Hydrogen and Methane Breath Testing

Hello my Low FODMAP Friends!

As promised in my July monthly newsletter I have written a blog post about Hydrogen and Methane Breath Testing! Also if you don’t receive my monthly newsletter you can sign up on the bottom of the website by entering in your e-mail. The monthly newsletter gives you a monthly synopsis about what has been happening during that month and what exciting news and events are going to be happening the following month.

So how does breath testing work?

Common foods we eat contain FODMAP sugars. In normal digestion when we eat something which contains these sugars they are broken down into their single sugar molecules throughout the small intestine enabling absorption into the blood stream. However, for a variety of reasons, the ability of the small intestine to absorb these sugars undergoes change – leading to partial or total inability to absorb different sugars. This then leads to the sugars continuing to the large intestine where a large colony of bacteria reside, subjecting the sugar to bacterial fermentation. This fermentation process involves the production of hydrogen (H₂) and methane (CH₄) gases which are then excreted in the breath [1]. These H₂ and CH₄ breath tests are simple and non-invasive tests which can be used in the diagnosis of oro-caecal transit time (how long it takes for your food to move through your gastrointestinal system), small intestinal bacterial overgrowth (SIBO- bacteria that has moved up to the small intestine from the large intestine so sugars are fermented far earlier – I will do another blog post on SIBO in a couple of weeks) and carbohydrate/sugar malabsorption (fructose, lactose, sorbitol, mannitol and sucrose) [1]. The malabsorption of carbohydrate/sugar is a key trigger of irritable bowel syndrome (IBS)- type symptoms such as diarrhoea and/or constipation, bloating, excess flatulence, headaches and lack of energy [1].

What do you have to do?

Each breath test takes 2-3 hours and will be completed on a separate day and not on consecutive days to distinguish which sugar is causing the issue. Each test will also be conducted after a 24-48hr low FODMAP diet along with a minimum of 5 hours fasting. You can do tests in clinic or at home with a home test kit. You will be required to drink a sugary solution consisting of the sugar you are testing for and then you will breath into a bag at 15-20minute intervals until the 2-3 hours is completed.

The research shows that a proper diagnosis of carbohydrate/sugar malabsorpotion or SIBO via breath testing and an appropriate dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS [1].

Why do a breath test?

You do not have to do a breath test to see which FODMAP sugars affect your tummy. Instead you can do an elimination and re-introduction diet with your dietitian who specialises in the area. However, from experience patients like the quantifiable measure of what a breath test provides showing them the key FODMAPs which are affecting them. This knowledge educates the patient on where they are starting from, further motivating them to adhere to the relatively strict dietary elimination and re-introduction after the breath test because they know that there is malabsorption occurring and that they are not simply taking a stab in the dark .

Breath tests are also valuable in distinguishing between a FODMAPs issue and a SIBO issue which require different treatment methods. I will be attending the SIBO summit in Melbourne in October so after that I will give a summary about what I have learned in a blog post.

Take Home Message

If you experience uncomfortable gastrointestinal symptoms such as diarrhoea and/or constipation, bloating, excess flatulence, headaches and lack of energy you may be a carbohydrate/sugar malabsorber or suffering from SIBO. Contact your GP first to eliminate any other causes. If you are believed to be a carbohydrate/sugar malabsorber visit the stream diagnostics website for more information about breath testing. Otherwise, on the FODMAP Friendly App there is a list of FODMAP specialist dietitians so you can find a specialist in your area that can help you effectively implement the low FODMAP diet.

I hope this was helpful!

Until next time I am Atlanta Miall.

Good Eating!!

[1] Rana SV, Malik A. Breath tests and irritable bowel syndrome. World J Gastroenterol. 2014 Jun 28; 20(24): 7587-7601

[2] http://www.breathtest.com.au/