SIBO Diet Guide

A healthy SIBO diet can reduce symptoms and improve your gut health. It does not cure the disease but it plays a key role in the treatment and management of IBS with bacterial overgrowth.

Eating can be a hassle. I’ve been there. It’s tough when you feel like everything you eat is toxic to your body. In this guide I will walk you through the basics of dietary treatment for SIBO including a comparison of the different diets, foods to avoid, and a SIBO diet food list which can help simplify your grocery shopping.

It is important to remember that each person needs to customize their SIBO treatment diet because we all have unique guts!

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How Do Dietary Treatments for SIBO Work?

All SIBO diets reduce food sources for bacteria in the gut. Bacteria mainly feed on carbohydrates so each SIBO specific diet limits the amount of fermentable carbohydrates. This helps reduce the amount of bacteria by limiting their food supply which then reduces digestive symptoms. A few things to keep in mind are:

• The combination of bacterial species is unique in each individual so food tolerance will be different for each person
• Changes in diet can change the fecal microbial footprint rapidly
• There is no sound evidence based dietary treatment for SIBO although some diets have more research than others
• Each diet modifies specific carbohydrates

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How to Use Diet for SIBO Treatment?

• As a part of your treatment protocol after taking antibiotics, herbal antibiotics, or elemental diet
• As the main treatment for SIBO. Diet alone takes much longer but in some cases it can reduce symptoms enough to be the main source of treatment
• Ongoing as a prevention and maintenance strategy. If you can get enough variety in your diet most of the moderately restrictive SIBO diets are very healthy whole food diets

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What is the goal with any SIBO diet?

1. To decrease bacterial fermentation and increase nutrient absorption

• We want our bodies to get as much nutrition from our food as possible and not the bacteria in the small bowel
• Some fermentation is healthy but excessive fermentation is not normal in the small intestine

2. To allow time between eating to give your migrating motor complex a chance to clean  

• Research has shown that a large majority of people with SIBO have a decrease in cleansing waves which can be an underlying cause of bacterial overgrowth
• With weak migrating motor complex waves it is important to try and allow at least 4-5 hours between meals
• Night time is when you have the longest period of fasting so it can help not eating late

3. To eat a balanced whole food diet with as much diversity as you can tolerate

• It is the healthiest to eat a balanced diet so that your body can stay as strong as possible
• Stick to the least restrictive diet that helps manage symptoms and try to enjoy life
• In general eat less processed foods which all SIBO diets stay away from

If you keep these goals in mind when choosing foods eating can be simple and stress free! It is important to remember not to overthink things too much. Diet is just one piece of the puzzle and you should do everything you can to stick to a healthy diet, but don’t stress about it too much. This condition is not caused by food but by other underlying factors we cannot control.

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Best Diets for SIBO Compared

SIBO Diet	Restrictiveness (5 is very)	Science Based?	Foods to Avoid	Okay to Eat
SCD	5	Some evidence for IBD	Complex carbs, lactose, artificial sugar, processed foods	Simple carbs, fruits, meats, vegetables, lactose free dairy
Low FODMAP	3	Yes, strong evidence for IBS	High FODMAP carbs	Low FODMAP carbs, meats
GAPs	5	No	Complex carbs, processed foods, specific food timeline	Simple carbs, bone broth, meat, specific food timeline
Cedars Sinai-Low Fermentation	2	Not studied but developed by SIBO scientist	High fiber foods, excess fructose and high residue	Simple carbs like rice & potatoes, meats, small amounts veggies/fruit

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Specific Carbohydrate Diet

The SCD diet was developed by Elaine Gottschall & Dr. Sidney Haas. It has helped many people with various forms of bowel disease to improve their quality of life. The diet is mainly intended for people with Crohn’s disease, ulcerative colitis, celiac disease, diverticulitis, cystic fibrosis and chronic diarrhea. Practitioners also use this diet for IBS-SIBO but it can be too restrictive for some people. The foods that are allowed on this diet are based on their carbohydrate structure.

