bilophila wadsworthia infection natural treatment options how to treat bilophila overgrowths

Bilophila wadsworthia is a gram negative bacterium that belongs in the Proteobacteria phylum. It is one of a number of bacteria that produce hydrogen sulfide, a gas that, when it reaches a certain threshold, is implicated in the breakdown of the intestinal wall and the progression of inflammatory bowel disease.

This article will cover some of the basics when considering Bilophila wadsworthia, some testing options used to find this particular bacteria and ideas on natural treatments. 

Bilophila wadsworthia 101

What is Bilophila wadsworthia and why is it an important bacterium in our gut microbiota to really understand.

Well first off Bilophila wadsworthia is one of a few bacteria that can produce hydrogen sulfide in the human gut.  

This topic has been covered in a previous article – Hydrogen sulfide bacteria – Implications for IBD and Leaky Gut 

Today we won’t be covering the in’s and out’s of hydrogen sulfide so pop over there and have a read to catch up to speed on hydrogen sulfide.

Bilophila wadsworthia was discovered and characterised in the late 80’s and is commonly associated with a number of different infections including the following list (1).

  • Appendicitis
  • Sepsis
  • Cholecystitis
  • Osteomyelitis

It’s growth is stimulated by bile – an important point that we will circle back to shortly –

Bilophila wadsworthia is a part of the normal, or healthy human gut flora. However, as with many opportunistic bugs in our gut, if it is given the chance to grow beyond healthy numbers (more than 0.01% of the bacterial population or thereabouts) it can cause digestive symptoms and even do damage to the gastrointestinal tract.

To drive this point home Bilophila wadsworthia has been isolated in the infected appendix of approximately half of the people with appendicitis (2). 

Bilophila wadsworthia is not a sulfate reducing bacteria per say, although it is classified within the same family of bacteria as many of the sulfate reducing bacteria (Desulfovibrionaceae). Instead it uses taurine, abundantly supplied in our bodies and often associated with bile, to form the toxic metabolite hydrogen sulfide (3).

Why is Bilophila wadsworthia an issue?

When we talk about the issues of Bilophila wadsworthia it is important to note that we are talking about an overgrowth of this particular bacteria. When it is below approximately 0.01% of the gut bacterial makeup it is seen by most as a commensal bacteria – think harmless here.

When it is given the space and the specific nutrition to grow then it can become a problem. The more bacteria the more hydrogen sulfide, the more of an issue. Pretty simple math right?

Bilophila may be the reason why some people don’t do well on a high fat diet. Animal studies have shown that high fat diets, which in turn increase the secretion of bile (and taurine that this bacteria loves), actually feed Bilophila.

These higher fat diets result in an overgrowth of Bilophila wadsworthia (4).

This scenario brings to mind everyone that has turned to a ketogenic diet to help deal with their digestive symptoms. I have been there in the past, and while it may have helped in the short term, I feel that a long term ketogenic diet may lead to some issues in the microbiota balance. Here we can see the possibility of a Bilophila wadsworthia overgrowth as a result!

So what do we make of this high fat notion?

While some would recommend limiting saturated fat I think the devil is in the detail. Balancing a moderate intake of fat in your diet – remember we want to focus on high quality fats like organic extra virgin olive oils, essential fatty acids (EFAs) from wild caught, cold water fish and then a smaller intake of grass-fed butter, ghee and organic coconut oil – with plenty of fibre, may help to reduce the chances of a Bilophila overgrowth.

More research is needed to really tease out the details here.

But what is the impact of an overgrowth of Bilophila wadsworthia?

That is a good question, again one that needs more research. These hydrogen sulfide producing bacteria aren’t getting the focus they need at the moment.

For now I think it is best to focus on the toxic byproduct from Bilophila which is hydrogen sulfide. As we have covered before excessive hydrogen sulfide, produced by Bilophila and a number of other bacteria, can lead to leaky gut and even trigger an immune response akin to inflammatory bowel disease.   

In an animal study, a strain of Bilophila wadsworthia was introduced to pathogen free mice. Not only did the mice loose a considerable amount of body weight – not a healthy kind of body weight loss! – their spleen and liver also became enlarged. Plus there was evidence of systemic inflammation. 

To quote the authors 

“We hypothesize that increased numbers of B. wadsworthia in gut microbiota induces systemic infammation and thus contributes to the onset of chronic diseases.”

A human stool-derived Bilophila wadsworthia strain caused systemic infammation in specifc-pathogen-free mice

It is worth pointing out that this may be a particularly pathogenic strain of Bilophila wadsworthia. It is possible that not every strain of this bacterial species would have the same effects.

