Constipation Methane SIBO Treatment: 2024 Guide
Methane SIBO is its own special kind of small intestinal overgrowth. It even has its own name - Intestinal Methanogen Overgrowth (IMO). But for now, understanding how it differs from the more common hydrogen form of SIBO (Small Intestinal Bacterial Overgrowth) is critical to developing a natural methane SIBO treatment protocol that addresses its well established defences. From chronic constipation and fat-loss resistance, to interpreting test results and choosing interventions, methane SIBO constipation is an extremely complex GI condition and one that can be difficult to eradicate.
Last Updated: April 2024
Here is what we are going to cover in this guide:
As always, we’ve referenced peer-reviewed scientific journals where possible to illustrate the current research on methane SIBO. We’ve also relied on our own clinical experience at The Functional Gut Health Clinic working with thousands of clients who have tested positive for methane SIBO. I’ll also share insights from how I cured my methane SIBO years ago, the journey that ultimately inspired the work we do now to help others.
What is Methane SIBO?
Methane SIBO occurs when methane-producing organisms, known as archaea, overgrow in the small intestine. This type of SIBO is most commonly associated with constipation and bloating. It is diagnosed through a breath test that measures methane levels and is also referred to as Intestinal Methanogen Overgrowth (IMO).
Is IMO the new Methane SIBO?
As the science around methane SIBO develops, researchers have proposed a new term, intestinal methanogen overgrowth (IMO), for methanogens rather than SIBO. This is for two important reasons:
Methanogens that produce methane gas are not “bacteria” (the “B” in SIBO) but are part of the Archaea domain.
Methanogens can also overgrow in the colon (large intestine) and not just the small intestine (the “SI” in SIBO).
For us, this update is in name only but it highlights why we have approached methane SIBO differently to hydrogen SIBO for a long time. Hopefully a name change helps more practitioners to do the same in the future with a targeted approach to IMO treatment. Until the term becomes widely adopted, we will continue to use the term methane SIBO throughout our blog posts and articles.
What causes Methane SIBO?
To address methane SIBO effectively, it is important to understand the root causes and key mechanisms at play. Put simply, the first thing we need is for archaea to make it into the small intestine and secondly, they need the right conditions to actually overgrow.
Archaea can enter the small intestine from the mouth and flow down into the small intestine. This typically happens when stomach acidity is low and this first line of defence is not working. The other way archaea can arrive in the small intestine is from a bloom in the large intestine that works it’s way back up through the ileocecal valve (ICV). This happens when the ICV isn’t working properly.
If archaea do end up in our small intestine, they should normally be moved along by the Migrating Motor Complex (MMC), the cleansing wave that pushes food and waste through our small intestine. So for archaea to become ‘stuck’ and overgrown, the MMC needs to be damaged or not working properly.
The most common causes of methane SIBO are conditions that impair motility, digestion and/or outflow, such as:
Food poisoning (most common)
Traumatic brain injury
Hypothyroidism
Diabetes
Mold
Chronic infections (parasites, Lyme)
Scleroderma
Ehlers-Danlos syndrome
Disordered eating
Abdominal surgery
Endometriosis
Ileocecal value dysfunction
Impaired digestion (HCL, enzymes and bile)
Medications such as PPIs, opioids, tricyclic antidepressants
We’ll discuss the way in which we identify and address root causes of methane SIBO later in this article.
The archaea behind Intestinal Methanogen Overgrowth
It’s not technically bacteria that cause methane SIBO, but single-celled organisms called archaea. But, ‘SIAO’ just doesn’t have the same ring to it. The specific species of archaea in the small intestine that is most commonly responsible for methane SIBO is Methanobrevibacter smithii (M. smithii).
And because archaea feed off hydrogen to produce methane, it was previously thought that all methane SIBO cases were accompanied by a hydrogen SIBO overgrowth as well. But we have recently learned through research from Dr Pimentel and his research team that the bacteria feeding archaea are commensal or normal flora for the small intestine.
Archaea are getting hydrogen from Christensenellaceae and Rimunococcaceae (commensal bacteria), not Klebsiella and E.coli, the bacteria responsible for hydrogen SIBO.
