The Best Kind of Test for SIBO (Small Intestinal Bacterial Overgrowth)

Breath testing for SIBO Hydrogen and methane

Hi guys

Dr Hagmeyer here and If you are watching this on my website I’m glad you found us! If you are came across this on my YouTube channel I hope you will find value in the information I will be sharing with you.

In my last video I talked about “10 Warning Signs Of SIBO And When to Get Tested”

Today, we are continuing the video series and we are talking about a very special test called the Hydrogen and Methane breath and how it is used in detecting SIBO or small intestinal bacterial overgrowth.

A couple of other things I want to address in this video is the difference between a Glucose Breath Test and Lactulose Breath test, I will also share with you the limitations of each one because they definitely provide different kinds of information.

If you or someone you know suffers with IBS, you know the daily struggles and challenges that many people simply take for granted but with this test, you might finally start getting on a path that can lead to a drastic improvement in your symptoms and ultimately change your life.

Depending on which study you read, anywhere between 50-80% of people who have been diagnosed with IBS have SIBO. Now it might seem odd that collecting your breath is going to tell you something about a problem in your gut, so let me explain this a little bit. First off, within our large intestines, we have an environment that is teaming with bacteria. This is what we call the micro biome.

The primary function of the colonic bacteria making up the microbiome, is the fermentation of non-digestible carbohydrates, and starches resulting in the formation of short chain fatty acids.

Short chain fatty acids maintain the intestinal barrier function, are the fuel sources that simulate healing and repair within the gut lining, they also regulate electrolytes and water balance, support the commensal bacterial strains- the good guys.

Recently, there has been an increasing number of studies showing that SCFAs can affect the metabolic syndrome, cancer, Ulcerative colitis, Crohn’s disease, and antibiotic-associated diarrhea.

The primary functions of the small intestine on the other hand are those of digestion and absorption of nutrients from our food. The bacteria in our small intestine aid in digestion and absorption, produce valuable nutrients, support gut immunity and protect us from other invading organisms.

The small intestine on the other hand houses approximately 10 thousand bacteria per milliliter of fluid, as compared to the large intestine which houses approximately 1 trillion bacteria per milliliter of fluid.

That’s one of the key points I want you to remember! not the numbers, but the fact that the Large intestines have lots of bacteria such as Escherichia coli, Enterococcus spp., Klebsiella pneumonia and Proteus mirabilis and Small intestines….. not so many bacteria unless of course …… we have a problem….. ie SIBO.

When we have SIBO- we have an overgrowth of bacteria from the Large intestines into the small intestines. The bacteria in our guts feed off of the undigested carbohydrates and starches and in the process of this buffet/smorgasbord, they produce gases as a byproduct.

Those gases may be Hydrogen, Methane or hydrogen sulfide. The reason we measure them from a breath test is that some of the gases produced by these bacteria are absorbed through the lining of the colon where they can now enter and get into our blood stream.

From our blood, the gases make it to our lungs where they are then exhaled in our breath- hence the name Hydrogen and Methane breath test

So a Breath Test Tells Us 3 Things

1. WHICH gases are present, (Hydrogen or Methane)
2. The LOCATION of the overgrowth (upper or lower part of the small intestines where we have the problem)
3. SEVERITY of bacterial overgrowth and if you are wondering about that third gas, I mentioned earlier (hydrogen sulfide), At the time of this video, there is no testing for hydrogen sulfide yet.

So you be wondering what a breath test looks like so let me show you an example and explain a bit more about the test.

You can see along the vertical axis (up and down) numbers that go from 0-80 this is the concentration or the amount of Hydrogen and Methane produced during a sample.

Along the horizontal axis (along the bottom of the graph) we have the elapsed time and number of samples that are collected.

In this particular test there are 10 samples collected over 180 minutes.

The 180 minutes or 3 hour breath test is what is now considered the gold standard for testing according to researchers.

A positive SIBO breath tests, is a test that shows elevated levels of hydrogen or elevated levels of Methane or elevated levels of both. This person that you see here is positive for both Hydrogen and methane.

So this is a bit more complicated than a case where it is only hydrogen. In another video,I will talk about treatment for these because a person diagnosed with + Methane tests is going to require a different treatment program than a person who has a + Hydrogen Breath test.

This is also the reason that I believe testing is very important and not just treating for SIBO because you have a hunch or a suspicion.

I know some functional medicine doctors who tell their patients not to get tested but treat them as if they have the problem.

In my opinion, this is not a good idea because like I mentioned earlier, depending on the type of bacteria that are producing hydrogen or methane, treatment will be different.

So we don’t want to nuke the GI microbiome with antibiotics or anti-microbials based on a hunch.

The last thing I want to talk about in today’s video is the difference between a lactulose breath test and glucose breath test and the pros and cons of each. Each has a limitation that you should be aware of.

The reason I tell you this is that if one test is negative, let’s say a lactulose test is negative, many doctors will say you don’t have SIBO.

Unfortunately, it’s not that simple. While you may be negative for a lactulose test you may be positive for a glucose breath test and sometime this is why you need to do both

The difference between a Glucose Hydrogen Breath test and a Lactulose Breath test.

First off, the small intestines is approximately 20 feet long.

The reason I tell you this is that depending on the breath test you use (Glucose or Lactulose) you are only going to be able to test either the upper most portion or the lower most portion of the small bowel. One test cannot evaluate or assess both areas.

The glucose breath test evaluates (SIBO) the in the upper most portion of the small intestines- which is the section that the stomach empties its contents into and Lactulose Breath test evaluates SIBO in the lower portion (the section that empties into the large intestines)

So remember 20 feet of intestines- Glucose breath test is better for bacterial overgrowth upper portion (Duodenum) of the small bowel and Lactulose breath test is better for the lower portion of the small bowel.

Both lactulose and glucose are types of sugars.

Certain kinds of bacteria in the gut digest the these sugars and produce gas hydrogen or methane as a byproduct, those gases are what is measured in a hydrogen breath test.

The upside to Glucose breath tests are considered more accurate by researchers.

The downside is that most cases of SIBO are identified in the distal portion (Jejunum and Ileum) or the end portion of the small bowel. This is why we start with a Lactulose Breath Test

So a Negative Glucose Breath Test Is Only Negative For Overgrowth In The Upper Portion Of The Small Bowel.

Ok, what about the lactulose test? The problem with a lactulose breath test is that it is Not as accurate as glucose breath tests, but will diagnose SIBO in the end of the small intestine- which is where the vast majority of SIBO is found.

Alright- That’s going to wrap up today’s video- I hope you found it helpful and that learned a few things.

Couple of reminder points as we close today’s video.

1. If you or your doctor orders a SIBO breath test- make sure it is the three hour test NOT a 2 hour test.
2. By the way these tests can be done at home- you don’t need to spend 3 hours in a doctors office. I simply have the lab mail my patients the test kit and so its super simple.
3. One thing I will say is that there is a very specific SIBO test preparation that needs to be followed. You wouldn’t even believe how many doctors administer this test incorrectly. Please be sure if you are getting tested, that you are following the precautionary steps- – I did a video on this and I suggest if you are thinking about getting tested or you already have a test kit, you go back and watch that test and follow those precautions.
4. Remember that a glucose breath test is more accurate but a lactulose is more sensitive for the areas where the majority of SIBO is found.
5. Whoever you decide to work with- this is something that hopefully they are knowledgeable about and can order the correct test for you

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