Small Intestinal Bacterial Overgrowth and Intestinal Methanogen Overgrowth
Here at the Personalized Natural Medicine (PNM) Clinic, we routinely perform a three-hour-long Hydrogen and Methane Breath Test for SIBO and IMO. Though this isn’t a new test, few physicians perform it. During all visits, we have each patient blow once into a bag to collect a sample for the breath machine to get a baseline breath measurement. What we look for is an overgrowth of microorganisms that create hydrogen or methane as a byproduct. When there is an abundance of these microorganisms, it is called dysbiosis. Common symptoms of dysbiosis include gas, bloating, diarrhea, constipation, heartburn, fatigue, and nausea. If this dysbiosis is caused by bacteria in the small intestine, it is called SIBO. If this dysbiosis is caused by archaea in the small or large intestine, it is called IMO.
How does a SIBO/IMO Breath Test work?
The test works by monitoring the amount of hydrogen and methane gas that is exhaled during the course of 12 seconds. While there are bacteria all over the body from the skin to the digestive tract, they are usually beneficial. When the system gets disrupted, the digestive tract changes and non-commensal bacteria (aka bad bugs) take up residence. These non-commensal bacteria start “stealing” food and supplies and wreaking havoc on the body. While these microorganisms are stealing supplies, they start producing hydrogen or methane gas as a waste product.
The goal of this breath test is to not just determine how many microorganisms are in your digestive tract and their location, but what their byproduct is. Bacteria and archaea each require different treatment plans to get rid of, as do bacteria that produce hydrogen and those that produce hydrogen sulfide.
What do your results mean?
If the test comes back low, it means one of two things:
- You are healthy and do not have dysbiosis or SIBO/IMO
- You have dysbiosis or SIBO/IMO and might have a strain of bacteria that produce hydrogen sulfide instead of hydrogen or methane gas (ISO, or Intestinal Sulfide Overproduction), a diagnosis of SIFO (Small Intestinal Fungal Overgrowth), or a different underlying condition (very few patients fall under this category).
If the test comes back elevated, it can mean a few things:
- You have SIBO or IMO
- You have recently consumed food, or improperly prepped for the test
The Methane Spot Test
This is a test that PNM can offer to return patients to check-in on their treatment status. The Methane Spot Test is a fasting test, but patients do not need to take the provided sugary liquid.
The Complete SIBO and IMO Test
A full hydrogen and methane test includes fasting for 12 or more hours followed by taking a baseline breath blow. After we take the baseline blow, the patient drinks a sugary liquid. We then take breath readings every 20 minutes for the next three hours. When the bad bacteria consume the sugar, they produce hydrogen or methane as they try to digest this undigestible sugar.
The interesting part about the full test is we can gauge where the dysbiosis is depending upon when the result appears. For example, if after the first 20 minutes of drinking the provided sugary drink, your hydrogen blow result is high, this indicates bacteria in your upper GI tract resulting in a SIBO pathology. If your hydrogen blow results are high after 120 minutes, it would indicate dysbiosis in the lower digestive tract, sometimes called LIBO. Methane can be present anywhere in the digestive tract, but we can use the timeline to pinpoint where the archaea are.
At the moment, insurance companies do not cover the hydrogen and methane test on the first visit. Anyone who wishes to have the test done in-office and have it covered by insurance needs to establish care with a new patient appointment first.
SIBO and IMO Prep Diets and Procedure
Following a strict prep diet and procedures is crucial to ensure the most accurate and reliable results.
Starting 2 weeks before the breath test, please finish taking any and all antibiotics and/or antifungals if this is your first breath test. If this is a repeat breath test, follow the doctor’s instructions. During this time frame, it is important to not have any colonic hydrotherapy appointments, barium enemas, or colonoscopies scheduled or performed.
3-4 days before your breath test, please stop all laxatives. This includes Magnesium, Vitamin C, Senna, and other prescription-based laxatives.
The day before your breath test, please follow the prep diet based on blood type specified below. If you don’t know your blood type, there is a general diet you can follow. As a general rule of thumb, patients are encouraged to have baked or broiled chicken, fish or turkey with salt and pepper, steamed white rice, white bread, clear chicken broth or beef broth, and eggs. Butter and olive oil along with weak black coffee and/or tea without sugar or creamer are ok. Please note the only liquid that should be consumed should be pure water, no mineral water.
