Dietary Treatments

All dietary treatments strive to reduce 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 try to reduce the bacteria and especially the gas they produce, by limiting their food supply.  The only carbohydrate that bacteria do not eat much of, is insoluble fiber.  The established SIBO treatment diets are the Specific Carbohydrate Diet (SCD), the Gut and Psychology Syndrome Diet (Gaps Diet), the Low FODMAP Diet (LFD) or a combination of these diets such as SIBO Specific Food Guide (SCD + LFD, see below) and it's variant the SIBO Bi-Phasic Diet.  The established prevention diets include all the above plus the Cedars-Sinai Diet (see below).  Many also use The Fast Track Diet for IBS and various forms of the Paleo Diet.
"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 fermentable carbohydrates.

How to use Dietary Treatments for SIBO

  • As the main treatment for SIBO, without antibiotics or other treatment.  Diet alone may provide enough symptom relief that no other treatment is desired.  However if malabsorption or leaky gut is present, other treatment is advised.  Diet will likely be needed to long-term with this approach.
  • In combination with antibiotics or herbal antibiotics, for symptomatic relief and added benefit.
  • As a therapy to allow the damaged SI lining to heal after eradication with antimicrobial treatment.  The lining may need time to repair from the damage of SIBO before it can properly digest all foods.  1 month is the recommendation for this purpose.
  • As relapse prevention to stop the overgrowth from recurring.  In this case, ongoing use is encouraged, but diet can be more expanded. 

SIBO Specific Food Guide (SSFG)

This is my version of a combination of The Specific Carbohydrate Diet and The Low Fodmap Diet (see below).  It includes my clinical input and several alterations from the original diets, based on my experience treating SIBO with diet.  I have found this combination best for SIBO and specifically best for those who do not get adequate symptom relief from the other diets.  It combines the best of both diets, reducing a broader range of fermentable carbohydrates than any other SIBO diet.  Unfortunately it is also the most restrictive option.  Therefore it is recommended to try the other less restrictive diets before this option.

Resources
SIBO Specific Food Guide  This handout is a reference food guide and contains only minimal usage instructions (on page 7).  I am in the process of updating it- estimated 2020 publication.
 
SIBO APP, by Dharmaworks.  SIBO Specific Food Guide + Paleo Autoimmune guidelines.  Created by a SIBO patient and offered for $Free.   

Cookbooks- SIBO Bi-Phasic Diet cookbooks by Rebecca Coomes.  The SIBO Bi-Phasic Diet is the SIBO Specific Food Guide aligned into 3 treatment phases by Dr. Jacobi (see below).

Recipe Sites
 

SIBO Bi-Phasic Diet (B-PD)

A variation of my SIBO Specific Food Guide by Australian SIBO specialist Dr. Nirala Jacobi.

My hope was that practitioners would customize my SIBO Specific Food Guide into more specific diet plans for their patients.  That’s just what Dr. Jacobi did with the SIBO Bi-Phasic diet, and countless doctors and patients have benefited from it. The SIBO Bi-Phasic Diet puts my SIBO Specific Food Guide into 3 phases, which are then combined with other treatment such as herbal antibiotics.

Resources
SIBO Bi-Phasic Diet - ebook available here

Histamine SIBO Bi-Phasic Diet -  sign up free at this SIBO Doctor Education link to access the handout
Vegetarian SIBO Bi-Phasic Diet - sign up free at this SIBO Doctor Education link to access the handout

Cookbooks- SIBO Bi-Phasic Diet cookbooks by Rebecca Coomes. 

Recipe Sites

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 different than the SCD Intro and has many phases.

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 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

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

The Fodmap diet has excellent success rates for IBS, IBD and other GI conditions with similar symptoms.  Because it allows grains, fiber, sugar and other fermentable carbs it may need to be slightly adapted for some with SIBO.  For a full discussion, please listen to my Fodmaps Podcast and my discussion of honey from 2015 SIBO Symposium.  There are numerous successful studies on this diet.

Resources
APP (for smart phones)
Website by Monash University
Book: The Complete Low-FODMAP Diet by inventors Drs. Sue Shepard & Peter Gibson
Podcast: Dr Siebecker explains the art and science of the Fodmap diet 
Testing and Treatment Overview Flowchart
Articles by creators Drs. Peter Gibson & 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
    Monash University Low Fodmap App  - which includes the booklet, see a user guide

Cedars-Sinai Diet (C-SD)

This is the prevention diet created by Dr. Pimentel of Cedars-Sinai Hospital in Los Angeles.  It allows a moderate amount of grain as 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. 
  OFFICIAL Updated HANDOUT
  Specialists in Gastroenterology Version (Dr. Weinstock)

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