Histamine Well Podcast: Exploring Histamine, Methylation & Holistic Health

30. Hydrogen Sulfide SIBO Explained: Symptoms, Testing & Treatments with Rosaria Nithart

• Joanne Kennedy • Episode 30

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In this episode of The Histamine Well Podcast,  Joanne sits down with Rosaria Nithart, a French-based naturopath specializing in digestive health, to uncover the complexities of Hydrogen Sulfide SIBO—one of the most misunderstood forms of Small Intestinal Bacterial Overgrowth (SIBO).

Together, they break down how Hydrogen Sulfide SIBO differs from hydrogen- and methane-dominant SIBO, exploring the unique bacteria and biochemical pathways involved. Rosaria shares her step-by-step naturopathic framework for identifying, testing, and treating Hydrogen Sulfide SIBO naturally. The conversation also dives deep into the role of sulfur metabolism, oxalates, and molybdenum in managing symptoms and restoring gut balance.

Listeners will learn:

  • The root causes and drivers behind Hydrogen Sulfide SIBO
  • How to identify key symptoms and understand testing limitations
  • The connection between sulfur, oxalates, and bacterial imbalances
  • Practical treatment strategies that support gut healing without extreme diets
  • How Hydrogen Sulfide SIBO links to UTIs, histamine intolerance, and detox pathways

Whether you’re a practitioner seeking deeper clinical insights or a patient navigating chronic gut issues, this episode offers a clear, actionable approach to understanding and managing Hydrogen Sulfide SIBO naturally.

 Connect with Rosaria Nithart:

Breath Tests for Hydrogen, Methane & Hydrogen Sulfide:

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Joanne Kennedy:

Hi, it's Joanne. Hydrogen sulfide SIBO. That elusive type of SIBO that keeps everyone guessing. There are only a handful of labs in the world that can actually test for it, which means we are often relying on careful case taking and symptom patterns to unravel this complex picture in our patients. To make things even more interesting, hydrogen sulfide SIBO is intricately linked with oxalate toxicity and disruptions in the transsulfuration pathway creating a perfect storm in the gut liver connection. It's a lot to wrap your head around. I know, which is exactly why you'll want to stick around for this episode. I'm joined by SIBO expert and French-based naturopath, Rosaria Nihart, as we unpack the hidden world of hydrogen sulfide SIBO.

Welcome to the Histamine Well Podcast. Designed for practitioners and patients alike. This is your trusted source for insights on histamine intolerance, methylation, gut health, women's hormones, and much more. I'm Joanne Kennedy, your host, naturopath, author, and educator. Passionate about breaking down complex science into clear, accessible knowledge. Whether you are a health professional or navigating your personal wellness journey, the Histamine Well Podcast bridges the gap between cutting edge research and practical understanding to empower you with the tools to thrive. Before we get started, I just wanna say thank you so much to all of you who've been tuning in. I've loved hearing from so many of my loyal listeners, and even from my patients about how much this podcast is helping you understand your health and giving you extra knowledge about your condition. It honestly means so much to know these episodes are making a difference. If you can just take a minute to leave a quick review. It helps the show so much. It gives us extra traction so more people can find this information, learn and start healing too. Hi everyone. Welcome back to the show. Today I'm joined by French-based naturopath, Rosaria Nithart to unpack hydrogen sulfide SIBO. We'll break down what it is and how it differs from hydrogen and methane types. The microbes involved. How to test it and where testing falls short. The symptom patterns that raise a red flag. We'll also explore key drivers. Including the livers phase two sulfation pathway, how oxalates can intersect with hydrogen sulfide SIBO presentations. Rosaria's step-by-step treatment framework, and why these cases can be trickier to resolve than other types of SIBO. So whether you are a practitioner or navigating these symptoms yourself, this episode will help you understand the landscape of hydrogen sulfide SIBO. So Rosaria, thank you so much for your time today. Thank you for having me on your show, on your podcast, Joanne. Yeah. Yeah. Rosaria and I used to work together back in the day at MTHFR support. And we've just kept in touch. Rosaria did my histamine methylation course and then we met up last year. It was last year in