Why SIBO May Not be the Cause of Your Constipation

Did you miss the SIBO Summit? No worries. I’m keeping you updated on some of my biggest take-aways.

One of my favorite speakers from the summit was Dr. Nirala Jacobi. She’s a Naturopathic Doctor in Australia who specializes in treating SIBO. She’s even created her own SIBO diet protocol called the Bi-Phasic diet.

Her topic of discussion was specific to methane-dominant SIBO and treatments for constipation. She shared some new information that indicates that many people who test positive for SIBO due to high methane may not actually have SIBO. WHAT???

This information was first presented by Dr. Pimentel at the SIBO Symposium in June. He discussed that when it comes to SIBO, we know that there are those that are methane-dominant, and those that are hydrogen-dominant.

Until now we’ve classified IBS/SIBO in three main groups: IBS-C (constipation) which is related to high methane, IBS-D (diarrhea) which is related to high hydrogen, and IBS-M which is the mixed type where people have alternating constipation and diarrhea.

It’s now thought that the IBS-M and IBS-D (so the more diarrhea dominant) is really, truly SIBO. And we’re starting to think that IBS-C is actually a completely separate condition.

The reason is because when we see high levels of methane at baseline on a breath test, and it stays high, it is now thought that is more of a contribution from the large intestine. It’s not actually a small intestinal issue.

Speaking very generally, people who fall into this category won’t have so much the classic bloating right after meals very often. They have bloating, but more towards the end of the day. They also may be able to tolerate more fiber, and typical low-fiber SIBO diets may make them more constipated.

The confusing thing, is that when methane is high, it’s really hard to interpret hydrogen because methane feeds on hydrogen. It takes about four hydrogens to make one methane. So, methanobrevibacter smithii (methane producer) takes the hydrogen from the fermenting bacteria and actually creates methane.

Wherever there’s high methane, you will have hydrogen producing bacteria. But we don’t know what the true hydrogen levels actually are.

On a breath test, we want to see a rise of about 12ppm or so in the first 60 to 100 minutes of methane for you to have SIBO positive methane. In other words, if the methane levels rise by 12 from one point to another within that time period, then you are positive for SIBO.

If you have high methane levels starting at baseline and they just waver by a couple of points, then that is not SIBO, even though your methane levels are high. That is IBS-C and is more of a large intestine issue.

What does that really mean?

It means that if you have SIBO, then everything you know about treating SIBO probably applies to you.

But if you have methane positive IBS-C, we might need to develop a protocol that’s much more specific for you. And it might actually mean that we have to involve the large intestine.

Often times that may involve a slightly different diet than the SIBO diet along with retraining the functionality of the large intestine.

Chronic constipation will cause some tissues or muscles to become lax so even though you may not have high methane, you’re still constipated.

How do we actually get the bowels functioning again?

Certain things help the bowels to move—not just prokinetics in the upper gut, but lower gut stimulants and exercises will help to reduce methane.

Solutions

Squatty Potty – This helps align your bowel or your sigmoid colon into the correct position to have an easier bowel movement.

Coffee Enemas – We know that enemas or the addition of coffee to the enema bag can actually help to re-stimulate certain nerve fibers and improve peristalsis.

Breathing Exercises – breathing exercises also improve vagal tone. The last bit of your colon, the sigmoid colon, is actually under vagal control. Sometimes when you’re in this complete sympathetic overdrive, lots of stress, you can’t release very well in the last part of your colon. 

Natural Supplements – A good option to start with is magnesium oxide or citrate. It’s more of an osmotic agent—it draws water into the colon. Additionally, there are certain herbs that help stimulate the peristaltic action of the colon. Start with the mildest option, like magnesium to see what actually works, and work your way up.