Dietary Treatments

All dietary treatments strive to reduce the food sources for the bacteria.  They seek to feed the person but starve the  bacteria.  Our diet has a significant impact on our intestinal bacterial population.  Bacteria primarily eat carbohydrates so all the recommended diets decrease carbohydrates to reduce the bacteria by starvation.  The only carbohydrate that bacteria do not eat much of is insoluble fiber.  The established SIBO diets are the Specific Carbohydrate Diet (SCD) and the Gut and Psychology Syndrome Diet (Gaps Diet) (see below).  "Fermentable" refers to what bacteria eat.
Fermentable Carbohydrates/Saccharides:
Starch
Resistant Starch
Soluble Fiber
Sugar (in all it's forms)
Prebiotics (inulin, FOS, MOS, GOS, arabinogalactan)
Sources of Fermentable Carbohydrates/Saccharides:
Starch-  grains, beans, starchy vegetables
Resistant Starch- whole grains, seeds, legumes
Soluble Fiber-  grains, beans, nuts/seeds, vegetables, fruit
Sugar-  fruit, sweeteners
Prebiotics- agave, beans, vegetables, roots/herbs, supplements
Some carbohydrates are absorbed so quickly they may not have time to be fermented.  These are the single sugars glucose and fructose, which exist on their own in honey but are combined with fermentable carbohydrates in all other foods.  Ripe fruit, non-starchy vegetables and nuts are allowed on the diets for health and variety purposes, even though they do contain some fermentable carbohydrates.

How to use Dietary Treatments for SIBO

  • As the main treatment for SIBO, without antibiotics or other treatment.  Diet alone may reduce bacteria, just at a slower rate than antibiotics.   1 1/2 years up to 3+ years is usually needed.  The established diets are the Specific Carbohydrate Diet (SCD) and the Gut and Psychology Diet (Gaps Diet).
  • As a therapy to allow the damaged SI lining to heal after antibiotics.  The lining needs time to repair from the damage of SIBO before it can properly digest all foods.  3-6 months is the minimum recommendation for this purpose.
  • As prevention to stop the overgrowth from recurring.  In this case, ongoing use is encouraged.  The two treatment diets (SCD and Gaps) may be used or the Cedars-Sinai or Low Fodmap Diet, which are for prevention only (after SIBO is gone). 

Specific Carbohydrate Diet (SCD)

See SIBO History for the history of the diet.  This diet is explained in Elaine Gottschall's book Breaking the Vicious Cycle (BTVC) and much information may be obtained on SCD websites. 

The Diet
  • Allowed:  meat/fish/poultry, eggs, some beans, lactose-free dairy, non-starchy vegetables, ripe fruit, nuts/seeds, honey and saccharine.
  • Not Allowed:  grains, starchy vegetables, lactose, some beans and any sweeteners other than honey, saccharine and occasional stevia.
  • An Introduction diet is recommended to start with. 
  • Then the diet is progressive as the intestines heal.  At the beginning, cooked vegetables, cooked ripe fruit, no beans and very little nuts are recommended. 
  • Personal tailoring of the diet within the allowed foods is recommended as individuals vary greatly as to what they can tolerate.

The SCD has a 75% to 84% success rate if followed strictly.  Originally used for children with Celiac Disease (as defined before the discovery of gluten), it was found that they could return to eating an unrestricted diet after following the diet for 1 year after the disappearance of symptoms.  Adults may need to stay on the diet to remain symptom free.

This diet is famous for explaining and including lactose-free dairy foods, especially the introduction of 24-hour homemade yogurt as well as introducing nut-flour (predominantly almond flour), as a substitution for standard wheat and grain flours in baked goods or breading. 

Resources
Besides the book (BTVC), which contains great recipes (Lois Lang's Bread and Basic Muffins are my favorites), there are a plethora of SCD websites which include free recipes, supplies and mail order foods.  I highly recommend getting 1 or more of the SCD Cookbooks.

SCD Legal & Illegal Food Web List 
SCD Legal & Illegal Food Handout- 4 pages (2 legal, 2 illegal)  from healththroughdiet.com
Also see the Gaps Diet Food List for an easy 1 page version of allowed and not allowed foods.

Gut And Psychology Syndrome Diet (Gaps diet)

See SIBO History for the history of the diet.  This diet is explained in Dr Campbell-McBride's book Gut and Psychology Syndrome and much information may be obtained on Gaps websites.   

The Diet - Gaps diet is the SCD with a few modifications:
  • A few less beans, no baking soda or store bought juice.
  • The dairy protein casein is begun more slowly - cultured vegetables are emphasized in place of yogurt. 
  • An Introduction diet is recommended to start with (see below) which is more clearly defined then the SCD Intro.

See a more comprehensive explanation of the differences here. 

Resources
Besides the book (Gaps), there are several websites with excellent information as well as many yahoo support/discussion groups and a cookbook.

Gaps Brief Simplified Intro Diet - the full intro diet explanation is lengthy, this is a brief bare bones version
Gaps Simplified Intro Diet - the full intro diet explanation is lengthy, this is a simplified 2 page version
Gaps Full Intro Diet - full explanation, 9 pages
Gaps Full Main Diet - 5 pages, builds on the Intro explanation
Gaps Food List - chart of what to eat and avoid
Gaps and SCD Answers -how to find answers
Frequently Asked Questions - invaluable answers from Dr Campbell-McBride

Cedars-Sinai Diet (C-SD)

This is the prevention diet created by Dr Pimentel of C-S Hospital in Los Angeles.  It is only to be used for prevention once the SIBO is gone since it allows a moderate amount of grain (starch) and sugar.  Many people are gluten-sensitive, independent of SIBO and Celiac Disease.  In this case, gluten grains should be avoided while on C-SD.

Low FODMAP Diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)

The Fodmap diet addresses IBS, IBD and other GI conditions with similar symptoms.  It has very helpful suggestions for SIBO but must be slightly adapted if used as a primary treatment diet.  For a full discussion, please listen to my Podcast.

Resources
Official Website by Monash University
Podcast: Dr Siebecker explains the art and science of the Fodmap diet 
Testing and Treatment Overview Flowchart
Articles by creators Dr Peter Gibson and Dr Sue Shepherd:
    2012- Food Choice as a Key Management Strategy for Functional GI Symptoms
    2010- Evidence-based dietary management of functional GI symptoms: the Fodmap approach

Food Charts/Lists
Partial Food Chart by Patsy Catsos RD, visit her site IBS Free
Full Food Chart & explanation:
    Official booklet from Monash University-1  Online Ordering  2 PDF Order Form
    iPhone App- which includes the booklet, see a user guide



For more dietary details, please see page 2 of my article SIBO: Often Ignored cause of IBS, my class videos and the other resources at Learning More.



Site author:  Dr Allison Siebecker