Do you suffer from chronic constipation, IBS-C (irritable bowel syndrome, constipation predominant) or SIBO-C (small intestinal bacterial overgrowth -constipation predominant)? or do you have a special interest in these conditions? If yes, this article is for you.
It may feel like no one understands you. You probably took several trips to the doctor, had many tests done and everything looked normal. Maybe you received the diagnosis of chronic idiopathic constipation (idiopathic means no known cause) and advised to take some laxatives. Perhaps your doctor ruled out other digestive conditions, suggesting you suffer from IBS-C, and prescribed you laxatives, antidepressants or specific meds for IBS-C (ie Lubiprostone). In fewer cases, the test for SIBO may have been recommended- and when it came back positive you had to take antibiotics.
Despite these treatments, you are still feel unwell, extremely fatigued, bloated and stressed out. You no longer enjoy things you used to enjoy. You may turn to Google and read hundreds of articles looking for a real solution. Blogs, youtubes, podcasts…everything. You tried a supplement, and another one …and another one. Checked a new diet and nothing seem to work. Other people don’t really understand why you feel so sick. No big deal, it’s just an IBS or SIBO, they would think.
Yet, you know that something is going wrong in your body. You feel sick, you have symptoms Not only your digestion, but also your energy, mood, memory and your overall quality of life are affected.
2.What Is the Real Cause of Chronic Constipation, IBS-C and SIBO-C? And A Few Other Questions
When I researched this topic, I had some questions in my mind :
What if the REAL cause of chronic idiopathic constipation, IBS-C and SIBO-C is a simple bug? I am talking about methane producing microbes (Archaea kingdom)
What if chronic constipation, SIBO-C and IBS -C are not 3 different conditions, but just one disease: Archaea overgrowth ?
Could chronic constipation, SIBO-C, IBS -C be the starting point of other problems, thus increasing the risk of MS/other autoimmune conditions, or cancer?
I know these ideas seem unusual. A medical book would indicate Archaea overgrowth as main problem in SIBO-C, and no association with chronic constipation, IBS or other conditions. According to a medical textbook, chronic constipation, IBS or SIBO are not considered a risk factor for autoimmune conditions or cancer. A medical textbook and even integrative physicians -will describe chronic constipation, IBS-C and SIBO-C as being different diseases- and treated differently.
However, I see them all connect, perhaps one-not three distinct conditions. I also found evidence that there is “depression “ in the gut just the same we see “depression” in the brain- more details in this article.
2.About Archaea Microbes
Archaea kingdom includes three types of microorganisms, including the gas producing microorganisms called methanogens. They are called methanogens because they produce methane (the well-known gas with chemical formula: CH4). Methanogens are considered part of the normal intestinal flora as they cohabitate with other gut microorganisms and have their own functions.
The problem develops when they overgrow. I blame this overgrowth of methanogens as being the main cause of chronic constipation, SIBO-C and IBS-C.
Here is why: We are just starting to learn about methanogens. For a long time (up until 1985), scientists believed they are harmless bacteria found in the gut of humans and animals. Archaea microorganisms are found in abundance in nature as well (hot springs, salt lakes, and submarine volcanic habitats). It was also thought that Archaea are bacteria (thus were labeled Archaebacteria).
Only in the last few decades we have learned that :
Archaea are not true bacteria, but a distinct type of microorganisms (Archaea kingdom)
They cause health problems when they overgrow- currently seen as a problem (and treated) in SIBO only
Methane producing Archaea are very hard to treat and the recurrence rate is very common
3.The Link Between Archaea Methanogens and Chronic Constipation, SIBO-C, IBS-C, and Many Other Conditions
What happens in SIBO-C: instead of populating the large intestine (as they normally do), these methanogens manage to get in the small intestine and overgrow. SIBO-C is treated with diet and antibiotics (rifaximin plus neomycin or metronidazole). Treatment is not that effective (less than 50% successful treated), and the recurrence rate is frequent (over 40% recurrence rate within 9 months).
Newer studies indicate that methanogens also play a key role in chronic constipation (as a stand alone symptom) but also in IBS-C. Methanogens slow the intestinal transit time by almost 60% -which explains the constipation and bloating.
The overgrowth of methanogens can also cause gum infections (periodontitis) and vaginal infections.
