Small Intestinal Bacterial Overgrowth and Intestinal Methanogen Overgrowth
Here at the Personalized Natural Medicine (PNM) Clinic, we routinely perform a three-hour-long Hydrogen Breath Test for SIBO. 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 bacteria that create hydrogen as a byproduct. An abundance of these bacteria 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.
How does a SIBO Breath Test work?
The test works by monitoring the amount of hydrogen 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 bacteria are stealing supplies, they start producing hydrogen 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
- You have dysbiosis or SIBO and might have a strain of bacteria that produces hydrogen sulfide (ISO) or methane gas (IMO) instead of hydrogen gas, 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
- You have recently consumed food, or improperly prepped for the test
The SIBO Screening Test
During your first visit, the physician may offer a screening hydrogen breath test. This test requires no preparation and is to get a general idea of the bacteria levels in your digestive tract. This is also a test we can offer to return patients currently undergoing digestive treatment as a check-in.
The Complete SIBO Test
A full hydrogen 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 gas 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.
SIBO Prep Diets and Procedure
While there are specific prep diets based on blood type and general diet choices, there is a general diet you can follow if you don’t know your blood type. 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 or beef broth, and eggs.
As a general rule, patients need to fast for 12 hours before the test. 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 determined by 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.
- 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.
- 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.
- 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 and chicken broth, and plain steamed white rice.
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.
Post-Test Side Effects
After taking the Hydrogen 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 Breath Test Appointment
If you are interested in taking the Hydrogen Breath 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. 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.