Methane SIBO

For constipation you can do water enema, for neuropathy what brings the quickest relief is removing blood, i use 50ml disposable syringue with 21G needle and find some vein in the upper leg/groin area so i can use both hands to secure syringue and pull on it to remove blood, it's a pain in the ass and requires some trial and error at first but brings the quickest relief from neuropathic pain at least for me also it probably gets rid of some bacteria from blood (not much but still), 50ml isn't much though, ideally you can find a doc that can remove 500ml at a time and that would probably bring much more significant relief.

Hi dcd. Sorry to hear about that. Regarding SIBO, I see it as a consecuence of the three B's and/or other chronic infections you may have, so my understanding is that using a Broad-spectrum antibiotic might get things back to normal. Back to the end of 2022 my breath tests didn't look good and I had chronic diarrhea, and just by taking minocycline a couple of days and one day of azithromycin all my GI symptoms went away. Another alternative that MichiganLymie has mentioned is Rifaximin. The good thing about it is that it's barely absorbed in the GI tract so your neuropathy shouldn't trigger that much.

My main advice is that you focus on your diet. Try going carnivore or keto. By reducing the intake of carbohidrates you'll be limiting the amount of food you are giving to your GI bacteria, that should reduce your symptoms. If you want additional information about diet, I recommend you reading the book "The carnivore diet", by MD Shawn Baker. It's a quick read. it will help you understand many concepts about nutrition and why the carnivore diet is extremely helpful in people who have health issues.

Hi dcd

good to see you here - although sorry to hear of your IBS-C

i dug pretty deeply into SIBO when i first got sick in 2015 - as my partner and i had so many gut symptoms initially, and since lyme etc was completely dismissed as impossible by GP's and Infectious Disease specialists - that we thought that our illness must just be a gut issue - like SIBO or dysbiosis

from what i still retain

usually rifaximin is paired with neomycin as the first line - the pairing that has the most research behind it - i think metronidazole is used perhaps as a second line treatment - because rifaximin is typically prohibitively expensive - and i think there have also been supply issues over the last 10 years of so - but as above rifaximin has the benefit of remaining in the gut - rather than systemic

ref the potential for metronidazole to be a carcinogen - there was a discussion on here recently where we dug into the potential for metronidazole to cause cancer and indeed there is evidence of some increased risk. the risks go up with dose and duration
under 2 weeks is best / safest - i think sibo treatment is usually 4 weeks or more. so another reason to choose rifaximin if possible i think

i think the GI-MAP test is a good one - i did it a few years ago - came away believing it was one of the best ones out there - others we did at the same time turned out to be random number generators

herbal treatments for the most part are likely to be tricky - as you mention - they tend to cause v strong reactions - even more than pharmaceutical antimicrobials - in my case even things like berberine - which is supposed to remain almost entirely in the gut - causes radical systemic herx. oregano oil also - alicin i think too - so i think most of the ones typically quoted for methanogens will cause systemic flare

there are some new developments in the word of SIBO and methane dominant SIBO - eg in the link below - trials of a statin type drug that seem to shut down the archaea responsible - that one is interesting in that it was not a normal antimicrobial ( does not kill the microbes ) so might be a promising approach for you ( as no killing seems to lead to no herx and less flares of the auto-immune stuff)

https://thefunctionalgutclinic.com/blog/news/treatments-for-methane-production/

it also mentions probiotic strain, Lactobacillus reuteri, as having shown reductions in methane production in trials

there is also Atrantil - a herbal based supplement that treats SIBO and leaky gut - i think you know of it already - mainly some plant extracts - and peppermint oil ( not sure if that is antimicrobial enough to trigger you)

there are also herbs used in animal trials - eg in beef cattle to reduce methane production
from what i've seen the reductions are typically only moderate eg 30-40% - but may be worth a browse for ideas that are non-killing - humans have a lot less methanogens than cattle

the connection between all auto-immune disease and leaky gut has been established by Pimentel et al over the last few years - in that leaky gut is a pre-requiisite for developing auto-immunity (he may be the guy behind Atrantil...?)

