Swedish Egg

Swedish Egg

Tuesday, March 17, 2015

My lactulose breath test.

I was on the fence about doing a lactulose breath test. 

There were a few reasons for the ambivalence. 

First, based on my symptoms, I was pretty sure I had SIBO anyway. The GI doc I'd seen had warned me the test was really expensive ($375 if I did it through her with Commonwealth Labs). She also said she was ready to treat me without testing and even gave me a prescription for Rifaxamin before I left her office. 

Considering her opinion, and knowing that one accepted way of diagnosing SIBO is retrospectively—in other words: if symptoms resolve on treatment, you have SIBO—why spend the extra dough on testing?

The second reason for my hesitation was that some controlled studies (comparing the results of people with and without IBS) have cast doubt on the validity of the lactulose breath test itself. There may be a high rate of "false positives" in IBS-free people. This makes some experts think the lactulose test may be more useful for ruling out SIBO (when a negative result is found) rather than for diagnosing it from a positive result. So again, why should I bother?

Third, the test takes 2 or 3 hours to do at home and requires a restrictive prep. Part of the prep is to not take any antibiotics (including herbal), probiotics or laxatives for TWO WEEKS prior to testing. WHAT? Magnesium and herbal laxatives help make my life possible!

And there was the restrictive prep diet: your choice of eggs, chicken, fish, white rice (unless you are grain-free) and white bread (unless you are gluten free) the day before you test. That's it. A little salt and pepper is permitted, but no honey, sugar, dairy, fruit, vegetables, whole grains, etc. Nada. Plus you have to fast on water for the final 12 hours preceding the test.

It was a lot to wrap my mind around, but in the end, I decided to do the test anyway, albeit through a different lab and with a different doctor who only charged me $130 (that's more like it).

Why did I make this decision? Because inquiring minds want to know! I wanted that formal diagnosis. If the test came out positive, it would give me a baseline, too. And there's nothing like a positive test to confirm a diagnosis and help keep the patient on track.

I took the test the second week in February, sent it in to Genova Diagnostics and the results came back on the 17th. Positive. It was official. I have SIBO.


These are my results. The graphs show my baseline breath levels of hydrogen and methane gasses before drinking a lactulose solution, and my production of these gases over the 2-hour post-imbibing period. In the case of a positive test (which this is) the type of gas produced indicates which type of microbe is overpopulating the small intestine.

As suspected, I am a methane producer. IBS-C people usually are. (My proud motto"My farts don't smell"was another tipoff, since methane, as I recently learned, is an odorless gas.

As you can see, I started out with high baseline levels of methane. These levels decreased initially, but when the lactulose hit my distal ("far away") ileum, they shot up again. Hydrogen levels shot up at that point, too. This indicates the presence of both methane-producing and hydrogen-producing microbes, although the methanogens are prominent.

At my house, everybody eats.

I found it a bit confusing why at first, my breath gas levels went down but apparently that is not uncommon, according to this excellent article from Allison Siebecker (my hero) and her research partner Steven Sandberg-Lewis, which helped me make sense of the results:


Anyway, considering that I began with elevated baseline levels, the reported "mild increase" of 14 points suggests I have a mild-to-moderate case of SIBO.

It was good to have confirmation. A little weird (bacteria are taking over my body!) but good. I suppose I could feel invaded, but I decided instead to position myself as a wonderful host. The hostess with the mostest, you could say.

Nevertheless, I've had it with these guests. Hence I came up with a plan: Herbal antibiotics, biofilm disruptors, digestive support and motility support (a key component). At this writing, I am, in fact, nearing the end of a 30-day protocol that I will share in forthcoming posts. So stay tuned. And leave a comment below if you're thinking about doing lactulose testing, or have any questions. I'd love to hear from you.

xo Diana



 

22 comments:

  1. I'm preparing to do my SIBO test on Wednesday morning, so that means I start with the food prep tonight. I'm already on a limited elimanation diet right now, so this makes things even harder. Can't wait to have it over with, any suggestions? What did you eat while prepping?

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    1. Hi Carey - I'm excited for you to do your breath test on Wednesday! I remember the idea of prepping for my test felt kind of daunting but I just went with a big pot of chicken soup for the day and it wasn't too bad. I even had a little Jasmine rice, since it was allowed on the instructions. Just no veggies... or anything else. Hang in there - it's only for one day! -Diana :)

      P.S. I did blog about my test prep in real time on the old SS site. Here is the link if you want to read more: http://sexysibo.wix.com/sexy-sibo#!My-lactulose-breath-test-prep-day-diet/cy97/54d7988a0cf29efd94a71f99

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  2. Hi Diana, I've just stumbled across your blog. I had a lactulose breath test in Feb this year and I too have high baseline methane of 46 ppm and my hydrogen went from 1 ppm to 140 ppm in 120 mins. Needless to say, some farting went on that afternoon! I'm IBS-C as you would expect.

    I'll be following your blog with interest. I'm also trying the herbal route and on the low-fodmap diet, but I can't afford to lose any weight so for now I haven't cut out grains etc. Good luck with your healing journey.

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    1. Hi Nicki - Thanks for commenting and I know what you mean about the lactulose gas test—I mean breath test, lol.

      Best of luck with the herbal protocol and I hope the grains are manageable for you. Low-FODMAP definitely the way to go there. And remember your winter squashes, they provide a decent calorie count, too. Also: they are yummy!

