Tag Archives: irritable bowel syndrome

SIBO (Small Intestine Bacterial Overgrowth) Breath Test

Is the SIBO breath test the right laboratory test for you?

In our experience, many persons having digestive symptoms receive a diagnosis of irritable bowel syndrome (IBS), but no particular guidance in identifying possible causes, or options for treatment other than symptom management (e.g., laxatives). SIBO (Small Intestinal Bacterial Overgrowth) breath testing may be the first step to understanding your digestive symptoms, and taking action at the “root cause” level.

Although this test is commonly referred to as SIBO breath testing, it may also be used to diagnose carbohydrate (sugar) malabsorption.

This laboratory test is used primarily to identify possible causes of:

  1. Unexplained irritable bowel syndrome (IBS) symptoms1 (abdominal pain, bloating, gas; diarrhea and/or constipation; mucous in stool2)
  2. Unexplained abdominal bloating3

Other health conditions associated with SIBO include:

  • Weight loss1
  • Anemia1
  • Malnutrition1
  • Hypothyroidism
  • Fibromyalgia1
  • Parkinson’s disease1

Specifically, this test diagnoses:

  1. Overgrowth of bacteria in the small intestine, or migration of bacteria from the large intestine to the small intestine3

  2. Carbohydrate (sugar) malabsorption3

How does SIBO breath testing work?

Breath testing relies on measurement of gases produced in the intestines that diffuse into the bloodstream and are ultimately expired through the lungs.3

Two of the main gases found in the breath, and produced exclusively by microbial fermentation of carbohydrates, are hydrogen and methane.3

Excess hydrogen and/or methane will be produced if excessive gut bacteria cause excessive fermentation of carbohydrates, either:

  1. In the small intestine because of small intestine bacterial overgrowth (SIBO)4, or
  2. Malabsorption of carbohydrates in the small intestine, allowing excessive carbohydrate to progress to the large intestine (colon), where there is excessive fermentation by bacteria.4

Basically: expired air is collected, and if it contains excessive hydrogen or methane, the only possible causes are excessive fermentation of carbohydrates by bacteria, either in the small or large intestine (depending on the timing of the higher than normal readings).

How does this SIBO breath test compare with other assessment options?

At Toronto-Centre for Naturopathic Medicine, we use BioHealth Laboratory’s test for SIBO breath testing, which is the most comprehensive option available to naturopathic doctors in Ontario.

The BioHealth Laboratory test:

  1. Measures both expired hydrogen and methane, and
  2. Offers testing using any combination of lactulose, glucose and fructose as test substrates.

These are important considerations, as:

  • 15% or more persons will produce methane rather than hydrogen   with microbial fermentation of carbohydrates. Tests measuring only hydrogen may result in a “false-normal” result for these persons.5
  •  Although measuring glucose fermentation alone is more sensitive (i.e., less likely to miss a diagnosis) than measuring lactulose fermentation alone in assessment of SIBO4, measuring both offers the most accurate assessment of gut bacteria status. Glucose is completely absorbed in the first section of the small intestine4, lactulose is absorbed throughout the small intestine, including the later portion of the small intestine6 and large intestine.Measurement of both allows for the most sensitive assessment of SIBO the first section of the small intestine; (slightly less sensitive) assessment of the later portion of the small intestine; and carbohydrate malabsorption resulting in excessive fermentation in the large intestine. 
  • Fructose malabsorption, although poorly understood as related to digestive symptoms, has been demonstrated to relate to increased severity of IBS symptoms.1

Importantly, breath testing is more reliable for “ruling in” SIBO than “ruling out” SIBO – if breath testing demonstrates you have SIBO, you almost certainly do; if breath testing suggests you do not, you probably do not, but be open to the possibility the test is incorrect.4

Other methods for assessing possible SIBO are:

  1. Bacterial culture – the most direct method, considered by some to be the “gold standard” (other experts are of the opinion no “gold standard” exists for diagnosis of SIBO4), but inconvenient to the patient, and prone to “false-normal” (i.e., incorrectly “ruling out” SIBO) results and contamination in the sampling process1, 4
  2. Urine organic acids testing (OAT) – sometimes suggested as an assessment option, but not diagnostic for SIBO7
  3. Stool analysis – sometimes suggested as an assessment option, but not diagnostic for SIBO7

How can you ensure the most accurate result possible?

Different laboratories suggest different (or no) guidelines for preparing for breath testing, but according to guidelines established in the 2017 Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus statement3, in order ensure the most accurate result possible:

  1. Antibiotics should be avoided for four weeks prior to breath testing.
  2. (If possible), promotility drugs and laxatives should be stopped at least one week prior to breath testing.
  3. Fermentable foods such as complex carbohydrates should be avoided on the day prior to breath testing.
  4. A fasting period  of 8 to 12 hours prior to breath testing.
  5. Smoking should be avoided on the day of breath testing.
  6. Physical activity should be limited during breath testing.
  7. Discontinuation of proton pump inhibitors prior to breath testing is not necessary.