Barcelona, wasn't it? Yes. At the conference. So it's been great to know Rosaria all these years. She was really, really like a mentor to me back in the day at M-T-H-F-R support. I'm so happy to have her on the show. Thank you. Before we start the questions, Rosaria, can you just give our listeners a bit of background about you and the exciting things you're up to with your SIBO work there in Europe? Sure. Thanks Joe. I've been back to Europe since 2018. So almost seven years now. And I work internationally online, but mainly focused in Europe, France and Italy. And actually, I see a lot of SIBO patients and IBS patients. And the good news is that I'm almost ready to launch my first book on SIBO, which is going to be first published in Italian. And then hopefully in French and maybe in English later on. So that's very exciting. No, that's wonderful. That's great. So how is it getting traction over there? SIBO, obviously in Italy and France. Yes. Traction still very much unknown unfortunately. But yeah, hopefully we'll get more traction. But it would still be so prevalent because that it's just prevalent globally. Yeah. They just dunno. It is very prevalent. They just don't know yet. But it is absolutely very prevalent, especially in Italy as you can imagine with all the gluten and, you know, bread and pasta. Yeah. Yes. All the good things. I've got some questions. Let's start at the beginning. So for anyone who isn't familiar, what exactly is hydrogen sulfide SIBO and how is it different from the more common hydrogen and methane types? Sure. That's a great question to start with. Hydrogen sulfide SIBO, which has been renamed. If you want to stick to the technical definition, which is intestinal sulfide overproduction. So ISO. I-S-O is the overproduction of sulfur basically in the small intestine and in the colon. So we are talking here about the whole tract. The whole digestive tract very similarly to methane SIBO. Do you remember during the past we used to call it methane SIBO. Then the denomination has been changed into IMO or I-M-O. Intestinal methanogens overgrowth. This is different from simple SIBO. Hydrogen SIBO. Hydrogen SIBO is the classic SIBO, which means that we have overgrowth of hydrogen producing bacteria. Hydrogen in the small intestine only, whereas methane and hydrogen sulfide SIBO can also be present in the colon. So we're having a look at a small intestine and colon. So already the area is different. But why is this different? It is different to the other two types of SIBO. Let's call them like this. Because it's a more toxic presentation. So clinical presentation is much more toxic than the other two types. So we see many more, of course, digestive issues and symptoms, but we also see extra digestive symptoms. So a lot of inflammation. A lot of inflammation, a lot of symptoms that later on we're going to talk of course about oxalates. So there are extra digestive symptoms. And people generally feel toxic. They feel bad much more so than normal SIBO. So these very important. And the other thing is that I think in my clinic I see a lot of patients with hydrogen sulfide SIBO. Because it's testing is not that easy yet, especially depending on the country you are living. But of course there's a breath test. I'm going to talk about testing later, but I think it's more tricky. It's trickier to be identified and to be diagnosed. Yeah. What are the main symptoms of hydrogen sulfide SIBO? Well, aside from the digestive issues, there would be more prevalence, more diarrhea.. So, and sometimes, you know, even urgency. But there would be brain fog, lack of focus and concentration. There may be muscle and joint pains. There may be some inflammation even in the skin. So maybe some rosacea. Acne. There's going to be even presence of UTI. Urinary tract infections. And also urgency to urinate more often. Well more intolerance to sulfur foods. And the typical, flatulence with kind of rotten eggs type of sulfur smell. It doesn't have to be there all the time, but some people do have this. But not all the time. I don't see this all the time. and more intolerances. So more food intolerances. More histamine intolerance. More sulfur foods intolerance. So the person is really more toxic. Yeah. And why is this? Because hydrogen sulfide is a gas that we have in small quantities, which is good because in small lower doses it is actually anti-inflammatory. It is good to have a little bit. The problem is that when we have too much. And so at this time when it is there's a lower production of hydrogen sulfide, we're going to have more inflammation. It can affect leaky gut, so intestinal, hyperpermeability. It