Methane is produced when archaea (single-celled organisms similar to bacteria) consume hydrogen.
Methane levels are considered abnormal if they reach ≥10 ppm (parts per million) at any point during the breath test.
Utilization of breath methane levels for SIBO assessment is controversial largely due to a lack of validation related to diagnostic specifics such as timing and magnitude of increase; however, CH4 measurements are increasingly obtained to address other clinical questions. Recent evidence has associated CH4 production with the pathogenesis of common clinical conditions, such as obesity, irritable bowel syndrome (IBS), and constipation.
- The peer-reviewed literature suggests an association with certain clinical conditions and methanogen overgrowth at levels as low as 3 ppm, CH4 values between 3 and 9 may indicate the need for clinical intervention in the symptomatic patient.
- ELEVATED BASELINE - An elevated baseline may be a more common pattern with CH4 positive tests primarily due to the ability of methanogenic organisms to ferment in the absence of an ingested carbohydrate substrate.
Methane gas itself may slow intestinal transit, and patients with CH4-predominant bacterial overgrowth have been found to be five times more likely to have constipation compared to individuals with H2 - predominant overgrowth. Moreover, the severity of constipation has been found to directly correlate with the CH4 level.
Risk factors:
Decreased intestinal motility is a key factor in the development of SIBO and its recurrence. Out of all the diseases and disorders associated with SIBO, 90% of cases involve either small intestinal motility disorders and/or chronic pancreatitis.
The migrating motor complex (MMC) describes the waves of electromechanical activity that sweep through the intestines in regular cycles between meals. The MMC triggers waves that move non-digestible substances through the gastrointestinal tract from the stomach distally to the terminal ileum. In addition, the MMC is responsible for moving bacteria from the small intestine to the large intestine, as well as inhibiting the migration of colonic bacteria into the terminal ileum. Any disorder that impairs MMC function can be a risk factor for SIBO. Gastroenteritis that leads to post-infectious IBS-D is thought to be a risk factor for SIBO. Campylobacter jejuni, Salmonella, E. coli, and Shigella produce cytolethal distending toxin (CDT), and the host can produce an autoimmune response that damages the pacemaker cells for the MMC, resulting in decreased MMC activity. Other key SIBO risk factors include conditions that result in immunocompromise, decreased bacteriostatic digestive secretions (HCl, pancreatic enzymes, bile acids), and ileocecal valve dysfunction.
Complications of SIBO:
Because SIBO is not consistently characterized by the same species, different symptoms or complications may result, depending on the organisms that are present and their specific function in the GI tract. SIBO can result in damage to the small intestinal mucosa leading to malabsorption and intestinal permeability. Microscopic inflammatory changes in the lamina propria and villous atrophy are common. Destruction of the intestinal mucosa can result in reduced disaccharidase function and increased intraluminal bacterial carbohydrate degradation, causing SIBO symptoms. The bacteria themselves can consume nutrients, leading to micronutrient deficiencies, and deconjugate bile acids, leading to fat and fat-soluble vitamin malabsorption. Bacteria can produce toxic substances resulting in increased serum endotoxin, stimulating inflammatory cytokine production.
SIBO complications include:
- Weight loss
- Steatorrhea
- Vitamin/mineral deficiency
» Fat-soluble vitamins (A,D,E,K)
» Vitamin B12
» Iron
- Hypoproteinemia/hypoalbuminemia
- Bile acid deficiency
- Anemia
- Osteoporosis
- Neuropathies
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References:
Rezaie A, Buresi M, Lembo A, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. The American journal of gastroenterology. May 2017;112(5):775-784. [PubMed]
Chatterjee S, Park S, Low K et al. The degree of breath methane production in IBS correlates with the severity of constipation. Am J Gastroenterol 2007;102:837–841. [PubMed]
Attaluri A, Jackson M, Valestin J et al. Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS. Am J Gastroenterol 2010;105:1407–1411. [PubMed]
Hwang L, Low K, Khoshini R et al. Evaluating breath methane as a diagnostic test for constipation-predominant IBS. Dig Dis Sci 2010;55:398–403. [PubMed]
Kunkel D, Basseri RJ, Makhani MD et al. Methane on breath testing is associated with constipation: a systematic review and meta-analysis. Dig Dis Sci 2011;56:1612–1618. [PubMed]
Low K, Hwang L, Hua J et al. A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. J Clin Gastroenterol 2010;44:547–550. [PubMed]
Pimentel M, Chang C, Chua KS et al. Antibiotic treatment of constipation-predominant irritable bowel syndrome. Dig Dis Sci 2014;59:1278–1285. [PubMed]
Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep 2016;18:8. [PubMed]
Elevated levels of methane are indicative of IMO.
