The difference between methane vs. hydrogen SIBO (small intestinal bacterial overgrowth) mainly comes down to the types of microbes that cause them. Methane-producing archaea cause methane SIBO while hydrogen-producing bacteria lead to hydrogen SIBO.
Methane and hydrogen SIBO also have distinct symptoms and are diagnosed slightly differently. Getting tested is crucial to tailoring improvement plans accordingly, as protocols differ per patient.
This guide explains the essential similarities and differences between these two SIBO types. By the end, readers should better understand methane SIBO and hydrogen SIBO and their options for improvement.
Methane SIBO Symptoms
First, Methane SIBO is also known as methane-dominant SIBO. An estimated 10% to 15% of adults and children, respectively, have methane SIBO.
Its hallmark symptom is constipation and is associated with the IBS-constipation type (IBS-C). Signs someone is constipated include:
- Straining to have a bowel movement
- Incomplete evacuation
- Blood in stool
- Abdominal distension
Weight gain is a downstream effect of methane SIBO. Constipation and weight gain are linked because the former features slower transit times. Slower transit times equate to greater nutrient absorption, which can lead to weight gain.
Some experts have recommended changing the name of this SIBO type to small intestinal or just intestinal methanogen overgrowth due to the type of microbes that cause it. Learn more about the causes of methane SIBO next.
Methane SIBO Causes
Another name for Methane-dominant SIBO is also intestinal methanogen overgrowth (IMO) because methanogens, not bacteria, cause it. Methanogens are archaea, and archaea and bacteria have slightly different cell walls.
Methanogen overgrowth can occur when the gut is exposed to excess carbon dioxide and/or hydrogen. Methanogens ‘eat’ carbon dioxide and use hydrogen to transform it into methane gas (CH4).
Excess hydrogen production in the gut can happen for a few reasons. For example, if undigested polysaccharides enter the intestines, gut bacteria will ferment them. Hydrogen is a byproduct of the fermentation process.
Methane SIBO Diagnosis
Doctors can diagnose Methane SIBO by evaluating someone’s symptoms and ruling out other potential causes. SIBO testing is a more foolproof way to identify this gut health condition.
Small intestine aspiration and quantitative culture tests, urinalysis, and SIBO breath tests are used to diagnose SIBO. Of these, breath testing is the most common and may be the most accurate.
Breath tests require people to drink a sugary substance before collecting a breath sample. A lab will evaluate the sample for gasses. If the sample is high in methane gas, the test may indicate methane SIBO.
Expert Opinion
In many circumstances, practitioners may try to distinguish between the different types of SIBO using a variety of tests. Here at Revolution Gut Health, we believe that regardless of the type of SIBO, the protocol for improving symptoms begins with the same foundation: removing environmental toxins, which seem to be at the core of this condition.
Methane SIBO Treatment
It can be challenging to improve Methane SIBO. Archaea do not always respond to antibiotics, which are the gold standard for SIBO. In this case, herbal antimicrobials may be more effective.
The Elemental Diet is another option for SIBO, in general, with research backing its effects. A recent case study reported on the benefits of a form of the Elemental Diet for methane SIBO, in particular.
In some cases, treating hydrogen SIBO can also reduce symptoms of methanogen overgrowth. Learn more about hydrogen SIBO and its link to methane SIBO next.
Hydrogen SIBO Symptoms
The most common type is Hydrogen SIBO or hydrogen-dominant SIBO. It is linked to IBS-diarrhea type (IBS-D) and features diarrhea as its most common symptom.
The most obvious sign of diarrhea is loose, watery stools. People with this symptom may need to have a bowel movement more often. Other symptoms associated with diarrhea may include:
- Stomach cramps or pain
- Bloating
- Nausea
- Fever
- Blood in stool
- Incontinence
If left untreated, diarrhea can lead to dehydration. Diarrhea features fast transit time, which may not give the small bowel long enough to absorb water from stools.
Malnourishment can also be a consequence of chronic diarrhea. Fast transit times are also to blame, as the intestines will not have enough time to extract nutrients from digested food.
Hydrogen SIBO Causes
An overgrowth of hydrogen-producing gut bacteria in the small intestine causes Hydrogen SIBO. Hydrogen is the most prevalent gas produced by Firmicutes and Bacteroides. These two species account for 92% of bacteria in the large intestine.
Bacteria produce hydrogen by breaking down carbohydrates. Fiber is the primary fuel source for bacteria living in the small intestine. If they can’t access their food of choice, they may migrate to the small intestine, where carbohydrate digestion primarily occurs.
People who are lactose intolerant may also inadvertently cause hydrogen-producing bacteria overgrowth if they consume lactose. In people with lactose intolerance, this sugar passes to the large intestine undigested. It may then lead to bacterial overgrowth in the small intestine.
