Madeleine Hull
Small intestinal bacterial overgrowth (SIBO) is a bacterial overgrowth in the small intestine. While no specific diet is proven to treat SIBO, dietary treatments aim to reduce food sources for bacteria while ensuring the patient is nourished. The low-FODMAP diet, which focuses on limiting certain carbohydrates that are not easily digestible, is a common treatment for SIBO. The paleo diet, which eliminates grains, is another approach. However, the low-FODMAP diet does allow grains, but it may need adjustments for SIBO patients. The elemental diet, a type of liquid diet, is another treatment option for SIBO, but it cannot be used alongside antibiotic treatments.
| Characteristics | Values |
|---|---|
| Goal | To restore a balance of gut bacteria |
| Treatment | Liquid diet, low-FODMAP diet, elemental diet, antibiotics |
| Diet | Moderate fiber, low fat, low carbohydrates, lactose-free dairy, almond flour |
| Grains | Allowed in moderate amounts, but gluten grains should be avoided |
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What You'll Learn
The FODMAP diet
The low-FODMAP diet is often prescribed for limited periods for people diagnosed with IBS and SIBO. Studies show that a majority of people living with these conditions benefit from the diet. It can also be used as a short-term elimination diet for anyone who has digestive problems and wants to isolate the foods that are causing them. An elimination diet removes common problem foods and then adds them back in systematically to observe how your system reacts.
The low-FODMAP diet has three phases: an elimination phase, a reintroduction phase, and a maintenance phase that’s customized to you. During the elimination phase, you'll avoid all of the high-FODMAP foods, including specific fruits, vegetables, dairy products, and grains. In the reintroduction phase, you continue your low-FODMAP diet while completing a series of ‘FODMAP challenges’ to identify which FODMAPs you tolerate and which trigger symptoms. In the final phase, you relax dietary restrictions, expand your variety of foods, and establish a ‘personalized FODMAP diet’ for the long term.
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The elemental diet
While some evidence suggests that the elemental diet may benefit some people with SIBO, the scientific community is divided on whether it is the most effective treatment. Some researchers note that there is greater evidence for using pharmacological treatments such as antibiotics. Additionally, the elemental diet is considered a last resort treatment as it is very challenging to consume only liquid nutrition for 1-3 weeks. However, it can be very effective in treating SIBO if adhered to.
It is important to note that the elemental diet should not be used at the same time as any antibiotic treatment for SIBO. Before starting the elemental diet, it is recommended to consult with a healthcare provider or a registered dietitian to ensure that daily nutritional needs are being met.
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The paleo diet
- Meat: Beef, lamb, chicken, turkey, pork, etc.
- Fish and seafood: Salmon, trout, haddock, shrimp, shellfish, etc.
- Eggs: Free-range, pastured, or omega-3 enriched.
- Vegetables: Broccoli, kale, peppers, onions, carrots, tomatoes, etc.
- Fruits: Apples, bananas, oranges, pears, avocados, strawberries, blueberries, etc.
- Tubers: Potatoes, sweet potatoes, yams, turnips, etc.
- Nuts and seeds: Almonds, macadamia nuts, walnuts, hazelnuts, sunflower seeds, pumpkin seeds, etc.
- Healthy fats and oils: Extra virgin olive oil, avocado oil, etc.
- Salt and spices: Sea salt, garlic, turmeric, rosemary, etc.
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The low-fermentation diet
The Cedars Sinai Diet, also known as the Low Fermentation Diet, was developed by researcher and SIBO expert Dr. Mark Pimentel. It is the only diet that has been specifically studied as a treatment for SIBO. The low-fermentation diet emphasizes the importance of meal spacing, allowing for "cleansing waves" in the digestive system. These are described as "housecleaning" for the gut.
The diet can be followed long-term and focuses on achieving a sense of normalcy while still limiting the odds of SIBO recurrence. It has some overlap with the low-FODMAP diet, which focuses on limiting certain types of carbohydrates that are not easily digested. FODMAPs are a group of carbohydrates that include lactose and fructose, which might be poorly absorbed due to inflammation along the small intestine lining.
The goal of treating SIBO is to restore a balance of gut bacteria. All dietary treatments strive to reduce food sources for the bacteria, feeding the person but starving the bacteria. Antibiotics are the primary treatment for SIBO, and the low-fermentation diet can be used as an adjunct treatment. The diet's nutrients are believed to be wholly absorbed in the first part of the small intestine, reducing the number of food components available to bacteria.
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The bi-phasic diet
The SIBO Bi-Phasic Diet is a dietary approach developed by Dr. Nirala Jacobi to help manage Small Intestinal Bacterial Overgrowth (SIBO). It is a comprehensive and structured approach that combines food restriction with reintroduction, dividing the diet into two phases.
Phase 1
The first phase of the SIBO Bi-Phasic Diet focuses on restricting dietary fermentable carbohydrates to reduce bacterial overgrowth and their production of metabolic byproducts. This phase includes eating low-FODMAP and easily digestible foods. FODMAPs are a group of carbohydrates that include lactose and fructose, which might be poorly absorbed due to inflammation in the small intestine. Examples of low-FODMAP foods include non-starchy vegetables like leafy greens, zucchini, bell peppers, cucumbers, and healthy fats like olive oil, coconut oil, and avocado. It is important to avoid or minimize the consumption of foods that can worsen SIBO symptoms, such as certain vegetables (onions, garlic) and fruits (apples, apricots).
Phase 2
During the second phase of the SIBO Bi-Phasic Diet, antimicrobial agents are introduced to help manage the remaining bacterial overgrowth. Simultaneously, patients begin to reincorporate foods from the previously restricted groups back into their diet. This reintroduction phase is done slowly and systematically, introducing each new food separately and observing the body's reaction. This helps identify individual trigger foods and maintain a healthy and balanced diet that supports gut health.
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Frequently asked questions
SIBO stands for Small Intestinal Bacterial Overgrowth. It occurs when bacteria that usually grow in one part of your digestive tract, like your colon, are growing in your small intestine.
The SIBO diet does not restrict grains. However, some grains contain lactose and fructose, which may be poorly absorbed due to inflammation along the small intestine lining. Thus, it is recommended to consult a dietitian to plan a suitable diet.
There is no single proven diet to treat SIBO. However, some common diets include the elemental diet (a liquid diet), the low-FODMAP diet, the Cedars Sinai Diet, the SIBO Bi-Phasic diet, and the Paleo diet.