Finally Bilophila wadsworthia was seen to be almost 2x higher in patients with colorectal cancer compared to healthy people (6).

We still aren’t sure what this means but it may be relevant in the future. 

Testing for Bilophila wadsworthia

DNA based stool tests that report back on the complete bacterial composition (that we can screen for presently) of the large bowel is the only test that I am aware of that will screen for Bilophila wadsworthia. 

One of my favourites is the Thyrve. It is cheap and accurate, although it does take some time to get the results back. 

Natural Treatments for Bilophila wadsworthia infections

This particular bug appears to be quite resistant to different antibiotics. To me that isn’t a major concern as I would never take antibiotics to treat this form of bacterial overgrowth. I have written a good overview of why I would shy away from antibiotics for these particular cases. Have a read at your convenience. 

Prebiotics to treat Bilophila

To tell you the truth there isn’t a whole lot of research out there on natural treatments for  Bilophila wadsworthia. That said, there is one human trial (a randomised, double blind cross over trial, aka some of the best human studies we have!). 

This trial, published in BMJ in 2017, assessed the effects of the prebiotic inulin on healthy volunteers with mild constipation. They found that 12 grams of inulin, compared to placebo, significantly increased Bifidobacterium counts as well as Anaerostipes species and significantly decreased Bilophila counts. 

Image taken from: Prebiotic inulin-type fructans induce specific changes in the human gut microbiota

Here’s the thinking behind this beneficial shift of the microbiome. The image below helps to outline these points too. 

  •  Bifidobacterium species in the gut can degrade the inulin prebiotic – This selective food substrate (inulin) boosts the number of the beneficial Bifidobacterium species in the gut.
  • Anaerostipes species – a key butyrate genus in the gut – increased due to a concept called cross-feeding. This interesting process really shines a light on the complexity of the human gut microbiome and digestive health.  Beneficial bacteria in the gut can feed and multiply using the byproducts from the Bifidobacterium. Boosting Bifidobacteria results in an increase in Anaerostipes species. 
  • Bilophila wadsworthia was significantly reduced in the samples from the trial after the inulin prebiotic worked its magic. The thinking here is the alterations in the taurine conjugated bile acids (a favourite food source for Bilophila wadsworthia) resulted in less food for Bilophila to feed on. Other popular ideas on how prebiotics like inulin help to reduce less friendly bugs is the reduction in the pH of the large intestine. A more acidic gut favours beneficial bacteria and impairs the growth of less friendly bugs. 
Image taken from: Prebiotic inulin-type fructans induce specific changes in the human gut microbiota

These incredible results from the supplementation of a inulin, fructooligosaccharide prebiotic, really points to the powerful value of prebiotics in general. The key message here is that they selectively feed beneficial bacteria.

Prebiotics are not colonic foods or general fibers per say. They have a precise and targeted impact on the gut microbiome. Using advanced stool testing (like Thryve or Microba) we can laser target our approach and modulate the gut microbiome, and in doing so, shift it more towards health and away from disease – or dysbiosis. 

For a deeper dive on prebiotics head over here – Prebiotics Resource: Gut Health and Disease

Probiotics to treat Bilophila 

Lactobacillus rhamnosus CNCM I-3690 was used to successfully treat mice who were infected with Bilophila wadsworthia. This particular probiotic effectively reduced the load of Bilophila and also improved fasting glucose and insulin (8).

Impressive stuff!

Unfortunately this particular strain doesn’t appear to be available for commercial use. This is a common issue when delving into the research around probiotics. There are dozens of promising strains that have shown good success in the scientific literature but aren’t available! We just have to keep an eye on them and hope that they are taken up by probiotic manufacturers.

Increase Vegetables and Fibre Intake (Possibly limit fat)

Both high fat diets and excessive consumption of dairy have been shown to increase Bilophila in animal studies. One human study looked at the effects that a plant based diet vs an animal based diet had on the microbiome and found some significant alterations that favour Bilophila growth (9).

Image taken from: Diet rapidly and reproducibly alters the human gut microbiome

If you are struggling with a Bilophila overgrowth then it may be worth increasing the amount of plants in your diet – here I am talking about fibre rich legumes and leafy greens – and reducing the amount of fat you eat. Don’t forget about dairy here, especially full cream milk, cream and butter which are all high in dairy fat.

While I do think that high quality fat plays a beneficial role in most people’s diets it may be worth limiting these while you are treating a Bilophila overgrowth.

byron herbalist todd mansfield gut health specialist

Need help with your digestion?

