# Hydrogen breath test - could it be SIBO or lactose intolerant or both?



## Gem Spall (Jan 23, 2013)

Hello. My partner has had chronic diarrhea/abdominal pain/nausea (on off) for over 4 years now. So many investigations - majority come back clear.

A year ago M had a hydrogen breath test which showed he had bacterial overgrowth. I assumed it was Small Intestinal Bacterial Overgrowth (SIBO). Anyway he was given a 14 day course of Metronidazole; but M took 21 days to complete course. Consultant and GP both informed of this but they said it would be OK. I asked (on behalf of M) if the breath test could be redone as a) one antibiotic does not fit all b) what effect did the antibiotics have on the bacterial overgrowth. The consultant advised that the course should of killed the bacteria. I felt a bit peed off as he had no evidence to support this.

Anyway, what I can't get my head around is that if M had a diagnosis of a bacterial overgrowth - should he be on a lactose free diet? I think M has given up but I am determined to get to the bottom of this (excuse the pun). We are waiting for results back for allergy blood tests and if they come back clear I might privately pay to get a hydrogen breath test redone. M's GP has been very supportive but is very inexperienced with IBS. We are from the UK.

Any advice or information regarding similar experiences are very welcomed! Many thanks G.


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## Kathleen M. (Nov 16, 1999)

If he digests lactose fine it should be digested and absorbed before it gets to where the SIBO or colon bacteria live (as you can have gas and diarrhea from lactose with a totally clear small intestine. There are a lot more bacteria in the colon and they make gas from lactose just as much when they are in the right place (the colon) or in the wrong place (the small intestine).

That being said, it may be worth doing a 2-3 week lactose free trial just to see if that reduces diarhhea and/or gas. It is a separate issue from SIBO. SIBO tests usually use lactulose which is not absorbed by any human so will be made into gas by the gas producing bacteria in all people. Lactulose is not lactose, so you can't assume that a positive lactulose profile (the two peaks needed to diagnose SIBO) would say anything about lactose intolerance or tolerance. If you are lactose intolerant and they do a test with lactose you get one hump of gas you shouldn't get (if you are both SIBO and lactose intolerant you could get the SIBO double hump as well).


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## Gem Spall (Jan 23, 2013)

I'm sorry I'm now even more confused! I have read many articles stating that a hydrogen breath test (which is a lactulose test?) can be used to identify SIBO and lactose intolerances.

All I know is that a hydrogen breath test was performed and it was positive for bacterial overgrowth. M can't remember any more details than that.


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## Kathleen M. (Nov 16, 1999)

They use the breath test for a lot of things, but usually I've heard when they test for lactose intolerance they use lactose as the sugar. When they test for fructose intolerance they use fructose as the sugar.

Lactulose is supposed to be a sugar no human absorbs so I don't know how it tells lactose intolerance (some people) from lactulose intolerance (all humans) if everyone always makes gas from it (unless they are lacking in H2 producing bacteria which a few people are and then you get a completely negative test for everything). Lactulose is sometimes used as an osmotic laxative because it will get to the colon in all humans and not be absorbed.

So there are lactose intolerance breath tests, but they have to be done with lactose. If you get any gas from lactose (or fructose) you are intolerant of the sugar. Doesn't matter if it gets to your colon without running into any bacteria, you will still react. SIBO is when you get two peaks (one from the small intestinal bacteria and a larger one from the colon bacteria when it gets to that).


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## Gem Spall (Jan 23, 2013)

Bupa.co.uk states "Hydrogen breath test. After you've drunk some milk, you doctor will measure the level of hydrogen in your breath. If there is a large amount of hydrogen in your breath, this may be a sign that you have lactose intolerance. This is because hydrogen is formed when bacteria in your bowel act on undigested lactose"

and http://www.medicinenet.com/lactose_intolerance/page5.htm#breath_test states "The hydrogen breath test is the most convenient and reliable test for lactase deficiency and lactose intolerance".

