You May Not Have SIBO Despite Your Test Results

You May Not Have SIBO Despite Your Test Results - DrR FeatureImage TBT

SIBO (small intestinal bacterial overgrowth) has become a very common condition lately, and it’s thought that many people suffering with IBS may actually have SIBO. Testing for SIBO can be a little tricky, and certain tests may have a high rate of indicating positive SIBO when the patient doesn’t actually have SIBO.


The gold standard for diagnosing SIBO is with a breath test that measures the levels of hydrogen and methane gas in your breath. Bacteria produce gases, and when there’s an overgrowth of bacteria in your small intestine, the gases can be measured through your breath.

If gas levels are above a certain number, then the test indicates a positive result for SIBO.

There are two types of SIBO breath tests based on the type of substrate that is used. Your doctor will order either a lactulose or glucose breath test. Upon taking the test, you will drink either the lactulose or glucose substrate, and then breathe into a bag every 20 minutes for three hours.

Which Version Is the Best?

The lactulose breath test is favored in the SIBO community. However, we’re now recognizing that lactulose can sometimes deliver a false positive—in other words, your test results indicate that you have SIBO when you really don’t. This happens because in some people, lactulose makes its way through the small intestine and into the large intestine very quickly.

You May Not Have SIBO Despite Your Test Results - AdobeStock80267412WEBquestionsIdeally, gas levels in the small intestine will be low, and you’ll naturally see them elevated in the large intestine where bacteria will feed on the lactulose. This would be normal and expected.

If lactulose makes its way through your small intestine too quickly and gets into the large intestine faster than expected, then you’ll get a false elevation of gas, resulting in a positive SIBO test when in fact you don’t really have SIBO.

The benefit of using lactulose is that it does travel throughout the small intestine and gives you a good indication of what’s going on in the distal portion of the small intestine. This is where SIBO typically resides.

The other option is to use the glucose breath test. Glucose does not produce the same false positive. If you get a positive result on a glucose breath test, you can feel confident that it’s an accurate positive result for SIBO. The downside is that glucose is rapidly absorbed, and it does not make its way to the end of the small intestine. If a person has SIBO in the distal portion of the small intestine, the glucose test may not catch it, and you’ll end up with a false negative.

What Does This Mean?

Let’s assume you’re a practitioner and you test a patient using the lactulose breath test. It comes back positive and you treat them. Their symptoms improve, but when you retest, their labs don’t improve. In this case, you may be seeing a false positive, and it’s likely unnecessary to continue treating them for SIBO.

This is especially important to explain to the patient or to understand if you are the patient. We’ve been noticing that many patients come to our clinic with quite a bit of fear around SIBO and with beliefs that you can’t really get rid of it. They hear of stories of people who continually treat SIBO but their test results are still positive. We don’t find this situation to be true in most cases.

For the majority of people, SIBO is something that can be overcome, but you must understand how to treat SIBO in the right way and understand how to interpret the test. Otherwise, patients can fall into a cycle of thinking they’ll never be able to treat their SIBO.

Understanding the issue of false positives and explaining it to a patient is important because it can prevent the patient from feeling like there’s still something wrong with them even though their symptoms have cleared. It also prevents the practitioner from doing unnecessary treatment.

SIBOIn summary, lactulose may over-report positive SIBO test results, while glucose may under-report. When we look at the studies, they actually favor the use of the glucose breath test. Both tests have merit. Both tests can be used. The key is to find a skilled practitioner to help you out.

Also, with lactulose, if you only see elevated gas levels at the very end of the test around 100 or 120 minutes, then that could very likely be a false positive.

With glucose, if you see positive SIBO, then that person definitely has SIBO. However, if a person tests negative for SIBO using glucose, but they have symptoms suggesting SIBO, then it could have been missed on the glucose breath test. In this case, you may want to consider a lactulose breath test or consider treating them for SIBO.

We cover this topic of testing for SIBO in even greater detail in both our video from this Monday and a recent podcast episode with Gary Stapleton, founder and CEO of Aerodiagnostic Labs.

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

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132 thoughts on “You May Not Have SIBO Despite Your Test Results

  1. Michael,

    Your work is a tremendously positive force for anyone trying to figure out the picture of what may or may not be going on in their gut. Keep it up – you are giving people lots of people hope.

    I’m still looking forward to listening to the podcast on SIFO, and separately, it would be really interesting to hear your thoughts on Atrantil, considering the attention it now seems to be attracting in the world of SIBO treatments.

    Many thanks,
    Ross

    1. Hi Ross,
      Thank you for your kind words, this sort of feedback is always nice to hear. Working on scheduling the SIFO interview now, should be a few months hopefully until it airs. We are studying Atrantil at my office now – more to come once we analyze the data 🙂

      1. Hi I trying to figure out if i SIBO. Mine is extreme. Symptoms match SIBO-C but regular dr disregards the idea. Just completed the breath test w my Nutrionist waiting on the result but I have found Antrinal has been a huge help with treating the symptoms and my suffering in the meantime. I’m sooo happy I found it.

  2. Hello Dr. Ruscio,
    Thanks for all the great info you provide regarding SIBO. It has been very helpful for me through this journey.
    I’d like to hear your opinion on a lactulose breath test I recently completed. 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. I also had a very negative reaction to the lactulose (diarrhea f0r 2-3 days and other digestive and cognitive symptoms for a week). Listening to a podcast with Dr. Pimentel, it sounds like he would consider it a positive because of the initial high value of CH4. I also have many symptoms of SIBO – chronic constipation, inability to digest many carbs and sugars, and very impaired cognition and fatigue.
    Thanks a bunch,
    Andrew

  3. Hello Dr. Ruscio,
    I have been diagnosed with h-pylori. Long story short, I had a long list of strange symptoms throughout my body that all started after finding the h-pylori. I wasn’t able to take the antibiotics and I have tried treating naturally with an ND. My ND also suspected sibo which I tested positive for. My question is can h-pylori cause a false positive in a sibo test? I had a high baseline with the lactulose test and it peaked at 95 hydrogen 7 methane at 120 but was pretty high throughout. I’m just wondering if the h-pylori bacteria can cause these results? After treating sibo I still have many symptoms but they also overlap with h-pylori symptoms which is making me wonder if it’s just been h-pylori all along. Thanks in advance, Rebekah

