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 small intestine 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 recommended diets, which foods to avoid, helpful tools 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 Does Diet Work to Treat SIBO?
All SIBO diets reduce food sources for bacteria in the gut. Bacteria mainly feed on carbohydrates so each SIBO specific diet limits the number of fermentable carbohydrates. This helps reduce the number 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
How to Use Diet for SIBO Treatment?
For most people, sticking to a healthy whole food diet is essential for long-term health. In the case of SIBO, diet can be used as treatment and as long-term maintenance.
- 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
What Are the Main Goals of a 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 get all essential nutrients
- Stick to the least restrictive diet that helps manage symptoms effectively
- 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.
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 |
| 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 |
Low FODMAP Diet
(Fermentable Oligo-Di-Monosaccharides and Polyols)
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 disorders.
FODMAPs are osmotic carbohydrates which are found in foods. They may not be digested or absorbed well allowing for bacteria to ferment them when eaten in excess causing symptoms like gas and bloating.
When beginning the diet, high FODMAP foods are limited to 2 weeks to 2 months 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 balanced diet which includes starches. There is strong scientific evidence showing the effectiveness of a low FODMAP diet for treating IBS and SIBO.
Low FODMAP Foods to Eat
| Food Type | Low FODMAP Foods |
| Meat, Poultry, Eggs, Fish | Chicken, fish, eggs, pork, shellfish, turkey, beef, lamb, all other meats |
| Dairy (low lactose) | Lactose free dairy, half and half, lactose free cream cheese, lactose free cottage, cheddar, colby, parmesan |
| Non-Dairy Alternatives | Almond milk, rice milk, nuts, nut butters, seeds, hemp milk |
| Grains (wheat free) | Wheat free grains and flours without a ton of fiber: bagels, breads, noodles, pasta, pretzels, waffles, tortillas, pancakes, quinoa, rice, cream of rice, cheerios, grits, oats, sourdough bread, soba noodles |
| Vegetables | Cucumbers, carrots, celery, eggplant, lettuce, leafy greens, pumpkin, potatoes, squash, yams, tomatoes, zucchini, bamboo shoots, bell peppers, bok choy, bean sprouts, collards, spaghetti squash, olives, green beans, rutabaga, spinach, ginger root, radish, turnips, corn, mushrooms |
| Fruits (limit to one serving) | Bananas, berries, cantaloupe, grapes, honeydew, grapefruit, kiwi, lemon, lime, orange, pineapple, rhubarb, passion fruit, kiwifruit, dragon fruit, papaya |
| Beverages | Small amounts of low FODMAP juice, coffee, tea, gin, vodka, wine, whiskey |
| Seasonings, condiments, spices | Basil, cilantro, coriander, lemongrass, parsley, mint, sage, thyme, homeade broth, chives, flaxseed, margarine, mayonnaise, olive oil, pepper, salt, sugar, mustard, vinegar, balsamic vinegar, pure maple syrup, vanilla, dark chocolate |
| Desserts | Any made with low FODMAP foods |
High FODMAP Foods to Limit
| Food Type | High FODMAP Foods |
| Meats, Poultry, Eggs, Fish | Anything made with HFCS or high FODMAP ingredients |
| Dairy | Cottage cheese, ice cream, creamy sauce, milk, soft cheeses, sour cream, whipped cream, evaporated milk, yogurt, custard |
| Non-Dairy Alternatives | Coconut cream, beans, hummus, pistachios, soy products, coconut milk, black eyed peas, fava beans, kidney beans |
| Grains | Inulin, wheat, wheat flours, flour tortillas, rye, chicory root, barley |
| Vegetables | Artichokes, garlic, onion, onion and garlic powder, asparagus, beets, broccoli, brussel sprouts, cabbage, cauliflower, fennel, okra, snow peas, sun-dried tomatoes |
| Fruits | Large amounts avocado, apples, apricots, dates, canned fruit, cherries, dried fruit, figs, guava, mango, nectarines, pears, peaches, persimmon, watermelon, plums, prunes |
| Beverages | High FODMAP fruit and vegetable juices, rum, anything with HFCS, milk |
| Seasonings | HFCS, garlic, jams and jellies, onions, pickle, relish, artificial sweeteners like sorbitol, mannitol, isomalt, xylitol, agave, coconut |
| Desserts | Any made with High FODMAP |
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 and 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 main difference is that the SCD diet does not allow starches and grains which are complex carbohydrates. There is some evidence for the SCD diet in inflammatory bowel disease but it has not been studied in IBS or SIBO.
