By focusing on gut health, most foods don’t have to be avoided forever.
Key Points:
- Eating the right diet can help you manage unpleasant SIBO symptoms like bloating, abdominal pain, diarrhea, and constipation.
- Research has shown that three diets are helpful for SIBO: the low FODMAP diet, the Elemental diet, and the Specific Carbohydrate diet.
- All of these elimination-style diets are temporary and meant to help you find a longer-term, less restrictive diet that you can easily maintain.
- The goal of any SIBO diet is to figure out which foods trigger your symptoms, as every gut is different, and develop a dietary approach that works for you specifically.
SIBO and Your Diet
The right diet can help you manage unpleasant SIBO symptoms like bloating, abdominal pain, diarrhea, and constipation. [1, 2, 3, 4]. Diet is also an important part of a SIBO treatment plan.
Since SIBO is a bacterial overgrowth of the small intestine, dietary changes are meant to reduce bacterial populations in the digestive system. This is done by reducing the foods that feed gut bacteria.
While there are several options for a SIBO diet, it’s important to understand that the bacterial makeup of your digestive tract is unique. The goal of any SIBO diet is to figure out which foods trigger your symptoms and develop a dietary approach that works for you.
Some SIBO patients believe they must follow restrictive diet guidelines forever and live in fear of eating the wrong foods. This is a big mistake. Instead, use the guidelines for what to eat and not to eat as a starting point only. Be strict about eliminating foods for the first two to four weeks and monitor your symptoms. Once your symptoms have improved, you can try some reintroductions.
Ultimately, you want to be able to eat as broad a diet as possible while still managing your symptoms.
SIBO Diet Options
When bacteria consume carbohydrate foods in your digestive tract, they produce gases as a byproduct. This process is known as fermentation. The best diets for SIBO are designed to feed you while starving your gut bacteria, thereby keeping fermentation levels low. This is done by reducing the fermentable carbohydrates in your diet.
- Low-FODMAP diet [5]
- Specific Carbohydrate Diet (SCD) [6]
- Elemental diet [7]
The GAPS diet and the Fast Tract diet follow similar principles, but no research supports their use yet.
Each of these diets is an elimination diet designed to remove fermentable foods that may trigger symptoms. The low-FODMAP diet is the least restrictive. The most restrictive is the Elemental diet, which replaces all normal foods with a liquid meal replacement. However, the Elemental diet is the most short-term option, with a two-to-four-day gut reset being enough for some to quell symptoms.
While detailed guides and apps are available for each of these diets, let’s start with a simple overview of the foods you should consider restricting with SIBO.
Which Foods Should Be Avoided With SIBO?
I often recommend the low-FODMAP diet to patients with digestive conditions because it is supported by research [8, 9, 10, 11, 12] and is less restrictive than some other dietary choices.
FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These categories of foods are all high in fermentable carbohydrates and are the most likely to cause digestive symptoms.
- Lentils and beans
- Wheat and rye
- Natural and artificial sweeteners, including agave syrup, xylitol, sorbitol, and high-fructose corn syrup
- Dairy products like cottage cheese or ice cream
- Certain vegetables, including onions, garlic, artichokes, cabbage, and cauliflower
- Certain fruits, especially apples, pears, and stone fruits (peaches, plums, apricots)
- Dried fruit and fruit juices
- Prebiotic fiber (supplements intended to feed beneficial bacteria)
It’s important to remember that a low-FODMAP diet isn’t meant to be forever. In fact, it’s often effective in as little as 30 days. By quelling SIBO with an elimination diet like low-FODMAP, foods can often be reintroduced later with little or no symptoms, especially when food is reintroduced in moderation. A diet is meant to support your health and living well, so it’s about getting to a place with as few symptoms and restrictions as possible.
Which Foods Are Safe to Eat With SIBO?
