Treating Methane SIBO: What Are My Options?

Updated by: Jennifer Huddy, MS, RD

Small intestinal bacterial overgrowth (SIBO) is a condition that’s been around for decades but only recently gained recognition among medical practitioners. 

SIBO is caused by excessive amounts of bacteria in the small intestine, causing digestive issues.

It’s often mistaken for other digestive conditions like irritable bowel syndrome (IBS).

Treatment for SIBO is complex and depends on the type of bacteria and gas present in the gut. Methane SIBO is characterized by the presence of methane gas, causing constipation, severe bloating, and other gut symptoms.

If you are struggling with SIBO or suspect you may have it, it’s essential to see a qualified healthcare provider to create a treatment plan designed for you.

Here’s what you should know about treating methane SIBO.

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What is SIBO?

Small intestinal bacterial overgrowth (SIBO) is when you have more bacteria in the small intestine than should be there.

When this bacteria ferments the carbohydrates you eat, it produces gas, which can cause symptoms like:

• Bloating. 
• Abdominal pain.
• Diarrhea
• Constipation.

SIBO can also be associated with other symptoms, like fatigue, joint pain, headaches, and skin rashes.

What Causes SIBO?

The cause of SIBO can vary from person to person, but it’s often related to dysmotility, meaning the muscles of the small intestine are not working as they should.

As a result, bacteria may not properly move through the digestive tract and instead build up in the small intestine. 

Other potential causes of SIBO include:

• Intestinal hernia or scar tissue. 
• Certain medications, like antibiotics or antacids.
• Inflammation of the digestive tract. 
• Dysfunction of the valve connecting the small and large intestines. 
• Abdominal surgery.
• Gastroparesis, a condition that involves slowed digestion. 

What is Methane SIBO?

There are two main types of SIBO: hydrogen-dominant and methane-dominant. Both types refer to the gas that the microbes produce.

‍Methane SIBO means there is an overgrowth of organisms that make methane a byproduct.

More recently, methane SIBO is referred to as intestinal methane overgrowth (IMO) because the overgrowth isn’t technically bacteria.

The organisms that produce methane are called archaea; they aren’t bacteria but different, distinct types of organisms.

Archaea create methane gas from hydrogen, a byproduct of bacterial fermentation in the intestines. Too much methane leads to symptoms like constipation and bloating. 

Hydrogen vs. Methane SIBO Symptoms

Hydrogen SIBO symptoms tend to include more abdominal pain and diarrhea.

In contrast, people with methane SIBO experience constipation, bloating, and gas. It’s also possible to have a mix of all symptoms. 

To complicate things, it’s possible for someone with methane SIBO also to have hydrogen SIBO (an overgrowth of bacteria that produce hydrogen). This can make diagnosing the condition difficult.

What Causes Methane SIBO?

Though the causes of methane-dominant SIBO are not fully understood, several conditions have been linked with an overgrowth of archaea in the small intestine, including IBS-C. 

IBS-C is a form of irritable bowel syndrome where constipation is the primary bowel pattern.

‍One study found that over 26% of people with IBS were also positive for methane SIBO. 

The presence of methane is thought to slow down digestion, which is associated with constipation.

However, it’s unclear whether methane SIBO is a cause or symptom of IBS. 

Another study found that individuals with anorexia nervosa had higher levels of archaea in their intestines.

However, more research is needed to understand this connection fully.  

How is Methane SIBO Treated?

Treatment for SIBO takes time, multiple interventions, and sometimes a combination of therapies.

These include medications, diet, supplements, and lifestyle changes. 

Unfortunately, relapses are common if the root cause isn’t addressed, whether related to a problem with motility, a structural issue, or something else. 

Medications

Antibiotics are the primary approach for treating SIBO.

‍Rifaxamin is an antibiotic often used to treat SIBO on its own or with other antibiotics. Rifaxamin combined with Neomycin, another type of antibiotic, has a success rate of 85%.

However, while Rifaxamin is known to cause less damage to the healthy bacteria in the gut, Neomycin is broad-spectrum, which means it kills much more than SIBO-related bacteria.

Weighing the pros and cons of this approach is a conversation you can have with your provider.

Methane SIBO Diet

The goal of nutrition interventions is to manage digestive symptoms of SIBO while you undergo medical treatment to address the root cause of the overgrowth. 

Unfortunately, there is mixed evidence regarding the effectiveness of dietary changes for methane SIBO. 

Much of the research on the diets commonly recommended for SIBO was conducted on people with irritable bowel syndrome (IBS).

Though SIBO and IBS can have overlapping symptoms, limited evidence exists specific to a SIBO diet. 

Low-FODMAP Diet

The most common dietary recommendation for SIBO is the low FODMAP diet, a plan that includes foods low in fermentable carbohydrates.

It can help reduce symptoms in some people, though strong evidence is lacking.

Working with a dietitian and a GI doctor who understands SIBO can help you understand how to reduce methane in the gut and develop a diet plan that works for you.

Elemental Diet

In some instances, an elemental diet may be used.

