IBS symptoms, click here.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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162 thoughts on “Hydrogen Sulfide SIBO – When SIBO Tests Are Negative but You Have IBS Symptoms

  1. Thanks! Great info. I’m pretty sure that this is what’s going on for me – I can’t seem to kick this bacterial overgrowth. My last breath test showed a complete flat line for both methane and hydrogen. My doctor wanted to start me on another round of rifaximin and neomycin, but I read that bismuth is helpful for treating this type of sibo along with herbs or antibiotics. Any thoughts on that?

  2. Thanks! Great info. I’m pretty sure that this is what’s going on for me – I can’t seem to kick this bacterial overgrowth. My last breath test showed a complete flat line for both methane and hydrogen. My doctor wanted to start me on another round of rifaximin and neomycin, but I read that bismuth is helpful for treating this type of sibo along with herbs or antibiotics. Any thoughts on that?

  3. Wouldnt H2S SIBO produce really foul smelling gas? my methane and H2 tests were negative but i have SIBO like symptoms and no smelly flatulence

      1. Perhaps I missed it but what is the protocol for H2S Sibo?

        Dr. Ruscio,

        Does neomycin or metronidazole help? I finally have my gut bacteria out of the dysbiosis imbalance. and hate to disrupt with antibiotics but I want to get rid of my gas. The only symptom I have is large amounts of rectal gas, mildly odiferous but not really rotten egg like.

        I have treated with Rifaximin and Atrantil and much better with my last breath test showing no hydrogen with Methane comparably low at 11.

        Any suggestions?

  4. Wouldnt H2S SIBO produce really foul smelling gas? my methane and H2 tests were negative but i have SIBO like symptoms and no smelly flatulence

      1. Perhaps I missed it but what is the protocol for H2S Sibo?

        Dr. Ruscio,

        Does neomycin or metronidazole help? I finally have my gut bacteria out of the dysbiosis imbalance. and hate to disrupt with antibiotics but I want to get rid of my gas. The only symptom I have is large amounts of rectal gas, mildly odiferous but not really rotten egg like.

        I have treated with Rifaximin and Atrantil and much better with my last breath test showing no hydrogen with Methane comparably low at 11.

        Any suggestions?

  5. I have Sibo for years and have been on many rounds of antibiotic. My last dose of meds didn’t even work. I have foul smelling gas. I need to get my like back. What can I do. ? It gets me very depressed

  6. I have Sibo for years and have been on many rounds of antibiotic. My last dose of meds didn’t even work. I have foul smelling gas. I need to get my like back. What can I do. ? It gets me very depressed

  7. Thank you for this awareness. Like the other responders here, my lactulose breath test results were ‘flat lining ‘ leaving me puzzled when I still have SIBO symptoms. I agree that until a reliable diagnostic test is available, it is wise to go low FODMAP if this has proven to work for your unique circumstances and maybe try antimicrobials to treat. With respect to my naturopath, are there any resources that she could access to find and recommend the most appropriate and successful antimicrobials and probiotics for H2S type SIBO? Dr Nirala Jacobi mentioned in her podcast that Quintron are working on a test for this type of SIBO.
    Best wishes,
    Andrew Fisher

  8. Thank you for this awareness. Like the other responders here, my lactulose breath test results were ‘flat lining ‘ leaving me puzzled when I still have SIBO symptoms. I agree that until a reliable diagnostic test is available, it is wise to go low FODMAP if this has proven to work for your unique circumstances and maybe try antimicrobials to treat. With respect to my naturopath, are there any resources that she could access to find and recommend the most appropriate and successful antimicrobials and probiotics for H2S type SIBO? Dr Nirala Jacobi mentioned in her podcast that Quintron are working on a test for this type of SIBO.
    Best wishes,
    Andrew Fisher

  9. Great post. Seems like Hydrogen Sulfide SIBO is one of the trickiest cases to treat. I have struggled with h2s SIBO and experience fowl smelling gas, bloating, and constipation like symptoms when it gets the worst. It also seems that most hydrogen sulfide producers have a flat line breath test. Do you know if there has been any new information lately on h2s sibo or what the best methods for treating these patients is?

    Thanks,
    Josh

    1. Hi Josh,
      There might be a H2S breath test soon, I am trying to facilitate this proximaly, and hear Dr. Pimentel might be working on a test. Bismuth may aid in H2S SIBO and I just started experimenting with that. More to follow maybe in a few months when I have something to report back.

  10. Great post. Seems like Hydrogen Sulfide SIBO is one of the trickiest cases to treat. I have struggled with h2s SIBO and experience fowl smelling gas, bloating, and constipation like symptoms when it gets the worst. It also seems that most hydrogen sulfide producers have a flat line breath test. Do you know if there has been any new information lately on h2s sibo or what the best methods for treating these patients is?