Methane SIBO Symptoms
Research studies indicate that up to almost 80% of those with diagnosed IBS, have SIBO as an underlying root cause. The most common symptoms of methane SIBO are:
Constipation
Bloating
Distension
Flatulence
Abdominal pain
Unexplained weight gain
Methane SIBO symptoms are often different to those of hydrogen-dominant SIBO. Here are the three main signs we look for to indicate whether a SIBO lactulose breath test for methane SIBO is warranted:
> Constipation: discussed in more detail below, methane gas slows down transit time and causes constipation in most of those who test positive for methane SIBO.
> Bloating and distension: bloating is probably the most common and noticeable symptom of methane SIBO. While the archaea consume the hydrogen gas which might theoretically reduce total gas volume, our experience clinically is that methane SIBO clients tend to have more sustained bloating. This may be because of the slow motility (constipation) causing the gas to become trapped in the GI tract for longer compared to the more diarrhea-dominant form of SIBO.
> Unexplained weight gain: the archaea responsible for methane SIBO are also known as obesogens that help the body extract additional calories from our diet. Previous studies have also demonstrated that methane gas slows small intestine transit time, which may contribute to increased weight gain by increasing the amount of time during which energy is extracted from meals. This methane SIBO weight gain is something that I experienced first hand, gaining over 10 kg in the space of two months before testing positive for methane SIBO (and then losing it again post-treatment). It’s also something we see a lot with our clients who have methane SIBO constipation. The good news is it’s fixable.
The Methane SIBO Constipation Connection
SIBO Constipation: How does SIBO affect bowel movements?
The way that methane SIBO can cause constipation is through slowed motility in the small intestine. Elevated methane gas from methane SIBO slows down transit time which leads to constipation. Research has also shown that the higher the methane gas elevation, the more severe constipation becomes.
While you might think SIBO constipation is preferable to diarrhea, and symptomatically in the short-term you might be right, constipation caused by archaea can create a vicious cycle of SIBO that is harder to break than the traditional SIBO-H, diarrhea type. Constipation caused by methane SIBO was one of the main causes of my own healing struggles, so let me explain some more.
Methane slows transit time and causes constipation, and this slowed motility allows more archaea to grow, which causes more methane and more constipation… and so on, and so forth. SIBO constipation is a difficult cycle to break without the right approach.
While you're working on eradicating methane SIBO, it's essential to manage constipation in the short term. Our Chronic Constipation Clear-out e-Guide outlines the exact strategies we use with clients to get things moving when nothing else works. Get it here: Constipation eGuide LINK
Methane SIBO Testing
There are a number of testing options for methane SIBO, including:
SIBO Breath Test - an at-home, non-invasive, simple and relatively cost-effective way to measure methane on the breath. The most practical, standardized and clinically useful testing option we have available right now.
Aspirate culture - a procedure to take samples from the small intestine to grow and identify bacteria and archaea. Expensive and invasive so mostly used for clinical research.
Breath test devices such as FoodMarble - can be helpful if you independently source the sugar substrate and follow standardized test prep guidelines.
We prefer to use a lactulose breath test for clients we suspect have methane SIBO, ideally being consistent and using the same lab for retesting since there can be variability between labs.
The way that a SIBO breath test works is we take a baseline breath sample, then we drink a sugar solution, and then we wait for the bacteria or archaea in our gut to start fermenting those sugars, which causes the gas production. We then take a breath sample every 15-20 minutes for up to 3 hours which measures the type, timing and amount of gas being exhaled to get a picture of what is happening in the small intestine.
If we get a rise, or an elevation, in methane gas within a certain time, we have a positive methane SIBO, or IMO breath test result.
Which sugar substrate is best for methane SIBO testing?
Lactulose is an artificial lab-made sugar that humans can’t digest. It basically passes unabsorbed through the small intestine and into the colon. This ability to pass through the whole small intestine without being absorbed is why it works so well as a SIBO testing option. It allows us to get a full assessment of the small intestine from top to bottom. And the really good news is that archaea have no issues fermenting lactulose.
Fructose can also be used, but glucose is not a good choice of sugar substrate for methane SIBO. This is because glucose is highly absorbable. This means it really only measures overgrowths that exist in the upper part of the small intestine and can miss an overgrowth in the later part of the small intestine.
SIBO Lactulose Breath Test INTERPRETATION
SIBO test interpretations aren’t always ‘black and white’ and there are still inconsistencies between practitioners, researchers and labs in different countries about what is considered a positive methane SIBO result. As per the North American Consensus, the currently agreed numbers that indicate a positive methane SIBO result on a three-hour lactulose breath test are: Methane levels ≥10 p.p.m.
