Table of Contents
SIBO Diet | What Is SIBO? | Low-FODMAP Negative Impact | Effective Treatment
However, diet on its own does not cure SIBO. In fact, eating a higher-FODMAP diet in combination with your antibiotic protocol leads to more successful eradication of the bacteria.
Can you get relief for your symptoms by following a SIBO diet? While diet is an important part of healing your gut, it’s not enough to really treat the condition. Check out this article to find out what works for SIBO.
What Is a SIBO Diet?
Are you dealing with SIBO? If so, you may be looking for a way to treat the condition without antibiotics. In most cases, that means adopting a SIBO diet that limits your carbohydrate intake and removes carbs that are difficult for your body to digest or absorb. Some common SIBO dietary protocols are:
- Low-FODMAP diet
- Specific carbohydrate diet (SCD)
- Gut and Psychology Syndrome (GAPS) diet
- Elemental diet
- Low fermentation potential (FP) diet
- Low-starch or even no-starch diet
While these specific diets differ from each other, their general goal is similar: limiting the types of carbs you consume to avoid feeding the bacterial overgrowth in your small intestine that’s driving your SIBO. The low-FODMAP diet, for example, limits FODMAPs, or short-chain carbohydrates that aren’t completely absorbed in the gastrointestinal tracts. FODMAPs can linger in the gut and feed bacteria, resulting in a variety of digestive symptoms.
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What Is Considered the Best Diet for SIBO—And What’s the Problem with It?
The low-FODMAP diet is a common choice for SIBO (and other digestive disorders like irritable bowel syndrome). This diet has been shown to provide at least short-term relief by reducing bacterial overgrowth in the small intestine. (1)
If you’ve tried a low-FODMAP diet for SIBO and noticed significant improvements in your symptoms, it’s easy to think that this must be the answer—a low-FODMAP (or low-carb) diet has cured you!
Unfortunately, this is not the case. A low-FODMAP (or low-carbohydrate) diet will keep symptoms under control simply by starving the bacteria in your small intestine. When these bacteria don’t have food to eat, they aren’t able to metabolize that food, and produce gas as a result. This gas is what causes the common symptoms of SIBO—bloating, abdominal pain, diarrhea (in the case of hydrogen gas), and constipation (in the case of methane gas). (2)
But starving the bacteria over the short term does not eradicate the bacteria, which is what we’re trying to accomplish, as the small intestine is not supposed to contain much bacteria. If you continue this restriction for a long period of time in an effort to kill the bacteria, you’re also starving the bacteria in your large intestine that should be there and that play a vital role in your health.
Simply put, a low-FODMAP or low-carb diet does not eradicate an overgrowth in the small intestine in a short period of time, and continuing on a long-term low-FODMAP/low-carbohydrate diet in an effort to starve the bacteria to death has potential detrimental effects on the bacteria in the large intestine. I have had clients who have been on long-term low-FODMAP diets before working with me who still have positive breath tests for SIBO despite their restricted diet. There is a difference between controlling symptoms and actually clearing the bacteria. We want to do the latter, which has the added benefit of improving symptoms, as well.
What Is SIBO?
The large intestine contains the majority of the digestive system’s bacteria. The small intestine is typically relatively sterile (compared to the large intestine), so when bacteria translocates and overgrows in the small intestine, it causes problems. If there are changes in the number or type of bacteria present in the small intestine, SIBO occurs. For many people, this is caused by an overgrowth of a variety of bacteria that should be in the colon. (3)
SIBO impacts the structure of the small intestine and its ability to function. The condition often causes damage to the mucosa lining the small intestine, which can impair nutrient absorption and lead to leaky gut—a condition where protein molecules can pass through the intestinal barrier into the bloodstream, causing an inflammatory response.
Symptoms of SIBO
SIBO doesn’t always cause symptoms (some studies suggest that up to 15 percent of healthy people are experiencing SIBO without any symptoms). (4) However, some of the most common signs of SIBO include:
- Diarrhea
- Constipation
- Abdominal pain and discomfort
- Bloating
- Gas and belching
- Weight loss and vitamin deficiencies (in severe cases)
SIBO is, unfortunately, an under-diagnosed condition. Many people aren’t aware that SIBO could be causing their symptoms, and many doctors don’t realize how common this condition really is. Some of the most commonly used testing methods (breath tests) have some issues with accuracy. All those factors play a role in making SIBO difficult to diagnose and treat.
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The Negative Impact of a Long-Term Low-FODMAP Diet
There have been limited studies on the long-term impact of low-FODMAP diets on microbial balance in the large intestine. The studies that show the impact of short-term FODMAP restriction on the microbiome, however, do not bode well for the long-term implications.
