0:00 Are you struggling with chronic constipation and bloating? Well, this video is for you. Today, we're going to talk about one of the biggest root causes, known as intestinal methanogen overgrowth, also known as the methane variety of SIBO. Now, most people have never even heard of this condition. And unfortunately, most doctors are not familiar with diagnosing it or treating it. I'm Dr. Ruscio, and I'm a Wooder Pot. I'm a gut health specialist, and today I'm going to break down intestinal methanogen overgrowth, also known as IMO, and how to treat it effectively. >> [music] [music] >> IMO is actually the methane subtype of SIBO, which stands [music] for small intestine bacterial overgrowth. It's when bacteria overpopulate in the wrong place, in the small intestine, and can
0:47 cause gas, bloating, and changes in your bowel habits. Now, there are three main types of SIBO: hydrogen, methane, and hydrogen sulfide. And they can all cause bloating, food sensitivities, and IBS symptoms. We can make this diagnosis through a lactulose breath test. In this report, the person is positive for both hydrogen and methane SIBO. Today's video is dedicated to the methane variety of SIBO, also known as intestinal methanogen overgrowth, because of its unique properties. Now, just to be super clear, throughout this video, whenever you see a bubble with a CH4 in it, that's representing methane gas. Now, when we talk about methane gas, a lot of people think about cows, since they emit large amounts of methane. And interestingly, in cows, methane
1:33 production is actually part of their digestive process, called enteric fermentation, where methanogens in their intestines ferment the grass that they eat to help them extract more energy from their food. But in humans, the same process can work against us. Today, we'll talk about how methane gas can slow the motility in the gut, leading to constipation and bloating. Did you know that methane gas is actually odorless? Foul-smelling gas is a separate issue. It could reflect what you ate, or it could be a sign of dysbiosis, which is a bacterial imbalance in the gut microbiome. Kind of like having weeds growing in your gut garden. Normally, when I talk about SIBO, I use that as an umbrella term to include all three types, which are hydrogen, methane, and hydrogen sulfide. And some
2:20 of you may have seen my prior videos on SIBO. So, this was my original video explaining the condition in detail, all about my herbal protocol for SIBO, and most recently, the SIBO revolution. But, I decided that the methane variety of SIBO is so unique for a variety of reasons that it deserves its own video. >> [music] >> So, let's go over the reasons that make IMO unique. First, IMO extends beyond the small intestine. So, it could be in the small intestine, or the large intestine, or both. So, you can see why the term small intestine bacterial overgrowth isn't exactly accurate, and why we now refer to it as intestinal methanogen overgrowth, or IMO.
3:07 >> [music] >> The second unique feature is that methane producers are not bacteria. They belong to a completely different set of microorganisms called archaea. So, these are considered some of the most ancient life forms on Earth. They've been around for billions of years, long before humans even existed. One of the main methane-producing archaea is called Methanobrevibacter smithii, also known as M. smithii for short. And this is what it looks like under a microscope. And because they're so different from bacteria, this is again why the term small intestine bacterial overgrowth isn't entirely accurate anymore, and why we now like to refer to it as intestinal methanogen overgrowth, or IMO.
