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SIBO diet plan pitfalls + how to eat to feel better

SIBO diet plan suggestions vary widely and have surprisingly little research behind them.  But, that doesn’t mean that certain foods and nutrients aren’t healing for this condition because they certainly are!

In this post, I will help you to understand what SIBO and SIFO are, if and when a special diet may be needed, and some ways to make some high FODMAPS foods fit in your diet. 

I will also include how eating food that tastes good and heals at the same time perhaps will do more for your body than the extreme SIBO-restrictive diets out there. 

Please note that this blog is intended for informational purposes only and is not meant to diagnose or treat illnesses.  SIBO can be extremely challenging to treat so you will want a qualified medical team to support you, such as a functional medicine doctor or dietitian like my colleague Sara Kahn, MS, RD

Consult with your doctor or healthcare practitioner before making any changes to your diet or lifestyle routine. 

What is SIBO and SIFO and how do they differ? 

SIBO stands for small intestinal bacterial overgrowth, while SIFO stands for small intestinal fungal overgrowth.  

Both SIBO and SIFO symptoms can be identical and can look exactly like irritable bowel syndrome too.  And you can have both conditions at the same time.  

Luckily, a good diet plan can help with both!

Symptoms of SIBO and SIFO include: bloating, gas, abdominal pain, nausea, constipation, and/or diarrhea.

Bloating is a hallmark symptom of SIBO and SIFO.  In a big way.  This is because the microbes are growing where they shouldn’t be and this results in a lot of belly distress. 

Also, half of all people with irritable bowel syndrome-diarrhea predominant have SIBO [R].

Common treatments for SIBO include following a special diet and taking antibiotics called rifaximin. 

Who is at risk of SIBO and SIFO?

Risk factors for SIBO and SIFO are abdominal surgeries, using PPI medications, opiate drug use, antibiotic use, slow gut motility (constipation), and previous gastrointestinal infections like diverticulitis and IBS. 

If you suspect you have SIBO or SIFO, ask your doctor to perform a hydrogen breath test and methane breath test to confirm a diagnosis for you  [R].

While these tests only pick up if you have SIBO, you can suspect you have SIFO if you have identical symptoms.  SIFO diagnosis is usually made by endoscopy. 

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SIBO diet plans and pitfalls

Many diet options for SIBO are used by various practitioners.

There are:

  • Low FODMAPS diet (FODMAPS stands for fermentable olig-saccharides, di-saccharides, mono-saccharides, and polyols).
  • Specific carbohydrate diet
  • Elemental diet
  • GAPS diet
  • Low fermentable carbohydrate diet

As stated before, there is a big overlap in SIBO and IBS, so using a low FODMAP diet or specific carbohydrate diet can be helpful for managing SIBO symptoms initially.  

Most guidelines for SIBO diets focus on low FODMAP diets for symptom relief, so I will describe that diet in a bit more detail.  

FODMAPS are carbohydrates that are fermented in the gut.  Under normal circumstances, these carbohydrates should be fermented in the large intestine so that they can help fuel the microbiome.

But, in SIBO and SIFO, these carbohydrates ferment in the small intestine, which can cause pain, irritation, reduced vitamin levels, inflammation, and more. 

The most common high FODMAP foods are: 

  • Grains: wheat, barley, rye
  • Vegetables: artichokes, onions, garlic, cauliflower, avocados, asparagus
  • Fruits: watermelon, apples, cherries, figs, peaches, plums
  • Legumes: all 
  • Dairy: milk, ice cream
  • Sweeteners: honey, high-fructose corn syrup
  • Artificial sweeteners: all
  • Nuts: almonds, cashews, pistachios

The low FODMAP diet is most effective in controlling short-term symptoms of people with diarrhea-predominant IBS or SIBO/SIFO.  

These FODMAPS carbohydrate foods have poor absorption and high fermentation, making them logical candidates to remove from the diet for people who have SIBO. 

But, there are some huge pitfalls to these diets, so keep reading. 

Related: Do You Need Low FODMAP Tea for IBS? (thehealthyrd.com)

SIBO diet plan confusion

Almost every website about the topic provides different recommendations for SIBO and SIFO but are often subtly overlapping, which can be quite confusing for anyone trying to get over SIBO symptoms. Even low FODMAPS diets vary a lot!

I want people to also know that while these diets may seem like a good idea, there is a huge variability in response to SIBO with them.

And if continued long-term, they can do more harm than good. 

