Everything you need to know to start treating SIBODr. Alison Vandekerkhove BSc, ND

SIBO Canada

▪ I started with the treatment of SIBO for IBS type symptoms

▪ My practice has a large focus on women’s health and hormones

▪ Patients that would not get better with treatment- particularly patients who are SENSITIVE to treatments

▪ Started testing and treating for SIBO▪ Great results- got passionate in the treatment of

SIBO- started SIBO Canada

Why I became interested in SIBO

SIBO Canada: What I wanted to do for my profession

I wasn’t getting what I needed from the other local labs and USA labs so pricey.

I have a Quintron machine and kits in my office that I use for my patients.

My fellow Doctors that were friends were asking if they could do testing for their patients

I wanted to start a small company that could do the following:

▪ Have more clinics able to do SIBO- all Naturopaths should be treating for it.

▪ Make it easy for the patient

▪ Make it easy for the doctors

▪ Make that the doctors could make some money

▪ Not make a clinic affiliated with the lab for the patient

WHAT IS SIBO

What is SIBO

▪ SIBO Stands for Small Intestinal Bacterial Overgrowth

▪ SIBO occurs when bacteria ( that is normally present in the large intestine ends up in the small intestine)

▪ These are not pathogenic bacteria- just bacteria in the wrong place

▪ These bacteria interfere with the digestive processes leading to the many symptoms of SIBO

▪ HCl in the stomach and the ileocecal valve below the small intestine should keep these bacteria in check

▪ It is estimated that about 70-80% of IBS sufferes have SIBO

IBS after the stomach flu Patients feels better on antibiotics

Absortion issues ( ie: always low ferritin)

Never well since surgery

Sensitive to everything

Fibre or probiotics makes them feel unwell or very bloated

1. 2. 3.

4. 5. 6.

Key symptoms that I look for:

01

02

03

04

05

06

07

08

09

10

Gas

Bloating

Constipation

Diarrhea

Anemias

Weight loss

Fatigue

General feeling of being unwell

Anxiety and depression

Weight gain in the abdomen

Sensitivities to foods and medicine

11

12

Brain fog

Symptoms of SIBO

Associated Conditions

Acne ( vulgaris and Roscea)

Anemia

Autoimmune conditions

Gastritive

Autism

Cancer

Celiac Disease

Cystic Fibrosis

Medications ( PPi, Opiates, NSAIDS)

IBD

IBS

Interstitial Cystitis

Leaky Gut

Lymes

CFS

Obesity

Pancreatitis

Parasites

Diverticulitis

Fatty Liver

Fibromyalgia

Gallstones

GERD

Hepatic Issues

H-pylori

Hypochlorhydria

Hypothyroidism

Parkinsons’s

Malabsortion

Diabetes

syndrome

Prostatitis

Restless legs syndrome

Surgery

SIBO Diagnosis

Test Endoscopy Breath Test Stool Analysis Organic Acids

Procedure Invasive Non-invasive Non-invasive Non-invasive

Cost $$$$ $$ $$ $$$

Measurement Direct Indirect Direct Indirect

Culture Able to culture only Aerobic bacteria

Unable to culture Unable to culture Unable to culture

Location of bacteria

Only the proximal part of the small intestine

The whole intestine with the 10 breath sample

The distal part of the colon only

Does not distinguish location of bacterial growth

▪ Test for Hydrogen and Methane gases in the intestine

▪ Can use lactulose or glucose for the test

▪ Recommended to use lactulose due to:

1 2

3

Not absorbed by humans so it is still in the distal part of the intestine

Glucose is absorbed so may only detect bacteria in the proximal part of the small intestine.

Not a Rx in Canada so readily available

Quintron Breath Test

Quintron breath Test Continued

▪ This is a 3 hour breath test that is done in the A.M after 24-48 hours of preparation

▪Breath samples are done every 20 minutes till the 10 tubes are completed.

▪Prep Diet: for the test- recommended to do for 24 hours(severe constipation do for 48 hours)

▪Can consume: animal proteins, hard cheeses, eggs, white rice, oil, salt and pepper, black coffee

▪ Fast required for 12 hours before the test

antibioticsAll

enzymes

antacidslaxative

s

PPI’sprobiotics

1 week prior to test

Breath test instructions

Best is to show your patients a u-tube video.

Here is an example of one:

https://www.youtube.com/watch?v=GICPncxiyhY

Some examples of the Breath test Report

It is very important when you get a test back that you look at the patients clinical picture when reviewing the test

Some key points to keep in mind

▪ Most of the time over 120 minutes is considered to be in the large intestine

▪ A test where the baseline is high can mean a few things: they did not do the prep correct, the bacteria are in the

stomach, in the case of methane- high baseline is a positive

▪ If the patient blows too hard the CO2 will increase and the numbers will be out( the chart will show a zero)

▪ Sometimes a methane producer of a 3 will be considered positive

▪ Methane bacteria eat hydrogen bacteria- might show hydrogen negative till the methane bacteria have been

irradicated

SOURCE OF SPECIMEN:10 timed breath samples

SUBSTRATE USED: Lactulose CLINICAL HISTORY: Not Indicated

CLINICAL IMPRESSIONS:Rule out small intestinal bacterial overgrowth

Summary Report Of Hydrogen & Methane Breath Analysis with Carbon Dioxide

Correction

Sample Norm-illutio

n*

Gasses Analyzed:

Patient Result (ppm)

Expected (Small Intestine only)

Number

Collection Interval

ppm H

2

ppm CH

4Combined

ppm CO

2f CO

2

1 Baseline 3 0 3 4.7 1.06

Increase in Hydrogen (H

2) Level:

26 HI

(ppm

)

SIBO example #2

SIBO example

Breath analysis standards for abnormal tests are suggested if an increase of 20 ppm for Hydrogen (H2) or 12 ppm for Methane (CH

4), or a combined 15

ppm for Hydrogen (H2) & Methane (CH

4) is detected.

Only the treating clinician is able to determine if there are additional factors that colud have a material impact on the results of this analysis.

A diagnosis can only be obtained from a medical professional that combines clinical information with the results of this breath analysis.

The results of this Hydrogen (H2) & Methane (CH

4) breath test should be utilized as a guideline only.

Sibo Canada does not have access to patient clinical information that is critical for diagnosis determination.

Quality Control:

Sibo Canada performs quality control analysis on specimens processed using rigorous standard operating procedures, established Quintron

Hydrogen (H2) & Methane (CH

4) breath test values are corrected by Sibo Canada state-of-the-art solid state sensor technology & scientific algorithm for

Carbon Dioxide (CO2) content in the sample.

* The correction factor, f(CO2) is used to determine if each sample is valid for analysis. A f(CO2) close to 1.00 is indicative of a good alveolar sample, while

a factor in excess of 4.00 is indicative of a poor sample.

** 3 ppm of CH4 with reportof small intestinal bacterial overgrowth.

Important Information - Please Read:

Summary Report Of Hydrogen & Methane Breath Analysis with Carbon Dioxide Correction Sample Norm-illution*

Gasses Analyzed: Patient Result (ppm) Expected (Small Intestine only)Number Collection Interval ppm H

2ppm CH

4Combined ppm CO

2f CO

2

1 Baseline 4 28 32 3.4 1.47

Increase in Hydrogen (H2) Level: 50 HI

SIBO test #5- Methane positive(ppm

)

Hydrogen & Methane Breath Results

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