Breath Test Interpretation for SIBO

Presenter: Dr Nirala Jacobi BHSc ND
Topics covered:

  • Basics of breath testing
  • Preparation Diet prior to testing
  • Test result interpretation
  • Common patterns
  • Q&A

Please click the link below to view the presentation.
Watch anytime + download the slides by registering here.

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For Patients
– The SIBO Bi-Phasic Diet by Dr Nirala Jacobi BHSc ND
– Easy online ordering & fast global shipping

Presentation notes

What is breath testing?

  • Stool test NOT accurate for SIBO
  • Breath test: assess bacterial fermentation over 90-100 minutes measures Methane and Hydrogen gas (not produced by humans)
  • SIBO-D = diarrhea dominant:
  • E coli, Klebsiella, Proteus, Aeromonas (most common)
  • Produce hydrogen gas (H2)
  • SIBO-C = constipation dominant
  • Methanobrevibacter smithii produce methane gas (CH4)

Laboratories– how to be
a discerning practitioner

Important questions to ask

  •       Prep diet – how restrictive?
  •       open or closed sample collection system
  •       testing for hydrogen, methane, and CO2
  •       grams of test sugars
  •       Sample timing (eg 20 min vs 30 min) and length of test (2h vs 3h)

Prep Guidelines- what to avoid
Prep Diet
What test to order?
Interpreting the Results

  • Lactulose Test Results- positive
  • Lactulose and Glucose Breath Test Positive
  • Lactulose negative, Glucose positive
  • Methane (CH4) Positive
  • Methane conundrum
  • Methane positive IBS-C but negative for SIBO
  • Methane positive, negative SIBO
  • High methane followed by high hydrogen on re-test. Frequently seen- no need for alarm!
  • Fructose Positive
  • Fructose- timing matters!
  • High Baseline
  • Bad sampling
  • “Flatlining”
  • Lactulose “non-fermenters”?
  • Normal rise in the large intestine

Treatment – how long?

Any questions, please email us!

Dr Nirala Jacobi BHSc ND

Sick and tired of SIBO? Find out what to do next at the SIBO SOS™ Virtual Summit Part Two – 2017

The FREE, inspiring and highly informative SIBO SOS Virtual Summit 2017 is getting under-way very soon – October 21 – 29, 2017 to be exact.

The SIBO SOS™ Summit Part I brought together over 20 SIBO speakers and had over 100,000 views.

SIBO Summit brings together even more fantastic video presentations from a wide range of SIBO treating health professionals, researchers and patients.

Watch the 1-minute teaser clip with SIBOTest Director Dr Nirala Jacobi ND discussing the SIBO Bi-Phasic diet.


Nirala Jacobi 1 Minute from Shivan Sarna on Vimeo.

Sign up here for this free SIBO Summit

SIBO and Detoxification with Dr Chris Shade

In this episode, Dr Nirala Jacobi is in conversation with Dr Christopher Shade.

Listen to the entire episode now.

Dr Shade is the CEO and founder of Quicksilver Scientific, a lab that specialises in the environmental, biological, and analytical chemistry of mercury and all of its forms, and its interaction with sulphur compounds, particularly glutathione, and its enzyme systems.

Dr Jacobi met Dr Shade at the Bioceuticals Research Symposium in Sydney, 2017, and was riveted by his presentation on detoxification.

Topics discussed in this episode include:

  • The liver, gallbladder, and GI connection, and how to align them so as to clear gastrointestinal issues.
  • How failure to move bile is at the heart of detox reactions
    • Bile as a detergent in the small intestine and how bile can be a core issue in SIBO.
  • Bile acid destruction and fat malabsorption in SIBO.
  • Emunctories and what this means.

And more…

Listen to the entire conversation at The SIBO Doctor Podcast Episode 17.


SIBO SOS Summit is back this October, and we’re thrilled to be a part of it again with our latest presentation aimed especially at SIBO patients.

Methane, Constipation, and The SIBO Biphasic Diet by Dr Nirala Jacobi BHSc ND, Chief Medical Officer, will highlight the latest research and treatments for small intestinal bacterial overgrowth (SIBO).

Sign up FREE to grab a spot and get access to 30+ of the latest SIBO presentations by top SIBO experts, nutritionists and SIBO patients.

Click here to sign up now for free!

Breathing and GI Health with Mim Beim

In this episode of The SIBO Doctor podcast, Dr Nirala Jacobi is in conversation with Mim Beim about the effect of the breath on the digestive tract. Mim has 30 years of naturopathic experience, she has authored books, and is a respected naturopathic voice in the media. Mim has also held lecturing positions at the Australian College of Natural Therapies (ACNT) and has two practices.

