Small Intestinal Bacterial Overgrowth (SIBO) Diet and nutrition
Learn about the dietary approaches and treatment strategies for SIBO.
CONTACT USIntroduction to Diet’s Role in SIBO Management
Most people with SIBO diagnosis find that certain foods trigger bloating, pain or bowel movements. However, it’s common for the trigger foods to be unknown and reactions to be unpredictable.
While removing foods may not treat SIBO, short-term eliminations are a valuable tool that we consider. This is to improve symptoms in the short-term while the bacterial overgrowth is addressed. It is also to provide clear guidelines around what to include in the diet to ensure calorie and nutrient requirements are met.
What foods can be eaten with SIBO?
For many with SIBO, a low FODMAP diet may be an important starting point. This diet removes or reduces specific types of fermentable fibre found in a wide range of fruits, vegetables and grains.
These fibres can be fermented by the excess bacteria in the small intestine which may then trigger symptoms in those with SIBO.
What foods should be avoided with SIBO: Trigger Foods for SIBO
While not SIBO patients react to FODMAPs in the same way, this diet for SIBO can help as an initial assessment to provide clarity.
The most common FODMAP foods that appear as triggers for SIBO symptoms include the following.
- Fruits – apples, pears, grapes, dried fruits and apricots
- Vegetables – aspragus, garlic, onion, caulifloer and brocolli
- Grains – wheat and rye
- Natural and artificial sugars – honey, agave syrup, poylols, sorbitol
Recommended Diets for SIBO Relief
The approaches that are considered for SIBO focus on the amount of fibre that may need to be reduced for each SIBO patient. This means that there is a scale regarding how limited that diet may need to be to manage symptoms.
The recommended diets include:
- A modified low FODMAP diet. This will only remove the FODMAPs known to be most problematic to the individual.
- The low FODMAP diet. This removes or limits a wider range of FODMAPs to assess for sensitivties.
- The Bi-Phasic diet. This is often referred to as the SIBO diet and it removes resistant starch fibres. While these are not FODMAPs, they may be poorly fermented in the small intestine of those with SIBO.
As to note overly restrict the diet, the key consideration is to only limit foods the degree where symptoms are much improved.
The Low FODMAP Diet for SIBO
FODMAP fibres are naturally present in a wide range of very healthy foods. When the gut is healthy and balanced, these fibres are fermented and act as an energy source for the gut microbiome in the large intestine.
In cases of SIBO, higher levels of bacteria can be present that are capable of fermenting these dietary fibres. This means that an overgrowth in the small intestine can lead to more gas being produced and also in the inappropriate part of the digestive symptoms. Eg in the small intestine, rather that in the large intestine.
This can lead to many of the symptoms seen in SIBO that include bloating, diarrhoea and abdominal pain.
The Elemental Diet for SIBO
For SIBO patients who do not respond to initial treatments, further dietary restrictions and considerations can be considered. One of which is the elemental diet. This is a liquid diet that is followed, commonly for up to 4 weeks.
The aim of this diet is to remove fibre but also take an immunological strain off the gut, thus reducing inflammation. As a low-grade inflammatory response is commonly at the root of the bacteria overgrowth in SIBO, resolving this inflammation may be a way to ‘reset’ the gut and resolve the bacterial overgrowth.
This diet can only be followed under the supervision of a dietitian or doctor.
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Frequently asked questions
What is the best diet for SIBO?
The optimal SIBO diet varies individually and is determined by symptom severity, patient preference and overall therapeutic approach.
The aim is to find the balance between appropriate levels of dietary restriction to manage symptoms while also focusing on calorie and nutrient intake.
Has the low FODMAP been studied for SIBO?
The majority of the research into the low FODMAP diet is around its benefits for IBS. However, research indicated that up to 86% of those with IBS actually have SIBO as their underlying cause.
Therefore it’s safe to assume that this diet is appropriate for those with SIBO.
Are elimination diets long-term?
Elimination diets serve short-term dietary strategies to manage symptoms, not as permanent dietary solutions.
Once the underlying issue is addressed, the aim is for the diet to be diverse and relaxed.
Can SIBO return?
For some, SIBO can return following treatment. This may occur if the root cause has not been addressed.
Tailoring Your SIBO Diet Plan
The benefit of working with a gut specialist is that it provides a clear plan and dietary approach to address SIBO. This can involve how long to follow a diet before assessing how effective it has been.
Additionally, where a low FODMAP or SIBO diet mostly considers fibre content, there are additional ways in which foods can trigger symptoms. This is where approaches such as immune reaction to foods or histamine intolerances may also need to be considered by the practitioner. This will personalise the diet to the individual.
Complementary SIBO Treatments
Elimination diets such as the low FODMAP diet can often be very helpful for those with SIBO. This is due to the removal or reduction in fibre helping the digestive process. It is however important to understand that a low FODMAP diet is a form of symptom management, rather than a treatment. This means that removing foods does not address the underlying overgrowth or imbalance in the gut of those with SIBO.
In addition to forms of symptom management, SIBO treatment is often required. This involves addressing the bacterial overgrowth in the small intestine and can involve:
- antimicrobial treatment
- probiotic supplements
- prebiotic fibres
Conclusion
The precise treatment required to address SIBO requires personalisation that can depend on several factors. These include not only the levels of gas on a SIBO test and the individual symptoms but also the underlying cause of the bacterial overgrowth.
SIBO diet plans and dietary approaches can form a central part of a strategy to address SIBO.
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Read moreShort and long-term dietary approaches and treatment of SIBO
In the short term, reducing fermentable dietary fibres with a low FODMAP or Bi-Phasic diet can often help with reducing symptoms. However, these diets to not address the overgrowth in the small intestine.
With the appropriate treatment, the long-term dietary aim to for the diet to diverse, unprocessed and unrestricted.
Are SIBO diets safe for my to follow without help?
Working with a gut and digestive health specialist can help to guide the dietary approaches. This can provide details on the level of restriction needed as well as how long it should be followed. This can ensure the diet contains adequate nutrition and calories.
Can I eat sugar with SIBO?
Sugar provides an easily fermentable source of carbohydrates. This can lead to an increase in gas levels in those with SIBO as well as providing a source of energy for less beneficial gut bacteria. When treatment SIBO suggest keeping sugar intake to a minimum.
Do I need a positive SIBO test to try a SIBO diet?
With or without a positive SIBO test, SIBO diets can be trialled for a short period of time. This can be a helpful first step to understanding trigger foods and how they influence symptoms. Even without positive SIBO test results, SIBO diet plans are best used while being supported by a gut health practitioner.
