SIBO Diet

SIBO diets do not attack bacterial overgrowth head on like antibacterial treatments (pharmaceutical antibiotics, herbal antibiotics and elemental diet). Instead, SIBO diets are primarily used to decrease symptoms, which they do very successfully. SIBO diets work by reducing carbohydrates, which bacteria ferment into the gases that cause symptoms in SIBO. Less carbohydrate foods for bacteria, means less gas produced, and thus less symptoms. Reducing food for bacteria may also reduce overall bacterial levels somewhat, or at least maintain current levels by stalling their growth. SIBO diets can be used in various ways along the SIBO treatment journey: a) alone to manage symptoms; b) along with antibacterial treatments to manage symptoms and bacterial die-off; and c) after antibacterial treatment for relapse prevention.

The Two Primary Patterns of Food Intolerance in SIBO

Carbohydrate Foods Cause Symptoms in SIBO
The fact that carbohydrate foods lead to symptoms in SIBO is one of the worst parts of the condition, because carbohydrates are a huge, nourishing and delicious category of food. It also explains why seemingly everything a person eats bothers them, since carbohydrates are typically consumed at most meals. Carbohydrates are bacteria's favorite food. After eating (called "fermentation" for bacteria) they excrete one or more of the SIBO gases (gas is a normal end product of fermentation), which trigger symptoms. Therefore SIBO Diets reduce carbohydrates to help reduce SIBO symptoms. Carbohydrates include: Vegetables, Fruits, Beans, Nuts, Seeds, Grains (i.e. bread and baked goods), Milk and milk products with lactose, Bone Broth, Sugars.
Which Carbohydrate Foods Cause Symptoms Varies Greatly Per Person
In SIBO, what is and isn't tolerated varies greatly per person. One person’s most aggravating food can be the next person’s best tolerated food. ​By reducing carbohydrates overall, SIBO diets greatly help symptoms, but can't account for this level of individuality across all SIBO patients. Thus customizing a SIBO diet by experimentation to find one’s individual food tolerances is recommended for the best success - both in reducing symptoms and increasing nutrition (so as not to avoid foods that are actually tolerated). While opinions vary, my opinion is that if a food is known to be tolerated (does not cause or worsen symptoms), it does not need to be avoided, even if a SIBO diet says to avoid it. (Note: consult your practitioner before altering a prescribed diet - see full disclaimer below.)
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Carbohydrate Foods Include:
Vegetables, Fruits, Beans, Nuts, Seeds, Grains (i.e. bread and baked goods), Milk and some milk products (due to lactose), Bone Broth, Sugar and Sweeteners.

Which Diets are used for SIBO?
How much do they help SIBO symptoms?

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*clinical estimate from 6 SIBO specialists of 12,000 patients
See below for diet descriptions and resources.
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Free download
Quick-Start SIBO Diet Guide

Quick Start SIBO Diet

How to use Dietary Treatments for SIBO

  • As a stand-alone treatment for SIBO, to manage symptoms.
    Diet alone does not eliminate the bacterial overgrowth, but may provide enough symptom relief that no other treatment is desired. To sustain symptom relief, diet needs to be continued ongoing. If the diet poses a hardship, or if malabsorption or leaky gut are present, antibacterial treatment should be considered. 
  • In combination with antibiotics or herbal antibiotics, for symptomatic relief.
    Because symptoms may not improve with the first antibacterial treatment round (see How to Treat SIBO), diet can be used to help reduce symptoms more quickly. Diet is often used with herbal antibiotics, since the overall treatment time is longer (each round is 4 weeks vs 2 weeks for pharmaceutical antibiotics). 
  • To allow the damaged small intestine lining to heal after eradication with antibacterial treatment. 
    The small intestine lining may need time to repair from the damage of SIBO before it can properly digest all foods. For example, lactose malabsorption is common in SIBO due to reduction of the small intestine enzyme lactase. This is why SIBO diets remove lactose containing foods. One month is the recommendation for this purpose.
  • As relapse prevention to delay the overgrowth from recurring.  
    Diet can help delay relapse by reducing fuel (carbohydrates) for bacteria, like reducing fuel on a fire, helping to maintain post-treatment lower bacterial levels. Time frames for this purpose range from 3 months to ongoing depending on the situation. Diet is often expanded to include more foods that are now tolerated, in the prevention phase.  ​
  • For chronic SIBO symptom management
    Ongoing use of a SIBO diet is a key treatment to reduce symptoms in chronic SIBO.
  • Personal tailoring of the diet increases symptom relief
    Individuals with SIBO vary greatly as to which carbohydrate foods they can and can't tolerate. While SIBO diets do their best to figure this out ahead of time, there is no substitute for individual customization.