Long-term, these plans will wreak havoc on your microbiome and the nutrients you can get in your diet.  

These SIBO diets  aren’t all-encompassing either, as they only address fermentation of carbs in your small intestine, not all the other healing properties that high FODMAP foods can deliver.

And your approach should be individualized to you. 

Other experts like Chris Kresser and Dr. Pimental discourages using a low FODMAP diet during antibiotic treatment for SIBO.

This is because the bacteria are easier to kill in the presence of a more diverse diet. 

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Sugar and SIBO

Many SIBO websites often forget to mention some common foods that can worsen SIBO and SIFO: added sugars and processed foods.  

Harmful bacteria that cause SIBO love processed sugar and when you eat a lot of it, you can make your belly sad or full of SIBO symptoms.  [R].

At the same time, these sugars make the harmful bacterial and fungal “cohabitants” very happy. By causing inflammation and robbing nutrients, they also weaken the immune system’s response to SIBO.

People with SIBO are also more likely to get Type 2 diabetes too and vice versa [R].

However, there is often more to the story than just sugar and processed foods because we are all unique. 

So, it’s quite perplexing to most people about what to do and how to follow a SIBO diet plan. 

As a long-time dietitian and nutritionist, some of the concepts behind these diet plans throw up some red flags. 

Guar gum and SIBO

One of the best examples of a high FODMAP food that actually helps SIBO is guar gum, which is derived from beans. If you were to go by the FODMAP premise, you could be missing out on a very healing fiber. 

For example, people with SIBO were given a fermentable carbohydrate called guar gum along with the standard antibiotic Rifaximin.  The people receiving both the guar gum and the Rifaximin had a better response than those getting Rifaximin alone [R].

Another study found that people with IBS who received guar gum had less bloating than those who received placebo [R].

Based on this, I’m not sure how much utility a broad low FODMAP diet has for people.  My suspicion is that it doesn’t serve all people well. 

SIBO diet alternatives

One topic that hasn’t been researched, but I have long suspected might be true is that a gentler approach may be even better for SIBO symptom relief and SIFO symptom relief than following a SIBO or SIFO specific diet.  

A gentler approach (and in my experience, more healing) would mean including most foods-as long as they are nutritious, gut-friendly, and that they are already fermented.  Here, cooking and preparation methods of foods really matter!

This approach also would include gut-healing supplements to support recovery from SIBO. 

When foods are fermented before you eat them, they become somewhat predigested, making the fermentable carbohydrates healing to the digestive tract. This is regardless of their FODMAP content.  

Could high FODMAPS foods help heal SIBO? 

Many foods that are fermentable, or high FODMAP, are very healthy. Eliminating them can have big consequences long-term. 

If you are healing the gut, you will be more resilient to SIBO and SIFO by including some of them in your diet, but doing so carefully. 

For example, while some mushrooms are a high FODMAP food, they are also very healthy for the microbiome and your gut-related immune system.  

Other high FODMAP foods help fight bacteria too, which could be more of a benefit than a drawback in SIBO.

So, eliminating all high FODMAP foods may do more harm than good, even if you have SIBO. 

Fermenting foods, probiotics and SIBO/SIFO

By eating fermented foods, you are eating already pre-fermented and partially “digested” food by microbes.  This means that you are way more likely to tolerate any high FODMAP food if it has been fermented, such as asparagus, cauliflower, and artichokes.  

Plus, these foods will have more nutrients and you will get more digestive enzymes to help you break down your food. 

Read more about fermented vegetables in my sauerkraut and fermented carrots post. 

And, by adding in the probiotic-rich foods as discussed in my Whole Body Guide to Gut Health book, the invading bacteria and fungi may be reduced naturally. You see, healthy bacterial and fungal species may help kill off bad and invasive species [R].

Not up for fermenting foods or you know you can’t tolerate them?  Try soaking, sprouting, and cooking these foods to help remove anti-nutrients and tough-to-digest fibers. 

Related: Best Probiotic for SIBO and Histamine Intolerance

Honey and SIBO

Another example of a healing food that is often on the SIBO no-no list is honey, but let’s take a closer look at this food. 

Honey has fructose, which is rich in FODMAPS. 

If this is the only factor you consider, you would say, hey, you should avoid this with SIBO.  

But honey is more than fructose!  For some people with SIBO and SIFO, adding honey could have some healing benefits for the gut.  

