Fermentation in the small intestine
The small intestine is built to absorb, not to host a heavy ferment. When bacteria there break down carbohydrates, gas can build under the ribs within an hour or two of eating. You may look pregnant by evening, belch, or swing between diarrhea and constipation.
That pattern is the concept behind SIBO. It is not a verdict you can make from bloating alone. Dr. Sani Kohen, D.C. and Dr. Tara Kohen, D.C. ask what you ate, how soon symptoms started, and whether an antibiotic, a stomach bug, or abdominal surgery came first.
Lactulose and glucose breath tests in plain language
SIBO breath testing measures gases in your breath after a sugar drink. Lactulose is not absorbed early, so it travels farther down the intestine. A rise can reflect the small bowel, and it can also reflect fermentation once the drink reaches the colon, which is why timing is part of the reading.
Glucose is absorbed higher up, so it mainly challenges the upper small intestine and can miss a problem farther down. Neither sugar is a better test for every person. FRI chooses with you, then reads the graph next to symptoms. A number without a story is not a plan.
A positive test is interpreted with symptoms
A positive breath test in someone who bloats after meals is a different situation from a positive test in someone who feels well. FRI does not treat the printout as the patient. Constipation, diarrhea, and upper abdominal swelling point the plan in different directions.
Stool testing answers a colon question, not this one. The gut health overview explains when GI-MAP is the better first step. If food reactions dominate the history, that is yet another page. Stacking tests without a reason is how people end up confused.
Diet changes stay individual
In Functional Medicine, some people feel better when fermentable carbohydrates are reduced for a while. Others get worse if the diet becomes so narrow that they under-eat. Nutrition and supplementation is built around what you tolerate and what the test showed. There is no herbal antibiotic dose on this page, and no brand protocol.
Functional medicine at FRI does not replace a primary physician, endocrinologist, gastroenterologist, or mental health clinician. Weight loss you did not intend, bleeding, or vomiting needs medical care. A breath test does not rule those out.
What to expect when you are seen for SIBO
You can start with a complimentary 20-minute consultation. The office is out of network, accepts HSA and FSA payment, and provides a superbill. Visits run Monday–Thursday, 9–6.
If a breath test is ordered, you follow a prep diet and a collection schedule. Results are reviewed with your symptom timing. Any food change is revisited, not handed down as a permanent menu.
Services that match this coastline
Board sports and trail hills make shoulder, neck, and knee complaints ordinary reasons to come north. McKenzie-based spine care is a fit when back or leg pain has a clear directional preference. Corrective exercise is how a Talega hill gets written into the plan instead of fought with a generic core sheet.
Families also come for problems that are not sports. Thyroid, sleep, and migraine questions are evaluated with the limits those conditions require. A migraine plan does not replace a neurologist. A thyroid plan does not replace the prescriber. Read the city overview at the San Clemente chiropractor page.
Before you get on the 5
No referral is required. Bring shoes you hike or walk the trail in if the foot or knee is the issue. Prior MRIs are useful and not mandatory. If you have bowel or bladder changes, saddle numbness, or a rapidly weakening leg, do not drive past an emergency department to reach us.
The practice is out of network. San Clemente patients typically use HSA or FSA funds and a superbill. We will not guess your benefits. The doctors are Drs. Sani and Tara Kohen. Their biographies are on the about page, and the clinic layout is on the office page.
Pier Bowl, Talega grades, and Trestles mornings
San Clemente has two terrains that matter clinically. The Pier Bowl, the beach trail, and the streets near the water are relatively level and sandy. Talega, Forster Ranch, and the newer hills are the opposite: repeated grades, youth sports, and a drive just to reach I-5. Surfing at Trestles and along the pier loads shoulders and low backs. Hill neighborhoods load knees on the way down and necks on the drive. We ask which part of town you live in because the home program has to match the grade outside.
A lot of San Clemente patients are trying to stay active while working north of here. The I-5 commute itself is a sitting test. If your low back or sciatica eases when you walk the beach trail and worsens in the car, that detail changes the exam. Tell us the direction of the commute and how long you sit, not only where it hurts.
Coming north on I-5 to the clinic
The drive is I-5 north through San Juan Capistrano into Mission Viejo, about 16 miles. Without a slowdown it is a little over 20 minutes. A backup through the Capistrano stretch pushes it toward 35. Exit for the La Alameda side of Mission Viejo and come to 26400 La Alameda, Suite 100, CA 92691. Parking is on site. The doors are open Monday through Thursday, 9 to 6.
Because the drive is simple, people sometimes stack a visit onto a day that already includes a surf and a commute. Say if that is the plan. We may want the exam before the surf, or we may want you to skip the session that morning so the tests mean something. Call (949) 312-1754 if you are sorting the order. The 20-minute consultation can be the first appointment if you are not ready for a full evaluation.
Questions patients ask
Which breath test is better, lactulose or glucose?
They look at different stretches of intestine. Lactulose travels farther, so the timing of a gas rise has to be read carefully, including the chance that the colon joined in. Glucose is absorbed sooner, so it speaks more to the upper small intestine and can miss a lower problem. FRI picks from your symptoms. Neither result is read in isolation.
Does a positive test mean I must treat it?
A positive result is interpreted with symptoms. If you bloat, hurt, and change stool pattern in a way that matches the graph, the finding is more useful. If you feel well, FRI will not build an aggressive plan around a number. Your gastroenterologist remains the right clinician for disease of the bowel itself.
Will you give me an herbal antibiotic dose?
No. This page does not list herbal antibiotic doses, and the visit does not copy a protocol from a forum. If antimicrobial support is discussed, it is individualized and coordinated with your physicians. Nutrition changes are similarly specific to you. There is no brand protocol and no promise that gas will be gone in a set number of days.
How is this different from a stool test?
A breath test asks about gases produced after a sugar challenge, which is the SIBO question. GI-MAP stool testing looks at organisms and markers in a stool sample, which is a different compartment. You can read both on the gut health page. FRI does not order them as a pair unless your history asks two questions.
Related care for San Clemente
SIBO is handled at the Mission Viejo clinic, not in a satellite office in San Clemente. The related pages below stay on that same visit and add the methods or neighboring problems that usually come up in the history.
- San Clemente chiropractor
How people from San Clemente reach 26400 La Alameda and what the three pillars cover.
- SIBO clinical overview
The non-geographic condition page, if you want the clinic-wide explanation without the drive.
- Functional Medicine
The pillar this problem sits in at Functional Restoration Institute.
- Gut Health in this city
Digestion problems rarely arrive as one tidy symptom. Bloating, stool changes, and food reactions can travel together or take turns. This page.
- Leaky Gut in this city
People say leaky gut when they mean the gut barrier might be letting more through than it should. The plainer name is.
- Food Sensitivities in this city
A food sensitivity panel that looks at IgG or IgA is not an allergy test. Allergy, the IgE kind, is a different.
- Chronic Inflammation in this city
Inflammation is a process your body uses, not a personality and not a mood. It can be useful while you heal and.
- SIBO Breath Testing
A SIBO breath test measures hydrogen and methane in the breath after you drink a substrate, either lactulose or glucose. A rise.