can also block absorption into the cells of butyrate, which is essential and great anti-inflammatory. And it is toxic. It is a toxic gas. So this is why people may feel really bad. Toxicity is the Mel, the key word. Melanie said to me.'Cause she had it herself like a huge sulfur problem from an oxalate problem. She said it was like next level fatigue and feeling like you are hungover. Toxic. Yes, totally. Yeah. Toxic. So brain fog, fatigue, neurological symptoms as well. And of course it can affect fatigue because of the mitochondrial dysfunction as well. So yeah, definitely. And it can affect so many things. So many not just digestive issues. So Yeah. Systemic. Yeah. Yeah, systemic. Systemic issues. So wherever we tend to have more issues with inflammation, it can affect. It can increase those issues for inflammatory patients. Yeah. So are there any specific bacteria that cause this hydrogen sulfide SIBO? Yes, ofcourse we have specific bacteria. And bacteria they may use different ways, different pathways to create hydrogen sulfide SIBO. There's a sulfate root. This will be mainly the sulfur librio. For those who are familiar. For those who don't ofcourse, microbiome testing and analysis. And then there's another root, which is basically, this bacteria eat and produce, hydrogen sulfide via amino acids. So cysteine, methionine. This is the other way of having, you know, increasing. And for instance, in this way, a big one, a very common one is fusobacterium varium. So fusobacterium and also nuclear tomb. You will see, we'll talk about this in a few seconds, but these bacteria, especially fusobacterium is being linked even to a colorectal cancer. So it can contribute to cancer development. But these are just a few of course. But there's so many. Even Escherichia coli, Salmonella, Klebsiella, clostridia. Some Clostridium species can also produce hydrogen sulfide. So there are so many. Even some Bacteroides. Bacteroides fragilis and other types of Bacteroides.. They're not just a few. There are hundreds of species of bacteria can contribute to hydrogen sulfide SIBO. So many. So it is interesting to remind these two pathways through which we can produce hydrogen sulfide. Not just the sulfate pathway, but also via amino acids. So methionine cysteine. That's really interesting. And also Taurine as well. So if people are even consuming a lot of red meat with methionine and cysteine in it. Will those bacteria convert that methionine and cysteine into hydrogen sulfide? It could, yeah, definitely it could. Wow. What about with N-Acetyl Cysteine supplement? It could as well. Yeah. Especially with these amino acids, cystine and methionine. This is a big way. And also bile and taurine. Yes. Which are of course important. So there are a few different ways. At least three ways. Just touching upon, because you mentioned red meat already. Of course we know that most people with SIBO. Normal SIBO. Hydrogen SIBO would fall into the low FODMAP diet, right? Yeah. Of course it helps. It helps you with the symptoms. But unfortunately, sometimes this diet is followed for so long. So many months. Sometimes years which is very tricky. And what do they eat? These people. What do they eat? Yeah, they often consume more animal protein'cause they can't have legumes and they'll eat a lot of brassica vegetables. Yes. So it is tricky and of course, dietary advice is always personalized. I think has to be personalized. Oh, it totally does. I have so many patients that put themselves on a low FODMAP diet, and it's not a low sulfur diet, and it's not a low oxalate diet. So listeners, if you don't feel well on a low FODMAP diet, there's a reason. Absolutely. Potentially hydrogen sulfide SIBO, potentially an oxalate problem. Thanks for bringing that up. So let's get to one of the big clinical dilemmas with hydrogen sulfide SIBO, which is the testing. Testing. Well, we know that there's a breath test, which is called a Trio Smart breath Test. This has been created by Dr. Pimentel, like the father of SIBO, right? Yeah. So it is a test, a breath test that can test for the three gases. Hydrogen, methane and hydrogen sulfide. It is not available everywhere in the world. In the US ofcourse, it is available. I think in UK.. Really? you can get it in the UK? There are few labs. Really? You can't get in Australia. Is that right? You can't. I don't think you can. No, not yet. We can't get it in France or Italy. In Spain there's lab that is proposing some sort of test. It's called teletest. And then we have Nordic labs as well in Europe. So they sell it. These are breath test and there are some pros and cons of course. The first thing that we need