FODMAPs are fermentable carbohydrates that help to feed the beneficial bacteria in the large intestine. When you begin to think about them this way, it becomes a lot easier to understand why adhering to a diet low in the substrates that our healthy gut bacteria thrive on may not be a great idea.
Indeed, the studies to date on the effects of FODMAP restriction show exactly what we would imagine would happen when restricting these beneficial substrates: the overall amount of bacteria was decreased (by 47 percent in this study), along with a decline in bacteria that produce butyrate (a beneficial substance made when probiotics feed on fermentable fibers). (5) While this particular study did not show a decrease in the probiotic strain Bifidobacteria, another study has. (6) In my clinical experience, it is very common to see low levels of both the Bifidobacteria and Lactobacillus strains in my client’s stool tests if they’ve been on long-term low-FODMAP diets.
While these bacteria would likely thrive once again with the addition of prebiotic substances, staying in a chronically diet-induced altered microbiological state is likely not a healthy choice when you start to think about the importance of our microbiome and its effect on our health.
Clearly, more research needs to be done in this area if patients are going to be on long-term low-FODMAP diets. However, after reading this article, it is my hope that you won’t need to be on a long-term low-FODMAP diet to keep your symptoms under control.
What to Use as an Effective SIBO Treatment
So, if you’re not treating your SIBO with diet, what is used to treat it?
Rifaximin
Rifaximin is the most commonly used antibiotic for the treatment of SIBO, and has been shown to be safe and well-tolerated. (7) Figures vary on its efficacy (with rates as high as 87 percent in one study), but on average, it is about 50 percent effective. (8) However, this may not take into account the necessary difference in treatment for those with methane-positive SIBO. A study on those with methane-positive SIBO shows that when rifaximin is combined with another antibiotic, neomycin, it is about 85 percent effective. (9) If you’re getting tested for SIBO, make sure you’re getting tested for both methane and hydrogen. These tests will guide your practitioner in treating you more effectively.
Herbal Antimicrobials
Herbal antimicrobials have been shown to be at least as effective as rifaximin, and about 57 percent of those who fail on rifaximin will succeed on herbal antimicrobials. (10) I have personally seen this the other way around, as well; those who fail on herbal antimicrobials usually do well with rifaximin. Others may need to do multiple rounds of either herbal or pharmaceutical antibiotics to clear the overgrowth.
Whether you choose herbal or pharmaceutical antibiotics, the important thing is that you are using something that will eradicate the bacteria instead of covering up the symptoms with diet change. You’re getting to the root cause of your symptoms!
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Diet during and after SIBO Treatment
Now that you’re being treated with herbal or pharmaceutical antibiotics, what should you eat?
If you listened to Chris’s podcast with Dr. Pimentel, you’ll know that having happy and fed bacteria is a good thing when treating SIBO—this is not the time to starve them, as they will “hide” and become more difficult to eradicate. Eating FODMAPs and carbohydrates is exactly what you want to do!
Your Diet during SIBO Treatment
In my own practice, I recommend that clients undergoing treatment eat as many FODMAP foods as they can tolerate and that they do not go on a low-carb diet. (I like to see a minimum of 100 grams of carbohydrates daily, and more, if tolerated.)
I also will typically add some kind of prebiotic if the client can tolerate it. A study that compared rifaximin alone versus rifaximin treatment plus partially hydrolyzed guar gum supplementation showed that providing fermentable carbohydrate along with the antibiotic improved success rates from about 62 percent (rifaximin alone) to 87 percent (rifaximin plus guar gum). (11)
Of course, I don’t want my clients to be miserable with digestive symptoms during this time, so treatment is always personalized to each client. Some may have no problems whatsoever eating FODMAPs or high-carbohydrate foods, while others may be very sensitive. I encourage clients to eat the maximum amount that they are comfortable with and remind them that, in the end, feeding these bacteria is a good thing. They may experience some uncomfortable symptoms like bloating or gas during this time, but as long as it does not interrupt their life or cause pain, the more FODMAPs or carbohydrates they can eat, the better.
Your Diet after SIBO Treatment
As many sufferers of SIBO know, SIBO has a high rate of recurrence, which begs the question: what should you eat after treatment to prevent another overgrowth? In my eyes, that’s the million-dollar question right now, and it’s a question we don’t have the answer to quite yet.