| Food Type | Allowed | Not Allowed |
| Protein | Beef, pork, chicken, fish, eggs, bacon, shellfish, lamb | Any meats that are processed, canned, or made with added starch |
| Dairy | 24-hour yogurt, natural cheeses like cheddar, Colby, gruyere, Havarti, dry curd cottage cheese, swiss, | Milk, cottage cheese, chocolate, ice cream, cream, feta, mozzarella, ricotta, primost, gjetost, Neufchatel |
| Vegetables | Any fresh or frozen non-starchy vegetables | Potatoes, yams, parsnips, okra, chickpeas, bean sprouts, soybeans, mung beans, fava beans, garbanzo beans, barley, chicory root, pinto beans, yucca root, seaweed |
| Fruits | Any fresh fruit | Plantains, any that are dried with added starch or sugar |
| Grains | No grains allowed | All grains and flours are avoided on the SCD |
| Nuts | All nuts are allowed | |
| Beverages | Fresh squeezed juices without added sugars, weak tea or coffee, almond milk, gin, scotch, whisky, vodka, dry wines, club soda | Milk, sugary drinks, soymilk, instant coffee, concentrate juices, beer, brandy, port wines, sake, sherry |
| Condiments | All spices and condiments without starch or sugar | Spices and condiments with starch and sugars added |
| Desserts | Desserts made with nut flour, honey, and acceptable fruits | Desserts made with any starch that isn’t allowed or sugar besides honey |
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 low fermentation diet is very similar to the low FODMAP diet but even simpler.
- The diet is designed to allow you to be able to find food anywhere
- It was created by an IBS and SIBO researcher
- It emphasizes meal spacing to allow cleansing waves to function (no snacking)
- Simple sugars which are easily digested are ok
| Food Type | Allowed | Not Allowed |
| Protein | All proteins are good | |
| Dairy | Lactose-free dairy | Anything with lactose |
| Carbohydrates | Simple easy to digest carbs like rice, potatoes, white, French, or sourdough bread | Whole wheat bread, high fiber bread or carbs |
| Vegetables | Anything that grows underground like potatoes, yams, carrots, turnips, rutabaga, peppers, tomatoes, cucumber, zucchini, squash, eggplant, peas, mushrooms | Beans, legumes, cabbage, broccoli, Brussels sprouts, cauliflower, leafy vegetables, hummus |
| Fruits | Small amounts of fruit | Large amounts of fruit |
| Beverages | Water, tea, coffee | Sodas with sucralose or Splenda, milk |
| Desserts | Lactose-free ice cream, cheap cakes made without dairy | Dairy products |
Beverages on a SIBO Diet
So what’s best to drink on a SIBO diet? It’s pretty simple. Stick to water, light teas, lactose-free milk, green juices, and the occasional glass of dry wine if you like to have a drink.
You’re best off avoiding sugary drinks, too much alcohol, dairy with lactose, sodas with Splenda, and too much fructose in fruit juices. Some drinks like herbal teas and green juices can even be helpful for your gut. Below is an outline of the best drinks to stick to with SIBO.
Best Drinks for SIBO
Water: Drink lots of water. It’s always best to stay hydrated and drink 8 cups of liquid a day.
Lactose-free milk: Unsweetened almond milk, rice milk, pea milk and lactose-free milk are best.
Tea: Tea can actually be very helpful for gut health. If you get a high quality medicinal herbal tea this can help a lot with digestion, bloating, cramps, and other symptoms. It’s best to stick to herbal, white, green, and yerba mate teas since they have smaller amounts of caffeine. Some people with IBS and SIBO can’t tolerate highly caffeinated beverages but the smaller amounts in light teas are usually ok. For more info, check out the gut-friendly tea guide.
Coffee: Coffee without cream and sweeteners is fine. But, it’s important to note that a lot of people with IBS and SIBO can’t tolerate the strong stimulant and acidic effects of coffee. Tea can be a better option. It really just depends on your main symptoms. If you deal with diarrhea, coffee probably isn’t going to be a great choice.