to be aware of is the gas is highly unstable. So it's very unstable and reactive. It is technically can be a bit challenging to capture and measure accurately in a breath test samples, you know, the hydrogen sulfide. There's limited access as we were saying, and also standardization. And also sensitivity issues. So sometimes, breath tests may still miss some cases. You remember in the past we were saying when there's a flat line in a normal breath test, we're thinking, oh, this is because it could be hydrogen sulfide SIBO. But this is not always the case. So I would say accessibility is an issue. And then instability. Gas instability is another issue. Because in where I live and where I work, you know, from France, Italy, we can't access easily. So I don't test, I'm not sure. Of course you don't test it because you're in Australia. No, no. And I've seen also in other countries where it is available, it can be very expensive as well. So I tend to have a look more at the clinical presentation. Yeah. So the clinical presentation. And the other thing that actually I use a lot is the microbiome analysis because we know that we can see hydrogen sulfide in a microbiome test. Which is meta metagenomic test with sickness or shotgun. So these are good tests where we can see, actually, we can see Polyfilla, Viso vibrio, we can see fusobacterium. So if I see those bacteria in the colon, of course we're not in the small intestine. But you know, if symptoms are there, then I can connect the two. So I know we're gonna get to treatments Rosaria, but would you just treat hydrogen sulfide SIBO the same as sulfur producing bacteria in the large intestine? Is it the same treatment? I would, I would, yeah. It's the same treatment. Yeah. Okay. Yeah. Interesting. Yeah. If it's in the colon, of course, I can't say a hundred percent, it will be in the small intestine because you know, we're not seeing that in the small intestine. But if it's in the colon, if the person has the clinical presentation. I would treat it just for the presence confirmed in the colon. And as Dr. Pimentel said, you know, it's a pan gut condition. So it is in the colon and in the small intestine. Okay. So we can very much rely on doing a large bowel microbiome test. Yes, yes, definitely. Yeah. And considering symptoms more and more. Yeah. Yeah, yeah. No, that's really interesting. Great. So can we just go back. So I know Trio Smart is available in the United States, probably Canada, Nordic Labs sell that test in Europe? Yes. What countries in Europe? Do you know? All European countries. Yeah. Nordic Labs, they ship everywhere. Okay. And to the uk or is that separate in the uk? UK is separate. Do you know what it's called? The lab in the uk? I'm thinking it could be in vivo. Okay. I can confirm. I think it's in vivo that sells the Jamali test test. Yeah, the breath. Yeah. Okay. Okay, so listeners, we'll put links to those testing labs in the show notes for you. Unfortunately, Australian people, it's a bit hard for us. We just have to rely on symptoms and doing a large bowel to stool test. Yes, definitely. So Rosaria, what do you see as the main drivers or root causes of hydrogen sulfide SIBO or sulfur producing bacteria in a large intestine? We had this overgrowth bacteria such as Desulfovibrio, bilophila, e coli, fusobacterium. And so the, these bacteria lead to excessive hydrogen sulfide production, right? But these overgrowth, where is it coming from, right? Mm-hmm. So there are many, many, many root causes of course. I think dysbiosis could be one. Impaired gut motility. Similar to normal SIBO, of course. Some dietary factors that we mentioned before. Some people may tend to overeat red meat and other high protein foods. There could be all the other causes like structural abnormalities, microbiome disruptions and medications, of course, and immune deficiencies. But then more typical, if you want to get more, we would say possibly the really root causes of hydrogen sulfide. I think it would be two. One is to do with impaired sulfur detoxification. This could be genetic. Could be also functional impairment of sulfur metabolism. You are one of the specialists, of course who are talking about, you know, genetics. So CBS, gene variations and also molybdenum deficiency. Molybdenum is a great. It's an essential co-factor for the enzyme that converts sulfide into sulfates, right? And also this is one you will see later that it's part of the treatment as well. We use Molybdenum as well for treating hydrogen sulfide SIBO. So I would say maybe this is one. But more so, and I think you are going to like this one. I think there could be actually a problem