?


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## Kathleen M. (Nov 16, 1999)

They give you lactose to test for lactose intolerance

They give you lact-u-lose a different sugar for SIBO testing.

For SIBO you need a sugar that NO ONE digests absorbs rather than a sugar SOME people do not digest.

The equipment they check for the hydrogen in lactose intolerance testing is the same as the hydrogen you produce from lactulose, but it only tests for lactose intolerance if you give someone lactose.

Lactulose in the drink (and sometimes Sucrose) = SIBO testing

Lactose = Lactose intolerance testing

Fructose = Fructose intoleance testing.

But in all cases they test for the Hydrogen the same way. The bacteria make the same hydrogen no matter which sugar you feed them with. Really, they don't make different gases from the different sugars, if they make hydrogen they make hydrogen from every single sugar you give them. What differentiates the different tests is what they put in the drink. Not what gas they test for. Sugar only has carbon, hydrogen and oxygen in it. They are in different configurations so it takes different enzymes to break them down, but you can't make that many different things when you break them down. Some enzymes only bacteria have (like to break down lactulose). Bacteria tend to make Hydrogen gas out of sugars (and sometimes methane). Humans tend to make carbon dioxide and water out of sugars.

Lactose intolerance = you make any hydrogen because if you digest lactose it never gets to the bacteria that make hydrogen out of it.

SIBO = you will always make hydrogen, every person makes hydrogen, what they look for is WHEN you make the hydrogen. Do you make it only when a normal human with normal colon bacteria does, or do you make it early because there are bacteria in the small intestine where they aren't supposed to be.

Is that any clearer??

http://www.medicinenet.com/hydrogen_breath_test/page2.htm and http://en.wikipedia.org/wiki/Hydrogen_breath_test discuss how use the same test to look for different things depending on what they make you drink before they start measuring the hydrogen.


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## Brownish72 (Aug 26, 2012)

First off, sorry to hear you have a friend who suffers from SIBO. It's rough. I've had it for years, and I'm only now coming on top, but not without hours of study, months of trial and error, and much much more. A 100 page book is necessary to describe my true experience!!!

Kathleen is very correct in how she described the test. A SIBO test is, WITHOUT A DOUBT, a lact-u-lose test, and NOT a lac-tose test. Simply for the reason described above in Kathleen's posts. Some people may refer to the sugary drink that one drinks before the test as "a milk like drink" or a "milky" substance, most likely because they here lactulose, and think lactose, but also its a white powder they mix in the cup, and the drink resembles milk. I've done the test 3 times, I promise it's lactulose, and not lactose.

The same machine, and same method, is used to test for lac-tose intolerance. But, again, NOT during a SIBO test.

Please buy the book : Breaking the Vicious Cycle, by Elaine Gotschall for your friend. Also, A New IBS Solution, by Dr. Mark Pimentel. They are two must have books for SIBO.

Antibiotics work for some to get rid of SIBO, but for many, they do not. I myself did not have success, after 5-6 times, trying flagyl, ciproflaxin, and Rifaxamin. I got rid of SIBO by actually fasting, and my post is on this form entitled SIBO and Vivonex Plus Fast. Sibo has a 90%+ relapse rate. Even if we get rid of it, it comes back in most cases, if not all cases without on going treatment. The on going treatment part however is not necessarily medicine, but mainly diet. Lactose is not a good idea for someone with SIBO because, in theory, the sugar will reach the part of the infection before being broken down and absorbed. I could talk hours about it, but your best bet is truly to go buy those books mentioned above. They're cheap, and they are lifesavers. I came out of a hole, having diarrhea 20x+ a day, losing lots of weight, and very sick, to feeling incredibly healthy because of those two books. Please buy them. I wish I had discovered them on my early stages of SIBO so I would of known how to get over it sooner.

Your a true friend for looking out for somebody else on here. Great idea.

Best of luck


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