Alcohol: For most people with gut issues, drinking too much alcohol is not going to help. From my experience, I’d recommend staying away from alcohol. If you do like to have a couple drinks every once in a while stick to dry wines, gin, vodka, and whiskey. If you want to learn more about alcohol, check out the article on alcohol for sensitive stomachs.
Juices: It’s best to avoid too much fruit juice. Some people can tolerate some but others need to stay away from large amounts of fructose. But, there is one juice I’ve found that is actually helpful. Pure green juices without a lot of added fruit can actually help digestion. Green juices made with spinach, parsley, ginger, celery, or cucumber are good. Green juice can be helpful for people who deal with constipation.
So, Which SIBO Diet Should You Use?
Sticking to a diet can be confusing since there are a few different options to choose from. Let’s keep it simple and remember the basics. For most people, it’s going to be best to use a low FODMAP or fermentation diet and adjust foods based on your bodies tolerance.
Keep it simple, and don’t drive yourself insane.
If you have a severe gut issue and want to try a little bit stricter diet you can reduce the amount of starch and grains you consume and transform your diet into an SCD friendly diet.
But, I have found from my health journey and talking to other patients that a lot of people need some starch in their diet. That being said, it really is individualized!
In Summary:
- First, try sticking to foods in the low FODMAP or Fermentation lists
- Customize your diet based on your body and keep it simple
- Over time you will develop a custom diet that works for you
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 time 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.
Get the SIBO Food List
I'll send you a PDF that simplifies the SIBO Diet food list. A lot of people make this list super complicated but you need to keep it simple to reduce stress.
Other SIBO Diet Tips That Help
- 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 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 your gut: If your symptoms are acting up, be more careful with your carbs and occasionally give your gut some rest
Helpful Tools for a SIBO Diet
When you’re busy, maintaining a gut-friendly diet can be challenging. It’s important that you streamline your routine as much as possible. Below are some tools and resources that have been helpful for me that you may find helpful.
Kitchen Essentials
Rice Cooker: One of the simplest ways to make large batches of brown or white rice. I do great with rice so I usually use a rice cooker to cook rice each week.
Tea Making Equipment: High-quality herbal teas have been super helpful for my gut health. It’s worth buying a nice tea kettle, infuser, and a travel mug.
Blender Bottle: Very helpful if you make a smoothie, protein drink, or semi-elemental diet drink.
Measuring Devices: a teaspoon and cup measuring tools are helpful. I use the teaspoon for scooping teas and the measuring cups for scooping rice and potatoes to monitor my carbs.
SIBO Diet Recipe Books
SIBO Survivor Cookbook (Low FODMAP recipes)
Eat Well Feel Well by Kendall Conrad (SCD Compliant Recipes)
SIBO Diet Frequently Asked Questions
How long do you need to stay on a SIBO Diet?
For most people, it’s best to stick to a healthy SIBO friendly diet for the long term. This means that you should eat a wide variety of foods that don’t cause issues. When your symptoms are most severe you will need to restrict the number of fermentable carbohydrates a bit more. When your symptoms are improved you will be able to branch out into other foods slowly to find what you can tolerate. Over time with medical treatment and symptom improvement most people can get back to eating a healthy amount of different kinds of foods.
Which foods should you definitely avoid with SIBO?
The foods that usually cause the most symptoms are: milk, cheese, beans, large amounts of raw vegetables, cabbage, cauliflower, garlic, onions, broccoli, large amounts of fruit, wheat, anything with added fiber, hummus, beer, brussel sprouts, artificial sugars.
Which foods are the best to eat with SIBO?
The best foods to stick to with SIBO are the lower fermentation foods like rice, potatoes, cooked low FODMAP vegetables, meats, lactose-free dairy, nuts, nut milks, herbal teas, cream of rice, sourdough and french breads, olive oil, ginger, salt, pepper, condiments without added sugar, natural spices, dry wine, eggs, low FODMAP fruits, gluten-free foods without tons of additives.
What’s the difference between the low FODMAP and Fermentation diets?
