SIBO information


Senior Member
Northern southern California
I didn’t want to muck up someone else’s thread, so I’m posting this here. It’s probably common knowledge to most of you but it was a huge eye opener for me, and I thought I would share in case it could help someone else. This is the most straight forward information I’ve seen on SIBO.
The full interview can be seen here,

These are some excerpts from this interview with a Dr Pimitel. I spent a few hours last night researching him after reading a posting by bertidog. Very interesting and relevant if you are having gut issues.

In particular, the research on lactic acidosis, as Avenger has posted about.

44:30 Hydrogen Sulfide SIBO. We think that hydrogen sulfide is causing diarrhea in SIBO patients. Methane causes constipation, hydrogen sulfide causes diarrhea, and hydrogen is just the fuel source for either direction. Dr. Pimentel usually uses antibiotics to kill the bugs that cause SIBO, but he tries to use as few antibiotics as possible. He uses Rifaximin for hydrogen SIBO and Rifaxmin and Neomycin for methane SIBO and he’s not sure what to do for hydrogen sulfide. He is hopeful to have a new breath test out that will enable us to diagnose hydrogen sulfide SIBO. He is hopeful that the data on Lovastatin will pan out and they can use that for methane SIBO. If they don’t respond, they may use natural products like peppermint and berberine and allicin. If they are positive on IBS Smart test for vinculin antibodies, then he will give a prokinetic. Once they get rid of the SIBO, they place patients on a specialized diet like low FODMAP, but he prefers the low fermentation diet, because you will have a better quality of life. He’s not sure if a low sulfur diet might be helpful for hydrogen sulfide SIBO. He prefers not to use a low fiber diet until after the antibiotics treatment, since if you starve the bacteria, the antibiotics may not work as well.

48:30 Dr. Allison Siebecker and Dr. Steven Sanford-Lewis, two of the top integrative doctors who are experts on SIBO, both treat SIBO successfully by using Rifaxmin or natural antimicrobials and a low FODMAP diet simultaneously and they find that using both simultaneously is more effective. Dr. Pimentel will typicall treat with antiboitics first and then add in the low fermentation diet and often a prokinetic, and Prucalopride or Motegrity is his favorite one to use, though he may use low dose erythromycin because of the lower cost.

56:36 Lovastatin that’s on the market now is designed to be absorbed into your blood to reduce cholesterol. In order for Lovastatin to have the desired effect in the gut for methane SIBO, it will have to be non-absorbed into the bloodstream and slowly released in the gut, so Dr. Pimentel is developing a novel form of the drug, which is not yet available on the market.

59:07 Some patients with SIBO get brain fog and neurological symptoms. This could be caused by D-lactic acidosis, which Dr. Satish Rao has published on. Methane is a gas similar to halothane and isoflurane, which are gases used in the operating room to induce sleep. Methane is also associated with higher blood sugar and higher cholesterol, so methane is clearly a bad actor.