A breath test is a non-invasive diagnostic tool used to detect various gastrointestinal conditions by measuring the levels of hydrogen, methane, and carbon dioxide in your breath. These gases are produced by bacteria in your digestive system as they ferment undigested sugars and carbohydrates. The test involves consuming a specific sugar solution and then providing breath samples at regular intervals over a few hours. The amount and speed of gas production can reveal information about your digestive health.
To ensure accurate results, it is crucial to follow specific dietary instructions before the test. This article provides a detailed guide to help you prepare for a breath test, including what to eat, what to avoid, and other important considerations.
Understanding the Purpose of the Breath Test Diet
In a healthy digestive system, the small intestine is relatively free of bacteria, while the colon contains a large population of bacteria that aid in digestion. However, when bacteria overgrow in the small intestine, it can lead to symptoms such as gas, bloating, diarrhea, and weight loss.
The breath test diet aims to starve these bacteria in the days and hours leading up to the test. By restricting the intake of fermentable carbohydrates and other substances that fuel bacterial growth, the diet helps to:
- Reduce baseline gas production: This ensures that the test results accurately reflect the fermentation of the test sugar.
- Enhance the sensitivity of the test: By creating a "clean slate" in the digestive system, the test is more likely to detect even small amounts of bacterial overgrowth or sugar malabsorption.
- Minimize false negatives: If bacteria are not adequately starved, they may not react during the test, leading to inaccurate results.
General Guidelines for Breath Test Preparation
Before undergoing a breath test, it is essential to consult with your healthcare provider for specific instructions. However, here are some general guidelines to follow:
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- Medications and Supplements:
- One month before: Stop taking antibiotics and probiotics, as these can alter the balance of bacteria in your gut.
- One week before: Discontinue the use of laxatives, fiber supplements, antacids, and prokinetics, which can affect gut motility. Also, stop smoking.
- During the prep diet, stop taking all non-essential medications, supplements, and pro-biotics. This includes over the counter pain medications, allergy medications, and antacids. If unsure, consult your prescribing physician.
- Dietary Restrictions:
- One day before: Follow a low-fiber, easily digestible diet. This typically excludes oils, fats, sweeteners, seasonings, dairy products, and most grains.
- The prep diet is incredibly restrictive. Any changes to the diet can affect the results of the test.
- On the day of the test: Fast for 12 hours before the test. This means no food or water.
- Other Considerations:
- Avoid exercise or sleeping within a few hours of the test.
- Inform the nurse if you are diabetic before consuming the sugar solution.
- Allow up to four hours at the testing center.
Detailed Dietary Instructions
The 24-48 Hour Prep Diet
The SIBO breath test typically involves a 24-48 hour prep diet, followed by a 12-hour fast and a 3-hour breath test after drinking a lactulose solution. The length of the prep diet depends on your doctor's recommendation.
During the prep diet, focus on consuming foods that are easily digestible and low in fermentable carbohydrates. The following foods are generally permitted:
- Proteins: Baked or broiled seafood, lean beef, lean pork, chicken, or turkey (prepared with minimal olive oil, salt, and pepper)
- Carbohydrates: Plain white bread, white rice, boiled or mashed potatoes (no skins), boiled or mashed carrots, boiled or mashed turnips (no skins)
- Other: Minimal olive oil, salt, and pepper
Foods to Avoid During the Prep Diet
To ensure accurate test results, it is crucial to avoid the following foods during the prep diet:
- Complex carbohydrates: Bread (except plain white bread), cereals, grains, pasta, crackers, beans, lentils, rice (except white rice), vegetables (except potatoes, carrots and turnips without skins), fruit, dairy products, dairy substitutes
- Sugars and sweeteners: Candy, mints, soda, sports drinks, fruit juices, added sugars, brines, or cures
- Other: Deli-meat, lox, pre-prepared meats with herbs and spices besides salt and pepper, sashimi with sauce, Nigiri (unless homemade with steamed white rice and no sauces), meat broth with bone, cartilage, vegetables, or herbs (aside from salt and pepper)
Important Notes on Specific Foods
- Rice: The only grain acceptable on the prep diet is plain, white rice. Other rice/grains have a higher level of fiber and macromolecules that SIBO bacteria like to eat. Any substitutions can give inaccurate test results. If you do not eat grains, for example, do not consume the rice.
- Meat Broth: If you consume meat broth for the prep diet, it must be made from ONLY the meat. There cannot be any bone or cartilage included, and it cannot have any vegetables or herbs (aside from salt and pepper) in it.
- Meats: Any meat ingested must be made without any added sugars/brines/cures/etc. to avoid contaminating the prep diet.
- Sashimi and Nigiri: The sashimi fish is fine on the prep diet, when eaten alone and without sauce. The rice in Nigiri is usually made with sugar-based binders to make it stick together better, and thus should be avoided on the prep diet. The only exception is home-made Nigiri with steamed white rice and no sauces.
Sample Meal Ideas
To help you plan your meals during the prep diet, here are some sample meal ideas:
- Breakfast: Scrambled eggs with minimal salt and pepper, two slices of white bread toast.
- Lunch: Baked chicken breast with boiled carrots and mashed potatoes (no skins), seasoned with minimal salt and pepper.
- Dinner: Broiled lean beef with boiled turnips and white rice, seasoned with minimal salt and pepper.
For additional recipes and meal ideas, you can use online resources such as ChatGPT or other chat bots. Use the following prompt to ensure only permitted foods are used:
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"Generate a recipe with cooking instructions for breakfast, lunch, and dinner that can be made using ONLY the following ingredients: minimal olive oil, minimal salt, minimal pepper, plain white bread, eggs, plain tofu, baked or broiled seafood, baked or broiled lean beef, baked or broiled lean pork, baked or broiled chicken, baked or broiled turkey, white rice, boiled or mashed potatoes (no skins), boiled or mashed carrots, boiled or mashed Turnips (no skins)."
Be sure to check the recipes carefully and adjust accordingly, as chat bots can make mistakes.
What to Expect During the Test
On the morning of the test, you will be asked to blow into a bag to collect a baseline breath sample. After that, you will be given a sweet liquid to drink (the test sugar solution). You will then be asked to blow into a different bag every 15-30 minutes for the next 3 hours.
During the test, it is important to limit physical activity. You may also be asked to record any digestive symptoms you experience, such as abdominal pain, bloating, or farting.
Other Important Considerations
Smoking and Tobacco Use
If you are a smoker (tobacco or cannabis), there is no recommendation to stop use during the prep diet. However, do not smoke anything for at least one hour prior to taking the breath test, or during the time of the test (4 hours total). If you ingest cannabis in edible form, it must be avoided during the prep diet. Smokeless tobacco (chew) should be avoided during the prep diet and prior to the test as well.
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Accuracy and Individual Variations
The manufacturer of the SIBO test created the prep diet based on their research and testing to produce the best results. Certain doctors will modify the diet to what they feel is the best test for them. However, it is crucial to follow the instructions provided by your healthcare provider or testing center.
Remember that individual responses to the breath test may vary. Some people may experience more discomfort than others, and the results may not always be conclusive. In such cases, your healthcare provider may recommend additional testing or treatment options.
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