Hi, my name is Todd Mansfield. I am a clinical herbalist with a special interest in all things gut health.

If you are looking for digestive health support consider working with me. I see people online as well as in person from my clinic in Byron Bay.

More booking information here.

Have you had any experience with digestive troubles? Leave a comment below and share your thoughts.

References and Resources

  1. Bilophila wadsworthia: a Unique Gram-negative Anaerobic Rod
  2. Hydrogen as an energy source for the human pathogen Bilophila wadsworthia
  3. Hydrogen as an energy source for the human pathogen Bilophila wadsworthia
  4. Bilophila wadsworthia aggravates high fat diet induced metabolic dysfunctions in mice
  5. A human stool-derived Bilophila wadsworthia strain caused systemic infammation in specifc-pathogen-free mice
  6. Bilophila wadsworthia Is More Abundant in the Colonic Microbiome of Colorectal Cancer Cases Compared to Healthy Controls
  7. Prebiotic inulin-type fructans induce specific changes in the human gut microbiota
  8. Bilophila wadsworthia aggravates high fat diet induced metabolic dysfunctions in mice
  9. Diet rapidly and reproducibly alters the human gut microbiome
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  1. HI – I have read elsewhere that a plant based diet could reduce the number of B.Wadsworthia in as little as 24 hours (as this bacterium thrive on high fat from dairy). I have various food intolerances and can’t eat soy, legumes, grains, etc – basically all of the things used as dairy alternatives.

    My own research about my long term symptoms lead me to a prebiotic with inulin that did not seem to help, but I realise now was only half of the problem. 2 questions – how much diary fat would be considered high fat? Would consumption of semi skimmed milk be high fat in this setting? I drink about a litre a day in hot drinks. Also, if I do not manage to give up dairy, would adding this prebiotic be enough to control this overgrowth?

    I do realise you will probably recommend seeing a specialist but I am on state benefits and cannot afford private testing/treatment. My GP knows nothing about this kind of thing, so I am left with no option but to do trial and error on a number of foods.

  2. Sorry – can I also add that I am confused regarding the plant based diet helping with B.Wadsworthia because I have also read that butyrate is the best way to combat it. Butter is the best source…which is of course, high fat dairy. Please help a lay person understand which way to turn.

    1. Hi Rose. Thanks for taking the time to share your experience.

      Let me take the questions one at a time.

      1 litre per day of dairy milk might definitely feed this particular bug, especially if your diet does not offset this high fat intake. If you don’t tolerate legumes and grains then leafy greens and resistant starch as well as brown, black and red rice (if tolerated) may help.

      Prebiotics can help to reduce the numbers of this particular bacteria. Anything that helps to produce short chain fatty acids in your large bowel (butyrate is number one here) will help to lower the pH and reduce Bilophila numbers.

      Finally butyrate needs to be produced in the large intestine by our beneficial bacteria to be of value as a local anti-inflammatory and energy providing substance. Butyrate that is eaten (for example in butter) will be absorbed into the body well before it makes it to the large intestine where it is needed.

      Hope that helps!


      1. Sodium butyrate capsules?

        I don’t have a high fat diet. No dairy. No alcohol. Rolled oats and oat milk for breakfast.

        But I have been eating 6 boiled eggs as well to help with protein intake as I have potentially got CFS. Oligoscan show moderately high sulphur at the cellular level.

        So having now found that I have Wadsworthia overgrowth (6% of microbiome for Wadsworthia – 16% total of phylum proteabacteria) via Biomesight 16S rRNA sequencing stool test, I am going to stop the eggs as a source of sulfur for Wadsworthia. I also used to take taurine supplements to promote ALDH to metabolise acetaldehyde due to pathogens and immune issues – so need to stop that as well as a food source for Wadsworthia.

        Low dose lactulose (1 to 2 g) has been suggested by Biomesight to feed beneficial bugs and reduce the proteabacteria.

  3. Ive been having lower intestinal painful gas for about 3 days. No bowel movements except mucas..dont know what to do and this is disrupting my life. Cant work with this condition and I NEED TO WORK! What can I do?

  4. Hello Todd, when you are able to communicate with the US, please let me know. I have a complicated situation, yet i think you can help me. Thank you in advance, Debbie

  5. Are you aware of any way to manage desulfovibrio, the other major H2S producer?

    And BTW, Thryve does not report bilophila. Somehow they manage to miss it. Ubiome used to report it.

    1. Hi David,

      That is concerning that Thyrve doesn’t report on it. I checked in with them before recommending it as an alternative to Ubiome and they replied that they do. I checked many of my patients results and have not found a positive so you may be right!

