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Ep.40 – Eating well with SIBO: Understanding SIBO Diets
11 Mar, 2024

Episode Intro

What should you eat when you've got SIBO? This question is very confusing, so I thought I'll dedicate a whole episode to explaining a bit more about what to eat when you've got SIBO, what should you eat when you're going through treatment, and what to do longer term when you're trying to get back to a maintenance diet. Should you go low FODMAP and cut out all the fermentable fibres or do you need to go even further and go on one of the strict SIBO diets to remove all carbohydrates? If you're struggling with small intestine bacterial overgrowth and just no clue about what to eat, going from one diet to another, I hope this episode will give you some answers.

Podcast transcript

Welcome to episode 40 of The Inside Knowledge with me, Anna Mapson.

This episode is going to be all about eating with SIBO. The diets are very confusing and all the diet advice is conflicting sometimes, so I’m going to dig a little bit into the research and explain where some of these contradictions come from and how to navigate it if you’re trying to do this on your own.

Find a SIBO Nutritionist

Now first up, I really do suggest if you’ve got diagnosed SIBO and you can work with a nutritionist. That is going to be your easiest way to get the best diet that is tailored for you. And I also want to say not just any nutritionist, but someone who really understands SIBO or IBS. That whole area.

I’ve had a couple of clients come to me recently who’ve been working with other nutritionists and they might have had the best of intentions but they really don’t understand the symptoms. The diet that’s needed, or the treatment.

The wrong SIBO treatment can make things worse

So they’ve been advising people to take the wrong kind of supplements. Or not treat SIBO at all and just go on a very strict diet. And this has led to my clients kind of coming to me and feeling even more confused. Because they tried what the other nutritionist said and it didn’t help. It didn’t get better, and in one case it got worse.

And so, I would stress, if you’re looking for somebody, make sure that they are talking about SIBO on their website. When you speak to them before you sign up, that you get a good sense that they really have worked with a lot of people. Who’ve got different types of SIBO and that they’re experienced as well. Not just talking the talk. That is just a little preface to the content for today.

What is SIBO

Just as a quick reminder, SIBO stands for Small Intestine Bacterial Overgrowth, which is an excessive amount of bacteria or microbes in your small intestine where we shouldn’t have loads of bacteria.

For some background on SIBO, listen to episode 11 about what is SIBO, episode 12 of how to treat SIBO and episode 31 which covers different supplements for treating SIBO.

This episode is going to be all assuming that you know you’ve got SIBO. We’re not going through that like, is it, isn’t it thing. This is for people who have got a diagnosis and had a positive test and then are in the realm of treating it with some supplements or antibiotics.

Two SIBO diet theories

There are two schools of thought really when it comes to what to eat when you’ve got SIBO.

And it differs slightly when you’re going through treatment or whether you have finished your treatment and you’re in between rounds.

The challenge for getting a really good sort of scientific evidence based position on this is that there is just really not very good research data to support any of the positions.

Starving SIBO with a low fibre diet

So one school of thought thinks that you should treat SIBO by removing all the fermentable foods. All the fibre from your diet that bacteria would love to eat. If you take them out, then that would help to starve the bacteria and reduce down their numbers.

Keep fibre in your diet through SIBO treatment

Then the other way people do it is to try to eat fibre whilst treating it. Because, as the bacteria are replicating, you’ve got a chance to attack them with your antimicrobial treatment or antibiotics.

Either way, there is just a lack of good studies that show clinical applications that we can sort of translate into day to day use.

My view as a SIBO nutritionist

But from my experience of working with hundreds of people who’ve got IBS and SIBO, the diet is mostly about helping you with your symptoms.

The diet is not going to treat your SIBO. Diet alone is not going to reduce down your numbers effectively to the extent that your SIBO will not come back.

You need to have antibiotics or antimicrobial treatments that are effective at reducing SIBO and make sure that you’re taking them at the right times, the right level. The dosage is correct.

We have got more evidence about how to treat it. But the diet I would say is mostly about how to manage your symptoms. Which will hopefully allow you to keep going with the treatment. And that’s what we can dive into a little bit today.