  4. Hello Dr. Ruscio,
    I have been diagnosed with h-pylori. Long story short, I had a long list of strange symptoms throughout my body that all started after finding the h-pylori. I wasn’t able to take the antibiotics and I have tried treating naturally with an ND. My ND also suspected sibo which I tested positive for. My question is can h-pylori cause a false positive in a sibo test? I had a high baseline with the lactulose test and it peaked at 95 hydrogen 7 methane at 120 but was pretty high throughout. I’m just wondering if the h-pylori bacteria can cause these results? After treating sibo I still have many symptoms but they also overlap with h-pylori symptoms which is making me wonder if it’s just been h-pylori all along. Thanks in advance, Rebekah

  5. I did the lactulose breath test in 2013 and it said I wasn’t positive for SIBO. I was put on Rifaxmin anyway because my symptoms are similar to those of someone with IBS-D and it didn’t help except to give me diarrhea. I did the IBSCheck blood test and it came back positive for the antibodies. I’ve done one round of Dr. Jacobi’s natural treatment plan for SIBO with the B-Phasic diet and still have IBS-D symptoms. How do you advise a patient when their breath test was negative but they have a positive blood antibodies? I’ve tried Lion’s Mane and Actyl-L Carntine for nerve regeneration. Would love to learn more about how to heal the gut nerves.

    My nervous system has become compromised through this as I’m more sensitive than I was before these events. My pelvic floor muscles are on heightened alert which is not helping me stay in parasympathetic dominance. Any guidance is welcome.

  6. I did the lactulose breath test in 2013 and it said I wasn’t positive for SIBO. I was put on Rifaxmin anyway because my symptoms are similar to those of someone with IBS-D and it didn’t help except to give me diarrhea. I did the IBSCheck blood test and it came back positive for the antibodies. I’ve done one round of Dr. Jacobi’s natural treatment plan for SIBO with the B-Phasic diet and still have IBS-D symptoms. How do you advise a patient when their breath test was negative but they have a positive blood antibodies? I’ve tried Lion’s Mane and Actyl-L Carntine for nerve regeneration. Would love to learn more about how to heal the gut nerves.

    My nervous system has become compromised through this as I’m more sensitive than I was before these events. My pelvic floor muscles are on heightened alert which is not helping me stay in parasympathetic dominance. Any guidance is welcome.

  7. Hi DR. I will have my test tomorrow . But I’m worried that maybe gonna give me false positive results just because they want to take my money for treatment . How I can get to your clinic because I live in London . I need your help . Thanks
    Afshin

  8. I recently had the SIBO breath test. None of the specimens came back positive but my other tests indicated that I had inflammation in the intestines and my naturopath thought I could still have it.

    Is it common to get a false negative test?

  9. Hello, my question is for my 12 year old son. We have been low fod map for about 9 months and low Fructose for 2 months. We are one year into this journey. He has had a positive Fructose Breath Test reaching 109 at the 90 min mark for hydrogen. We then did a Glucose breath test and it was negative. My dr doesn’t think we need to do a Lactulose breath test. I would like to just to completely rule out SIBO. He is doing better and as long as we stay low Fructose/fructans he is mostly symptom free. I’m wondering how hard i should push for a LBT. It seems most Fructmal people have SIBO as well. What do you think? Should I push for the test?

    1. Monica,
      I don’t think its a bad idea, especially consider the North American expert consensus is that SIBO should be ruled out before fructose testing. Feel free to contact my clinic if you need help.

  10. Hi! I did my test a while back and the numbers only start to spike at 160-180mins with H2 109 and 94. Is that a indication of false positive? My natural path diagnosed me with Hydrogen SIBO after 2 months of herbal treatment and 11 days of elemental diet I still have the same bloating and pain on my right abdomin. Please advice! Should I get another test?Thanks Dr Ruscio!

    1. Sara,
      Elevations at 160 does not indicate SIBO. You may still require treatment of your gut to improve your symptoms however. Testing may or may not help, its hard to say. If you get stuck either contact my office or go through the protocol in my book.
      Hope this helps!

  11. Dr. Ruscio,

    I love your work – thank you for actually taking the time to comb through research and clinical studies. I have hydrogen dominant SIBO and have been treating over the last 8 months with both herbs and Xifaxan. I experienced symptomatic relief after the first round of Xifaxan, but the follow up breath test actually showed an increase in PPM after treatment (peak of 130 on first test, and 160 on second test after being treated). I’ve always felt that I have fast motility and a small bowel series indicated that as well. Could this be a false positive? I’ve also had issues taking prokinetics and was curious on your thoughts about them for patients with SIBO-D or hypermotility. Thank you!

    1. Thanks JH,
      It could be a false+, using a cutoff time of 80 or 90 minutes would reduce this risk of this. If you have rapid SI transit then a prokinetic might not be indicated. Also, remember to consider your symptoms over your lab test results, ‘treat the patient no the labs’.

  12. Hi Ruscio, is it possible to have a positive sibo test but not have symptoms caused by sibo? I tested positive but my peak wasn’t that high 26ppm hydrogen and 7ppm methane. I been treating it very aggressively with abx and elemental diet but yet I have zero symptoms improvement. Feels same before and after treatment. I do have some symptoms pointing to sibo like gas, belching, nausea and heartburn, loose stools but no diarrhea and no bloating. I have Gastritis as well. So I may think some of my symptoms are from gastritis. So I wonder if it is possible to not have symptoms even with a low positive sibo score?

  13. Hi Ruscio, is it possible to have a positive sibo test but not have symptoms caused by sibo? I tested positive but my peak wasn’t that high 26ppm hydrogen and 7ppm methane. I been treating it very aggressively with abx and elemental diet but yet I have zero symptoms improvement. Feels same before and after treatment. I do have some symptoms pointing to sibo like gas, belching, nausea and heartburn, loose stools but no diarrhea and no bloating. I have Gastritis as well. So I may think some of my symptoms are from gastritis. So I wonder if it is possible to not have symptoms even with a low positive sibo score?