For now, I have my clients eat whatever they can tolerate on a healthy, real-food, ancestral diet. If they need to restrict FODMAPs slightly or eat rapidly digested carbohydrates to keep symptoms under control, that’s okay. (However, if you can’t tolerate FODMAPs or complex carbohydrates after your treatment, you’ll definitely want to retest to make sure that you’ve completely eradicated the overgrowth in the first place.)
We’ll also investigate any potential underlying causes of their SIBO, such as:
- Low stomach acid
- Pancreatic enzyme insufficiency
- Intestinal motility disorders
- Poor diet
- Stress
I know from speaking with Chris that he has come to believe that SIBO—and especially recurring SIBO—is often a symptom of a deeper problem. The solution in that case isn’t just to keep treating the SIBO, but to address that root cause.
There’s a lot we still don’t know about SIBO. As we learn more, some of these protocols may change, but I hope this article has given you a better idea of what you should do to heal from SIBO with the knowledge we have now.
Additional Resources on SIBO:
- What Causes SIBO (Small Intestinal Bacterial Overgrowth) and Why It’s so Hard to Treat
- RHR: A New Understanding of SIBO and IBS, with Mark Pimentel
- RHR: Unanswered Questions About SIBO
- RHR: New Treatment for SIBO and IBS-C—with Dr. Kenneth Brown
- RHR: SIBO Update—an Interview with Dr. Mark Pimentel
- RHR: SIBO and Methane—What’s the Connection?
I am curious if you have had anyone with adverse side effects from neomycin either early or late? My doctor afraid to use rifaximan neomycin together due to side effects from neomycin. Also what is your recommendation for herbal treatment?
Hi. My doctor has me doing a 10 day diet. I can only have green vegetables and wild caught fish, grass fed all natural meat and chicken. Water, weak green tea and supplements to kill bacteria and lysine and Taurine plus lots of gluamine. That’s it. I am starving it feels like. Was 124 lbs. Now 120 in just 5 days. At 5′ 7″. I’m not sleeping due to restless leg syndrome recently it began. I am as weak as ever, can barely prepare food. Today I felt so bad I stayed in bed.
Is this the right protocol or not, I have 4 more days to go and have an appointment with him after.
thanks so much, please I am suicidal and in a bad place mentally. Have been forever due to MTHFR polymorphisms.
thank you.
Bek
Can I suggest/urge you to see your doctor immediately
Thanks for chiming in here Robyn. I absolutely agree – you need to consult with your personal physician ASAP.
Hi Rebecca,
In my experience only raw eggs make me feel good.
Please check the book – “we want to live the primal diet”
You dont feel good because your diet is not good – all those people recommending cooked low carb diets have no idea what they are doing – they are just trying to make money.
Also cooked protein is very hard to digest if you have low stomach acid and or leaky gut. Try raw eggs for 1 -2 days and you will see the difference. Bacteria is very important for digestion – when you cook the egg or milk you kill bacteria and enzymes.
also what is the idea of this diet – if you try to starve bacteria – then vegetables can feed bacteria – fibers can feed bacteria.
I can help. I am a functional medicine trained dietitian that reversed SIBO after a 3 yr battle. I know how terribly frustrating it is but it takes an open mind to heal and I think most here have already tried so much. Please see my website at threecupsofwisdom.com for contact info. I have a small practice but do have a few openings for remote clients.
Rebecca, I just read your post so I hope you’re doing better. I was alarmed by two things in your post: that you’re suicidal and you have MTHFR issues. If you are being treated with methylated supplements you could be one of those people like myself (estimated at 20% of those taking methylated B vitamins) who have significant “over methylation” side effects. I was suicidal for six months (!!!) before I found, quite by accident, that the methylfolate I’d been on for most of that time was responsible for severe anxiety, nausea and a major host of other symptoms, including increased inflammation. Google “over methylation” or check out Methylfolate side effects on Dr. Ben Lynch’s website. Another good discussion can be found on the website for Amy Neuzil, ND. If nothing else, taking a break from these supplements would tell you fairly quickly if they’re the cause. Dr. lynch suggests 24 hours, but it took much longer for me as my body is not detoxing. Please take care! I hope you’ve hung on and are doing better.
i was hoping to learn something new but i guess it’s all the same still. i have an incurable form of sibo and it seems nobody has any information on it. my doctor said the key is to go to the bathroom 2 or 3 times per day so the bacteria dont spend time traveling back up my small intestine.
Hello Joanna,
Don’t give up. I’ve been fighting this for years now.
Take what you can from the Internet and Dieticians. (Frankly, I think the advice here is patently absurd. A 100 gram carb ancestral diet? Nuke the bacteria in your digestive treatment while feeding the “happy” bacteria? What does that even mean?)