Research found a significant association between the severity of constipation and the presence of methane in the breath tests. Higher levels of breath methane have also been detected in individuals with diverticulosis, obesity, precancerous conditions (colonic polyps) and cancer of the colon (when compared with healthy subjects).
On the other hand, lower levels of methanogens are associated with diarrhea, Crohn’s disease and ulcerative colitis and diarrhea induced by chemotherapy [1],[2],[3],[4],[5],[6],[7].
A quick note here: There are other factors that increase the overgrow of methanogens (ie lack of dietary fibers, dehydration, low stomach acid, food intolerances, changes in gut microbiome, diet, post surgery, etc) but it’s that excess methane produced by Archaea overgrowth that actually makes you feel bloated and constipated, and gets your test positive for SIBO-C (note: hydrogen is also tested along with methane for SIBO).
The methane basically paralyzes the gut. The accumulation of methane also leads to inflammation, neurotransmitter imbalances (in the gut), impaired gut -brain axis and immune system imbalances thus increasing the risk for developing autoimmunity and cancer.
Chronic constipation is clearly associated with excess methane production. Yet (ironically), chronic constipation is often labeled idiopathic (meaning that the cause is unknown) and simply treated with laxatives. While laxatives help to a certain degree to remove excess methanogens, they do not address the cause (the reason why these microbes overgrow in the first place). Antibiotics had also been researched for treating common constipation (and they were found to relief the symptoms).
Excess methane production is seen in IBS-C, according to research studies. Yet current treatments include fiber supplements, laxatives, drugs like linaclotide and antidepressants. IBS-C treatment does not include antimicrobials, although some studies did test rifxamin and a few other antibiotics, which had been found helpful [8].
Another interesting concept: there is a significant overlap between IBS and acid reflux [9]. Note: The acid reflux is from low (rather than high) stomach acidity, in my opinion. Hydrochloric acid has many functions, including strong antimicrobial effects. As you will see below, excess methane does lower stomach acidity.
Back to my question: could chronic constipation, SIBO-C and IBS-C be one disease and not three different conditions?
The overgrowth of methanogens can be the root cause in all cases. All three conditions respond to antimicrobials, which would further support the microbe overgrowth as being the key player. There is a significant overlap between IBS and SIBO (SIBO found in up to 85% of cases of IBS) [10] .
Of course, constipation is the hallmark of all three conditions. SIBO does not affect just the small intestine, but also the rest of the GI tract. The small intestine is connected with the rest of the GI tract-anatomically and physiologically and the overgrowth of methanogens in the small intestine does cause alterations of the entire flora of the digestive tract. The same happens in IBS as well. The infectious cause of IBS is well-known- the majority of cases of IBS develop following a gut infection (gastroenteritis).
There is a dysbiosis (an imbalance of gut microbiome) in all three conditions, and that excess levels of methanogens could be the reason of this imbalance, I think.
In all three conditions there is an increased intestinal permeability (aka leaky gut). That excess methane could be the trigger leading to increased inflammation and accumulation of toxins- as seen in leaky gut. Increased intestinal permeability also increases the risk of of autoimmune conditions and cancer [11],[12],[13].
The bottom line: Association does not prove causation but it’s worth to further investigate this idea. Right now, there is an increased amount of research pointing to the link between methanogens and SIBO-C. High methane /methanogen levels also correlate with chronic constipation and IBS-C. I do believe that chronic idiopathic constipation, SIBO-C and IBS-C eventually will be treated in a similar way (targeting excess methane with antimicrobials and diet).
4. More about Archaea, and The Impact of These Microbes on Human Health
Archaea are some of the oldest and most resilient microorganisms on Earth. These microorganisms know how to adapt and be resistant to harsh environments. They can live in the boiling mud of volcanoes, in deep oceans, at extreme temperatures (above 100° C / 212° F), in very acidic or alkaline environments. They can even live on Mars [14]- I am sure Elon Musk is aware of this.
Archaea survives without light or oxygen(in fact, they are strict anaerobic). There are three well-known species of archaea relevant to humans: M. smithii (found mostly in the gut and vagina; M. stadtmanae (mostly in the gut) and M. oralis (mostly in the mouth) [15]. My note: This tells me that we should look in all these three places for Archaea overgrowth and treat all of them as needed.