  14. I was treated for H Pylori at the beginning of the year and finally convinced my doctor to do a Breath Test to rule out SIBO after seeing no results on H Pylori treatment. My results are below and I was treated with rifaximin. I felt a little better for 3 weeks and now back to the same symptoms. My doctor is now prescribing to try augmentin .
    One person on a SIBO group suggested I might have a glucose/fructose malobsorption with my hydrogen levels being so elevated after 180 minutes of testing. Any thoughts?
    I did a glucose breath test – see results below:

    20 min: Hydrogen 9 Methane 17
    40 min: Hydrogen 27 Methane 15
    60 min: Hydrogen 51 Methane 15
    80 min: Hydrogen 55 Methane 17
    100 min: Hydrogen 75 Methane 19
    120 min: Hydrogen 89 Methane 20
    140 min: Hydrogen 91 Methane 20
    160 min: Hydrogen 77 Methane 18
    180 min: Hydrogen 108 Methane 20

  15. Dr. Rusico,
    Do you think i have SIBO or have you ever treated anyone in my situation? I tested high methane but also have constant diarrhea. I am wondering if this does happen and the best treatment or if something else could be giving false positive? any advice appreciated. I have severe diarrhea, gas, bloat, brain fog, fatigue & insomnia. and now dry skin, hair loss and weight loss.
    Base. Hydrogen 3 Methane 35
    20 min: Hydrogen 1 Methane 36
    40 min: Hydrogen 3 Methane 55
    60 min: Hydrogen 3 Methane 48
    80 min: Hydrogen 3Methane 96
    100 min: Hydrogen 1 Methane 60
    120 min: Hydrogen 3 Methane 80
    140 min: Hydrogen 2 Methane 89
    160 min: Hydrogen 3 Methane 74
    180 min: Hydrogen 1Methane 52

  16. Dr. Rusico,
    Do you think i have SIBO or have you ever treated anyone in my situation? I tested high methane but also have constant diarrhea. I am wondering if this does happen and the best treatment or if something else could be giving false positive? any advice appreciated. I have severe diarrhea, gas, bloat, brain fog, fatigue & insomnia. and now dry skin, hair loss and weight loss.
    Base. Hydrogen 3 Methane 35
    20 min: Hydrogen 1 Methane 36
    40 min: Hydrogen 3 Methane 55
    60 min: Hydrogen 3 Methane 48
    80 min: Hydrogen 3Methane 96
    100 min: Hydrogen 1 Methane 60
    120 min: Hydrogen 3 Methane 80
    140 min: Hydrogen 2 Methane 89
    160 min: Hydrogen 3 Methane 74
    180 min: Hydrogen 1Methane 52

  17. Dear Dr. Rusico,

    I really hope you can help. My 13 year old has been unwell with abdominal pains since June. He has recently had a hydrogen breath test using lactulose and the results are as follows:

    Base 4 ppm
    30 mins 3 ppm
    60 mins 18 ppm
    90 mins 69 ppm
    120 mins 68 ppm
    150 mins 150 ppm
    180 mins 147 ppm
    210 mins 154 ppm
    240 mins 149 ppm

    His current gastroenterologist diagnosed SIBO and prescribed two weeks of antibiotics, which have made little if no difference.

    Seeking a second opinion, we contacted another gastroenterologist who has said the results are completely normal and he doesnt have SIBO.

    It would be great to know your opinion and also why two very experienced gastros could have such different opinions?

    1. Unfortunately there isn’t a standardized way of interpreting results, so overdiagnosis does occur.

      You may want to check out Dr. Ruscio’s book, “Healthy Gut, Healthy You”, which walks you through a very comprehensive protocol that he uses in his clinic to help with tough gut issues. https://drruscio.com/getgutbook/

      Good luck!

  18. Dear Dr. Rusico,

    I really hope you can help. My 13 year old has been unwell with abdominal pains since June. He has recently had a hydrogen breath test using lactulose and the results are as follows:

    Base 4 ppm
    30 mins 3 ppm
    60 mins 18 ppm
    90 mins 69 ppm
    120 mins 68 ppm
    150 mins 150 ppm
    180 mins 147 ppm
    210 mins 154 ppm
    240 mins 149 ppm

    His current gastroenterologist diagnosed SIBO and prescribed two weeks of antibiotics, which have made little if no difference.

    Seeking a second opinion, we contacted another gastroenterologist who has said the results are completely normal and he doesnt have SIBO.

    It would be great to know your opinion and also why two very experienced gastros could have such different opinions?

    1. Unfortunately there isn’t a standardized way of interpreting results, so overdiagnosis does occur.

      You may want to check out Dr. Ruscio’s book, “Healthy Gut, Healthy You”, which walks you through a very comprehensive protocol that he uses in his clinic to help with tough gut issues. https://drruscio.com/getgutbook/

      Good luck!

  19. Just got my SIBO results and my head is spinning. Your website is great!

    I received Lactulase.

    80m after baseline= 5ppm hydrogen | 5ppm methane
    120m= 47ppm | 18ppm
    160m= 2ppm | 0ppm
    180m= 64ppm | 21 ppm

    I’ve got IBS-D, and burping after I ingest anything (my whole life).

    Is this a straight forward case of hydrogen SIBO or should i push to be retested with glucose?

    1. Hi Anar,
      I would save you money on testing and instead go through the self-help program in my book. It will walk you through the treatments that can help to heal your gut and reduce your symptoms.

  20. Dear Dr. Ruscio

    I feel like I have had something wrong in my gut for many years but was always diagnosed with IBS. I am now 57 years old and symptoms (loss of appetite, energy, weight loss etc. have become chronic with no real relieve. Sibo test showed:

    Baseline
    Hydrogen 4. Methane 3
    20 minutes. 7. 8
    40 minutes. 51. 14
    60 minutes. 41. 15
    80 minutes. 58. 18
    100 minutes. 64. 18
    120 minutes. 61. 16
    140 minutes. 47. 10
    160 minutes. 54. 16
    180 minutes. 55. 12

    I no not have any pain, constpation or diarrhea…. just the symptoms noted above. Is this normal for SIBO? I am currently on day 5 of Xifaxan at 550 mg twice a day with no improvement yet. T
    Any thoughts are appreciated… could I have a false positive because I don’t have C or D? Thanks!