    Thanks,
    Josh

    1. Hi Josh,
      There might be a H2S breath test soon, I am trying to facilitate this proximaly, and hear Dr. Pimentel might be working on a test. Bismuth may aid in H2S SIBO and I just started experimenting with that. More to follow maybe in a few months when I have something to report back.

  11. I just tested positive for hydrogen with the breath test but methane was negative. However, I know that hydrogen has no smell and thiol type foods cause bad smelly gas. If I treat the hydrogen with my doc, does that also treat hydrogen sulfide?

  12. I just tested positive for hydrogen with the breath test but methane was negative. However, I know that hydrogen has no smell and thiol type foods cause bad smelly gas. If I treat the hydrogen with my doc, does that also treat hydrogen sulfide?

  13. My SIBO test came back negative according to my doctor. Methane went form 40ppm to 31ppm. Hydrogen stayed at 6ppm. I have a lot of SIBO symptoms (big bloated belly, constipation, leaky gut), along with the HORRIBLE rotten egg gas. I am going to try herbal antibiotics soon. What brand of bismuth would you recommend? Or will the herbal antibiotics alone be enough? Thanks so much!

    1. I’ve also read that hydrogen sulfide feeds on allicin, so you shouldn’t take Allimed as a herbal antibiotic if you have hydrogen sulfide SIBO. Is that true?

      1. Hi Natalie,
        I’m not sure if the brand of Bismuth matters. You are still positive for methane if your at 31ppm. Bismuth may enhance the effect of herbal antimicrobials. I am not sure on the allicin peice, but it makes sense theoretically. Hope this helps.

  14. My SIBO test came back negative according to my doctor. Methane went form 40ppm to 31ppm. Hydrogen stayed at 6ppm. I have a lot of SIBO symptoms (big bloated belly, constipation, leaky gut), along with the HORRIBLE rotten egg gas. I am going to try herbal antibiotics soon. What brand of bismuth would you recommend? Or will the herbal antibiotics alone be enough? Thanks so much!

    1. I’ve also read that hydrogen sulfide feeds on allicin, so you shouldn’t take Allimed as a herbal antibiotic if you have hydrogen sulfide SIBO. Is that true?

      1. Hi Natalie,
        I’m not sure if the brand of Bismuth matters. You are still positive for methane if your at 31ppm. Bismuth may enhance the effect of herbal antimicrobials. I am not sure on the allicin peice, but it makes sense theoretically. Hope this helps.

  15. I too came back negative for both gases in 2 separate tests. But my SIBO symptoms are extreme and getting progressively worse. I did herbals for a year along with low FODMAP /low carb. Recently, I finally tried rifaxamin and vancomycin – but only the vanco made a difference, but SIBO sx returned immediately after stopping. Also, since taking the vancomycin, I have total insomnia and feel like I’m losing my mind. I have constant pain in SI, GERD and have become terribly depressed and hopeless. One possible silver lining is I am scheduled for an FMT at Taymount in a month and I hope and pray that it helps. If anyone has any thoughts about what might be going on for me, please share them with me,. And doc Ruscio, what are your thoughts on FMT helping SIBO?

    1. Hi Jennifer,
      Sorry to hear of your troubles but happy that you are taking action and pursuing the FMT as an another option. The research performed thus far shows promise for IBS so I am hopeful for you. Please share your experience after you have had it. Good luck!

    2. Hi Jennifer,
      Hope you feel better meanwhile!
      Would you mind sharing your experience with FMT at Taymount? I am getting very depressed and hopeless myself, so I keep thinking about it as a possible option…

  16. I too came back negative for both gases in 2 separate tests. But my SIBO symptoms are extreme and getting progressively worse. I did herbals for a year along with low FODMAP /low carb. Recently, I finally tried rifaxamin and vancomycin – but only the vanco made a difference, but SIBO sx returned immediately after stopping. Also, since taking the vancomycin, I have total insomnia and feel like I’m losing my mind. I have constant pain in SI, GERD and have become terribly depressed and hopeless. One possible silver lining is I am scheduled for an FMT at Taymount in a month and I hope and pray that it helps. If anyone has any thoughts about what might be going on for me, please share them with me,. And doc Ruscio, what are your thoughts on FMT helping SIBO?

    1. Hi Jennifer,
      Sorry to hear of your troubles but happy that you are taking action and pursuing the FMT as an another option. The research performed thus far shows promise for IBS so I am hopeful for you. Please share your experience after you have had it. Good luck!

