Small intestinal overgrowth (SIBO) is a disorder in which the small intestine contains excessive intestinal bacteria. There are some different SIBO diets used to help reduce associated symptoms and complications, including abdominal bloating, cramps, diarrhea, nutritional deficiencies, weight loss, etc. While dietary strategies can be part of a comprehensive treatment plan, there is limited evidence to support a single SIBO diet.
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The goal of SIBO treatment is not to eliminate bacteria in the gut, but rather to restore it to an average balance.
Antibiotics such as Xifaxan (Rifaximin) are typically the cornerstone of treatment with SIBO. However, because SIBO is normal in people with other gastrointestinal disorders such as Crohn’s disease and irritable bowel syndrome ( IBS), these underlying conditions often need to be handled because they may aggravate symptoms and promote bacterial overgrowth in the small intestine.
SIBO diet can play a role here by preventing the proliferation of gut bacteria, reducing inflammation and correcting nutritional deficiencies.
Gastrointestinal health experts recommend personalizing treatment for SIBO.
Two standard SIBO diet regimens include the elementary diet and the low FODMAP diet. The use of these nutritional protocols may depend on the severity of your symptoms.
A necessary diet is a liquid diet typically used for patients with compromised digestive systems. However, as a potential cure for small intestinal bacterial overgrowth (SIBO), the diet is getting new attention. However, some work has suggested that the overgrowth of bacteria in the small intestine is responsible for the symptoms of IBS in some people, although it remains somewhat controversial.
The elementary diet is considered as a possible supplement to antibiotics for the following reasons:
- It believed that nutrients from an elemental diet are entirely absorbed in the very first part of the small intestine, reducing the number of food components available to bacteria.
- Necessary diets have shown to reduce the number of gut bacteria. Therefore, its theorized that it could help eliminate bacteria from the small intestine.
- Researchers in the only clinical trial published to date on the subject theorize that the elementary diet can increase the amount of bile released from the gallbladder. This effect would theoretically enhance the cleansing wave of the small intestine, reducing the levels of bacteria.
- These same researchers also suggest that the effects of diet on immune cells in the intestinal lining may also be used to eradicate bacteria from the small intestine.
The diet used in the trial assessed the effect of nutrition on the level of lactulose in the breath. This measure reflected the presence of excessive amounts of bacteria in the small intestine. The information has also gathered about the effect of diet on IBS symptoms.
In the case, 93 IBS patients who had abnormal lactulose breath test (LBT) results limited their diet to a basic diet formulation for two weeks. After the two weeks, those who continued to display irregular LBT results requested to continue for another week.
In the first two weeks, 80% of patients have had regular LBT exams. After adding those who observed the diet for the extra week, the amount rose to a total of 85%.
There was more limited data on the effect of diet on clinical symptoms. However, the study reports increased improvement in IBS symptoms in patients with normal LBT at the end of the study, regardless of subtype of IBS, compared to those who continued to show high results LBT.
Other studies have investigated the use of the elementary diet for Crohn’s disease, another condition that often accompanies SIBO. There is mixed Proof to support its use.
The author of a published report notes that diet adherence is a barrier. Many patients find the diet unpleasant to taste, and others find that sticking to a liquid diet is not sustainable long for the diet to be effective. However, the author notes that most patients that have had pharmacological procedures trouble are able to acknowledge the inconvenience involved in seeing progress.
Low FODMAP Diet:
The diet low in FODMAP is most widely used to treat SIBO symptoms. FODMAPs are a group of carbohydrates which comprise:
- Oligosaccharides (composed of fructans and galactan)
- Disaccharides (milk sugar lactose)
- Monosaccharides (fructose)
- Polyols (e.g., sorbitol, mannitol, xylitol, and maltitol)
FODMAPs are poorly absorbed from the small intestine, and symptoms of irritable bowel syndrome are likely to deteriorate. Researchers have found that many experience substantial relief from their symptoms when people with IBS adopt a diet low in FODMAP.
