Do You Really Have SIBO?

Do you really have SIBO? I often hear horror stories about people who can never clear SIBO. However, I rarely see this in the clinic. Part of the reason for this might be because the most popular SIBO test can cause what’s known as a false positive. This is when you don’t actually have SIBO but the labs say you do. It’s important to understand this so you know when you can stop SIBO treatment and so you don’t have to follow a SIBO diet forever.


Dr. Michael Ruscio, DC: Hi. This is Dr. Ruscio. And let’s talk about SIBO (small intestinal bacterial overgrowth) to know when you have it and, more importantly, when you don’t have it.

SIBO, or small intestinal bacterial overgrowth, is a condition of bacterial overgrowth that may cause many of the cases of irritable bowel syndrome, or IBS. And this can include things like abdominal pain or gas; altered stool frequency or consistency—so constipation, diarrhea, and oscillation between the two; and also altered formation of the stool—loose stools, hard stools, compact stools. This is a common condition. IBS affects about 10% of the population. And SIBO (small intestinal bacterial overgrowth) can underlie many of those cases. So because of this, SIBO is often tested for.

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And there are two different types of tests that can be used. They’re both breath tests. One uses lactulose. One uses glucose. And they both have merit. And they can both be used very successfully. But there are some intricacies to especially the lactulose test that are important to understand to prevent you from having what’s called a false positive. And this is where the lab says you have SIBO but you actually don’t have SIBO.

“If you don’t understand how to treat SIBO the right way (a), and also (b) understand how to interpret the tests, you can fall into the syndrome of thinking you’ve never been able to clear SIBO.”

And what I’ve been noticing over the past year or so is many patients come in with quite a bit of fear surrounding SIBO. They’ve heard that you can never get rid of it. They’ve heard of people that keep treating it and retesting and are still positive. And I have not found that to be true for most cases. There is certainly a smaller subset of patients that have a very hard hand that they’ve been dealt.

And they have to work very hard to gain symptomatic improvement. And they’re much harder cases. But for the majority of people, SIBO is something that can be overcome. But if you don’t understand how to treat SIBO the right way (a), and also (b) understand how to interpret the tests, you can fall into the syndrome of thinking you’ve never been able to clear SIBO.

Now, recently in one of our podcasts we went into great detail comparing the lactulose and the glucose tests. And I’ll try to find that link and put that in here if you want to go to that episode and get all the science behind these different tests. But the main thing to understand is that with lactulose testing, there is a higher chance of having a false positive, meaning you’re falsely positive, meaning the test shows you have the condition but you don’t actually have the condition.

And one of the keynote things that can suggest this is if someone first has SIBO—again, all this will be on the lactulose test I’m referring to. Someone tests positive for SIBO. They treat it. And they respond very well to treatment. But their retesting shows they still have SIBO.

And especially if that retesting is done once and then maybe you do it again a month later or if you finish SIBO treatment and then your retest was several weeks later and you retested and your symptoms were still gone at that point, as long as there have been a few weeks where you’ve been symptom free and the retest shows that you actually have SIBO, that can denote a false negative.

Case Study

And so I’ll put up on the screen in a minute here a patient’s lab results just from today that perfectly encapsulated this. But essentially, this gentleman came in with quite a bit of symptoms. He was also positive for SIBO. We treated him. He responded marvelously. Symptoms were pretty much completely gone, was feeling great. And we retested. His SIBO was positive. We decided, since this looked fishy, to wait a few weeks and retest again to see if that positive result was still found. And it was still found again.

So this gentleman, still feeling great and exhibiting none of the signs and symptoms of SIBO, came in feeling like he was a failure, he was doing something wrong, and he had this underlying problem. And he was actually very upset—excuse me—until I simply explained to him the issue of false positives.

And this is important because understanding the issue of false positives and explaining that to a patient can prevent them from thinking that something is wrong with them or they failed or they’ve done something wrong or they’ve eaten the wrong way. And it can take a lot of stress off them. And it can also prevent the clinician from needing to treat the patient again and more importantly treat the patient unnecessarily.

