SIBO Diet: What to Eat If You Have Small Intestinal Bacterial Overgrowth

Its very name tells us it's unpleasant: small intestinal bacterial overgrowth. A SIBO diet, though, can ease symptoms (bloating, cramps, diarrhea...).

sibo diet

A SIBO diet will help relieve such symptoms as bloating, gas, cramping, and diarrhea.

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Bloating, flatulence, cramps, diarrhea, and fullness? You may have SIBO, an overgrowth of bacteria in your upper intestines. If so, some counterintuitive changes in your diet can help. Let’s explore the SIBO diet.

The health-conscious among us will be aware of this simple fact: The health of your body depends on the health of your cells. You will also be aware that your lifestyle and diet can significantly impact the health of your cells.

But did you know that around half of the total number of cells in your body are bacteria? Yes, half! A fact confirmed by 2016 research. So it goes without saying that the health of your body—and in particular your gut—depends on the balance of these bacteria. The term used to describe the bacteria in the body is microbiome.

What Is Gut Bacteria?

sibo diet

More than half of the total cells in our body are bacteria. Within this “microbiome,” there are “good” and “bad” bacteria; your good health can hinge on the balance.

The bacterial populations in the gastrointestinal tract (gut) affect not only the health of your gut, but also the health of every system, organ, and cell in your body. The gut microbiome contains tens of trillions of microorganisms; these come from more than 1,000 different species. And each of us has our own unique microbiome.

Crudely put, some bacteria are “good” and others are “bad.” Many factors influence the microbiome, from stress to sugar through to antibiotics and probiotics. According to experts at Duke Health, “The bacteria in our bellies may be controlling which foods we crave…. The food we eat is feeding (or starving) our gut microbiome, which could directly affect our cravings, our resilience against infection, and our risk for a host of other illnesses.”

What Is SIBO—and What Are the Symptoms of SIBO?

According to the U.S. National Library of Medicine, SIBO, or small intestine bacterial overgrowth (previously known as dysbiosis), is a “condition in which very large numbers of bacteria grow in the small intestine.”

The small intestine is composed of the stomach, duodenum, jejunum, and proximal ileum. This area of the gut was once believed to be sterile (free from bacteria).

SIBO symptoms mimic many other bowel conditions, and may include some or all of the following:

    • Bloating and abdominal fullness
    • Abdominal pain and cramps
  • Diarrhea (usually watery)
  • Flatulence
  • Fatty stool (pale and floats)
  • Unexplained weight loss

SIBO COMPLICATIONS

With small intestinal bacterial overgrowth (SIBO), absorption of vitamins and minerals can be a problem. And if left untreated for long periods, vitamin and mineral deficiencies may develop and lead to such conditions as the following:

  • Joint and muscle pain
  • Generalized fatigue and feeling unwell
  • Dehydration
  • Excess bleeding due to vitamin deficiency
  • Liver disease
  • Osteomalacia (softening of bones) or osteoporosis (fragile bones)
  • Neuropathy (tingling, numbness, or pain in the extremities)

Treating SIBO

The mainstay of medical treatment for SIBO is treating underlying conditions (such as Crohn’s or diverticulitis), antibiotics, dietary change, and prebiotic supplementation. Rarely, SIBO sufferers require hospital admission and IV fluids.

A small study in 2014 set out to “determine the rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice.” The study concluded that a formulated herbal therapy was “as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders.” However, more research is needed.

SIBO Diet Considerations

Dietary change is recommended to most people with SIBO. A fascinating article in the journal Gut and Liver in 2017 explains that these troublesome bacteria thrive on certain carbohydrates such as lactose, fructose, and the group called FODMAPS (fermentable oligo-, di-, monosaccharides, and polyols).

When you ingest these foods, they are fermented by the bacteria, producing gas (just like home-brew beer), resulting in flatulence, abdominal bloating, and pain. Gut Liver reported that “restriction of these dietary components may improve these symptoms. Moreover, some preliminary data suggest that manipulation of the diet may alter gut microbiota.” They also recommend taking a probiotic supplement (one that contains “good” bacteria).

The aim of dietary change is to reduce the intake of foods the bacteria thrive on. The big problem is that it isn’t obvious or intuitive as to what these foods are; many of them are usually considered healthy. Plus, because each of us has our own unique microbiome, foods that give most sufferers unbearable symptoms may be just fine for you. Your primary care physician or gastroenterologist may be able to give you some information on dietary change or he may recommend that you see a dietician or nutritionist.

There is a lack of consensus as to what is the best diet for SIBO, but most recommend reducing carbohydrates, excepting insoluble fiber. Examples of formalized diets include: the Low Fodmap Diet (LFD), the Specific Carbohydrate Diet (SCD), the Gut and Psychology Syndrome Diet (Gaps Diet), and the Cedars-Sinai Diet. Discuss with your doctor before starting any of these diets and don’t follow them if you do not have SIBO.

FODMAP Diet

The FODMAP diet is the best researched of all of these diets and is widely accepted by the medical profession. It was developed by researchers at Monash University in Australia.

Experts at the prestigious King’s College Hospital in London recommend three stages to the Low FODMAP diet:

  • Stage 1 Restriction: Avoid High FODMAP foods for four to eight weeks.
  • Stage 2 Reintroduction: If symptoms have improved, reintroduce foods slowly and track symptoms.
  • Stage 3 Personalization: Create a personalized diet to avoid trigger foods.

