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Alyssa Simpson RD, CDE, CLT
Alyssa Simpson

RD, CDE, CLT​

Confused by All the Info on SIBO? Here’s your SIBO Diet Plan Cheat Sheet

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registered dietitian weight loss tips

Maybe you’ve gotten a diagnosis, or maybe Dr. Google has got you wondering if you have SIBO. 

SIBO symptoms can be troubling. You may be dealing with pain, diarrhea, bloating, cramps, gas, and more. If these uncomfortable — and sometimes embarrassing — symptoms are taking over your life, you’re ready to take charge and do something about it.

If you’re not sure how to tell if you have SIBO, check out last week’s blog post here. It covers all the symptoms and testing options. 

Treatment

Since SIBO is an overgrowth of bacteria, it is typically treated with antibiotics. Antibiotics will reduce the population of bacteria in your small intestine, giving you relief from your symptoms. 

But there are disadvantages to antibiotic use. Antibiotics are not targeted at any one type or location of bacteria. So while they kill problematic bacteria, they will also attack the beneficial bacteria in your large intestine (known as the microbiome).

And antibiotics do not address the root cause of your SIBO. Unless you work with a practitioner to find and treat the problem that caused your bacteria overgrowth in the first place, SIBO is likely to return.

If you’re working with a naturally-minded practitioner, you may want to explore the idea of using herbal antibiotics in place of pharmaceuticals. One study concluded that herbal antibiotics were at least as effective as the antibiotic rifaximin.

So, whichever treatment plan you and your practitioner decide is right for you, you’ll still need to address the root cause and take steps to avoid bacterial overgrowth in the future. The best way to begin? Start a SIBO diet plan.

Diet

I’m not talking about weight loss. In this sense, diet is just a generic term referring to the types of food you eat. And when it comes to SIBO, there are quite a few diets out there. Unfortunately, there is very little research on these diets and their effects on SIBO.

But there is often a connection between SIBO and irritable bowel syndrome (IBS). In fact, more than one-third of IBS patients test positive for SIBO. In fact, SIBO is so prevalent with IBS that some experts estimate that up to 60-80% of IBS patients have undiagnosed SIBO. Since both conditions are affected by the bacteria growing in your digestive tract, they often benefit from similar dietary approaches. 

Often with SIBO, you have carbs that don’t fully break down during the earlier stages of digestion. And when those carbs reach your small intestine, they become the perfect food for the bacteria living there. 

When bacteria eat the carbohydrates in your small intestine, they produce gases (fermentation). That’s when you get symptoms like diarrhea and bloating. 

The goal of any SIBO diet plan is to starve the uninvited bacteria in your small intestine while still feeding you. We do this by reducing the foods that feed your gut bacteria so your fermentation levels stay low.

There are many SIBO diet plans that reduce symptoms. They range from being fairly flexible to extremely strict. Your practitioner can help you figure out which one is the right fit for you. They’ll consider factors including the severity of your SIBO, your known food sensitivities, and your treatment plan.

Most of the SIBO diet plans are not intended for extended use. There are certain guidelines that you’ll need to follow to keep your SIBO from returning. But many of these diets serve as elimination diets. 

You give up specific foods for a prescribed amount of time, allowing your body to heal. Then you slowly add back in some of those foods. Eating a diverse diet is generally healthful. So you don’t want to restrict more — or longer — than necessary.

Here are the SIBO food plans I most often recommend for my patients, from most flexible to the most intense. 

Most Flexible SIBO Food Plan:

Low Sugar/No concentrated sweets

With this SIBO food plan, you don’t have to follow long lists of foods to keep track of.

Generally, you avoid or strictly limit processed sugars and alcohol. Processed sugars include sweets like baked goods, soda, candy, etc. You get the idea. You don’t necessarily need to give up these foods completely forever. But these are the types of carbs that can turn a small bacteria population into a big one. So it’s best to avoid them completely for a while. And then only indulge very occasionally on special occasions.

The Low Sugar/No Concentrated Sweets Plan can be a good choice for longer-term use after you’ve wrapped up your SIBO treatment. This diet is not usually effective as a treatment. This SIBO food plan helps you maintain a healthy gut once you’ve completed your treatment and spent some time following a more restricted food plan.