So to put this patient’s lab results up on the screen, here is what you see. You see there are samples 1, 2, 3, 4, 5, 6, 7, and so on. And they coincide with a time-interval-like baseline, 20 minutes, 40 minutes, 60 minutes, 80 minutes, 100 minutes, and so on. And then next to that, you see the ppm H2, which is just parts per million of hydrogen. And you also see ppm CH4, which is parts per million of methane. I’ll be referencing just the hydrogen for our conversation, the H2, because they both coincide with each other.

So when you drink the lactulose as part of this breath test, after you drink it, the lactulose works its way down your small intestine. And very little gas should be released there. But eventually when it gets into the large intestine, that’s where there’s a lot of bacteria and a lot of gas should be released. And we should see the levels elevate.

So around 100 to 120 minutes is when this transition should occur. This is why you see that black line between 7 and 8. That’s probably the latest point at which we’d expect this transition to occur. Now, that’s when we normally would see the gas levels elevate.

But in this patient, they’re elevated before that black line, which shows a positive. However, they’re only elevated kind of toward the end of this test, which could mean that that person has either a short small intestine or the lactulose is making its way through their small intestine too quickly, maybe because the lactulose is somewhat irritating to this individual’s small intestine.

So the small intestine rushes it through. It gets to the large intestine earlier than we think it should from a timing perspective. And we see this elevation of gas. So that’s what we’re seeing here. At 80 minutes and 100 minutes, we’re seeing the score of 109 and 119. But because this has happened in a patient who has for several weeks been symptom free, this is almost certainly a false positive.

So why this is important to understand is that, again, this prevents the patient from feeling like they did something wrong or there’s something wrong with them. It prevents the doctor from doing more or unnecessary treatment.

This doesn’t happen with glucose as a testing agent. So if you really wanted to verify this, you could repeat the test using glucose instead of lactulose. The patient and I today decided not to do that because really we had gotten to the clinical endpoint we were trying to get to. He was feeling much better. There wasn’t a need to do anymore testing.

This is not to say that lactulose is a bad test and can’t be used. It definitely has utility. It’s just important to understand this presentation. If someone has been treated and responded really well and their labs look like this with lactulose, meaning they’re positive but they’re only positive toward the end of the test, that’s very suggestive of a false positive.

Working With a Good Clinician

So something very important to keep in mind, and I think this may prevent some people out there that I hear about indirectly in the clinic who claim they can never get rid of SIBO. It may be because you’re not working with a good clinician. It may be because you’re using an unvalidated test like potentially a urine test. Or it may be because you’re using a test, like the lactulose breath test, that has a high incidence of false positives.

At the end of the day, it’s important to be practical and think through these issues. If you’ve seen a great improvement in your symptoms, but your labs haven’t improved, I would always trust the symptoms ahead of the labs in most cases. It’s not an absolute rule. But certainly this case supports that.

So lactulose and glucose can both be used for SIBO breath testing. But lactulose has a much higher incidence of false positives. Be on the lookout, if you’re a patient or if you’re a clinician, for this type of presentation.

The short takeaway is if you see elevations of the gas levels only toward the very end of the test in a patient that has no symptoms or their symptoms have responded very nicely, then it’s most likely a false positive.

A little bit deeper of a concept than we usually discuss, but I think this hopefully will help a lot of people. So this is Dr. Ruscio. I hope this information helps you get healthy and get back to your life. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

44 thoughts on “Do You Really Have SIBO?