for a lot of us here - our infections are probably the start of that process - i used to be able to eat absolutely anything in any country visited and just digested it - no fuss no matter what i threw in
but since getting ill i get bloating, gurgling , discomfort no matter what i eat - low carb / keto helps minimise it

i think you have tried Keto before - found it helped but hard to maintain

one further point in case its been missed - is that methane making organisms actually eat hydrogen - and that hydrogen comes from hydrogen making microorganisms - ie normal SIBO organisms - so the upshot is people with methane SIBO need to treat both methanogens and normal sibo organisms - as they have overgrowths of both

there is usually other causal factors at work with SIBO - motility issues in particular - and dietary or lifestyle issues - so the overall approach often has to tackle these too - ie be multipronged

astro's suggestion might be worth a whirl - on the basis that its least likely to flare your symptoms ( just watch which laxative is used as some are absorbed to some extent and may trigger something)

given you are likely to be sensitive to most other approaches - how about doing that followed by a few weeks of v low carb to help your body keep control of overgrowth on the rebound - then gradual re-introductions - as a kind of mini-reset

hope you are otherwise doing OK - and that something here was of at least a little use / interest

all the best!

astroman said...
I apparently had methane SIBO for several years.

I first noted the odd symptoms after diving into the keto diet - which slowed my digestion and then created the perfect environment for methane SIBO.

First doctor only tested me for hydrogen SIBO two years ago. Then 2 1/2 years later, (Just this last fall ) I took both breath tests. Positive for methane.

I cured it in a very odd way: The digestion emptiness of preparation for a colonoscopy sometimes fix this. And that’s exactly what it did to me. That was three months ago. I was surprised the Gastro doctor said sometimes that happens. I googled it, it happened to other people also.

I am Late 50s so this is the second scheduled back door “ Examination “ I’ve had in my life.

*I used zero Medication to remove methane SIBO.*

Hi all. I got a lot of responses with some great information! Some of the things I had tried, and a few of the ideas were new to me. I will be looking into each of them. Unfortunately given the state I'm in at the moment I dont think I can respond to each individual post, but understand that you are appreciated!

I did want to respond to Astro's comment as it hit on something I've been worrying about.

My concern is that I did this to myself. In an effort to control inflammation and see if I could take control of the autoimmune myself, from jan 2021-apr2023 I did some some really strict diets. 1y of a paleo/GAPs ketogenic diet, 6m of carnivore, etc. While I did feel better for the first 6m or so, and I lost weight and looked better, I felt that it was really just an extreme version of trigger avoidance, and near the end I began to flare as if I were no longer on any kind of helpful diet, so I quit.

about 4m after quitting in Aug 2023 is when the first issue began. I started to notice cramping and pain after consuming dairy. I was never lactose intolerant before, and my recent endoscopy revealed basically 0 lactase (.7, >14 is normal). So I think that during the diet by not consuming dairy I made myself lactose intolerant, and I've kind of been beating myself up about it.

The lactose intolerance seemed to get better after a month so i continued eating dairy for 2023 into 2024, until the cramps came back in early 2024, except with constipation. I was thinking that continuing to eat dairy while sensitive to it (and probably other sensitivities I developed while limiting exposure to processed foods) post extreme dieting likely slowed my motility and caused methane sibo.

so seeing astro mention how his motility slowed during ketosis and he developed methane sibo was interesting. maybe i had the MOA wrong and it is as astro says, ketosis slows your digestion (maybe not enough fiber?) and causes methanogen development. This is extremely interesting and very helpful, as I was thinking the lactose intolerance or food sensitivities gained during extreme dieting are what did it.

Astro can I ask you how high were your methane numbers? How bad was your constipation, could you go on your own at all? Wo a prokinetic like linzess I go 10+ days w/o going. Reason I ask is level of severity may determine how well an intervention works or how long you have to do it. I did have an endoscopy/colonoscpy 2 weeks ago actually (the one where they discovered the no lactase), and I was thinking i felt remarkably better after (neuropathy calmed down) and digestion felt better for a few days.

Do you guys think its safe to use Colyte or colonoscpy prep for a few weeks? Any other tips or info come to mind on how i couild reproduce your results?