    2. Hi Jennifer,
      Hope you feel better meanwhile!
      Would you mind sharing your experience with FMT at Taymount? I am getting very depressed and hopeless myself, so I keep thinking about it as a possible option…

  17. Dear Dr. Ruscio,

    I was diagnosed with hydrogen-dominant SIBO back in March, even though I was experiencing constipation along with bloating and gas. After 2 courses of antibiotics (Metronidazole + Levofloxacin, followed by Rifaxamin), a 2nd Lactulose breath test showed that SIBO was gone. However, I was still suffering from the same symptoms. A GI MAP stool analysis showed dysbiosis in the colon, which were Proteus spp. and Morganella spp. After being on herbal antimicrobials for 2 months (Oil of oregano, Berberine, Garlic Plus), I suddenly started to suffer from cramping, diarrhea, and foul gas. I was told that a Urine Th1/Th2 Balance Test Kit (UBT) from PROTEA Biopharma could diagnose the presence of H2S-producing bacteria. I did the test, and it was positive. Do you think that I have H2S SIBO, or that the H2S-producing bacteria is localized more in the colon?

    Regards,
    Alex

    1. Hi Alex,
      Its possible but H2S responds to Abx (according to the one study performed that tested H2S) and I would expect responds to Habx also. So, you might be barking up the wrong tree with antimicrobial treatment and need to consider a different treatment method. See here for options if you need help, http://www.DrRuscio.com/resources

      1. I am sorry, but what is the difference between herbal antibiotics and antimicrobials? I have actually already had 2 courses of antibiotics earlier this year for hydrogen SIBO.

        Thanks,
        Alex

  18. Dear Dr. Ruscio,

    I was diagnosed with hydrogen-dominant SIBO back in March, even though I was experiencing constipation along with bloating and gas. After 2 courses of antibiotics (Metronidazole + Levofloxacin, followed by Rifaxamin), a 2nd Lactulose breath test showed that SIBO was gone. However, I was still suffering from the same symptoms. A GI MAP stool analysis showed dysbiosis in the colon, which were Proteus spp. and Morganella spp. After being on herbal antimicrobials for 2 months (Oil of oregano, Berberine, Garlic Plus), I suddenly started to suffer from cramping, diarrhea, and foul gas. I was told that a Urine Th1/Th2 Balance Test Kit (UBT) from PROTEA Biopharma could diagnose the presence of H2S-producing bacteria. I did the test, and it was positive. Do you think that I have H2S SIBO, or that the H2S-producing bacteria is localized more in the colon?

    Regards,
    Alex

    1. Hi Alex,
      Its possible but H2S responds to Abx (according to the one study performed that tested H2S) and I would expect responds to Habx also. So, you might be barking up the wrong tree with antimicrobial treatment and need to consider a different treatment method. See here for options if you need help, http://www.DrRuscio.com/resources

      1. I am sorry, but what is the difference between herbal antibiotics and antimicrobials? I have actually already had 2 courses of antibiotics earlier this year for hydrogen SIBO.

        Thanks,
        Alex

  19. Hello Dr. Ruscio,

    Could hydrogen sulfide SIBO cause terrible odors from the stomach? I have what has been described as a rotton egg or sewage odor. It’s not from passing gas, I think it’s coming from my stomach. It’s incredibly embarrassing and it has been effecting all aspects of my life. Thank you in advance for your time.

    -MV

      1. Thank you for your reply. Is that a symptom only of hydrogen sulfide SIBO? Or could the other SIBO types have the same side effect?

          1. Hi DR. Ruscio,
            So I was diagnosed with SIBO and am about to begin my 2 week course of Xifaxan. I was wondering, can the bacteria exist in the actual stomach? I ask because my odors occur immediately after eating. For example, if I eat ice cream or have an alcoholic beverage, an odor instantly emits from my stomach within minutes. I would say like 2 minutes. Then it’s continuous from there. This happens on both a full (after a meal) or empty stomach. It is extremely socially crippling and I’m hoping that the Xifaxan will cure this. What’s odd is I cannot smell it, but people around me ask if I have passed gas. Another odd thing is that when I’m sick with some sort of sinus infection or virus, the odor is completely terrible and room filling – the odor can be smelled from across a room. I wish I was exaggerating, but this is my unfortunate life right now. Lentils also have a bad effect. Hoping for any advice on what this horrible condition can be.

          2. This could be from SIBO, including hydrogen sulfide SIBO, or from fungus. If Xifaxan doesn’t resolve the issue I would use the protocol listed in my book, especially Step 3. I have seen a few cases of odor clear from doing this. And, yes there are bacteria in the stomach.

          3. I have also suffered from this foul fecal smell which I personally can’t smell but based on peoples reactions, I’ve come to realize I emit it from my nose not just my breath when I talk. I have seen a huge improvement eliminating eggs for the about a year now and coffee just recently. Eggs are tricky since they can be in many foods, dressings, condiments, mayonnaise, ice cream, etc. – again this is also based on peoples reactions after eating these foods. Lentils also seem to be a problem, also if I eat the smallest amount of beans I get the instant rotten egg smelling gas. Supplementing with Bismuth (Devrom) for the past year occasionally before social situations has helped but this past week it seemed to not have worked based on peoples reactions while speaking during a meeting.