  1. Hello Dr. Ruscio,
    Thanks for the great info in this article. I recently completed a SIBO hydrogen and methane breath test with lactulose. The initial values were high (H2 was 20 and CH4 was 8), then all of the following hydrogen values were 1 or 2, and all but one of the following methane values were 3 or 4. Would love to hear your opinion on if you would consider this a positive for SIBO. Listening to a podcast with Dr. Pimentel, it sounds like he would because of the initial high value of CH4.
    Thanks a bunch,
    Andrew

    1. Hi Andrew,
      My pleasure. This is definitely a gray area finding. If you have constipation it’s more suggestive of SIBO, if not it’s less. It’s important to keep in mind that SIBO test results are not the end-all-be-all regarding SIBO treatment and the context (your presentation) is very important here. Often times when labs are in this gray area I treat based upon context rather than labs. Hope this helps!

      1. Great, thanks for the reply Dr. Ruscio. This is very helpful. I do have very slow motility, which is leading me to believe it’s very likely I’m dealing with SIBO. Thanks!

  2. Hi sir, I am from india. Age 26. I am suffering these tipes of abdominal pain at right side. I went to a gestrolosist. He did a lactulose tipe of sibo test. And the interpretation is ” HBT was performed to diagnose SIBO, test became positive after 40 minute.” He suggested me some tablates these are 1. Mobeverine hydrochloride 2. Mytrip 3. Digestive anzyme syrup 4. Rifaximine & metronidazole tablet 5.Rafron 40 DSR. Sir i am taking these medicines from 2 months. My point of pain which was at lower abdominal pain now came upside of mi stomuch. Sir plz suggest me what i do? And sir plz tell me these tipe of disease can be treatable or not? If treatable than how long it’s treatment? Plzzz sir reply me..

  3. Hoping you can provide some insight-my MD has been out of the office and will not respond to my emails.
    Have had bloating after meals for about 4 yrs, symptoms worsened in past year with loose stools, stomach pain, and marked progressive food intolerances.
    Was diagnosed in October by a GI doc with hydrogen and methane SIBO. Here are my initial Lactulose breath test results:
    Baseline Hydorogen(H) :2 Methane (M): 0
    20 H:2 M:2
    40 H:2 M:2
    60 H:2 M:3
    80: H:2 M:3
    100 H:3 M:3
    120 H:9 M:3
    140 H:13 M:4
    160 H:12 M:5
    180 H: 17 M:5
    Was put on two 14 day courses of Rifaximin and Neomycin and was told to “liberalize my diet,” which I did (except for gluten) and felt terrible the entire time with worsened symptoms. I ate a lot of simple carbs and more sugar which usually I avoid.
    New symptoms included terrible burping, nausea, severe bloating, diarrhea, and a peri-anal yeast infection. Also have a fungal infection on my foot x2 yrs and intermittent angular chelitis in the corners of my mouth.
    After abx, am on strict SIBO Biphasic diet. 4 weeks later, slightly better but still have all of same symptoms. Have felt some improvement since reintroducing probiotics. Taking 0.5mg Prucalopride since stopping abx.
    Follow up breath test results 2.5 weeks post abx:
    Baseline H:2 M:6
    20 H:2 M: 8
    40 H:2 M:6
    60 H:2 M:6
    80 H:7 M:10
    100 H:7 M:11
    120 H:12 M:12
    140 H:16 M:13
    160:H:24 M:12
    180: H:21 M:12
    Does this appear to be a false positive SIBO diagnosis? How do you explain the worse gas levels on breath test on follow up? Recommended follow up tests? I suspect SIFO but MD shot me down. Any other potential diagnoses?
    I applied to be your patient but no response from your clinic yet 🙂 THANK YOU!

    1. Hi Katie,
      Your number are much but only slightly. I get the sense that SIBO might not be the primary driver here. If your going to become a patient we will tackle this together. We are short staffed at the office at the moment, but as long as you applied to become a new patient you should hear back. I will pass your email onto our office now also. Talk soon 🙂

  4. I have suffered for years with IBS. Had a SIBO breath test and was told I was positive for methane. Tried to rid myself with natural methods instead of antibiotics. My dr gave me flagyl to take for a week and wait 2 weeks and do 1 weeks of augmentin, I didn’t want to do this because I have been on numerous rounds of atb for years. During my “natural” tx, I developed diverticulitis and ended up on augmentin for that and bactrim for a UTI. Dr wants me to retest 2-3 days after coming off the atb. My test kit says wait 2 weeks. It is a lactulose test. Who is correct?