Middle-of-the Road SIBO Food Plans:

Low FODMAP

FODMAPs are a specific type of carbohydrate. If you want to impress your friends with your science knowledge, you can tell them you are avoiding fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. 

But most of us just call them FODMAPs. Unfortunately, FODMAPs are in a lot of foods. So following the low FODMAP diet can get a little complicated. But gratefully, there are some apps and resources that make it much easier. Check out my IBS Resource Guide to learn more.

Some of the foods you’ll eliminate or avoid on the low FODMAP diet include high fructose corn syrup, honey, garlic, onions, and apples. 

The diet is called low FODMAP because it’s virtually impossible to avoid FODMAPs altogether. So there are a lot of guidelines with this program. Some foods you avoid completely, some you limit to specific portions. It can get complicated, but with a good practitioner and the right resources, it can be done.

SIBO Specific Diet by Dr. Allison Siebecker

This diet combines the principles of low FODMAP with another SIBO food plan called the Specific Carbohydrate Diet (SCD). 

Along with limiting FODMAPs, you’ll avoid some of the specific carbohydrates thought to feed the bacteria in your small intestine like rice, potatoes, quinoa, and legumes.

Recognizing the complexity of this diet, Dr. Siebecker developed a plan to help you navigate the restrictions. Foods are color coded like a stop light. The green foods are legal, the yellow foods should be limited, and red foods are avoided altogether.

SIBO Bi-Phasic diet by Dr. Nirala Jacobi

This diet also combines the low FODMAP diet with the Specific Carbohydrate Diet (SCD). But in Dr. Jacobi’s version, the patient moves through the diet in two phases.

During the first phase, you eliminate all fermentable starches for up to 6 weeks. This will starve the bacteria in the small intestine. Symptoms should improve dramatically during this phase.

Then in the second phase, you’ll reintroduce a few starchy foods. While you don’t want the bacteria in your small intestine to multiply, you do want to feed the beneficial bacteria in your large intestine. That’s the idea of phase 2. It’s about finding the right balance. 

Strict SIBO Food Plans:

Low Histamine Diet

Histamines are chemicals that help fight off allergens. Your body produces histamines, but they are also found in certain foods. They are not inherently bad. On the contrary, they are helpful for fulfilling their purpose. But like that really loud person at the party, sometimes they come on a little strong.

SIBO can be an underlying cause of the overproduction of histamine. So if you are showing signs of histamine intolerance (headaches, skin irritation, diarrhea, etc.), this SIBO diet plan can make a big difference.

Fermented foods have the highest histamine levels, so you’ll need to skip the fermented foods — sauerkraut, kombucha, picked veggies, alcohol, etc. You also find high histamine levels in foods like tomatoes, eggplant, and spinach.

Fresh, unprocessed foods have the lowest histamine levels. So when you are avoiding histamines, it’s important to eat the freshest food available and make sure you store everything in the fridge.

Elemental Diet

This is the most restrictive of them all. So if you and your practitioner decide that the Elemental Diet is for you, you will follow it for a very limited amount of time, usually 2 weeks.

This diet is liquid only. The drink comes pre-made or as a powder and contains protein, carbohydrates, fats, vitamins, and minerals that are already broken down. Your body doesn’t have to do the work of digestion so you quickly absorb the nutrients, starving the bacteria in your small intestine.

This diet is challenging. Very few people want to drink their food for 2 weeks. It’s also expensive and not typically covered by insurance.

But it is effective. According to clinical trials, this diet has an 80-84% success rate in getting rid of SIBO. 

So Which SIBO Diet Plan Do You Choose?

Deciding which treatment and diet plan is the best for your SIBO is a decision best made in concert with your practitioner. A good practitioner will look at the specifics of your SIBO (everyone is different you know), as well as your lifestyle and preferences to create a treatment and eating plan that will keep you comfortable and get rid of your symptoms.

I’ve worked with over 1,000 patients dealing with the discomfort of conditions like SIBO and IBS. I utilize all the latest techniques, along with tried-and-true methods, to find the root cause of your symptoms and get you feeling better fast!

If you’re ready for a bio-individual approach to your digestive problems, let’s hop on a call and figure out an approach to healing that will work for you!

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