SIBO Diets: Diet Plans and Food Lists
SIBO diets are temporary diets that are used to control symptoms of SIBO while other treatments resolve the underlying bacterial overgrowth. Here are the SIBO diets and foods to eat.
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What is SIBO?
Small intestinal bacterial overgrowth, better known as SIBO, remains one of the most poorly understood digestive diseases. It refers to excessive bacterial growth in the small intestine and causes multiple issues such as extreme bloating, gas, burping, diarrhea, and constipation.
SIBO is far more common than believed but is hugely under-diagnosed because most doctors are not familiar with this newly discovered illness. So a large majority of people with SIBO are given an incorrect IBS (Irritable Bowel Syndrome) diagnosis, are told to "eat more fiber" (which can make SIBO worse), or they are told there is nothing they can do. Luckily, if you're struggling with gut issues and suspect you may have SIBO, you don't need your doctor's permission, you can get your SIBO home testing kit here.)
Here's a video if you want to learn more about SIBO:
Signs and Symptoms of SIBO
Although the symptoms of SIBO are similar to lactose intolerance, IBS, and other gut issues, there are some common indicators that can help you identify SIBO.
SIBO can include:
SIBO can usually be differentiated from other digestive issues like IBS by its sudden onset. For example, if one day you're fine and the next you all of a sudden look like you're pregnant with a firm, bloated belly, the it's a good idea to get tested for SIBO.
Another common and unique feature of SIBO is excessive burping. A bad case of SIBO can lead to dozens of burps per minute, especially after eating foods that feed bacteria.
How Do You Get SIBO?
Some people think that SIBO is caused by a single type of bacteria but SIBO can be caused by any bacteria (both good and bad) if it has migrated from the large intestine to the small intestine. We generally have large numbers of bacteria in the large intestine—this is why we are often encouraged to take probiotics and feed our good gut bacteria. But the small intestine is (or should be) relatively free of bacteria.
Complications of SIBO
The majority of nutrient absorption happens in the small intestine, so we don't want bacteria there. When bacteria get in the small intestine, they interfere with digestion and nutrient absorption. In other words, the bacteria are eating our food so we can't. And when bacteria eat, they produce gases like hydrogen and methane (burping and flatulence).
It is also common in SIBO for the cell lining of the small intestine to get damaged, leading to permeability of the intestinal barrier. This condition is known as leaky gut and as a result of it, protein molecules flow out of the gut and into the bloodstream. Leaky gut can not only amplify SIBO symptoms, it can give rise to food allergies, autoimmune disease, inflammation, food sensitivities, and lowered immunity.
Why Do We Get SIBO?
The body generally has mechanics in place to prevent SIBO. For example, there is a little valve that periodically lets food from our small intestine into our large intestine. If this value gets stuck open, bacteria from our large intestine can travel back up into the small intestine.
The small intestine is also protected by a variety of fluids—acidic fluids from the stomach, anti-bacterial bile from the liver, and even immunoglobulin in intestinal secretions. However, if any of these systems are compromised, then risk for SIBO goes up. A variety of environmental factors and individual lifestyle and dietary habits can affect these systems.
How To Treat SIBO?
Since SIBO is caused by many different types of bacteria, not every treatment will work equally well on every type of SIBO.
For hydrogen dominant types of SIBO, most doctors will prescribe the antibiotic Xifaxan or Rifaximin which are gut-specific antibiotics. For methane-dominant SIBO (which is harder to treat), doctors will usually prescribe one of these plus Neomycin. But these treatments are effective in less than half of SIBO cases (learn how to improve your SIBO treatment in the section on "Underlying Causes" of SIBO).
A slightly more effective approach to treating SIBO is by using anti-microbial herbs. One study found that taking 2 capsules, 2 times per day of both Candibactin-AR and Candibactin-BR for 4 consecutive weeks was at least as effective as antibiotics if not more effective than antibiotics.
How Long Does It Take to Treat SIBO?
People with difficult cases of SIBO often have to do multiple rounds of herbal antimicrobials (or antibiotics) with breaks in-between to ensure that they don't kill off all their healthy gut bacteria or harm their intestine. You also want to rotate between different types of herbal antimicrobials so as not to develop a tolerance to any one herb. This is why it's always best to consult with a SIBO practitioner.
Some experts will recommend you start with less aggressive antimicrobials like cinnamon,
cloves, or allicin. More intense antimicrobials include oregano oil, olive leaf, berberine, pau de acro, or grapefruit seed extract. Rotating between these herbs can keep the bacteria guessing. But be careful with all of these as they are potent herbs.
