My lactulose breath test: prep day diet.

The gastroenterologist I saw 2 weeks ago agreed that I probably have SIBO. She told me that if I wanted to do the 3-hour lactulose breath test to help confirm the diagnosis, I was welcome to do so... but she didn't think it was necessary. She was willing to treat me with drugs (Rifaxamin, Flagyl and Culturelle) even without a test.

That was interesting.

Why wouldn't I want to do the test? Well, first of all, it's expensive. Second of all, it takes three hours and you have to do a bunch of restrictive prep. Third, a lactulose test is not exactly a gold standard. There is no gold standard for confirming SIBO. One accepted way to diagnose SIBO is simply if the patient gets better from treatment!

As for the lactulose breath test, controlled studies (comparing test results of people with and without IBS) have cast doubt on its validity. Evidently, there is a high rate of "false positives" in people without IBS. This makes the lactulose test perhaps most useful in ruling out SIBO, when a negative result is found.

However, a negative test result is not considered conclusive either.

With all this controversy, why bother testing at all? Why not just treat with diet, prokinetics and antibiotics of choice (drug or herbal)?

I was leaning towards going that route. I know how to treat this thing and I'm raring to get started!

But in the end I decided to do the test anyway. Why? I guess my reason, in the words of Sir Edmund Hillary, is simply this: "Because it's there."

I'm curious. I want to know what it will say.

Which brings me to chicken. The day before taking the lactulose breath test one can only eat a limited prep diet. It allows no food other than your choice of: eggs, chicken, fish, white rice and (!) white bread. (Weird.) For drinks you can choose between: water, black coffee and black tea. That's it. A little salt and pepper is permitted, but no honey, sugar, dairy, fruit, vegetables, whole grains, etc. Nada. Plus you have to fast on water for the final 12 hours preceding the test. This means no food from dinner on, until after the test is done the next morning.

I'm planning on doing the test tomorrow at 9 AM. So for today, I'm all about:

I bought an organic chicken at Whole Foods yesterday. This morning, I woke up and put the whole thing in my big old Le Creuset. Covered it with cold water. Brought the pot to a boil and simmered for a few hours, until the meat was soft and the bones broke apart with the side of a spoon. That's what I'm eating today. Chicken meat and chicken stock. No salt, no vegetables, no herbs. Just plain.

I'm a teensy bit surprised, but it has a lot of flavor! When you're hungry, simple really tastes good.

Meanwhile, I'm making bone broth for later on. This is fragrantly seasoned—with chopped ginger, carrot trimmings, a bay leaf, fresh black pepper, oregano and tarragon. I also add a tablespoon of apple cider vinegar to help pull minerals from the bones into the broth. Yum.

But I won't be enjoying this mineral-rich elixir today.

Today it's just the basics: boiled chicken, chicken stock and white rice, if I dare. I've been avoiding rice and other grains for two weeks (see my previous safe food list post) but maybe I'll have some today. Feed the minions—why not? Their days are numbered, might as well let them go out with a bang. Or an explosive fart, as the case may be.

With thanks to Maurice Sendak. Going once, going twice...