Patient 9: Hydrogen-Methane SIBO, Dysbiosis, and Fibromyalgia in a Woman with Longstanding IBS-C

Patient Background  

This is the case of a 43-year-old woman with a lifelong history of constipation-predominant IBS (IBS-C), chronic bloating, abdominal pain, and fibromyalgia. She also struggled with fatigue, body aches, headaches, anxiety, and depression — symptoms that had persisted since adolescence and were compounded by a history of childhood trauma. 

She reported: 

• Needing senna or enemas multiple times per week for bowel movements (typically using senna ~3x/week)
• Significant bloating and abdominal discomfort
• Poor sleep quality, often using Ambien as needed for insomnia
• Heightened sensitivity to garlic and a tendency to avoid it in her diet 

Her diet at the time of consultation was relatively clean, consisting of:  

• Chicken, cooked vegetables, fruit
• Occasional kefir shots
• Small amounts of cheese
• Home-made sourdough bread
• Coffee (daily)

On physical examination, her abdomen was moderately distended and had mild diffuse tenderness to palpation. 

Previous Testing 

Seven years prior, she underwent an upper endoscopy (EGD) that was normal. She was told she had "just IBS."

More recently, she completed a GI MAP stool test, which revealed: 

• Dysbiosis, with elevated Enterococcus and Pseudomonas
• Secretory IgA > 6,000, indicating gut inflammation
• Normal zonulin, suggesting no active intestinal permeability or Leaky Gut   

These findings pointed to underlying microbial imbalance and immune activation, both of which can contribute to systemic symptoms like those seen in fibromyalgia.

SIBO Breath Testing

Lactulose breath testing showed:

• Hydrogen (H₂): 34 ppm
• Methane (CH₄): 27 ppm 

— consistent with mixed-type SIBO. The elevated methane levels suggested Intestinal Methanogen Overgrowth (IMO) associated with chronic constipation.

Blood tests were negative for IgE food allergies as well as Celiac disease (negative TTG IgA) .

Treatment: Dr. Rajsree’s 4-Phase SIBO Protocol  

We initiated Dr. Rajsree’s 4-Phase SIBO Protocol, with a comprehensive plan to address SIBO, dysbiosis, and gut inflammation. 

Phase 1-2: Promote Motility and Reduce Gas Levels  

• Digestive Enzyme Pro (2 capsules after meals)
• Betaine and Pepsin — (1 capsule after after meals)
• Essential Magnesium (up to 4 capsules at bedtime)
• Motility Activator (1 capsule at bedtime)
• Aloe Pro (1 capsule at bedtime) — as needed for constipation to assist in weaning off senna

Dietary Strategy:  

She began a low FODMAP / low lectin SIBO diet, with specific instructions to practice meal spacing: 

• Avoid snacking between meals
• Maintain 4–5 hours between meals
• Maintain a 12-hour overnight fast between dinner and breakfast
• Intermittent fasting — encouraged to support migrating motor complex (MMC) activity 

Phase 3-4: Reduce Inflammation and Targeted Herbal Antimicrobials 

In the next phases of the protocol, we introduced Spore Probiotics and targeted herbal antimicrobials to address bacterial and methanogen overgrowth:

Addition of:  

• Spore Probiotic IgG in AM on empty stomach
• Berberine Pro, Oregano Oil, and Allicidin (1 capsule of each after each meals, 3x/day) 

Additional Gut Healing Support:  

Addition of:  

• L-Glutamine (1–2 scoops in water each morning)
• IgG Guard (2 capsules on empty stomach in AM)

— both used to reduce intestinal inflammation and support mucosal immunity, targeting findings from her GI MAP

Outcomes

After 6 weeks of herbal antimicrobials:  

Repeat breath testing showed: 

• Hydrogen (H₂): decreased from 34 → 10 ppm
• Methane (CH₄): decreased from 27 → 10 ppm (borderline) 

She was advised to complete an additional 2 weeks of antimicrobials, after which her symptoms had fully resolved.

Clinically, she reported:  

• Daily, regular bowel movements without the need for senna or enemas  
• Complete resolution of bloating  
• Improved tolerance to a wider variety of foods  
• Marked improvement in anxiety, mood, and fibromyalgia symptoms  
• Better sleep and reduced dependence on sleep medications  

Maintenance Plan  

To prevent relapse and support long-term healing:  

• She transitioned to Probiotic 100 Billion
• Continued Digestive Enzyme Pro and Betaine and Pepsin with meals
• Continued Motility Activator and Essential Magnesium at bedtime
• Periodic use of Aloe Pro only as needed
• Ongoing gut healing support with L-Glutamine and IgG Guard 

Key Insights 

This case exemplifies the gut–brain–body connection, especially in patients with fibromyalgia and chronic constipation.

It also illustrates:  

• How SIBO and gut dysbiosis can drive not only IBS-C symptoms but also systemic inflammation, mood disorders, and chronic pain
• Use of the herbal antimicrobials to simultaneously address the SIBO and dysbiosis.
• The importance of addressing immune activation and microbial imbalance with targeted tools like L-Glutamine and IgG Guard
• The value of gentle motility support and strategic antimicrobial use in sensitive patients 

By addressing the root causes through Dr. Rajsree’s 4-Phase SIBO Protocol, this patient achieved:

• Digestive relief
• Emotional and neurological improvement
• Greater autonomy and food freedom 

This case reinforces the principle that healing the gut can be transformative — not just for digestion and bowel regularity, but for overall health and wellbeing.

Patient Testimonial:

"I cannot praise Dr. Rajsree more! She is one of the nicest, caring and knowledgeable doctors i had to deal with. After years of pain and struggles, with no results from my primary doctor, i ended up in her office. She listened to me and went right to the bottom of my problems fast. Now I am on my way to recovery and feeling much better than I did in years. I just can’t thank her enough for everything she did and is still doing for me."