with oxalates. They're a big problem, aren't they? Yeah. They're big problems although not very well understood. It's not common for us. They're not. I see oxsight issues all the time and it's just simply not picked up. Yeah. And so Why we are thinking of oxalates because it could be a sort of oxalates, basically, they use the same pathway if you want to get excreted. And when they get excreted in the urine, they also take sulfur together. So basically this would be it's an interesting metabolism. It's an interesting connection. It's almost a mechanistic link. They use the same transporter, the same membrane transporter. The transporter called SAT-1. Sulfur is depleted and then they will disrupt sulfur metabolism, right? So this is the connection between oxalates and sulfur. But because the body wants, the body needs sulfur. Because sulfur is essential for so many reactions. So basically there may be kind of an alternative sulfur source and maybe there's this promotion of hydrogen sulfide producing bacteria that can increase sulfur production is a way of compensatory response so that we can maintain a good sulfur supply. It's a bit Tricky and it's a bit complex to understand, but let's say really in basic terms. If too many oxalates in the body, they can disrupt sulfur metabolism by decreasing sulfur. And as a sort of compensation, the body wants sulfur and it will increase these bacteria that can increase sulfur. Yeah. So whenever I see the desulfovibrio in the stool test, I'm always like, why are they high? What is causing this need for sulfur? Yes, and I'll always run a homocysteine test to look at that. But that's interesting. So that's how I think of it too. If the body will increase these sulfur producing bacteria when it needs sulfur. So is that true for the other, like the Klebsiella, the e coli, the salmonella or the other bacteria that take Methionine and tuarine and cysteine and convert it into sulfur, so they'll upregulate as well. Yeah. There are other bacteria. Maybe to a lesser degree. I wouldn't be able to tell you exactly the average. But yeah, there are many other bacteria. There are hundreds of bacteria species that can actually do these things. So imagine, these are all the proteobacteria. The proteobacteria, those bacteria that are concerned in SIBO in all different Types of SIBO. And interesting when I see high hydrogen sulfide, in stool test, in microbiome tests high, very often these people, especially women, unfortunately, have UTIs, chronic UTIs. They have pain, they have inflammation, they have all these things and all these symptoms I have here the list of symptoms. Basically they are overlapping, right? Oh, with oxolate? With oxalates. Yeah. Yeah, yeah. Joint muscle pain or stiffness. Digestive issues. Increased inflammation and oxidative stress, fatigue, brain fog, neurological symptoms. Kidney. Urinary issues, frequent urinary tract infections and kidney stones, skin problems, mood disturbances, anxiety, insomnia, mineral deficiencies. I'm so glad you brought this up, Rosaria. Listeners, I haven't put my head to hydrogen sulfide SIBO properly. I just haven't. But because of the work with oxalates that I do, I'm very aware of the sulfur link, and these are the symptoms of oxalates and sulfur together. Very much so. Yes. I'm so glad that you said that. So we are seeing that with classic hydrogen sulfide SIBO sulfur producing bacteria in the large intestine. There's this complete link. I guess these opening up to a new way of treating these people. Especially, we can go much more in depth with the treatment and prevention. Because if we take into account not just hydrogen sulfide, but why is this gas there? Why these bacteria are over producing hydrogen sulfide because the body needs it. And of course testing for homocysteine is always great. And keeping into account oxalates. The oxalate picture and cause is essential. Yeah. Rosaria, so we get hydrogen sulfide produced. Hydrogen sulfide is a gas that's normal part of physiology. It could just get too high. Is that right? And it's just not processed properly. How does the body break down hydrogen sulfide? Does it go into that sulfation pathway in the liver? Yes, it does. Okay. Yeah. And it needs that suox enzyme, which is molybdenum dependent to process.. So you can have gene SNPs on Suox, but you can also have molybdenum deficiency, as Rosaria said, but also iron. Iron is the co-factor for Suox as well. Interesting. You know, I need to bring it in. Mold is a massive, massive contributor to this entire situation as well.'cause it depletes sulfur from the body and it increases oxalates. It's all connected, isn't it? And it's