Everything they don’t tell you about the TrioSmart SIBO Breath Test

I definitely always smile sweetly while breathing into my SIBO breath bags.

Back before I lost my innocence, I thought a SIBO breath test would be like…you go into a doctor’s office, breathe into a machine, and your results pop out. Easy peasy, lemon squeezy.

Sweet summer child.

You’re probably ahead of past Kira, but in case you aren’t, a SIBO (small intestinal breath overgrowth) breath test collects a sample of your breath every 10-15 minutes over a few hours. There’s a strict prep diet and fasting period involved, and the test requires detail wrangling that I personally find more painful than hella-chugging a lactulose solution on an empty stomach (also part of the test), but I’m a wimp about details.

TrioSmart vs. Genova

TrioSmart Breath Test is the one you want. It costs slightly more than the Genova, but it measures for hydrogen, methane AND hydrogen sulfide. Currently, it’s the only test to test for all three gases.

I personally also prefer the TrioSmart’s kit—it’s just nicer and easier to use. Also, after watching UPS (no shit) DROP KICK the boxes 30 feet into the truck (sigh), I appreciated the heavier-duty breath bags.

The test comes with easy-to-follow directions in a simply printed brochure, which I appreciate when the brain fog kicks in. They’ve put a lot of thought into the patient experience designing it.

That said, there’s always little things to make the experience better. I personally like to know EXACTLY what I’m getting into. So, lemme share my little tips for getting through this.

I’ve now taken a whopping FIVE SIBO breath tests. Hot tips:

Way before the test:

1) You can do them at home, but you may have to ask for the kit. In fact, TrioSmart is ONLY done at home, whereas the Genova can be done in-clinic or at home (I’ve done both. Home is better!)

2) If you choose to do the TrioSmart or another at-home test, MAKE SURE the provider signed the requisition form. Check IN THE OFFICE when you are picking the test up. Check right away if the package has been mailed to you. Providers forget to sign home test requisition forms all the time. And you do not want to wake up on Day 2 of food deprivation, ready for a quiet morning of doing your test, only to find you are signature-less and have to use all your spoons to dash to the clinic and deal with bad masking and bureaucratic nonsense (me this am).

3) Get your substrate! The TrioSmart doesn’t come with glucose or lactulose—make sure to get a prescription for it, and pick it up. Doctors like to tell patients to get glucose, because it’s less likely to give a false positive. This is because glucose only tests the uppermost portion of the small intestine—you have to have SIBO in the right PLACE to trip the wire. I personally believe lactulose requires a more artful reading based on an understanding of your own transit time, and that’s what I prefer—but I’ve read enough studies to know that if my “spike” hits at 70 minutes, that doesn’t automatically mean SIBO. (IYKYK, if you don’t, I’ll do a post about it sometime.)

3) Time your test right. At bare minimum, a SIBO breath test means a full day of special diet, 12 hours of fasting, a following morning to do the test (to get the 12 hour fast in), and possibly feeling like crud for a day or three afterwards from the lactulose, which is a SIBO trigger. (I personally have never felt THAT awful from it, but I kinda feel awful all the time?) For many, it also means avoiding certain medications for MONTHS beforehand, and not taking laxatives or promotility drugs for a week.

You’ll also need to get the test to UPS within 24 hours, so patients who plan on doing that errand the next morning will need to take into account when UPS is open or can do a pickup. I personally do not trust pickup and take mine in the instant the test is over. But this means watching for Sundays and holidays.

4) Plan to keep calm during the test. You might think you can run errands or field important calls between breath samples—DON’T. For one thing, exercise of any kind throws off your test. For another, you’re likely to be spacy and out of it during the test, because you’ll be food-deprived and sugared-up. Plan on low-stakes distractions, NOT multi-tasking on anything important.

5) Follow the strictest iteration of the prep diet possible for the best results. Yes, it sucks, but it’s worth it for accurate results.