What is the procedure for SIBO breath testing?

This test is conducted at home with a provided test kit.

  1. Beginning 24-hours before beginning the testing procedure, the specified diet must be followed.
  2. Beginning 12-hours before  beginning the testing procedure, the patient must fast.
  3. A baseline breath sample is collected.
  4. The glucose, lactulose or fructose mixture is consumed.
  5. Breath samples are collected every 15-minutes following mixture consumption until all 9 to 12 vials are filled (135 to 180 minutes, depending on test conducted).

In a nutshell:

  1. Consider this laboratory assessment if you have been diagnosed with IBS, or have digestive symptoms, with no identifiable cause.
  2. Measurement of both hydrogen and methane (as opposed to hydrogen only) allows for the  most accurate assessment of SIBO and carbohydrate malabsorption.
  3. Hydrogen/methane breath test using lactulose-only as a test mixture is more affordable (compared to lactulose and glucose test mixtures), and although slightly less sensitive, more reliably assesses the entire length of the small intestine.
  4. Testing for fructose malabsorption may be considered if suffering from severe IBS symptoms.
  5. This test is non-invasive, conducted at home, and requires up to three hours to complete.

Jonah Lusis, ND


  1. Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut. 2006;55(3):297-303. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856094/.
  2. Mayo Clinic [Internet]. Irritable bowel syndrome. [cited 2018 Nov 23]. Available at: https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016.
  3. Rezaie A, Buresi M, Lembo A et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol. 2017;112(5):775-784. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418558/.
  4. Ghoshal UC. How to interpret hydrogen breath tests. J Neurogastroenterol Motil. 2011;17(3):312-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155069/.
  5. deLacy Costello BP, Ledochowski M, Ratcliffe NM. The importance of methane breath testing: a review. J Breath Res. 2013 Jun;7(2):024001. doin:10.1088/1752-7155/7/2/024001.
  6. BioHealth Laboratory [Internet]. Small intestinal bacterial overgrowth (SIBO) breath testing.  [cited 2018 Nov 23]. Available at: https://www.biohealthlab.com/test-menu/sibo/.
  7. Siebecker A, Sandburg-Lewis S. SIBO: the finer points of diagnosis, test interpretation, and treatment. Naturopathic Doctor News and Review [Internet]. 2014 Jan 7 [cited 2018 Nov 23]. Available at: https://ndnr.com/gastrointestinal/sibo/.



Posted: 2018 Nov 23

Bowen Therapy (Bowen Technique)

Relax, Reset, Rebalance

Bowen Therapy is a gentle, hands-on treatment used primarily to decrease pain and increase mobility, and reduce stress and anxiety.

A much more gentle intervention than many conventional pain treatments (e.g., some forms of chiropractic manipulation or physiotherapy), Bowen Therapy may be an effective alternative for patients having much pain (e.g., severe injury), increased sensitivity to pain (e.g., having fibromyalgia); or simply requiring gentle treatment (e.g., elderly, children).

It addresses an area that most pain therapies ignore, “centralized pain”, “re-training” your brain to “let go” of it’s pattern of experiencing pain, particularly chronic pain, pain that has not responded well to other treatments (e.g., “frozen shoulder”), and pain in persons seeming to be extraordinarily sensitive to pain (e.g., fibromyalgia).

Bowen Therapy may be used as either a primary treatment, or supportive treatment. As a primary treatment, it typically used for chronic conditions affecting the musculoskeletal system (e.g., fibromyalgia, recovery from injury, “frozen shoulder”).

It is used as a supportive treatment in cases where the autonomic (“unconscious”) nervous system appears to be in need of being “re-set” (e.g., constipation, heart palpitation) or for stress management (e.g., management of anxiety).

The goal of treatment using Bowen Therapy is usually complete resolution of pain, or complete return to previous function.

Benefits of Bowen Therapy

Bowen Therapy may be of benefit, in some capacity, the treatment almost any health condition.

