If you have small intestinal bacterial overgrowth (SIBO), these statements may sound familiar:
- I was almost bedridden with fatigue.
- I had constant headaches that became so severe I couldn’t leave the house.
- I woke up in the morning and felt great. By the end of the day, I felt swollen, and I looked like I was six months pregnant.
- I struggled with constipation my entire life.
- I was afraid to go out with my friends because I always needed to be near a bathroom.
SIBO can cause various digestive and non-digestive symptoms (IBS symptoms, fatigue, anxiety, joint pain, and more). Symptoms range in severity from non-existent to severe.
Patients with symptomatic SIBO may wonder what foods should be avoided with SIBO. That’s because finding the right dietary approach can make a huge difference. Let’s take a look at some of the foods known to trigger SIBO symptoms and why some patients should avoid them.
What Is SIBO?
Small intestinal bacterial overgrowth (SIBO) is a type of digestive tract dysbiosis. Simply stated, dysbiosis means that the bacteria in the digestive tract have become unbalanced. When there’s a bacterial overgrowth in the small intestine, SIBO occurs.
SIBO is not a “condition” in itself but is a lab finding based on a glucose or lactulose breath test. It’s important to note that some people who test positive for SIBO do not experience any symptoms.
Dietary Impacts on SIBO
If you have taken a breath test and tested positive for SIBO, it’s essential to understand how the foods you eat may aggravate your symptoms. Finding the right dietary approach can help you manage uncomfortable SIBO symptoms like bloating, abdominal pain, diarrhea, and constipation [1, 2, 3, 4].
Each patient’s intestinal microbiome is unique. Foods that feed bacteria and trigger symptoms for one patient may not cause a reaction for another patient. For this reason, the goal of any SIBO diet is to identify your food triggers and develop a SIBO dietary approach that works for you.
What Foods Should Be Avoided with SIBO?
The objective of any SIBO diet is to reduce bacterial overgrowth in the small intestine. Eliminating foods that feed gut bacteria can help to reduce bacterial overgrowth.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Simply stated, FODMAPS are fermentable carbohydrates and starches that feed bacteria. The low FODMAP diet temporarily eliminates high FODMAP foods. Once symptoms are reduced, the patient gradually reintroduces foods to identify which ones trigger symptoms.
Examples of high FODMAP foods to avoid:
(High in fructans or fructose)
|asparagus, cabbage, garlic, onions, peas, artichoke, cauliflower, brussels sprouts|
(High in polyols or fructose)
|apples, apricots, bananas, blackberries, dried fruits, watermelon, grapes|
|Grains||wheat, rye, barley|
(High in fructans)
|pistachios, almonds, hazelnuts|
|Dairy products |
(High in lactose or fructose)
|fresh cheeses, milk, yogurt, cottage cheese, ice cream|
|Meat products||containing gravies, broth, sauces|
|Natural and artificial sweeteners||high-fructose corn syrup, agave syrup, honey, xylitol, sorbitol, mannitol|
Eliminating high FODMAP foods can help starve the bacterial overgrowth causing SIBO symptoms. Eliminating these foods can also reduce IBS and SIBO symptoms, such as bloating, gas, abdominal pain, diarrhea, and constipation .
We encourage our patients to avoid unnecessary food restrictions. Trial and error is an important tool for a patient to learn what works for them. During this process, remember the foods that can be tolerated will vary substantially from patient to patient. As SIBO heals and bacterial overgrowth is eliminated, most patients will be able to broaden their diet. However, some SIBO patients may have structural or neurological conditions that require ongoing dietary management.
SIBO Diet Basics
Now that we’ve discussed what foods should be avoided with SIBO, let’s talk about all the foods you can eat.