6) Plan an (easy) reward. These tests always make me feel extra sick—not symptomatically, just…patient-y. The restrictive diet makes me crabby and having to take a morning away to breathe in bags just reinforces that I’m sick and things aren’t going well. For me, it’s depressing—which is why I plan a treat to look forward to. For me, it’s getting my decaf espresso shots on the way to UPS to deliver the test. For you, it may be an extra good lunch, or clicking buy on something you’ve had in an online shopping cart, or watching some extra bad TV for the afternoon. Whatever it is, plan to reward yourself for getting through this.

A completed TrioSmart breath bag—one of 9. The flute top reminds me of playing the recorder in fifth grade.

Doing the test:

I like to deal with all the paperwork and labeling and minutiae during the test—the 10-15 minute breaks aren’t really enough to focus on a ton else. (Confession: I’m writing this post between samples, but it’s my fifth rodeo.)

1) Don’t worry about getting all set up—just get your baseline sample to start the process. Then, immediately chug your lactulose or glucose as directed. That starts the timer, and gets you that much closer to lunch. Luuuunch…

2) As soon as you get the substrate down, SET ALARMS for each sample, not a timer (although a backup timer is cool!). After two days of food and coffee deprivation and a shot of lactulose on an empty stomach, you’ll be a space case. Can say from experience: if you don’t set an alarm for each sample, you are 100% likely to get distracted, space off, and miss one. Or, forget to set your timer for the next sample. Just set the alarms, and then you can spacily fill out labels in between samples, or futz around on the internet.

3) Do your breath test properly. The sample is essentially looking for the gases at the bottom of the lungs, not the top, which is why we let the first two seconds of air go through the hole in the valve. I never do it quite right on the first sample—the impulse is to close the valve too fast. By the last ones, I’m breathing like a champ, letting a full two seconds go. It’s helpful for me to focus on collecting from the bottom of the lungs.

4) I like to fill out my label, slap it on, and attach my valve for the next test as soon as I finish one. It’s easier to put the labels on a deflated bag, and then it’s set to go when I inevitably forget what I’m doing and the alarm rings telling me it’s time for the next test. I’ve also tried filling all the labels out in advance but it’s just a bigger pain to make sure you’re breathing into the right bag that way, for me.

5) Run it through insurance. This is a good time to print out copies of your insurance cards to send with the form. My insurance has only ever paid for one SIBO test, but hope springs eternal. I always think it’s worth trying, since the cash price is the same.

6) If you only have the energy to focus on a few samples done right, really focus on the first six. These are the most critical—getting your baseline, and tracing the roughly 80 minutes of transit through your small intestine. If you are losing steam due to ME/CFS, the last three samples don’t matter as much, because you’re likely already into the large intestine at that point. You’ll still need to get them done, but if your breathing is getting wimpy or you just can’t focus on doing them right, this is the place to fudge.

7) If I’m not planning to go out to get a reward, I start prepping my lunch around test 7. It takes awhile to cook (mostly inactive) but that means as soon as test 9 is done, I can EAT, for real, for the first time in days! My diet is still really limited, but nothing like a chicken-rice only diet to make me appreciate what I can have. If I am planning to go out to get a reward, by test 8, I am getting the box together so I can get out the door right after test 9. (When I’m hungry, I get weird manic energy.)

Gather your breath. (It’s weird that it’s a biohazard—really!?)

After the test:

The test is a pre-labeled UPS dropoff, which means theoretically, they will come pick it up. I’ve found mail services unreliable lately, and would rather drop it off myself. Since it’s pre-labeled, you could also ask or hire someone else to drop it off for you.

Stick to your reward (as long as you still want it—you might be a little off food rewards post-test). You made a promise to yourself—keep it.

You’re done! Don’t forget your requisition forms and insurance card copies, slap on the label, and ship it, ship it good. Then get your reward!

Did you find this helpful?

Consider throwing down in the tip jar—100% goes towards either upkeeping this website or paying my medical bills. (So far, I’m still back on trying to upkeep the site…)