As a general rule, patients need to fast for 12 hours directly before the test. If you have a 9:00 am breath test, please begin fasting at 9:00 pm the night before. Water can be consumed during the fast. Patients cannot exercise or smoke during the test or for an hour beforehand. Patients are encouraged to avoid coffee, magnesium supplements, laxatives, Vitamin C, fiber supplements (such as Psyllium), or PPIs for 24 hours before taking the test. Please wait at least 14 days to take the breath test if you have recently taken antibiotics, had a colonoscopy, an enema, a barium study, or runny diarrhea. Please contact your doctor to determine if this test is right for you.
Speciality Prep Diets
Blood Type Prep Diets
Our blood types are made up of a different sugar on the outside of our cells. These sugars can act as free meals for the different bacteria in our bodies. By following the recommended prep diets, patients will have more accurate test results.
- For Blood Type As should limit your food the day before to baked or broiled chicken, fish, or turkey with only salt and pepper, chicken eggs, and plain steamed white rice. Bone Broth (allowable meats), butter, olive oil, weak black coffee, or tea can also be consumed if needed.
- Blood Type ABs, please limit your food the day before to baked or broiled fish or turkey with only salt and pepper, egg whites, and plain steamed white rice. Bone Broth (allowable meats), butter, olive oil, weak black coffee, or tea can also be consumed if needed.
- Blood Type Bs, please limit your food the day before to baked or broiled fish or turkey with only salt and pepper, eggs, beef broth, rice milk, puffed rice, or steamed white rice. Butter, olive oil, weak black coffee, or tea can also be consumed if needed.
- And for Blood Type Os, please limit your food the day before to baked or broiled fish or turkey with only salt and pepper, eggs, beef broth, and chicken broth, and plain steamed white rice. Butter, olive oil, weak black coffee, or tea can also be consumed if needed.
Diabetic Prep Diet
For diabetic patients, it is recommended to follow a low FODMAP diet with fruits or veggies in small amounts to help stabilize their blood sugar. This can be half a banana, or 2-3 baby carrots during the 12-hour fast as needed.
Vegetarian Prep Diet
Vegetarian patients can have eggs, white rice or wheat bread, hard aged cheese, and the same fruits or veggies as recommended for diabetic patients as needed.
Vegan Prep Diet
Vegan patients can have white rice and bread, or a cup of plain/firm tofu that isn’t silken. They can also have the same fruits or veggies as recommended for diabetic patients.
On the day of your test, wake up 1 hour before your appointment. You can brush your teeth like normal. No smoking or exercise for at least 1 hour before your test. Keep avoiding all foods and drinks other than water.
Post-Test Side Effects
After taking the breath test, it is possible to see a temporary increase in symptoms. This is due to the sugary drink. The nature of the test is provocative, in that we are intentionally feeding the bacteria to read the results and make a diagnosis. This can induce gas, bloating, loose stools, and cramping among other symptoms. While these symptoms are rare with the low dose of the sugar, they are occasionally seen after the test.
Retesting
PNM retests all breath test patients after a round of treatment to check their progress. Some patients may require multiple rounds of treatment, whereas others may only need one round. By retesting after each round, the physician is able to adapt his treatment plan accordingly to each patient’s needs. Even though symptoms may go away, the patient may still have the diagnosis. PNM prefers to continue treatment until the microorganisms have been flushed out. If a patient is feeling 80-90% better, he will continue testing on a less frequent basis to make sure the microorganisms don’t come back.
Retesting should take place at the latest within two weeks of completing the round of treatment, with a retest within 24 hours being preferable. We recommend booking your retest appointment as soon as you begin the round of treatment.
SIBO and IMO Breath Test Appointment
If you are interested in taking this test and want to become a new patient, please schedule a new patient visit. If you are a returning patient, please schedule a return visit with the breath test. And if you are interested in taking the test but are under the care of another physician, please ask your physician about a referral to take the test. Test results will be directly sent to the referring physician to be reviewed with you. The test is covered by most major insurances, but supplies may not be. If you are curious to see if this test is covered, please call your insurance and provide the CPT code 91065.
Please feel free to contact the front desk with any questions at (203) 270-0070.