  5. Hi Dr. Ruscio,

    I’ll echo several positive comments from the various respondents to your articles and interviews…I appreciate the time commitment to share your expertise with many who suffer from SIBO – it is one of the wonderfully positive results of my journey towards health to meet or interact with selfless people like yourself.

    I recently received my lactulose breath test results (was told I have SIBO – and am scrutinizing the results)…hydrogen below 6 for the first 105 minutes then elevating to the 20s towards the 180 minute mark….yet methane was in the mid teens at basel level – was 14, with a slight rise and general fluctuations around =/- 4ish). To me this looked like negative hydrogen as the rise could be attributed to large intestine, but I’m puzzled by the immediate “teens” level value for methane…and haven’t found any tidbits in your or Dr. Siebecker, Ruscio, Pimentel, Coomes or other SIBO gurus to help me interpret that result.

    Thoughts?

    Peace and thank you.
    Mike

    1. Hi Mike,
      In short, this is negative H2 and just slightly positive for CH4. New suggested cutoff for CH4 is 10. We discuss in the podcast covering North American Consensus updates. Hope this helps!

  6. Hi Dr. Ruscio,

    I’ll echo several positive comments from the various respondents to your articles and interviews…I appreciate the time commitment to share your expertise with many who suffer from SIBO – it is one of the wonderfully positive results of my journey towards health to meet or interact with selfless people like yourself.

    I recently received my lactulose breath test results (was told I have SIBO – and am scrutinizing the results)…hydrogen below 6 for the first 105 minutes then elevating to the 20s towards the 180 minute mark….yet methane was in the mid teens at basel level – was 14, with a slight rise and general fluctuations around =/- 4ish). To me this looked like negative hydrogen as the rise could be attributed to large intestine, but I’m puzzled by the immediate “teens” level value for methane…and haven’t found any tidbits in your or Dr. Siebecker, Ruscio, Pimentel, Coomes or other SIBO gurus to help me interpret that result.

    Thoughts?

    Peace and thank you.
    Mike

    1. Hi Mike,
      In short, this is negative H2 and just slightly positive for CH4. New suggested cutoff for CH4 is 10. We discuss in the podcast covering North American Consensus updates. Hope this helps!

  7. Hi Dr. Ruscio,

    I received my test results yesterday via email and will be following up with my doctor next week. My doctor is new to SIBO testing and I would love to get your take on my results, are they positive or negative? Can you explain why my baseline Hydrogen number would be elevated? I follow the diet prep for 24 hours prior to the test and did the 12 hour fast. Thanks for much. Love your podcasts and I ordered your book, can’t wait to get it!

    8:00 – H:33 M:<2 (Baseline)
    8:20 – H:39 M:<2
    8:40 – H:16 M:<2
    9:00 – H:18 M:<2
    9:30 – H:28 M:<2
    10:00- H:69 M:2
    10:30- H:93 M:2
    11:00- H:112 M:2

    Evaluation for Hydrogen – Result 6
    Evaluation for Methane – Result 2

    Thanks,
    Kacie

    1. Hi Kacie,
      Thanks for ordering the book. These results don’t appear to indicate SIBO. However, and as I discuss in the book, there is far more that can occur in the gut than SIBO. You may in fact have dysbiosis just not dysbiosis of SIBO. The book will walk you through a protocol to sort this out. So instead of speculating over what could be happening, I would walk through that protocol step by step to find what works for you. 🙂

  8. Hi Dr Ruscio
    I have recently been tested for SIBO
    My symptoms are long term bloating and abdominal distension after meals. No diarrhea, no constipation.
    Symptoms improved with gluten and dairy free diet, but not totally. Then I tried the SCD/FODMAP diet with excellent results . Probiotics (pills) and fermented foods worsened my symptoms so I stoped taking them. I’m only doing the diet
    I tested positive for fructose malabsorption and SIBO