    1. Hello Tom , I have the same symptoms exact , did you find any help with this at all? I don’t have any stomache issue , but all the symptoms you mentioned and positive on methane and hydrogen .

  21. Dear Dr. Ruscio

    I feel like I have had something wrong in my gut for many years but was always diagnosed with IBS. I am now 57 years old and symptoms (loss of appetite, energy, weight loss etc. have become chronic with no real relieve. Sibo test showed:

    Baseline
    Hydrogen 4. Methane 3
    20 minutes. 7. 8
    40 minutes. 51. 14
    60 minutes. 41. 15
    80 minutes. 58. 18
    100 minutes. 64. 18
    120 minutes. 61. 16
    140 minutes. 47. 10
    160 minutes. 54. 16
    180 minutes. 55. 12

    I no not have any pain, constpation or diarrhea…. just the symptoms noted above. Is this normal for SIBO? I am currently on day 5 of Xifaxan at 550 mg twice a day with no improvement yet. T
    Any thoughts are appreciated… could I have a false positive because I don’t have C or D? Thanks!

    1. Hello Tom , I have the same symptoms exact , did you find any help with this at all? I don’t have any stomache issue , but all the symptoms you mentioned and positive on methane and hydrogen .

  22. I am wondering if I have SIBO. I’ve currently been treating a Candida infection with diflucan. This has worked in the past for me when I’ve experienced distressing digestive symptoms such as, extreme bloating and belching . I’ve been on diflucan and for whatever reason this time it’s notnreleuveing my symptoms. It sounds like SIBO has alot of the same symptoms and I’m wondering if this could be my issue and not the Candida. I have been following fodmap diet and I’m still having symptoms . I’ve been tested for celiac and IBS and both were negative . I’m losing weight because of difficulty of eating. I’m at a loss and feel miserable. Any advice ?

    1. Hi Crystal,
      There is a quick ‘try this’ I would recommend. But my book will walk you through a step by step guide for improving your gut health. So I would grab a copy and go through the personalized self-help plan.

  23. I am wondering if I have SIBO. I’ve currently been treating a Candida infection with diflucan. This has worked in the past for me when I’ve experienced distressing digestive symptoms such as, extreme bloating and belching . I’ve been on diflucan and for whatever reason this time it’s notnreleuveing my symptoms. It sounds like SIBO has alot of the same symptoms and I’m wondering if this could be my issue and not the Candida. I have been following fodmap diet and I’m still having symptoms . I’ve been tested for celiac and IBS and both were negative . I’m losing weight because of difficulty of eating. I’m at a loss and feel miserable. Any advice ?

    1. Hi Crystal,
      There is a quick ‘try this’ I would recommend. But my book will walk you through a step by step guide for improving your gut health. So I would grab a copy and go through the personalized self-help plan.

  24. Thank you for writing this! I have been doing herbal treatments for SIBO/candida for several months, but my symptoms were more consistent with a fungal infection. Excess throat mucous was the worst symptom, along with some mild joint pain, but I’ve never had abdominal pain, diarrhea or constipation. My symptoms are all but gone, but my test came back as follows for SIBO.
    Base H1, M1
    20-2, 0
    40-2, 1
    60-34, 4
    80-35, 3
    100-59, 5
    120-40, 4
    140-44, 4
    160-43, 5
    180-31, 4
    How long should I be symptom free before I can assume a false positive? Is this even a positive? I’m struggling to trust my naturopath, and was hoping to get your thoughts. Thanks in advance!

    1. Hi Breanna,
      I wouldn’t be overly focused on test results. Use how you feel as the primary barometer. Your results looks mild and I might not treat a patient with similar results if they were feeling well. Give you body some time and see; if you are feeling better, don’t treat. But, if you are feeling like your not all the way there, treat again. My book will walk you through this process, its a common concern.

      1. Dr. Ruscio,

        Thank you for your response! I appreciate your feedback, as it is helpful to have a second opinion on test results as my Dr definitely tends to lean the other direction in assuming any positive is a major issue. I will keep track of any symptoms so I can be as informed as possible at my next appointment. I plan to order your book after the first of the month, so as to be able to treat any future symptoms with more confidence!

  25. Thank you for writing this! I have been doing herbal treatments for SIBO/candida for several months, but my symptoms were more consistent with a fungal infection. Excess throat mucous was the worst symptom, along with some mild joint pain, but I’ve never had abdominal pain, diarrhea or constipation. My symptoms are all but gone, but my test came back as follows for SIBO.
    Base H1, M1
    20-2, 0
    40-2, 1
    60-34, 4
    80-35, 3
    100-59, 5
    120-40, 4
    140-44, 4
    160-43, 5
    180-31, 4
    How long should I be symptom free before I can assume a false positive? Is this even a positive? I’m struggling to trust my naturopath, and was hoping to get your thoughts. Thanks in advance!

    1. Hi Breanna,
      I wouldn’t be overly focused on test results. Use how you feel as the primary barometer. Your results looks mild and I might not treat a patient with similar results if they were feeling well. Give you body some time and see; if you are feeling better, don’t treat. But, if you are feeling like your not all the way there, treat again. My book will walk you through this process, its a common concern.

      1. Dr. Ruscio,

        Thank you for your response! I appreciate your feedback, as it is helpful to have a second opinion on test results as my Dr definitely tends to lean the other direction in assuming any positive is a major issue. I will keep track of any symptoms so I can be as informed as possible at my next appointment. I plan to order your book after the first of the month, so as to be able to treat any future symptoms with more confidence!