3:53 >> [music] >> The third unique feature is that methane gas slows the motility throughout the intestines. So, this is what healthy gut motility looks like. As you can see, there are active waves of peristalsis that can move food and bacteria efficiently through the intestines. And these waves are controlled by the migrating motor complex, also known as the MMC, which is like the pacemaker of the gut. Now, this is what happens when methane gas enters the picture. All of a sudden, everything slows down. This is why methane SIBO or IMO is strongly associated with constipation or IBSC, which is constipation predominant IBS. Interestingly, chronic constipation can be a risk factor for IMO, further slowing gut motility, so it becomes a
4:40 vicious cycle. In contrast, hydrogen SIBO is associated with loose stools and diarrhea or IBSD, which is diarrhea predominant IBS. Now, many people have both conditions overlapping, so they have a combination of both hydrogen SIBO and IMO. And this can present with alternating bowel patterns or IBS-M, which is the mixed form of IBS. Now, it's also important to understand that methane gas doesn't always cause symptoms. Some people are natural methane producers and feel completely fine. I've actually seen several patients with high levels of methane who had completely normal bowel movements and no bloating. So, that's why I don't just treat the number. I treat the [music] patient, factoring in how the methane levels are contributing to their
5:26 symptoms. >> [music] >> The fourth unique feature of IMO is that it can make it harder to lose weight. Methane has been associated with higher body weight, possibly because methane-producing organisms make fermentation more efficient, allowing the body to extract more energy from food. While this may be helpful in animals like cows to extract more energy from grass, in humans it can work against us. While this doesn't apply to everyone, I have seen patients with IMO lose weight with treatment and keep it off. And it likely comes down to what's happening in the gut, improving motility and changing how energy is being extracted from food. Now in contrast, patients with hydrogen SIBO often have frequent loose stools
6:13 where food is moving too quickly through the intestines. >> [music] >> So they're at higher risk of malabsorption, weight loss, and nutrient deficiencies. >> [music] >> The fifth unique feature of IMO is that it's a hydrogen sink. So what does the phrase hydrogen sink exactly mean? Well, methane-producing archaea, also known as Methanobrevibacter smithii or M. smithii for short, convert four hydrogen molecules along with one carbon dioxide to one molecule of methane and two molecules of water. So they're basically using up hydrogen to make methane. And that's why in severe cases of IMO, on a lactulose breath test, we see high levels of methane and hydrogen is often a flat line because the archaea are
7:00 using up the hydrogen to produce the methane. Now let's talk a little bit more about the lactulose breath test and how the results differ for IMO versus hydrogen SIBO. So in this test, you first collect a baseline breath. And then you drink a solution of lactulose mixed with water. And this is a type of sugar your body can't absorb. But it will feed the bacteria or archaea in your gut and they'll convert it into gas, either hydrogen, methane, or hydrogen sulfide. So then you collect your breath at 20-to-30-minute intervals for a full 3 hours. When someone has hydrogen SIBO, the bacteria ferment the lactulose as it moves through the small intestine. So in a 3-hour test, the first 90 minutes is considered the small intestine. So, if we see a rise in
7:46 hydrogen by 20 parts per million in the first 90 minutes of the test, this is considered positive for hydrogen SIBO. But, methane behaves very differently. Methane-producing archaea are already active in the gut, constantly converting hydrogen to methane even before the lactulose arrives. So, instead of seeing a rise, we often see methane present from the very beginning of the test and throughout. As you can see in this test, the methane is starting at 20 parts per million right at the beginning, even before the patient drinks the lactulose. And that's why for methane, we don't necessarily look for a rise. Any methane level over 10 parts per million during any point of the test is considered positive for IMO. And this includes the entire 3 hours of
8:31 the test, which includes both the small intestine and the large intestine. And here's the fascinating part. When we treat IMO and we see methane levels go down, there's often a surprise. We see a rise in hydrogen levels. Remember, the methane-producing archaea are converting hydrogen to methane. So, when we kill the archaea, it makes sense that methane levels go down, but hydrogen levels go up. And this is why if you only treat IMO, you'll end up unmasking hydrogen SIBO. Because of this, when we treat IMO, we really have to treat IMO and hydrogen SIBO simultaneously. Because otherwise, we'll just end up lowering methane levels and increasing hydrogen levels. The great news is that my herbal
9:17 protocol for SIBO targets both IMO and hydrogen SIBO, and I'll walk you through this protocol later in this video. Now, let's talk about why treating IMO is uniquely challenging. So, this is primarily related to achieving good bowel regularity. Because remember methane gas slows motility throughout the gut and it can be associated with stubborn constipation. In my herbal protocol for SIBO, phase one is dedicated to promoting motility. In order to successfully treat IMO, we really have to spend time in phase one optimizing motility and improving bowel regularity before moving on to the next phases of treatment. The other reason that treating IMO is a bit more challenging is because it