Honey contains prebiotics and it’s actually antibacterial.  I’ll repeat that.  Honey is anti-bacterial [R].

I’m not saying everyone should eat honey when they have SIBO, but I suspect many can eat a moderate amount of it and actually benefit from it.  

Almonds and SIBO

Almonds are a food to avoid on a low FODMAP diet, which makes sense in some ways. 

But, things change when you soak and sprout them. The fibers become much more easy on the digestive tract and the anti-nutrients are reduced.  In my experience, they become more nourishing and easy-to-digest.  

Win-win.  

By now you get the point.  A gentler, more holistic approach to SIBO and SIFO could be more healing for you than the overly restrictive approach.

SIBO and mushrooms 

Another example of a high FODMAP food that may help with SIBO are mushrooms.  

Reishi mushrooms help reduce gas, bloating, and other symptoms of IBS in a clinical study [R].

Other mushrooms that are low FODMAP and may be particularly healing for the gut and gut immunity are Lion’s mane, Shiitake, Turkey tail, and Cordyceps

Lion’s mane may be extra healing for the gut because they may help the MMC function in the gut. 

Onions with SIBO

Ok, so there is no disputing that onions and garlic are fermentable because they make almost anyone, ahem, gassy. 

I have found a hack, at least for me.  After about a week of starting to use bovine colostrum powder, my gut loves onions and I experience no gas.  Zero.  

Win-win for me and everyone around me.  Will it work for you?  It might, because other reviews of colostrum supplements suggest this is true. 

Plus, you may be able to get all the gut-healing compounds that onions and garlic provide in this way.  Just start with a little bit of onions and garlic to test it out. 

Bone broth and SIBO

A popular gut healing food is bone broth because it is rich in protein and collagen that is thought to soothe an irritated digestive tract. Most people find it quite comforting and nourishing when they use it in cooking.

Some people feel better if they make bone broth without the cartilage, especially if their SIBO is high up in the digestive tract.

Supplements for SIBO and SIFO

Before throwing extreme diets into the mix, I fully believe that focusing on healing the gut and letting that process start first is the best approach.  

After all, when you have a strong gut lining, it may begin to balance out the intestinal bacteria naturally.  

Leaky gut supplements

With SIBO, it is best to heal and seal the gut along the way so that it is easier to recover and feel better. 

Some great gut-healing supplements that you can try include: 

Some of these supplements have research to support their benefits for SIBO and others are researched to help heal a leaky gut, which occurs in SIBO.

Regardless, adding in supplements like glutamine, bovine colostrum, probiotics, guar gum, and high-quality vitamins and minerals can help speed the healing process. They can also help your immune system fight off the intestinal bacteria too.

Finding the right probiotic for you can take some trial and error, but experts in the world of SIBO believe that probiotics are the way of the future in SIBO treatment.

Motility supplements

For people who suffer from infrequent bowel movements as a root cause of their SIBO, adding in a supplement may help this too. 

Supplements that may help with bowel movement frequency include: 

Ginger helps stimulate intestinal muscle movements, while peppermint helps reduce abdominal muscle spasms and pain in some people.  

Magnesium is critical to having normal bowel movements and vitamin C is a natural way of increasing gastric motility. 

Triphala also is thought to stimulate motility and is safe because it is derived from 3 fruits. A bonus is that it has anti-bacterial properties too.

Fennel seeds could be another great herb to try because it helps to reduce gas and bloating.

Other SIBO Tips

While food and medications are a big part of how you may feel if you have SIBO, other factors are really important. The following tips help the intestinal muscles move in a more productive way. 

  • Minimize stress
  • Chew food slowly and well
  • Get regular exercise
  • Work on slow breathing 
  • Stimulate the vagus nerve by laughing, singing, humming
  • Try using a sauna for stress relief
  • Take a 30-second cold shower daily
  • Consider tapping techniques for digestive health
  • When in doubt, trust your gut instincts about a particular food

Foods can’t digest or move through the digestive tract well if you are stressed.  This means that focusing on the mind-body connections and giving yourself some extra time to relax are key to success when recovering from SIBO. 

Summary

SIBO diet plans should never be a one-size-fits all approach and should be treated with your individuality in mind.  

A healing, more well-rounded approach to SIBO probably works better than any restrictive diet long-term.  

Remember, with good food preparation techniques, most healthy, gut-healing foods can fit.

The information on this website is not intended as medical advice.  Consult your doctor or healthcare provider before making changes to your supplement regimen or lifestyle.


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