In one of Chris’s ebooks I read perhaps one of the two useful things I’ve ever read on the topic, three if you count a failed experiment I tried. He recommended a probiotic that I call “dirt pills” because they are capsules that look like dirt. They’yre called Prescript-Assist and they don’t contain L. acidophilus, the most common strain in other probiotics. For some reason that’s important.
The other piece was the Specific Carbohydrate Diet, which seems to have been stolen by someone in the Internet Age and repurposed as the FODMAPs diet, which is being dismissed in this article. Contrary to what I’m reading here, it actually works quite well, as long as you don’t take it like gospel and take the time to “play” with it (which the authors insist you should not do). The key is to play one variable at a time. You actually can deduce quite a lot from that. It helps to have an open partner and not to eat socially. Luckily, I don’t socialize much, at least not with food.
The third thing is interesting because I’ve never heard anyone anywhere mention Rifaximin, outside of where I first read about it, in some PubMed reference. This was when I was first reading about celiac disease (I’m lucky enough to have some bad alleles on chromosome 6, and I say that not sarcastically because failure to discover this on my own would have kept me morbidly obese and very unhappy). The article suggested treatment with this antibiotic, which restricts itself to action only within the digestive system. It was extremely expensive and gave me a rash, so I discontinued it. (Note, my doctor is great. I handed her the article and she said, “huh, thanks for sharing,” wrote me the script.) Anyway, I thought I’d give it a shot because I’d noticed dramatic improvements in my condition on rare occasions when I’d been having antibiotic treatments.
Another excellent symptom-reducer includes opiates; however, that’s not really sustainable, for obvious reasons.
The answer: a permanent food-based solution. And, yes, it happens to be low carb, which is not to say yours (or anyone’s) needs to be. My answer is, in fact, highly idiosyncratic, and I’ve been working at it for years.
This dietician does the topic a real disservice and I’m shocked to find it on this website.
William Jones
The low FODMAP diet was developed by scientists T Monash University in Australia. That diet along with only 3 days of RiFaximin saved my life. Yeah, I was becoming suicidal from stomache pain and discomfort. It’s all relative and very personal so I wouldn’t dis this article as I followed this exact protocol unknowingly about a year and a half ago and I’m proof that it works. Maybe not for every individual but it’s not an absurd theory. And BTW, Chris book is called your PERSONAL paleo code….may you find health and peace always.
Jennifer,
I don’t dismiss antibiotics or GAPS/FODMAPS-related diets. Amoxicillin did the trick for me, as did SCD. Don’t want to niggle, but SCD is pretty much the same thing.
The quackery comes in the statement that someone with SIBO can follow this regimen and then, eventually, get to eat whatever he/she wants. This isn’t stated specifically, but it’s implied.
And 100 grams carbs (or whatever) may be fine for some people, but for others it’s a get out of jail ticket that can really mess them up.
Sincerely,
William
Interesting. After reading all these comments, it’s really just listening to how your body responds to everything. William, I was on the scd diet a few years and lost too much weight and flares kept happening. Steve and Jordan put fear in their info that carbs will destroy you. I don’t like that about them. After testing positive for SIBO and reading Chris’s article about how you do NOT need to test positive for ketone in urine tests, I changed things up. I did test positive for Ketone. Amoxicillin wrecked me. It was awful. Now I’m on a low fodmaps diet, off the scd diet and taking Berberine and Uva Ursi to rid the SIBO. Bringing some carbs in slowly and the supplements has made a huge difference. Carbs are important to restore balance in the gut. But it’s a slow process and being aware of what works and what doesn’t.
I feel like it’s just a trial and error for everyone to get their health balanced again. There’s no straight forward answer to heal you gut and stomach. And hopefully there will be one day. Good luck to everyone out there on this roller coaster ride. I’m not off it and it’s been a long miserable one. But these articles and comments help a lot along the way.
You mention the root cause behind SIBO? It implies there is a deeper level to go to in order to solve the SIBO problem. Can you provide a link to a discussion about that. I have diagnosed SIBO and my family doc would only give me 3 days worth of rifamaxin (sp?) because she said insurance wouldn’t pay for more than that and then I would have to take some other antibiotics. I took them for 3 days and didn’t see a marked change. I need to find someone who really specializes in SIBO in Denver so will check PrimalDoc.com
Thanks for the info.