          4. MV – Your post on March 2, 2018 IS MY EXACT ISSUE as well. I took Xifaxin for 2 weeks while following Dr Siebecker LowFODMAPS Diet and it works while on the Xifaxin but as soon it’s over the dreaded poop smell is back. I can’t smell or taste it but others around me can smell it from across the room. So embarrassing. So Dr R, how do I kill/starve for good the H2S in my esophagus & stomach? I’ve purchased & read your book but can’t find anything.
            TIA – TD

  20. Hello Dr. Ruscio,

    Could hydrogen sulfide SIBO cause terrible odors from the stomach? I have what has been described as a rotton egg or sewage odor. It’s not from passing gas, I think it’s coming from my stomach. It’s incredibly embarrassing and it has been effecting all aspects of my life. Thank you in advance for your time.

    -MV

      1. Thank you for your reply. Is that a symptom only of hydrogen sulfide SIBO? Or could the other SIBO types have the same side effect?

          1. Hi DR. Ruscio,
            So I was diagnosed with SIBO and am about to begin my 2 week course of Xifaxan. I was wondering, can the bacteria exist in the actual stomach? I ask because my odors occur immediately after eating. For example, if I eat ice cream or have an alcoholic beverage, an odor instantly emits from my stomach within minutes. I would say like 2 minutes. Then it’s continuous from there. This happens on both a full (after a meal) or empty stomach. It is extremely socially crippling and I’m hoping that the Xifaxan will cure this. What’s odd is I cannot smell it, but people around me ask if I have passed gas. Another odd thing is that when I’m sick with some sort of sinus infection or virus, the odor is completely terrible and room filling – the odor can be smelled from across a room. I wish I was exaggerating, but this is my unfortunate life right now. Lentils also have a bad effect. Hoping for any advice on what this horrible condition can be.

          2. This could be from SIBO, including hydrogen sulfide SIBO, or from fungus. If Xifaxan doesn’t resolve the issue I would use the protocol listed in my book, especially Step 3. I have seen a few cases of odor clear from doing this. And, yes there are bacteria in the stomach.

          3. MV – Your post on March 2, 2018 IS MY EXACT ISSUE as well. I took Xifaxin for 2 weeks while following Dr Siebecker LowFODMAPS Diet and it works while on the Xifaxin but as soon it’s over the dreaded poop smell is back. I can’t smell or taste it but others around me can smell it from across the room. So embarrassing. So Dr R, how do I kill/starve for good the H2S in my esophagus & stomach? I’ve purchased & read your book but can’t find anything.
            TIA – TD

          4. I have also suffered from this foul fecal smell which I personally can’t smell but based on peoples reactions, I’ve come to realize I emit it from my nose not just my breath when I talk. I have seen a huge improvement eliminating eggs for the about a year now and coffee just recently. Eggs are tricky since they can be in many foods, dressings, condiments, mayonnaise, ice cream, etc. – again this is also based on peoples reactions after eating these foods. Lentils also seem to be a problem, also if I eat the smallest amount of beans I get the instant rotten egg smelling gas. Supplementing with Bismuth (Devrom) for the past year occasionally before social situations has helped but this past week it seemed to not have worked based on peoples reactions while speaking during a meeting.

  21. HI, I was diagnosed with H2S Sibo and I am wondering if I can take Restore-gut health natural minerals and probiotics at the same time?

    1. Hi Dada,
      I suppose you could, but monitoring your response and making adjustments is very important. The self-help plan in my book will provide this so if you need additional help I would pick up a copy.

  22. HI, I was diagnosed with H2S Sibo and I am wondering if I can take Restore-gut health natural minerals and probiotics at the same time?

    1. Hi Dada,
      I suppose you could, but monitoring your response and making adjustments is very important. The self-help plan in my book will provide this so if you need additional help I would pick up a copy.

  23. Thanks for your information. I have been suffering with Bacterial overgrowth/ and possibly Candida at an earlier stage for a number of years. I have made much headway, however, after treatments and a colonoscopy which showed no polyps or cancer, I tested negative for SIBO breath test. I did test positive for Dysbiosis with stool analysis..So now I am thinking possibly hydrogen sulfide SIBO because I have most of the symptoms.of SIBO. Does this make sense? There is so much mystery to these bowel diseases!!! I appreciate any thoughts!!

  24. Thanks for your information. I have been suffering with Bacterial overgrowth/ and possibly Candida at an earlier stage for a number of years. I have made much headway, however, after treatments and a colonoscopy which showed no polyps or cancer, I tested negative for SIBO breath test. I did test positive for Dysbiosis with stool analysis..So now I am thinking possibly hydrogen sulfide SIBO because I have most of the symptoms.of SIBO. Does this make sense? There is so much mystery to these bowel diseases!!! I appreciate any thoughts!!