      :) Diana

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  3. I just read the instructions for Genova SIBO test. I wonder if yours are different. These say to avoid laxatives and stool softeners which I take to mean products for that. I don't see anything about magnesium citrate or Vitamin C which I use for that purpose. My instructions also have a specific list of foods to avoid and some vegetables you can include.

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    1. Hi Beth - I replied below...want to be sure you see it! D

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  4. Hi Beth, good questions!

    I agree they probably DO mean to avoid branded laxative and stool softening products in the instructions. But if you are taking the mag citrate and C for the same reason, you want to consider avoiding them during prep, too. Check with your practitioner. It may not be an issue, but the idea is to get an accurate reading of the bacteria in your small intestine, so you don't want to be over-sweeping them out.

    As for the food list, I would follow the one in your kit, but don't add in any foods you are not currently eating just because they are on the list! One example is white bread. If you don't eat white bread or are gluten-free, this is not the time to start.

    I avoided all the grains except white rice, which I had once at dinner. (Jasmine rice is even better.) It's actually not that horrible living on chicken soup for a day, lol. Scrambled eggs, turkey burgers, spinach, zucchini...

    Good luck with your test! :) Diana

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  5. Hi Diana,
    I'm halfway through my prep day, and am wondering if I should abort, as I didn't know Magnesium citrate was an issue. (Seriously, not sure I can live without it for a week!) The directions do mention magnesium hydroxide, and Milk of Magnesia, though. I can't get a hold of my practitioner to ask...so I may be starving for no reason!
    Also, in regards to your response to Beth, the prep diet instructions for the Genova test I'm doing says zucchini and spinach are no-no's!

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  6. Hi Unknown -

    Oh, boy. I hear you on not wanting to give up the magnesium for a week. But...probably, you should. If the test weren't so expensive, it wouldn't be such a big deal to retest. But at that price, you probably want to give yourself the highest chance of accuracy the first time around. Sorry, it's frustrating I know.

    Thanks for pointing out the Zuke and Spinach no-no on Genova instructions. It's confusing why different labs have different prep day guidelines, but seems best to stick to the program as outlined by whoever is conducting/reading the test.

    Best of luck with all, Diana xo

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  7. Hi Diana,
    Did the treatment work for you? How are you now?

    I just had the test done and I am having trouble understanding my results. Apparently it's technically "negative" but I have read some doctors would see my test as positive so I am totally confused and at a loss. Can you help?

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    1. Hi Brooke,

      Yes, I could help you interpret your results. Email me at eat2evolve@gmail.com and we'll figure out a time/place/mode if you'd like to schedule a consultation.

      Thanks and best wishes, Diana

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  8. If you have methane producing bacteria you should consider taking Atrantil. This is a natural treatment, quite new on the market. I've listened to a podcast of Chris Kresser and he did this interview with Keneth Brown, one of the greatest researchers of Sibo. The product is developped from him. He was the one who realized that only about 40% with sibo can heal their gut with the former supps or Antibiotics because they adress just the hydrogen producing bacteria. Atrantil is now adressing both - hydrogen and methane producing bacteria.
    Greetings from Switzerland, Nicca

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    1. Hi Nicca, Thanks for your comment. I've heard about Atrantil—have you tried it? ~Diana

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  9. Can you take curcumin? I have a headache

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  10. Can I take curcumin before the test? I have a headache.

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    1. Tammy, it may depend on how long before the test... Probably best to wait until after test is done to take curcumin, but I'm sorry for your headache...poor you. :(

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  11. Hi Diana! Just stumbled across your blog while doing some research on SIBO testing. My gastro gave me the take home glucose hydrogen breath test. After researching, I know now I need to test for methane as well as hydrogen. I am also now wondering if the lactulose test is a better option? Do you have any thoughts on this?

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    1. Hi Jessica. Both tests are useful, and neither is perfect. Because glucose is absorbed at the beginning or proximal end (within the first 3') of the small intestine, the Glucose Breath Test is more accurate at finding bacteria in that region. However, SIBO is thought to be more common in the distal end (farther down in the small intestine), and that is where lactulose is absorbed. So the advantage to the lactulose test is that it can diagnose overgrowth in the distal end; however it cannot diagnose bacterial overgrowth as well as the Glucose Breath Test, especially for diarrhea predominant patients. The 3-hr lactulose test is currently the most popular test, especially for constipation rather than diarrhea type. Hope that helps! -diana

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  12. Hi. I am prepping for my second SIBO test and also hate the thought of going without magnesium citrate for even a day. My test prep requires stopping the magnesium and other laxative products 5 days prior. My doctor said that glycerin suppositories are ok as an alternative since they won't affect the small intestines. Hope that helps other people! Ask your doctor if in doubt.

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    1. Melissa, Thanks for sharing this tip. I hope you get good results on your second test! :) Diana

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  13. Hi there,

    I dont suppose you would know why some website suggest doing the dreaded prep diet for 48 hours rather than 24 do you?

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    1. Hi, It's possible that some of the test kits themselves make this request. Also, if you are a slow transit type (IBS-C), there might be a risk of some partially digested, non-prep-type food remaining in the gut from the day before yesterday, which 48-hours of prep might clear. But a one-day prep diet is the general standard (with water only for the final 12 hours before the test is performed).

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