Focus on choosing foods that are fresh, whole, unprocessed, and low in FODMAPs. Here are a few examples to get you started:
- Meat, poultry, fish, seafood, eggs, and wild game
- Rice, oats, quinoa, and bulgar
- Low FODMAP vegetables: green beans, tomatoes, zucchini, cucumbers, lettuce, carrots, and spinach
- Low FODMAP fruits: unripe bananas, blueberries, cantaloupe, honeydew, kiwi, oranges, pineapple, raspberries, and strawberries
- Starches: plantains, turnips, white potatoes, and white rice
- Lactose-free dairy products
- Dairy products: butter and ghee
Tips for Implementing SIBO Dietary Changes
Don’t overcomplicate it. Making dietary changes can be overwhelming, but it doesn’t have to be. When you begin, choose a few go-to foods and recipes. It’s okay to repeat meals when you’re first starting. As you get comfortable with the diet and identify your trigger foods, it will be easier to expand your food choices and try new recipes.
Plan ahead. Remove the foods that should be avoided with SIBO from your kitchen. It’s best to remove these temptations. Instead, stock your pantry and refrigerator with all the foods you need for a simple, low FODMAP eating plan. Batch cook and freeze a few of your favorite meals.
Be as strict as possible for 3-4 weeks. During this time, adhere to your plan as closely as possible. If your dietary changes are helpful, your symptoms should improve during this time. Once your symptoms have improved, you can slowly reintroduce foods to identify your food triggers.
Reintroduce foods one at a time. Pick the foods you missed the most and start there. Monitor your symptoms for at least two days after reintroduction. If you don’t have any symptom flare-ups, try another new food, and so on. If you do experience an adverse reaction, wait until your symptoms subside before trying any different foods.
Don’t fear your food. As your digestive tract heals, the foods you can eat may change. You may find that you can eat moderate amounts of food that caused a reaction months ago. Don’t fall into the trap of thinking you have to avoid certain foods forever. We encourage our patients to have the fewest dietary restrictions possible and develop a healthy non-fear-based relationship with food.
Other SIBO Diets
If eliminating high FODMAP foods does not provide symptom relief, here are two other dietary approaches to consider.
Specific Carbohydrate Diet (SCD)
The specific carbohydrate diet includes more dietary restrictions than the low FODMAP diet. In addition to removing high FODMAP foods, it also eliminates all grains and all complex carbohydrates. For example, quinoa, oats, and rice are allowed on the low FODMAP diet but not the specific carbohydrate diet. The SCD also eliminates most sugars and starchy vegetables. Some fruits and vegetables with simple sugars are allowed .
Dr. Syndey Hass developed SCD in 1951 as a therapeutic diet for patients with celiac disease. SCD has proven helpful for patients with inflammatory bowel diseases (including Crohn’s Disease) [6, 7, 8, 9].
The specific carbohydrate diet offers an alternative for patients who don’t experience improvement on the low FODMAP diet.
When dietary changes do not improve a patient’s symptoms, research suggests that the elemental diet may help manage SIBO.
An elemental diet is a short-term, therapeutic treatment that involves replacing all meals with a liquid elemental diet formula. The removal of all fiber and solid food starves harmful gut bacteria that cause SIBO symptoms.
Research on the elemental diet and SIBO is evolving. One study demonstrated normalized breath tests in 80% of SIBO patients after a two-week elemental diet . In the same study, 65% of participants experienced IBS symptom improvement.
Your SIBO Treatment Plan
When it comes to treating SIBO, dietary changes alone don’t always address the underlying bacterial overgrowth. If you’ve experienced this, don’t feel discouraged. Long-term success is possible. However, sometimes, a combination of treatments is needed. Treatments may include probiotics , diet , fasting , digestive supports , and herbal antimicrobials .
Probiotics have demonstrated treatment effectiveness for SIBO, improving both lab values, and SIBO symptoms [15, 16, 17]. A low FODMAP diet combined with high-quality probiotics is the recommended starting point for SIBO treatment and can be very effective for reducing symptoms.
Diet is an integral part of a SIBO treatment plan and management of SIBO symptoms. For some patients, treating SIBO means getting back the life they once enjoyed.
Learning what works for you takes some personal experimentation, but the right treatment approach can make all the difference in enjoying your life again.
Relief is possible. Contact us today for help determining what foods should be avoided with SIBO.