Debbie,
I too am in the Denver area, desperately seeking a doctor with a fair amount of Sibo knowledge. I am currently seeing a GI doc that prescribed me rifamaxin for ten days, twice a day dosage. I felt great for roughly four weeks, and my symptoms returned. It’s such a roller coaster ride. I also have Celiac, and try really hard to stick to a Paleo based diet, but when I had the hydrogen breath test and did the prep the day before of only eating rice and chicken, I felt amazing! But if you find someone who is worth going to in the Denver area, please let me know! Thanks!
I have SIBO and tested positive for both a parasite and fungal infection. I was told to go Paleo and avoid FODMAPS.funny enough, that’s when I got much worse and develop a whole new host of symptoms. Probiotics give me terrible reactions and cannot tolerate proteins even with Hcl and enzymes. Trying to find a diet that works for me while treating all these infections herbally. If one has SIBO and parasites is there anything diet wise that should be done differently?Thanks for article!
For a tough case of SIBO (as in years + a few rounds of treatment) when do you like to add in probiotics?
Also, have you seen people fail a round of rifaxamin+ neomicin, try herbs with some success, and return to rifaxamin + neomicin and succeed?
Lastly, does anyone know how to get Resolor (a prokenetic) from Canada?
Jason
Resolor in Canada is called Resotran. Here is some info.
http://bodyandhealth.canada.com/drug_info_details.asp?brand_name_id=6054
THought I would share with you guys, i found a lab that will test for a good bit cheaper than commonwealth: http://www.metsol.com/hydrogen-breath-test/small-intestinal-bacterial-overgrowth/
Kelsey, given that some respond well to herbals and others to pharmaceuticals, rather than try both if the frist one fails, do you see any problem in using both collectively together at the same time?
Has an RD who works with G.I. patients and University medical Center, this article is a summation of what I’ve been preaching to the doctors I work with. Thank you for putting in a concise way and for emphasizing that we don’t know what the best diet is after SIBO/sifo erraditation happens or what the best diet is to prevent recurrence. I wish we had message board for like-minded practitioners to discuss such things. Call me sometime 619-543-3784. #rdsthinkingoutsidethebox
Kelli, thanks for the kind words. Message me through my website http://www.healthyguthealthylife.com. There is a Facebook group of like-minded RDs I can add you to. 🙂
I have had poor digestion coupled with gas my entire life, and have been gluten free for 10 years. I suffer from chronic fatigue and thyroid symptoms (low energy/always cold). I was treated for SIBO last year with Rifaxim followed by 10 weeks of berberine. Unfortunately I am no better. I have been on a paleo and low fodmap diet. I can tolerate moderate amounts of polyols, though fructose and fructans are a problem. No lactose. I follow a paleo diet, so no grains. I am trying to eat white potatoes cooked and cooled but they seem to be causing me trouble as well. Celiac and Type 1 diabetes run in my family. My naturopath has recommended I try WEDO (?) Thank you for this informative article.
I went to doctors for years to try and solve my problems then started doing my own research. My symptoms led me to gluten so I did a DNA gluten sensitivity test and discovered I carried the celiac genes so gave up gluten. I improved but I was still not 100% so found a naturepath doctor who thought I may have leaky gut. I did the test which came back postive so he tested for SIBO and that was positive too. He did not know too much about how to treat SIBO as its relatively new so I did my own research. I took Oregano oil, Berberine, Alacin and Neem leaf oil twice a day for one month to kill the bacteria. I cut out all fermented foods and pre and probiotics and followed the Fast tract digestion diet which I found on the Digestive Health institute website. This diet is based on the fermentation potential of food and is not the same as the FODmap diet. I retested for SIBO after 4 months and got a negative test. I have not yet retested for leaky gut but my liver enzymes which have been raised for the past 7 years are now normal and I am now absorbing vitamin D3 and zinc, my levels were low before, despite taking supplements. I now have reintroduced probiotics back into my diet and am eating a diet based on fruit, vegetables, fish, some meat but no grains apart from rice and restricted dairy and I feel great.
How great is this news! Thank you for sharing your protocol.
Hi Corinne,
I myself am on the Fast Tract diet and it works great for me too, but if I were to deviate all my symptoms would return within 12 hours.. Your experience with the Naturepath doctor sounds brilliant, but unfortunatly they don’t seem to exist in the United Kingdom. Could you add some more detail about the Oregano oil, Berberine, Alacin and Neem leaf oil twice a day for one month.
It would be great to know the amounts of each.
Thanks
Mark
I took 2 caps of Berberine after breakfast and dinner, 2 caps of Allacin, also after breakfast and dinner, 1 capsule of Oregano oil after breakfast and dinner and 7 drops of Neem leaf liqud in water also after breakfast and dinner. During this time I cut out all pre and probiotics. Took the capsules for a month while following the Fast tract diet. Once I stopped taking them I started taking Iberogast before meals and Betaine HCl and Pepsin as my Dr thought i might be low on stomach acid. All are available on iherb. I am still taking the Betaine HCI.
