SIBO testing mistakes

It is not uncommon for people to get bad information about SIBO from health practitioners. I discovered this during my second opinion consults.

Because digestive issues are hard enough to navigate without bad information, I need to set the record straight about SIBO testing and other important SIBO info.

Once you understand these basic rules, you’ll be able to pick a practitioner who knows what they are doing.

Basics of SIBO testing

1) You can’t determine SIBO from a stool test like the GI Map or the GI Effects.

The only test that can determine if you have SIBO is a breath test. This is a 2 to 3 hour test that requires a prep diet, drinking a sugar-based solution (lactulose or glucose), and taking breath samples.

If a practitioner tells you that you have SIBO based on your GI Map test or a similar stool test, they don’t understand the basics of SIBO testing, or addressing SIBO. This happens more often than it should and is a real shame.

2) Never address SIBO without testing first.

This is the second most frequent mistake I see practitioners make. If you don’t test you can’t create the correct SIBO protocol.

Doctors are often guilty of this. But functional medicine practitioners also make this mistake. Prescribe antibiotics (or antimicrobials) without understanding what gas you are dealing with is irresponsible. The protocol is dependant on the type of SIBO gas that’s present. You need a different approach for hydrogen than for methane.

And if you don’t establish a baseline measurement of the overgrowth you won’t now how long to treat. Not measuring before and after is extremely unprofessional. Why do practitioners do this? Most likely, they don’t know how to read the SIBO test so they discourage people from taking it.

The throwing antibiotics at the problem and hoping it goes away is not a great solution.

There are three types of SIBO gases that could be present. The most common are methane and hydrogen. But a third type of gas, called Sulfide, can be tested along with the other two, with a Triosmart test.

3) Not using a lactulose solution in your test.

There are two types of sugar solutions used to test SIBO: lactulose and glucose. The lactulose solution is more likely to test the entire small intestine. The glucose is likely to just test the top part of the small intestine. If the overgrowth is in the lower part of the small intestine, it can be missed.

It is important to use lactulose if you have slow motility and constipation, as the glucose will move more slowly through the system and miss what’s happening at the end of the small intestine. Use lactulose to increase test accuracy.

4) Always test after completing a protocol of antimicrobials or antibiotics

This is important to see if the protocol worked and how much longer it needs to be continued. This is also true if you did the elemental diet instead of antibiotics or herbs. Testing afterwards is crucial to improve successful outcomes.

5) Make sure you do proper preparation diet before the test.

Doing the 24-hour prep diet correct is essential because it can throw off the results (particularly the baseline reading). You are allowed to eat white bread, white rice, broth, protein and oil/butter only. No veggies or fruit or spices allowed.

If you are very constipated and have very slow motility (you can test it by swallowing whole sesame seeds and timing how long it takes for them to come out into the toilet bowl).

A 2 day prep diet may be requires instead of just 1 day. The length of the prep diet can be determined by a (qualified!) practitioner.

6) Get proper interpretation and don’t self interpret.

Reading a SIBO test is tricky and some practitioners are not well versed in it. At the 90 or 100 minute mark that the sugar solution can cross over into the large intestine and the spike we see is normal. So a 20 plus point rise at this point could indicate normal microbial activity in the large intestine.

7) Don’t do a SIBO protocol at the same time as an h. pylori or parasite protocol. This is more of a client mistake. There is so much urgency to recover that people want to address multiple pathogens at once. When you do this, you’re putting a lot of pressure on your immune system to deal with two things at once. It will compromise the efficacy of both protocols.

If you have h. pylori or parasites, they need to be addressed before moving on to SIBO. Addressing things one at a time will boost the chances of a protocol working.

These are the basics of addressing SIBO to right way. Now you know what red flags to look for.

If you want more SIBO tips on how to address SIBO correctly, you can download the SIBO Rescue Guide.

It helps people avoid the most common mistakes I see with SIBO like: starving your biome, ignoring the nervous system, not adding motility support and not supporting stomach acid.

When you understand the proper approach to SIBO you can easily spot a practitioner that doesn’t and avoid working with them.

A skilled practitioner can be invaluable in guiding and personalizing a protocol, avoiding histamine and other triggers and helping reintroduce foods.

If you need support, I’m currently taking clients for second opinions and testing packages. I can help you order a SIBO test, interpret it correctly and give you a protocol based on your unique needs. I do hour long and half hour consults that come with follow up e-mail support.