Perhaps more important than what you can’t eat is what you can eat. Here is a list of low-FODMAP foods that you can eat freely:
- Meat, poultry, fish, seafood, and eggs (without standard gravies, breading, or marinades)
- Rice, oats, corn meal, quinoa
- Many types of vegetables, including green beans, zucchini, tomatoes, lettuce, and cucumbers
- Most starchy vegetables, including potatoes, yams, parsnip, and taro root
- Many types of fruits, including blueberries, strawberries, grapes, cantaloupe, and oranges
- Lactose-free dairy products
It’s a good idea to eat fresh, whole foods with a SIBO diet, as this eliminates the many problematic ingredients found in processed foods.
Tips for Successfully Navigating SIBO Dietary Changes
Keep it simple to start. Choose a few basic recipes and use them to develop a simple food list. Be willing to repeat meals a lot at first. Don’t be tempted to try fancy recipes right away. Once you are comfortable with your dietary changes and know which foods trigger your symptoms, explore new recipes and expand your menu options.
Be prepared. Stock your pantry with ingredients you need for your basic menu plan, and remove all high-FODMAP foods that may be tempting. Make a few big batches of staple low-FODMAP meals and load up your freezer.
Be as strict as possible about the diet for two to four weeks. This will help you resolve symptoms quickly and give you a good baseline for food reintroductions.
Don’t stay on any diet too long if it’s not working. If you don’t notice any benefit after a few weeks, consider a different approach.
Reintroduce foods slowly and one at a time. The best food to reintroduce first is the one you missed the most. Pay attention to your symptoms for at least two days after the reintroduction. If a reintroduction goes well, you can follow up with another after a few days. If your symptoms flare up as a result of a food reintroduction, wait until they are under control before reintroducing another food.
The purpose of any elimination diet is to reduce symptoms and identify your trigger foods. Over time, you should be able to expand your diet while avoiding the foods you know cause problems.
Diet as a Part of Your SIBO Treatment Plan
When it comes to the treatment of SIBO, quick fixes don’t always work. Diet is an important part of an overall SIBO treatment plan and can help you manage symptoms.
The best approach for long-term success is a combination of treatments that address overall gut health. These may include probiotics [13], fasting periods [14], digestive supports [15], and herbal antimicrobials [16].
Probiotics can be very effective in treating SIBO, improving both symptoms and lab values [17, 18, 19, 20]. A low-FODMAP diet combined with high-quality probiotics can reduce symptoms in a matter of weeks for many patients.
You have a unique intestinal microbiome, and the best combination of SIBO treatments for you may not be the same for someone else. Learning what works for you is a process of personal experimentation.
The Benefits of Treating SIBO
If you have been struggling with digestive symptoms, getting them under control is a big win. Plus, by treating SIBO, you may experience beneficial effects on other health conditions.
Research shows a significant connection between SIBO and irritable bowel syndrome (IBS), with more than one-third of IBS patients testing positive for SIBO. [21] Both conditions are the result of an unbalanced gut microbiome and benefit from similar treatment approaches.
- Rosacea [22]
- Restless leg syndrome [23, 24]
- Blood sugar, cholesterol, and potentially weight [25, 26, 27]
- Depression (improved by probiotics) [28, 29, 30]
- Rheumatoid arthritis [31]
- Nonresponsive celiac disease [32]
Research shows that SIBO is associated with other health conditions, including hypothyroidism [33], coronary artery disease [34], diabetes [35], chronic kidney disease [36], chronic pancreatitis [37], and Parkinson’s disease [38]. We still need more research to identify whether SIBO treatments can help resolve these conditions.
Do You Know Your Food Triggers?
Knowing what foods trigger your symptoms is a powerful tool for restoring your good health.
Don’t be reluctant to try an elimination diet. With a bit of planning and preparation, following a low-FODMAP diet doesn’t need to be difficult. Keep in mind that you only need to follow the strictest version of the diet for a few weeks before you can start reintroducing foods.
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