Two of the main forms of FODMAP, lactose, and fructose, may be poorly absorbed with SIBO due to inflammation along the small intestine lining. Besides these two, Any unabsorbed FODMAPs may be fermented by bacteria that reside incorrectly in the small intestine, causing bloating and other digestive symptoms.
The low-FODMAP diet may be helpful for SIBO because reducing carbohydrate intake could “starve” bacteria in the small intestine.
Some research suggests that the low FODMAP approach may be beneficial. But more research is needed to be sure whether the treatment is effective enough to recommend as a standard approach. In 2018, the authors of a study published in Gastroenterology Clinics of North America said the role of dietary changes in the management of SIBO was still poorly understood.
Additionally, there is speculation that the low FODMAP diet may reduce the effectiveness of antibiotics if a person takes them for the management of SIBO. Therefore, it generally recommended that a person eat a normal diet while taking the antibiotic, and then follow a low FODMAP diet after the drug treatment finished, to avoid future recurrence of SIBO.
How It Works
Your health care provider will provide you with recommendations on the best SIBO diet for you. The low FODMAP diet and the elementary diet are possible treatments.
The elementary diet involves complete dietary restriction to a specific liquid formulation. The diet gets the name from the fact that nutrients are introduced into the body as close to the elemental primary form possible.
How long you are on a basic diet depends on your symptoms and how well you stick to the program. One of the biggest challenges of the elementary diet is to give up solid foods.
According to a published report, only about 25% of patients are willing to limit their nutritional intake to a liquid diet long enough to see results. But several studies report that those who comply see results in two to three weeks.
Some people who are unable to adopt a complete elemental diet may, with the consent of their doctor, use a partial elemental diet and combine liquid food with foods known to be tolerable. A partial elementary diet is sometimes also used for long-term maintenance. But it is essential to work closely with your healthcare professional to maintain adequate nutrition.
What To Eat
The Basic Diet has given as a drink that you drink, or it can give through a feeding tube. The amount of fluid given is slowly increased over the first few days to reduce unwanted side effects such as diarrhoea or abdominal pain.
— formulation is easily digestible and contains nutrients. Typical formulations encompass:
- Essential and non-essential amino acids
- Glucose (an easily digested carbohydrate)
- Vitamins (fat-soluble and water soluble)
- A small amount of fat (less than 1%)
There are some different variations of the Basic Diet that can be purchased online. Powder mixes contain only essential nutritional ingredients and provide 150-300 calories or more. Your healthcare professional will help you decide how much to use for adequate nutrition.
No artificial flavors or colors applied to elemental diet mixes (which blended with water), and many people consider the drink to be unpleasant. Some experts suggest adding ice to give it texture so that it is easier to consume.
Because the basic diet can be impractical and distasteful, it usually used as a last resort. However, if the symptoms of SIBO are severe enough, then a basic diet may be worth it for you.
The elementary diet must be used only under medical supervision, as it carries certain risks. Do not try a homemade elementary diet formulation because of the risk of significant nutritional deficiencies, which could put your health at risk. The regimen should not be used simultaneously with antibiotic therapy for SIBO.
Low FODMAP Diet
With this diet, you will avoid foods high in FODMAP during an elimination phase. At the end of this phase, you slowly reintroduce each type of FODMAP into your diet – one by one – to accurately identify the FODMAPs that are causing the symptoms of SIBO.
The process of elimination will last from two to eight weeks. You’ll definitely see a decline in symptoms during this period. The next phase, called the re-introduction process, is crucial. The time it takes for this phase varies greatly depending on your symptoms.
Not all types of FODMAP are a problem for every person. It recommended that you choose one FODMAP subgroup at a time to test the effect of each group on your body.
This diet not intended for long term use. Many foods high in FODMAP are very good for overall health. Many of them are considered prebiotics, which means that they improve a healthy balance of gut bacteria. Thus, the reintroduction phase and continued food testing are extremely important to ensure that you are eating a varied diet without experiencing symptoms again.
What To Eat
During the elimination time, you will avoid foods rich in FODMAPs. Non-compliant foods during this time will contain one of five types of FODMAP:
- Fructans: Fructans are not digestible, and are mainly present in wheat, many fruits, and some food additives, including inulin.