    This is my resulte for Lactulose breath test:
    H2 CH4
    Basal 2 13
    10 min 2 20
    20 min 2 23
    30 min 2 19
    40 min 2 19
    50 min 15 25
    60 min 16 21
    70 min 10 21
    80 min 26 32
    90 min 38 35
    100 min 38 32
    110 min 39 33
    120 min 42 34
    130 min 29 28
    140 min 36 34
    150 min 28 31
    160 min 39 39
    170 min 41 36
    180 min 40 35

    This is my result for Fructose Breath test

    H2 CH4
    Basal 1 3
    20 min 1 6
    40 min 1 4
    60 min 1 5
    80 min 3 8
    100 min 5 10
    120 min 10 14
    140min 17 16
    160min 24 17
    180min 26 15

    I’d truly appreciate your opinion.
    I have to go to see my doctor to see what he prescribes.

    Thank you very much

    1. There is a lot you could potentially do here. The challenge is how much do you need to do? diet(s), enzymes, antimicrobials, liquid diets…? The best answer I can offer you is to go through the self help protocol in book. SIBO here is minimal to moderate. This should be addressed before a fructose test in administered. So start with SIBO, as the book will walk you through. Hope this helps!

      1. Thanks Dr Ruscio for taking the time to answer. I bought your book and today I started reading it. As you say I think my symptoms are not severe, and I’m not convinced about using antibiotics. Since the test showed a mixed SIBO I’d have to use Rifaximin + Neomycin but I am scared of the possible adverse effects of neomycin. I agree with you about the fructose test, maybe it’s a false positive. I do have symptoms (bloating) when I eat fruits that are high in fructose, but I think maybe it is because of SIBO and not because of malabsorption, because I remember not having this issues when I was younger. For now I’ll continue with the Paleo Fodmap diet. I hope your book will help me find out how to cure my gut. Thank you very much

  9. Hi,

    I recently tested positive for Cyrex Array 22 for IGM antibodies to the cdtb 2 toxins and vinculin. I was negative for IGG and IGA antibodies but was in severe pain with nausea, bloating etx and had an endoscopy and colonoscopy resulting in increased IELS due to the SIBO. I just finished my second round of Xifaxan and my GI doctors don’t seem to understand the Vinculin antibodies or that my MMC may be damaged from food poisoning and refuse to prescribe me any medication to speed up the repair of my GI tract. They say only stomach emptying medicine exists but I tested negative for gastroparthesis. I am still nauseous with burning all over my torso that they believe is from irritated nerve endings. The only other finding was H Pylori which is now eradicated. If I take natural prokentics such as LDN and Motilpro with these Vinculin antibodies how long will I need to stay on them? I read such different opinions…some saying I will need to be permanently be on natural things to speed up my MMC and others saying the ICC can repair itself within 2-3 weeks. I’m so confused. I’m considering a wireless motility capsule just to see how bad my MMC may be. I had a video endoscopy as well with normal small intestinal transit of 3 1/2 hours. If you could please give me any advice regarding the antibodies and what could be causing my nausea that would be a huge help. I am struggling daily to take care of my two little girls due to the post infectious IBS. I thought I just had the stomach bug but apparently it must have been food poisoning since I have the IGM antibodies in my blood. Thank you for all your help and advice!

  10. Hey Dr. Ruscio i wanted to talk to you about whats been going on for around the past 3 or 4 months. One day out of the blue my stomach started to act up. My gas was uncontrollable and my stool was was either diarrhea with a different consistency or constipation. My stomach also gurgles at times randomly and i just all around dont feel good. I play sports and get in workouts all the time but its a short relief but i can still feel it there. I do remember before my symptoms had started i was taking diet pills that supposedly help you lose weight. Im not overweight or anything just have bad body image issues. Im starting to think that could have caused it because before my stomach never had any of these types of problems. Ive told my parents and they believe im just constipated and say that gas is normal but i know how my body works and this is far from normal. What do i do? And can you help me? Ive started to become very depressed at the fact that i dont wanna go out anymore because the smell of the gas is so bad and i cant eat anything without having a bad feeling in my stomach. Please help!

