Methane SIBO (IMO): Symptoms, Causes, and Effective Management

Having chronic constipation, persistent bloating, and digestive discomfort that will not clear, despite the standard interventions. Then, you may have Methane SIBO. This is often called IMO (Intestinal Methanogen Overgrowth).

SIBO refers to Small Intestinal Bacterial Overgrowth. It is a condition where bacteria overgrow in the small intestine.

However, Methane SIBO is not like that. It is not caused by bacteria, but rather by archaea. These are ancient single-celled organisms that generate methane gas in the course of their metabolic activity.

We often hear patients at Conscious Medicine in Alpharetta who were diagnosed with IBS or reported that they only got stressed after they had Methane SIBO. It is the first step to knowing this condition and finding a way to get effective relief.

By implementing our functional medicine model, we assist patients in diagnosing and treating the underlying cause of any digestive problems, and this is a condition that frequently goes undiagnosed.

In this blog, we will talk about Methane SIBO, its unique symptoms, and causes. And will find ways to manage this illness.

What Is Methane SIBO (Intestinal Methanogen Overgrowth)?

Methane SIBO is a distinct type of small intestinal overgrowth that is radically different from natural SIBO. Whereas regular SIBO is characterized by an increase of bacteria that lie in the small intestine, Methane SIBO or IMO is characterized by the proliferation of archaea, in this case, such organisms as Methanobrevibacter smithii.

These methanogens are not bacteria but are made of an entirely different domain of life. They are old creatures that have adapted to live in low-oxygen conditions. They use Hydrogen gas (generated by bacteria) and carbon dioxide and convert them to methane. This is known as methanogenesis, and that is what makes Methane SIBO different in comparison to other SIBOs.

Methanobrevibacter smithii is the main causative organism in Methane SIBO and the most common source of methanogens in the human bowel, which represents up to 94 percent of methanogens. These organisms do not act independently; they live in symbiotic relation with hydrogen-generating bacteria. The bacteria ferment carbohydrates and give hydrogen gas that is utilized by the methanogens to generate methane.

The production of this methane affects the gut a great deal. Methane has been shown to decrease the time of intestinal transit as opposed to hydrogen gas, unlike hydrogen gas, which is comparatively inert. This decelerating nature is what causes constipation to be the typical symptom of Methane SIBO.

Note that methane production is linked to slower gut motility.

The studies have indicated that the migrating motor complex (MMC), which is the wave-like contraction that passes through your intestine after every meal to clear away bacteria and debris, is directly interfered with by methane gas. Methane suppresses the intensity and repetition of these cleansing waves, resulting in:

• Reduced food passage in the intestines.
• Prolonged duration of fermentation.
• More gas production
• The aggravation of constipation is vicious.

Common Symptoms of Methane SIBO

Constipation

It is a characteristic of Methane SIBO, as it occurs in more than 90 percent of patients with this disorder. It is not merely some intermittent bowel movement problem; it is long-term, tenacious constipation that may not readily yield to usual treatment measures such as fiber supplements, increased water consumption, and even over-the-counter laxatives.

The constipation within Methane SIBO is marked by:

• Less than three bowel movements a week.
• Your stools are dry and hard to pass.
• You are having difficulty passing bowel movements.
• Sense of unsuccessful evacuation.
• Defecation requires manual manipulation.

Other associated issues

In addition to constipation, Methane SIBO is associated with a cascade of digestive symptoms, potentially with severe quality-of-life consequences:

• Continuous bloating and abdominal distension: Patients complain that they look pregnant. Some say that their stomachs have been inflated with a balloon. The bloating normally increases day by day and can be high so that even the clothes feel unusually tight. This distension is brought about by the buildup of the methane gas, which flows more slowly in the intestines, because of the diminished motility.
• Feeling of fullness or slow digestion: A lot of individuals with Methane SIBO describe that they get full easily, even if they eat less.
• Excessive gas or discomfort: In spite of the constipation, patients tend to have a great amount of gas. The cramping and discomfort caused by the slowed motility may result in the gas not passing easily.

Nausea or unformed bowel movements: People feel nausea because of intestinal content buildup. Many patients feel like they have not completely cleaned out their stomachs.

What Causes Methane SIBO?

Discuss the biological process.

Methane SIBO is caused by a complex biological mechanism that is based on a number of factors:

Hydrogen-producing bacteria feed methanogens:

this involves the fermentation of carbohydrates in the small intestine by the hydrogen-producing bacteria. The waste produced by these bacteria is hydrogen gas.

This hydrogen is then used by methanogens such as Methanobrevibacter smithii. It combines with carbon dioxide to produce methane.