It’s ok to deviate from the SIBO diet at times

But if you have that mindset, that actually what you eat is not the be all and end all of getting rid of the SIBO. So if you decide to eat something that you know will trigger your symptoms and maybe cause more bloating. But actually you just want to have that meal. You want to eat with your friends or something.

It’s not ruining your SIBO treatment in eating food that has got fibre in it or food that’s got sugar in it

It’s not going to completely invalidate the treatment that you’ve already been working on. I think that’s what I want to give you out of this episode as well. Reassurance that if you are eating to meet your taste requirements sometimes. Not just thinking about nutrition, not just thinking about the SIBO and getting rid of it. But you’re also thinking about what you enjoy eating, then it’s really important to to feel okay about that.

SIBO diets can help get your symptoms under control

One of the reasons I do focus on diet with my clients though is to get those symptoms under control. People come to work with me and they are just desperate. They want to reduce the bloating that is making you take your clothes off by the end of the day. To reduce that nausea every time you eat or you get up in the morning and you’re feeling sick.

Maybe it’s frequent toilet trips or urgent toilet trips that mean actually you’ve had instances of incontinence. These are all common symptoms of people who have IBS and SIBO. By maintaining a diet that reduces some of these symptoms. You tend to get more energy, tend to start to feel better, and then you can focus more on the treatment.

It’s really hard to just do it through the antimicrobial or antibiotic treatment.

What are the options for SIBO diets?

I thought I’d take you through a few of the options that are on the internet. If you look for SIBO diet, you will come up with a couple of suggested options. So the main purpose of all of these diets is to reduce down your intake of fibre that can be fermented by the gut bacteria.

And then the hope is that it will reduce your symptoms. Commonly discussed diets might be the:

specific carbohydrate diet (SCD)

SCD was created for people with coeliac disease. It’s actually, used in inflammatory bowel disease to reduce down some of the disaccharides. These are like two sugar elements stuck together. You can eat foods that have got monosaccharides, like one type of sugar. Which includes most vegetables and fruits, but it doesn’t include any grains, for example, any dairy, or any starchy veg, like root vegetables.

So, It hasn’t really been proven much in the SIBO world, but some people started off using it as an approach to reduce down the fermentation and some of the bloating, for example. That is the specific carbohydrate diet.

Low FODMAP diet

Then there’s also the low FODMAP diet, which you will have probably heard me talk about a lot. This is a really well tested IBS dietary intervention. Again, there’s not much evidence for using it in SIBO. But we know that in three out of four people who’ve got IBS, some benefit will be shown. So a lot of people do feel better on the low FODMAP diet. The key thing with it is you have to go through the retesting process. And take some time to bring the foods back into your diet.

It’s not about restricting it. So that’s, that is one diet that’s probably the most common IBS diet that’s out there.

SIBO specific diets

Then there are two other diets that have been created by key SIBO practitioners. So one is called the SIBO specific food guide by Dr. Alison Siebecker. She is like the main SIBO doctor, in America.

She created a diet based a little bit on the low FODMAP diet. But also taking elements of the specific carbohydrate diet, also just adapted it based on hundreds of clients that she’s worked with. So it’s very restrictive because it’s cutting out even more things than the low FODMAP diet.

Then there’s another doctor called Dr. Nirala Jacobi who took Dr. Siebecker’s diet and has kind of turned it into a timed and phased approach to eating. That is called the SIBO biphasic diet.

This again is very restrictive and it has a two week restriction where you’re really stripping things out a bit like the low FODMAP restriction phase. Then you expand the diet a little bit more for another sort of six to eight weeks.

Liquid only elemental diet

The final diet I want to mention is called the elemental diet. Now this is a liquid only diet for two to three weeks and you just basically have shakes instead of meals. You have no food at all. Now it’s a properly put together meal in a shake. The problem with it is that you’re not eating at all and that’s really hard mentally.