How To Eliminate SIBO Permanently
People with SIBO often say it's more of a symptom than a disease in itself. SIBO most often develops due to some "underlying cause", medical condition, or problem with digestion. That's why treating SIBO on it's own with diet or antibiotics is rarely an effective strategy for eliminating it. There are many instances of reinfection within a year of recovering from SIBO.
Some Common "Underlying Causes" of SIBO
Any illness or condition that affects digestion can cause SIBO, but according to a popular SIBO forum, these are some of the most common causes of SIBO:
This is not a complete list of SIBO causes, but exploring these potential causes is a great place to start when trying to treat your SIBO.
Addressing Underlying Causes of SIBO
While treating your SIBO, it's key to address your underlying causes. Luckily, some of the common causes of SIBO have simple fixes. Here's some things you can try:
Mold can hide in walls, furniture, and food. Thats' why a huge portion of people suffering from mold illness never know it. If you're having unexplained, weird symptoms, test yourself for mold (you can do this at home).
Parasites are another thing that we often don't realize we have. We pick them up from international travel or contaminated food. Get a parasite test here.
Stress slows down our digestion, hurts our immunity, and taxes our detox system. That's why stress causes SIBO. Get your stress under control with our Stress Detox Program.
Slow speed of food moving food through the small intestine (Migrating Motor Complex problems):
Ginger is helpful for those with sluggish migrating motor complex (MMC), which helps clean out the small intestine between meals. MotilPro is a fairly popular ginger supplement for helping the MMC.
Low levels of stomach acid:
Betaine HCL and Apple Cider Vinegar are helpful for folks with insufficient stomach acid, your guts first barrier.
Low levels of liver bile:
Digestive enzymes, Ox bile, and bitter herbs like coptis or genetian are helpful for folks with a sluggish gallbladder, liver, or pancreas, organs that help keep your body free of invaders.
Take vitamin C and zinc and be sure to get plenty of sunshine to help boost your immunity.
What Do SIBO Diets Have in Common?
SIBO diets are aimed at improving nutrient absorption, minimizing inflammation of your digestive system, and controlling your symptoms. So to start, this means eating anti-inflammatory foods—removing inflammatory foods like diary, gluten, sugar, preservatives, and alcohol is a great start.
With this anti-inflammatory diet as a base, choose the SIBO diet below that you feel works best for you. You probably already have some sense of your most offending foods. So choose a diet that seems like it might help you and if it doesn't try a different one.
Another trick for picking a successful SIBO diet is to think about the types of foods you ate most of before you got SIBO. The bacteria you have in your body will be the ones that eat your diet. So if you ate a ton of sugar before you got SIBO, sugar-eating bacteria are likely to be in your small intestine (meaning you shouldn't eat sugar). If you ate a ton of meat before getting SIBO, meat-eating bacteria are likely to be in your small intestine (meaning you shouldn't eat meat). And if you ate a ton of fibrous veggies before you got SIBO, fiber-eating bacteria are likely to be in your small intestine (meaning you shouldn't eat fiber). Looking at your standard diet can help you identify which foods to eat in your SIBO diet. And often the diet that is the opposite of what you ate before, is the most effective SIBO diet.
But remember, no diet treats SIBO. So the goal of any SIBO diet is to reduce symptoms and potential complications of SIBO while you treat your SIBO. Measure the success of your SIBO diet by assessing your symptoms after eating certain foods or a certain diet.
SIBO Diet 1: The Low Fermentation Diet
The low fermentation diet was designed specifically for SIBO. It avoids any foods that bacteria are likely to ferment. Since fermentation is what causes SIBO symptoms, this diet is often quite successful at reducing the symptoms of SIBO. If you're not sure where to start, this diet is a safe bet.
Here’s a list of foods to include in your low fermentation SIBO diet:
Limit these foods on your low fermentation SIBO diet:
Here's a complete guide for this SIBO diet.
SIBO Diet 2: The Low Sugar Diet
If the type of bacteria that are in your small intestine prefer to eat sugar, eating a low sugar, low carb diet will be the diet that works best for you. Based on the SIBO forum (and just how many of us eat high-sugar diets), it seems that a low sugar diet tends to help many people with SIBO.
