Today, I'm going to teach you how to read and interpret your SIBO test, so stay tuned.
If you're a returning viewer, welcome back, and if you're new here for the first time,
welcome. My name is Amanda Malachesky. I'm a certified functional nutrition health coach
and a digestive and allergy detective. For weekly videos on how to find your personalized plan to
resolve IBS and SIBO symptoms, please consider subscribing and be sure to hit the bell to be
notified when I post a new video. One of the first functional medicine tests I was taught to
read when I was a functional nutrition student in training was the SIBO Breath test. And this
is with really great reason because one of the very most common underlying causes of IBS is
SIBO or small intestinal bacterial overgrowth. As an IBS gut health coach, I find the SIBO
Breath test invaluable because it helps a lot of my clients find some very clear answers about
what exactly is causing their IBS symptoms like bloating, constipation and diarrhea, but it's
important to interpret the test properly so that you can get the appropriate answers to guide your
treatment. And there are some common mistakes made when interpreting the test even by doctors,
so today I want to make sure that you have the best information to do this task correctly because
it really does impact how you approach your treatment with your doctor. So let's dive in.
So first I briefly just want to explain exactly what the SIBO test is and how it works. So for 24
hours before the test, you do a special prep diet, and then once you're ready to run the test, you
take a baseline sample, and then you drink a sugar solution which is either lactulose or glucose,
and then you take a breath sample every 15 or 20 minutes, depending on the test kit you're using,
for three hours. This is usually a total of 10 samples, a baseline sample, and then nine follow
up samples. Most SIBO tests are still just looking for hydrogen gas and methane gas, but
there is a third gas that can cause symptoms and that's hydrogen sulfide. And currently I believe
there's only one test that's looking for all three gases, and that's the trio-smart SIBO test. And so
generally, I'm recommending people use the trio-smart test to check if they have SIBO.
Fortunately, even if you don't have a doctor that's willing to order a SIBO test kit for you,
trio-smart has a medical director program where you can call them, and they'll do a
quick assessment and decide if it's appropriate for you to run that test, and they will send you
a test kit if it seems like the right thing. I do have a whole other video called How to Access SIBO
Testing Without A Doctor, so if you're having trouble accessing SIBO testing, be sure and go
check that video out. Now, there are a couple of important rules that you need to keep in mind as
you're looking at SIBO tests. Number one, is that you're looking for hydrogen levels at, or above 20
parts per million, methane levels at, or above 10 parts per million, hydrogen sulfide levels at, or
above three parts per million or a combined total of gas levels at 15 parts per million or more.
And then beyond these cutoffs, here is the other really key essential rule for interpreting SIBO
tests. You're looking to see these gas levels at, or before the approximately 90 minute
mark on the test, and this is because it takes approximately 90 minutes for whatever you drink
to make its way through the small intestine and then to enter the large intestine. Now,
we know that the large intestine is supposed to have large numbers of beneficial bacteria
and other kinds of microorganism, and so we expect to see quite a large rise of gas levels once that
sugar solution makes it to the large intestine. A lot of people make this mistake by thinking,
"Oh, I see that big rise, that means I have SIBO," but if it's happening at,
or after the 90 minute mark, this is just when the test solution reaches the large intestine
and the gas levels are expected to go up there. Now, the truth is that, everyone's motility is a
little bit different. Not every single person has exactly 90 minutes transit time through the small
intestine into the large intestine, so these are just some of the nuances that you have to
be aware of when you're interpreting SIBO tests. So now, let's take a look at some
actual tests and see what this really looks like in real life. So I'm going to start by showing
you one of my very first SIBO tests that I took back in 2017. So on this test result,
I've marked out that 90 minute mark which on this test because it has 20 minute sample intervals is
in between reading number five and six. And so the first thing to notice here is that my
methane levels starts out at a really high level at a 40, so this is well above the 10 parts per
million cutoff for methane. So I clearly have a significant methane overgrowth at baseline here.
My hydrogen levels, however, are well below 10 through that whole first 90 minute period,
so what we're hear seeing here is methane, excess and a little bit of hydrogen, but not
much to speak about, and certainly the combined parts per million of the methane and hydrogen
is well above the 15 parts per million cut off. Also on this test, you can see that once we get
to that 90 minute mark, the methane level goes up and so does the hydrogen just a little bit,
so this is a really clear test result. Yes, there's a methane problem for sure. So let's take
a look at another test result. This is from one of my clients who is struggling with severe bloating
and gas. On this test result, I've marked that 90 minute mark which, because this kit uses 15 minute
sample intervals is at reading number seven. You can see that well before the 90 minute mark,
this client had a hydrogen level of 20 parts per million or above. You can see there at reading
number four, it edged right up over 20, and then it just keeps going up and up all the way
till that 90 minute mark where it goes even further beyond that level. So in this case,
this client certainly has a hydrogen SIBO case and there is no methane to speak of. So now,
let's take a look at a test that's a little bit more nuanced. So here's this result, I've drawn in
the 90 minute mark for you, and you can see that at reading number four which is at 45 minutes,
their methane level goes up above that 10 parts per million line, and it hovers right about that
10 part per million area even up until the end, so there's a little bit of a methane problem here.
And then we see that with hydrogen between reading six and seven, it drastically goes up.
Now, is this indicative of hydrogen SIBO? It's a little hard to say because again,
sometimes people's motility is a little bit on the fast side, and this might just indicate that the
substrate got to the large intestine at reading number six instead of at reading number seven,
so this has to be interpreted with a little bit of savvy. In any event, there's certainly
an indicator of a methane problem, and then the combined values of methane and hydrogen
are well above 15 parts per million. Now, the hydrogen and methane combined are at 32 parts
per million at that last reading right before the 90 minute mark, and so that combo essentially is
above the 15 parts per million level which suggests, yes, there's a SIBO problem here,
but again, we don't really know if that's because the motility has just gone a little quicker than
is ordinary or if there really is SIBO all the way at the end of the small intestine.
In this case, you would just be wanting to address the methane problem and see how things
netted out later on a follow up test. Let's take a quick look at one more test here. In this test,
there's really nothing to speak of through the whole test all the way to between reading six
and seven. And at that point, the level of hydrogen gas goes up to 16 which is still
below the 20 parts per million cutoff. I suspect that in this case, this rise is showing us when
the substrate reached the colon, and I don't think it's necessarily SIBO, so you can see how
there's a little bit of nuance here to this. You have to consider the motility of the gut,
the normal motility, and you have to consider it in context. So it's important to interpret
these SIBO tests with a little bit of savvy, a little bit of thinking, and not just blindly
accepting what you see on the paper, but at the same time, there are some rules to follow.
They use those rules to guide you, and use the results that you got on your SIBO test to help
guide your next step whether that's, "Okay, I'm going to table this and work on something else
right now," or, "I'm going to work to address SIBO and see whether my symptoms improve or not." So if
you've been struggling with how to approach your SIBO treatment to get the best results or you've
been struggling and not getting results, I really want to encourage you to download a free copy of
my Roadmap to Gut Recovery. This is a free guide that shares the exact strategy that I teach my
students and clients inside my Calm Digestion Method program to find their personalized plan
for gut symptom resolution. You can grab your free copy at confluencenutrition.com/roadmap,
and I will leave a link for that below this video for you. All right, I hope this video was helpful
for you. And be sure to watch that video about how to access SIBO testing without a doctor if
you're needing to find access to a SIBO test, and I will look forward to seeing you next time.