  25. Hi Dr, Ruscio,
    i understand that if i texted negative for hydrogen and methane, it could still be HS, but i am just curious…could it not be SIBO at all?? what other things mimic SIBO? i have done rifaximin, elemental diet, NO fodmap diet (i react to everything besides meat and white rice), and herbals all with no luck, no improvement…maybe even getting worse. shouldn’t i be feeling better by now? and my SIBO tests come back negative. just don’t want to keep treating SIBO if it is something entirely different. is there anything else i should ask my doc about testing for?? thanks for all your info and help!!

    1. Hi Kellie,
      I would read my book because there is no short answer to this question. The book will provide a plan to optimize your gut health, and answer you question regarding other things to consider and/or speak with your doctor about if the gut plan doesn’t not provide relief.

  26. Hi Dr, Ruscio,
    i understand that if i texted negative for hydrogen and methane, it could still be HS, but i am just curious…could it not be SIBO at all?? what other things mimic SIBO? i have done rifaximin, elemental diet, NO fodmap diet (i react to everything besides meat and white rice), and herbals all with no luck, no improvement…maybe even getting worse. shouldn’t i be feeling better by now? and my SIBO tests come back negative. just don’t want to keep treating SIBO if it is something entirely different. is there anything else i should ask my doc about testing for?? thanks for all your info and help!!

    1. Hi Kellie,
      I would read my book because there is no short answer to this question. The book will provide a plan to optimize your gut health, and answer you question regarding other things to consider and/or speak with your doctor about if the gut plan doesn’t not provide relief.

  27. Hi dr I came across your post I’ve been tested twice positive for sibo and had rifaximin how can I be sure that this is a cause of my acne cause I read everywhere this causes acne and how can I keep it at bay?

  28. Hi dr I came across your post I’ve been tested twice positive for sibo and had rifaximin how can I be sure that this is a cause of my acne cause I read everywhere this causes acne and how can I keep it at bay?

  29. Hello Dr. Ruscio

    Wondering if you have any information on CBS mutated gene?
    After months and months of painfully researching on Sibo, (full time sibo schooling) trying to find some answers and a solution, I came to the conclusion my son has Hydrogen sulphide Sibo, which just recently lead me to some interesting and mind blowing information on this mutated gene.
    Explains SO much of my own and now my sons ongoing ridiculous/horrible health issues.
    Any ideas? We live in Canada, (which in itself has caused a lot of roadblocks in treating Sibo properly, buying the right supplements and so on) so I think we might be limited with having an actual genetic test done. But maybe you will know more.

    Second question : I could not order JoMar labs AA – using pure encapsulations Amino-NR instead… any objections?

    Thank you in advance for your time! And thank you for all your hard work and information sharing… Super great full for Dr’s like you. 🙂

    1. Hi Natasha,
      In short, I don’t advocate treating genes SNPs… the promise often far exceeds the actual results. I would certainly recommend starting with the gut. I would go through the protocol in Healthy Gut, Healthy You https://drruscio.com/getgutbook/ which will allow you to treat SIBO, and lays out good elemental diet options. Our store ships internationally also. I would recommend using our Elemental Heal, when it’s back in stock, the straight amino acids powders are very bitter. 🙂

  30. Hi doctor Russio, i have battled bad breath and ibs symptoms for a long time however my tests for SIBO and h pylori are negative. The main symptoms I have is very fouls bad breath ansia chronic. It doesn’t go away at all I’ve seen many dentists and currently seeing a GI but he seems to have no answers for me and I don’t know what else to do. Can you please give me some advise? Do you think I can suggest him treating me with rifaximin antibiotics to see if It helps and would be even consider giving me the antibiotic if my tests are negative.. please help I have not been able to get any help from the doctors I am seeing

    1. I am new to this forum but I too suffer from fecal breath from the nose and breath. I also notice a sweet and sour smell. It cause people to cough or sneeze. Especially when I get hot. I strongly feel it is coming from my stomach. I too was tested for sibo but yes was negative. I think it is the way my body processes sugar and carbs. I feel so helpless. If anyone wants to reach out to me maybe we can talk and start a support system.

  31. Hello Dr. Ruscio

    Wondering if you have any information on CBS mutated gene?
    After months and months of painfully researching on Sibo, (full time sibo schooling) trying to find some answers and a solution, I came to the conclusion my son has Hydrogen sulphide Sibo, which just recently lead me to some interesting and mind blowing information on this mutated gene.
    Explains SO much of my own and now my sons ongoing ridiculous/horrible health issues.
    Any ideas? We live in Canada, (which in itself has caused a lot of roadblocks in treating Sibo properly, buying the right supplements and so on) so I think we might be limited with having an actual genetic test done. But maybe you will know more.

    Second question : I could not order JoMar labs AA – using pure encapsulations Amino-NR instead… any objections?

