Methane SIBO: Frontline Treatments and Clinical Pearls

SIBO, or small intestine bacterial overgrowth, is a condition that occurs when bacteria overgrow in the small intestine, leading to a range of digestive symptoms. Methane SIBO, a type of SIBO, is driven by methane-producing archaea in the gut, which produce an excessive amount of gas. In this blog post, we will discuss frontline treatments and clinical pearls for methane SIBO.

Symptoms of Methane SIBO

The main action of methane SIBO on the gut is to slow down motility, which can cause constipation, sluggish digestion, bloating, and distension. Gassiness, burping and abdominal pain are also common symptoms. If you are waking up bloated and distended before food, this may be an indication that methane is playing a role in your symptoms.

“If you are waking up bloated and distended before food, this may be an indication that methane is playing a role in your symptoms”

Testing for Methane SIBO

I recommend a SIBO breath test anytime that I suspect that methane is causing symptoms and really value the insight that exhaled gas levels can provide compared to a stool test showing the amount of the bug in the stool.

Why?

Because a small amount of a methane producing archaea (predominantly Methanobrevibacter smithii, although there are others including Methanosphaera stadtmanae) on a stool test can be producing a LARGE amount of methane gas on a SIBO breath test.

How much methane is considered excessive on a SIBO breath test?

This is clinical experience time. You won’t find this in any research paper.

I have come to see levels of exhaled methane gas around the 20 parts per million level as a mild methane case, while 30-50 parts per million trends more towards a moderate case. Above 60 parts per million I would consider extreme on the methane front.

I’ve only counted six or seven cases where the numbers were above 100 parts per million, which is extreme!

“Levels of exhaled methane above 100ppm on a SIBO breath test I would consider extreme!”

Frontline Treatments for Methane SIBO

The fundamental treatment for methane SIBO is to work on improving the slow motility / slow transit time and breaking the vicious cycle of constipation and incomplete emptying of the bowels.

Here we tend to recommend specialised herbal medicine, prebiotic fibers, hydration, and exercise. Prokinetic herbs can also be used to get the bowels moving and improve motility and specific probiotic strains can improve bowel movements and transit time too.

Clinical Pearl: Do better bowel movements Improve Bloating?

As a clinical herbalist, I coach my patients to observe how much better they feel when they completely empty their bowels regularly.

Do you see a significant improvement in bloating and distension when you have more consistent bowel movements?

If the answer is yes this is a great outcome.

If you find that as your treatment progresses you begin to eliminating gas through burping or flatulence I would consider this a win as well (short term!). Trapped gas is a major cause of abdominal pain and visceral hypersensitivity.

Frontline methane SIBO treatments for the win!

Methane SIBO is a condition that can be successfully treated through breaking the slow motility and transit time in the gut and by improving constipation. If you don’t see significant improvements in symptoms or a reduction in gas levels on SIBO retesting then stronger herbal antimicrobials may be needed as an additional layer.

Here I would recommend a repeat SIBO breath test to confirm that methane is still playing a role in your symptoms first.

Keep in mind that watching for better bowel movements and gut transit time leading to an improvement in bloating and distension is key to tracking the success of the treatment!

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7 comments

  1. I suffer from a lot of gas and digestive issues. Do you have a book on how to help SIBO and other digestive disorders. I have been diagnosed with Hafnia Alvei however I have issues with taking antibiotics.

    Please advise. I live in the USA.

  2. Hi Todd, Great video. Other than prokinetics and basic lifestyle stuff (exercise, stress reduction, good hydration) what else might you recommend for decreasing intestinal transit time? Any specific pro/prebiotics, foods or other supplements you would suggest for this? I would love to hear your thoughts on this! Maybe even another blog post or video doing a deeper dive on this topic? Great video, I love your presentation style, you have such a calming way of delivering information.
    Warmest regards,
    Matt

    1. Thanks Matt, I appreciate the great feedback!
      I’m working on a big one here as this approach has been so helpful for many of my patients in the clinic. As frontline therapy probiotics, prebiotics like PHGG and strong prokinetic herbs are where I like to start. Nutrients and vitamins can be helpful for some (B1 and B5 for acetylcholine production) and maybe things like 5-HTP in a few.
      As always treating the root cause and applying therapies to address it is key to sifting through possible options.
      Hope that helps!
      Todd

  3. Hi Todd
    Thanks for all the info. Great site. I have taken the SIBO breath test and my methane is 77 ppm. The problem is my symptoms are mainly diarrhea several times a day.
    How would you modify treatment in this case? It seems like slow motility is not the issue

  4. Good morning! God bless you in the New Year!
    I am so thankful for your earnest clinical studies in herbs of healing. ❤️‍🩹 —God’s idea of human wellness and vitality.
    My sister has worked in Calcutta and almost died from an infection while being there. The family thinks that she still may have parasites 🦠 from 30 some years ago. She is always in pain and suffers digestive issues. This has been going on for many years. She has never been treated professionally using herbs.
    What could you suggest we do for her by way of seeking your advice via email or phone call?

  5. Hi Todd, That’s an excellent video. I’ve a question: Let’s see how to frame it —

    Background: I have lyme disease and have had it about forty years, though only successfully diagnosed about 17 yearss ago).

    Now: I recently took a breath test and it showed I have 40 ppm Methane throughout the whole test period (even before I drank the lactulose solution!) Now, I definitely have very, very excessive bloating and distension (as if I were pregnant) and I’ve had it on and off for much of my adult life. But I do not feel like I struggle with constipation at all: I generally have one (sometimes two) good and satisfying bowel movements a day.

    So, is methane my real problem?

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