Candida and The Human Microbiome 253breakdown of sugars and starches, including tartaric acid and short-chain
fatty acids such as acetate, proprionate, succinate and butyrate, and other
alcohols such as iso-propanol, butanol and 2,3-butylene glycol. Testing for
these substances is now available commercially in certain centers and may
provide useful insights.
Of course it is not just about what the body produces on board
but the further fate of these compounds. Such substances should be swiftly
eliminated by the detoxification process. But if detoxification pathways are
blocked due to overload, many other non-alcohol but equally unwanted
metabolites will accumulate, such as epoxides, aldehydes and even chloral
hydrate, the potent ingredient of the classic ‘Mickey Finn’. Typically this
chemical produces a tired and ‘spacey’ feeling. Here is at least part of the
reason these patients can’t take alcoholic drinks.
The hydrogen breath test will also reveal compounds in exhaled air
which can give a clue to the state of bowel flora.
Breath hydrogen test
In Man, only anaerobic bacteria in the colon are capable of
producing hydrogen in our bodies. They do this by fermenting sugars,
such as lactose, sucrose, sorbitol, fructose, lactulose etc. (depending on
the purpose of the test). The hydrogen enters the bloodstream and is out-
gassed via the lungs. This gives rise to the possibility of testing breath for
hydrogen content as a means of estimating bacterial activity in the colon.
Prior to hydrogen breath testing, individuals fast for at least twelve
hours. At the start of the test, the individual blows into a balloon, filling the
balloon. The concentration of hydrogen is measured in a sample of breath
removed from the balloon. The individual then ingests a small amount of
the test sugar. Additional breath samples are collected and analyzed for
hydrogen every fifteen minutes for three to five hours.
Any significant production of hydrogen means that there has been
a problem with digestion or absorption of the test sugar and that some of
the sugar has reached the colon.
When rapid intestinal transit is present, the test dose of non-
digestible lactulose reaches the colon more quickly than normal, and,
therefore, hydrogen is produced by the colonic bacteria soon after the
sugar is ingested. When bacterial overgrowth of the small bowel is present,
ingestion of lactulose results in two separate periods during the test in
which hydrogen is produced, an earlier period caused by the bacteria in the