You will commonly see SIBO test reports and interpretation guidelines that reference a rise of ≥12 p.p.m. within 100-120mins as being positive for methane SIBO. These numbers can be used but we do see lower numbers correlating with methane SIBO symptoms so we don’t use this higher cut-off clinically.
Having worked with thousands of SIBO clients and reviewing thousands of SIBO test results, we have a more nuanced approach to interpretation that considers gas levels, the timing and correlations with clients’ symptoms. The most important part is relating the lab results back to the client’s symptoms and making sure there is a fit between them both. For clients who have all the classic methane SIBO symptoms, but lower levels of methane gas, we might still consider this as methane SIBO and do something about it with the aim of reducing their symptoms.
Where gas levels are low but symptoms are severe, this is a clue for us to look outside of the small intestine for additional root causes that could be contributing to a client’s overall symptom load.
Example SIBO Breath Test Report
Stool Analysis and Microbiome Assessment
When a client presents with the classic signs of methane SIBO, it is rare that we would only order a SIBO lactulose breath test. We would also typically recommend an advanced stool analysis and microbiome assessment for the following reasons:
1. SIBO symptoms overlap with other gut infections and imbalances: the symptoms of constipation, gas and bloating are common to many other GI imbalances and so only relying on a SIBO breath test could result in missing a whole range of other imbalances that need to be considered while addressing methane SIBO. This includes bacteria associated with methane elevations like H.pylori as well as levels of beneficial bacteria known for keeping methane in check.
2. Not all methane producers are symptomatic: somewhere between 30-50% of the world’s population are thought to be methane producers, many of whom are not constipated or otherwise symptomatic. This means methane levels alone, may not be the sole reason for symptoms and dysfunction. Identifying or ruling-out other imbalances will help inform the most effective treatment approach to address the underlying root cause of symptoms in each client.
How to Treat Methane SIBO
While we’ve previously written a separate blog on our approach to treating SIBO, here are the key things you need to consider when treating methane SIBO specifically. Basically, archaea are tough organisms to kill and you need to work with someone who specializes in methane SIBO and understands how to get rid of constipation from SIBO to break that cycle.
1. Diet for Methane SIBO
A methane SIBO diet is helpful for two reasons. First, the right diet can help to reduce symptoms in the short-term and lay the foundation for healing. Second, restricting the food supply to the bacteria and archaea responsible for excess gas production is an important part of the methane SIBO treatment approach.
While we customize our methane SIBO diet plans to each individual client, here are some of the general things we consider and the most common methane SIBO foods to avoid:
Fermentable fiber
Given that archaea feed off hydrogen, what do hydrogen producing bacteria feed off? The answer is: fermentable carbohydrates. This is why diets like Low FODMAP are often used to restrict fermentable fiber content for SIBO. However, for methane SIBO associated with constipation, reducing fiber will often exacerbate constipation. This is not something hydrogen SIBO sufferers generally need to consider. Less fiber in the diet also lowers Short Chain Fatty Acids (SCFA) like butyrate which have been shown to be inversely related to methane levels and enhance colonic motility.
It is for this reason that we can’t cut out fiber for methane SIBO and why diets like Low FODMAP can cause further issues if not properly adapted. It is important to try and increase fiber and polyphenols where tolerated to help feed up the beneficial bacteria associated with improved motility and methane reduction. Here are a few foods we like to incorporate and prioritize when tolerated:
> Flax seeds
> Berries
> Nuts and seeds
> Brown rice
> Quinoa
> Green tea.
FAT and HIGH FAT Protein sources
Another consideration is the type of protein being consumed. When reducing carbohydrates, many people replace it with increased quantities of fat and animal proteins. This can be problematic as recent studies suggest excess dietary fat promotes absorption of lipopolysaccharides (LPS). LPS are the endotoxins released by bacteria that can promote inflammation. So, increasing their absorption may contribute to various inflammatory disorders or at least an increase in inflammatory type symptoms. Reducing high-fat foods like high-fat cuts of red meat and adding in other proteins like chicken or fish can help for some.
