DIETS FOR SIBO

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So many people with SIBO struggle because they simply weren’t given good advice on what diets may work for them. Unfortunately, diet and nutrition are not subjects emphasized in medical school, and doctors who use diet in their medical practices have had to teach ourselves.

Regardless, finding the proper diet is absolutely critical to improving GI symptoms and fixing SIBO. In fact, sometimes making a simple dietary adjustment is enough to put SIBO behind you.

Here are the diets that I find help the biggest difference in my patients. But before we start, a warning:

Eating disorders are on the rise, and a growing number of patients are being harmed by practitioners recommending excessively strict and restrictive diets.

In my practice, I ask my patients to start with the least restrictive diet and only advance to a more restrictive diet if they aren’t getting the results they want on a simpler diet, or have already tried other basic treatments.

“How strict do I have to be?”

The answer to this question varies quite a bit from patient to patient. As an example, I may see two patients with SIBO, and one is able to see an improvement in symptoms by cutting the amount of processed foods from their diet by 25%, while another may need to be on a low FODMAP diet 90% of the time. Although we clinicians can give you our best guess, ultimately it is up to you to do the work of trialing to see what works for you.

You don’t have to be perfect on any diet to heal. In my experience, aiming for about 75% compliance is a good initial goal because it is usually enough to learn if it is a good fit without driving my patients crazy. So, if the diet is a good fit you should see improvements within a week, two at max. Seeing these changes as short term experiments helps avoid some of the restrictive and problematic eating behavior that can come with overly strict or dogmatic diets.

You want to do a good enough job with the diet to identify if it helping reduce symptoms. Then, once we determine which diet is the best fit for you, we can relax because diet is only one tool in treating SIBO.

A perfect diet doesn’t lead to perfect results - it usually backfires and makes things worse in the long run.

As you advance through treatment you want to be continually expanding your diet, moving toward the broadest diet that keeps your symptoms at a minimum.

Fiber, Fasting & SIBO

For most patients with SIBO, high fiber diets are counterproductive and make symptoms much worse. This is because if you have too many bacteria in your small intestine, you are simply feeding them and making the problem worse. The bacteria metabolize the carbohydrates from your diet, and have a party - they reproduce, spread, produce inflammation, bother your immune system and generate the gases that you see on a breath test.

While not every patient needs or feels better on a lower fiber diet, this is often the best place to start.

To test if whether a patient will benefit from a low fiber diet (like the low FODMAP diet described below) I often ask them to fast for 24-48 hours. Many patients with SIBO feel significantly better from a GI standpoint even if they feel a little weak and lightheaded. If this happens then it is a big hint that a lower fiber diet is a good idea.

My favorite book for those interested in learning more about fasting is the “Complete Guide to Fasting” by Dr. Jason Fung.

For those that are used to making dietary changes, then may only need a few days to understand if a diet is a right fit. Others may need a full week to to plan meals, go shopping and then another week to implement the diet understand what foods work well for them.

“How long does it take to see a difference in my symptoms?”

Low Processed Food / Whole Food Diet

We Americans exercise more than Europeans, and have followed guidelines recommending that we lower our sugar and cholesterol intake.

Despite this changes Americans suffer with staggering amounts of obesity and chronic disease. The reason?

Over the last several decades, our diet has become more and more processed.

Emerging scientific evidence shows that processed food intake is the leading risk factor in a host of metabolic conditions, and is increasingly being linked to the development of SIBO.

Processed food is anything wrapped in plastic that contains one or more ingredients that you don’t have in your kitchen.

Reducing the amount of processed foods is much more important than whether you eat a Mediterranean, keto, pescatarian, vegetarian or paleo diet.

Very large companies have spent a lot of time and money designing highly addictive food products that can stay shelf stable for a very long time at the lowest price possible. Remember that big food companies companies are interested in your money, not your health.

On the bright side, some common foods are minimally processed and are perfectly fine to incorporate into your diet as long as they don’t cause you symptoms. These are foods like cheese, milk, sausages and deli meats.

To understand this topic in more detail, I highly recommend the book “Ultra-Processed People”, by Chris van Tulleken. Read the book to find out what happens when he eats a diet of 80% processed food for a month.

My patients really get into trouble when processed foods and especially UPFs begin to make up a large percentage of their caloric intake. Working on lowering processed food consumption is a common starting point for many of my patients.