Hey corrine,
Iam in nj. Can yoi provide the contact details of naturopath
Wow, you destroyed the overgrowth in a matter of months! Gives much hope to correcting this issue in others.
I second the request for what amounts you used: mg of each capsule/quantity of herbs you used for your protocol?
Thank you for posting what helped you!
Your story sounds similar to mine. I believe one of my root causes was mercury. You can check out my story here-http://familyhomeandhealth.com/2015/04/how-i-recovered-from-mercury-poisoning.html. I am not saying that mercury is a problem for you. I researched and thought for probably a year or two (and also saw an integrated doctor) before I decided to have my fillings replaced. But, you may want to look at my website and articles. I know I have been greatly helped by reading other people’s stories even if I decided not to follow the path they did. I hope you soon find the answers for you!
I get so confused with so many things to try I suffer severe chronic acid continually in pain. I have just read fast tract diet and think I probably need to try low carb diet as I am eating plain bland food and it’s not working I am also taking prescription drugs that help but not anywhere enough. I don’t know it’s all very confusing. I just want some relief
I think that *(many) people/”experts” in the field Love to hear when somebody has Sibo. All I keep reading about (since I found out I had sibo 9 months ago) is how treatment needs to be tailored or individualized to the person. Well that means that they have to keep going back to the doctors and it takes hundreds of dollars to get help. I completely understand that every BODY is different. I also understand that pharmaceutical drugs sometimes don’t help people. I also know from experience that herbal products don’t necessarily or won’t necessarily help as well (not for me at least). All are SIBO diets vary. It seems to be utterly confusing? I just don’t understand how to heal from this bacteria?? Personally I feel great when I’m following the diet to the T but I just don’t know how to stick with it for a lifetime? I have gone on it about 100 times and I’ve also gone off of it 100 times…. I don’t know if I felt worse or better before I ever knew I had SIBO!!!!
Kelsey,
I’ve had bloating, fluid retention, constipation etc for years and years. Horrible, ugly, embarrassing, stressful, worrisome. Less than a year ago I did a breath test that was positive for SIBO, as I had expected.( I am also suspicious of h pylori, which I’ve been treated for but feel has recurred.)
Bottom line is, after eating a diet informed by Norm Robillard’s charts I’ve felt great. I realize that subsisting on white bread and foregoing most vegetables would not be seen as ideal by most, but here’s my question: I have undergone the treatments and dietary modifications (and many more!) that you suggest for many years, all manner of synthetic and herbal antimicrobials included, and am continuously using two prokinetics (LDN and d-limonene, erythromycin did not work for me at all) but nothing but eating carbs that are absorbed quickly and high in the GI tract and avoiding fiber and other kinds of more difficult to digest carbs has brought relief. Is there any evidence that eating in a way that keeps severe symptoms at bay is truly worse than eating food that feeds the colonic microbiome but at the expense of significant symptoms from intractable SIBO? I am aware of and concerned about the long-term effects of limiting fermentable foods, but not convinced of the superiority of continuing to suffer in order to feed bacteria where they belong (LI).
Thanks for any thoughts!
Webraven,
I just want to say that I appreciate your comment and question and how you write. It articulates things that i’m interested in too. Thanks
No expert here, just want to say that.
In reference to your comment that you doubt the need to eat the foods that exacerbate your symptoms, I would counter that since you are already suffering symptoms from your food, it’s quite certain that you are suffering from nutritional deficiencies already. I would think that with continued lack of nutritional support from food (you didn’t mention vitamin, mineral, or herbal supplementation) your immune and endocrine systems will continue to struggle. I’m sure you’re well-aware that the simple carbs present in the highly refined foods that digest quickly have little to offer in the way of nutrition.
I guess that’s the question – are you getting adequate nutrition in what you’re eating, or are you simply eating to feel full?
Hi Ann,
thank you for commenting!
I’ll assume that you are referring to micronutrients (vitamins, minerals) and not to macronutrients (protein, fat, carbohydrate). I agree with you that limiting your diet puts you at risk for deficiencies in micronutrients, and am taking steps (supplementation, eating small amounts of certain vegetables I seem to tolerate, such as tomato and cucumber) and supplementing vitamins C, Bs, K, A, D, E and trace minerals and Magnesium. I also use herbal supplements, hormones (Pregnenolone in minute doses to support adrenal and brain function) etc.