- Fructose: Fructose is the sugar present in many vegetables, honey, and corn syrup high in fructose.
- Galatians: Galatians can also be present in legumes, including beans, chickpeas, and lentils, also called galactooligosaccharides or GOS.
- Lactose: Lactose is the sugar present in milk and other products made from milk.
- Polyols: These are sugar alcohols whose names usually end in “- ol.” They are found naturally in certain fruits, like blackberries, and vegetables, like cauliflower and mushrooms, and often used as artificial sweeteners.
Almost all food groups (fruits, vegetables, grains, etc.) contain foods high in FODMAP and foods low in FODMAP.
Following this diet, it’s a good idea to consult with a registered dietitian who is experienced in SIBO diets to help you choose the right foods to suit you. A list of food samples in each category that may be on your compliant or non-compliant list is given below.
- Vegetables include aubergines, green beans, cucumbers, cabbage, tomatoes and zucchini
- Fruits, including cantaloupe, grapes, kiwi, and strawberries
- Dairy products, including feta cheese, camembert, hard cheeses, almond milk, and soy milk
- Proteins such as eggs, firm tofu, tempeh, and seafood
- Bread and grain products, including corn flakes, oats, rice cakes, corn noodles, and barley-free bread
- Medium, dark chocolate, maple syrup and table sugar
- Nuts and seeds, including peanuts, macadamia nuts, and sunflower seeds
- Vegetables like asparagus, cauliflower, mushrooms, onions, and peas
- Fruits, including apples, cherries, dried fruits, peaches, and watermelon
- Dairy products, including cow’s milk, evaporated milk, ice cream, and yoghurt
- Proteins include most legumes, marinated meats and other processed meats
- Bread and grain products, including wheat, rye and barley pieces of bread and snacks
- Sweet treats, including honey, high fructose corn syrup, and sugar-free treats
- Nuts and seeds, including cashews and pistachios
Note that any food low in FODMAP may be eaten during the elimination process. The above list is merely a sampling of foods available based on knowledge produced in Australia by Monash University, a leader in research on this subject.
The timing of your meals and snacks is not a factor in both the elimination and reintroduction phase. You can eat food on a schedule that works best for you. However, since reintroducing FODMAP foods can cause symptoms, you may want to introduce them when you are home and can be comfortable.
Many people with SIBO have other disorders, such as celiac disease, chronic pancreatitis, liver cirrhosis, Crohn’s disease, diabetes, and other diseases. It is also very normal for people with these conditions to experience malnutrition since they have SIBO.
For example, fat-soluble vitamins (vitamins A, D, E, and K) may not absorbed properly if you have SIBO. Those with SIBO may also have iron deficiency or vitamin B12 deficiency.
For this reason, its strongly recommended that you work with your health care provider and a nutritional professional to manage SIBO and any underlying conditions. Your care must relate to your particular symptoms and may include supplementation.
When following the FODMAP diet, most experts recommend keeping a food journal. A simple journal will help you better understand the relationship between the foods you eat and the symptoms you experience.
You’ll also want to put together resources so that you can assess the FODMAP content of each food you choose. The low FODMAP smartphone app from researchers at Monash University is a must-have. It can also be helpful to buy low FODMAP cookbooks and find low FODMAP recipes online.
Finally, remember that the low FODMAP diet not designed to be a permanent diet. Many foods high in FODMAP are also healthy foods. Therefore, you’ll want to ensure that your diet continues to reintroduce new foods at regular intervals and see whether your sensitivities have changed. You’ll be driven through this step by your food log.
A Word From Verywell
A SIBO diagnosis can be frustrating, but luckily the disease is becoming more widely recognized, so proper treatment is easier to find. Work closely with your healthcare team for personalized advice. When your nutritional needs have fulfilled, you will generally recover strength and feel more relaxed. Bear in mind that SIBO will fluctuate over time, so you can interrupt treatment at a time for months or even years. Be sure you speak to the doctor about recurrent symptoms, so that flare-ups can handled easily.