Weight Loss Resistance & Overgrown Intestinal Methanogens

I am going to ask the hard question: Are you sure your bloating is “IBS” (irritable bowel syndrome)?

If we zoomed out further than the conventional questionnaire criteria used in Gastroenterology to come to the label of “IBS,” would we find a deeper issue like intestinal methanogens that are overgrown – either diagnostic levels or subclinical – that are influencing the gut function & possibly contributing to weight loss resistance too?

The back and forth between allopathic and functional medicine schools of thought leads to discrepancies on how “IBS” is labeled and consequently handled. Those in the functional medicine world cite there is more interventions that can be done besides the cliche: “here is your linzess, go low FODMAP and try to stress less, okay?”

Signs & symptoms of overgrown intestinal methanogens can include:

• Abdominal pain
• Bloating/distension
• Bad breath
• Feeling excessively full
• Gas
• Nausea
• Constipation
• Indigestion
• Heartburn
• Weight loss resistance

Now of course, these symptoms could be from a multitude of things, so in the spirit of due diligence you should access seeing a Physician for medical evaluation; but the reality is many Physicians diagnose IBS based off the Rome IV criteria (the lackluster standard of care) which is essentially a (pardon my French, bullshit) questionnaire and then saying, “yup this is IBS.” I wonder why there are so many misdiagnoses when it comes to gastrointestinal symptoms (insert sarcasm).

What are methanogens exactly?
They are archaea (kinda like bacteria but technically another microbe) that produce methane gas. Methanogens normally reside in the intestinal tract and do have roles: help with digestion, produce short-chain fatty acids, and remove excess hydrogen. When they overgrow is when symptoms and problems happen.

Why can methanogens overgrow in the gastrointestinal tract?
It is multifaceted in regards to why they overgrow; it could be one or any combo of the following: 

• Diet low in fiber, and consequently low in antioxidants
• Degrees of impaired gut motility such as a weaker migrating motor complex (standing while eating, snacking often and not allowing enough times for cleansing waves of peristalsis to complete a full cyle) or full on gastroparesis
• Stress – triggering “fight or flight” versus “rest and digest”
• Not eating enough volume or often enough (will often see elevated methanogens in people with a history of disordered eating)
• Certain medications including proton pump inhibitors, tricyclic antidepressants, narcotics
• Certain conditions like diabetes, or EDS, hypothyroidism
• Weak vagal tone, traumatic brain injury
• Being exposed to unsafe levels of toxic indoor mold
• Ileocecal valve removal (can happen with appendix removal surgery)

One or all of this collectively can disrupt the delicate balance of the gut microbiome, allowing these archaea to proliferate and then produce excessive methane gas, often leading to symptoms like bloating and constipation; It can become full on IMO – methane dominant sibo growing in the small intestine. Methanogens can also overgrow in the large intestine.

How is this detected?
NOT Western medicine’s Rome IV criteria….

1. SIBO breath testing is the western medicine way to diagnose methanogens in the small intestine (if you beg and plead for the test because the care algorithm says don’t do this right away, and I have flat out fired some of son’s Gastroenterologists because they said “SIBO & IMO aren’t real” or another choice phrase was said to me: “that is overmedicalized.” But my take is keep working them up if the patient doesn’t feel good – just order the dang test.
2. GIMAP functional stool testing is often utilized in the functional/integrative medicine world too; a GIMAP is functional test (not diagnostic) but is is FDA approved test and it can detect overgrown methanogens in large intestine.

Overgrowth is a problem and is bigger than just symptoms
An imbalance of methanogens can also contribute to digestive tract diseases like Crohn’s disease, ulcerative colitis, as well as obesity & metabolic dysfunction. There are multiple studies showing that eradicating methanogens improves metabolic measures in obesity.

Excess methanogens and weight gain?
Research suggests a link between excess methanogens (archaea that produce methane gas in the gut) and weight gain, with studies showing that higher levels of methane on breath tests can be associated with increased body mass index (BMI) in humans. The school of thought is an overgrowth of methanogens could contribute to weight gain by influencing how the body absorbs calories from food; this is often linked to the ability of methanogens to digest certain fibers, potentially leading to increased calorie extraction from the diet. Another thought is that constipation that goes hand in hand with excess methanogens contributes to suboptimal drainage pathways, upregulated enterohepatic circulation of toxins and estrogen, and consequently impaired metabolic detoxification.

So what can be done? Here are some strategies to address excess intestinal methanogens:

1. Eradicating the overgrowth – antimicrobials or antibiotics can both accomplish this; I will often use biofilm busters too
2. Resolving constipation (and its other contributing factors like inadequate magnesium intake, poor fiber intake, poor fluid intake, etc.)
3. Supporting gut motility: optimizing the migrating motor complex by proper spacing of food, sitting down versus standing to eat, taking time to eat
4. Probiotics to increase healthy bacteria in the large intestine
5. Prebiotics like PHGG 
6. Stress management to encourage “rest and digest”- being in a parasympathetic state supports bile flow and adequate stomach acid production which promotes motility through the gastrointestinal tract
7. Pro-kinetics like ginger or artichoke to help with bile flow, stomach acid support and ultimately gut motility
8. Addressing lower stomach acid levels; acv gummies or capsules can be helpful
9. Optimizing fiber intake and polyphenol rich food or polyphenol supplements
10. Hiring a certified mold inspector for formal evaluation of your home
11. Going to therapy or seeing a Psychologist; exploring strategies to cope with life’s stressors

Finding overgrown intestinal methanogens and addressing them can improve and sometimes resolve GI issues and also support being at a healthy weight. The gut is truly linked to so much!

 I have a general education protocol linked here for addressing intestinal methanogens and also feel free to schedule a consultation package if you need one on one individual assistance.

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093012/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895606/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093012/
• https://helpcentre.healthpath.com/en/knowledge/can-eating-disorders-cause-sibo
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3277195/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3895606/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC9769613/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3615195/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC4769647/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3400877/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3400877/
• Mathur R, Amichai M, Chua KS, Mirocha J, Barlow GM, Pimentel M. Methane and hydrogen positivity on breath test is associated with greater body mass index and body fat. The Journal of clinical endocrinology and metabolism. 2013;98:E698-E702.
• Basseri RJ, Basseri B, Pimentel M, Chong K, Youdim A, Low K, Hwang L, Soffer E, Chang C, Mathur R. Intestinal methane production in obese individuals is associated with a higher body mass index. Gastroenterology & hepatology. 2012;8:22-28.
•  Mathur R, Chua KS, Mamelak M, Morales W, Barlow GM, Thomas R, Stefanovski D, Weitsman S, Marsh Z, Bergman RN, et al. Metabolic effects of eradicating breath methane using antibiotics in prediabetic subjects with obesity. Obesity (Silver Spring, Md). 2016;24:576-582.
• Mathur R, Mundi MS, Chua KS, Lorentz PA, Barlow GM, Lin E, Burch M, Youdim A, Pimentel M. Intestinal methane production is associated with decreased weight loss following bariatric surgery. Obesity research & clinical practice. 2016;10:728-733.

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