EP.406/ SIBO Retesting: Your Methane or Hydrogen Gas Levels Have Gone Up - Here’s Why That Might Be a Good Sign
When I am working with endo clients on their SIBO, I always start the discussions not by diving into the protocol options, but by setting expectations and giving some cautionary warnings.
This is so important, because SIBO is not easy to treat, but also, if you misunderstand your test results as you go through the protocol, you may give up or change protocols when in fact, you should keep going.
Often I have people come to me and tell me they tried one round of herbs and their levels went up, or they tried antibiotics and only one gas came down whilst the other went up, and so on.
So, today, I want to give you a very brief insight into some of the gas patterns you can expect to see when you’re going through SIBO treatment, so that if you’re doing this on your own, or you’re doing it with the help of your doctor but perhaps they are not as versed in SIBO as you’d like, you know what to do when you see these patterns.
Now, there are other patterns and issues that we can come up against during this time, but these are the most common I see.
First up, before we get into the patterns, let’s quickly talk about retesting. Retesting is recommended after each round (ideally) to observe how effective the last treatment was, and whether more treatments are needed.
Dr Siebecker, my tutor and leading SIBO doctor, advises retesting Days 2 - 6 following treatment, as backsliding (a.k.a regrowth) occurs at two weeks.
Labs will advise NOT to test after antibiotics/antimicrobials for 2 weeks - one month. This is true for diagnostic testing, but we want to retest close after treatment to observe changes in SIBO levels.
If you can’t afford retesting after every round, I tend to aim for retesting after three rounds, as that is the average minimum number of rounds we tend to see required to clear SIBO or when symptoms have improved (as taught to us in our SIBO Pro certification with Dr Siebecker).
So, here are some gas patterns to watch for:
Methane rising
Methane often rises before it starts to die - this is dubbed by Dr Siebecker as ‘pissed off methanogen syndrome’, basically it’s methanogens fighting for dear life. The standard advice is to keep going, it will begin to fall with the next one to two rounds. I see this almost with every client, and as Dr Siebecker recommends, we keep going and these levels always come down. Then only exception is when a treatment is not working for the methane (which is common, as methane is hard to treat) and in that case, normally we don’t see levels go up, we just don’t see them change much at all, so we change tactics.
Hydrogen rising
Then, once methane starts dying, hydrogen often rises because the archaea that make the methane use four hydrogen atoms for every methane molecule produced, so when methane dies, we see the ‘true’ hydrogen levels, then the hydrogen starts to fall. So, as you may have just worked out, if you test for SIBO and you come back positive for Intestinal Methanogen Overgrowth yet negative for hydrogen, or very low levels of hydrogen, don’t be fooled - you may have higher levels of hydrogen that are being hidden by the methanogens.
Gases fall earlier in the test, but start rising further down
Once the SIBO starts dying, when you retest you may still be positive, but you might see that the rise in gases occurs later into the retest and this is a typical pattern as bacteria die. The SIBO tends to start clearing higher up in the small intestine and then begins dying further along, rather than all levels lowering at the same time. This is a good sign so keep going.
Areas where the levels stay elevated despite numbers coming down overall
If you see time frames that aren’t shifting as you retest, for example, the other numbers are coming down but at 70 minutes there’s a bump in gas and it’s always there, this could potentially indicate a structural abnormality allowing bacteria to thrive there, basically a “pocket” when the bacteria is collecting and thriving, and in some cases, evading treatments. When I see this, I tend to bring in structural work and testing if I haven’t done so already, such as motility investigations, visceral manipulation and/or acupuncture for scar tissue.
The exception to this is that sometimes there is a dip in levels at the transitional point between the small and large intestine, which usually occurs around the 90 to 120 minute mark, and then levels start to rise again as the substrate (the solution you drink) makes its way into the large intestine. This does’t occur for everyone, so don’t panic if you don’t see it.
Okay, I hope that helps you navigate your SIBO journey, but if you get stuck and would like some support, you can book in a single or multiple SIBO sessions with me here.
References
No references today as these findings are based on my own and Dr Siebecker’s clinical observations.
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