      I am in the process of writing up an article for desulfovibrio spp at the moment. Unfortunately it seems to be a bit more stubborn to move but there are treatment approaches that I use.

      Thanks again for the update!


  6. Hi Todd,
    Thanks for this, was very informative.
    I’ve done a Microba test and I have higher levels B. wadsworthia, I eat a fair amount of ghee, cultured butter and goats milk kefir. I feel better on a higher fat diet, would you recomend eating or completly leaving out those foods? or maybe sticking to extra virgin olive oil instead?

    1. Hi Jackson,

      Yes, I am seeing it all the time with the advanced testing methods. The high dairy fat diet will be feeding it up most likely. The monounsaturated fats don’t seem to be a food source for bilophila. Low saturated fats, especially diary, is a key part of my treatment approach.


  7. Hi Todd. What is currently your top recommended gut microbiome stool test? Do you prefer Thryve or Microba?

    1. Hi Tania

      So sorry on the delay! I like them both. Currently I lean more towards Microba as I love their chemistry panels (SCFAs, hydrogen sulphide production and neurotransmitter panels too) but I also like that Thyrve reports down to the 0.01% as opposed to the 0.05% from Microba. I believe microba is going to expand their reporting to 0.01% soon.

      Hope that helps!


  8. Hi Todd. Great article! The new BiomeFx test checks for Bilophila wadsworthia. I just got my results yesterday and wow do I have a lot of issues. I’m in the US, so I know I can’t consult with you at this time.

    Anyway, I’m high in Bilophila wadsworthia. The healthy range is 0.05 – 0.27. Mine was 1.22. I’m on a ketogenic diet for multiple reasons. I’m 60 and have two copies of the Alzheimer’s gene (APOE4), and a mild ketogenic diet is recommended by the doctor whose work I follow (Dale Bredesen, MD). This diet eliminated my years-long hypoglycemia. I was clearly insulin resistant and no longer am. For fats, I focus on EVOO and avocado oil, as well as fats from almonds and seeds. I’m sensitive to dairy but can eat ghee and eat moderate amounts of that. Three times a week I eat full-fat coconut milk ice cream. I eat a small amount of meat two out of three meals a day. I eat more vegetables than ever before, although my digestive system limits how much food I can eat.

    I’m afraid that if I stop the ketogenic diet, the insulin resistance will return and my brain will suffer from the lack of ketones. (People with APOE4 have a problem with glucose hypometabolism in the brain.) I’m eating some resistant starch nearly every day, but I could eat more and add inulin in. I had hydrogen sulfide SIBO for years (even before I was on a ketogenic diet, but I was low carb) and was successfully treated for that two years ago and haven’t had a reoccurrence, but I’ve been reluctant to overdo the prebiotic fibers. I have many food sensitivities, and the only grain I eat is quinoa on occasion. I don’t eat beans because they are so high carb.

    Can you suggest anything to me amid my long ramble?

  9. Hi,
    I understand this article was published quite a while ago in September, 2019. Today, Lactobacillus rhamnosus probiotics are available commercially (although I don’t know how important the strain ‘CNCM I-3690’ is, which have been used in mice experiments). In India, “Superflora GG” contains Lactobacillus rhamnosus as one of the main ingredients. In Germany, ‘”DarmfloraKapseln” by Dr.Fleckenstein also contains Lactobacillus rhamnosus as one of the ingredients. I would like to know your thoughts or experiences with these. Thanks!

    1. hi Shreya, Thanks for the comment. Yes, LGG is a great strain of l. rhamnosus which I frequently use. I am not sure we can extrapolate from strain to strain within the species but would definitely use this probiotic when treating bilophila as I haven’t been able to track down CNCM I-3690

  10. Hi Todd,
    Would a good Butyrate supplement be a good idea?
    And wouldn’t green leafy veg feed H2S bacteria? I was told to avoid green leafy veg and resistant starch due to h2s and hydrogen Sibo 🙁

  11. Hello, interesting article! I recently took a Biomefx test and it shows that I have elevated b wadsworthia. However, my holistic practitioner didn’t prescribe l rhamnosus, she opted for a megasporebiotic. I have been researching and all I see for treating b wadsworthia is the l rhamnosus. Are you familiar with using sporebiotics to treat it? Should I ask her to switch me to the L rhamnosus instead?? I’d love any input. Thank you.

  12. Hey Todd! Loved this article. Do you happen to know how closely related the species are between different strains of Rhamnosus? Meaning would Rhamnosus GG potentially do the same thing?

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