    Thank you in advance for your time! And thank you for all your hard work and information sharing… Super great full for Dr’s like you. 🙂

    1. Hi Natasha,
      In short, I don’t advocate treating genes SNPs… the promise often far exceeds the actual results. I would certainly recommend starting with the gut. I would go through the protocol in Healthy Gut, Healthy You https://drruscio.com/getgutbook/ which will allow you to treat SIBO, and lays out good elemental diet options. Our store ships internationally also. I would recommend using our Elemental Heal, when it’s back in stock, the straight amino acids powders are very bitter. 🙂

  32. Hi doctor Russio, i have battled bad breath and ibs symptoms for a long time however my tests for SIBO and h pylori are negative. The main symptoms I have is very fouls bad breath ansia chronic. It doesn’t go away at all I’ve seen many dentists and currently seeing a GI but he seems to have no answers for me and I don’t know what else to do. Can you please give me some advise? Do you think I can suggest him treating me with rifaximin antibiotics to see if It helps and would be even consider giving me the antibiotic if my tests are negative.. please help I have not been able to get any help from the doctors I am seeing

    1. I am new to this forum but I too suffer from fecal breath from the nose and breath. I also notice a sweet and sour smell. It cause people to cough or sneeze. Especially when I get hot. I strongly feel it is coming from my stomach. I too was tested for sibo but yes was negative. I think it is the way my body processes sugar and carbs. I feel so helpless. If anyone wants to reach out to me maybe we can talk and start a support system.

  33. Well I had a breath test and hdrogen is high 40 to 60 ppm in each of the 15 min interval test and my GI just told me that I’m negative for sibo.. any chance I’m negative 0-10 ppm is the reference for normal

  34. Well I had a breath test and hdrogen is high 40 to 60 ppm in each of the 15 min interval test and my GI just told me that I’m negative for sibo.. any chance I’m negative 0-10 ppm is the reference for normal

  35. Hi dr Ruscio. I am Nino from Italy. I have lupus disease from 10 years. I have itch, muscle cramps, brai fog and arrythmias, digestive difficult,flatulence, gerd. 1 year ago, i tested my hair and results was that I have low level of magnesium, low level of vitamin b, d and low level of SULPHUR!4 months ago i tested my small intestine by lactulose breath test and I was h2 positive. Then i take 1200mg of rifaxim for two weeks, but digestive problems do not risolve. Then i tested my gut microbiota and result was presence of desulfovibrio bacteria, that propably produce h2s. I have not flatulence that is like rotten eggs. In Italy do not understand this condition and i am very confused. Can you help me, please? Excuse me for my bad English…

  36. Hi dr Ruscio. I am Nino from Italy. I have lupus disease from 10 years. I have itch, muscle cramps, brai fog and arrythmias, digestive difficult,flatulence, gerd. 1 year ago, i tested my hair and results was that I have low level of magnesium, low level of vitamin b, d and low level of SULPHUR!4 months ago i tested my small intestine by lactulose breath test and I was h2 positive. Then i take 1200mg of rifaxim for two weeks, but digestive problems do not risolve. Then i tested my gut microbiota and result was presence of desulfovibrio bacteria, that propably produce h2s. I have not flatulence that is like rotten eggs. In Italy do not understand this condition and i am very confused. Can you help me, please? Excuse me for my bad English…

  37. Hi dr. Ruscio,

    I get rid if methane and h2 sibo. I have two breath test with flat curves. However, when I reintroduce FODMAPs and starch I have flatulence and some diarrhea with smell rotten eggs. Are there some way to know if I have h2s SIBO? I read that some cases with both methane and h2 flat curves could be h2s sibo? Thanks.

  38. Hi dr. Ruscio,

    I get rid if methane and h2 sibo. I have two breath test with flat curves. However, when I reintroduce FODMAPs and starch I have flatulence and some diarrhea with smell rotten eggs. Are there some way to know if I have h2s SIBO? I read that some cases with both methane and h2 flat curves could be h2s sibo? Thanks.

  39. I have severe bloating, constipation and benching hundreds of times a day. No smelly gas unless I’ve been constipated for days. I’ve tested negative twice in breath test, negative on a stool test and muscle testing. I’m thinking maybe parasites. I can also eat meat and six hours later burp up meat. No joke. I did an endoscopy last week and no GERD. I did a Heidelberg Test and I do have severe low acid. I take HCL but that seems to just sit in my stomach with the food. I’ve been treated by five very well known gut docs and have right now 88 supplements for gut alone that I’ve bought depending on the protocol. The belching hundreds of times a day makes my stomach feel like someone punched me repeatedly. I seen where John Hopkins did a study on herbal remedies that seem to be just As affective as Rifaximin. I just started that. This is miserable.

  40. I have severe bloating, constipation and benching hundreds of times a day. No smelly gas unless I’ve been constipated for days. I’ve tested negative twice in breath test, negative on a stool test and muscle testing. I’m thinking maybe parasites. I can also eat meat and six hours later burp up meat. No joke. I did an endoscopy last week and no GERD. I did a Heidelberg Test and I do have severe low acid. I take HCL but that seems to just sit in my stomach with the food. I’ve been treated by five very well known gut docs and have right now 88 supplements for gut alone that I’ve bought depending on the protocol. The belching hundreds of times a day makes my stomach feel like someone punched me repeatedly. I seen where John Hopkins did a study on herbal remedies that seem to be just As affective as Rifaximin. I just started that. This is miserable.

