Frequently Asked Questions
1. This prep diet is incredibly restrictive. I can’t replace things on it?
No. Any changes to the diet can affect the results of the test. The manufacturer of the SIBO Test created the prep diet based on their research and testing. Only the things on the prep diet can achieve the cleanest results for the SIBO Test.
- Any meat, poultry, fish, seafood that is not brined or cured
- Plain steamed white rice
- Clear meat broth (made only from the meat – no bone, cartilage, or vegetables)
- Fats and oils (coconut, olive, vegetable oils, butter, or lard)
- Salt and pepper (no other herbs or spices)
- Weak black coffee and/or weak black tea (plain, no sweeteners or cream, no green or herbal teas)
2. Do I have to eat everything on the prep diet?
No. If you do not eat grains for example, do not consume the rice. If you do not eat eggs, then do not start just for this diet. Eat things on the list, but only of what you would normally eat.
3. Can I eat cheese on the prep diet?
Certain doctors will modify the diet to what they feel is the best tests for them. If your doctor has a specific modification (such as hard cheeses) then you must discuss it with them, as we cannot give advice about foods outside of the manufacturer’s guidelines.
4. Can I eat brown rice, quinoa, etc.?
The only grain acceptable on the prep diet is plain, white rice. Other rice and grains have a high level of fibre and macromolecules that SIBO bacteria like to eat. Any substitutions can give inaccurate test results. If you normally do not eat rice, do not eat any during the prep diet.
5. What if I’m a vegetarian/vegan?
The SIBO prep diet specifically cuts out plant products and sugars to starve the bacteria for a day prior to taking the test, which will give you the most accurate results. If you do not adhere to the diet, the bacteria may not react during the test, leading to possible false negative results. If you do not normally consume meat and eggs, you can replace these with white rice, tofu, and some lentils. Vegetarian or vegan patients should follow a prep diet of: white rice, coconut oil, olive oil, salt and pepper. Although this is very restrictive and rather bland, the prep diet is only required for a single day so the protocol should be manageable. Take caution with this diet if the patient has known blood sugar issues. Speak to your doctor about balancing blood sugar spikes.
6. Why is the meat broth so specific on the prep diet?
Regular bone broth is often cooked with cartilaginous bones or meat. When cooked, polysaccharides (specifically glycosaminoglycan’s or GAGs) from the cartilage leech into the bone broth and can feed a bacterial overgrowth and therefore be problematic for people with SIBO.
It is important that 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. Most store-bought broths have ingredients that are not appropriate for this prep diet, so homemade broth is the best decision.
7. Can I eat cured meats, lox, or sausage?
Any meat ingested must be made without any added sugars, brines, cures, etc. to avoid contaminating the prep diet. Avoid meats like deli meat, lox land pre-prepared meats that have any other herbs and spices beside salt and pepper. Meats like sausage usually have other herbs or sugars in them and should be avoided during the prep diet.
8. Can I eat sushi?
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 homemade Nigiri with steamed white rice and no sauces. Sushi rolls are to be avoided.
9. What about smoking and consuming alcohol?
If you are a smoker, of 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 (four hours total). If you ingest cannabis in the edible form, it must be avoided during the prep diet. Smokeless tobacco (chew) should be avoided during the prep diet prior to the test as well. Avoid all alcohol during the prep diet.
10. Do I continue taking my medications?
Avoid all non-essential medications 1 day prior to the test and on the day of the test.
11. What is the purpose of the Prep Diet?
The purpose of the prep diet is to provide a clean baseline for the test by limiting the presence of fermentable foods (foods that feed the bacteria) in the digestive tract prior to the ingestion of the lactulose solution. The prep diet is typically followed for 24hr prior to testing but may be increased to 48hr in cases of constipation (at the doctor’s discretion).
During this prep, stop taking all non-essential medications, supplements, and probiotics. This includes over the counter pain medications, allergy medications, and antacids. If you don’t know what medication is considered essential, consult your prescribing physician. The goal is to starve the bacteria for the day to produce the best results when doing the test. SIBO bacteria loves plant products and sugars, so the only foods that you can have on the prep diet are listed here. If it is not on the list – do not eat it.
12. What about oral hygiene on test day?
Avoid mouthwash and brushing your teeth on the morning of the test to avoid interference with test interpretation.
13. Can children take this test?
Children of all ages are eligible for the lactulose breath test but the child must be able to form a seal around the tube. In-office practice is recommended with the parent and child to promote proper test technique and limit the need to repeat the test.
The lactulose breath test procedure must be adjusted for children up to a certain weight:
- Bag Size: in patients weighing less than 100lb the bag size must be adjusted – roll it down to the correct weight and clip.
- Lactulose Dose: administer 1g/kg body weight up to 10g (children weighing 22lbs or greater receive the full adult dose of 10g).
- Test Timing – It is recommended to begin the test at least 1 hour after waking, smoke exposure (including second-hand smoke), and vigorous exercise. The test must be performed after a 12 hour + fast (during which only water is allowed).
- Vomiting During the Test – If a patient vomits during the test, the test must be repeated to ensure the lactulose solution made it through the small intestine, or the doctor may choose to treat presumptively without repeating the test.
- Lactulose vs Lactose (Lactose Intolerant Patients) – Lactulose and lactose are different sugars. Lactulose is a man-made sugar that stays in the gut because it is not absorbed. Lactulose preparations do contain some lactose so patients who are anaphylactic to lactose should not consume lactulose. Speak to your doctor about alternatives.
- Mailing Completed Test – The test does not need to be mailed immediately but should be received by the lab within 7 days of sample collection. Send your test as early as you are able, preferably within 3 days of collection.