So you literally have no meal times with your family or your partner or however you will not be chewing anything. Which is quite challenging people have told me and It’s also more of a treatment for SIBO rather than a dietary intervention. It’s more Something to reduce down the microbes.

Don’t take SIBO treatment with the elemental diet

Now again, people do see some reduction similar to a round of treatment Alongside the elemental diet. This is one diet that you should not also be taking antibiotics with, you do it separately.

It’s not a diet that you follow with treatment as well. In the UK, it has to be prescribed by a doctor and I think that’s right.

Only a doctor should prescribe the elemental diet

I would suggest that you don’t source it off the internet and try and do it yourself. Because you don’t know that you’ll be getting all the right quality ingredients. And also I do think it’s appropriate that you have a proper assessment as to whether mentally and physically you actually need it because it’s quite challenging to cut out all food from your diet.

So those are the different options for like what you can eat or what people suggest that you eat with SIBO.

SIBO diets alternative option – eat what you want

As I said, the other approach is just to eat normally and keep eating the same foods that you’ve always eaten alongside taking your treatment. What you won’t get with that though is perhaps the same reduction in your symptoms.

Sometimes you need to get your symptoms under control in order to feel better and to start, like, noticing a difference.

Summary of SIBO diet options

Just to be really clear, the options are

  • eat normally and take your SIBO treatment,
  • eat a reduced fibre diet, like one of the ones, one of the approaches I’ve mentioned, and take your treatment alongside it.
  • And then the third option is to get the elemental diet prescribed for you as a treatment but then you have to go back to eating normally after the elemental diet anyway.

Reducing fibre isn’t good for long term gut health

The problem with going on a reduced fibre diet, is that you are reducing the fibre for your large intestine bacteria, which are the good guys.

We want more of these good beneficial bacteria. And if you are following a low FODMAP diet or a very restrictive SIBO type diet for a long time, there is a danger that you will become deficient in key nutrients. Or that you will reduce down the good bacteria in your large intestine.

The role of gut bacteria in your health

The bacteria there are key for supporting and like training up our immune system, interacting with your digestive motility. Helping you absorb key nutrients like iron from your diet. So the bacteria have got a massive role to play in lots of different physiological processes. It’s not just nonsense happening at the end of the digestive tract that you don’t need to worry about.

It really is important to feed these good bacteria with fibre.

So what happens and what the danger is, is that you go on a restrictive diet, like the low FODMAP diet for six weeks, you feel a bit better and you carry on treating it with your treatment plan, whatever that is with your doctor or nutritionist.

And you have a little break from your treatment round and then maybe you go and you’re still on this restrictive diet. And then maybe you go on another round of treatment for another six weeks. And then you have another little break. Then maybe you need another round.

Restrictive SIBO diets can be hard to get off

During that time, it could be up to a year that you will be on a low FODMAP diet because you’re not re challenging your diet and re testing any of the foods.

Now, I completely understand why you wouldn’t want to do that. You don’t want to get those symptoms back. But what I encourage my clients to do is to be very cautious in re testing foods. as quickly as possible. So what we want to do is eat the broadest amount of foods that you can whilst keeping your symptoms under control.

You don’t have to stay low fibre if it’s not helping your SIBO

The other important thing that you should know is if you go on a low FODMAP diet and you don’t feel better. Your symptoms are no better, then there’s no point in staying on it. It’s not helping your SIBO to be on a low FODMAP diet. So if you don’t feel better on it. If you’re still on this restrictive diet and your symptoms are really bad. Then you definitely need to start eating more different foods and introducing that variety back to your diet again.

More information on food reintroduction

Two previous episodes that I’ve done about food reintroduction is episode 15 about how to reintroduce any foods to your diet. And episode 18 specifically about the FODMAP reintroduction process.

Those episodes might be helpful to you if you’re struggling with how to reintroduce foods to your diet.

Another reason for reintroducing foods is a lot of people I work with have a very low body weight because of the significant food restrictions. And we know that when you’re not eating enough food, that can also contribute to slow motility. Slow digestion, which is what we want to get over in SIBO. We want to re regulate your digestion.