Topics discussed include:

  • Mim’s story and how she came to Buteyko breathing.
  • Physiological effects of Buteyko breathing.
  • What actually happens with Buteyko breathing?
  • Overbreathing – chronic hyperventilation (breathing more than we metabolically need) and the effect of losing too much carbon dioxide.
  • What are the effects of increasing carbon dioxide in the body in minuscule amounts?
  • Digestive conditions and the breath.
  • What improvements and symptomatic relief has Mim seen with Buteyko breathing with SIBO and digestive conditions?
    • Nitric oxide improving the functioning of sphincters and how this affects the digestive tract.
  • An example of a Buteyko breathing exercise – a live exercise

Tune in to this fascinating talk over at The SIBO Doctor podcast page

Listen on iTunes

The number one question I get asked is…

…about SIBO Breath Test Interpretation!

Free 1-hour in-depth session
12 October 2017 7 pm (Sydney, Melbourne)

What you will learn in this free session:

  • Confidently interpret the nuances of hydrogen positive SIBO
  • Understand Methane positive SIBO vs IBS-C methane positive
  • When to consider hydrogen sulfide on a breath test result
  • When to retest your patient
  • What do rising hydrogen and falling methane mean on a retest
  • Followed by Live Q+A with SIBO expert, Dr Nirala Jacobi ND!

Can’t make the live event?

A catch-up video will be sent to everyone who registers!

Plus, you’ll also earn valuable rewards points that may be redeemed on the SIBO Education website as a discount on your purchase of any SIBO on demand learning course.

Sign up now

The SIBO Doctor – Dr Lenny Weinstock – SIBO, Restless Leg Syndrome and More

In this episode, Dr Nirala Jacobi is in conversation with world class gastroenterologist Dr Lenny Weinstock about Small Intestinal Bacterial Overgrowth (SIBO) and its connection to different conditions in the body.

Dr Weinstock is board certified in gastroenterology and internal medicine, is the president of Specialists in Gastroenterology and the Advanced Endoscopy Centre, he teaches at Barnes Jewish Hospital and is an associate professor of clinical medicine and surgery at Washington University School of Medicine. Dr Weinstock is also a primary investigator at the Sundance Research Centre and has written more than 80 articles, abstracts, editorials, and book chapters. He is passionate about SIBO and its connection to different conditions, such as Restless Leg Syndrome and Rosacea.

Head on over to our podcast page, The SIBO Doctor to listen in now to this fascinating conversation.


The SIBO Doctor – Dr Jason Hawrelak – Pre and Probiotic Use in SIBO

In this episode, Dr Nirala Jacobi is in conversation with Dr Jason Hawrelak on the topic of all things gut.

Head on over to our podcast page, The SIBO Doctor to listen in to this fascinating conversation.

Dr Hawrelak is a researcher, lecturer, naturopath, and nutritionist with over 16 years of clinical experience.  He also practices at Gould’s Natural Medicine – a 135-year-old natural medicine apothecary and clinic in Hobart, Tasmania, Australia.

Dr Hawrelak completed his PhD examining the capacity of probiotics, prebiotics, and herbal medicines to modify the gastrointestinal tract microbiota.  He is currently the senior lecturer in Complementary and Alternative Medicines at the University of Tasmania’s School of Medicine where he coordinates the evidence based complementary medicines programs.  Dr Hawrelak also teaches the gastrointestinal imbalances unit, within the Masters of Science and Human Nutrition, and Functional Medicine Program at the University of Western States, in Portland, Oregon.

Pre and Probiotic Use in SIBO


Listen to the podcast on iTunes


The SIBO Doctor – Dr Denise Furness – SIBO, Genomics and Methylation

SIBO, Genomics and Methylation

In this episode, Dr Nirala Jacobi is in conversation with Dr Denise Furness, molecular geneticist, registered nutritionist, and registered exercise professional


Today’s discussion centres around nutrigenomics, methylation, and digestive health.

Dr Furness completed her PhD at CSIRO Human Nutrition and a postdoctoral fellowship at the University of Adelaide’s Research Centre for Reproductive Health.

Her research focused on folate, nutrigenomics, methylation and DNA damage in relation to pregnancy outcomes.  She has published her work in peer-reviewed medical journals and regularly presents at national and international conferences.

In 2012 Dr Furness shifted from an Academic Research position to a consulting role at Your Genes and Nutrition, helping patients understand the role of nutrigenomics and genetic testing in relation to various health outcomes.

Dr Furness is passionate about helping couples achieve optimal health and wellness to improve their chances for natural conception and healthy pregnancy outcomes.  She also holds regular educational seminars and workshops discussing the links between our genes and our environment, and how these impact on our health throughout all stages of the life cycle.