A study titled “The Bowen Technique: a study of it’s prevalence and effectiveness”, presented at the University of North Carolina, Chapel Hill found that Bowen Therapy treatment was:

  • 95% effective in the treatment of temporomandibular joint (TMJ) dysfunction
  • 88% effective in the treatment of neck pain
  • 85% effective in the treatment of low back pain
  • 83% effective for the treatment of stress and tension
  • 80% effective for the treatment of fibromyalgia
  • 80% effective for the treatment of hip pain
  • 75% effective for the treatment of non-specific pain conditions

Other research has demonstrated that Bowen Therapy:

  • Improves decreases tremor and improves sleep quality in patients having Parkinson’s disease
  • Reduces heart rate variability (“normalized” heart rate) and slows heart rate in 100% of fibromyalgia patients
  • Increased neck range of motion, and decreased “disability scores” in patients having trapezitis (neck and shoulder pain, and restricted movement) when combined with physiotherapy
  • Improves mobility and function; and reduced pain (on average) from a score of 7/10 to 1/10 in 100% of “frozen shoulder” patients
  • Reduces migraine headache frequency and/or intensity in 80% of patients
  • Improves symptoms of restless legs syndrome in 3/5 patients receiving treatment
  • Completely reduces symptoms of carpal tunnel syndrome in 4/6 patients receiving treatment, with complete resolution of symptoms  in 3/4 of these cases
  • Significantly improves motor function of patients recovering from stroke
  • Improves sleep and a general sense of well-being

A single Bowen Therapy treatment has been demonstrated to:

  • Decrease feelings of depression by 51%
  • Decrease feelings of anxiety by 21%
  • Decrease fatigue by 41%
  • Decrease sense of tension by 62%
  • Decrease feelings of anger by 47%
  • Decrease confusion by 33%
  • Increase flexibility (in hamstrings) by 26-34%

Learn more about the experience of, and results from Bowen Therapy treatment for a range of health conditions at these sites:

  • Details of some of the research described above, including studies on treatment of frozen shoulder, carpal tunnel syndrome and restless leg syndrome
  • Six case reports, including treatment of disc injury
  • Six case reports, including treatment of sciatica, carpal tunnel syndrome and “tennis elbow”
  • Six case reports, including treatment of hip and knee pain, and recovery from knee and lung surgeries
  • Six case reports, including treatment of various neuralgias
  • Five case reports, including treatment of sciatica; and further insight into potential mechanisms of action of Bowen Therapy
  • Four case reports, including treatment of migraine headaches, sciatica and “frozen shoulder; and further insight into potential mechanisms of action of Bowen Therapy
  • Three case reports, including recovery from auto collision
  • 22 case reports, including treatment of children, “frozen shoulder” and sciatica
  • Seven case reports, including treatment of “frozen shoulder”, carpal tunnel syndrome and migraine headaches
  • Two case reports of treatment of Parkinson’s disease
  • A case report of treatment of migraine headaches

What to Expect

Bowen Therapy involves application of gentle pressure to the muscles, tendons and other soft tissues at specific points, and in specific sequence.

Treatments are approximately 30 to 45 minutes long, and performed weekly or bi-weekly for the first four sessions.

Treatment frequency is then individualized to your response to treatment (e.g., if your pain is resolved, but returns after three weeks, treatments will be scheduled at three week intervals).

Improvements in pain levels or function may be experienced after as few as one treatment.

Bowen Therapy at Toronto Centre for Naturopathic Medicine

Bowen Therapy treatments at Toronto Centre for Naturopathic Medicine are performed by Du La, ND and Jonah Lusis, ND, both of who have been certified in Bowen Therapy by the Bowen Therapy Academy of Australia since 2002.

Bowen Therapy treatments provided at Toronto Centre for Naturopathic Medicine are covered by most extended healthcare plans.

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Ginger Syrup, the Most Delicious Medicine

As promised in our Wellness Wednesday video, here is Du La, ND, Acupuncturists recipe for simple ginger syrup. Enjoy!

Ginger is one of our favourite herbs, not only for cooking but also as a natural remedy for fevers, colds, chills and nausea. It stimulates circulation supporting immune system activity; “loosens” congestion; and promotes a “good” sweat (releasing “heat” in the Traditional Chinese Medicine paradigm). It is an exceptional remedy for stomach-aches and nausea whether from pregnancy or motion sickness; and is recognized as the most useful herbs for reduction of nausea caused by chemotherapy.

Getting children to take medicines can be a challenge. Ginger is great because it is one of the few medicines they actually enjoy, especially when paired with honey.

One of our favourite home remedies is ginger syrup. It’s not only a medicine, but can be used as a base for homemade ginger tea, or ginger ale in hot summer months.

This is how we make a simple ginger syrup:

Peel 2 fist-sized pieces of ginger root (to minimize waste, scrape the skin of the root using a spoon).

  1. Slice roots into 1 cm pieces.
  2. In a small saucepan, add ginger pieces to 4 cups of water.
  3. Bring mixture to boiling, then reduce to medium heat and leave uncovered, at a rolling boil until approximately half the liquid has boiled off (approximately 1 to 2 hours).
  4. Strain ginger root pieces from mixture (technically called a decoction).
  5. Stir in 1 cup of raw honey.
  6. Let syrup cool, then refrigerate.
  7. Ginger syrup can be stored for up to one month if refrigerated.

