the foods we eat are delicious cuisine for bacteria, but are not digestible by humans. When we eat foods that contain fermentable fibers, we are feeding our gut bacteria. In people with a healthy gut, this is a health promoting activity. But in those who have SIBO, eating fermentable fibers can cause symptoms such as bloating, abdominal pain, acid reflux, constipation and/or diarrhea. The SIBO bugs "eat", or ferment these fibers, which produces gas. It is this excess gas trapped in the small intestine, that creates the symptoms.
The SIBO Diets
There are a few different diets that can be used to successfully manage the symptoms of SIBO. These diets were invented specifically for SIBO:
These diets were not invented specifically for SIBO, but can help to manage symptoms:
These diets Do Not Eradicate SIBO
These diets used to control the symptoms of SIBO do not eradicate or cure SIBO. Often, when someone with SIBO adheres to a strict low FOFMAP or SIBO diet, their symptoms will be minimal or non-existent. When they get off track and eat something which contains fermentable fiber or foods not "allowed" on the diet, their symptoms can come back with a vengeance. This is a sign that the SIBO is still present, but the symptoms are being controlled using diet. The reason SIBO cannot be eliminated using diet alone, is because starving the bacteria in the small intestine does not wipe them out. The eradication of SIBO often requires treatment beyond diet modification, and investigation into what the root cause of the SIBO is.
These Diets Are Not Ideal Long Term
When we follow diets that starve the bacteria in our small intestine, we inadvertently end up starving the bacteria in our large intestine, or colon. Keeping the bacteria in our large intestine fed and happy is vital to our health. The large intestine is where the majority of our gut microbiome resides. Having a diverse, and robust colonic gut microbiome is associated with total body health and vibrancy, while a dysbiotic colonic gut microbiome is associated with a whole plethora of health conditions and diseases (1, 2, 3, 4). The best way to improve the diversity of our large intestine microbiome, is to eat a diet rich in different types of fermentable fibers. But, eating fermentable fibers would most likely send someone with SIBO running to the washroom, or feeling uncomfortable abdominal pain, bloated and gassy.
Ideally, we would only use these diets only short term to control the symptoms of SIBO. In a perfect world, we would then treat and eradicate the SIBO so a person can comfortably return to a diet full of fermentable fibers. Of course, this is not always possible. Some people are unfortunately cursed with chronic SIBO. In chronic cases of SIBO, the root cause of the condition is not treatable so managing the SIBO becomes a long term task. These people may need to be on somewhat of a fiber restricted diet continually, to manage their symptoms.
So what can we do to manage symptoms of SIBO, but keep the bacteria in the large intestine fed? The first step is to, strictly follow one of the SIBO diets for some time until symptoms are minimal. When symptom management is going well, we can start to add small amounts of foods containing fermentable fibers into our diet. This way they can find out what foods we can tolerate, and in which amounts. Some people with SIBO cannot eat certain fermentable foods, such as cauliflower, while others with SIBO can. As well, sometimes a person with SIBO can eat just a small amount of fermentable fibers, such as one or two Brussles sprouts, but not a whole plateful. Test the limits of what you can eat. The goal is to keep the diet as varied as possible. If this all seems too confusing to figure out on your own, work with a skilled practitioner.
Personalization is Key!
There is no one perfect diet for SIBO. Due to the nature of SIBO - being caused by so many different types of bacteria overgrowing in the small intestine - every person with SIBO will tolerate different foods, and be sensitive to different foods.
Every one is different, therefore experimentation and personalization is key! There is no sense in eliminating a food that you tolerate because it is black listed on one of these diets.
I would Like To Hear From You!
Have you tried any of these diets to manage SIBO? Are they successful?
Lindsay Rusk, R.Ac., fmp
Lindsay Is a Registered Acupuncturist, Functional Medicine Practitioner, Health Investigator, Paleo Enthusiast, and Blogger.
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