Patient 6: Intestinal Methanogen Overgrowth in an Elderly Woman Longstanding Constipation and Osteoporosis
Patient Background
This is the case of a 75-year-old woman with a history of osteoporosis and osteoarthritis, who had been suffering from chronic constipation and bloating for over 10 years. Despite various attempts to address the issue over the years, her bowel movements remained sluggish and incomplete, often requiring daily interventions to maintain regularity.
A previous comprehensive stool analysis revealed:
- Candida overgrowth and increased intestinal permeability (“Leaky Gut”), both of which resolved on repeat testing six months later following targeted treatment.
- Low pancreatic elastase, indicating reduced pancreatic enzyme production
- High fecal fat, consistent with malabsorption
Prior IgE allergy testing was completely negative.
These findings pointed to significant digestive dysfunction likely contributing to her nutrient deficiencies and osteoporosis.
Patient followed a whole foods diet with included ample vegetables and fruit.
On physical examination, her abdomen was moderately distended and had mild diffuse tenderness to palpation.
SIBO Breath Testing
Lactulose breath testing revealed:
- Methane (CH₄): 61 ppm — diagnostic for severe Intestinal Methanogen Overgrowth (IMO)
- Hydrogen (H₂): 3 ppm
This pattern was consistent with methane-dominant SIBO, which is closely linked with chronic constipation and sluggish gut motility.
Treatment: Implementing Dr. Rajsree’s SIBO Protocol
We initiated Dr. Rajsree’s 4-Phase Herbal SIBO Protocol, tailored to target methane-producing archaea and support bowel regularity.
Phase 1 and 2: Promote Motility and Reduce Gas Levels:
- Digestive Enzyme Pro 1-2 capsules (to support digestion and address pancreatic insufficiency)
- Essential Magnesium (4 capsules at bedtime)
- Motility Activator (1 capsule at bedtime)
- Aloe Pro (1 capsule as needed at bedtime for constipation)
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 (3 capsules in the morning on an empty stomach)
- Berberine Pro, Oregano Oil, and Allicidin (1 capsule of each after every meal for 6 weeks)
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
Outcomes
After 6 weeks of herbal antimicrobials:
Repeat breath testing showed:
- Methane (CH₄): reduced from 61 → 13 ppm
- Hydrogen (H₂): increased slightly to 10 ppm (normal range)
Clinically, she experienced:
- Major improvement in bowel regularity
- Resolution of bloating
- Was able to discontinue Aloe Pro
- Increased confidence in natural bowel function
Given the slight residual methane levels, she was advised to continue with an additional 2 weeks of the herbal antimicrobial phase.
Following this extended treatment, she reported feeling fully regular, with no bloating, and sustained results using only Essential Magnesium and Motility Activator nightly.
She remained on Digestive Enzyme Pro long-term due to her persistently low pancreatic elastase and history of fat malabsorption, both of which are common in elderly patients, especially in the setting of osteoporosis.
Maintenance Plan
To prevent relapse and support nutrient absorption, she was maintained on:
- Essential Magnesium (bedtime)
- Motility Activator (bedtime)
- Digestive Enzyme Pro (with meals)
For bone health we also optimized her vitamin D level with supplementation and helped her introduce Essential Calcium back into her supplement routine, without impacting bowel regularity.
Key Insights
This case highlights how methane-dominant SIBO (IMO) can present as chronic constipation and bloating for decades, often overlooked or misattributed to aging or diet alone. In this patient, the IMO contributed not only to GI symptoms but likely to impaired nutrient absorption — a critical factor in her osteoporosis.
By addressing the root cause through Dr. Rajsree’s Herbal Protocol, this patient experienced:
- Resolution of long-standing constipation and bloating
- Improved digestion and nutrient assimilation
- A gentle, sustainable return to gut health in her 70s
Patient Background
This is the case of a 75-year-old woman with a history of osteoporosis and osteoarthritis, who had been suffering from chronic constipation and bloating for over 10 years. Despite various attempts to address the issue over the years, her bowel movements remained sluggish and incomplete, often requiring daily interventions to maintain regularity.
A previous comprehensive stool analysis revealed:
- Candida overgrowth and increased intestinal permeability (“Leaky Gut”), both of which resolved on repeat testing six months later following targeted treatment.
- Low pancreatic elastase, indicating reduced pancreatic enzyme production
- High fecal fat, consistent with malabsorption
Prior IgE allergy testing was completely negative.
These findings pointed to significant digestive dysfunction likely contributing to her nutrient deficiencies and osteoporosis.
Patient followed a whole foods diet with included ample vegetables and fruit.
On physical examination, her abdomen was moderately distended and had mild diffuse tenderness to palpation.
SIBO Breath Testing
Lactulose breath testing revealed:
- Methane (CH₄): 61 ppm — diagnostic for severe Intestinal Methanogen Overgrowth (IMO)
- Hydrogen (H₂): 3 ppm
This pattern was consistent with methane-dominant SIBO, which is closely linked with chronic constipation and sluggish gut motility.
Treatment: Implementing Dr. Rajsree’s SIBO Protocol
We initiated Dr. Rajsree’s 4-Phase Herbal SIBO Protocol, tailored to target methane-producing archaea and support bowel regularity.
Phase 1 and 2: Promote Motility and Reduce Gas Levels:
- Digestive Enzyme Pro 1-2 capsules (to support digestion and address pancreatic insufficiency)
- Essential Magnesium (4 capsules at bedtime)
- Motility Activator (1 capsule at bedtime)
- Aloe Pro (1 capsule as needed at bedtime for constipation)
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 (3 capsules in the morning on an empty stomach)
- Berberine Pro, Oregano Oil, and Allicidin (1 capsule of each after every meal for 6 weeks)
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
Outcomes
After 6 weeks of herbal antimicrobials:
Repeat breath testing showed:
- Methane (CH₄): reduced from 61 → 13 ppm
- Hydrogen (H₂): increased slightly to 10 ppm (normal range)
Clinically, she experienced:
- Major improvement in bowel regularity
- Resolution of bloating
- Was able to discontinue Aloe Pro
- Increased confidence in natural bowel function
Given the slight residual methane levels, she was advised to continue with an additional 2 weeks of the herbal antimicrobial phase.
Following this extended treatment, she reported feeling fully regular, with no bloating, and sustained results using only Essential Magnesium and Motility Activator nightly.
She remained on Digestive Enzyme Pro long-term due to her persistently low pancreatic elastase and history of fat malabsorption, both of which are common in elderly patients, especially in the setting of osteoporosis.
Maintenance Plan
To prevent relapse and support nutrient absorption, she was maintained on:
- Essential Magnesium (bedtime)
- Motility Activator (bedtime)
- Digestive Enzyme Pro (with meals)
For bone health we also optimized her vitamin D level with supplementation and helped her introduce Essential Calcium back into her supplement routine, without impacting bowel regularity.
Key Insights
This case highlights how methane-dominant SIBO (IMO) can present as chronic constipation and bloating for decades, often overlooked or misattributed to aging or diet alone. In this patient, the IMO contributed not only to GI symptoms but likely to impaired nutrient absorption — a critical factor in her osteoporosis.
By addressing the root cause through Dr. Rajsree’s Herbal Protocol, this patient experienced:
- Resolution of long-standing constipation and bloating
- Improved digestion and nutrient assimilation
- A gentle, sustainable return to gut health in her 70s