  26. Dr. Ruscio,

    Really enjoy your site. I have been dealing with gut issues all my life, but not a medicine taker so I have never taken any PPI’s or even over the counter antacids. Chronic throat clearing, grumbling stomach, abdominal pain, loose stools, etc. The only time it seemed to clear up was when I would take an antibiotic for something else through the years. Always wondered about that but never put 2 and 2 together. I eat very good and take natural supplements, dig enzymes, and probiotics…along with working out twice a day. Recently was tested for SIBO (lactulose) though as they have always just put my symptoms off as IBS. Sibo said positive but my results are unlike any I’ve found on the internet.

    Here they are:

    Hydrogen: Baseline: 0 – 15 min: 10 – 30 min: 28 – 45 min and beyond all 0’s. (said the 28 ppm over baseline was positive)

    Methane: Baseline 0 – ALL 0’s.

    My questions are is this minor bump really SIBO? And is it normal to have so many 0 readings especially all methane 0’s? And why does my colon readings stay at 0 as that seems odd based on many other results I’ve seen?

    Thank you and wish I was closer to you.

    1. Hey William,
      This is technically SIBO, but a very mild case that may not require treatment. Food allergies, H. Pylori and histamine intolerance are things to consider here. My book will provide more guidance on specifics of how to address these. Hope this helps!

  27. Dr. Ruscio,

    Really enjoy your site. I have been dealing with gut issues all my life, but not a medicine taker so I have never taken any PPI’s or even over the counter antacids. Chronic throat clearing, grumbling stomach, abdominal pain, loose stools, etc. The only time it seemed to clear up was when I would take an antibiotic for something else through the years. Always wondered about that but never put 2 and 2 together. I eat very good and take natural supplements, dig enzymes, and probiotics…along with working out twice a day. Recently was tested for SIBO (lactulose) though as they have always just put my symptoms off as IBS. Sibo said positive but my results are unlike any I’ve found on the internet.

    Here they are:

    Hydrogen: Baseline: 0 – 15 min: 10 – 30 min: 28 – 45 min and beyond all 0’s. (said the 28 ppm over baseline was positive)

    Methane: Baseline 0 – ALL 0’s.

    My questions are is this minor bump really SIBO? And is it normal to have so many 0 readings especially all methane 0’s? And why does my colon readings stay at 0 as that seems odd based on many other results I’ve seen?

    Thank you and wish I was closer to you.

    1. Hey William,
      This is technically SIBO, but a very mild case that may not require treatment. Food allergies, H. Pylori and histamine intolerance are things to consider here. My book will provide more guidance on specifics of how to address these. Hope this helps!

  28. Dr Ruscio,
    Hi! Thank you for your informative article!
    I have been having huge abd bloating and abd pain that started suddenly 2 years ago, bowels completely normal and regular. I recently had a lactulose breath test and it was positive for hydrogen/methane but no elevation until 120minutes. Peak hydrogen 94, methane 23.
    I have already had a course of rifaxin TID x3wks amd flagyl TID x3wks and nothing changed, it was like I hadn’t taken anything at all. I am now on the elemental diet for 15 days as a last ditch effort. I am 7 days in and every time I drink a cup of the elemental my stomach gets huge just as if I’d eaten a meal, how can this be if I am not feeding the bacteria??
    Do you suppose there is something else going on and my sibo test showed a false positive?
    It begins to get huge with any food that I eat and it starts in the first 2 bites of food- is that typical o sibo?? It wouldn’t have even reached the small intestines yet.
    So confused! Any insight would be awesome!

    1. Hi Zoe,
      It’s hard to say, testing only gives us a fraction of the picture. Some of this should like a food intolerance reaction, or potentially gastritis. I would check in with your doctor and consider the protocol in Healthy Gut, Healthy You which might help you apply the available therapies most efficiently.

  29. Dear Dr. Ruscio,

    I had very regular bowel movements for over 15 years and then started to have severe constipation. I did a Genova GI Effects Stool Profile Test in Feb that showed high m.smithii and high fecal fat in my large intestines. We assumed Methane SIBO and I took Antril for a month with no good results (but loud lion-like burping). In April, I did a 3 hour lactulose Genova SIBO test that showed CH4 methane >81 for each reading including the baseline. I found one article that said that a flatline for methane may indicate I have IBS-C and not SIBO. Other articles say it means I have SIBO.

    I am perplexed because I have chronic constipation but NO OTHER SYMPTOMS or digestive issues (I do NOT have bloating, pain, odor, candida, acid reflex, h. pylori, klebsiella, parasites, weight gain; never taken proton pump inhibitors.) I just have chronic constipation and a positive SIBO test. I had a swollen read eyelid last fall but that disappeared.

    I love your article and hope you look forward to your insight.

    1. Hi Marry,
      I would start with the Healthy Gut, Healthy You protocol – this could be very helpful.
      Next, and only if you need additional help after the book, read my two posts on constipation. Use homepage search box.

      1. Thank you Dr Ruscio! I have the book and will read it and follow the protocol. I also listened to appreciated your interview with Dr. Perlmutter. The other part of my question was: Does a 3 hour lactulose SIBO test that showed methane >81 for every reading, including the baseline, indicate that I have SIBO? I know I have a bacterial overgrowth. But I don’t know if it is just in my large intestines or also in my small intestines. Thank you!

          1. I also was flatline CH4 for my entire SIBO test, I am primarily IBD-d and my entire life is suffering. Although everything I read about methane dominance is that I should have constipation. My H2 was a result of 7. I started Xifaxan and Neomycin combo but could not tolerate as I had horrible, horrible, diarrhea. I kept on the Xifaxan and begin a SCD tomorrow. I don’t know where to go from here but I will be looking for your book tonight and the podcast during my commutes. Thank You!

  30. What is name of your book and where can I get it ?
    I had my SIBO test a few days ago .
    I was given glucose and breathing into a gastrolyzer.
    My baseline was 14
    Then after an hour of drink glucose
    12
    10
    6
    4
    6
    4
    4
    I can read so o don’t know if I have sibo or not .
    I been in low fodmap diet and feel better but lost 90 pounds . I get gassy at night sometimes.
    I am a little constipated have to push a lot and sometimes I suddenly get a watery movement.
    I started get getting a year ago in June and developed a frcal impact , gastritis with lot of nausea and frequent bowel movements .
    After the removal of my frcal impact.

