man taking a SIBO breath test
  Irritable Bowel Syndrome (IBS) is just one of the many conditions associated with small intestine bacterial overgrowth (SIBO). It is estimated that an average of 70% of all IBS cases are caused by SIBO, yet most go undiagnosed. Bacteria, yeast and other microorganisms live in the trillions in the large intestine. Many species are beneficial and required for good health. Probiotic supplements and fermentable foods are meant to replenish the good species and colonies, known as the human flora. When any of the flora moves backwards and into the small intestine, potential colonies can form where they should not. This causes inflammation, gas, bloating, constipation and/or diarrhea and the condition is known as SIBO. Testing and treatment of SIBO can alleviate these symptoms and return the gut to a healthy state.

What is a SIBO Test?

The gold standard test for diagnosing small intestine bacterial overgrowth is the SIBO lactulose breath test. This is a take home test that at this time is only offered at private laboratories outside of conventional testing. A special diet is required 1-2 days before the test that must be adhered to exactly to get accurate results. By starving the gut bacteria for 1-2 days of their food sources, better results are achieved on the test day when a sugar solution is consumed to allow the bacteria to feed. This produces several types of gas, hydrogen and methane are mainly off-gassed and measured. In a normal exhalation very minimal amounts of these gasses are released but in a person with SIBO, there are higher levels measured. Elevated hydrogen and/or methane gasses correlates to a diagnosis of SIBO.

Is it worth getting a SIBO test?

Absolutely. Testing for SIBO will provide information on the severity and the type of bacteria present. This guides treatment as different pharmaceuticals and herbs can be used for hydrogen and methane-specific SIBO. Just assuming that a person has SIBO and treating it with broad-spectrum herbs or drugs will often not get rid of the condition long-term. For the best protocols, a retest after the final 2 weeks of treatment is advised so that eradication can be confirmed.

How is a SIBO Test in Vancouver Performed?

Once the test kit arrives, certain supplements should be stopped for several days and even up to 2 weeks prior to testing. Usually a nutrient called NAC is given for at least 5 days prior to testing which helps uncover deep colonies for testing and a better result is achieved. For 1-2 days, a special plain diet consisting mainly of white rice is consumed and must be strictly followed. On the morning of test day, 4 hours must be allocated to testing. The first hour is just to be awake and ready to test. A breath sample is collected prior to starting to get a baseline gas level. This takes place before the lactulose gel is consumed. 20 minutes after drinking the sugar, the second breath sample is provided. For the next 3 hours, a breath sample every 20 minutes is collected so there are a total of 10 samples. The tubes are sent to the laboratory and a machine analyses the gasses and creates a report. Results are usually quite quick after mailing off and can be reported after 1-2 weeks back to the ordering physician.

Can you test for SIBO at home?

Yes, and really it should be done at home. It is possible to take the kit into work and do the breath samples discreetly every 20 minutes for 3 hours if that is what works best. SIBO tests are not offered in a laboratory setting or clinic office.

What Does the SIBO Test Measure?

There are 3 types of gasses found related to SIBO. Hydrogen, methane and hydrogen sulphide. At this point in time, only hydrogen and methane can be identified in the breath sample tubes. Bacteria of different families and classes release these gasses and elevated values are highly correlated to overgrowths of bacteria in the small intestine. Hydrogen sulphide SIBO can be inferred using SIBO breath results and specific symptoms.

What is Lactulose?

Lactulose is a type of simple sugar. Humans can’t absorb it into the bloodstream but bacteria can use it to survive and produce gasses as a byproduct. The importance of only choosing lactulose and not glucose breath tests has to do with absorption. Glucose will easily be absorbed into the body mid-way through the small intestine. Thus tests using glucose will show low levels of gasses in the second aspect of the small intestine because the food provided to the bacteria is no longer available. Lactulose moves in its entirety through the digestive tract and feeds bacteria all the way through. It is a safe sugar to consume, but in some individuals it may cause mild side effects such as gas, bloating and loose stool.

How Long Does It Take to Get SIBO Test Results?

Using reputable and efficient laboratory companies allows for quick results. On average, once results have been mailed away with the overnight delivery option, results can be expected in 7-10 business days.

What does a positive SIBO test mean?

A positive result requires some interpretation by the physician and is based on the levels of hydrogen and methane but also symptoms. Ideally adding an additional stool test to look at the microbiology of the large intestine at the same time of the SIBO breath test will allow for complete interpretation of digestion flora. This yields the most comprehensive protocol to get digestion back on track.