Soy isoflavones
Isoflavones found in soy products have been shown to reduce methane and hydrogen sulfide gas production. This is because hydrogen (the food for methane and sulfate-reducing bacteria) is consumed by equol-producing bacteria when a soy isoflavone known as daidzein is converted to equol. This means including lower FODMAP and organic, fermented soy products like tamari, tempeh and miso (if tolerated) can be a helpful addition to a methane SIBO diet.
2. Eradication options
Antibiotics for methanogenic archaea
A lot of methanogenic archaea are resistant to the majority of antibiotics that are commonly used against bacteria. So the antibiotics that are typically used to clear out bacterial infections tend to be ineffective with these types of archaea.
Even the most commonly used antibiotic for SIBO, Rifaximin (Xifaxan) has reported success rates of around 30% in methane-producing subjects, when used on its own. However, the combination of Rifaximin and Neomycin together has produced success rates of up to 87%. Unfortunately, Neomycin is a broad-spectrum antibiotic known to cause damage to the microbiome. For the last fifty years, it has commonly been used in sterilizing the GI tract, permanently reducing the population of many beneficial bacteria species. Medical research also demonstrates that Neomycin can disturb the intestinal membrane, increasing the risk of other disease states. As such, it may be effective in wiping out SIBO but your gut may not easily or ever recover properly from the impact it has on the microbiome.
It’s worth noting that Rifaximin is considered to be narrower in spectrum to more commonly prescribed antibiotics and is not as well absorbed outside the upper GI tract. That basically means it is less likely to wipe out your gut flora to the extent that other antibiotics like Neomycin might. But because Rifaximin on its own has low success for methane SIBO and we don’t want to permanently damage the gut with Neomycin, antibiotics definitely aren’t our preference for first line treatment.
Natural HERBAL Antimicrobials for Methane SIBO
When it comes to what kills methane SIBO naturally, our preferred first-line approach involves using natural herbal antimicrobials (botanicals). Not only do we find them less aggressive, they have also been shown to be at least as effective as antibiotics in clinical trials for SIBO and are less detrimental to your beneficial gut microbes.
Two important principles to keep in mind when using antimicrobials to eradicate methane SIBO are:
1) Combine to kill - there are varying types of bacteria and archaea that can cause SIBO and not all antimicrobials can kill off all types. The best way to overcome this is through the use of two different herbs for maximum effectiveness.
2) Rotate to avoid resistance - bacteria and archaea are smart and will adapt quite quickly. While not as common as antibiotic resistance, the effectiveness of a given herb tends to diminish with successive rounds.
Most protocols last around 30-45 days per cycle and vary by the type of SIBO you have. Depending on methane gas levels, more than one round of treatment may be required. In terms of specific herbs, a lot of the research comes from livestock where methane production is a significant environmental concern. So, while not perfect, it does give us some science to back up what we see clinically.
Having treated methane SIBO constipation in thousands of clients, our preference is to use blends and combinations that include the herbs listed below. We create individual protocol recommendations, personalized to each client that both combines and rotates through methane SIBO specific products.
While specific brands and dosages are being updated all the time, our preference for methane SIBO is to use blends and combinations that include the following main herbal ingredients.
Allicin (garlic) - Animal study. One option we often recommend is Allimax Nutraceuticals, Allimed Capsules 450mg.
Oregano - In vitro study. One option we often recommend is Biotics Research, A.D.P. Oregano.
Neem - Animal feed study. One option we often recommend is Ayush Herbs, Neem Plus.
You can access these (and many more) products from our Fullscript Dispensary at 20% OFF RRP. You will need to sign-up to create a Fullscript account to access these products and discounts and find them in our favorites under ‘SIBO Antimicrobials’. Click the link below or visit: https://us.fullscript.com/welcome/blindemann
Elemental Diet for Methane SIBO
The Elemental Diet for methane SIBO is another approach we often consider for particularly stubborn instances of methane SIBO. If various rounds and combinations of herbal antimicrobials or antibiotics haven’t been sufficiently successful, the Elemental Diet has pretty strong clinical evidence for reducing hydrogen, which we know is a fuel source for methane-producing archaea.
It is basically a liquid diet of pre-digested nutrients that are absorbed in the upper part of the small intestine. This effectively starves the bacteria in the lower part of the small intestine that is responsible for feeding methane SIBO. Given this approach starves beneficial gut bacteria, it is best used as a last resort and for a short period of time to avoid long term dysbiosis.
