Mark Pimentel, M.D., is Professor of Medicine, Geffen School of Medicine and Associate Professor at Cedars-Sinai Medical Center in Los Angeles, California. Rebecca joined him live at Cedars-Sinai in Los Angeles to speak to him about his research into Hydrogen Sulphide SIBO.

• The difference between IBS & SIBO, and what comes first? IBS or SIBO?
• What is Hydrogen Sulphide SIBO and how is it different from Hydrogen and Methane SIBO?
• How do you test for Hydrogen Sulphide SIBO? When will it be available and where?
• Why a traditional SIBO breath test would show a flatline result if a patient has Hydrogen Sulphide SIBO?
• Why Hydrogen can look falsely negative when Hydrogen Sulphide or Methane is present?
• Why Hydrogen takes 60 minutes to be produced and longer for Methane
• Why Hydrogen is not a reliable gas on SIBO breath tests
• Should patients be asking for Hydrogen and Methane breath tests?
• Why some people have a high baseline reading – how does this happen?
• What the methanogens are (ie. M. Smithi)? And what produces Hydrogen and Hydrogen Sulphide?
• Why and how methane slows intestinal transit time?
• If methane SIBO is more likely to cause weight gain, does that mean Hydrogen SIBO is more likely to cause weight loss? What does it mean for Hydrogen Sulphide SIBO regarding weight?
• How do you clinically handle the SIBO patient who has lost significant amounts of weight and can’t regain it? What’s your advice for SIBO patients who are gaining unwanted weight?
• Can you have 1, 2 or 3 of the gases present at the same time? If so, what’s the correlation between the gasses?
• What are the symptoms of Hydrogen Sulphide SIBO in comparison to the other types of SIBO? And how do the symptoms change depending on the presence of the other gases?
• What are the treatments for Hydrogen Sulphide SIBO? Are there any treatments/supplements Hydrogen Sulphide SIBO patients should avoid?
• Does the diet need to be modified any differently for Hydrogen Sulphide SIBO than the commonly used SIBO diets?
• Should we be staying on a low FODMAP/SIBO diet long term? What are the risks if we do? 
• What do you see clinically works for your patients who don’t respond to traditional SIBO treatments (potentially multiple rounds of all currently available treatment options)?
• How important is it for us to identify the underlying cause(s) of SIBO? What should a patient do if they can’t identify an underlying cause?
• How can we test our MMC and transit time? How important is it to know this?

Watch the video recording of the interview here: https://zoom.us/recording/play/mIOWPAiaRiQjVshBf-vs-4EPo7blkFwSIaw8v9HjBEyuvuuaPszjq8b1NzXMEJ6l

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