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May 24, 2025

Trio-Smart Breath Test for SIBO: Comprehensive 3-Gas Detection

The Trio-Smart breath test is the most advanced SIBO diagnostic tool, detecting hydrogen, methane, and hydrogen sulfide for a complete picture of gut health. This article explains who benefits, how to prepare, and what the test reveals to guide targeted treatment.

Trio-Smart Breath Test for SIBO: Comprehensive 3-Gas Detection

The Trio-Smart Breath Test for SIBO: Comprehensive Detection and Personalized Treatment Insights

Small Intestinal Bacterial Overgrowth (SIBO) is an increasingly recognized root cause of many chronic gastrointestinal and systemic health issues. Characterized by an overgrowth of bacteria in the small intestine—where bacterial levels should be relatively low—SIBO can lead to symptoms such as bloating, gas, abdominal pain, and altered bowel habits. Diagnosing SIBO accurately is critical for effective treatment, and the Trio-Smart breath test is emerging as a superior diagnostic tool.

In this article, we’ll explore the science behind the Trio-Smart breath test, who benefits from it, how to prepare for testing, how the sample is collected, and what the results reveal.

What Is the Trio-Smart Breath Test?

The Trio-Smart test is a clinically advanced breath test for SIBO that measures the three key gases associated with bacterial fermentation in the gut:

  • Hydrogen

  • Methane

  • Hydrogen Sulfide

Developed in collaboration with gastroenterologist Dr. Mark Pimentel—who pioneered much of the research on SIBO—the Trio-Smart test is the only FDA-registered breath test that detects hydrogen sulfide in addition to hydrogen and methane. This expanded panel improves diagnostic accuracy and provides a more complete picture of gut fermentation.

Why Is Testing for All Three Gases Important?

Historically, SIBO testing focused only on hydrogen and methane levels. However, recent discoveries have shown that hydrogen sulfide is another critical gas involved in SIBO, particularly in patients with diarrhea-predominant symptoms or IBS-like presentations.

  • Hydrogen is produced by bacterial fermentation of carbohydrates and can cause bloating, gas, and diarrhea.

  • Methane is produced by methanogens and is associated with constipation and slow intestinal transit.

  • Hydrogen sulfide, produced by specific bacteria such as Desulfovibrio, is linked to diarrhea, gas, and in some cases, systemic symptoms like fatigue and brain fog.

By evaluating all three, the Trio-Smart test offers a triple detection capability that allows clinicians to tailor treatment strategies more precisely.

Who Should Take the Trio-Smart Test?

The Trio-Smart breath test is recommended for individuals experiencing:

  • Chronic bloating or gas

  • Diarrhea, constipation, or alternating bowel habits

  • Abdominal pain or cramping

  • Irritable Bowel Syndrome (IBS)

  • Food intolerances (especially to fermentable carbohydrates)

  • Unexplained fatigue, brain fog, or nutrient deficiencies

  • A history of antibiotic use, food poisoning, or gastrointestinal infections

  • Autoimmune disorders and skin conditions like rosacea or eczema

It is also beneficial for people who have not responded well to standard IBS or gut health interventions, as it can reveal specific bacterial overgrowth types that require targeted treatment.

Pre-Test Preparation: Getting Ready for Accurate Results

Proper preparation is critical to ensure valid and interpretable results. The Trio-Smart test involves a specific pre-test protocol that includes dietary and medication restrictions.

1. Diet Preparation (24-Hour Preparation Diet)

The day before the test, patients follow a low-fermentation diet to reduce baseline gas levels. This minimizes the chance of false positives.

Allowed foods include:

  • Plain white rice

  • Plain chicken or turkey

  • Eggs

  • Clear broth

  • Fish

  • Black coffee or tea (no milk, sweeteners, or flavors)

  • Water

Avoid all high-fiber, fermented, dairy, and carbohydrate-rich foods, including:

  • Fruits and vegetables

  • Whole grains

  • Legumes

  • Sugary drinks

  • Alcohol

2. Fasting Requirement

Patients must fast for 12 hours before the test, usually overnight. Water is allowed.

3. Medication Restrictions

Certain medications can affect the test and should be paused at least 1–2 weeks before testing, depending on the drug and medical advice. These may include:

  • Antibiotics

  • Probiotics

  • Laxatives or motility agents

  • Fiber supplements

  • Antimicrobial herbs

Always consult with your healthcare provider before stopping any prescribed medications.