Understanding why excess hydrogen leads to diarrhea is less clear. Hydrogen is typically beneficial for human health. It protects the gut from free radicals and oxidative stress.
In excess, hydrogen may damage the intestinal lining, draw water into the bowels, create enzyme deficiencies, or cause fat malabsorption. All of these are proposed causes of diarrhea-dominant SIBO.
Hydrogen SIBO Diagnosis
Hydrogen SIBO is diagnosed in the same ways as methane SIBO: evaluating symptoms and ruling out other causes and SIBO testing. Again, breath tests are most common.
Unlike methane SIBO, hydrogen SIBO breath tests do not evaluate levels of methane in the breath. Instead, they look for high levels of hydrogen gas (H2) to identify an overgrowth of hydrogen-producing gut bacteria.
Hydrogen SIBO Treatment
Since bacteria cause hydrogen SIBO, this type responds well to antibiotics like rifaximin. Antibiotics target and kill bacteria, but they aren’t selective. They will destroy overgrown bacteria and beneficial bacteria.
For these reasons, antibiotics should never be used for long-term SIBO treatment. Overuse of antibiotics is a known cause of SIBO.
Additionally, many people may prefer natural remedies with fewer side effects. Rifaximin has side effects like dizziness, muscle spasms, rapid breathing, shortness of breath, and difficulty sleeping.
The better option for symptom improvement is a combination of diet and herbal therapy. In one study, herbal antimicrobials were effective in 46% of hydrogen-dominant SIBO patients. Rifaximin was only effective in 34% of these patients.
Difference Between Methane and Hydrogen SIBO
Methane and hydrogen SIBO may share the same underlying cause- an overgrowth of small intestinal microbes- but that’s about where their similarities end.
We compare more similarities and differences in hydrogen vs. methane SIBO next.
Methane SIBO vs. Hydrogen SIBO Symptoms
To begin, Methane SIBO primarily causes constipation. Meanwhile, hydrogen SIBO features diarrhea as its predominant symptom.
However, the symptoms of these conditions are not always so cut and dry. For example, a 2003 study assessed 551 people who tested positive for SIBO. Interestingly, hydrogen SIBO caused constipation in addition to diarrhea, and methane SIBO featured diarrhea and constipation.
Methane SIBO vs. Hydrogen SIBO Causes
An overgrowth of methanogens, a type of archaea, causes methane SIBO. Hydrogen SIBO, on the other hand, happens when hydrogen-producing bacteria multiply.
Despite these differences, some cases of methane SIBO may be caused by excess hydrogen in the gut. We will talk more about this in a moment.
Methane SIBO vs. Hydrogen SIBO Diagnoses
Both Methane and hydrogen SIBO can be diagnosed using breath tests. However, the gasses these tests will look for differ. Hydrogen SIBO breath tests look for H2 gas, while methane SIBO breath tests evaluate CH4 levels.
In some cases, a positive hydrogen SIBO breath test may also indicate methane SIBO. Excess hydrogen creates the ideal breeding ground for methanogens, which is why these SIBO types often co-occur.
Methane SIBO vs. Hydrogen SIBO Treatments
Different types of microbes cause Methane and hydrogen SIBO. These distinct causes explain why hydrogen SIBO responds well to antibiotics, but methane SIBO does not. Still, since methane SIBO can be caused or exacerbated by excess H2 gas, treating hydrogen SIBO may help anyway.
Berberine is a natural herbal antimicrobial that can neutralize hydrogen and methane gasses. Neutralizing these gasses can alleviate symptoms of both types of SIBO, though it will not address the underlying overgrowth.
Diet also plays a role in treating SIBO. The Carnivore Diet has been studied as a cure for hydrogen SIBO. Meanwhile, research shows that the Elemental Diet can be an effective option to improve methane SIBO.
Can You Have Both Hydrogen and Methane SIBO?
Yes, you can have hydrogen and methane SIBO simultaneously. In a study of 331 people, 68.1% tested positive for SIBO. 40.3% tested positive for hydrogen SIBO, 47.3% tested positive for methane SIBO, and 12.4% tested positive for both.
Methanogens need hydrogen gas to produce CH4. Hydrogen SIBO produces an excess of H2, creating the perfect breeding ground for these archaea. A breath test should show the presence of both types, though some methanogens use so much hydrogen that there is little left to show up on a breath test.
Methane vs. Hydrogen SIBO: Which Is Causing Your Symptoms?
The most important thing to understand when comparing methane vs. hydrogen SIBO is that their underlying causes and symptoms differ. As such, they can sometimes require dissimilar plans to eradicate the bacterial overgrowth and find digestive relief.
Are you ready to find out which SIBO type is causing your symptoms? Revolution Gut Health’s experts are here to help, even when your physician’s prescribed treatment has failed.
Schedule a consultation with our gut health doctors for a customized plan tailored to your unique type, symptoms, and needs.