  31. What is name of your book and where can I get it ?
    I had my SIBO test a few days ago .
    I was given glucose and breathing into a gastrolyzer.
    My baseline was 14
    Then after an hour of drink glucose
    12
    10
    6
    4
    6
    4
    4
    I can read so o don’t know if I have sibo or not .
    I been in low fodmap diet and feel better but lost 90 pounds . I get gassy at night sometimes.
    I am a little constipated have to push a lot and sometimes I suddenly get a watery movement.
    I started get getting a year ago in June and developed a frcal impact , gastritis with lot of nausea and frequent bowel movements .
    After the removal of my frcal impact.

  32. HEre is a copy of my laculose breath test Can you tell me what it all means? My troubling symptom is INTESNSE near constant pressure in my diaphragm area and severe bloating even when I don’t eat or eat appropriate foods. I have no gas symptoms, I have been told this is inflammation of the intestines by bacteria and causing water bloat- but I cannot get rid of it yet. I Am currently trying herbal protocol for sibo but don’t know if this is what is even wrong with me! I have good bowel movements daily. The pressure in my upper abdomen is so intesnea nd so is the bloat. I had an abdominal ultrasound which came bac begative PPMH2 said ( each # is every 15 minutes): baseline 0 then 3 7 29 50 69 78 77 77 PPMCH4 said baseline 2 then 3 6 12 15 16 17 17 18 CO2F said baseline 3.8/1.60 then 3.8/1.60 4.1/1.48 3.6/1.69 3.3/1.84 3.8/1.60 3.5/1.74 3.5/1.74 3.3/1.84

    1. Hi Kate,

      So sorry to hear you’re dealing with these symptoms. Your results need to be interpreted by a qualified practitioner. If you’d like to become a patient of Dr. Ruscio’s, you can apply to do so here: https://drruscio.com/gethelp

      I would also recommend checking out his book “healthy gut, healthy you”, which is a self-help guide he wrote detailing the exact process he takes patients through in his clinic. https://drruscio.com/getgutbook/

      Good luck!

  33. HEre is a copy of my laculose breath test Can you tell me what it all means? My troubling symptom is INTESNSE near constant pressure in my diaphragm area and severe bloating even when I don’t eat or eat appropriate foods. I have no gas symptoms, I have been told this is inflammation of the intestines by bacteria and causing water bloat- but I cannot get rid of it yet. I Am currently trying herbal protocol for sibo but don’t know if this is what is even wrong with me! I have good bowel movements daily. The pressure in my upper abdomen is so intesnea nd so is the bloat. I had an abdominal ultrasound which came bac begative PPMH2 said ( each # is every 15 minutes): baseline 0 then 3 7 29 50 69 78 77 77 PPMCH4 said baseline 2 then 3 6 12 15 16 17 17 18 CO2F said baseline 3.8/1.60 then 3.8/1.60 4.1/1.48 3.6/1.69 3.3/1.84 3.8/1.60 3.5/1.74 3.5/1.74 3.3/1.84\

    1. Hi Kate,

      So sorry to hear you’re dealing with these symptoms. Your results need to be interpreted by a qualified practitioner. If you’d like to become a patient of Dr. Ruscio’s, you can apply to do so here: https://drruscio.com/gethelp

      I would also recommend checking out his book “healthy gut, healthy you”, which is a self-help guide he wrote detailing the exact process he takes patients through in his clinic. https://drruscio.com/getgutbook/

      Good luck!

  34. I’ve just completed the three hour breath test, having followed a two day prep diet and then 12-hour fast. I felt very nauseous (a very rare thing) before the test, before the lactulose. I vomited part way through drinking the lactulose, drank the rest, then vomited again 6 minutes prior to sample #3. My stomach was calm for the remainder of the test.

    I recorded this on the form and will speak with my doctor, but would love to have your opinion on the potential effect on the validity of the results.

    1. Hi Dana,

      Not sure which test you took, but according to the Commonwealth Diagnostics International website: “If the event was within 15-30 minutes after consuming the substrate, the test needs to be repeated. If the event was more than 30 minutes after consuming the substrate, the test can be continued as normal.”

      Hope this helps!

  35. I’ve just completed the three hour breath test, having followed a two day prep diet and then 12-hour fast. I felt very nauseous (a very rare thing) before the test, before the lactulose. I vomited part way through drinking the lactulose, drank the rest, then vomited again 6 minutes prior to sample #3. My stomach was calm for the remainder of the test.

    I recorded this on the form and will speak with my doctor, but would love to have your opinion on the potential effect on the validity of the results.

    1. Hi Dana,

      Not sure which test you took, but according to the Commonwealth Diagnostics International website: “If the event was within 15-30 minutes after consuming the substrate, the test needs to be repeated. If the event was more than 30 minutes after consuming the substrate, the test can be continued as normal.”

      Hope this helps!

  36. Hi,
    I was wondering if you’ve ever seen when SIBO test numbers all come back zeroes. The lab is saying that it is not a faulty test, but I am suspicious.
    Thank you,
    Gala

  37. Hi,
    I was wondering if you’ve ever seen when SIBO test numbers all come back zeroes. The lab is saying that it is not a faulty test, but I am suspicious.
    Thank you,
    Gala

  38. Hi Doc! my name is Ricardo. I’m had been suffering for Sibo in the past and for the past 2 months I had been dealing with gases, bloathing and a weird sensation that I have sometime stock in my throat. So I did the lactulose Sibo test and it came back negative. Prior to that I did 2 weeks of elemental diet and the symptoms stays the same. So the question is could SIFO gives almost the same symptoms as SiBo do and also gives you a false lactulose breath test for SiBO???

  39. Hi Doc! my name is Ricardo. I’m had been suffering for Sibo in the past and for the past 2 months I had been dealing with gases, bloathing and a weird sensation that I have sometime stock in my throat. So I did the lactulose Sibo test and it came back negative. Prior to that I did 2 weeks of elemental diet and the symptoms stays the same. So the question is could SIFO gives almost the same symptoms as SiBo do and also gives you a false lactulose breath test for SiBO???