While it is possible to make your own, we tend to recommend Physicians’ Elemental Diet by Integrative Therapeutics (available on our Fullscript Dispensary) as it contains a balance of macronutrients, minerals, essential vitamins and electrolytes that can be used as a sole source of nutritional intake for a two to three week period. We typically prefer the Dextrose-free formulation, especially for clients who are wanting a lower sugar option and may have a fungal overgrowth in the small intestine.
A note on SIBO biofilms
An estimated 80% of bacterial infections, and possibly higher in archaea infections, involve biofilms. Biofilms are colonies of microorganisms that are protected by an extracellular matrix - which we think of simplistically as a protective home for the infection to live in. This protective home makes the infection up to 1000 times more resistant to antibiotic therapies and therefore, more difficult to kill. This is why a comprehensive antimicrobial methane SIBO treatment protocol will generally include the use of a biofilm disrupting agent, like Biofilm Defense by Kirkman Labs or Interfase Plus by Klaire Labs (available on our Fullscript Dispensary).
Did you know that all of our practitioners specialize in Methane SIBO Constipation? At The Functional Gut Health Clinic, we specialize in ordering and interpreting SIBO breath tests as well as restoring proper microbiome balance and GI function for those with IBS symptoms.
3. Microbiome Support
Prebiotics for methane SIBO
After antimicrobials (or in some cases, at the same time), it is often advisable to use a prebiotic called partially hydrolysed guar gum (PHGG) that has been shown to reduce methane levels. PHGG helps feed good bacteria that are anti-inflammatory, improve transit time and restore balance to the small intestine. Feeding the good guys, such as anti-inflammatory butyrate-producers and Bifidobacteria, and encouraging the right balance of flora is an important part of reducing methane production and long term rebalancing of the microbiome. A product we often recommend to our clients is Tomorrow’s Nutrition PRO, Sunfiber (available on our Fullscript Dispensary).
Another prebiotic known as Galacto-oligosaccharides (GOS) has also been shown in animal studies to reduce methane levels. In clinical practice, we have found this best to be introduced toward the end of treatment to avoid symptom reactions. We most commonly recommend to our clients a prebiotic blend that contains GOS by Microbiome Labs called MegaPre (available on our Fullscript Dispensary).
Given many SIBO sufferers react negatively to prebiotics, there is obviously a delicate balance here and prebiotics are something that needs to be introduced slowly. As with many complicated conditions, there is a subset of methane SIBO clients who seem to thrive on prebiotics during and after treatment and those that become very symptomatic, something that is not yet well understood but will hopefully become clearer over time. It just highlights the point that what works for some people, can make things worse for others (and vise- versa).
Probiotics for methane SIBO
There is both clinical and scientific evidence for probiotics improving constipation outcomes. The challenge is that while certain beneficial bacteria families are helpful, the literature suggests strain, quantity and other ingredients all matter. Bifidobacterium lactis (HN019) strain has been shown to improve transit time while Bifidobacterium infantis (35624) using a product known as Align, actually increased methane levels. In another study, the probiotic Lactobacillus reuteri (17938) had a beneficial effect on chronic constipation via decreases in methane production (as well as hydrogen), including the complete eradication of methane in 11 of the study patients.
As with prebiotics, probiotics for SIBO can be a delicate balance to find. The right strains for the right clients can help significantly but use the wrong product, strain or quantity and you might make symptoms worse. This is an area of research that is constantly evolving, which highlights the importance of working with an expert team who are up to date on the latest science and clinical perspectives on SIBO treatment.
4. Digestive support
Managing SIBO constipation in the short term
We know that methane SIBO causes constipation. So, while we are eradicating and healing from SIBO, what can we do about managing the constipation that comes with it? Simple. We do exactly the same thing that we do for constipation while we are healing any root cause of IBS-C. We use specific forms of magnesium and vitamin C in combination and vitamin C flushing most commonly. For detailed instructions on these effective constipation-clearing strategies that we use with our clients, get our Chronic Constipation Clear-Out e-Guide here: Constipation e-Guide LINK. The key thing is that the bowel is kept clear as we kill off the overgrowth, so waste, dead bacteria and archaea and the toxins they produce are being removed from the body.