Eat 3 meals a day in SIBO

Eating three proper meals a day with sufficient portions is also really helpful. So it’s not just about variety, but it’s also about eating enough food. I’m going to do a couple of episodes on how to gain weight with IBS and SIBO later in the year.

I’ve just done the episodes on how to lose weight and the challenges around that.

And I also really want to acknowledge a lot of people struggling with the opposite problem. My overall approach for you, if you’re trying to do this by yourself, is to, wherever possible, focus on whole, natural foods.

Eliminate your biggest triggers, but not all

Consider your biggest triggers from the high FODMAP foods list that might be really exacerbating your symptoms, and perhaps reduce those down. For example, some key things that might be triggers for you might be beans and pulses. Maybe it’s things like watermelon. That’s quite a common thing that people are sometimes surprised about. It’s high in lots of the different FODMAPs. And if there are a couple of foods that you just can’t eat, it’s okay to remove those from your diet.

If you know that these are really clear triggers. But when you’re removing whole food groups. Going gluten free unnecessarily, or removing multiple food groups. Then you just need to be aware, I suppose, that there is a potential for you to be low in key nutrients.

Restriction can lead to deficiencies

Some of the things that people are commonly low in with IBS, through restrictive dieting, are B vitamins, iron, zinc, and calcium.

Those are often low in people who are cutting out lots of different foods. And there are a couple of different research studies showing that people with IBS tend to eat less fibre.

Again, there’s not many studies for people with SIBO, but for IBS, we know that people tend to eat less fibre. Tend to eat more foods repetitively. So less variety in their diet.

Blood tests have shown that people who’ve got IBS tend to be lower in those nutrients. It’s not just that they’re not eating them, their bodies are low in things like zinc, B vitamins, and particularly in SIBO.

We know that there are nutritional impact of having an overgrowth of bacteria, so the bacteria can interfere with your ability to process B12 with iron. And other B vitamins as well, but also fat soluble vitamins like A, D, E and K.

After SIBO treatment eat a varied diet

If you’ve got over SIBO and you’ve treated it, you’ve retested. Your levels are low, you’re worried about SIBO coming back. One of the best things you can do is to try and eat a normal diet as possible. And eat a normal amount of food as possible. So, gradually reintroducing higher fibre foods if you’ve been on a restrictive diet. Making sure you’ve got a good balance of complex carbohydrates, healthy fats, proteins.

Slowly reintroduce foods

You can slowly reintroduce some of those higher fibre foods. Really monitor your body’s response to how you’re getting on and just gradually expanding back your diet to include a variety of different nutrient rich foods.

It helps so much when you can eat normally. You can socialize more, you can just be freer without reading ingredients for every product that you buy. You could even go on to take prebiotic and probiotic foods like sauerkraut and kefir and kimchi and all of these things that are high in beneficial bacteria. As well as fruits and vegetables that feed the good bacteria. Like try to think about your long term gut health.

Don’t stay restricted

So if you’re in that place where you have got your SIBO down, what you definitely don’t want to do is stay on a restrictive diet. You want to try to eat as much as you can and as much variety as you can.

So I hope this episode focusing on food for SIBO has plugged a little hole in the episodes that I’ve done so far. Obviously I’ve talked about treatment for SIBO and that included supplements and antibiotics and things and they are key really important to your removal of the bacteria from your small intestine you need to get on top of that.

Hopefully, I’ll give you some ideas in this episode about how to eat and what to eat whilst you’re doing that.

Your next steps

I can help you with this individually if you want to get in touch. I run a three month gut reset program. I’d love to hear from you. My email is info@goodnessme-nutrition.com if you want to get in touch and work with me one to one or in a group.

And if you’ve enjoyed this podcast or if you’ve learned anything, please will you rate and review the podcast?

It helps me so much and I’d love to hear your feedback as well. Plus any questions that you want me to cover in future episodes, drop me an email. I do read all my emails and I try to respond to them as well.

Okay. See you next week. Goodbye.

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