  40. I found this article very interesting. My daughter did the Lactulose breath test and as told she was positive for Methane. She did a few weeks of Low FODMAP before getting results and 4 weeks of herbals and SIBO specific diet (following gluten free/dairy free the entire time) and had no results. Her Methane level was 12 (just over the limit of 10 given) and she peaked at 120 minutes. During the rest of the time she was anywhere from a 3-6. Now I wonder if she really even has SIBO.

  41. Hi Dr Ruscio,

    Thank you so much for the helpful article and resources you offer. I’m learning a lot just by reading the comments. I took the sibo breath test a few months ago and they came back positive with the lactulose. Although, I am suspicious after reading this because the lactulose gave me practically instant diahrrea, which continued throughout the test. Is this a sign that the lactulose moved through my small intestine too quickly resulting in a false positive?

    Thanks

    Sara

  42. Hi Dr Ruscio,

    Thank you so much for the helpful article and resources you offer. I’m learning a lot just by reading the comments. I took the sibo breath test a few months ago and they came back positive with the lactulose. Although, I am suspicious after reading this because the lactulose gave me practically instant diahrrea, which continued throughout the test. Is this a sign that the lactulose moved through my small intestine too quickly resulting in a false positive?

    Thanks

    Sara

  43. I recently tested positive for SIBO . My results were as follows for ppmh2
    Time. Ppmh2
    0. 6
    20. 6
    40. 9
    60. 14
    80. 24
    100. 43
    120. 76
    140. 71
    160. 88
    180. 105.
    Could this be a false positive or does it read right
    Thankyou for looking at this

    1. Hi Susan,

      Unfortunately, we can’t offer personalized advice or diagnosis on this forum. I would say not to get too wrapped up in what the test results show, how you feel is most important. And make sure you’re working with a practioner who is experienced in this sort of thing. You may also want to pick up a copy of Dr Ruscio’s book “Healthy Gut, Healthy You”, which lays out the exact protocol he uses in his clinic to help patients overcome tough gut issues (including SIBO). You can find it here: https://www.drruscio.com/getgutbook

      Good luck!

  44. Michael,

    Your work is a tremendously positive force for anyone trying to figure out the picture of what may or may not be going on in their gut. Keep it up – you are giving people lots of people hope.

    I’m still looking forward to listening to the podcast on SIFO, and separately, it would be really interesting to hear your thoughts on Atrantil, considering the attention it now seems to be attracting in the world of SIBO treatments.

    Many thanks,
    Ross

    1. Hi Ross,
      Thank you for your kind words, this sort of feedback is always nice to hear. Working on scheduling the SIFO interview now, should be a few months hopefully until it airs. We are studying Atrantil at my office now – more to come once we analyze the data 🙂

      1. Hi I trying to figure out if i SIBO. Mine is extreme. Symptoms match SIBO-C but regular dr disregards the idea. Just completed the breath test w my Nutrionist waiting on the result but I have found Antrinal has been a huge help with treating the symptoms and my suffering in the meantime. I’m sooo happy I found it.

  45. Hello Dr. Ruscio,
    Thanks for all the great info you provide regarding SIBO. It has been very helpful for me through this journey.
    I’d like to hear your opinion on a lactulose breath test I recently completed. 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. I also had a very negative reaction to the lactulose (diarrhea f0r 2-3 days and other digestive and cognitive symptoms for a week). Listening to a podcast with Dr. Pimentel, it sounds like he would consider it a positive because of the initial high value of CH4. I also have many symptoms of SIBO – chronic constipation, inability to digest many carbs and sugars, and very impaired cognition and fatigue.
    Thanks a bunch,
    Andrew

  46. Hi! I did my test a while back and the numbers only start to spike at 160-180mins with H2 109 and 94. Is that a indication of false positive? My natural path diagnosed me with Hydrogen SIBO after 2 months of herbal treatment and 11 days of elemental diet I still have the same bloating and pain on my right abdomin. Please advice! Should I get another test?Thanks Dr Ruscio!

    1. Sara,
      Elevations at 160 does not indicate SIBO. You may still require treatment of your gut to improve your symptoms however. Testing may or may not help, its hard to say. If you get stuck either contact my office or go through the protocol in my book.
      Hope this helps!

  47. Hi DR. I will have my test tomorrow . But I’m worried that maybe gonna give me false positive results just because they want to take my money for treatment . How I can get to your clinic because I live in London . I need your help . Thanks
    Afshin

  48. Dr. Ruscio,

    I love your work – thank you for actually taking the time to comb through research and clinical studies. I have hydrogen dominant SIBO and have been treating over the last 8 months with both herbs and Xifaxan. I experienced symptomatic relief after the first round of Xifaxan, but the follow up breath test actually showed an increase in PPM after treatment (peak of 130 on first test, and 160 on second test after being treated). I’ve always felt that I have fast motility and a small bowel series indicated that as well. Could this be a false positive? I’ve also had issues taking prokinetics and was curious on your thoughts about them for patients with SIBO-D or hypermotility. Thank you!

    1. Thanks JH,
      It could be a false+, using a cutoff time of 80 or 90 minutes would reduce this risk of this. If you have rapid SI transit then a prokinetic might not be indicated. Also, remember to consider your symptoms over your lab test results, ‘treat the patient no the labs’.

  49. Hello, my question is for my 12 year old son. We have been low fod map for about 9 months and low Fructose for 2 months. We are one year into this journey. He has had a positive Fructose Breath Test reaching 109 at the 90 min mark for hydrogen. We then did a Glucose breath test and it was negative. My dr doesn’t think we need to do a Lactulose breath test. I would like to just to completely rule out SIBO. He is doing better and as long as we stay low Fructose/fructans he is mostly symptom free. I’m wondering how hard i should push for a LBT. It seems most Fructmal people have SIBO as well. What do you think? Should I push for the test?

    1. Monica,
      I don’t think its a bad idea, especially consider the North American expert consensus is that SIBO should be ruled out before fructose testing. Feel free to contact my clinic if you need help.

