Hydrogen-Methane Breath Test


Results of your breath test provides your clinician information regarding the possible role of bacterial gases 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.


Are you Concerned About Your Digestive Health?

Increasingly, the light is shining upon the important role the digestive system and the organisms that live there have on many aspects of health. While irritable bowel syndrome (IBS) is a common condition and you may or may not have it, understanding the role of gut bacteria in a digestive problem is now possible.
When bacteria overgrow in the small intestine, “Small Intestinal Bacterial Overgrowth” (SIBO) can occur. Excessive bacteria in the small intestine ferment your food, causing common problems such as:

  • Gas (wind)
  • Bloating (abdominal distension)
  • Pain
  • Altered bowel habits (constipation and/or loose stool)
  • Feeling unwell after eating.

Now you can test for SIBO, fructose intolerance and/or lactose malabsorption or test FODMAPs at home by collecting samples of your breath!

Written instructions for the breath test, including the preparation diet, are here. In brief, you will follow these steps

  1. Follow a special diet for either 1 or 2 days (depending on the diet you choose to follow) before performing the test.
  2. On the morning of testing ONE HOUR after getting up (no vigorous exercise, eating or smoking allowed), a baseline breath sample is collected
  3. You’ll have a drink with the provided testing substance (a type of sugar) with a glass of water. You are not permitted to have anything else to drink for the the first hour, then you may drink water only.
  4. Breath samples are collected every 15-20 minutes 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 also 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 – we advise being guided by a competent practitioner. The main thing to be aware of is that the breath test is a measure of bacterial activity – no matter which test you choose. Testing using a hydrogen-methane breath 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 3 breath tests, using lactulose, glucose and fructose challenges as each sugar gives different information. 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 book to do the breath test 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.

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 08.30am and 09.30am 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, the recommended procedure is to first do a lactulose challenge, followed by lactose.
  • 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. It can be tested after a lactulose challenge.
  • 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. It can cause digestive distress in those who cannot digest it.
  • 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. It can also cause digestive distress in those who cannot digest it.

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.

  • There are two diet options:
    1.  A one-day, low residue diet. Diet preparation instructions are here.
    2. A two-day, low FODMAP diet. This is the preferred option if you are constipated.
  • 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 fructose & 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: YouTube (you can pause it at any time) For conducting the GLUCOSE test

Instructions for conducting the LACTULOSE Breath test

Instructions for the collection procedure YouTube

If you have already done some breath tests and need to do a Lactose or Fructose or other FODMAP 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. This involves 3 seaparate tests, with Lactulose, Glucose, and Fructose. These three tests are conducted with at least one “rest & diet” day in between. You can leave longer between each test if every second day is not an option for you.

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, if doing the one-day prep diet, 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.

For the two-day low FODMPA prep diet, your plan could look like this:

  • Saturday & Sunday: Low FODMAP prep diet
  • Monday: Lactulose challenge test 9am – 12 noon. Resume low FODMAP diet
  • Tuesday: Low FODMAP diet
  • Wednesday: Glucose challenge: 9am – 11.30am. Resume low FODMAP diet
  • Thursday: Low FODMAP diet
  • Friday: Fructose challange: 9am – 12 noon. Eat normally thereafter.

Analysis of results from 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 are easily confused, overwhelmed, anxious or unsure if you can collect the samples correctly, please contact us to book the test at our lab. 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.

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?

Reports are typically ready within 5-7 working days of them being received at our lab. We will send them to your ordering health professional. If you have self-referred to do the test, please nominate the health professional who will review and discuss your breath test results and to develop a management plan for you. If you do not have a practitioner who is knowledgeable about breath testing, please book and initial appointment with any of our naturopathic consultants.

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 should be 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.

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

Weight 1 kg
Dimensions 10 × 10 × 20 cm

Test kit (1 Kit), Two-test combo (Kits), Three-test combo (Kits), Four-test combo (Kits), In-clinic test


Lactulose, Glucose, Fructose, Lactose (not for SIBO testing)


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


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


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


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