An elemental diet is a medically-supervised liquid diet that eliminates all but the most basic food components.

Protein, carbohydrates, and fats are already broken down, making them easy to digest.

The plus side is that the elemental diet can be effective when followed correctly, but the downside is that it’s expensive and challenging for some people to follow. 

Supplements

Similar to nutrition interventions, there is limited and conflicting evidence regarding supplements for managing SIBO.

Talk to your doctor before starting any supplements at home. 

Probiotics

Using probiotics with SIBO is controversial because, in some cases, adding more bacteria to the gut can worsen symptoms and increase methane. 

However, some research suggests that certain strains of probiotics may help by supporting a healthy balance of beneficial bacteria, reducing inflammation, and lowering methane levels. 

Prebiotics

Prebiotics are the food that probiotics need to survive.

There are multiple types of prebiotics found in foods like asparagus, artichoke, and chicory root. 

However, many people with SIBO can’t tolerate these foods, so supplements (starting in small amounts) may help. 

Partially hydrolyzed guar gum is a prebiotic that has been well studied for its role in supporting gut health and helping with constipation. 

It also increases short-chain fatty acid (SCFA) production, the byproduct of bacterial fermentation.

‍Butyrate, an SCFA, is known to help reduce methane and support healthy gut motility.

Pro-Motility Agents

Daily bowel movements are essential for SIBO treatment and to prevent relapses.

Certain botanicals like ginger, bitters, or peppermint, and nutrients like magnesium and vitamin C may help keep bowels moving to reduce methane levels in the gut. 

Lifestyle

Stress and sleep are always important considerations when supporting health. Implementing stress-reducing activities and getting 7-8 hours of sleep every night can benefit SIBO treatment. 

Additionally, some research suggests stimulating the nervous system to help gut motility is essential to managing methane SIBO.

One way to do this is by activating the vagus nerve, the primary nerve connecting the brain and digestive system.

This is, again, a complex topic and worth discussing with your practitioner but gargling and singing are simple methods to exercise the vagus nerve. 

How Long Does It Take To Treat Methane SIBO?

The first line of treatment for methane SIBO is a two-week round of antibiotics.

While many people recover after completing the antibiotic therapy, around 45% of people with SIBO will experience a recurrence of their intestinal overgrowth. 

In the case of a recurrence, an additional course of antibiotics may be prescribed.

A two- to three-week elemental diet may be recommended if the symptoms persist.

At this point, a workup for other conditions like inflammatory bowel disease may also be considered. 

Foods to Avoid for Methane SIBO

While there is not a list of foods everyone with methane SIBO should avoid, you may find individual foods that trigger your symptoms.

Try keeping a food and symptom log to track what you eat and drink, your symptoms, and the severity. 

It may be helpful to work with a registered dietitian specializing in digestive health to identify the best eating plan for you as you undergo treatment for SIBO. 

Limit High-FODMAP Foods

If your doctor or dietitian recommends a low-FODMAP diet as part of your treatment plan, consider limiting high-FODMAP foods such as: 

• Fruits: Apples, pears, cherries, and watermelon. 
• Vegetables: artichoke, garlic, onion, cauliflower, and mushrooms.
• Grains: bread, pasta, and rye. 
• Legumes: kidney beans, split peas, and lentils. 
• Dairy: soft cheese, milk, and yogurt.

What Naturally Kills Methane SIBO?

Many natural treatment options recommended online for SIBO have not been well-studied. More research is needed to identify effective doses and protocols. 

According to some research, herbal antimicrobial supplements like allicin or neem that contain natural compounds to kill off bacteria may be just as effective as antibiotics.

Other herbal supplements like berberine and oil of oregano may also be beneficial for treating SIBO. As always, talk to your doctor before starting any natural SIBO treatments at home. 

Testing for Methane SIBO

Testing for SIBO requires a breath test that measures the amount of hydrogen or methane gas produced in your breath after drinking a test solution containing lactulose or glucose. 

Lactulose or glucose is fermented in your intestines, producing hydrogen or methane gas if there’s an overgrowth of bacteria present.

Someone with SIBO will have higher amounts of hydrogen or methane gas in their breath than someone without the condition.

• Hydrogen levels over 20 ppm by 90 minutes are considered positive for hydrogen SIBO.
• Methane levels over 10 ppm at any point during the test are considered positive for methane SIBO.

Breath tests aren’t perfect because they may not catch all cases, and researchers are still exploring the best way to diagnose SIBO. However, a breath test is worth exploring if you have digestive issues.

Takeaway

Methane SIBO is a digestive condition characterized by an overgrowth of archaea in the small intestine, causing constipation and bloating. It’s diagnosed by a breath test and is typically treated with antibiotic therapy. 

Research is limited, but supplements, diet, and lifestyle changes may also be involved in treatment. 

Working with a Dietitian to Treat SIBO

SIBO is a condition where professional support is essential for accurate diagnosis and individualized treatment plans.

A dietitian with experience supporting SIBO treatments can help create a customized methane SIBO diet plan to help promote balance and health in the gut. 

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