List contributing factors

The Methane SIBO can be developed due to a number of factors:

• Slow gut motility or migration motor complex, abbreviated as MMC: This is the cleaning mechanism of your gut, sweeping bacteria and debris through the bowel during the interval between meals. In case of impairment, the bacteria and methanogens may pile up in the small intestine. The causes of MMC dysfunction are food poisoning (post-infectious IBS), diabetes, hypothyroidism, and some medications.
• Changes in the post-infection or the structure of the gut: Food poisoning can destroy nerves that govern gut motility and result in permanent problems.
• High-fermentable carbohydrate diets (high-FODMAP foods): Diets rich in fermentable carbohydrates can be fuel for fermentation in bacteria, which feed the methanogens. Food such as beans, some fruits, dairy products, and wheat may aggravate symptoms.
• Gut dysbiosis or prior antibiotic treatment: Antibiotics have the potential to cause disturbance in the normal gut microbiome, which may, in turn, enable the thriving of the methanogens. Ironically, antibiotics are administered to treat SIBO, yet they might cause its occurrence if they cause an unequal environment in the gut.

Diagnosis: How Methane SIBO Is Tested?

The lactulose or glucose breath test is the major diagnostic method of Methane SIBO. This is a non-invasive experiment that measures the gases that are generated by the intestinal organisms when a sugar solution is taken.

During the test:

• You starve yourself at night (usually 12 hours).
• Baseline breath samples are taken.
• You take a solution either with lactulose or glucose.
• Breaths are taken after every 15-20 minutes with 2-3 hours.
• The samples are tested for the levels of hydrogen and methane.

Detailed test preparation

To get accurate results, it is important that you prepare properly:

• Fasting: Do not take any food or drink other than water during the 12 hours before the test.
• Antibiotic avoidance: You should not take any antibiotics for 4 weeks before.
• Avoidment of fermentable food: Prep diet. It is important to follow a special preparation diet the day before, which excludes high-fiber food, dairy, and some carbohydrates.

A positive test for Methane SIBO (IMO) shows:

• The level of Methane of 10 ppm or more at any moment of the test.
• This may happen in the presence or absence of high levels of hydrogen.
• Gas production patterns may also show the location of the overgrowth in the small intestines.

Treatment and Management Strategies 

1. Medical Treatments

Rifaximin + Neomycin is the most studied combination: The most common combination of rifaximin (550 mg 3 times a day) and neomycin (500 mg 2 times a day) is the gold standard of Methane SIBO treatment in 14 days. It has been found that this combination results in normalization of methane in approximately 85 percent of patients as opposed to 28 percent with the use of rifaximin alone.

Rifaximin is an antibiotic that is non-absorbable, and it remains in the gut, whereas neomycin targets methanogens. This is a two-fold solution since methanogens are resistant to antibiotics compared to bacteria.

Significance of the physician recommendation and use of individualized dosing: Therapy must never be without a healthcare professional who has experience in the treatment of SIBO. Some patients may need:

• Extended courses (up to 21 days)
• Higher doses
• Substitutes for regular treatment when the effect is unfavourable.
• Several courses of therapy.

2. Herbal or Functional Approaches

Allicin is a derivative of the garlic plant, which has been found to have selective activity against methanogens. Research indicates that it can be as effective as antibiotics for certain patients. Common dosage is 450 mg two times daily for 4-6 weeks.

Other herbal antimicrobials that can help include:

• Oregano oil (200 mg twice daily)
• Berberine (500mg three times a day)
• Neem (300 mg three times daily)

The long course of treatment (4-6 weeks) with herbal protocols is usually less than antibiotics, and the protocols might have fewer side effects. They are applicable both alone and in combination with antibiotics in cases that are stubborn.

3. Dietary Management

The diets limit fermentable carbohydrates, which nourish bacteria and methanogens. The low-FODMAP diet excludes the following foods:

• Some fruits (apples, pears, watermelon)
• Dairy products with lactose
• Wheat and rye
• Beans and lentils
• Some vegetables (onions, garlic, cauliflower)

Reintroduction of foods: Once the patient is better, one food should be reintroduced at a time to determine triggers. The process assists in coming up with an individualized long-term diet that sustains the control of the symptoms without undue restrictions.

Mark the role of professional dieting: It is hard to overestimate the significance of having a dietitian who is knowledgeable about SIBO in making sure that nutritional adequacy is achieved when adhering to restrictive diets.