  41. Dr. Ruscio,
    This is a quote from a Dr interview I saw online; “Body temperature, if it’s not responding to thyroid, it could be SIBO. Hydrogen sulfide gas will down regulate your body temperature. ”
    This caught my attention because for 20 years I’ve never been able to raise my temperature. I can take thyroid and raise my heart rate up to 90, but my body temperature never gets close to normal. I’ve been chronically fatigued for 20 years. Should I make an appointment with you? Am I on to something I should try? Thank you.

    1. I forgot to mention that I had a negative breath test recently. I’ve taken a good dose of HCL w/betaine twice a day for 20 years.

  42. Dr. Ruscio,
    This is a quote from a Dr interview I saw online; “Body temperature, if it’s not responding to thyroid, it could be SIBO. Hydrogen sulfide gas will down regulate your body temperature. ”
    This caught my attention because for 20 years I’ve never been able to raise my temperature. I can take thyroid and raise my heart rate up to 90, but my body temperature never gets close to normal. I’ve been chronically fatigued for 20 years. Should I make an appointment with you? Am I on to something I should try? Thank you.

    1. I forgot to mention that I had a negative breath test recently. I’ve taken a good dose of HCL w/betaine twice a day for 20 years.

  43. Hi. I have F 4 Alcohol related liver cirrhosis. I was diagnosed 2 years ago. I quit drinking, changed careers ( I was a bartender ), changed diet took all the meds and still had awful pain , bowel problems, weight loss, etc. 3 months ago my gastrointerologist diagnosed me with sibo, moderate high levels of both gases. I thought “Great! Now we know what’s wrong finally!” The agonizing cramps ,bloating, diarrhea, nausea, etc have been literally ruining my existence! I immediately started on the elimination diet, threw out everything FODMAP, and started praying it would work. My insurance denied Xifaxan, said SIBO is not a condition worthy of it. But travelers diahrea is?! I wont waste your time talking about that. I was then prescribed Augmentin to eradicate the bacteria. I felt almost back to normal , or what I can vaguely remember is normal. That unfortunately did not last much longer tha pr and on for a couple weeks and back to square one. I am still on the elimination diet in hope that my Xifaxan will arrive from Canada soon. To reiterate I have been on the diet for 3 months. I used to weigh 210 lbs, I’m 6’3. I weigh now consistently 170 lbs. My gastrointerologist was dismissive of the sibo evaluation from the beginning and I have been basically educating myself on the condiotion/ herbal treatments ever since. I’m using a prokinetic, 30 grams a day of L glutamine, digestive enzymes 3 times a day, a bacterial cleanse 3 times a day, something called Anatril at meals, 3xs low fodmap probiotics and multivitamin, milk thistle, nadalol, lasik, and spironolactone. (Last 4 are for the liver ). Any advice would be appreciated as I really dont have anywhere left to turn. I might check into Mayo Clinic end of month if I’m still in this position. I HAVE TO GET RID OF THIS AWFUL LIFE ALTERING SIBO !

  44. Hi. I have F 4 Alcohol related liver cirrhosis. I was diagnosed 2 years ago. I quit drinking, changed careers ( I was a bartender ), changed diet took all the meds and still had awful pain , bowel problems, weight loss, etc. 3 months ago my gastrointerologist diagnosed me with sibo, moderate high levels of both gases. I thought “Great! Now we know what’s wrong finally!” The agonizing cramps ,bloating, diarrhea, nausea, etc have been literally ruining my existence! I immediately started on the elimination diet, threw out everything FODMAP, and started praying it would work. My insurance denied Xifaxan, said SIBO is not a condition worthy of it. But travelers diahrea is?! I wont waste your time talking about that. I was then prescribed Augmentin to eradicate the bacteria. I felt almost back to normal , or what I can vaguely remember is normal. That unfortunately did not last much longer tha pr and on for a couple weeks and back to square one. I am still on the elimination diet in hope that my Xifaxan will arrive from Canada soon. To reiterate I have been on the diet for 3 months. I used to weigh 210 lbs, I’m 6’3. I weigh now consistently 170 lbs. My gastrointerologist was dismissive of the sibo evaluation from the beginning and I have been basically educating myself on the condiotion/ herbal treatments ever since. I’m using a prokinetic, 30 grams a day of L glutamine, digestive enzymes 3 times a day, a bacterial cleanse 3 times a day, something called Anatril at meals, 3xs low fodmap probiotics and multivitamin, milk thistle, nadalol, lasik, and spironolactone. (Last 4 are for the liver ). Any advice would be appreciated as I really dont have anywhere left to turn. I might check into Mayo Clinic end of month if I’m still in this position. I HAVE TO GET RID OF THIS AWFUL LIFE ALTERING SIBO !