As my patients replace processed foods with whole foods they become more resilient and their symptoms reduce. If they develop digestive problems like SIBO, they heal quickly.

The more processed a food is, the worse it is for your health, and the more likely it will lead to SIBO.

It seems obvious that the most highly processed foods the so called “Ultra Processed Foods” (UPF) that are clearly a problem. These are the items like breakfast cereal, twinkies, microwave meals, fast foods and candys and soda - things we know to be unhealthy.

However, even foods we might think of as healthy like almond milk or Greek yogurt have a lot of processing and commonly make my SIBO patients feel poorly. Don’t be fooled by a label claiming “heart healthy and gluten free” - the harder someone is trying to convince you that their product is healthy, the less likely it actually is.

Gluten Free, Dairy Free (GFDF)

The GFDF diet has a lot going for it. It is relatively simple to follow - gluten and dairy free foods are all over these days, and this is a great thing for my SIBO patients.

Gluten containing foods are generally highly processed, and holding these foods means that you are going a long way to reducing the amount of processed foods in your diet. Another bonus of lowering the gluten is that many wheat containing products contain toxins from our from our agriculture system.

Another reason is that many people who have GI disturbances can react immunologically to the proteins in dairy and gluten, especially when they have out of control SIBO. (When the SIBO goes away, most patients can eat some amount of dairy or gluten without problem). Lowering gluten and dairy while fixing GI problems can help by lowering the amount of inflammation produced by the immune system.

A final reason, (and the main reason why I think this diet strategy is so helpful for patient with SIBO) is that foods containing gluten and dairy are both extremely high in FODMAPS. Lowering the bread, crackers, cakes and cheeses and cream goes a long way to helping fix your GI health. One way to think about this diet is that you get many of the benefits of both reducing processed foods and low FODMAPs without specifically having to think about either.

Most people who first start a gluten and dairy free diet immediately begin looking for replacements. They often find substitute products that are made from almonds like almond milk or almond flour. While people with robust GI health may tolerate these foods without problem, most of my SIBO patients try these foods and feel terrible.

Low FODMAP Diet

This is the diet I use the most with my SIBO patients.

Most of the patients that come to work with me have already tried one or more of the above diets, and so I frequently ask them to start out by pulling the high FODMAP foods from their diet. Most find that they have significantly less bloating, discomfort and their stools start to normalize.

There is excellent scientific evidence that the diet helps in SIBO and IBS.

This diet wasn’t listed first, because it’s not the easiest to follow and is actually somewhat counterintuitive, because it is hard for people to wrap their head around the fact that the healthy foods they have been eating (broccoli, onion, garlic, apples, nuts and seeds) are not a good for them. It takes more planning than either the low processed food or GFDF diets, but in the right patient, can be absolutely wonderful.

Despite the name, this one isn’t a diet. (No food involved!)

An elemental diet is a powdered nutritional formula that is used in place of food for a period of time. Because the formula is quickly absorbed in the first part of the intestinal tract, it starves bacteria that are located lower down in the small intestines. The formula itself also stimulates bile flow which can improve digestion and lower bacterial counts. It is extremely helpful used for a few days to reset the gut, as a meal replacement .

More at the treatment page.

The Elemental Diet

“How long do I have to be on a diet?”

The most important thing to remember with diets is that your body’s needs change over time. The diet you ate when you were twenty is almost certainly not the diet you should be eating when you are forty. Similarly, the diet that helps you resolve symptoms when first diagnosed with SIBO is different than the diet you can eat after treatment.

Once you’ve found a diet that helps manage symptoms, you’ll generally stay there for about 3 months while cleaning up the underlying causes.

During this time you should be working with your doctor to find and implement treatment to get 80% or greater symptom reduction. The good news is that after some work, most patients can to expand their diet- they find they no longer have such severe reactions to garlic, bread or dairy. The goal is to heal your gut and improve your health so you can the occasional pizza night.

However, it’s important to acknowledge that there are patients who learn that in order to remain symptom free that they need to be much stricter with their diet than others. This is okay, people are built differently and have different life circumstances. Even those that are initially frustrated by their body’s response to their favorite foods can learn to gracefully juggle dietary restrictions, symptom reduction and a fun social life.