IMO, or intestinal methanogenic overgrowth, is an overgrowth of methane-producing archaea in the small and large intestines. Methanogens are not bacteria (the “B” in SIBO) but are archaea and may also overgrow in the colon and not just the small intestine (the “SI'' in SIBO). In humans, excess methane production appears to be caused by Methanobrevibacter smithii, which is the predominant methanogen in the human gut.
A peak methane level > 10 ppm at any point is indicative of a methane-positive result.
Methane gas itself may slow intestinal transit, and patients with CH4-predominant bacterial overgrowth have been found to be five times more likely to have constipation compared to individuals with H2 - predominant overgrowth. Moreover, the severity of constipation has been found to directly correlate with the CH4 level.
- The peer-reviewed literature suggests an association with certain clinical conditions and methanogen overgrowth at levels as low as 3 ppm, CH4 values between 3 and 9 may indicate the need for clinical intervention in the symptomatic patient.
- ELEVATED BASELINE - An elevated baseline may be a more common pattern with CH4 positive tests primarily due to the ability of methanogenic organisms to ferment in the absence of an ingested carbohydrate substrate.
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It may be useful to discuss your results with a healthcare practitioner who is familiar with the management of intestinal methanogen overgrowth, such as a gastroenterologist or registered dietitian. If you undergo treatment for methane, it is easy to repeat the Methane Breath CH4ECK regularly to see if your methane has been reduced/eradicated.
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Methane (CH4) positivity on breath test has been associated with constipation. Patients with CH4-predominant bacterial overgrowth usually present with bloating and abdominal distention. However, they are 5 times more likely to have constipation as opposed to H2-predominant overgrowth. Moreover, the severity of constipation directly correlated with the methane level and the choice of antibiotics for the treatment of SIBO differs between these two groups as the predominant methanogen in the human gut, Methanobrevibacter smithii, is resistant to many antibiotics.
Conditions in which a high prevalence of overgrowth are commonly observed include, but are not limited to:
- Functional GI disorders (such as irritable bowel syndrome and gastroparesis)
- Hypothyroidism
- Neuromuscular diseases (such as restless leg syndrome)
- Inflammatory bowel disease (IBD)
- Pancreatic disease
- Celiac disease
- Liver disease
- Diabetes
- Fibromyalgia
- Rosacea
- Parkinson’s disease
- Obesity
- Interstitial cystitis
Treatment considerations:
Antibiotics are commonly used to treat SIBO, and studies show normalized breath tests as well as symptomatic relief. The underlying causes of SIBO must be treated properly. Otherwise, the likelihood of SIBO recurrence is very high, even after antibiotic therapy.
In general, clinical management of the SIBO patient involves antibiotics and/or natural antimicrobial agents, promotility/prokinetic agents, nutrient supplementation for depleted nutrients and/ or for brush border healing, dietary interventions, meal spacing, and treatment of comorbid conditions.
Antibiotics
- Rifaximin is a non-absorbable antibiotic that has been FDA-approved for IBS-D, traveler’s diarrhea, and hepatic encephalopathy. It has been extensively studied in functional bowel disorders.8 It is efficacious against Grampositive and Gram-negative aerobic and anaerobic bacteria.4 It can target common SIBO organisms including E. coli, Klebsiella spp., Enterobacter spp., and E. faecalis. In addition to its direct antibiotic effects, rifaximin may also modulate the host inflammatory response with its anti-inflammatory effect. It is best used for hydrogenpredominant SIBO.
