Fiona Lawson | 05 Dec 2018 | SIBO

What’s the best diet to treat SIBO?

If you suffer from uncomfortable bloating, gas and irregular digestion, it’s worth considering a test for SIBO.

What is SIBO?

SIBO stands for ‘Small Intestine Bacterial Overgrowth’. In other words, it means there’s too much bacteria in the small intestine [1].

In a healthy digestive tract, the large intestine is filled with lots of different types of bacteria. The small intestine contains much less. This is because the small intestine is where we absorb most of our food, and we don’t want bacteria interfering with this important process.

However, in some people, bacteria can start to creep up to the small intestine. This can happen for a variety of reasons, such as:

  • Use of certain medications, including PPIs
  • Gastric deficit, or not having enough stomach acid
  • Slow motility, which means food doesn’t move through the digestive system quickly enough. This can stem from a bout of food poisoning
  • Adhesions, which can result from abdominal surgery

Symptoms of SIBO typically relate to digestion. These include [2]:

  • Bloating
  • Stomach pain
  • Diarrhoea
  • Gas
  • Nausea
  • Constipation

Common conditions linked to SIBO include autoimmune diseases, chronic fatigue syndrome, certain types of anaemia, fibromyalgia and irritable bowel syndrome. This doesn’t mean SIBO is causing these conditions, but it may be associated in their development.

SIBO can also be accompanied by rapid weight loss, simply because it prevents a person from absorbing their food properly.

How to cure SIBO with diet

Some of the main SIBO symptoms are caused by excessive gas production. This is because the bacteria lurking the small intestine grab hold of the food passing through and quickly get to work on fermenting it, releasing gas as a by-product [3].

Because of this, a key approach to tackling SIBO is to reduce the intake of fermentable foods. This is where the low FODMAP diet comes in.

Before going in to detail on the low FODMAP diet, it’s worth highlighting that there are several other dietary strategies that have been proposed for SIBO, such as the elemental diet, the specific carbohydrate diet and the GAPS diet.

However, these strategies are only supported by anecdotal evidence or single studies. The low FODMAP diet has been heavily researched—and has even been reported to have a 75% success rate in irritable bowel syndrome—which is why we consider it to be a good starting point.

Having said this, it’s also worth emphasising that diet alone is often not enough to treat SIBO. Other lifestyle factors—which are personal to the individual, but may include exercise and relaxation—are equally important, as is a personalised supplement programme.

Sibo diet info graphic

The best diet to treat SIBO

The low FODMAP diet stands for  ‘Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols’.

It can involve cutting a few foods out (including some healthy foods), which is why the diet is recommended for four to eight weeks maximum [4]. If symptoms improve, the duration can be shortened appropriately. It all depends on the individual.

When to start the SIBO diet?

There’s no ‘right’ time to start a SIBO diet. It depends on the severity of symptoms, the individual’s normal dietary habits and what they’ve previously tried (if anything).

For example, there’s lots of evidence to suggest that probiotics can decontaminate the small intestine—so there are options to consider either before, or alongside, some form of elimination diet.

However, it can also be argued that for the quickest improvement in symptoms, the diet should be implemented once SIBO has been confirmed by a breath test.

How to do the SIBO diet

The low FODMAP diet involves three stages:

  • Restriction
  • Re-introduction
  • Personalisation

If your symptoms have improved following FODMAP restriction, it’s important you don’t skip the reintroduction stage. Start with moderate FODMAP foods, then move on to high FODMAP foods (more on these below). This will help you to identify which FODMAPs you are most sensitive to, as well as how much of a high FODMAP food triggers your symptoms.

Remember: the low FODMAP diet should only ever be a short-term intervention. We want to diversify the diet as quickly as possible—and reintroduce fibre—to support the bacteria in the large intestine.

The long-term aim of a low FODMAP approach is to personalise your diet so you only avoid foods that trigger your symptoms, while returning to as normal a diet as possible.

What to eat on a SIBO diet

While it may feel easier to focus on what needs to be avoided during a restrictive diet, we encourage our community to see it as an opportunity.

Sound strange? Hear us out: this is an opportunity to try new foods, to explore parts of the supermarket you rarely visit and to re-engage with cooking and preparing food. It can be a way to discover new favourites, and to really engage in nourishing yourself. You may find it’s a transformative process.

There are still a wealth of foods that can be eaten on the low FODMAP diet, including:

Protein: all fresh animal products, including meat, poultry, fish, seafood, game and eggs

Starch: grains such as oats, quinoa, sourdough spelt bread and rice, plus white potato and turnip

Vegetables: bok choy, carrot, cherry tomatoes, aubergine, green beans, strawberries, parsnips, spring onion, cucumber, spinach

Fruit: banana, blueberry, orange, raspberry, strawberry, rhubarb, lemon and lime, grapes, kiwi fruit, pineapple

Fats: coconut oil, ghee, olive oil, olives, lard, hard cheese (e.g. cheddar)

As you can see, this diet doesn’t have to be as restrictive as people think. A cheese and salad sandwich is even possible! Grab some sourdough spelt bread, add some cheddar, top with grated carrot, cucumber, sliced tomato and mustard and voila! You have a lovely low FODMAP lunch.

Foods that need to be reduced on the FODMAP diet include:

Vegetables: onions, broccoli, leeks, asparagus, garlic, cabbage, artichoke, okra, sugar snap peas

Grains: wheat, rye, barley

Fruit: apples, apricots, blackberries, cherries, dried fruits, mango, peach, pears, plums

Dairy: fresh cheese, milk, yoghurt

The foods that should be avoided, or limited, when suffering with SIBO are very individual, but a general reduction of fermentable foods is most often needed to help establish which foods these are.

Reduction is the key point. You don’t necessarily need to be overly strict—the way you implement this therapeutic diet will depend on your current symptom severity and quality of life.

Interested to learn more? Find out about our SIBO breath test here.

For further support, why not book a consultation with one of our practitioners?

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