Hydrogen-Methane Breath Test


Breath analysis provides your clinician information regarding the possible role of bacterial metabolism in your digestive symptoms. Tests can be conducted in the privacy of your home, or in our Auckland clinic. Diagnose problems related to lactose, fructose, sucrose, sorbitol and mannitol.

NOTE: Lactulose and Lactose are used to test different things. Please check you are ordering the correct test.



Written instructions, including the preparation diet are here. In brief, you will follow a special diet for 1-2 days. Then on the morning of testing a baseline breath sample is collected, after which you’ll have a drink with the provided testing substance (a type of sugar). Then, every 15-20 minutes breath samples are collected for a total of 2.5-3 hours. The exact spacing and number of samples is dependent on the sugar being tested (see videos below).

The hydrogen-methane breath test can help determine the role of bacteria in the small intestine in your health and overall digestive function.
Small intestinal bacterial overgrowth (SiBO) has been associated with irritable bowel (IBS), inflammatory bowel diseases (IBD), eczema, rosacea, fibromyalgia, liver disorders and many other conditions. Emerging evidence links it to autoimmune diseases such as scleroderma and neurological disorders such as Parkinson’s Disease & depression.
Breath testing is also used to test for malabsorption or intolerance of other sugars, such as lactose, fructose and sucrose (table sugar), as well as for intolerance of polyols, such as mannitol and sorbitol.

Who Should do the Hydrogen-Methane Breath Test?

There are several indications for running the Hydrogen-methane breath test. The main thing to be aware of is that it is a measure of bacterial activity – no matter which test you choose. Testing for SiBO test may be indicated if you experience any of these symptoms:
  • Gas, bloating, reflux or heartburn
  • Abdominal pain
  • Constipation or diarrhoea
  • People with irritable bowel syndrome (IBS)
  • Hypermobility disorders
  • Unexplained food malabsorption
  • Digestive disturbance after a tummy bug, antibiotics, pain killers or stomach acid-reducing drugs (may also be worse from probiotics, fibre, certain fruit/veges or wholefoods).
  • Skin problems (acne, psoriasis, rosacea etc)
  • Body pain or fibromyalgia
  • Brain fog or fatigue
  • Iron deficiency or gut symptoms when taking iron supplements
  • Cognitive dysfunction (poor memory, concentration/brain fog)
  • Neurological disorders including Parkinson’s Disease
  • Women with endometriosis and digestive problems
  • People with intolerance to FODMAPs

The best strategy for determining the role of bacterial aberrations in the small bowel, is conducting lactulose, glucose and fructose challenges. Additional sugars or polyols can be tested as well.  Discuss with your health practitioner if these might be suitable for you.

Each substrate is tested on different days, with at least 2 days between. You have to follow the same preparation diet for each test.

What are the Options for Doing the Hydrogen-Methane Breath Test?

You can do the Breath Test at home or in our Auckland clinic. The hydrogen-methane breath test kit is designed so that you can collect breath samples in the convenience of your own home. The test is also suitable for children, as long as they can blow into a bag following instruction to do so.

Alternatively, you can arrange to conduct the test in our clinic (Mt Albert, Auckland). If a person is easily confused, overly anxious or for some reason unable to follow instructions accurately, an in-clinic test is the preferred option for accurate results. NOTE: In-clinic tests are run on weekdays. You will need to arrive at the clinic between 9.00am and 9.30am on the test day, and expect to be at the clinic for at least 3 hours.

  • Bacterial Overgrowth: Three breath tests should be conducted, first using glucose then lactulose, then fructose. Each test has its different advantages and disadvantages. Best practice is to complete three tests – glucose, lactulose and fructose. Together, this will inform your practitioner of the bacterial role with a higher degree of accuracy
  • Lactose Intolerance: If you are concerned about dairy intolerance, then lactulose, followed by lactose is the recommended procedure.
  • Fructose Malabsorption: Commonly associated with IBS, a challenge with fructose can be run after a lactulose challenge.
  • Sucrose (sugar) intolerance: Sucrose is common sugar, but also naturally occurs in many fruits and vegetables as well.
  • Sorbitol: this is a polyol that occurs naturally in some fruits (such as apples and some berries). It is commonly added to processed foods and as a lower-calorie sweetener in desserts, chewing gum, snack bars and sweets.
  • Mannitol: this is another polyol, found in some fruit and vegetables such as cauliflower, mushrooms, and commonly used in chewing gum, sweets and other processed foods.

NOTE: according to current breath testing guidelines, a lactulose (+/- glucose) challenge must be conducted before lactose intolerance or fructose malabsorption testing is done.  

How is the Hydrogen-Methane Breath Test Done?