For homemade ginger ale:

add sparkling water to ginger syrup to taste (approximately 3 tablespoons syrup in a cup of water). Add ice cubes and garnish with lemon or lime slices.

For ginger tea:

Simply add approximately 3 tablespoons of ginger syrup to a cup of boiled water. Sprinkle with a pinch of freshly ground cinnamon or add a few cracked cardamom pods.

To make a digestive cordial:

Do not strain ginger slices from the decoction. Add honey as above, together with 2-3 cinnamon sticks and 10 or so cracked cardamom pods.

Refrigerate for 1-2 weeks and strain before use.

A digestive cordial can be had on it’s own (1 teaspoon at a time when having abdominal bloating or fullness), or as a sparkling drink or tea.

We hope this simple recipe inspires you to add this great medicinal food to your lifestyle!



Posted: 2014 August 27

Should I do an elimination diet or do an allergy blood test?

In dealing with inflammatory and irritable bowel diseases, elimination diets and IgG food testing are an important tool in crafting a treatment plan. In this post, Jonah Lusis, ND discusses what they are, and which is preferred.

I suspect my diet may be contributing to my digestive symptoms. Should I do an elimination diet or do an allergy blood test?

You can do either.

The strength of an elimnation diet is that it is a “bottom line” evaluation, asessing whether or not a food causes you to feel unwell regardless of whether the cause is immune-related, intolerance-related or sensitivity-related. It is ideal for conditions in which symptoms are the primary concern, such as irritable bowel syndrome.

Allergy blood testing is for an “IgG immune response” and will only identify foods causing an autoimmune response (i.e., “allergic”).

This approach is recommended for persons having autoimmune (i.e., inflammatory) conditions (e.g., inflammatory bowel diseases, multiple sclerosis, widespread rheumatoid arthritis) because it identifies foods that cause an immune system response, regardless of whether you are aware of symptoms in the digestive tract.

The bottom line:

  • Irritable bowel disease: elimination diet > IgG assessment (but IgG assessment can be helpful if an elimination diet is not possible)
  • Inflammatory condition: Do an IgG assessment

In our final post for Crohn’s and Colitis month, Jonah Lusis, ND will explain the difference between a food allergy test administered by an MD and an IgG test.

Let us know if we can help (with your digestive health or otherwise)!


Posted: 2014 November 20

What is an Elimination Diet?

Continuing our conversation on improving digestive health, Jonah Lusis, ND discusses in this two-part question, an elimination diet and its benefits in treatment.

What is an elimination diet?

An elimination diet is a therapeutic diet used to identify foods a person doesn’t tolerate well.

There are various versions of an elimination diet, depending on the specific health concern being addressed, but at their core they will feature removal of foods most people are either allergic to or do not tolerate well, but are commonly eaten. Examples of commonly “eliminated” foods are dairy products, wheat and eggs.

The goal of the diet is to confirm whether or not the persons symptoms abate in the absence of these foods.

An elimination diet will typically last three weeks.

I have already removed foods I suspect are causing my symptoms, do I need to complete an elimination diet?


It is important to remove all suspect foods simultaneously. For example, if you do not tolerate wither wheat or dairy, and have removed them from your diet, but not at the same time, you many have concluded: while not having wheat, but feeling unwell from the dairy you are still consuming, that wheat is not causing your symptoms. The same applies in reverse. This can lead to the ultimate conclusion that neither wheat or dairy or your problems foods when in fact both are.

Tune in next week when we will discuss gluten: the good, the bad, and the ugly.

For more help with elimination diets and digestive symptoms, get in touch!



Posted: 2014 November 6


What is the difference between the food allergy test I have had with my MD, and an IgG allergy test?

In our last “Ask the Doctor” post for Crohn’s and Collitis Month, Jonah Lusis, ND answers a commonly asked question about IgE and IgG food testing.

What is the difference between the allergy test I have had with my MD, and an IgG allergy test?

The allergy test you have with your MD is usually a “skin-scratch” test. This test evaluated whether your body has an IgE (a type of immune system chemical) response to foods. The IgE response is the “immediate” response (e.g., hives, throat constriction) your immune system mounts to foods you are allergic to.

An IgG allergy assessment (such as this one) is a blood test that evaluates foods that trigger an IgG (a second, different immune system chemical) response by your body that also produces inflammation, but is typically delayed, and therefore more difficult to detect (e.g., migraine headaches, eczema).

Jonah Lusis, ND

We hope you enjoyed our digestive health series!

If you are struggling with digestive issues and are ready to get you tummy on track, we can help.


Posted: 2014 November 27