The Specifics

• Allowed carbohydrates are monosaccharides and have a single molecule structure that allow them to be easily absorbed by the intestine wall. Complex carbohydrates which are disaccharides and polysaccharides are not allowed.
• Allowed: Meat, eggs, poultry, fish, non-starchy vegetables, fruits, nuts, honey, lactose-free dairy
• Not allowed: Grains, starchy vegetables, artificial sugars, lactose
• The diet must be customized for each individual since people can tolerate different foods
• This diet can sometimes be too restrictive for IBS patients because individuals with SIBO often times have to limit their fruits and vegetables due to high FODMAP fermentation
• There is evidence for the SCD diet to help in inflammatory bowel disease but not studied in IBS-SIBO (1,2)

Helpful Resources for Starting SCD

• Awesome SCD Lifestyle Guidebook to reduce stress and ease of starting diet
• Breaking The Vicious Cycle Website
• Dr. Allison Siebecker’s Food List

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Low FODMAP Diet

The Low FODMAP diet is a dietary approach developed by Sue Shepard, Peter Gibson, & colleagues at Monash University (Australia) to manage IBS and other functional gastrointestinal disorder symptoms. It is a diet where the amount of FODMAPs is limited then re-introduced depending on your tolerance. FODMAPs stands for fermentable oligosaccharides (fructans/GOS), disaccharides (lactose, milk sugar), monosaccharides (excess fructose), and polyols (sugar alcohols like mannitol and sorbitol). This is one of the most effective dietary treatments for SIBO and it is a more balanced diet which includes starches.

The Specifics

• Reduces osmotic load and gas production in small bowel (helpful for SIBO)
• Moderately restrictive compared to other diets. Allows foods from each food group (starch, fruit, veggies, meats, legumes)
• Strong evidence for symptom control in IBS; 50-86% of patients have positive response to diet (1)

Helpful Resources for Starting Low FODMAP

• Gut RX Gurus, the first ever FODMAP recipe & cooking program
• Monash University Page
• SIBO Survivor Cookbook

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Gut and Psychology Syndrome Diet

The GAPS diet was developed by Dr. Campbell McBride. It is very similar to the SCD diet but it is even more restrictive and follows a specific timeline for food introduction. This is one of the hardest diets to follow and often times it is too restrictive for SIBO patients.

The Specifics

• Same as the SCD where the allowed carbohydrates are monosaccharides
• Fermented vegetables are emphasized in place of yogurt
• A specific supplement guideline is encouraged
• No scientific studies have been conducted
• Very challenging to follow since there are so many restrictions

Helpful Resources

• GAPS diet website
• Gaps Food List

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Cedars Sinai-Low Fermentation Diet

This diet was developed by Dr. Pimentel at Cedars Sinai in Los Angeles. It emphasizes meal spacing and low fermentation foods. It allows easily digested starches and sugars and is not super restrictive. This diet as well as the Low FODMAP diet are both recommended options for patients with SIBO because they limit fermentable carbohydrates but are not too restrictive.

The Specifics

• Allows some wheat in the form of white and sourdough breads (people who are sensitive to gluten need to adjust)
• Sticks to easily digestible carbohydrates like rice, potatoes, white bread
• Emphasizes meal spacing to allow intestinal cleansing waves a chance to work
• Not specifically studied but developed by a SIBO researcher so it is based on expert knowledge of IBS
• Designed not to be too restrictive and allow people to find food anywhere they go

Helpful Resources for Starting

• Low Fermentation Diet Handout

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SIBO Diet Food List

I have put together a simple food list to stick to when eating with SIBO. This list takes into account factors from each of the different diets and simplifies them so that it is easy to follow. People can often times stress too much about each particular food they put into their body. I have found it’s best to stick to the basics of a Low-FODMAP diet and modify it from there as you monitor your body.

I have also found it super helpful to use a recipe book to help organize your cooking, grocery shopping, and meal planning. I created a recipe book that combines the Low-FODMAP and SCD allowed foods in one book. It has been extremely helpful and I would recommend checking it out.

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Diet Tips That Help Me

• 3 meals a day with 4-5 hours of fasting in between eating
• Stick to Low-Fermentation vegetables in small portions and starches like rice, potatoes, and sourdough/french bread
• Eat real food: Avoid lactose, artificial sugar, processed food, sucralose, sorbitol, xylitol, lactulose
• Don’t overdo fruit. Many people have issues with fructose malabsorption
• Stick to lean meats like chicken, fish, turkey, and lean beef
• Listen to my gut: If my symptoms are acting up I reduce carbs and occasionally allow my intestines to fast

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Conclusion

When customizing your own SIBO diet to help reduce symptoms and nourish your body it is important to remember not to stress too much about it. Some people can take diet to the extreme and cause too much stress for themselves. We need to remember that diet is just one part of the equation for gut health. I recommend a version of the Low FODMAP/Fermentation diets that is customized to your own body because they reduce fermentation but are not overly restrictive. Make sure to eat as much of a balanced diet as possible because your body needs nutrients to heal. With time, testing, and discipline you can find a custom diet that works for your body!