10:03 requires all three herbal antimicrobials, which are berberine, oregano oil, and allicin. In contrast, hydrogen SIBO only requires two herbal antimicrobials, which are berberine and oregano oil. And the reason we need three herbal antimicrobials when treating IMO is because we're actually treating IMO and hydrogen SIBO simultaneously. Now, let me share a case of my patient Lori who had severe IMO. So, Lori was a 42-year-old and when I first met her, she told me she only had a bowel movement once a month. I was shocked. Well, then I saw her lactulose breath test, which revealed methane levels over
10:48 81 parts per million and it all made sense. So, I treated Lori with my four-phase herbal protocol for SIBO. And unlike treating hydrogen SIBO, we had to spend more time in phase one. So, it actually took us a few weeks to get her bowels more regular and this part is critical. So, she had to take four capsules of essential magnesium, which is about 500 mg at bedtime. And magnesium works as an osmotic laxative to pull water into the colon. She also had to take two capsules of motility activator, which is a prokinetic made from ginger to activate the cleaning waves in her gut. And additionally, she had to take one capsule of aloe pro, which is the dried leaves of the aloe vera plant that work as a gentle stimulant laxative. So, once we got her bowels under
11:34 control, we proceeded with the rest of the protocol with great success. And because her methane levels were so high, I recommended that she take the herbal antimicrobials for a full 3 months. So, here's her lactulose breath test at the end of the treatment. So, as you can see, her methane levels drastically improved, and there was no rebound increase in hydrogen because my protocol covers both IMO and hydrogen SIBO. Best of all, her bloating vanished, and she was now having a bowel movement almost every day. So, this was life-changing. She also lost over 10 lb and inches off her waistline. Again, remember, IMO can make you hold on to weight. So, the lesson here is that addressing motility is key. If you try to kill the archaea before addressing motility, you likely won't have a successful outcome,
12:20 and you're much more likely to experience side effects from the herbal antimicrobials. Unfortunately, a lot of doctors are not familiar with IMO or SIBO, and hence they're not familiar with the difference between the two. I've seen a lot of patients who were simply handed a prescription for the antibiotic rifaximin, also known as Xifaxan, and they take it, but they don't get better. And that's because Xifaxan is the standard treatment for hydrogen SIBO, but it won't work by itself for IMO. If you're going the antibiotic route, IMO is usually treated with two antibiotics: Xifaxan with neomycin or Xifaxan with metronidazole. But a lot of people are rightfully concerned about the side effects of antibiotics, especially because in many cases, their SIBO symptoms started after
13:05 taking antibiotics in the first place. Additionally, these antibiotics don't do anything to address the motility in the gut. And as a result, IMO usually just comes right back. IMO, just like hydrogen SIBO, has other common root causes as well, like low stomach acid and low digestive enzymes. And that's why you really need to address all of this as part of a comprehensive protocol in order to get lasting results. [music] And that's exactly what my four-phase herbal protocol is designed to do. Now, you might be wondering, why did you get IMO? What caused it in the first place? Well, the reasons are similar to the root causes of SIBO in general. First is chronic constipation. Remember how it can create a vicious cycle with
13:52 IMO? Next, we have antibiotics. Then there's food poisoning, which can lead to post-infectious IBS and impact the motility of the gut. Next is hypothyroidism, an incredibly common hormonal disorder that's associated with slow gut motility, which can set the stage for IMO. Additionally, a lot of people with hypothyroidism also have low stomach acid. Then there's autoimmune diseases like rheumatoid arthritis, scleroderma, Hashimoto's, and lupus, which are all associated with slow gut motility. Low stomach acid or chronic use of proton pump inhibitors or PPIs, which shut down acid production in the stomach, is another risk factor. Low pancreatic enzymes or sluggish gallbladder function can also impact
14:37 digestion and increase the risk of IMO. And finally, if you've had prior abdominal surgeries and have scar tissue in your abdomen, that could also increase your risk. There really isn't a specific reason why some people get IMO as opposed to hydrogen SIBO. But here's the good news. Just because it's called IMO, it doesn't mean you need a completely different treatment approach compared to SIBO. In fact, my four-phase herbal protocol has been extremely successful in treating IMO, and I've treated hundreds of patients over the years. And I've collected some interesting case examples from a wide variety of patients that you can review in my SIBO library, and I'll share a link in the description below. Remember, we always want to address IMO and hydrogen SIBO simultaneously, and that's exactly what my four-phase herbal protocol was designed to do.