Topics discussed in this episode include:

– Overview of methylation.

– What to look out for with patients with ongoing digestive symptoms, and how can we utilise some of the genomic testing that’s available?

– Methylation as being responsible for switching genes off and on – the epigenetic component, as well as neurotransmitters, detoxification, and many other functions.

– How do we truly test methylation?

– Genetic terminology suggestions.

– How is methylation important in digestive issues?

– How SIBO relates to methylation variations.

– Nutritional cofactors implicated in the wider picture of methylation.

– Dr Furness’s most recent collaboration project with Bioceuticals.

– Clinical services

– Genetic Testing options

– Guidance with further testing

– Which genetic testing service will serve your needs the best?

– FUT2 gene variants and the link to a digestive disorder.

– FUT2 secretors and non-secretors, and the direct influence on the gut bacteria altering levels of Bifidobacterium and B12.

– Detoxification (CYP450) systems and their prevalence in the gut versus the liver.

– CYP polymorphisms, upregulation, and the resulting impacts on the digestive system.

– Glutathione S-transferase (GST) phase 2 deletions and the requirement for detoxification support in light of the body using different, slower pathways.

– Catechol-O-methyltransferase (COMT) as the safe pathway to process catechol oestrogen metabolites.

– Nutrients that support COMT and methylation, such as magnesium and b vitamins, respectively.

– Monoamine oxidase (MAO) enzyme system that helps to clear neurotransmitters.

– Why support COMT and methylation during times of stress and anxiety.

– Why to never just start with folate supplementally – The Folate Trap.

– Why the gut is the first port of call for systemic health.

– Dr Furness’s dosing inclinations.

– B12 deficiency in the presence of oxidative stress (due to gut issues), the recommendation towards hydroxy B12 supplementation over any other forms of B12, and why.

Various testing that Dr Furness recommends.

DUTCH testing

8-Hydroxyguanosine as a marker of DNA damage and oxidative stress

Endotoxicity and lipopolysaccharides (LPS) and how this can affect certain genes

Low homocysteine and what this can mean.

Gut issues and the relationship with oxidative stress.

Where to start with a client who has genetic complexities and oxidative stress issues.

Methylation education necessities for practitioners.

Dr Furness’s plan for upcoming workshops in Melbourne, and online offerings for clinical application.

The transsulfuration pathway and what can go wrong here.

The Cystathionine Beta Synthase (CBS) SNP as the first step in transsulfuration pathway, which pulls homocysteine into the pathway, and the CBS impact in detoxification.

Sensitivities with sulphur and the relationship to CBS.

How one SNP does not provide the whole picture – look at the diet, lifestyle, symptoms, and testing, using an integrative picture to address the issue.

How B6 works to speed up the transsulfuration pathway, pulling homocysteine down into it.



Dr Denise Furness

Consults available at Your Genes & Nutrition, Brighton, Melbourne

Consults available at Your Health, Brighton, Melbourne


Genetic Testing Services

Smart DNA

Fit Genes

DNA Life



Microbiome PCR testing


Dr Furness’s 1000 kit free link


Dr Anderson

DUTCH testing

8-Hydroxyguanosine as an indicator of DNA damage and oxidative stress

Doctor’s Data

8-Hydroxyguanosine as an indicator of DNA damage and oxidative stress



SIBO SOS: Day 4 Here’s what’s on tap:

Have you been able to watch any of the SIBO SOS?

  • Dr Allison Siebecker’s Fundamentals session focuses on how diet directly affects SIBO. (Is it a cure after all?)
  • Leonard Weinstock takes on SIBO, Rosacea, RLS (Restless Leg Syndrome) and LDN (Low Dose Naltrexone) it could be a game changer for you. It was for me.
  • Our own Nirala Jacobi of exposes the mysteries surrounding SIBO including salicylate intolerance and SIBO connections – we are including the Bi-Phasic Diet on the page.
  • Angela Pifer shows you the RIGHT choices to make when starting SIBO treatment with her food ideas and tips.
Then Sylvie McCracken rounds out Day 4 with her inspirational get-up-and-go success story on how she dealt with “2+ weeks of hard” to finally being well with the elemental diet.

Click here for Day 4 of The SIBO SOS™ Summit!

I simply can’t believe we’re already on Day 4!
So much incredible valuable information has been shared, and we’re getting close to the finish line!

P.S. Remember, there’s still time for you to grab the “event only” special! Unlimited access to the videos, MP3 recordings of all the interviews, and speaker bonuses. Click here

P.P.S. Day 3 Sessions are available for another few hours. These include sessions with Dr Siebecker, Dr Ruscio, Dr Rahbar, Larry Wurn & Katie Caldwell.

Click here to access the Day 3 Sessions.