How the Test Is Performed

The Trio-Smart test is convenient and at-home, making it accessible and patient-friendly. Here’s how it works:

Step-by-Step Process:

  1. Collect baseline breath sample after fasting and before ingesting the test substrate.

  2. Drink the Lactulose or Dextrose solution. We generally recommend the Glucose Solution which is included with the kit (if you get the kit from us at the clinic). However, in some cases, it is advisable to us the Lactulose solution. This is a prescription that we'll send to the pharmacy for you.  

  3. Collect breath samples every 15 minutes for 2 hours using the provided collection envelopes.

  4. Package the envelopes and mail them to the laboratory using the prepaid envelope.

Trio-Smart uses GC-FID (gas chromatography with flame ionization detection) for highly accurate gas measurement.

What Does the Trio-Smart Test Reveal?

The test measures the rise in hydrogen, methane, and hydrogen sulfide gases over a 120-minute period after lactulose or glucose ingestion.

Interpretation:

  • Hydrogen ≥ 20 ppm rise within 90 minutes: Indicates hydrogen-dominant SIBO.

  • Methane ≥ 10 ppm at any time: Suggests intestinal methanogen overgrowth (IMO).

  • Hydrogen Sulfide ≥ 3 ppm: Indicates hydrogen sulfide SIBO, often missed by traditional tests.

Test results are categorized into:

  • Positive for SIBO (hydrogen or methane or hydrogen sulfide dominant)

  • Negative (no significant rise in gases)

  • Flat-line (can indicate severely damaged gut lining or high hydrogen sulfide)

Why This Matters:

Understanding the type of gas overproduction allows your clinician to:

  • Choose the right antimicrobial agent (e.g., rifaximin, allicin, bismuth)

  • Support detox pathways (especially for hydrogen sulfide producers)

  • Recommend diet changes (e.g., low-FODMAP vs. low-sulfur diets)

  • Address motility issues to prevent recurrence

Trio-Smart vs. Other Breath Tests

Feature Trio-Smart Standard Hydrogen-Methane Tests
Gases measured Hydrogen, Methane, H2S Hydrogen, Methane
Detects hydrogen sulfide ✅ Yes ❌ No
FDA-registered ✅ Yes Varies
Developed by GI experts ✅ Yes (Dr. Mark Pimentel) Varies
In-home collection ✅ Yes ✅ Yes
Improved specificity ✅ Yes Limited

Trio-Smart is clinically validated and offers a significant step forward in SIBO diagnostics, especially for people who previously tested negative but still experience symptoms.

Benefits of the Trio-Smart Test

  • Comprehensive: Measures all three relevant gases for the most complete SIBO picture.

  • Convenient: At-home collection kit with clear instructions and easy return.

  • Evidence-based: Grounded in the latest microbiome and gut health research.

  • Actionable: Results guide personalized treatment plans for better outcomes.

  • Monitors treatment success: Can be repeated post-treatment to confirm resolution.

What to Expect After Testing

Once your samples are submitted, results are typically returned within 7–10 business days. Your practitioner will review:

  • Gas levels over time

  • Peak gas type and timing

  • Recommendations for treatment based on the dominant gas

Treatment protocols may include:

  • Prescription or herbal antimicrobials

  • Prokinetics to support motility

  • Targeted dietary interventions (e.g., low-FODMAP, elemental diet)

  • Gut-healing nutrients (e.g., glutamine, zinc carnosine, B vitamins)

Retesting is commonly done 4–6 weeks post-treatment to confirm success and prevent relapse.

Conclusion

The Trio-Smart breath test represents the most advanced and reliable way to diagnose Small Intestinal Bacterial Overgrowth today. By measuring hydrogen, methane, and hydrogen sulfide, this test offers deep insight into gut fermentation, allowing clinicians to personalize treatment and finally bring relief to patients with chronic digestive issues.

If you've struggled with bloating, bowel changes, or IBS symptoms without answers, Trio-Smart can provide the clarity you need to move forward with effective care. Talk to your functional or integrative healthcare provider about whether this test is right for you.

References

  1. Rezaie A, Buresi M, Lembo A, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112(5):775–784.

  2. Ghoshal UC, Srivastava D, Misra A, Ghoshal U. Breath Tests and Gastrointestinal Diseases. World J Gastroenterol. 2016;22(31):6845–6864.

  3. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020;115(2):165–178.

  4. Rezaie A, et al. Hydrogen Sulfide as a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome: A Novel Insight. Am J Gastroenterol. 2020;115(4):599–601.

  5. Trio-Smart Breath Test. https://triosmartbreath.com

  6. Rezaie A, Leite G, Pimentel M. Hydrogen Sulfide in Gut Dysbiosis: A New Player in SIBO Diagnosis. Digestive Diseases and Sciences. 2022.