15:24 Now, one of the most unique aspects of my protocol is that we address motility first in phase one. And this is something that's not talked about very much, even by gastroenterologists. But this is critical because if the gut isn't moving properly, food, bacteria, and archaea will continue to stagnate in the intestines. As I mentioned earlier, in IMO, this phase is often the most important and can sometimes take a bit longer. So, now let me give you a brief overview of the protocol, and I'll share a link where you can download the full protocol in the description below. So, in phase one, we promote motility. In phase two, we reduce the gas levels. In phase three, we reduce inflammation in the gut. And in phase four, we finally kill the archaea with herbal antimicrobials.
16:09 So, each phase is generally 1 week, but remember, phase one can take longer in IMO because we really need to get the bowels regular. And each phase layers on top of the prior phases, so you want to continue everything from the prior phases. And the final phase with herbal antimicrobials is 4 to 6 weeks, or sometimes up to 3 months for stubborn cases. So, now let me walk you through each of the phases. Phase one is to promote motility, and we have three treatments to optimize motility and bowel regularity. So, the first is essential magnesium, which is a chelated magnesium that has magnesium citrate, glycinate, and malate. And magnesium works as a natural osmotic laxative to pull water into the colon to keep your bowels regular. And it also improves sleep quality and helps
16:56 with muscle recovery at night. So, my patients really love essential magnesium, and you can take anywhere from two to four capsules at night, which is up to about 500 mg, and adjust it based on your bowel habits. Next, we have motility activator, a potent formula of ginger that works as a natural prokinetic to wake up the migrating motor complex, which are the waves of peristalsis in the intestines. And this helps move food, bacteria, and archaea throughout the intestines. So, you can take anywhere from one to two capsules at bedtime along with the essential magnesium. And if needed, you can take an additional dose of one capsule first thing in the morning on an empty stomach. And finally, we have Aloe Pro, which is the dried leaves of the aloe vera plant in capsules that works
17:41 as a natural stimulant laxative. And this is optional for those with stubborn constipation. Another big part of promoting motility is meal spacing. So, I recommend 4 to 5 hours between meals and 12 hours between dinner and breakfast to really allow the migrating motor complex to clean out the small intestine. And intermittent fasting is optional, but can also be helpful. Many of my patients notice right away that meal spacing can make a big difference in reducing bloating. In phase two, we reduce the gas levels by starting digestive enzymes and the SIBO diet, which is an overlap of a low FODMAP and low lectin diet. Digestive Enzyme Pro helps to target the breakdown of proteins, fats, and carbohydrates, so it significantly reduces bloating. And remember, these
18:26 methane-producing archaea are feeding off of undigested food in the intestines. So, the better we break down the food, the less gas and bloating you'll experience. For many people, Digestive Enzyme Pro is adequate, but for those with low stomach acid, an additional supplement called betaine and pepsin can be a game-changer. So, betaine is hydrochloric acid, and pepsin is the enzyme to break down proteins. So, a clue that you might have low stomach acid is if you feel like food just sits heavy like a brick in your stomach, or if you have belching or throat clearing after meals. Now, let me walk you through how to do a betaine challenge to figure out if you have low stomach acid. If you take one capsule of betaine and pepsin after a meal and don't feel anything, meaning you don't have any burning, that means you need it
19:12 and you're not making enough acid on your own. But if you do notice burning, that means you don't need it and you're already making enough acid. Now, if this happens, don't panic. You can easily resolve the burning by eating a little bit more food, drinking some water, or taking a quarter teaspoon of baking soda and putting that in a glass of water and drinking that. The second part of phase two is the SIBO diet, which is the same diet that we use for IMO. So, let's review that. So, I recommend an overlap of a low FODMAP diet and a low lectin diet. Low FODMAP means we eliminate fermentable carbohydrates like whole grains, beans, as well as fruit, garlic, and onions. And this helps starve the archaea and reduce bloating. Now, a lot of people with IMO and SIBO are also