Supporting digestion
Supporting digestion is important for those with methane SIBO. When gut function is compromised, short-term use of digestive support products can help keep the system running until balance is restored. The need for these products is assessed individually, but tend to include one or more of the following:
> Stomach acid support - Hydrochloric acid (HCL) can help kick-start digestion in those with low levels, but needs to be balanced against the fact that in high doses, the literature suggests that HCl appears to be a hydrogen donor.
> Digestive enzymes or herbal bitters - help break down food properly to avoid excess fermentation in the gut, thereby reducing excess gas production. We recommend digestive enzymes to almost all of our clients who have SIBO to support digestion while their small intestine is compromised by archaea and bacteria that are overgrown. We commonly recommend Enzymedica, Digest Gold with ATPro and have found this product is typically well tolerated (available on our Fullscript Dispensary).
> Support for things like pancreatic enzymes and bile depending on imbalances identified on testing and client’s symptoms.
Another aspect of supporting digestion relates to rest and stress reduction. This is all about increasing blood flow to the GI tract, and increasing parasympathetic tone in the enteric nervous system (ENS). When the body is stressed it deprioritizes certain functions like digestion in favor of others like blood flow to muscles (to run!). Practically, this means trying to be more relaxed, especially before eating, will help support digestion. Things like meditation, breathing exercises and yoga can also reduce stress and improve digestion.
DetoxIFICATION and managing SIBO die off symptoms
As bacteria and archaea are killed off, they release endotoxins like lipopolysaccharides (LPS) into the GI tract that typically promote an inflammatory response from the immune system. We’ve written a detailed blog on the science of die-off and common die-off symptoms HERE but in short, the most common SIBO die-off symptoms we see clinically are:
> Fatigue
> Headaches
> Body aches and pains
> Skin rashes or reactions
> Mood symptoms (e.g. anxiety and depression)
> Increased GI upset.
As with other forms of die-off, the key to reducing the severity of SIBO die off symptoms is to:
Reduce the rate of cell death by titrating in diet changes and supplements slowly.
Reduce inflammation by getting sufficient rest and using antioxidant and anti-inflammatory supplements.
Support detoxification pathways including the liver and using charcoal or clay binders as needed.
There’s lots more detail in our die-off post (and free Die-Off E-guide) if you need more support with this.
5. Identifying and addressing your root cause of methane SIBO
While relapsing cases are a common challenge with hydrogen SIBO, methane SIBO is noted more for its stubbornness/difficulty to treat in the first place. Once its gone though, it tends to stay gone more often than not. Nonetheless, identifying and addressing any underlying root causes of methane SIBO is an important part of the long term gut healing journey. We want to check for anything that impairs motility of the small intestine. Here are the top root causes we look for, summarized into four main categories:
Physical obstructions
Physical obstructions can impair outflow through the intestines. This means contents, including archaea, are not properly moving through and out of the small intestine, potentially causing an increase in the number of bacteria or archaea (i.e. an overgrowth). The two most common we see in methane SIBO clients are adhesions from past GI surgery (cesarean, hysterectomy, etc.), Endometriosis adhesions and scar tissue, and ileocecal valve (ICV) dysfunction. The ICV is the valve between the small and large intestine. If this is not working correctly and remains open, archaea from the large intestine may be able to migrate into the small intestine and cause methane SIBO.
Digestive defects
Proper digestion is part of our body’s defense against opportunistic bacteria and archaea. If our digestion is impaired, too much or the wrong kinds of organisms may make their way into the small intestine. Digestive markers we look for to assess digestive function include:
Hydrochloric acid (HCL)
Pancreatic enzymes
Brush border enzymes
Bile
Secretory IgA (sIgA) for mucosal immunity.
We also look for certain symptoms to indicate impaired digestion and cross-reference these with the markers on testing identified above:
Belching, gas or bloating within one hour of eating
Heartburn or acid reflux
Halitosis (bad breath)
Aversion to high protein foods
Feeling of excess fullness after meals
Greasy or undigested food in stool
Alone these are not likely SIBO root causes, but they all contribute and are often the result of impaired motility or medications.
Impaired Motility
While methane gas itself impairs motility, there are other common root causes that are often associated with methane SIBO:
Migrating motor complex (MMC) autoimmunity - often associated with ‘post-infectious IBS’, this is the result of anti-CdtB antibodies triggering anti-vinculin antibodies attacking the MMC. It is very common in hydrogen SIBO but only affects a small proportion of methane cases.