- While rifaximin can be used as an individual agent in patients with methane positive breath-testing, an additional agent may be a more effective treatment in instances of constipation-predominant symptomology or when both H2 and CH4 are present. Rifaximin plus neomycin, both non-absorbable antibiotics, have been described as an effective treatment for constipation-predominant cases.
- A variety of other antibiotics have been studied for SIBO with varying efficacy. These include metronidazole, ciprofloxacin, norfloxacin, amoxicillin-clavulanic acid, cefoxitin, and doxycycline.
Natural Agents
In addition to pharmaceutical agents, limited evidence suggests a possible role for natural anti-microbial agents such as berberine, allicin (a component of garlic), oregano oil, and/or neem. One study showed that herbal therapies are at least as effective as rifaximin for SIBO resolution confirmed by lactulose breath test. The herbal products used in this study were a combination of Dysbiocide and FC Cidal (Biotics Research Laboratories) or Candibactin-AR and Candibactin-BR (Metagenics, Inc.).
Elemental Diet
Elemental formulas are medical foods that provide nutrition that is absorbed in the proximal small intestine, thus limiting the delivery to the bacteria residing in the distal small intestine.
This diet may be an alternative to antibiotics in patients with allergies to antibiotics or who cannot tolerate antibiotics.
Provide Nutritional Support
Numerous nutritional consequences have been associated with SIBO including: weight loss, fat soluble vitamin deficiency, vitamin B12 deficiency, iron deficiency, hypoproteinemia, and low serum bile acids. Any patient with such secondary consequences may warrant nutraceutical support until SIBO has been addressed. Dietary adjustments to support the management of bacterial overgrowth are also commonly utilized in SIBO.
Because no dietary approach has been found to be uniformly effective for the management of symptoms, ongoing dietary modifications, based on patient feedback, is imperative. Common dietary SIBO interventions include the Specific Carbohydrate Diet (SCD), Low FODMAPs, SIBO Specific Diet (a combination of low FODMAPs and SCD designed by Allison Siebecker, ND), SIBO Bi-Phasic Diet (designed by Australian clinician Nirala Jacobi, ND), a liquid elemental diet, GAPS Diet, the Cedars-Sinai Medical Center’s Low Fermentation/SIBO Diet (Mark Pimentel, MD), and the Fast Tract Diet (designed by Norman Robillard, PhD).
Probiotics may be beneficial, but further studies are needed to determine the dose and strain. Prebiotics, often added to probiotic supplements, are fermentable foods for bacteria and can encourage overgrowth; these should be avoided during treatment.
Other supplements used by functional medicine key opinion leaders include hydrochloric acid, digestive enzymes, and brush border healing supplements, including mucilaginous herbs (licorice, slippery elm, aloe vera, marshmallow), colostrum, L-glutamine, zinc carnosine, vitamins A and D, curcumin, resveratrol, glutathione, and N-acetylcysteine.
Correct the Underlying Cause
While it may not always be possible, depending on the condition, treatment should include strategies to minimize any risk factors or comorbid conditions for SIBO. Patients with impaired GI motility that affects the migrating motor complex (MMC), or anatomical abnormalities of the digestive tract, are particularly susceptible to SIBO.
Optimal functioning of the MMC may be supported in the following ways:
- Meal spacing every 4 – 5 hours and an overnight fast. The MMC is active during fasting states and is stopped by feedings.
- Use of prokinetic/promotility agents:
» Pharmaceutical agents include low-dose erythromycin, low-dose naltrexone (LDN), and others. Erythromycin is a motilin agonist and can increase the frequency of phase III of the MMC. LDN is an opioid antagonist and can stimulate peristalsis and increase transit.
» Natural agents include the botanical product Iberogast, ginger, and others. Iberogast consists of 9 herbs and, when compared with the prokinetics metoclopramide and cisapride, there was comparable effectiveness in the treatment of dyspepsia. Ginger increases motility during phase III of the MMC.
Retesting
In a patient treated for SIBO, many variables affect the decision of when to retest, including the patient’s underlying condition and its severity, and the length and type of treatment. The North American consensus group suggests that breath tests may be performed shortly after cessation of antibiotic therapy to confirm eradication.