    1. HI there,

      I’m so sorry you’re dealing with this. Stomach issues can definitely make you feel like not wanting to leave the house. I would trust your body, if you think something is off, then it most likely is. I’d recommend staying away from the diet pills and picking up a copy of Dr Ruscio’s book “Healthy Gut, Healthy You” – it has a DIY protocol to help fix gut issues and get you back to normal. You can find it here: https://www.drruscio.com/getgutbook If you feel like you want more personalized guidance, you can apply to become a patient of Dr Ruscio’s (in person or online) here: https://www.drruscio.com/gethelp Good luck!

  11. Hi sir, I am from india. Age 26. I am suffering these tipes of abdominal pain at right side. I went to a gestrolosist. He did a lactulose tipe of sibo test. And the interpretation is ” HBT was performed to diagnose SIBO, test became positive after 40 minute.” He suggested me some tablates these are 1. Mobeverine hydrochloride 2. Mytrip 3. Digestive anzyme syrup 4. Rifaximine & metronidazole tablet 5.Rafron 40 DSR. Sir i am taking these medicines from 2 months. My point of pain which was at lower abdominal pain now came upside of mi stomuch. Sir plz suggest me what i do? And sir plz tell me these tipe of disease can be treatable or not? If treatable than how long it’s treatment? Plzzz sir reply me..

  12. Hoping you can provide some insight-my MD has been out of the office and will not respond to my emails.
    Have had bloating after meals for about 4 yrs, symptoms worsened in past year with loose stools, stomach pain, and marked progressive food intolerances.
    Was diagnosed in October by a GI doc with hydrogen and methane SIBO. Here are my initial Lactulose breath test results:
    Baseline Hydorogen(H) :2 Methane (M): 0
    20 H:2 M:2
    40 H:2 M:2
    60 H:2 M:3
    80: H:2 M:3
    100 H:3 M:3
    120 H:9 M:3
    140 H:13 M:4
    160 H:12 M:5
    180 H: 17 M:5
    Was put on two 14 day courses of Rifaximin and Neomycin and was told to “liberalize my diet,” which I did (except for gluten) and felt terrible the entire time with worsened symptoms. I ate a lot of simple carbs and more sugar which usually I avoid.
    New symptoms included terrible burping, nausea, severe bloating, diarrhea, and a peri-anal yeast infection. Also have a fungal infection on my foot x2 yrs and intermittent angular chelitis in the corners of my mouth.
    After abx, am on strict SIBO Biphasic diet. 4 weeks later, slightly better but still have all of same symptoms. Have felt some improvement since reintroducing probiotics. Taking 0.5mg Prucalopride since stopping abx.
    Follow up breath test results 2.5 weeks post abx:
    Baseline H:2 M:6
    20 H:2 M: 8
    40 H:2 M:6
    60 H:2 M:6
    80 H:7 M:10
    100 H:7 M:11
    120 H:12 M:12
    140 H:16 M:13
    160:H:24 M:12
    180: H:21 M:12
    Does this appear to be a false positive SIBO diagnosis? How do you explain the worse gas levels on breath test on follow up? Recommended follow up tests? I suspect SIFO but MD shot me down. Any other potential diagnoses?
    I applied to be your patient but no response from your clinic yet 🙂 THANK YOU!