Common Features of All SIBO Diets

  • Allow Animal Proteins - meat, fish, poultry, eggs
  • Allow Fats - oils, butter
  • Exclude lactose, sugar alcohol sweeteners (polyols) and sucralose
  • Exclude some types of Carbohydrates and Carbohydrate foods, but allow others

SIBO Diet Masterclass + Q&A
​with Dr. Allison Siebecker

"If you are new to a SIBO diet or are struggling with your SIBO diet, this Masterclass is hands down the best SIBO diet resource available anywhere." - Elena Wistey, Journey Through SIBO

Common SIBO Diets

SIBO Specific Food Guide (SSFG)

Dr. Siebecker's combination of The Specific Carbohydrate Diet (SCD) and The Low Fodmap Diet (LFD), created specifically for SIBO. It uses the SCD grain-free diet as the base, adds in the recommended food portions from LFD, and categorizes which foods are more or less likely to create symptoms. See descriptions of SCD and LFD diets below.

Pro: one of the most effective diets at reducing SIBO symptoms, because it reduces the most carbohydrates
Con: one of the most restrictive SIBO diets, because it reduces the most carbohydrates
Best For: those with severe food intolerances and those with inadequate symptom relief from the other diets
Resources

Free Handout

Download the SIBO
​Specific Food Guide HERE

SIBO Bi-Phasic Diet (B-PD)

A 2-phase variation of the SIBO Specific Food Guide (see above) by Dr. Nirala Jacobi, with more structure and instructions, meant to be used along with herbal antibiotics, and with low-histamine and vegetarian versions available.

Pro: same as SIBO Specific Food Guide, above
Con: same as SIBO Specific Food Guide, above
Best For: same as SIBO Specific Food Guide above, but with a more structured approach

Resources

Specific Carbohydrate Diet (SCD)

Created by Dr. Haas in the early 1900's for pediatric Celiac Disease, then updated and popularized by Elaine Gottschall in the 1990's, it is commonly used for Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease) with proven success [1], although many use it for SIBO as well. It was one of the first grain-free diets. This diet is is incorporated into the SIBO Specific Food Guide and it's variant the SIBO Bi-Phasic Diet, above.

Features:
  • Allows: meat/fish/poultry, eggs, fats/oils, some beans, lactose-free dairy (especially 24-hour homemade yogurt) (recipe here), non-starchy vegetables, ripe fruit, nuts/seeds, honey and saccharine
  • Excludes: grains/gluten, starchy vegetables, lactose, unripe fruit, some beans and any sweeteners other than honey, saccharine and occasional stevia
  • 1-5 day Introduction diet
  • Progressive: with easier to digest foods at the start (well cooked and pureed fruits and veg), and more difficult to digest foods added later (nuts and beans)

Pro: many resources available, effective
Con: not created for SIBO, thus it includes common SIBO trigger foods (i.e. onions, garlic, apple sauce), and is unnecessarily restrictive of foods often tolerated by those with SIBO (i.e. white rice, potato, bifidus probiotics/yogurt) - customization is suggested for best success
Best For: those with moderate food intolerances, diarrhea, co-existing IBD or Celiac
Notes: uses "legal"/"illegal" terminology and promotes strict adherence, which is not suited to SIBO (customization to the individual is helpful for best SIBO symptom relief). Also, the diet's discussion of "cure" does not apply to SIBO.

Resources

Low FODMAP Diet (LFD)

Created by doctors at Monash Univiersity, it targets four carbohydrate food groups found to aggravate symptoms in IBS patients: oligosaccharides, disaccharides, monosaccharides and polyols. It is widely recommended and studied [2] with proven success in Irritable Bowel Syndrome and Inflammatory Bowel Disease, and is used for SIBO as well. Aspects of this diet are incorporated into the SIBO Specific Food Guide and it's variant the SIBO Bi-Phasic Diet, above.