The low FODMAP diet and the low fermentation diet are very similar. The FODMAP diet was developed in Australia by researchers specifically for functional bowel disorders like IBS and SIBO. It is a little more particular where they researched the different types of fermentable carbohydrates and classified them in order to come up with a list of foods that have higher and lower fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. On the other hand, the low fermentation diet was created by the research team at Cedars Sinai Medical Center from an understanding of how the bowel works in SIBO patients. It is simpler and emphasizes limiting the overall amount of fermentation in the gut from indigestible carbohydrates and fiber. From my experience, most people usually come up with a simple combination of both of these diets.
Can the SIBO Diet cure me?
For a certain portion of people, diet can be the only treatment which is necessary since it can reduce symptoms dramatically. For other people with more severe cases more than diet will be needed for adequate relief. It really just depends on your health history and other coexisting conditions. But, for most people diet is a necessary maintenance and prevention strategy in the healing journey.
Is snacking ok?
It’s best to limit snacking. If someone has blood sugar issues then that obviously takes precedence but it’s generally best to allow between 3-5 hours between meals for the migrating motor complex cleansing waves to function. In most people with SIBO, they have weaker migrating motor complexes so they need to give those cleanup waves a chance to work during fasting.
What’s the best way to eat when your gut is flaring up?
When your symptoms are acting up it’s best to lower your fermentable carbohydrate intake, get adequate rest and relaxation, drink soothing teas, allow fasting time, and avoid excess sugar. Even supplementing with a semi-elemental diet can be helpful to allow bowel rest.
How do you find restaurants that are suitable for your diet?
It’s important to be able to enjoy friends, family, and food. You can google restaurant menus beforehand and see which restaurant has simple lower fermentation dishes. Also, keep in mind that most decent restaurants are able to take out certain ingredients and substitute items. You can usually find something at most restaurants that is suitable to eat if you stick to the basics. Keep in mind that eating small amounts of problematic foods occasionally is usually ok as long as you know your limits.
What’s the scoop with gluten?
Gluten is a protein found in grains like wheat, barley, and rye. These grains are also high in FODMAPs. Remember, fermentable carbohydrates which are not absorbed well will feed bacteria. In most SIBO and IBS cases the carbohydrates which are found in gluten-containing grains are causing the issues, not the gluten specifically. This is why people with SIBO and IBS can tolerate some amount of gluten-containing products that aren’t super fibrous like sourdough bread. On the other hand, people with Celiac Disease have to avoid all gluten because it causes damage to their intestinal tract. In summary, for the majority of people with SIBO the reason reducing gluten helps symptoms is because it reduces the number of fermentable carbohydrates.
Are probiotics ok with SIBO?
This is a tricky topic. On one hand, there has been some research and patient evidence that shows probiotics can be helpful in some people with SIBO. On the other hand, a lot of people with SIBO cannot tolerate any probiotics because they don’t clear bacteria from their small intestine effectively. It’s important to remember that all bacteria ferment, so if someone with SIBO cannot clear the bacteria in the small bowel which is already out of whack it may make their symptoms worse. It really just depends on the individual. If you’re going to experiment with probiotics it’s best to start really small and slow to see what kind of a reaction you notice. For more information, you can check out the probiotics for SIBO article.
Can you eat starch and grains?
For most people, the answer is yes. If you stick to the lower fermentation carbohydrates like rice and potatoes most people will do great. In some cases where people find that sticking to the SCD diet is necessary and helpful they will limit their starch and grains dramatically, but keep in mind that for some people eating even small amounts of starch can be important for their body.
People who are dealing with SIBO are already limiting their food and calorie intake so they need to find a wide enough range of foods to eat which they can tolerate. Remember, diet is just one part of the healing equation.
I don’t have the time to cook and eat healthily. Any advice?
A lot of people lead super busy lives. The best advice for sticking to a healthy diet is to keep it simple. Find your staple foods to stick to and simple recipe options to cook at home. Make large batches instead of cooking every meal. Find the healthy restaurants which you can count on for consistency and quickness where you live. If you can tolerate sourdough bread, whipping up a quick turkey sandwich with mayo and tomato can be a great option. Things like cream of rice, chicken soup, and rotisserie chicken with potatoes can be great options for busy people.
Also, there are a few services that may be helpful for busy people who are sticking to a healthy SIBO diet. These include Sun Basket which delivers healthy organic recipes to your doorstep. Thrive Market which allows you to get wholesale prices for specialty products and Chef V’s green drink delivery for people who want to incorporate some green juice.
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!
