I believe testing for SIBO is the number one thing anyone with IBS should do. Not everyone has SIBO, but many do, and it’s important to confirm you have it or rule it out. SIBO stands for small intestinal bacterial overgrowth. It’s when bacteria colonize the small intestine and overgrow, the problem is that the small intestine shouldn’t house more than a few bacteria.
The reason for my recommendation is simple. Dealing with SIBO has it’s own unique set of rules that largely contradicts much of the general digestive health advice out there.
So many people with SIBO are following this advice and getting scared and frustrated when they start to feel worse or experience no improvement.
That’s because most of the advice to eat fiber, raw veggies, fermented foods and take probiotics is to build up your biome (the bacteria that lives inside your gut). With SIBO however we are attempting to do the very opposite.
That’s why anyone who doesn’t want to waste their time should take a SIBO test. They’re not expensive and easy to take. I order SIBO lactulose breath tests for my clients and other practitioners do also. So it’s not hard to come by. Though your doctor may look at your funny if you ask him or her for one.
With SIBO you have to eat very specific foods and avoid taking certain popular herbs for adrenals and leaky gut to avoid feeling worse.
Approaching SIBO is extremely unintuitive because you have to avoid health foods and herbs. It’s not forever, of course, it’s just until you can get the overgrowth under control. And correct the underlying issue that caused it.
And of course, what makes it even worse is that the SIBO diets out there contradict each other. Some say cabbage is ok some say it isn’t. What to believe?
Most people react to different fermentable carbohydrates and the amount really does matter. You may be ok with half a cup of sweet potato but any more than that and you’re bloated and in pain.
That’s why designing a correct eating plan is really tricky with SIBO. And why treating yourself can be stressful and disastrous. But it doesn’t stop people from doing it anyway.
So my best advice is test for SIBO and then work with someone who understands it well. That’s the fastest tract to conquering IBS.
I know you may be tempted to use the dietary info in this blog post to just go ahead and treat yourself, but I have to emphasize that diet alone does not get rid of SIBO. It may control your symptoms, which is quite valuable but it won’t get you back on the road to eating the variety of healthy foods that you should be able to eat, like garlic, onions, apples and cauliflower.
The low FODMAP diet is the general recommendation for SIBO.
It’s been gaining popularity for IBS sufferers among dieticians and even some progressive doctors. Some people find symptom relief on the diet and some folks do not. This is not an indication of whether SIBO is present. Don’t use this as a test.
There can be other reasons the diet isn’t working, like doing it wrong, cheating or having other food sensitivities/allergies. The best way to deterine or rule out SIBO is the gold standard hydrogen breath test.
The test I recommend to my clients comes to their home and is self administered. This is the test that I took as soon as I started bloating and discovered that I had an overgrowth of hydrogen dominant SIBO.
The test costs $149 and it’s the best investment you can make in unraveling your health puzzle. It will bring you closer to figuring out the root cause of bloating, gas, abdominal pain, constipation or diarrhea, so you can do something about it.
So, if you have SIBO you have to change your diet.
The small intestinal bacteria survive on fermentable sugars, fibers and starches. These foods are hard to digest so instead of being absorbed they hang around the small intestine and become food for bacteria. After the bacteria eat they excrete toxins and gases that cause bloating, distention, pain and gas.
Also, these bacteria steal the nutrients meant for you so even if you are eating healthy you may be deficient in some nutrients. SIBO can often interfere with the liver’s ability to excrete bile so some people with SIBO will have trouble digesting fats.
That’s why it’s very important to take a digestive enzyme with every meal to help you break down your food better.
I take this one because it has hydrochloric acid to help digest protein and oxbile to help with fats. It also has plenty of enzymes to digest carbohydrates.
Chewing your food well is very important. As it breaking it down before you eat it by blending or pureeing it. Or cooking your food really well as in long cooked stews and well boiled veggies.
So the million dollar question is what’s the best diet for SIBO?
There are some guidelines but it largely depends on the severity of symptoms as well as your lifestyle and psychology.