Foods to Avoid with SIBO

The National Institutes of Health recommends that you keep a food diary and track symptoms. They give these examples of High FODMAP foods and products you may reduce or avoid:

  • Fruits such as apples, apricots, blackberries, cherries, mango, nectarines, pears, plums, and watermelon, or juice containing any of these fruits
  • Canned fruit in natural fruit juice, or large quantities of fruit juice or dried fruit
  • Vegetables such as artichokes, asparagus, beans, cabbage, cauliflower, garlic and garlic salts, lentils, mushrooms, onions, and sugar snap or snow peas
  • Dairy products such as milk, milk products, soft cheeses, yogurt, custard, and ice cream
  • Wheat and rye products
  • Honey and foods with high-fructose corn syrup
  • Products, including candy and gum, with sweeteners ending in “–ol,” such as sorbitol, mannitol, xylitol, and maltitol.

Foods That Are Safe with SIBO

sibo diet

For a SIBO diet, keep such standbys as sweet potatoes, vegetables, rice, and bread on hand. Be careful with fruits—there are some that are safe, but others you should avoid (see lists in text).

There are two types of fiber in food, soluble and insoluble—and we need both.

  • Soluble fiber draws fluid into your digestive tract and slows digestion, allowing the gut time to absorb vitamins and minerals from food.
  • Insoluble fiber, on the other hand, does not draw fluid into the gut and passes through quickly, bulking out your stools and making them easier to pass. SIBO bacteria don’t thrive on insoluble fiber.

The FODMAP experts at Monash University recommend that you eat:

THERE’S AN APP FOR THAT

SIBO and SIBO diets all sound rather daunting and confusing, we know, but the good news is that there are several phone apps that can help you identify potential trigger foods; some also help you track symptoms.

Examples include:

  • SIBO app from SIBO Center at the National College for Natural Medicine in Portland(free)
  • Monash University FODMAP app (the cost is $7.99 but funding goes toward ongoing research)
  • Vegetables (5-6 servings/day): Try carrots, zucchini, green beans, squash, pumpkin, lettuce, cucumber, and sweet potato.
  • Bread, cereals, rice, and pasta (4-6 servings/day): Try gluten-free or spelt bread, white or brown rice, and gluten-free pasta.
  • Fruit (at least 2 servings/day): Try oranges, banana, kiwi, berries, grapes, pineapple, or rhubarb.
  • Meat, fish, poultry (2-3 servings/day): Try chicken, turkey, fish, eggs, nuts, and seeds.
  • Milk, yoghurt, cheese (2.5-4 servings/day): Try milk, lactose-free milk (if you are lactose- intolerant), and ricotta or cottage cheese.
  • Fats and oils (limited): Limit oils, margarine, biscuits, cakes, pies, and alcohol.

This article was originally published in 2017. It is regularly updated.

Comments
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    Reply
  • Thank you for your comment Shirley. Indeed, some people find that Herbal remedies can be effective in treating a wide variety of medical conditions. Herbal therapies can be a useful adjunct to good medical care. Best Wishes Leonaura

    Reply
  • I have sibo & everyone’s bacteria are diff….I can have alcohol biscuits cakes pies but very small portions & I get no reaction on the other had red meat destroys me gotta listen to your body.

    Reply
  • Great summary, but constipation needs to be added as a symptom, especially for those patients with methane based SIBO.

    Reply
  • Um.. they said to LIMIT those things. Gotta read. Just diagnosed with sibo and there is so much conflicting info on what you can have. So basically rice, meats, broths, hard cheeses, and green crunchy vegetables. I am just not messing around with the legumes or fruits or other dairy. Also need to list weight GAIN as a symptom too. It happens when the body goes into starvation mode.

    Reply
  • This is quite confusing. The list of foods you can eat here does not align with the Monash Univerosty app that you refer to. For examples, sweet potatoes are a no go. Perhaps you can update your info?

    Reply
  • I was diagnosed with Sibo. I’ve looked at foods to eat & not eat. Not a big selection for me!! Can I get menus to go by somewhere thx

    Reply
  • When my husband was diagnosed with methane-based SIBO, I had to re-learn how to cook. I started following Dr. Siebecker’s list to develop my own recipes; when my lists got too long, I put them on a website, thinking maybe what I’d done might help others. Every recipe uses only ingredients from the safe “green” column of Dr. Siebecker’s ingredient list, which we found was helpful for my hubby’s healing. Maybe the recipes might help you too… http://www.mysiborecipes.com

    Reply
  • Rhen thanks for reading this article and for your comments. There is widely conflicting advice on what to eat on the SIBO diet as the research is conflicting. I recommend if you have SIBO you ask your doctor for their recommended list.

    Reply
  • Margarine? That thing a molecule away to plastic? Lol. No thanks. I’ll stick to olice oil, sunflower oil and even a bit of butter instead.

    Reply
  • I been burping/belching for one year and still going on. I was diagnosed with SIBO, just finished the antibiotics. My problem is trying to find the right food to eat without having acid reflux. I can’t have a peaceful workout without burping. Some doctors stated it can be swallowing air while I eat or drink. Can someone help me with this? This is so miserable.

    Reply
    • Hi Carol, the term used in the article is actually “triple antibiotic therapy.”

      Reply
  • I have the same issue with belching. I was just diagnosed but with the elevated hydrogen. I’ve been on the FODMAP Diet but I haven’t noticed any difference even though I’ve been doing it for a good month or so. I just want some relief and I’m waiting to hear back from the doctor. Concerned about taking antibiotics because I reacted so many different ones. I have been taking probiotics for sometime now. Perhaps I’ll give me different ones that will make me feel better. The bloating feeling is really very uncomfortable, not to mention some of the other, uncomfortable symptoms.

    Reply
  • Take a probiotic along with eating a SIBO diet, my doc recommends VSL3

    Reply

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