Madeleine Hull
Small intestinal bacterial overgrowth (SIBO) is a condition caused by an overgrowth of bacteria in the small intestine. SIBO can lead to bloating, gas, and digestive distress. While there is no one-size-fits-all dietary approach to SIBO, various diets aim to restore gut balance and reduce symptoms. The most well-known dietary approach for SIBO is the
Safe Diet for SIBO
| Characteristics | Values |
|---|---|
| Goal | Restoring gut balance and reducing uncomfortable symptoms |
| Diet Types | Low FODMAP, Elemental SIBO, GAPS, SCD, etc. |
| Foods to Avoid | Onions, garlic, apples, wheat, beans, asparagus, broccoli, leeks, cabbage, artichoke, okra, sugar snap peas |
| Foods to Consume | Eggs, cheese, sourdough spelt bread, cheddar, carrot, cucumber, tomato, mustard |
| Beverages | Lactaid milk, tea, decaffeinated drinks, water |
| Lifestyle Factors | Exercise, relaxation |
| Supplements | Fat-soluble vitamins (A, D, E, K), iron, vitamin B12 |
| Treatment Options | Antibiotics, liquid diet, elemental diet |
| Diet Duration | 4-8 weeks |
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What You'll Learn
The low-FODMAP diet
The diet has three phases: elimination, reintroduction, and maintenance. During the elimination phase, high-FODMAP foods such as certain fruits, vegetables, dairy products, and grains are avoided. This phase can be very restrictive, so it is important to work with a dietitian familiar with low-FODMAP protocols. After the initial phase, which typically lasts two to six weeks, the reintroduction phase begins, where high-FODMAP foods are gradually added back into the diet, one at a time, to identify which ones trigger symptoms.
While the low-FODMAP diet is commonly used for irritable bowel syndrome (IBS), it is also believed to be beneficial for SIBO, as there is often overlap between the two conditions. Research has shown that the low-FODMAP diet reduces symptoms in a majority of people with IBS, and it may also help decrease abnormally high levels of intestinal bacteria in those with SIBO. However, more research is needed to determine its direct impact on SIBO specifically.
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Elemental diet
The elemental diet is a liquid diet or a powder mixed with water that is prescribed by a doctor. It is often used for people who have trouble digesting food because they have compromised digestive systems. The diet gets its name because the nutrients are introduced into the body as close to their primary (elemental) form as possible. It is a restrictive, liquid-only diet that provides the body with essential nutrients in a "predigested" form. The elemental diet is not to be used at the same time as any antibiotic treatment for SIBO.
The elemental diet is a possible add-on (adjunctive) treatment to antibiotics. The nutrients in the diet are believed to be wholly absorbed in the first part of the small intestine, which reduces the number of food components that are available to bacteria. The diet reduces the overall number of gut bacteria, which could mean a reduction in bacteria in the small intestine as well. The elemental diet is often considered the last resort treatment. This is because it is exceptionally tough to drink only liquid nutrition for 1-3 weeks. It is, however, very good at treating SIBO, provided it can be adhered to.
The elemental diet is not proven to treat SIBO in every patient, but your provider might recommend a diet plan that can help keep the condition from coming back. An older study from 2004 found that a 14-day elemental diet was effective at treating SIBO. A more recent review from 2020 that included the elemental diet as a possible SIBO treatment concluded that there has not been enough evidence to support its use. The researchers also noted that an elemental diet can be hard for people to follow and requires help from a provider, which might limit how many people could realistically try it.
Before starting an elemental diet for SIBO, a person should meet with a healthcare professional to ask questions and clarify the process. A specialist may recommend adjusting or temporarily stopping certain medications and supplements for the duration of the diet. An elemental diet can be both mentally and emotionally challenging. A person’s doctor can help prepare for those challenges and create a plan for dealing with them.
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Elimination diet
An elimination diet is a tool that can help you identify connections between certain foods and your SIBO symptoms. It is important to note that an elimination diet is not a treatment for SIBO and should not replace other prescribed treatments.
SIBO, or small intestinal bacterial overgrowth, occurs when bacteria that usually grow in one part of your digestive tract, like your colon, start growing in your small intestine. This can lead to symptoms such as pain, diarrhea, and malnutrition. An elimination diet can be used to identify any connections between the foods you eat and these SIBO symptoms.
To conduct an elimination diet, it is recommended that you work with a registered dietitian who has training in SIBO conditions. They can help you perform the diet safely and effectively. An elimination diet typically involves a short-term removal of certain foods, followed by a careful and gradual reintroduction of those foods. The reintroduction phase is important as it helps identify any specific foods that may be contributing to your digestive symptoms.