19:58 sensitive to lectins, which is the outer coating of seeded vegetables like tomatoes, cucumbers, eggplant, and bell peppers. So, I recommend avoiding these as well. Now, what about fiber in IMO? Well, fiber is essential for helping with bowel regularity, which is critically important when treating IMO. So, I recommend continuing whatever vegetables you tolerate that don't cause bloating such as leafy greens, which could be raw or sautéed, sweet potato if tolerated, avocados, as well as cooked carrots and celery like in a soup. If supplemental fiber is needed, I recommend acacia senegal fiber, which comes from the sap of the acacia tree and it's harvested and turned into a powder. It's a soluble fiber that turns into a gel-like consistency, so it helps
20:43 to soften and bulk up the stool, so it helps with bowel regularity. And it's considered low FODMAP, so it's generally well tolerated in IMO and SIBO. Now, it's important to avoid other prebiotic fiber supplements because those can get fermented by the archaea and actually worsen bloating. Moving on in phase three, we lower inflammation in the gut by starting spore probiotic IGG. So, this has three different strains of spore-based bacillus probiotics, and clinical studies have shown that these strains can help reduce gas and bloating and are better tolerated in SIBO and IBS compared to traditional probiotics. This also contains IGG antibodies, which are immunoglobulins to reduce inflammation in the gut. Additionally, in the next phase, when we start killing the archaea with herbal antimicrobials, these
21:30 immunoglobulins can help bind toxins and reduce SIBO symptoms. Moving on in phase four, we finally kill the archaea using herbal antimicrobials. So, we use berberine, oregano oil, and allicin, one capsule each after every meal for 4 to 6 weeks, or sometimes up to 3 months for stubborn cases. When starting these herbal antimicrobials, it's best to start them one at a time and gradually increase the dose as tolerated. Now, the good news is because we've prepared your gut in phases 1 through 3, most people tolerate the herbal antimicrobials quite well and generally have much less side effects compared to other protocols. Now, a quick disclaimer. This protocol is not intended for children. It's not intended for women who are pregnant or
22:15 nursing, or for those who are taking blood thinners. It's always good to talk to your doctor and check for drug interactions if you're on prescription medications. After treatment, patients are usually feeling significantly better. Their bloating is gone, their bowels are regular, and they're tolerating more foods. Many even lose weight and have more energy. So, this is when we can start reintroducing foods back into the diet, but we want to take it slow and add one new food every 2 to 3 days and observe your response. And we generally want to start with fruits and vegetables. Eventually, many people are even able to add back dairy again. And I have a whole video where I outline my step-by-step plan to help your gut microbiome gradually adapt to tolerating dairy again, and I'll share a link in in description below. But, it doesn't end
23:02 there, because after completion of treatment, my protocol includes strategies for prevention of relapse. Because IMO, just like SIBO, has a very high relapse rate. In fact, studies suggest that 44% of patients relapse within 9 months of treatment. So, this is when we transition to a broad-spectrum probiotic, like our probiotic 100 billion, which has over five strains of lactobacillus and bifidobacterium, which are the good bacteria that help prevent the methane-producing archaea from coming back. We also want to continue to promote motility with essential magnesium and motility activator at bedtime. Now, if you were using Aloe Pro regularly, you want to start weaning off and just use it as needed and rely primarily on essential magnesium and motility activator to keep your bowels
23:47 regular. You also want to continue digestive enzymes if needed and betaine and pepsin, especially while reintroducing new foods back into the diet. It's also important to continue meal spacing. So, remember to have 4 to 5 hours between meals. So, if you're struggling with chronic constipation and bloating, definitely get tested for IMO. The good news is if you're positive, it's very treatable. You just need a structured protocol that addresses gut motility first and a treatment regimen that addresses methane and hydrogen gases simultaneously. So, now I want to hear from you. What questions [music] do you have? Be sure to post them in the comments below. And remember, you can download the full protocol in the description below and we carry everything for the protocol in our online store and we ship throughout the United [music] States.
24:34 Now, for more gut healing tips, follow me on Instagram, where I share new insights almost every day. And if you found this video helpful, please give it a thumbs up, subscribe [music] to my channel, and share this video with someone you know who needs help with their gut. I'm Dr. Rajshree. Thanks so much for watching and I'll see you next time. >> Mhm.