sometimes be a bit of a complex case. But we do see complex cases, right, Joe? Yeah, we do. We very much do. Oh, interesting. Before we go any further, I want to speak directly to the practitioners and students listening. If you're intrigued by histamine and methylation and eager to expand your knowledge in this fascinating area, we offer the Histamine and Methylation online group coaching course. The only program of its kind. It covers everything you need to know about histamine and methylation, providing both the theory and guidance you need to treat these issues effectively in clinical practice. We cover sibo, hormonal imbalances, oxalates, M-T-H-F-R, the four pathways of methylation, including the folate pathway, methionine pathway, tetra hydrobiopterin pathway, and the all important transsulfuration pathway and much more. The program is delivered by detailed online webinars and handouts for you to keep. And for eight weeks you'll meet with me for live coaching calls in a private community space with other practitioners from all over the world dealing with histamine and methylation issues in their patients every day. Together we learn so much. To learn more and apply, visit joannekennedynaturopathy.com. Okay. So Rosaria, do you wanna walk us through your general framework for treatment and how you're approaching this sulfur issue in your patients? Yes. So it's a bit of a puzzle, of course, and making sure that we understand the connection. Making sure that we understand the oxalate issues, if it's the diet, if it's, you know, molybdenum deficiency. Well, in the past my approach was more, you know, that of using some oregano essential oil. Oregano, dried with molybdenum. And in America they use a lot of bismuth as well. So bismuth subsalicylate, which we can find easily here in Europe. How does bismuth work? I think it works similarly to molybdenum. My preference, my favorite thing would be molybdenum. And I have to say, I see whether there's a shocks issue whether this conversion from sulfate to sulfate is not happening and you add molybdenum, the person really sees a difference almost straight away. What dosing are you doing of molybdenum? Well, if I get biotics research they have a very good supplement called Molzyme, which is not very high, but it's well absorbed. So there's 250 micrograms. Yeah. So it's pretty low. So, but you can go up, you know, and you're only doing 250 micrograms a day? Yeah, a few times a day. Yeah. Yeah, a few times a yeah. I've been, I'm doing like three times a day. Yeah, yeah. Yeah. So I tend to use this one if it's available. Otherwise, another type of molybdenum in America. There are so many other seeking health, there are different companies. Oregano and molybdenum can work well. So it could be an approach. and of course, oregano can work also in other types of SIBO, so we use it also for methane. And so is oregano just simply reducing those sulfur producing bacteria? Yes. Yeah. Yes. Yeah. But then there's another approach, which is a kind of more a novel approach when we are thinking about, okay, let's modulate the microbiome, okay? Because if these bacteria have increased so much. There's another production, right? So maybe there's a type of, you know, there's a dysbiosis in problem, right? So the other approach would be that of actually using some specific prebiotics that can also decrease things like GOS for instance. GOS or inulin, and FOS. So GOS is really good to decrease both desulfovibrio and bilophila like something like five grams a day. Ofcourse, introducing a little by little. But also some specific probiotics. We can use lactobacillus reuteri DSM 17938 specifically for desulfovibrio. Also lactobacillus for prognosis GG. And also we can use polyphenol. So antioxidants like green tea extract, pomegranate resveratrol excellent also to decrease bilophila. And then we want to use some cofactors as well. Things like zinc, B6, Coenzyme Q10 as well. So this would be my approach. My approach would be, okay, do I need oregano or not? So what is the situation? Molybdenum for sure. And then targeted prebiotics and some probiotics as well in the cofactor. So there's a real movement in our industry towards moving away from the traditional antimicrobial approach where you go in and use antimicrobial herbs such as Allicin, Oregano, berberine, et cetera. And you use things like antioxidants in Australia, we're very much looking at GEM protocol, which is sulforaphane based. With the heat stable probiotic, I can't exactly remember what strain it is. In complex and remarkable ways, modulates the gut's immune system. And so it's definitely a really good approach for