There are several choices and it depends on how strong and restrictive you want to go. Many IBS folks have extremist personalities, so if they do something they go extreme. This may work for some but may get others in trouble. It’s important to have some balance in your diet. The bacteria feeds on carbs and fiber but going completely carb free will cause other health problems.
Going hardcore may also entail results in more die off symptoms, which can be quite uncomfortable, characterized by flu like symptoms, head aches, body pain (joint pain) and irritability.
If you are new to this, just starting off with a regular low FODMAP diet can be enough of a transition. Monash University is the authority on this.
If you’ve been doing low FODMAP to no avail then trying a Paleo version of it may make it more effective (giving up grains except for white rice, processed foods (gluten free products) all sweetener and hard cheeses).
Whatever diet you choose compliance is key. Cheating occasionally will put you back to square one. SIBO is unforgiving. You cheat and the bacteria flourishes again. The aim is to starve the bugs and feed yourself.
The SIBO specific diet is the hardest core diet. It is a mix of the Specific Carbohydrate Diet and the low FODMAPs. It’s like Paleo low FODMAP but additionally takes out all starches: so no rice, no potatoes, no plantains, no yuca, no parsnips. Squashes are the only source of carbs. This diet is the most anti-inflammatory one but it’s also the hardest to follow.
I personally am choosing the middle of the road option of Paleo low FODMAP but my symptoms are extremely mild. And I find symptom relief following this plan. I still eat white rice but have to watch the quantity, which is hard because my body is craving this simple carb.
Those bacteria want to survive and they are very persuasive in their cravings. I know that I have a metabolic type that needs some carbs or I get tired or moody. It may take a little longer to get there but I will be feeling better along the way.
Some people can feel great with extremely low carb intake. That’s not me and that’s ok. You got to know your body and not force something that doesn’t work for it. That’s the key to sustainable recovery. This is where getting professional help is useful because left to our own devices, most of us will just choose the fastest route to recovery whether it works for us or not. A professional won’t let you make that mistake.
The most exciting option of all for SIBO is something called the Fast Tract Diet. You can buy the book here.
What I love about this diet is that no food is off limit. It measure the fermentation potential of each food and it must add up to just under your fermentation gram limit each day depending on the severity of your symptoms.
This diet is wonderful because it does not limit foods but it is also tricky because you have to have self control and be able to eat the correct amount of each food.
This comes down to personality type. I just read the book and am excited to try it as I believe that variety is the key to health and happiness when it comes to diet. Restricting healthy foods from my diet makes me a bit angry and sad. I would rather eat a little of something than cut it out completely.
No matter what diet you choose, what’s most difficult is having to food prep and cook all the time. It’s like a part time job. And if you don’t enjoy it then it’s a miserable experience.
While few people have the money to hire a personal chef, I’ve found the next best thing that cuts my food prep time down considerable. Let me introduce you to my favorite kitchen time save, the instant pot.
I use it to make bone broth in 2 hours instead of 24 hours. Bone broth has been an essential part of my SIBO recovery plan. Especially since SIBO can cause leaky gut in some people, and bone broth protects against leaky gut.
It also makes rice quickly and perfectly every time. I cook the rice in bone broth. It is perfect for making easy to digest soups and stews and well cooked veggies. It can be left unattended while cooking, will turn off automatically and keep your food warm until you are ready to eat it.
The elephant in the room while talking about diet is attitude. This is important. If you’re mad about the food you gave up or the hassle of following a restricted diet the food you eat will not digest as well. Remember, food is emotional and your emotions will dictate how your body processes the food you eat. So try to be thankful for the fact that you even have food to eat.
So food is the foundation for tackling SIBO but there are many more moving pieces. I believe addressing SIBO will require more changes than just dietary, but diet is the first place to start.
Angela Privin is proof that IBS is NOT an incurable disease or a disease at all. IBS is a body out of balance. It’s an invitation for change. After solving her own IBS mystery more than a decade ago Angela trained as a health coach to help others.
Angela uses both science and intuition to help people figure out what’s out of balance in their body. She works with lab tests, dietary changes, supplementation and nervous system rebalancing. Get help rebalancing your digestive system and solving your IBS mystery here.