As sarali said, keeping the bowels moving is important. My GI wont prescribe me flagyl or neomycin as he thinks theyre both too big a risk w/ neurological autoimmune (and i've seen some horror stories online). He has kept me on linzess which has created very unnatural and uncomfortable watery stools (but preferable to the pain and constipation), and said that by keeping the bowels moving, i may clear the infection on my own. this hasnt happened with linzess and i dont think its going to as its been months, but the thought process aligns w/ what astro experienced, so maybe i just need a more extreme cleansing like a colon prep but for longer

Also, anyone have any opinion on nitazoxinide for methane? It may have some activity against methanogens, and be better tolerated by a guy like me?

Post Edited (dcd2103) : 12/31/2024 3:56:22 PM (GMT-5)

Very good points on low carb diets being fine for the healthy, but maybe the less healthy have a more difficult time re-adapting to normal food. Makes sense and makes me feel a bit better. I spent some time reading stories about guy son keto for 9m and crapping their brains out after eating a piece of cake, but youre right, they probably adjusted fine over time.

Also good point on the gut microbiome and lactose intolerance! This is an interesting video where a woman who was lactose intolerant basically ate nothing but lactose (powdered milk) for 2 weeks, forcing her microbiome to adapt! no symptoms after adaptation https://www.youtube.com/watch?v=h90rekbx95w super fascinating

But there is definitely a correlation between lactase production and lactose intolerance, and a significant portion of the population has the gene for lactose non persistence, and is lactose intolerant. Maybe they cant maintain the microbiome to support its digestion, or else they stay away from it because they react to it, so they never adapt. All I know is my endoscopy in 2017 when i first got sick showed normal lactase, and in 2024 showed no lactase, and I'm suddenly lactose intolerant. Maybe I just need to do what that woman did and eat a ton? lol

You make good points on the MMC and lack of motility being a necessary pre-requisite for methane SIBO. I had assumed that my MMC dysfunction was a function of my neuropathy. It's pretty common to have motility issues w/ SFN and POTs given those nerves control the autonomic nervous system. Only thing is, my POTs is kind of gone. I've never had motility issues or constipation even once in the 10y I've had SFN, until now after that diet. But also, my MMC does function. I CAN take a normal poop, I just need to close the tight junctions to do it.

When I took larazotide acetate, I'd pass a few normal stools 2-3 days later (it flares my enthesitis, which a lot of things do, otherwise I'd just stay on it). This was not coincidence. I have not really had a normal stool since May of 2024. It was like the most glorious thing to ever happen to me when I did a few weeks ago, and then I repeated the experiment and the same thing happened.

This kind of shifted my thinking to thinking about food intolerances as being the driver of my MMC dysfunction, particularly gluten. Intolerance -> inflammation -> leaky gut -> impaired motility -> constipation is how I drew it up, and why I had started to focus on that. How would you explain larazotide making me go to the bathroom otherwise?

My question for you would be if you believe MMC dysfunction essentially causes or sets up methane SIBO, do you think fixing the MMC would ameliorate the issue? Does the SIBO clear? Or do you still need to do a killing phase?This is kind of what I was getting at w/ my last post about what my gastro said about getting the bowels moving to fix the issue.

My concern is that he has me on linzess, which is a little closer to an osmotic in MOA. I want to try to get him to prescribe Motegrity, which more closely stimulates natural peristalsis as you described. Maybe that will work better?

Also, I love your description of what may have happened w/ the colon cleanse and how resumption of food may replenish good bacteria, very insightful, and also possibly describes an opportunity to really hit the gut w/ some beneficial prebiotics to grow the good bacteria.

dcd2103 said...
My question for you would be if you believe MMC dysfunction essentially causes or sets up methane SIBO, do you think fixing the MMC would ameliorate the issue? Does the SIBO clear? Or do you still need to do a killing phase?This is kind of what I was getting at w/ my last post about what my gastro said about getting the bowels moving to fix the issue.

My concern is that he has me on linzess, which is a little closer to an osmotic in MOA. I want to try to get him to prescribe Motegrity, which more closely stimulates natural peristalsis as you described. Maybe that will work better?