How methanogens affect oral health
We can learn something from the gum infections: methanogens are associated with oral infections (ie periodontitis, apical periodontitis) and are actively involved in the overall poly-microbial infections (which means they do not cause infections alone, but in combination with other microbes) [16]. New species of methanogens had been discovered in the mouth and skin recently [17],[18].
For women: How methanogens affect vaginal health:
I did mention in this article that I consider vaginal microbiome very much connected with the gut microbiome -in both health and diseases. I suspect some changes in vaginal microbiome in all women who have imbalance of the gut microbiome(whether the methanogens or other microbes causing the problem).
Many people know about gut-brain axis. What about gut-vagina axis and its importance for women health? This is a very new concept currently under research [19]. Methane producing microbes are linked with bacterial vaginosis , according to research studies [20].
It looks that methanogens prefer women to men. They have another spot where they can overgrow- the vagina. IBS, SIBO and chronic constipation are more prevalent in women. Symptoms also tend to aggravate around menses as well as before/after menopause when the estrogen is low [21],[22], [23], [24]. Regarding IBS in women: IBS-C is more often diagnosed in women. Women are more likely than men to experience pain, bloating and distension. Women are more likely to develop IBS after an infection (post-infectious IBS) [37].
Multiple factors are involved, but serotonin deficiency seems to play a key role here. I wrote about serotonin deficiency and the link between serotonin and estrogen here.
Vaginal microbiome is very much connected with gut microbiome. Healthy levels of lactobacillus, especially L. crispatus, L. iners, L. gasseri, and L. jensenii are needed for a healthy vaginal flora [25].
5. More details about Archaea Methanogens
M. smithii is the main human methanogen, and one of the first microorganism established in human flora, being detected in 70% of newborns in the gastric juice [26]. Eating dairy products (which contain M. smithii) is another source of finding this microorganism in the gut from early age [27] (therefore cutting down on dairy products could be a very good idea to reduce methanogens in adults as well).
The old beliefs that methanogens are found in very low quantities and only in some individuals is just not true. DNA from stool samples detected M. smithii in almost all individuals (95.5%) and M. stadtmanae in 29.4% of individuals. M. smithii DNA makes up to 11.5% of the total human gut microbiome [28].
Another old belief is that methanogens can only form methane if there is hydrogen available. Newer studies show that methanogens can form methane independently of hydrogen (ie by using other electron donors, such as methanol, methylamine, acetate, ethanol, or formiate) [29].
Methanogens start to consume the food you eat before you do, particularly the carbohydrates from the diet. When they overgrow, methanogens slow down the gut motility by almost 60%. They impair the digestion, the production of hydrochloric acid, bile and digestive enzymes. Methanogens do not allow you to absorb nutrients. The result: multiple nutrient deficiencies particularly B12, A, D,E, K, as well as food intolerances. They also affect the sugar metabolism (technical: methane can directly stimulate the secretion of GLP‐1) [30].
Methane producing bacteria increase toxic substances in the body- not just by promoting constipation. Methanogens metabolize hydrogen produced by anaerobic fermentation of carbohydrates into methane (which is toxic); but also transform heavy metals and metalloids into methylated derivatives, such as trimethylbismuth or mercury which are toxic to humans and friendly bacteria in the gut [31], [32].
Add methanogens overgrowth to methylation issues (having the MTHFR gene variant), and that person will end up with a huge toxic build up. For this reason, detox supplements like NAC are always on my treatment plan for methanogen overgrowth.
6.Do Archaea Methanogens Have Any Health Benefits?
Yes, there is a good side of methanogens. The problems develop when they overgrow.
In normal, healthy conditions, the archaea microbes live together and closely interact with bacteria (especially anaerobic bacteria), fungi and other microorganisms of the gut flora. For example, they help break down organic matter under anaerobic conditions [33]. M. smithii optimize the digestion of dietary polysaccharides by other microbes [34]. The newly discovered methanogen- M. luminyensis may protect against heart diseases (technical: this methanogen prevent trimethylamine accumulation and TMAO production) [35]. Again, the problems develop when methanogens overgrow.
Technical : Methanogens can be replaced by two different groups of bacteria: 1. dissimilatory sulfate reducers (SRB) — which also seem to be involved in infections and 2. reductive acetogens (based on research done in oral infections) [36]. Acetogenic bacteria are very important in the (anaerobic) mineralisation of organic matter and overall health [37].