Head or whiplash injuries - brain injuries are associated with delayed gastrointestinal emptying due to changes in the autonomic nervous system.
Hypothyroidism - an underactive thyroid is commonly associated with delayed intestinal transit time.
Chronic infections - particularly other gut infections that cause chronic inflammation like parasites, mold colonisation and Lyme.
Diabetes
Scleroderma
Ehlers-Danlos syndrome
Medications
Certain medications can directly impact motility and the microbiome of the small intestine. These include:
Opiates/narcotics
Antispasmodics
Tricyclic antidepressants
Anti-diarrheal medications like Alosetron, Lomotil and Imodium
Proton pump inhibitors
Cholestyramine
Preventing methane SIBO relapse
As discussed above, methane SIBO is generally less susceptible to relapse than hydrogen-dominant SIBO in our experience. It’s also important to understand that at this stage of the methane SIBO treatment process, everything is going to be individually tailored to your specific case, given your test results, response to various treatments, health history, symptoms, etc. That said, here are a couple of general ongoing considerations to incorporate for long-term methane relapse prevention:
Diet diversity and food reintroduction
Bringing back more diversity into the diet will help feed levels of beneficial bacteria and help nurture a more balanced and healthy microbiome. This often needs to be done in a gradual and intentional way, to avoid a flare in symptoms like bloating and distension. If you’re lacking the number or type of bacteria required to break down and digest certain fibers, introducing them slowly will give your microbiome a chance to repopulate these strains.
Introduction and increased use of probiotics and prebiotics
While probiotics and prebiotics can be used as part of the eradication phase, they are sometimes not tolerated well at that time. In these cases, we generally introduce or increase the use of prebiotics and probiotics after eradication. This is to help repopulate a diverse microbiome that keeps methane producing archaea in check.
Continued digestive and motility support as needed to keep the colon clear until proper function is restored
If the cause of your constipation is methane alone, clearing methane SIBO will likely eliminate this problem. However, if your constipation was merely exacerbated by methane SIBO, then keeping the colon clear while we identify and rebalance additional root causes is of continued importance. For some clients who have been chronically constipated for years (or decades), the body needs a little bit of time and support to get into the flow of unassisted and regular bowel movements.
Explore additional root causes if methane levels are reduced but some symptoms remain
SIBO is only one of the many root causes for IBS type digestive symptoms. In many cases, we find additional infections and imbalances on advanced stool testing that also need to be addressed. Clients who have had a previously ‘clean’ stool test will often find new pathogens or imbalances showing up on retesting, likely because they have removed biofilms during SIBO treatment. It means those other infections were probably there all along, they just didn’t show up on testing because they were hiding in the biofilm. Where this occurs, it is important to address these additional root causes for long term symptom resolution and gut healing.
Work with our practitioners to treat Methane SIBO constipation
SIBO, and particularly the methane type, is an extremely complex condition. As a clinic, we have worked with thousands who have struggled with methane SIBO and no two clients are the same. We really encourage you to not waste years taking the trial and error approach. Ask for accurate SIBO testing and use the most up-to-date science and clinical perspectives so you can get back to your vibrant and healthy life. We truly hope that the information in this post is helpful so when you commence your healing journey it is a real partnership between you and a practitioner that you trust to help guide you through the process.
Healing methane SIBO is a journey. If you are ready to begin yours, please head to the Work With Us page to learn more about how we work online with clients in many countries to eradicate methane dominant SIBO and other root causes of IBS symptoms.
For more SIBO treatment information...
We’ve also written a three part series on SIBO. They cover:
> 1. Overview of SIBO
> 2. SIBO Testing
> 3. SIBO Treatment
Did you find this post on methane SIBO constipation helpful? Want to get back to this post later? Save THIS PIN below to your Gut Healing board on Pinterest!
References:
Ghoshal, Shukla, and Ghoshal (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver, 11(2): 196–208
Pimental, et al. (2020) ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. The American Journal of Gastroenterology, 115(2):p 165-178
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About author: Bella Lindemann, FDN-P
Bella Lindemann is the founder and lead practitioner of The Functional Gut Health Clinic. With her science degree, functional nutrition certification and extensive experience, she is a recognised expert in gut health and the science of SIBO. Having worked with hundreds of methane SIBO cases, including her own, Bella is passionate about helping her clients address this imbalance and take back control of their digestive symptoms.