Everything You Need to Know About the SIBO Test
Whether you’ve been told you have Small Intestinal Bacterial Overgrowth (SIBO) by your healthcare practitioner, have IBS and suspect you have underlying SIBO or have taken your health into your own hands and after hours of research think you might have SIBO, SIBO testing is a very important step that is often overlooked.
Often times practitioners think testing can be cost prohibitive and treat without really knowing if you have sibo and if you do, what type of sibo you actually have (which ends up leading to incorrect antibiotics or herbs that don’t resolve your issue).
But wouldn’t you rather pay for a test up front and know what exactly is going on in your body with a tailored killing approach than to keep guessing and spending months and tonnes of money on supplements that perhaps aren’t really helping?
I don’t know about you but I sure would have preferred to get back to living my life again as soon as possible!
For some of you who have gone through multiple diets and antibiotics or antimicrobial rounds, you’ll know from experience that it’s super tough to keep going through this process over and over without results.
The saying “test, don’t guess” is something I’m a big believe of, especially when it comes to SIBO and wanted to share why it’s such an important piece in your recovery.
SIBO Testing: How it Works
The main purpose of the SIBO test is to determine if you have an overgrowth of bacteria or methanogens in your small intestine and if you do, what type.
Before we dive into the test, let’s do a little recap on what exactly is going on in your gut that leads to symptoms of SIBO.
When you eat food, specifically foods higher in FODMAPs (types of carbohydrates), it feeds the bacteria in your gut. When they eat these carbohydrates, they ferment them which is a normal process that goes on in your digestive system. This fermentation process results in gas formation, which you may experience as bloating, burping or farting.
In a healthy gut, the bacteria are located in the colon or large intestine and there’s a good balance of bacteria which keeps the levels of fermentation at a normal level. When you have SIBO, there are bacteria in the small intestine (where they’re not supposed to be!) and fermentation is happening at higher levels, resulting in lots of bloating and gas.
There are 3 different types SIBO which is determined based on the gas type produced by bacteria or methanogens. It is also possible to have a both methanogens and hydrogen bacteria.
The 3 different types of SIBO are:
Methanobrevibacter Smithii: is actually a methanogen not a bacteria. It produces methane gas and if this type of gas is present on a SIBO test, then the test suggests you have Intestinal Methanogen Overgrowth (IMO), previously known as Methane SIBO.
Desulfovibrio Fusobacteria: this is a bacteria that produces hydrogen sulfide gas and if this type of gas is present on a SIBO test, then the test suggests you have Hydrogen Sulfide SIBO.
Klebsiella pneumoniae or Escherichia coli (E.coli): These two types of bacteria produce hydrogen gas and if this type of gas is present on a SIBO test, then the test suggests you have Hydrogen Dominant SIBO.
It’s also important to note that the only way to test these gas levels is using a breath test. Stool testing does not accurately reflect what is going on in the small intestine and only shows a picture of what’s going on in the large intestine.
At the beginning of the test you consume a substrate, ideally lactulose although glucose and fructose are also used. Once the lactulose is in the small intestine it is fermented by the bacteria into hydrogen, methane or hydrogen sulfide gas which is then absorbed into the blood and through circulation is carried to the lungs. You breath out the gas into the collection tool or tube and those gas levels are measured to produce your breath test results.
As each type SIBO is a result of different types of bacteria or methanogens, you need to use a tailored approach to killing theses with different antibotics or herbal supplements. Without testing, you don’t know which herbs or antibiotics to use and can therefore take the wrong ones and end up back at square one with no changes in symptoms or test results.
If you have think you might have SIBO based on your symptoms or have been diagnosed with IBS (and want to determine if SIBO is underlying your IBS), I offer at home SIBO breath testing so you can confirm you do have it and what type. You can book your free discovery call below, which is required to receive a testing kit.
SIBO Test at Home: Testing Types
There are a few different options when it comes to testing for SIBO. The type used generally depends on your health care provider and what type of tests are available in your country.
Below are the different types of SIBO test kits used to determine if you have SIBO (in North America):
Quintron Breath Test
This is an at home breath test that is ordered through from a lab by holistic and functional medicine practitioners. This test measures hydrogen or methane gas.
The test kit comes in a small box with a breath collection device and tubes to collect the breath samples. The test takes appx. 3 hours to complete and once completed, you send the tubes back to the lab to be processed. Results take about 1-2 weeks to process once the lab has receiving test.
Food Marble
This is a newer device that can be ordered through your holistic health care practitioner (and you can receive a discount) or on your own. This testing device measures hydrogen and methane gas.
The Food Marble is a small square device that you blow into and gives instant results. You have an easy to use app where you can input your food, symptoms, stress levels, bowel movements and sleep and all are uploaded to the practitioner dashboard for review.
This is my preferred way to work with SIBO clients now. The device allows for daily monitoring during a protocol and sends all the data to the practitioner to be monitored. It makes it much easier for me to analyze and determine if certain foods are connected to symptoms you’re experiencing and allows me to make adjustments to your diet if necessary.
Food Marble Device
Triosmart
This is an at home breath test that is the only test to measure all 3 gasses: hydrogen, methane and hydrogen sulfide. It is unfortunately only available in the United States and not available to Canadians yet.