    1. Hi Katie,
      Your number are much but only slightly. I get the sense that SIBO might not be the primary driver here. If your going to become a patient we will tackle this together. We are short staffed at the office at the moment, but as long as you applied to become a new patient you should hear back. I will pass your email onto our office now also. Talk soon 🙂

  13. I have suffered for years with IBS. Had a SIBO breath test and was told I was positive for methane. Tried to rid myself with natural methods instead of antibiotics. My dr gave me flagyl to take for a week and wait 2 weeks and do 1 weeks of augmentin, I didn’t want to do this because I have been on numerous rounds of atb for years. During my “natural” tx, I developed diverticulitis and ended up on augmentin for that and bactrim for a UTI. Dr wants me to retest 2-3 days after coming off the atb. My test kit says wait 2 weeks. It is a lactulose test. Who is correct?

  14. Hello Dr. Ruscio,
    Thanks for the great info in this article. I recently completed a SIBO hydrogen and methane breath test with lactulose. The initial values were high (H2 was 20 and CH4 was 8), then all of the following hydrogen values were 1 or 2, and all but one of the following methane values were 3 or 4. Would love to hear your opinion on if you would consider this a positive for SIBO. Listening to a podcast with Dr. Pimentel, it sounds like he would because of the initial high value of CH4.
    Thanks a bunch,
    Andrew

    1. Hi Andrew,
      My pleasure. This is definitely a gray area finding. If you have constipation it’s more suggestive of SIBO, if not it’s less. It’s important to keep in mind that SIBO test results are not the end-all-be-all regarding SIBO treatment and the context (your presentation) is very important here. Often times when labs are in this gray area I treat based upon context rather than labs. Hope this helps!

      1. Great, thanks for the reply Dr. Ruscio. This is very helpful. I do have very slow motility, which is leading me to believe it’s very likely I’m dealing with SIBO. Thanks!

  15. Hi Dr Ruscio
    I have recently been tested for SIBO
    My symptoms are long term bloating and abdominal distension after meals. No diarrhea, no constipation.
    Symptoms improved with gluten and dairy free diet, but not totally. Then I tried the SCD/FODMAP diet with excellent results . Probiotics (pills) and fermented foods worsened my symptoms so I stoped taking them. I’m only doing the diet
    I tested positive for fructose malabsorption and SIBO

    This is my resulte for Lactulose breath test:
    H2 CH4
    Basal 2 13
    10 min 2 20
    20 min 2 23
    30 min 2 19
    40 min 2 19
    50 min 15 25
    60 min 16 21
    70 min 10 21
    80 min 26 32
    90 min 38 35
    100 min 38 32
    110 min 39 33
    120 min 42 34
    130 min 29 28
    140 min 36 34
    150 min 28 31
    160 min 39 39
    170 min 41 36
    180 min 40 35

    This is my result for Fructose Breath test

    H2 CH4
    Basal 1 3
    20 min 1 6
    40 min 1 4
    60 min 1 5
    80 min 3 8
    100 min 5 10
    120 min 10 14
    140min 17 16
    160min 24 17
    180min 26 15

    I’d truly appreciate your opinion.
    I have to go to see my doctor to see what he prescribes.

    Thank you very much

    1. There is a lot you could potentially do here. The challenge is how much do you need to do? diet(s), enzymes, antimicrobials, liquid diets…? The best answer I can offer you is to go through the self help protocol in book. SIBO here is minimal to moderate. This should be addressed before a fructose test in administered. So start with SIBO, as the book will walk you through. Hope this helps!

      1. Thanks Dr Ruscio for taking the time to answer. I bought your book and today I started reading it. As you say I think my symptoms are not severe, and I’m not convinced about using antibiotics. Since the test showed a mixed SIBO I’d have to use Rifaximin + Neomycin but I am scared of the possible adverse effects of neomycin. I agree with you about the fructose test, maybe it’s a false positive. I do have symptoms (bloating) when I eat fruits that are high in fructose, but I think maybe it is because of SIBO and not because of malabsorption, because I remember not having this issues when I was younger. For now I’ll continue with the Paleo Fodmap diet. I hope your book will help me find out how to cure my gut. Thank you very much