Here’s a list of foods to include in your low-sugar, low-carb SIBO diet:
Limit these high sugar foods on your low sugar SIBO diet:
Although this SIBO food list is not exhaustive, it gives you some idea of how to plan your meals.
SIBO Diet 3: The Low FODMAP diet
There is evidence which supports that avoiding high FODMAPs in your diet can help improve your digestive health and reduce symptoms of irritable bowel syndrome (IBS). Some people report that the Low FODMAP diet also helps ease symptoms of SIBO.
In a Low FODMAP diet, the foods to be avoided are any foods that include fructose, lactose, mannitol, sorbitol, fructans, and oligosaccharides. For a large, detailed list, check out this FODMAP food list.
Figuring out which food to eat and how much of them you can eat on this SIBO diet is a huge pain. So if you plan to try it, I highly suggest getting the Monash FODMAP diet app. The app lets you search for most foods and see if they are okay or not.
Here's a video with more information on FODMAPs:
SIBO Diet 4: The Low Fiber/Low Residue Diet
While some people with SIBO have bacteria that primarily eat sugar, others have bacteria that primarily eat fiber. That means that eating foods with fiber feed your gut bacteria and give you unpleasant SIBO symptoms.
Here’s a list of foods to include in your low fiber SIBO diet:
Limit these high fiber foods on your low fiber SIBO diet:
Here's more information on starting a low-fiber diet.
Other SIBO Diets
With bad cases of SIBO it is possible that the gut has sustained more serious injury. In these cases you may benefit from mixing a SIBO diet with a gut healing diet like the GAPS diet.
The GAPS Diet was developed by Dr Natasha Campbell-McBride to help treat digestive conditions such as SIBO, IBS, IBD and leaky gut as well as neurological issues such as ADHD, autism, anxiety and depression.
The diet is comprised of a meal plan that helps repair the gut wall and restore gut health. The diet has six stages that you advance through as your gut heals and can handle a wider range of foods. If you are dealing with more complex gut issues, the GAPS diet can be helpful. But given the the foods you eat are often heavy in probiotics, be careful with the GAPS diet if you're still dealing with SIBO.
What Happens When You Do a SIBO Diet?
While treating SIBO, your body will be removing bacteria and maybe also parasites or viruses. This can cause you to feel kinda ill, an experience which is called a herxheimer reaction, also known as "die-off" symptoms.
Die-off symptoms can include fatigue, brain fog, gastrointestinal distress such as nausea, gas, bloating, diarrhea or constipation, low-grade fever, headache, sore throat, itching, muscle and joint soreness, chills, lethargy, intense sweet cravings, and irritability.
Be careful not to confuse die-off symptoms with a nutrient deficiency, which can also make you feel tired and sick. Die-off symptoms tend to come on suddenly (whereas insufficient nutrients can leave us feeling chronically bad). Some people also find that they have die-off symptoms only at a certain time of the day—morning, afternoon, or evening—possibly after taking an antibiotic.
How to Minimize Die-Off Symptoms from SIBO Diets
What About Probiotics on a SIBO Diet
Probiotics are complicated when it comes to SIBO. To keep your gut healthy and strong through all this, it can be good to take a probiotic. But since SIBO is all about having too much bacteria where it doesn't belong, probiotics often aggravate symptoms of SIBO. That's why most practitioners suggest you actually avoid probiotics and probiotic foods like yogurt, kombucha, fermented pickles, etc... while treating SIBO.
After you've healed your SIBO it's a good idea to help rebuild good bacteria in the large intestine by taking a probiotic with billions of CFUs. Here are some that tend not to aggravate SIBO: Saccharomyces Boulardii, and L. Reuteri.
Important Reminders about the SIBO Diet
Here are a few things about the SIBO diet that you should keep in mind
Our gut health influences everything from our weight, to our mood, to our cognitive ability. It can be the reason for our back pain, the root of our depression, and of course, the cause of our digestive issues. That's why healing SIBO is essential.
Here's a few more videos with more SIBO diet help:
More about SIBO symptoms and why SIBO is an issue:
How a Keto diet can help with SIBO
About Dr. Tchiki Davis
Dr. Davis is founder of The Berkeley Well-Being Institute. After getting her PhD in psychology at Berkeley, she started creating online content & programs to boost well-being—some of these have reached more than a million people. As author of Outsmart Your Smartphone, and contributor to Psychology Today, The Greater Good Science Center, and Shine Text, Dr. Davis aims to share her insights on happiness & health with people all across the world. Learn more about Dr. Davis.