SIBO
If you have been following my discussions, you are aware that a consumer device, the AIRE device from FoodMarble, now makes testing for hydrogen (H2) gas on the breath incredibly easy, accomplished in the comfort of your home.

Having the AIRE device spares you the hassle of:

  • Educating your doctor or persuading him/her that you need H2 breath testing. Sadly, most practicing mainstream physicians are woefully out-of-touch with the flood of science that has documented how SIBO and the associated endotoxemia play roles in virtually every aspect of health including blood pressure and blood sugar, insulin resistance, fatty liver, depression and anxiety, various forms of heart disease, dementia, weight gain, colorectal cancer and numerous other conditions.
  • Going to a lab or clinic to obtain the testing. The entire test requires up to 4 hours to complete, a substantial dent in your time. Most of the time is spent just waiting for samples to be obtained. And, of course, an interaction at any healthcare facility inevitably comes with endless forms to fill out.
  • Delayed results—Because the 7 or so breath samples have to be analyzed, there is typically days to weeks of waiting for results that are relayed to the doctor, who then has to relay them onto you. Most people know that conveying results of medical testing is not a sleek process in most doctors’ offices.
  • Cost—H2 testing in a lab or clinic can easily cost $300 or more, depending on how much they markup the basic test. This charge applies every time you undergo testing, including follow-up after, say, a course of antibiotics for SIBO, or testing for the all-too-common recurrences.

The AIRE device does not require a doctor, can be performed in your own kitchen or living room, and has a one-time cost of around $200 and can be used over and over again.It is a real-time method that yields immediate results. But I believe that there are other advantages that make home testing superior to conventional lab testing. Among the potential advantages of doing it yourself with the AIRE device rather than testing in a lab or clinic:

  • You blow directly into the sensor with the AIRE device and thereby more reliably capture breath contents. The conventional test requires you or a technician to capture breath in a container that you then cap. But H2 gas is the smallest gas molecule there is and can escape quickly. Because it is so small, a sample of breath contained in a vial escapes over time, also, especially if it sits on a lab counter for more than a few hours.
  • Results are immediate—There is no waiting for days to weeks for results. Results are Bluetoothed from the AIRE device to your smart phone within seconds.
  • We use inulin as the challenge substrate, a fiber that is consumed by more species than lactulose used in conventional testing. In other words, after obtaining a baseline H2 measure, we ingest 10 grams of inulin that is metabolizable by a wide variety of bacterial species, good and bad. The non-digestible sugar, lactulose (which is only available by prescription, oddly), used in conventional testing is not metabolizable by many of the species that dominate in SIBO. Some strains of E. coli, for instance, and Staphylococcus aureus, Salmonella, Shigella, and Proteus—all species that can proliferate in SIBO—have been shown to not metabolize lactulose and are therefore undetectable if they are among the dominant species. 
  • Repeated measures can be obtained—You can obtain daily breath H2 samples during your efforts to eradicate SIBO to assess response and gauge when you have achieved success. Repeated measures in a lab or clinic would be exceptionally time consuming and expensive.
  • SIBO recurrences are easy to confirm—Say your initial SIBO symptoms were gas, bloating, and evidence for fat malabsorption (fat droplets in toilet). You successfully eradicate the SIBO with a course of herbal antibiotics or my recipe for SIBO Yogurt (recipe in Super Gut). However, 6 months later you experience a panic attack—is this SIBO recurrence or not? You could go back to the doctor, who then orders another round of SIBO testing at the lab or clinic for another $300+, or you could just blow into your AIRE device and know immediately. (Recurrences can take on a different symptom profile than the original situation, likely due to a change in microbial composition.)

The newest AIRE device, AIRE 2, also measures methane (CH4) gas for detection and tracking of intestinal methanogen overgrowth that can cause constipation (including IBS-C, i.e., irritable bowel syndrome with constipation, or IBS-M, IBS with alternating diarrhea and constipation).

Inventor of the AIRE device, engineer Aonghus Shortt, Phd in Dublin, Ireland tells me that a clinical trial is ongoing comparing conventional H2 testing to AIRE testing. My prediction: AIRE testing, due to the above more reliable breath capture phenomenon, will succeed in identifying cases of SIBO with greater success than capturing breath in vials.

Note: I have no relationship with FoodMarble except that I’ve gotten to know the inventor and founder, Aonghus Shortt, PhD (PhD in engineering). Because he conceived of the AIRE device as a means of measuring H2 on the breath for people with irritable bowel syndrome (IBS) who are trying to navigate a low-FODMAPs diet, I called Dr. Shortt and informed him that it is also a “mapping” device to decipher where in the gastrointestinal tract microbes are dwelling. We have since talked a number of times and will likely collaborate on a study using the AIRE device. Because the instructions that come with the device only apply to IBS and low-FODMAPs diet, the full instructions on how to use the device and interpret results for SIBO detection are all contained in 7 pages of instructions in my Super Gut book.