The test is collected in the morning, over about 3-hours (depending on the test sugar), after period of diet preparation. You will need to:

  • Follow a restricted diet for one day (or two if constipated). Diet preparation instructions are here.
  • Fast (water-only) overnight (12 hours)
  • Be awake (no exercise) for one hour before starting the test.
  • Collect a baseline breath sample. Conduct a mouthwash (supplied), then another breath sample.
  • Drink the provided substrate, mixed or dissoved in water
  • Then, at the specified intervals, you will collect additional breath samples (11 samples in total for glucose & lactulose, 7 or 8 samples for frucose & lactose). Follow the instructions on your paperwork. If you are doing multiple tests (e.g., lactulose & glucose), you will only do the mouthwash once.

Watch our instructional video here: (you can pause it at any time) For conducting the GLUCOSE test

For conducting the LACTULOSE test

If you have already done some tests and need to do a Lactose or Fructose test, please check with us for the instructions. We strongly recommend that if this is your first hydrogen-methane breath test for digestive problems, you should complete the “gold trio” of tests, i.e., challenges with Lactulose, Glucose, and Fructose. These three tests are conducted with at least one “rest & diet” day in between – e.g., on alternate days over one week, such as Mon-Weds-Fri.

Each test takes about 3 hours, after which you can eat and drink normally until resuming the preparation diet the following day for the subsequent test.

An example of how this might look is:

  • Sunday: Prep diet
  • Monday: Lactulose challenge test 9am – 12 noon. Eat normally for lunch & dinner
  • Tuesday: Prep diet
  • Wednesday: Glucose challenge: 9am – 11.30am. Eat normally for lunch & dinner
  • Thursday: Prep diet
  • Friday: Fructose challange: 9am – 12 noon. Eat normally thereafter.

Analysis of results from challenging with each of these three sugars provides your clinician with the most accurate information regarding bacterial metabolism in your digestive symptoms.

What Will I Need to Conduct the Hydrogen-Methane Breath Test at Home?

If you choose to purchase kits to do hydrogen-methane breath testing at home, you will need:

  • One kit for each sugar substrate being tested
  • A timer (the one on your cell phone is perfect)
  • Water and glass
  • Pen
  • A 4-hour period for conducting the test (one hour of which is being awake before testing can start)

Everything else is supplied in the test kit. For accurate results, it is crucial that the breath samples are collected correctly, with at least one day between each test. Please watch the videos above and read the instructions in your kit, which explains the procedure.

If you are easily confused, overwhelmed, anxious or unsure if you can collect the samples correctly, please contact us to book the test at our lab. Once your test has been completed, you can eat and drink normally. Package the tubes in the box they came in, place in the pre-paid courier bag provided and either phone the courier to collect or drop in to your local post shop.

How do I get the Results of my Hydrogen-Methane Breath Test?

A consultation is required to discuss your breath test results and to develop a management plan when your samples have been analysed. Reports are typically ready within 5-7 working days of them being received at our lab. The results session/initial (comprehensive 90-minute) consultation can be booked with either Sharon Erdrich, Emma Gardiner, Elena Turner, Latimer Clark, or Verity Vincent, or your report will be forwarded directly to your registered health practitioner. You can read more about breath testing here.

Our testing and interpretation protocols are congruent with those outlined in the North American Breath Testing Guidelines (2017) as published in the American Journal of Gastroenterology (PMID28323273), the American College of Gastroenterology Clinical Guideline for breath testing, and have been further refined based on our own research.

Please note: Test results are delivered in the context of a professional consultation – either in our clinic, online or we can send the results to the registered health consultant you specify. For more information about the background and science behind the SiBO test, please read here or give us a call 09 846 5566 Read more about SiBO here

Lactulose and Lactose are used to test different things. Please check you are ordering the correct test. Samples must reach us within 5 days of collection (a return courier bag is provided). Results are generally completed and sent to your practitioner within 5-7 working days. You can read more about Hydrogen-methane breath testing here.

Book an in-clinic test by calling us on 09 846 5566

Additional information

Weight 0.3 kg
Dimensions N/A
Test Options

Test kit (at Home), Two-test combo (Kits, any two), Three-test combo (Kits, any three), Four-test combo (Kits, any four), In-clinic test (by appointment, Mt Albert, Auckland)

Test Substrate #1

Lactulose, Glucose

Test Substrate #2

Glucose, Lactulose, Fructose, Lactose (This is not for SIBO testing), Sucrose, Sorbitol, Mannitol, None

Test Substrate #3

Lactulose, Glucose, Fructose, Lactose (This is not for SIBO testing), Sucrose, Sorbitol, Mannitol, None

Test Substrate #4

Glucose, Fructose, Lactose (This is not for SIBO testing), Sucrose, Sorbitol, Mannitol, None