4. Support Gut Motility

Prokinetics are medications or supplements that enhance gut motility, which is needed to prevent Methane SIBO recurrence:

Natural prokinetics:

• Ginger (1000 mg daily)
• Iberogast (portion of herbs, 20 drops three times per day)
• 5-HTP (50-100 mg at bedtime)

Prescription prokinetics:

• Prucalopride (1-2 mg daily)
• Naltrexone low dose (1-4.5mg bedtime)
• Metoclopramide (short-term only because of side effects)

Address Underlying Factors

Inadequate stomach acid: Hypochlorhydria enables more organisms to survive and get to the small intestine. Consider:

• Diet Supplementation with meals with Betaine HCl.
• Apple cider vinegar in the morning before meals.
• It is better to avoid the use of the PPI long-term.

Problems with the bile flow: Bile contains anti-microbial properties. Support bile flow with:

• Ox bile supplements
• Bitter herbs such as dandelion or artichoke.
• Ensuring that one gets enough fat to stimulate bile production.

Gut structural issues or adhesions: These can be necessitated by:

• Physical therapy/visceral manipulation.
• In extreme instances, surgery may be required.

Stress, sleep, lifestyle management: Chronic stress decreases gut motility and immune function. Prioritize:

• Stress management (meditation, yoga, counseling) on a regular basis.
• 7-9 hours of quality sleep
• Frequent activity (enhances motility)
• Spacing of meals (4-5 hours to enable MMC operation),

Preventing Relapse and Supporting Long-Term Gut Health

The recurrence rate of Methane SIBO is high, and there is a likelihood of up to 44 percent of patients developing relapse after 9 months. This is due to the underlying factors that enabled it to develop, which usually continue to persist even after the treatment is successful.

Strategies for prevention

• Ongoing gut motility support: You can take prokinetics (naturally or prescribed), which may be needed to maintain normal gut motility and preclude recurrence.
• Balanced nutrition and microbial diversity: Although certain dietary restrictions might be necessary, someday a diverse, whole-foods diet is desired, which will promote a healthy microbiome without causing symptoms.

Constant observation and early detection of symptoms: Be attentive to early symptoms, such as constipation or bloating. It is possible to avoid the complete relapse through early treatment.

Encourage follow-up testing and long-term care planning.

Follow-ups with your medical practitioner are necessary. This may include:

• Repeat breath, in case of recurrence of symptoms.
• High-risk people should be tested annually.
• Continued treatment of chronic illnesses.
• Optimization of maintenance procedures.

In Conscious Medicine, we know that Methane SIBO needs to be dealt with using a long-term approach. Our view of functional medicine does not only focus on the excessive growth, but also on the factors that enabled it to grow.

When to Seek Professional Help?

Consult a professional in case you have:

• Constipation for over 3 weeks.
• Constant bloating and stomach distension.
• Unexplained weight loss
• Blood in stool
• Severe abdominal pain
• Symptoms that are not responding to basic changes in diet.

Although the presence of Methane SIBO may be hinted at by the symptoms, it is necessary to test it through proper testing:

• Confirming the diagnosis
• Determining severity
• Informing the direction of treatment.
• Evaluation of the efficacy of treatment.

Caution against self-prescribing antibiotics or herbs

Self-treatment is perilous and unproductive. Professional counseling guarantees:

• Proper choice of drugs and dosage.
• Monitoring for side effects
• Overcoming the root causes.
• Inhibiting antibiotic resistance.

SIBO is a complicated and yet treatable condition, and it is Methane SIBO. Through appropriate diagnosis, treatment, and follow-up care, most patients can experience a significant reduction of symptoms and gain a better quality of life.

We have been working with complex digestive conditions such as Methane SIBO at Conscious Medicine in Alpharetta using our functional medicine model of identifying and treating these disorders. We not only manage symptoms, but our treatment plans are based on deep-rooted causes and develop individualized treatment regimens that bring lasting remedies.

FAQ’s

1. How do you treat methane SIBO?

Methane SIBO can typically be treated using specific antibiotics or antimicrobials, dietary modifications, and treating underlying gut motility problems. Treatment should be directed by a medical worker.

2. What foods trigger methane SIBO?

Foods with high fermentability will exacerbate the symptoms in some individuals, such as beans, lentils, some fruits, high-fiber grains, and some dairy. Triggers vary by individual.

3. Does methane SIBO ever go away?

Yes. Many individuals undergo major improvement or remission with proper treatment and by addressing the underlying causes of the condition, including slow gut motility.

4. Can probiotics cure methane SIBO?

Methane SIBO is not normally cured by probiotics alone. Others can assist in maintaining the gut balance; however, caution is necessary and must be applied under the supervision of a specialist.

5. Can you starve methane SIBO?

The disease can be alleviated through changes in diet, yet starving of methane SIBO is not viewed as a viable treatment. Medical or antimicrobial support is normally needed as a treatment.