I found that fixing the gastric motility issue did resolve the gas. However, for me the cause was HPA dysfunction and not neuropathy, so I don't have any suggestions regarding neuropathy, other than the usual options for autoimmune disorders.

I tended to get salt loss and electrolyte disturbances due to herxing/detoxing and poor adrenal function, so I'd be a little cautious with linzess.

Great discussion guys

Appreciate all the feedback.

Garzie - The link you provided was interesting and definitely helped me understand better how MMC dysfunction keeps archaea out of the SI. It's well known that it's a motility issue at its root, but the physical description of how it works was very helpful, especially since it kind of illustrates why Linzess may not work (it's getting the bowels moving, yes, but its not necessarily normal MMC activity that would move archaea back out of the SI). Unfortunately the author comes back to antimicrobials, which I cant handle...it's the catch-22 I keep running into - neuropathy makes treating dysbiosis nearly impossible. Your info on the villi and the immune system was also helpful. Again, helps put a bit more of a physical description on a phenomenon I've noticed in myself, the flaring of my neuropathy w/ gut disturbances, and it sounds like you've noticed as well. Also interesting points on how this inflammation in the gut lining leads to stomach issues in other chronic illnesses.

Quin - great to hear you actually can beat this when motility is restored

Astro - very helpful story as well. Definitely found it interesting how you point out that the meat binge immediately precipitated the SIBO. Not that that was the cause, but just kind of illustrates why a lot of people fail to control SIBO w/ carnivore and low carb. Your points on very low-carb not being great for everyone are well taken. I used to take it as a fact that very low carb was superior, im kind of in your camp now where I prefer a balanced, lower-processed, lower carb diet, but not crazy. Just a common sense one. I'm almost your size exactly, 5'11.5", about 170 lbs now. On keto I got down to 158, which was way too low.


So basically, to summarize what I'm hearing from everyone:

1.) chronic illness leads to inflammation which almost always disturbs the gut.
2.) Sometimes if its mild, you can mess around with diet changes or things like cleanses, and it rights itself on its own
3.) If there's a motility issue at its root, that needs to be addressed or it will never correct permanently

Coming into this I knew all 3 points, but the discussion around point 2 was particularly helpful and insightful, as it helped me better understand and verbalize the mechanics in my head on why some people are able to get out of this loop so easily, and some aren't. Garzie's points on how readjustments coming off extreme diets are easy for a healthy person, and maybe harder for a sick person, were also helpful, as I had started to question my own dieting in 2021/2022. Appreciate the insights on all of this.

As a side note, we never answered why larazotide acetate seems to normalize my stools. No one seems interested in this anecdote but me. Maybe because I experienced it, and it was so intense and undeniable. If I could tolerate it I'd use it daily. But there is some mechanism by which leaky junctions slow motility, and I do think that could be part of the missing puzzle. If I could buy the patent cheaply, and fund a trial for IBS to get more than 1 datapoint, I would.


Next steps:
So where does that leave us.....well, I'm still not certain what I need to do. Tell me if my reasoning here on next steps, at this point, makes sense:

I've assumed I had a motility issue as well. But thats not an easy fix. If it was a food sensitivity causing leaky gut like I was starting to get curious about, based on my larazotide experiments, sure....but if the neuropathy is causing a motility issue, well I'm not sure yet how to make it go away; believe me, I want that and I've tried. Linzess, while keeping the food moving and the severe pain at bay, is not a fix for a properly functioning MMC, as we have discussed. The next option would be Motegrity, which stimulates the brain to make the MMC move, does get the MMC moving in at least a semi-natural way. I will try it next, but it does have side effects and I may not be able to handle it.

But...I do think I need to eradicate the archaea. My plan had been, if I cant fix my neuropathy or whatever is causing my motility issue, then I need to eradicate the archaea. That DOES fix things temporarily, until the MMC dysfunction causes a relapse. But in the mean time, I could clean up my diet again, and hopefully the motility agents like Motegrity could help keep it at bay for long periods, maybe even indefinitely.