these more sensitive patients. You know guys, this is a thing, we are talking about this stuff on the podcast. In real life, these patients have multiple, multiple, multiple food intolerances, right? So they can't have sulfur foods, they can't have oxalate foods. Their histamines are through the roof. They can't hear of histamine foods, they can't be eating a lot of animal protein. So we're just trying to save the microbiome, not go in and like eradicate more of it because it's often been so disrupted from antibiotics and mold. Molds, penicillin in it, isn't it? So it disrupts the microbiome. So the new approach is just try and save the microbiome.'cause these herbs are strong and a lot of people have been on these herbs for such a long time. They'll put themselves on these herbs for years. So that's interesting. Rosaria. I know Melanie for sure is using that approach as well. Yes. And as you said, modulating the microbiome and supporting the richness of the microbiome is really the ultimate goal. And of course the diet has to, you know, little by little come back to eating fiber because these people, they are avoiding fiber like the taste, right? Yeah. So the prebiotics, you're using GOS, which is Galactooligosaccharides. Now GOS is high fodmap. What happens when people got like hydrogen SIBO and they've got lots of sulfur producing bacteria in the large intestine, so they got the double whammy. Well, listen, you know what, I do use GOS or FOS. Of course I use, you know, PGG quite a lot. And, I think the secret is actually that of just adding these prebiotics very slowly. Very, very low dosage. So even like, you know, a sprinkle every two days. And they can include them like successfully. So little by little.. It's like reintroducing fiber, right? So they can. They can reintroduce certain foods of course. So to me it's not a problem. It's just the introduction, which has to be really low and slow. And what about dietary interventions? Okay, so those are interventions for hydrogen sulfide. We mentioned that amino acids or proteins may of course feed some bacteria. And things like Taurine and bile. Without getting into this, the other extreme, but I say I normally recommend people to eat more like, white meats, Turkey, chicken, fish, and some veggies. So basically we are getting away from the traditional, you know, low FODMAP diet. Yeah, it's the opposite. Guys a low sulfur diet is not a low FODMAP diet. It's definitely different. And this is so important to understand because sometimes if people don't know they may have a hydrogen sulfide SIBO. They may follow a low fodmap that which is actually increasing their hydrogen sulfide. So as we mentioned before, this is really important when, you know, a trained clinician has to understand what's happening. It's not easy. It's not easy for us. No, it's complicated. No, this is, we're heading into more complex part of gut issues and gut healing. Yeah. Interesting. So Rosaria, what about the mitochondrial damage that's happening. So I know the oxalates just literally damage mitochondria. And you need sulfur to run the mitochondria. So are you ever going in with supplements? Like I'm still using that ATP Fuel from research nutritional, do you remember that supplement? Where people really love. I get the sulfur down first to get the molybdenum in, and then I definitely deal with the oxalates. And I find that repairing the mitochondria, it just helps the entire body lift the energy and processes just start working properly. Like you can't detox properly. You can't have your liver processing things without proper mitochondrial function. Oh, totally. Yeah. Totally agree with you. You know what I do the same. After a month or two months of molybdenum, actually, these people are able to tolerate even sulfur containing supplements. And sulfur containing foods Little by little they eat again, even the, cruciferous veggies or even little by little, some eggs or a little bit of even garlic later on of course. But you know, they can. They can. Yeah. Yeah. And of course, your mitochondrial support is super important. I do agree. Totally. Yeah. Totally. And what about Epson salt baths? Do you recommend those to get the sulfate up when these people are so deplete? Well, personally I don't. But just because maybe they're not very common here in this part of the world, but yeah. I think it could be a way of. Yeah. So listeners, the reason we use Epson Salt Bath is not just'cause it's nice and relaxing. It because it contains sulfate. And sulfate is like the end product of the sulfur pathway. It's what you actually need for liver detoxification. And it's already done. It's