The at home sample kit includes a small box with breath collection device and tubes to collect the breath samples. The test takes appx. 3 hours to complete and once completed, you send the tubes back to the lab to be processed. Results take about 7 days to process once the lab has receiving test. As the patient, you can purchase this test on your own (however it’s advised to work with a practitioner once you have your results). It is only available in the United States.
Depending on where you’re located, your gastroenterologist may have in house testing equipment. I cannot comment on the type or accuracy of these, however, based on my personal experience, the SIBO test I had completed with my gastro said I was negative when the Quintron said I was positive and still suffered from symptoms.
SIBO Test Prices
I encourage you to speak to your healthcare practitioner about which may be the best for you. I’d also be very happy to answer any questions you may have! Feel free to send me an email here. Note that the prices below are current as of 2024.
Quintron (Between $230-$260 CAD + taxes) depending on the lab
Food Marble ($339 CAD) + duties and taxes.
If you purchase the Food Marble directly on the website, the only option is to get the device and food intolerance kit which costs more and you may not need. If you purchase through a practitioner, you may be able to save money by having the practitioner only request the device (which may save you appx. 20%.)
Trio Smart ($349 USD or appx. $480CAD) all in.
My preference is to use the Food Marble as it saves you a lot of time and money in the long run!
The most effective way to monitor the success of a killing round is to test before and after each round so you can monitor the decrease in bacteria levels and determine if SIBO has been cleared. It is common for people to need multiple rounds to get bacteria levels down and so you can end up spending hundreds or thousands of dollars on standard breath test kits if you end up needing multiple killing rounds.
3-4 weeks will also be needed for shipping and test turnaround time so if you need multiple rounds, months can be added onto your protocol which means more time on a semi restricted diet- not fun!
With the Food Marble, you only have to spend money once on the device and are able to complete as many tests as needed. The results are received by the practitioner within minutes so future rounds can start asap if needed, shortening the process for you!
SIBO Test Diet
Most breath tests involve a fairly restricted prep diet so it’s good to understand the requirements so the testing isn’t impacted or need to be redone which isn’t great when you’re eager to get results back!
The purpose of the SIBO test prep diet is to restrict FODMAP and fiber containing foods to create a base line for the test so that it’s easier to measure the gas levels once you take the substrate (lactulose or glucose).
The SIBO bacteria create symptoms based on these higher fiber and FODMAP foods so if you continued to eat them before the test, it would be hard to determine if you were reacting the foods or the substrate. By limiting them, it allows the symptoms to reduce so that when you do consume the substrate (which is a FODMAP type of carbohydrate) the test reading is more accurate.
Leading up to the test you want to make sure that:
You havn’t had any colonoscopy or antibiotics in the last month (unless you’re re-testing after a SIBO protocol)
Probiotics, fermented foods and herbal antimicrobials (unless re-testing) should be stopped 1 week before testing
All laxatives (magnesium, vitamin C, herbal, medication), digestive aids (enzymes, HCL, etc.) to be stopped 4 days prior to testing
Avoid eating high fiber foods, lactose containing foods or slow to digest foods (bran, coarse breads, nuts, beans, starches except for rice) 1-2 days prior to testing
Read all the test guidelines and ensure you’re clear and understand the process so that you can confirm with your practitioner prior to taking the test
The prep diet starts 24 hours prior to when you plan to test. There are 2 stages; the first 12 hours which is a restricted diet followed by a 12 hour fasting period (usually overnight) and then the test itself takes 3 hours. The SIBO test prep diet is outlined below.
If you suffer from constipation or know you have IMO, the first 12 hour diet should be done for 48 hours as transit time may be slower for you which can skew test results.
So if you decide to do the test on a Saturday, the prep diet is started either Thursday or Friday depending on your bowel movement type. It’s best to schedule the diet when you’ll be home and wont be rushed or interrupted during the 3 window so for most people this would be on your days off. Some people can also feel pretty crappy after doing the test (as they’re reacting to the FODMAPs) so it may be best not to schedule anything the rest of the day.
During the SIBO Breath Test
The test itself takes approximately 3 hours so it’s important to not schedule anything that will disrupt the 3 hour period. I suggest reading the directions before hand so you know exactly what you’ll be doing during the testing period.
To start out, you’ll add the substrate to some water and drink it. You’ll want to note down when you drank the substrate and start a timer on your phone (if using the lab kits).
Depending on the type of test you’re doing there may be different time intervals that they suggest using. You will then breath into the testing device every 15-20 minutes (which ever interval they suggest) and record the time and info required and add it to each test tube sample. If you’re using the Food Marble all of this is recorded digitally for you.
If you’ve ordered an at home test kit, you’ll then package it up and ship it back to the lab. If you’re using Food Marble, the test results will be sent right away to your practitioner.
SIBO Test Interpretation
The testing window for the small intestine is within the first 90-100 minutes from baseline. After that, a rise in gas reflects what is going on in the large intestine. This is something that can be easily missed if the practitioner isn’t trained in interpreting SIBO test results properly and can result in extra treatment that may not be needed!
Not every lab accurately reflects the proper guidelines either so it’s important to make sure the practitioner knows how to interpret the test instead of just reading what the lab interpretation says.
Are you ready to transform your digestive health so you can eat all your favourite foods again?
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By Krista Znebel, R.H.N.©
May 15, 2024