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Import Lab Results from Any Source
Easily upload lab results from any provider, whether it's a hospital, independent lab, or home testing service. We support PDFs, scanned documents, and JPEGs from patient portals. No need to log in to multiple platforms — everything is centralized in one secure space.
Easily upload lab results from any provider — we support PDFs, scans, and images. Keep all your reports organized in one secure place.
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Every lab result is automatically organized on a chronological timeline, giving you a complete picture of your health journey. Whether you're tracking a condition, managing treatments, or staying proactive, the timeline helps you and your doctor understand how things progress over time.
Every lab result is automatically organized on a chronological timeline, giving you a complete picture of your health journey.
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Whether it's a blood test, GI panel, urinalysis, or something else, lab reports measure numerous biomarkers that reveal what's happening inside your body. Our extensive database covers over 10,000 biomarkers, providing clear, simple explanations of what each result means and how you can take action—no matter your membership level. Say goodbye to confusion and get the insights you need to better understand your health.
Our database covers over 10,000 biomarkers with clear, simple explanations—so you can finally understand your results and what to do next.
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Enter Your Lab Reports — Always Free
If you'd like to handle inputting your health data into your account, you can do so with our easy-to-use data entry forms. Our user-friendly form is designed to guide you through the quick and easy submission process, making it simple to keep track of your health metrics. This is available to both Complete plan and Unlimited plan members.
Our user-friendly form guides you through a quick, simple submission process, making it easy to enter your health metrics.
Add your results anytime with our easy entry form. It's quick, guided, and helps you stay organized — free for all members.
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View your lab data through easy-to-read graphs and tables. Quickly spot patterns, track changes, and compare results across different dates — all without digging through multiple reports. You can also select and compare graphs of specific biomarkers side-by-side to better understand how they relate and change over time.
See your lab reports in clear graphs and tables. Spot patterns, track changes, and compare results over time — all in one place.
Export Your Complete Lab History in a Single File
Export Your Complete Lab History
After collecting lab results from different providers, you can download your entire history combined into a single file. Choose from PDF, Excel, or CSV formats to easily review, share, or get a second opinion—no more juggling multiple reports.
After collecting lab results from different providers, you can download your entire history combined into a single file.
Comprehensive Data Entry Service for Your Reports
Data Entry Service for Your Reports
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest. Complete plan members receive one report entered for free, then $15 per report after that. Unlimited plan members receive ten report entries for free, then $15 per report after that.
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest.
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Whether you're working with a doctor, nutritionist, caregiver, or wellness coach, you can securely share your complete lab history by sending an invite link to anyone you trust. You have full control over who sees your information and for how long, ensuring your privacy and peace of mind at every step.
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I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
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As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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Healthmatters is a personal health dashboard that helps you organize and understand your lab results. It collects and displays your medical test data from any lab in one secure, easy-to-use platform.
With a Healthmatters account, you can:
Professionals can also analyze client data more efficiently and save time managing lab reports.
Healthmatters.io personal account provides in-depth research on 4000+ biomarkers, including information and suggestions for test panels such as, but not limited to:
You can combine all test reports inside your Healthmatters account and keep them in one place. It gives you an excellent overview of all your health data. Once you retest, you can add new results and compare them.
If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.
While we work with many popular labs, we welcome reports from lots of other places too.
It's as simple as this: if you can get a test done, you can upload it to Healthmatters and we can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.
If you're on the hunt for a specific biomarker, contact us and we'll add it to our database. Anything from blood, urine, saliva, or stool can be uploaded, understood, and tracked with your Healthmatters account.
The Complete Plan ($15/month) is perfect for individuals who want ongoing access to their health data. It includes unlimited lab imports, visual tracking, custom ranges, result explanations, full account exports, and secure sharing — all with a simple monthly subscription. You can cancel anytime and restart your plan whenever you're ready — your data will still be there waiting for you. You can also upgrade to the Unlimited Plan at any time, with the cost prorated based on what you've already paid.
The Unlimited Plan ($250 one-time) is also designed for individuals but offers lifetime access with no ongoing subscription. You'll get all the same features as the Complete Plan, plus a larger initial data entry allowance (10 reports), making it a great choice if you prefer a one-time payment and long-term use without monthly fees.