  50. I recently had the SIBO breath test. None of the specimens came back positive but my other tests indicated that I had inflammation in the intestines and my naturopath thought I could still have it.

    Is it common to get a false negative test?

  51. I was treated for H Pylori at the beginning of the year and finally convinced my doctor to do a Breath Test to rule out SIBO after seeing no results on H Pylori treatment. My results are below and I was treated with rifaximin. I felt a little better for 3 weeks and now back to the same symptoms. My doctor is now prescribing to try augmentin .
    One person on a SIBO group suggested I might have a glucose/fructose malobsorption with my hydrogen levels being so elevated after 180 minutes of testing. Any thoughts?
    I did a glucose breath test – see results below:

    20 min: Hydrogen 9 Methane 17
    40 min: Hydrogen 27 Methane 15
    60 min: Hydrogen 51 Methane 15
    80 min: Hydrogen 55 Methane 17
    100 min: Hydrogen 75 Methane 19
    120 min: Hydrogen 89 Methane 20
    140 min: Hydrogen 91 Methane 20
    160 min: Hydrogen 77 Methane 18
    180 min: Hydrogen 108 Methane 20

  52. Just got my SIBO results and my head is spinning. Your website is great!

    I received Lactulase.

    80m after baseline= 5ppm hydrogen | 5ppm methane
    120m= 47ppm | 18ppm
    160m= 2ppm | 0ppm
    180m= 64ppm | 21 ppm

    I’ve got IBS-D, and burping after I ingest anything (my whole life).

    Is this a straight forward case of hydrogen SIBO or should i push to be retested with glucose?

    1. Hi Anar,
      I would save you money on testing and instead go through the self-help program in my book. It will walk you through the treatments that can help to heal your gut and reduce your symptoms.

  53. I found this article very interesting. My daughter did the Lactulose breath test and as told she was positive for Methane. She did a few weeks of Low FODMAP before getting results and 4 weeks of herbals and SIBO specific diet (following gluten free/dairy free the entire time) and had no results. Her Methane level was 12 (just over the limit of 10 given) and she peaked at 120 minutes. During the rest of the time she was anywhere from a 3-6. Now I wonder if she really even has SIBO.

  54. I recently tested positive for SIBO . My results were as follows for ppmh2
    Time. Ppmh2
    0. 6
    20. 6
    40. 9
    60. 14
    80. 24
    100. 43
    120. 76
    140. 71
    160. 88
    180. 105.
    Could this be a false positive or does it read right
    Thankyou for looking at this

    1. Hi Susan,

      Unfortunately, we can’t offer personalized advice or diagnosis on this forum. I would say not to get too wrapped up in what the test results show, how you feel is most important. And make sure you’re working with a practioner who is experienced in this sort of thing. You may also want to pick up a copy of Dr Ruscio’s book “Healthy Gut, Healthy You”, which lays out the exact protocol he uses in his clinic to help patients overcome tough gut issues (including SIBO). You can find it here: https://www.drruscio.com/getgutbook

      Good luck!

  55. Dear Dr. Ruscio,

    I had very regular bowel movements for over 15 years and then started to have severe constipation. I did a Genova GI Effects Stool Profile Test in Feb that showed high m.smithii and high fecal fat in my large intestines. We assumed Methane SIBO and I took Antril for a month with no good results (but loud lion-like burping). In April, I did a 3 hour lactulose Genova SIBO test that showed CH4 methane >81 for each reading including the baseline. I found one article that said that a flatline for methane may indicate I have IBS-C and not SIBO. Other articles say it means I have SIBO.

    I am perplexed because I have chronic constipation but NO OTHER SYMPTOMS or digestive issues (I do NOT have bloating, pain, odor, candida, acid reflex, h. pylori, klebsiella, parasites, weight gain; never taken proton pump inhibitors.) I just have chronic constipation and a positive SIBO test. I had a swollen read eyelid last fall but that disappeared.

    I love your article and hope you look forward to your insight.

    1. Hi Marry,
      I would start with the Healthy Gut, Healthy You protocol – this could be very helpful.
      Next, and only if you need additional help after the book, read my two posts on constipation. Use homepage search box.

      1. Thank you Dr Ruscio! I have the book and will read it and follow the protocol. I also listened to appreciated your interview with Dr. Perlmutter. The other part of my question was: Does a 3 hour lactulose SIBO test that showed methane >81 for every reading, including the baseline, indicate that I have SIBO? I know I have a bacterial overgrowth. But I don’t know if it is just in my large intestines or also in my small intestines. Thank you!

          1. I also was flatline CH4 for my entire SIBO test, I am primarily IBD-d and my entire life is suffering. Although everything I read about methane dominance is that I should have constipation. My H2 was a result of 7. I started Xifaxan and Neomycin combo but could not tolerate as I had horrible, horrible, diarrhea. I kept on the Xifaxan and begin a SCD tomorrow. I don’t know where to go from here but I will be looking for your book tonight and the podcast during my commutes. Thank You!

  56. Dr Ruscio,
    Hi! Thank you for your informative article!
    I have been having huge abd bloating and abd pain that started suddenly 2 years ago, bowels completely normal and regular. I recently had a lactulose breath test and it was positive for hydrogen/methane but no elevation until 120minutes. Peak hydrogen 94, methane 23.
    I have already had a course of rifaxin TID x3wks amd flagyl TID x3wks and nothing changed, it was like I hadn’t taken anything at all. I am now on the elemental diet for 15 days as a last ditch effort. I am 7 days in and every time I drink a cup of the elemental my stomach gets huge just as if I’d eaten a meal, how can this be if I am not feeding the bacteria??
    Do you suppose there is something else going on and my sibo test showed a false positive?
    It begins to get huge with any food that I eat and it starts in the first 2 bites of food- is that typical o sibo?? It wouldn’t have even reached the small intestines yet.
    So confused! Any insight would be awesome!

    1. Hi Zoe,
      It’s hard to say, testing only gives us a fraction of the picture. Some of this should like a food intolerance reaction, or potentially gastritis. I would check in with your doctor and consider the protocol in Healthy Gut, Healthy You which might help you apply the available therapies most efficiently.

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