This is a question I see and hear a lot among those in the small intestinal bacteria overgrowth (SIBO) community. And it’s valid for sure. There are quite a few recommended “diets’ to follow when you are on the healing path with SIBO and a lot of confusion and misinformation.
That’s why I’ve pulled together a list of SIBO-friendly foods that can be considered as part of your own protocol. I’ve broken them out into two phases: 1 and 2, which represent the “killing off” phase and the “rebuilding phase.”
Before we dive into the food aspect, I want to address something very important. A lot of the times, people will have a SIBO relapse, meaning their symptoms and suffering return once, twice or even more than that.
This is especially true if you are treating this issue with prescription antibiotics like rifaximin and neomycin as well as metronidazole, ciprofloxacin, tetracycline, and sulfamethoxazole/trimethoprim.
Why does this happen? It’s likely a combination of two things. First, a lot of people go back to their old diets of dairy, gluten, soy and processed foods/sugar. These foods are major triggers for SIBO and in fact, sugar and carbohydrates will feed the bad bacteria and are highly inflammatory. And SIBO is inflammation of the small intestine due to an overgrowth of bacteria that don’t belong there.
There is also growing research that shows that people with Celiac Disease as well as gluten intolerance are at a higher risk for developing SIBO and other digestive disorders because wheat creates transient leaky gut (or intestinal permeability) in everyone. With continued exposure to gluten, this evolves into systemic leaky gut that can cause food intolerances, IBS, SIBO etc.
In one study, 23% of those with Celiac tested positive for SIBO via the breath test and 11% via a culture. Moreover, 28% of those with symptoms had SIBO whereas only 10% of those without symptoms had SIBO.
This indicates that going gluten free and ensuring you are still getting the proper nutrients and pre/probiotics can help reduce the recurrence of SIBO. For people that did not get better on a gluten free diet, this might be indicative of the fact that they have low FODMAP sensitivity.
Secondly, you haven’t gotten to the root cause of the issue. Antibiotics are a band-aid solution that wipe out ALL of the bacteria in your microbiome (or gut) without facilitating any of the necessary repair work. Antibiotics are incredibly devastating to your gut and can in fact cause leaky gut. We know that there is a strong connection between SIBO, leaky gut and IBS, which a lot of people with SIBO also suffer from.
Without the proper gut healing protocol, you’ll likely fall back into a relapse because your gut is still “leaky” and so food, toxins, and other particles are entering your bloodstream where they don’t belong, creating an autoimmune response.
Thirdly, people with SIBO oftentimes suffer from low stomach acid (which presents in symptoms like acid reflux and heartburn). One thing to note is that heartburn, GERD and acid reflux are all a result of low stomach acid, not too much. Our stomach is a highly acidic place — on purpose. If you spilled your stomach acid on the floor, hopefully, it would burn a hole in the carpet. Other than our external barriers like our skin, our stomach acid is our next line of defense against pathogens. Bacteria, parasites, fungi, etc. should not make it past our stomach. When you have low stomach acid, they can get through to your intestines and wreak havoc. Not to mention, low stomach acid means food particles enter your intestines without being fully broken down, leading to things like IBS, constipation, and other digestive issues.
Antacids and acid blockers are not the answer. They purposely keep stomach acid low, which opens you up to more illness/infection and a host of other health issues. Instead, you might want to be looking at hydrochloric acid (HCl) and digestive enzyme support to help create additional stomach acid and facilitate the proper breakdown of food.
Let me preface this by saying that everyone is different. Some foods will work for others, whereas some will cause issues. Use every “elimination” diet as a starting place for you to customize based on your own unique situation.
During the first two weeks, you’ll want to follow some sort of low FODMAP diet. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are short chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating. That means you want to avoid all fructose foods (fruit/fruit juices, honey, baked goods, high-fructose corn syrup, maple syrup, processed sugars, etc.), all lactose (dairy products) and foods like wheat, garlic, onion, asparagus, leeks, artichokes, broccoli, cabbage, legumes, brussel sprouts, and any fake sweeteners found in “sugar free” foods. These foods can potentially feed the bacteria. The goal of this first phase is to kill off unwanted bacteria, and reduce inflammation.
Some healthy foods to focus on instead are:
You can find a fairly comprehensive list of low and high FODMAP foods here. Try your best to stick with this for the first two weeks at least, otherwise you will have to start over and repeat again. I’d actually recommend doing it a bit longer than two weeks, depending on how bad your symptoms were.
This next phase is all about repairing your leaky gut and restoring your microbiome back to its healthy normal state.
At no point should you be adding gluten, dairy, sugar/carbs/processed foods back into your diet.
The GAPS Diet is popular for those with leaky gut. I have personally never been on the GAPs Diet nor have I yet to recommend it to clients, but we do follow some lose version of it that is customized to their specific bioindividual needs.
You can learn more about the GAPS Diet and protocol here.
Healthy foods to focus on:
Following a strict food elimination protocol can be tough. The biggest advice I give my clients is to not look at this as a punishment, or at foods that you “can’t” or “can” have, but instead, foods that will heal and support you and foods that will not heal and support you.
Remembering (and repeating to yourself) that this is a temporary situation can help you stay grounded and focused on the bigger picture — supporting your long-term health and vitality. And while you might feel devastated and like everyone is working against you, trust in the process and in yourself. Because you CAN do this. I’ve done it. I’ve seen others do it. All you have to do is stay positive and focus on the foods that will nourish and heal your body. You can read about my personal SIBO/IBS journey here, as well as how I worked through SIBO die-off.
And don’t forget to snag my free SIBO Survival Guide below if you are looking for additional support, especially as you begin your journey and may be experiencing SIBO die-off symptoms yourself!