already ready to, it's gut. It's like, yeah, it's an all in one, so it's already done and it bypasses the gut. And go straight into the bloodstream so it can help replenish your sulfate without causing adverse reactions. But you do definitely need to go slowly. Potentially just start with even like a tablespoon in a foot bath. Build up to like one cup in a foot bath. And then if you're tolerating that well you can go up to even three cups in a bath. But they can really, really help get that sulfate up.'cause these people are just so deplete. This is the tricky thing you become intolerant to the body's second most abundant element, which is sulfur, which is crazy. Which, so it needs to be unraveled and it needs to be fixed. And it's so important to be picked up so quickly.'cause so many people have sulfur problems and they're put on FODMAP diets. They're told to go carnivore. Right? To heal their gut and they just feel terrible. Then they're given all these like glutathione, n-acetylcysteine, SAM E, all these sulfur based supplements and they feel absolutely terrible. So it's great that you're writing a book, Rosaria. People really need to get an understanding of like hydrogen sulfide SIBO. Because it's just tricky'cause you can't test it. So it's very hard to see it or it's hard to get the testing done and the symptoms can mimic other gut issues. It can mimic oxalate issues. But the treatment is very different. Especially the diet stuff. It's the opposite. And also what we just said Joe is so important because I've seen so many people that say, I can't tolerate garlic and onion and I just don't eat them. Right? Yeah. And they just avoid those essential, basically foods forever, whereas they're so important. Yeah, that's exactly right. Yeah. Yeah. It's, it that's so right. It's funny, you know what happens when people go completely plant-based sort of vegan they end up with an oxalate problem. And then they can't tolerate a lot of plant foods. And then they need to try and eat red meat again. But because they've got an oxalate problem, they inevitably have a sulfur problem. And so they try and eat red meat and they completely can't. They can't tolerate it. And so this is where it's become such a clinical dilemma with these patients is their plant-based diet that they lived on is now making them sick. And then to change it, they need to eat more meat. And they don't want to, but they have to. And even when they try, they can't. So I just think these extreme diets are problematic for so many people. You know, and if you are not feeling good on one of these extreme diets, there's a real reason. Yeah, there's a reason. There's a, yeah, there's sometimes a few reasons. Yeah. Do you see many people put on carnivore diets in Europe? Probably not. Well, the low food map diet is a kind of, you know, high protein diets. Yeah. But just full carnivore, like, just full note, like some people are just eating meat to try and heal their guts. Yeah. That absolute, that's good. But definitely most people would eat almost no veggies at all, or no fruits at all, you know? So a few fall into this type diet. Yeah. And have you noticed them that increases their sulfur bacteria? Yeah. Oh, sure. Yeah. Yeah, it totally does. Yeah. I've had people come in to see me, advocates for full carnivore, and they read all the books and they follow the gurus in that world. And I'm like, well, you're not thriving, so there's something wrong. So look, there's handpicked information for any kind of extreme diet. There really is, and potentially research for some population groups. But I think it's, and diet is such an individual approach and the whole oxalate sulfur issues that present from extreme diets is such a classic example of this. Wonderful. Yeah. Well, Rosaria, thank you so much for your time. Can you let our listeners know where they can find you? Yes, of course. They can find me on my website, so rosarianithart.com or.it for Italians. On Facebook as well, and Instagram and yeah, these are the main. We'll put all that information in the show notes. Well, good luck with your book. Thank you. Thank you. Very soon. Very soon. Alright, Rosaria. Speak to you soon. Bye. Thank you. Bye. So thank you for joining me. I hope you found this episode beneficial. Be sure to subscribe to the histamine well so you don't miss an episode. Leave a review and you can also share this episode with someone who could benefit. If you have any questions you'd like answered or have a topic you'd like me to discuss, please go to my website, joanne kennedy naturopathy.com, where you can provide us with that information. Until next time, take care and be well.