I’m not sure if you had a suggestion or just agreed with the obvious negatives of having to restrict ones diet? if what you meant is that I am experiencing my current symptoms due to having a bad diet I’m afraid you have it backwards; I have been forced to stop eating a conscientiously “healthy” diet due to my symptoms, which have gradually worsened over the years.
I followed the Fast tract diet but made my own recipes using the tables. I took natural antibiotics for a month and cut out all pro and prebiotics. I then took Iberogast and Betain HCI and pepsin. I re tested and the SIBO has gone. Now I eat a more normal diet but tend to choose vegetables and fruit that score lower on the fermentable index. I eat rice and potatoes but only the low scoring ones so avoid Indian food for example, which uses Basmati rice. I have introduced probiotics back into my diet and I eat a lot of coconut products. While I am not following the strict Fast Tract diet I try not to eat too much of the forbidden foods as i don’t want a recurrence of the SIBO. I still take the Betaine HCI and pepsin and i obviously have low stomach acid as I take 5 capsules per meal without any side effects.
Webraven, I completely relate to your situation!
Listen to your body and it will tell you what to eat or not to eat at any given moment. It has a wisdom that none of the so called nutritional experts will ever be able to obtain.
We are all different and one-size-fits-all approach is an outdated model.
I followed advice of many “nutritional experts” only to become worse.
Lots of people nowadays react to foods considered healthy. And by react I don’t mean just suffer an occasional bloating or acid reflux, but actual damage to their mitochondria and in some cases even autoimmune attack.
It has been proven that a lot of high oxalate foods like nuts, spinach, healthy grains like buckwheat, quinoa, seeds like chia etc actually damage the gut and mitochondria in people that are sensitive to them.
Some phenol (salicilate) rich foods like grapes, almonds, apples cause pain, brain-fog, mood issues in some people.
Histamines and other amines in bone broths, fermented vegetables, yogurts wreck havoc on some people’s bodies and minds.
Foods like spinach and tomatoes can launch an autoimmune attack.
Nightshade family (tomatoes, peppers, eggplant and potatoes) cause joint pain, brain fod, fatigue and other nasty symptoms in some people.
When are we going to finally acknowledge that each person has a unique situation and what is considered healthy for some might be downright poisonous for the others.
Once again, listen to your symptoms and your body will tell you what you can tolerate.
I myself am in love with the Fast Tract diet approach. Excessive fermentation in the small intestine for me means not only unpleasant bloating but inflammation in the gut, constipation, low energy, mood issues and heart palpitations.
If I continue eating so called healthy foods I will never get off my couch because being bloated makes me lethargic and ill.
You don’t need some expert telling you what to eat. Number of diets equals number of people.
Hi everyone,
I was wondering if there are any Fructose Malabsorbers out there who are also suffering from SIBO? I have both and a low FODMAPs diet seems essential for me at the moment to avoid the nasty symptoms of FM but I agree it’s not healthy to do it long term. I am yet to begin treatment for the SIBO. Could it be possible that the FM might be reversed if and when the SIBO is cured? I hear mixed information about whether FM is reversible or not….
Thanks
Excellent question and I’d like to see this answered as well.
I am 53 and suffered with Helicobator Pyloris, IBS, Constipation, Duodenal ulcer, SIBO and Diverticulitis off and on all my life —to the he point where I was becoming suicidal. I started a paleo diet at the end of 2013 and although i felt clear minded and had more energy my stomach pain persisted. In early 2014 I discovered the low FODMAP diet and found research on Rifaximin. I followed the low FODMAP diet for 6 months and took one round of Rifaximin (very expensive, it cost me about $600) prescribed by my Naturopath. My symptoms were gone in 2 weeks! I quit drinking alcohol completely, maintain a dairy free and gluten free diet ( I can eat a few grains with out problems) and I’ve never felt better!
SO happy to hear you’ve recovered, Jennifer!
That’s fantastic news!! All your hard work paid off. Well done
This is a risqué post for kresser.com and I like it!
From my own research, I’ve come to believe that starving infections can lead to them evolving into cystic forms or worse, burrowing into tissue in search for food. I think there are too many bodily and enzymatic processes that we need and food can help us get our fuel for these. We may feed infections this way, but I do think keeping immunity up, as well as getting adequate nutrition to keep metabolism strong, are vital for your fight against chronic infections. That said, the guy is an immune power house, so an infection there will undermine immunity. I get uneasy thinking about how many years some Lyme patients are on antibiotics. However, I do think, in my own n=1 experience, that I have stayed in remission for so long because even though I am “off” of anti-microbials, I take them every now and again. We are germs creatures! A good immune system can keep the good and bad balanced. An okay immune system might need some anti-microbial help, but it also needs breaks from antimicrobials and focus on nutrition and healing.