So how to eradicate the archaea? Flagyl is a no-go. I've seen too many people develop neurological issues on it, and I'm ultra vulnerable. Neomycin, I'm not risking that. Herbs cause bad flares and work extremely slowly on archaea, we know I cant handle that for several months.

But I did find this paper on what compounds archaea are vulnerable too.

https://www.sciencedirect.com/science/article/pii/s1198743x14610600

"Archaea are, however, susceptible to the protein synthesis inhibitor fusidic acid and imidazole derivatives"

Metronidazole is an imidazole derivative, so that checks out. There is another imidazole derivative that I had used before, in 2021, when I thought I had blasto. Tinidazole. I did not flare from it. There are also a few people who I've been able to find w/ methane sibo who have responded to it and believe it is active against archaea, based on their experience. So that likely will be what I try next. I'm not sure if it will work, but since I seem to tolerate it, why not. Thoughts?

Other imidazole derivs that are worth considering are secnidazole, and possibly ketoconazole (as it may help if there's a fungal component too, it's easy to get in pill form and relatively well tolerated, just have to watch liver). I understand that none of these may have activity against archaea, but it's also possible they do. It's likely that no one has looked into it before; archaea just dont seem to be on anyone's radar for some GD reason.

I'm also not familiar with fusidic acid, anyone else know anything about it? Safe? Tolerable?

So I will try switching to motegrity for motility, and will try to get some tindimax I think, and will continue to try to remove gluten/dairy for now in case those are intolerances slowing motilty.

Other ideas:

*The colon prep idea will have to be tabled unless I can get a prescription from a dr (and I would want to do at least a weeks worth, as my 2 days colon prep wasnt enough as we discussed, so that's probably not gonna happen), my source overseas does not have access to it unfortunately.

*Elemental diet. It seems a few people have been able to get their levels down doing this, although relapse rates are high.

Thoughts on tindimax? Or that game plan? or other ideas?

Finally, one other thought has come to mind. Immediately after developing this constipation this summer, I developed "fungal acne" on my forehead that comes and goes when its humid. I then had ringworm on my thigh which I got rid of w/ a topical. A couple months later I had some fungal thing on my ear. This past 2 weeks I developed what appears to be fungal follculitis.

I'm not sure if it's the same fungus which has caused all 4. I know it's usually candida which affects the GI tract and its not candida that usually causes fungal folliculitis...or maybe it is here.

I assume this is likely a downstream affect of the messed up microbiome, and not the cause, but to what extent would an oral antifungal help this?

Thanks again! Sorry for making this all about me, but maybe others can benefit from the discussion as well. And happy new year!

Post Edited (dcd2103) : 1/2/2025 8:22:25 AM (GMT-5)

Just in case another gentle herbal option is desired to help out the migrating motor complex, Bacopa monnieri could be considered. It can do something for the acetycholine receptors in the gut like it does in the brain. My son has slow digestive transit, probably secondary to a childhood "Bell's palsy of the gut"-like condition that got (relatively) better from B12 shots and LDI at the time.

He came home from the ICU severely relapsed back into constipation this summer, and Bacopa did the trick to get things moving again. I didn't even know it would have that effect, since it's mainly known as a nootropic. But it does have that effect on the gut at the right dosage. The Bacosides have to be high enough. I give him a source with 50% Bacosides.

Most online herb resources don't list this characteristic of Bacopa, but if you search, you can find a very few practitioners who know about it and recommend it to help with constipation and/or SIBO.

eating too much iron-rich food i a big cause for constipation.
it would be wise to look into oxalates too, one reason why the carnivore diet seems beneficial to many in the beginning is the body gets freedom from oxalates.

Good discussion there Garzie.

I’ve tried extended fasting and I naturally IF, I’ll often have only one meal a day, or just breakfast and lunch, w little to no snacking. It’s just how I eat.

I do not know why but extended fasting seems to make me worse. I’ve tried to go a couple days without eating and the bloat becomes intense to the point where eating something actually relieved it. This did not happen when I only had hydrogen - fasting immediately made me feel better. I’ve seen others w methane say the same thing. Can’t figure out why. Maybe if I tried to power thru and get to 5+ days it would die down. I’ve done an 11 day water fast pre-methane so I’m no newbie.