In short:
There are two ways to add your test reports to your Healthmatters account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."
Our data entry forms offer an easy, fast, and free way for you to input the reports yourself. Self-entry allows you to add an unlimited number of reports at no cost. We make the self-entry process user-friendly, providing dozens of templates that pre-populate the most popular laboratory panels and offering instant feedback on entered values.
For those who prefer assistance, we offer a "Data entry service" to help you input your data. Simply attach an image or file of your lab test results, and a qualified team member from our data entry team will add the results for you.
We support various file types, including PDFs, JPGs, or Excel. This service is particularly useful if you have many reports to upload or if you're too busy to handle the data entry yourself.
Our Data Entry Service is for when you don't want to manually type in your lab results yourself. You simply upload your report (PDF, image, or screenshot), and our trained team enters the information into your Healthmatters account for you — accurately and neatly organized, ready to view in graphs, tables, and timelines.
The $15 per report covers the time and care it takes for a real person to review your file, make sure each result is entered correctly, and double-check for accuracy. This ensures your health data is precise and easy to work with — without you having to spend the time doing it yourself.
Prefer to do it yourself? You can always use our free self-entry tool to add results manually — it just takes a bit more time and attention.
For users on the Complete monthly plan, the first report is entered free of charge, and each additional report incurs a fee of $15.
Unlimited account holders enjoy the entry of ten reports without charge. Subsequent reports are subject to a $15 fee per report.
Additionally, users on the Complete plan can upgrade to a yearly subscription from the account settings. The annual subscription includes a data entry service for five reports.
All professional accounts allow you to import and onboard an unlimited number of clients and their lab results. The distinction between professional plans lies solely in the data entry service.
The Pro Monthly Plus plan is priced at $75 per month and includes a data entry service for five reports each month. Additional reports can be self-entered at no extra cost or, if preferred, you can use our data entry service for an additional fee of $15 per report.
The Pro Monthly plan is priced at $45 per month and does not include a data entry service. Self-entry is free for an unlimited number of reports, and you can opt for the data entry service at a fee of $15 per report.
You also have the option to upgrade to higher monthly or to annual plans, which come with substantial discounts. All upgrades can be done directly from your account.
Simply log in and navigate to your account settings to cancel your subscription. Scroll down to locate the 'Cancel' button at the bottom of the page. Ensure you cancel at least one day before the renewal date to prevent any charges. Once cancellation is requested, the subscription remains active until the conclusion of the current billing cycle.
Our goal has been to make your Healthmatters account as intuitive as possible.
We've crafted multiple ways for you to navigate your data, whether you're glancing at a single report or delving into your historical test reports.
1. Graph View:Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.
2. All Tests ViewExplore neatly organized reports on a timeline, highlighting crucial details like dates, critical results, and lab/panel names. Each report opens up to reveal in-depth descriptions and additional recommendations for each biomarker. The history of previous results is just a click away, and you can download a comprehensive report for deeper insights. Color-coded and user-friendly, it's designed for easy reading, understanding, and navigation.
3. Table View:For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.
Yes, you can download your information anytime. We offer two easy ways to export your lab data:
This makes it simple to save, back up, or share your health data whenever you need.
Yes, you can print your report. To do so, navigate to "All tests" and open the report you wish to print. You'll find a print button in the right corner of the report. Click on it, and your browser's print window will open. If you prefer to print in a bigger typeface, adjust the scale using the print window settings.
Yes, you can! We highly recommend activating Two-Factor Authentication (2FA) for your account. To do so, please navigate to the "Profile and Security" section of your account, where you will find instructions for activating 2FA.
Yes, you can. When entering values for the biomarker, you will see an "Edit Range" button. Click this button, and you'll have the option to enter a custom range.
A personal account is all about keeping your own lab test results in check. It's just for you and your personal use.
The professional account is designed for health professionals who wish to track and organize their clients' laboratory results.
To learn more about Healthmatters Pro, please refer to the professional page.
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Optimal Result:
0 - 10 ppm.