One popular approach to an elimination diet for SIBO is the low-FODMAP diet. FODMAPs are a group of carbohydrates that can be difficult to digest and are fermented by gut bacteria. These include fructans, fructose, galactans, lactose, and polyols. The low-FODMAP diet has shown to be effective in managing symptoms for people with IBS, which often overlaps with SIBO. However, it is important to note that the low-FODMAP diet is restrictive and should be done under the supervision of a dietitian to ensure adequate nutrition.
Overall, an elimination diet can be a useful tool to identify any connections between your diet and SIBO symptoms, but it should be approached with caution and under the guidance of a healthcare professional.
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GAPS diet
GAPS (Gut and Psychology Syndrome) is a modification of the SCD (Specific Carbohydrate Diet) created by Dr. Natasha Campbell McBride. It focuses on the connection between the gut and the brain. The diet is designed for people with severe digestive issues and involves a 3-6 week introduction period.
The GAPS diet can be used to treat SIBO (Small Intestinal Bacterial Overgrowth), which is a bacterial overgrowth in the small intestine that can cause pain, diarrhoea, malnutrition, and, in rare cases, a serious neurological condition called D-lactic acidosis.
A GAPS-SIBO diet is a strict therapeutic diet that involves leaving 4-5 hours between daytime meals and 12 hours between dinner and breakfast. It is a hybrid of the GAPS and FODMAPS diets, with some adjustments to the foods that are allowed. For example, meat stock is chosen over bone broth, and most fermented foods are not tolerated except for homemade 24-hour yoghurt and sour cream. Probiotic supplements are recommended.
The No-Plant GAPS Diet is another version of the GAPS diet that consists of meat stock, meats and seafood, organ meats, eggs, salt, and dairy ferments. It is designed for people with severely damaged digestive systems.
It is important to note that there is no one-size-fits-all approach to managing SIBO through diet, and the best plan depends on factors such as lifestyle, personal preferences, and other health conditions. It is recommended to work with a healthcare provider and a nutrition expert to manage SIBO and any underlying conditions.
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Specific carbohydrate diet
The Specific Carbohydrate Diet (SCD) is a restrictive low-carbohydrate diet that removes grains and all complex carbohydrates to help reduce IBS and SIBO symptoms. It was developed by Dr. Sidney Haas in 1951 as a therapeutic diet for patients with celiac disease and was later shown to be helpful for patients with inflammatory bowel diseases (including Crohn's Disease).
SCD is more restrictive than the low-FODMAP diet, eliminating grains, starchy vegetables, and all sugars. Only simple sugars, fruits, and vegetables with simple sugars are allowed. While it is a potential SIBO diet, it is recommended to try less restrictive diets first.
The SIBO Bi-Phasic Diet is a combination of the SCD and the Low-FODMAP Diet, putting the SCD into three phases, which are then combined with other treatments such as herbal antibiotics. The Bi-Phasic Diet is explained in Elaine Gottschall's book, *Breaking the Vicious Cycle*.
The Gut and Psychology Syndrome Diet (GAPS Diet) is another gut-healing diet that involves a nutrient-dense diet and targeted supplements. It is designed to repair the gut lining.
It is important to note that there is no one-size-fits-all approach to managing SIBO through diet, and the best plan depends on individual factors. While different SIBO diets exist, they share a common goal: restoring gut balance and reducing uncomfortable symptoms.
Before incorporating any dietary changes into your treatment plan, it is important to discuss your options with your doctor and work with a registered dietitian familiar with SIBO conditions.
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Frequently asked questions
SIBO stands for Small Intestinal Bacterial Overgrowth. It occurs when there is an excessive growth of bacteria in the small intestine, which can lead to bloating, gas, abdominal pain, and altered bowel movements.
There is no one-size-fits-all approach to managing SIBO through diet, and the best plan will depend on factors like your lifestyle, personal preferences, and any other health conditions you may have. However, some common dietary approaches for SIBO include the Low-FODMAP diet, the elemental diet, the specific carbohydrate diet, and the GAPS diet.
The Low-FODMAP diet targets fermentable carbohydrates (FODMAPs), which can trigger digestive symptoms in people with IBS and SIBO. FODMAPs are found in foods like onions, garlic, apples, wheat, beans, and asparagus. The diet is meant to be short-term, followed by a structured food reintroduction phase.
The elemental diet is a liquid diet or a powder mixed with water. It is often used for people who have trouble digesting food due to compromised digestive systems. The nutrients are introduced into the body in their primary (elemental) form.