I’ve tried Tindimax before as I mentioned, for blasto in 2020 or 2021. I was expecting a massive flare, and it was pretty minimal - it’s less active again bacteria than metro. But like I said, what scares me the most about metro are the neuro side effects. It’s a known neurotoxin for some people and I’ve met a handful of people who have made their way into the SFN groups whose SFN began w metro. I’ve seen some other weird neuro stories on it as well. Given my profile, it’s a hard pass for me right now. Tindi seems preferable to me especially given I’ve taken it before.

WRT to larazotide, I agree with all your points. But you were more broadly talking about autoimmune and leaky gut. I was trying to directly explain the mechanism of how when I take larazotide, I poop normally a few days later, which I’ve otherwise been unable to do since literally May of last year. I’m obviously not resolving my autoimmune disease in a couple days. So I keep coming back to the fact that it stands to reason, at least to me, that food particles escaping the membranes is causing some sort of extra-intestinal inflammation which is affecting the enteric nerves/autonomics and slowing my motility. That is at least one theory on why/how motilty slows.

Post Edited (dcd2103) : 1/4/2025 11:59:50 AM (GMT-5)

hi dcd

yes - i recall you were experimenting with fasting and keto - was just trying to be complete rather than inferring you were new to any of this

i am not sure why you think tinidazole is less antibacterial that metronidazole - they are essentially the same class of drug - with the exact same active group - and behave extremely similarly with the same adverse reactions etc - some of the studies i have seen find tinidazole is actually more antibacterial - requiring lower MIC and MBC's than metronidazole
more info here https://pubmed.ncbi.nlm.nih.gov/318974/

ref the peptide - who knows - perhaps it is directly antimicrobial to the methanogens - or perhaps as you say - its closing the tight junctions and everything settles down in a coupleof days and the gut starts working again
the gut does have very fast healing times - so perhaps its able to bounce back quickly once the tight junctions close down -

i actually find this very interesting - how long have you taken it for - and what happens to your systemic symptoms if you take it for longer than a few days ?

maybe its not the kind of long lived auto-immunity we are used to discussing - perhaps there are forms that revert much more easily - after all the body is producing auto-antibodies to stuff all the time - and sudden stressors are known to cause short lived auto-immune responses - for instance people who are hospitalised can quite commonly have a flare of auto-immunity towards their thyroid gland - which seems to settle down when they are discharged

have you experimented with other agents that help close tight junctions ?
eg - perhaps other peptides do this
i read that L-Glutamine seems to and Zinc Carnosine does too i think

thanks for sharing your experiences dcd - i do find it interesting

sorry to hear how sensitive the enthesitis is to so many things - such a bummer that the things that help one thing often seem to irritate it - hope you manage to find some things that help and don't flare it

i tried l-glutamine also some time ago and it increased headaches and made me feel generally worse - but that was a good while back and i have virtually no headaches now

a few other things i dredged from my memory for improving gut motility

1, walking after meals. walking reduces gut transit time - running also - but walking works well enough.
in fact toddlers often get something called toddlers tummy - when they start to walk and then start running around all day. distance runners get the runs also for the same reason.
when my sibo symptoms flare i often notice the bloating and discomfort calms down significantly after a walk.
i know its not always convenient - but as its drug free i thought i would mention it as it may be helpful as a part of a multipronged attack / comprehensive program to try and get the MMC back on line

2, ginger/ gingerols from ginger - is a known gut movement stimulant that speeds up transit - often used in the post antimicrobial phase of sibo programs
i think ginger has some mild antimicrobial effects too though - but i have never experienced herx from it - even in high dose extract form - so probably not a strong antimicrobial

more info on other prokinetic herbs here
https://www.byronherbalist.com.au/herbal-medicine/prokinetic-herbs/

i see there is a herbal product called Iberogast which is aimed at improving motility and gut function - but i guess it could be risky in your case as multiple ingredients means more risk of reacting

i tried sodium butyrate - again some time ago - I felt like it had mild beneficial effects on my BM's

keep us posted on the BPC-157 trials - i think a few others here have tried it and found some benefits

all the very best !