Preparing for the SIBO Test (Diet)

The preparation diet one day before performing the SIBO breath test is imperative to follow exactly. By eating menial types of specific foods, bacteria in the small intestine will not be able to “eat” for that day. The next day, lactulose is consumed which feeds the bacteria and this causes more gasses to be released as a by-product of the bacteria using the sugar, meaning test results can be clearer. The diet consists of mainly eating white rice, eggs, plain fish or chicken with salt, pepper and oil. These foods can be consumed at any volume but no other foods such as fruits, vegetables, beans, spices and other grains can be added. Some supplements and medications should not be taken within a few days of performing the SIBO breath test. It is best to discuss this with the physician ordering the test as not all medications can be stopped and a plan can be determined. Importantly, no laxatives including magnesium and Vitamin C should be used prior to testing.

Is It Necessary to Prepare for the SIBO Test?

Yes. If the diet isn’t followed strictly, the results may look normal when in fact SIBO is present. If the bacteria have been fed regularly without a break, gas production will not peak and results can show negative for SIBO.

Food to Eat

The instructions in the test kit are very clear. Rice, white bread, eggs, poultry, fish, salt, pepper and oil are allowed. No seasonings, vegetables, fruit, nuts, seeds, legumes or sugar can be eaten. Making a huge chicken and egg fried rice with coconut oil and salt and pepper might just be delicious to eat all day long!

What is SIBO (small intestinal bacterial overgrowth)?

Small intestine bacterial overgrowth is just what it sounds like from the name. Bacteria normally live in the large intestine, if fact there are trillions of microorganisms that colonize the colon. Many help humans and provide nutrients, immune function, and even detoxification roles. Others are commensal and do not have specific roles that we know of. A third category would be the dysbiotic bacteria or the types that could cause inflammation and become invasive to our good flora. Any of these types of bacteria can migrate in a retrograde fashion and colonize the small intestine. The lining of the small intestine has the very important function of extracting and absorbing nutrients from food. When bacteria populate the lining, inflammation occurs and the absorption process is affected. Since bacteria release gasses just as humans exhale carbon dioxide, these gasses accumulate and can lead to a long list of symptoms. Bloating, flatulence, belching, heartburn, acid reflux, diarrhea, constipation, fatigue, headaches, skin conditions and even auto-immune diseases might be traced back to SIBO. 

What are the first signs of SIBO?

The most commonly reported symptom is bloating. Some people will bloat with any meal, others notice with onions, garlic, cauliflower and broccoli. Food poisonings and traveller’s diarrhea can initiate the start of SIBO because of the trauma that occurs to the gut lining. Others may report becoming reactive to foods that could normally be consumed without a response. Methane gas production by SIBO typically leads to constipation and hydrogen gas can lead to diarrhea. This is not always the case but is more common than not. Because the gasses travel, heartburn and acid reflux along with excessive flatulence are also common symptoms. 

Additional Symptoms of SIBO

With inflammation in the digestive system, there can be many symptoms outside of the gut to watch out for. Fatigue, headaches, skin conditions such as acne and eczema, joint and muscle pain, low mood, painful periods, difficulties with weight gain or loss are just some. If nutrients are not properly absorbed into the body, signs of vitamin or mineral deficiencies might be observed. A main cause of iron deficiency is poor absorption, and symptoms might include dizziness, fatigue, shortness of breath, hair loss and heavy periods. Some may also experience Vitamin B12 deficiency which can have nervous system symptoms such as numbness, tingling, tiredness or irritability.

Causes of SIBO

This is the big question, how do people get SIBO? One of the main causes is a traumatic event to the gut. This could be food poisoning, traveller’s diarrhea, abdominal surgeries such as C-sections, appendicitis, gallbladder removal or ovarian cyst removal. It can also be a result of requiring multiple antibiotics or taking long term antibiotics for conditions such as acne. Low production of stomach acid can also initiate SIBO. Stomach acid triggers digestive enzymes to break down food into small enough components to be absorbed into the blood. If enzyme levels are too low, larger pieces of food travel further down the small intestine and can feed any outlying bacteria that managed to make it past the large intestine and thus colonies grow. Low stomach acid can occur from periods of prolonged stress, use of proton pump inhibitor drugs, part of the aging process and in rare instances due to an auto-immune condition.