Why cant we just wipe out the bacteria with megadosing of antibiotics and then imediately start a combined Protocol of a healthy, carbreduced, paleoinfluenced, diet, + digestive enzymes, prokinetics, and Faecal therapy?
//. Patrik
Will Cats’s claw, Cystistatin and Monolaurin help fight off SIBO? I know one of these help get rid of H Pylori. Thanks.
SIBO is a constant recurring factor in my life. I have Gastroparesis (delayed stomach emptying) and sluggish intestinal contractions so I keep ending up with SIBO and taking Rifaxamin to “cure” it approximately every three months for the past 6 years. Any suggestions for my situation?
Have you tried supplementing with Iberogast before meals and using digestive enzymes along with Betaine HCL and Pepsin.
Corrine, Thank you for pointing out the Iberogast. It’s a prokinetic! Encourages the peristaltic mechanism to empty food faster and may really help in clearing out the settled SIBO of the upper GI. I can positively see that this along with the herbals you mentioned, may be the solution to turning things around…..and specific targeted diet of course.
I love the internet and the chances to connect with people who help others. Thank you!
Corrine–did you test positive for hydrogen or methane? I tested positive for hydrogen. After 7 days for Rifiximin I got C. Diff for the second time. I’m looking for how to treat SIBO that won’t cause another reassurance of c. diff. Your natural treatment sounds interesting. Thank you for sharing.
Somewhere I read that c. diff [colitis], due to c. diff overgrowth, is, in turn, possibly due to the *absence* of other species of clostridium. This is hard to google. It makes sense, though, seeing as *adding* species via FMT is an effective treatment to knock c. diff back in balance.
I have also heard that some generic rifaximin can affect colon bacteria, where the brand, Xifaxan, does not.
http://drruscio.com/allison-siebecker-interview-sibo-episode-30/
You can jump to the 58 minute mark to the discussion of antibiotics.
I wonder if this theory can be applied to candida overgrowth. I have one ND telling me to go on a low-carb starch and sugar free diet, and another ND telling me that is re worst thing to do because the yeast will become dormant. Both of these suggestions with diet are for following during a 3 month treatment with herbal antifungals and probiotics.
Mikel
I was wondering the same thing! I didn’t follow a strict diet when I took my Rifaximin for two weeks and I feel about 80% better. I can eat carbs that I had so much trouble with before. I still deal with Candida to this day and when I tried to eradicate my Candida, I followed a very strict diet for 4 months and took herbal supplements to kill it off. I think I will try this time around not to be strict and see what happens.
Nuking both the small and large intestine with antibiotics is not a solution. The solution is to heal the large intestine both mechanically and with the right probiotics, so the various microbes don’t have to migrate to the small intestine.
That’s certainly part of the long-term solution.
However, leaving an overgrowth of bacteria in the small intestine is a not a good idea, and the way to get rid of it is herbal/pharmaceutical antibiotics.
The idea is that they will migrate back to their natural environment if the large intestine is healed. I still maintain that nuking the whole system with antibiotics is not a solution, it’s a disaster with effects that last a lifetime.
Eugenia,
I’m guessing you have not done much research on this subject or even suffer from sibo by the sounds of your comments. Rifaximin is NOT a broad spectrum antibiotic. That means it will NOT travel to the rest of the body. This antibiotic is made to stay in the small intestine and do it’s job. It does not cause yeast infections nor does it kill off any of the good bacteria already present. Contrary to your belief, the bacteria will NOT migrate back to the large intestine! I speak from experience! I cleared my sibo by about 80% with the use of Rifaximin!
I do have SIBO and I have taken Rifaximin. It only worked for the few days I got it. Diarrhea stopped while taking it. After that, the same thing ensued. The strategy doesn’t work.
Eugenia, I’m sorry to hear it didn’t work for you but to comment that the strategy doesn’t work is a negative comment when it has worked for others. Maybe try another round and make sure you have the proper dosing and right amount of time to take it.
Or it could be you never had sibo in the first place. This has happened to some. Maybe it’s Candidiasis and/or parasites along with sibo and you are still suffering from parasites and/or candida. When I had my systemic candidiasis and almost died, I remember some of the symptoms were the same as sibo. I had diarrhea back then and at that time was only suffering from candida and parasites not sibo. Sibo only showed up years later. I hope you can find what is causing your distress. Good luck.