It’s finally here! The long awaited episode on how to test for SIBO. Many of you have been contacting me to ask how to get tested or whether you can test at home, so here’s my episode discussing all the ins and outs.
Here’s a breakdown of some of the key points in the episode:
Hydrogen and methane type SIBO can be detected through a SIBO breath test.
You can order at-home kits. In my experience, most GPs won’t/can’t order SIBO breath tests and aren’t familiar with it, though GI doctors may be able to and SIBO specialist doctors certainly can.
A SIBO breath test involves drinking a solution of glucose or lactulose and breathing into a test tube for 2-3 hours. The substrate will feed the bacteria, which will create fermentation, and the gas is then collected in the test tube and measured in the lab in parts per million.
Tests can be either 2 hours with 8 test tubes or 3 hours with 10 test tubes. 2 hours runs the risk of missing SIBO in a person with slow gut motility, so for that reason, I prefer to go with a 3 hour test.
Some specialists prefer testing with glucose, others lactulose. I like to use lactulose as glucose is absorbed in the first 1-3 feet of the small intestine and the small intestine is on average 22 ft long! So if the SIBO is further down, a glucose test can miss it entirely.
A prep diet and overnight fast is required before taking the test. This is a low to no carb diet of meat, fish, eggs, black tea or coffee. There are some allowances for vegans, vegetarians or diabetics. If a patient ate too many carbs, or did the prep test incorrectly it would skew the test results and the test would need to be redone.
The North American breath testing consensus states that a positive for hydrogen would be a rise of 20 ppm or more (parts per million) from the baseline (the breath before drinking the solution) in the first 90 minutes. A positive for methane would be 10ppm or more in the whole 180 minutes, including the baseline.
Dr Allison Siebecker, who I trained with, has a slightly different diagnostic range after years and years of working with SIBO clients and consulting with other SIBO specialists. A positive hydrogen for her would be 20ppm in the first 120 minutes, with no rise needed as long as the baseline isn’t the highest number. Methane is 10 within 180 but if constipation was present, the methane would be positive if the reading was 3-9ppm.
Though hydrogen sulfide SIBO cannot be detected with this test, some H2S patients have a flat line pattern that indicates the presence of H2S. This would be a result of 6ppm or less for hydrogen and 3ppm or less for methane.
An elevated baseline (so not 0) is normal for methane.
In the USA, lactulose requires a prescription so you would need to find a doctor who could help you order it.
For a deeper dive and my breakdown on how to take the test itself, have a listen to the show! I really hope this episode helps those of you who are suspecting that SIBO may be the culprit behind your endobelly.
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