  16. Hey Dr. Ruscio i wanted to talk to you about whats been going on for around the past 3 or 4 months. One day out of the blue my stomach started to act up. My gas was uncontrollable and my stool was was either diarrhea with a different consistency or constipation. My stomach also gurgles at times randomly and i just all around dont feel good. I play sports and get in workouts all the time but its a short relief but i can still feel it there. I do remember before my symptoms had started i was taking diet pills that supposedly help you lose weight. Im not overweight or anything just have bad body image issues. Im starting to think that could have caused it because before my stomach never had any of these types of problems. Ive told my parents and they believe im just constipated and say that gas is normal but i know how my body works and this is far from normal. What do i do? And can you help me? Ive started to become very depressed at the fact that i dont wanna go out anymore because the smell of the gas is so bad and i cant eat anything without having a bad feeling in my stomach. Please help!

    1. HI there,

      I’m so sorry you’re dealing with this. Stomach issues can definitely make you feel like not wanting to leave the house. I would trust your body, if you think something is off, then it most likely is. I’d recommend staying away from the diet pills and picking up a copy of Dr Ruscio’s book “Healthy Gut, Healthy You” – it has a DIY protocol to help fix gut issues and get you back to normal. You can find it here: https://www.drruscio.com/getgutbook If you feel like you want more personalized guidance, you can apply to become a patient of Dr Ruscio’s (in person or online) here: https://www.drruscio.com/gethelp Good luck!

  17. Hi Dr. Ruscio,

    I received my test results yesterday via email and will be following up with my doctor next week. My doctor is new to SIBO testing and I would love to get your take on my results, are they positive or negative? Can you explain why my baseline Hydrogen number would be elevated? I follow the diet prep for 24 hours prior to the test and did the 12 hour fast. Thanks for much. Love your podcasts and I ordered your book, can’t wait to get it!

    8:00 – H:33 M:<2 (Baseline)
    8:20 – H:39 M:<2
    8:40 – H:16 M:<2
    9:00 – H:18 M:<2
    9:30 – H:28 M:<2
    10:00- H:69 M:2
    10:30- H:93 M:2
    11:00- H:112 M:2

    Evaluation for Hydrogen – Result 6
    Evaluation for Methane – Result 2

    Thanks,
    Kacie

    1. Hi Kacie,
      Thanks for ordering the book. These results don’t appear to indicate SIBO. However, and as I discuss in the book, there is far more that can occur in the gut than SIBO. You may in fact have dysbiosis just not dysbiosis of SIBO. The book will walk you through a protocol to sort this out. So instead of speculating over what could be happening, I would walk through that protocol step by step to find what works for you. 🙂

  18. Hi,

    I recently tested positive for Cyrex Array 22 for IGM antibodies to the cdtb 2 toxins and vinculin. I was negative for IGG and IGA antibodies but was in severe pain with nausea, bloating etx and had an endoscopy and colonoscopy resulting in increased IELS due to the SIBO. I just finished my second round of Xifaxan and my GI doctors don’t seem to understand the Vinculin antibodies or that my MMC may be damaged from food poisoning and refuse to prescribe me any medication to speed up the repair of my GI tract. They say only stomach emptying medicine exists but I tested negative for gastroparthesis. I am still nauseous with burning all over my torso that they believe is from irritated nerve endings. The only other finding was H Pylori which is now eradicated. If I take natural prokentics such as LDN and Motilpro with these Vinculin antibodies how long will I need to stay on them? I read such different opinions…some saying I will need to be permanently be on natural things to speed up my MMC and others saying the ICC can repair itself within 2-3 weeks. I’m so confused. I’m considering a wireless motility capsule just to see how bad my MMC may be. I had a video endoscopy as well with normal small intestinal transit of 3 1/2 hours. If you could please give me any advice regarding the antibodies and what could be causing my nausea that would be a huge help. I am struggling daily to take care of my two little girls due to the post infectious IBS. I thought I just had the stomach bug but apparently it must have been food poisoning since I have the IGM antibodies in my blood. Thank you for all your help and advice!

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