Features:
  • Categorizes foods and portion sizes by fermentability (likelihood of gas formation): Low/Moderate/High
  • Allows: meat/fish/poultry, eggs, fats/oils, lactose-free dairy, certain portions of grains/starches/vegetables/fruit/beans/nuts/seeds, sugar, maple syrup
  • Excludes: many vegetables and fruits (due to oligosaccharide and polyols), lactose, honey, agave, high fructose corn syrup
  • Progressive: 4-6 wk Intro of Low FODMAP, then try Moderate and High foods to find tolerances

Pro: many resources available, proven effective in IBS
Con: not created for SIBO (hit or miss success), includes common SIBO trigger foods (i.e. high fiber foods), excludes foods often tolerated by those with SIBO (i.e. clover honey) - customization to the individual is suggested for best success 
Best For: those with mild food intolerances, or who are underweight, or can't/won't do the more restrictive diets; IBS without SIBO; vegetarians and vegans (soy, beans and grains are allowed); and the prevention phase when more foods are tolerated
Notes: helpful for vegetarians and vegans with SIBO by suggesting plant protein portions that may be tolerated

Resources

Low Fermentation Eating (LFE) formerly Cedars-Sinai Low Fermentation Diet

A variation of a low-residue diet (low fiber), created by Dr. Pimentel for prevention of SIBO relapse after successful eradication with antibacterial treatment. It was the first SIBO diet to include meal spacing (no snacking between meals).

Features:
  • Allows: moderate amounts of refined grains/wheat (rice, pasta, white breads), starchy vegetables, sugar, aspartame
  • Excludes: high fiber foods (i.e. whole grains, beans), lactose, sweeteners besides sugar and aspartame, probiotics and probiotic foods
  • No Introduction phase and not progressive (not expanded over time)
  • Meal spacing: avoid food/caloric beverages for 4-5 hrs between meals, 2 hours before bed and 12 hours overnight to optimize the migrating motor complex

Pro: good effectiveness, one of the easiest SIBO diets to follow (allows soda, wheat, sugar in moderation)
Con: includes common SIBO trigger foods (i.e. onions, garlic)
Best For: the prevention phase; those with mild-moderate food intolerances; those who are underweight; those who can't/won't do the more restrictive diets

Resources:

Fast Tract Diet (FTD)

Created by Dr. Robillard for Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome and SIBO, it uses food labels to calculate the "fermentation potential" of foods, to help identify which foods are more or less likely to cause symptoms.

Features:
  • Assigns foods “Fermentation Potential” points, calculated from food label/nutritional components
  • Fermentation/symptom Potential is controlled via portions and food choices (point system)
  • Excludes/limits portions of: Fiber, Resistant Starch, Lactose, Fructose, Polyols (except erythritol)
  • 3 Pillar system: 1) Diet: Fermentation Potential, 2) identify and address underlying cause, 3) gut friendly behaviors (i.e. chewing, food prep/storage)
Resources:

Video: How to Expand Diet After SIBO Treatment

Clip of Dr. Siebecker explaining how to expand diet after SIBO treatment, from a free training. 
Sign up to receive ​notification of Dr. Siebecker's live events here ​

Low Histamine and Low Sulfur Diets

Many with SIBO have histamine intolerance/Mast Cell Activation Syndrome (MCAS) and benefit from a reduced histamine diet. Taking DAO enzymes with meals may also help (Amazon) or (exclusive pricing at Fullscript).

Low Histamine SIBO Diet
Low Histamine Diet - not taking into account SIBO
Those with hydrogen sulfide SIBO may benefit from reduced sulfur in the diet.
Low Sulfur Diet
Thai Zucchini Salad with Peanut Sauce
from Low Fermentation Eating
Herb Salmon with Fennel & Tomatoes 
from Specific Carbohydrate Diet
SIBO Lemon Tart
from SIBO Bi-Phasic Diet
For more details about SIBO diets and SIBO treatment, see Courses, join a Q&A and join Dr. Siebecker's newsletter.
More Resources: SIBO Diet playlist on my YouTube  

   Learn more
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