Small intestinal bacterial overgrowth, or SIBO, is a persistent medical condition that affects many individuals, even those with a previously healthy gut. The main types of SIBO, hydrogen SIBO, methane SIBO (also called intestinal methanogen overgrowth, or IMO), and hydrogen-sulfide SIBO produce gas that causes constipation, diarrhea, and other stomach issues. The following article will delve into hydrogen SIBO specifically, highlighting the main symptoms of this medical condition and offering ways to treat and manage this digestive disorder.

Understanding Hydrogen SIBO: An Introduction

Hydrogen SIBO is the result of excessive bacterial overgrowth occurring in the small intestine. When large amounts of this bacteria build up in the small intestine, the result is the production of hydrogen gas. The small intestine is meant to be relatively sterile, while most of the healthy intestinal bacteria should be localized in the large intestine (colon). Serious digestive issues can occur when bacterial growth is out of control. The bacteria feed on carbohydrates, resulting in fermentation and gas production, production of excess hydrogen gas, and symptoms of intestinal bacterial overgrowth (SIBO).

Recognizing the Symptoms of Hydrogen SIBO

Individuals who suffer from hydrogen SIBO encounter many primary and secondary symptoms related to this medical condition, including the following:

Primary Symptoms of Hydrogen SIBO

Though some individuals present differently and may have multiple types of SIBO, the primary symptoms of hydrogen SIBO include diarrhea and bloating, as excess hydrogen gas can increase the amount and frequency of bowel movements. Bloating is a common symptom for both hydrogen SIBO and methane SIBO; however, this SIBO symptom may be more prevalent with hydrogen SIBO as the carbohydrates rapidly ferment and produce excessive gas. Cramping, abdominal pain, and flatulence are other symptoms of hydrogen SIBO.

Secondary Symptoms

Some secondary symptoms associated with hydrogen SIBO include fatigue, weight loss, and joint pain. Fatigue likely stems from bacterial overgrowth interfering with the normal absorption of nutrients, such as fat-soluble vitamins, B12, and iron, which can result in deficiencies. Weight loss may occur due to a combination of eating less because of discomfort and the body’s inability to digest and absorb nutrients properly.

How Symptoms Differ from Methane SIBO or Hydrogen Sulfide SIBO

When comparing the symptoms of hydrogen SIBO to methane SIBO, individuals suffering from methane SIBO will often experience constipation as opposed to diarrhea, as the methane slows down the processing time in the intestines. Hydrogen sulfide SIBO sufferers may experience a rotten egg (sulfurous) smell in their breath or flatulence, generally feel sicker overall, and have more non-GI-related symptoms.

Common Causes of Hydrogen SIBO

To properly treat hydrogen SIBO, it’s essential to understand the causes of this medical condition. Here are a few common causes of hydrogen SIBO:

Dietary Influences

Those whose diet consists of a lot of alcohol, artificial sweeteners, highly processed foods, and fermentable carbohydrates, such as grains, sugars, and fruits, may experience a bacterial imbalance as these carbohydrates can fuel hydrogen-producing bacterial overgrowth.

Structural Abnormalities and Surgery

If your small intestine has structural abnormalities, such as diverticula or adhesions, these areas can become locations where bacteria may collect and grow. Additionally, the remnants of procedures such as gastric bypass surgery may make an individual more likely to experience SIBO because the natural flow of digestive content could be disrupted.

Medications and Antibiotic Use

Certain medications may contribute to SIBO development. Proton pump inhibitors can change the gastric acid barrier and promote SIBO development, while antibiotics disrupt the gut microbiome.

Underlying Medical Conditions

Certain underlying medical conditions may increase the risk of developing hydrogen SIBO. Some medical conditions associated with this increased risk include irritable bowel syndrome, inflammatory bowel disease, celiac disease, and immune deficiency conditions.

Managing Hydrogen SIBO with Dietary Strategies

There are ways to help manage hydrogen SIBO via diet. Here are some top ways to manage your hydrogen SIBO symptoms through dietary changes:

• Consider a low FODMAP diet: A low FODMAP diet should be done with the help of a registered dietitian. It’s important to note that this diet is more for symptom management than for treatment.
• Limit dietary triggers: Avoid alcohol, artificial sweeteners, highly processed foods, and fermentable carbohydrates, such as grains, sugars, and fruits.
• Consider meal timing and size: Reduce your meal size and space out your meals for optimal results.

Testing for SIBO

Because symptoms of SIBO often overlap with other digestive issues, getting an accurate test is an important first step before beginning treatment. The most widely used method is the breath test, which measures hydrogen and methane gases after drinking a carbohydrate solution such as lactulose or glucose. A rise in hydrogen typically points toward hydrogen SIBO, while higher methane levels suggest intestinal methanogen overgrowth (IMO). 

Though not flawless, breath testing remains the most practical and non-invasive option available. In more complex cases, healthcare providers may recommend additional approaches, such as stool analysis or even aspirating fluid from the small intestine, though these are less common. Proper testing helps distinguish SIBO from conditions like IBS-C, which often present with similar symptoms.

Treating Hydrogen SIBO

Treat your hydrogen SIBO condition by using a few different treatment methods, including:

• Antibiotics and herbal supplements: Antibiotics are often the first treatment method prescribed for SIBO sufferers. The antibiotic treatment, typically Rifaximin, will quickly reduce bacterial overgrowth. Herbal supplements may also be recommended as an alternative to antibiotic therapy or used in conjunction with antibiotics. Always consult your doctor before using supplements to ensure they are safe for you.
• Dietary management: Consider working with a registered dietitian to figure out the best dietary approach to your treatment.
• Probiotics and prebiotics: Your health professional may also recommend taking probiotics and prebiotics to aid in managing your hydrogen SIBO symptoms. It’s essential that only specific types of probiotics are used during treatment, and that prebiotics are NOT used during treatment—only after. Always consult your doctor or dietitian for guidance when taking probiotics and prebiotics.

Prevention, Maintenance, and Personalized Care for Hydrogen SIBO

Long-term prevention and maintenance strategies will help you face your hydrogen SIBO diagnosis and digestive symptoms with confidence. As you adjust your diet, be sure to keep track of what works for symptom relief and which treatment options are less favorable for your individual journey with hydrogen SIBO.

Your Next Steps: Navigating Hydrogen SIBO with Confidence

It’s normal to feel overwhelmed by a hydrogen SIBO diagnosis. Knowing that there is support available for your journey of managing this medical condition can provide great relief. Healthcare providers at IBS clinics, particularly those well-versed in SIBO diagnoses, can assist you on your path to reducing and alleviating the symptoms associated with this condition. Embrace a treatment plan and symptom relief process that’s tailor-made to fit into your lifestyle and to help you face your hydrogen SIBO diagnosis with confidence.