Small intestinal bacterial overgrowth (SIBO) occurs when there is an overgrowth of bacteria, particularly the wrong kind in the wrong place, of the small intestine. This can lead to symptoms of low appetite, early satiety, nausea, gas, bloating, diarrhea, abdominal pain, malnutrition or weight loss. Irritable bowel syndrome (IBS) is often caused by SIBO.
The small intestine normally has a small population of bacteria in it due to the rapid movement of food stuff through the intestine, combined with the presence of bile acids. Sluggish movement of the intestine is thus one risk factor for SIBO. In addition to symptoms, SIBO may cause poor absorption of nutrients.
SIBO Test Preparation
Courses of antifungals and antibiotics must be completed two weeks before the test.
SIBO Test Preparation Diet
This diet is 24-48 hours prior to your SIBO Test. During this test, stop all non-essential medications, supplements and probiotics. Your provider will be able to assess this.
The bacteria will be starved for the 24-48 time period with this dietary protocol. As a result, they will react to the lactulose solution, yielding more accurate test results. There are small amounts of lactose in the lactulose solution. If you experience severe reactions to lactose, consult this with your provider.
Consume These Foods During the 24-48 Hours Prior to Your SIBO Test
- Non-processed meat, poultry, fish or seafood
- Plain, steamed white rice
- Clear meat broth (homemade without bone, cartilage or vegetables)
- Salt and pepper
- Plain, weak black coffee or plain, weak black tea
- Plain water
Alcohol, Tobacco and Marijuana
Eliminate chew tobacco, edible marijuana products and alcohol during the 24-48 hour preparation diet. Eliminate smoking tobacco and marijuana at least one hour prior to the test and throughout the duration of the test.
12 Hours Prior to the Test
You will need to be fasting 12 hours before the test. It is recommended to fast overnight (ie 7:00 pm-7:00 am).
One hour Prior to the Test
Wake at least one hour before the test. You may brush your teeth and drink plain water. Do not consume food/coffee/tea, exercise vigorously nor smoke before the test.
During the Test
Once the dietary protocol has been completed, you are ready to take the test. Fill out all of the labels, except for the collection time, and place them lengthwise on your ten test tubes. Mix your lactulose solution with eight ounces of water. Let it sit while you take your baseline test.
Breathe in normally, exhale into the collection device, mid-breath place your test tube on the needle, wait two seconds then take the test tube off the needle. Write the time on the test tube.
Now, drink the prepared lactulose solution, and write down the time you finished drinking the solution (ie 8:00 am). Set alarms at twenty minute intervals to collect samples (ie 8:20 am, 8:40 am, 9:00 am, etc.). You need to collect seven samples within the first two hours. Repeat the collection process with each test tube. Breathe in normally, exhale into the collection device, mid-breath place your test tube on the needle, wait two seconds then take the test tube off the needle. Write the time on the test tube. Make sure you only puncture each test tube once.
Please note that some individuals experience SIBO symptoms during the test. You may record these symptoms on the Patient Record.
After Taking the Test
Pack away the test tubes in the bubble wrap. Place the test tubes and Patient Record in the box to ship off to the lab. You may resume your normal dietary pattern.
SIBO: Dysbiosis Has a New Name
One of the best review articles by Steven Sandberg-Lewis, ND, DHANP and Allison Siebecker, ND, MSOM, from The Townsend Letter
A Breath of Fresh Air, Editorial by Dr Joseph Sellin, Clinical Gastroenterology and Hepatology Vol. 14, No. 2
Insight into some of the pitfalls and uncertainties of SIBO testing.