  45. Dear doctor:
    Can stress (only stress) cause sibo? In other way, can stress impair the phase III of MMC and consequently, produce sibo? I am desesperated to look for the underlying cause of my recurrent sibo (I do not remember any intoxication when my problems began, I do not have coeliac disease or crohn…). I do not know what to try. Maybe i must consider i will have impaired mmc all my life ? Sorry for my english. Thank you very much.

  46. Dear doctor:
    Can stress (only stress) cause sibo? In other way, can stress impair the phase III of MMC and consequently, produce sibo? I am desesperated to look for the underlying cause of my recurrent sibo (I do not remember any intoxication when my problems began, I do not have coeliac disease or crohn…). I do not know what to try. Maybe i must consider i will have impaired mmc all my life ? Sorry for my english. Thank you very much.

  47. Hi, I was interested to find the information in the comments on treating hydrogen sulfide sibo with bismuth. Wouldn’t that make constipation worse?

  48. Hi, I was interested to find the information in the comments on treating hydrogen sulfide sibo with bismuth. Wouldn’t that make constipation worse?

  49. Hi! Could you recommend specific strains or a brand of probiotics and specific herbal anti-microbials that can kill the hydrogen sulfide SIBO? Can they be used at the same time or introduced over stages? Thanks!

    1. Hi Lisa,

      Likely any probiotics that help with general SIBO and/or IBS would help with hydrogen sulfide, but we don’t really know because there are no studies specifically on H2S SIBO. Dr Ruscio lists a protocol here: protocol here: https://drruscio.com/probiotics-reduce-inflammation-scientific-proof/

      Also, Dr Ruscio + Dr Jacobi discuss treatment in this podcast: https://drruscio.com/hydrogen-sulfide-sibo-treatment/

      Hope this helps!

  50. Hi! Could you recommend specific strains or a brand of probiotics and specific herbal anti-microbials that can kill the hydrogen sulfide SIBO? Can they be used at the same time or introduced over stages? Thanks!

    1. Hi Lisa,

      Likely any probiotics that help with general SIBO and/or IBS would help with hydrogen sulfide, but we don’t really know because there are no studies specifically on H2S SIBO. Dr Ruscio lists a protocol here: protocol here: https://drruscio.com/probiotics-reduce-inflammation-scientific-proof/

      Also, Dr Ruscio + Dr Jacobi discuss treatment in this podcast: https://drruscio.com/hydrogen-sulfide-sibo-treatment/

      Hope this helps!

  51. Hello, I have had a breath test for SIBO with different interpretations. Someone suggested hydrogen sulfide SIBO. I’M a bit confused now. I know for sure I have chronic candida overgrowth. Could I send you the pdf with the results?
    Cheers

  52. Hello, I have had a breath test for SIBO with different interpretations. Someone suggested hydrogen sulfide SIBO. I’M a bit confused now. I know for sure I have chronic candida overgrowth. Could I send you the pdf with the results?
    Cheers

    1. Hi Cecilia,

      We’re unable to answer personal medical questions on this forum. If you’d like Dr Ruscio to take a look at your labs and offer his opinion, you’re welcome to apply to become a patient. You can do so here: https://www.drruscio.com/gethelp

  53. I cease told that I have inflammation in my nose and I read that inflammation in the body can cause bad breath or body odor. Like a sweet smell and this is what I smell on my hands and when I breath the smell is in my airway. I have been to ent and they have done a CT scan no infections or nothing with my sinus. Sibo test was negative I just got my results today. But I know it is coming from my diet and anything with sugar and carbs is the culprit. But these are the foods that I crave all the time especially sugar. If I decide to eat a small amount of something sweet it seems to trigger something in the brain and I cannot stop eating it.

  54. I cease told that I have inflammation in my nose and I read that inflammation in the body can cause bad breath or body odor. Like a sweet smell and this is what I smell on my hands and when I breath the smell is in my airway. I have been to ent and they have done a CT scan no infections or nothing with my sinus. Sibo test was negative I just got my results today. But I know it is coming from my diet and anything with sugar and carbs is the culprit. But these are the foods that I crave all the time especially sugar. If I decide to eat a small amount of something sweet it seems to trigger something in the brain and I cannot stop eating it.

  55. Hi Doctor. I have been diagnosed with hydrogen sulfide sibo based on my sibo symptoms and flat line breath test. Do you know if the breath test to detect the presence of hydrogen sulfide gas is available yet ? I’m not having much luck with my treatments thus far. Many thanks

  56. Hi Doctor. I have been diagnosed with hydrogen sulfide sibo based on my sibo symptoms and flat line breath test. Do you know if the breath test to detect the presence of hydrogen sulfide gas is available yet ? I’m not having much luck with my treatments thus far. Many thanks

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