It is likely that while you are on a SIBO protocol, your functional medicine practitioner has advised you to follow temporarily the low FODMAP diet (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols which feed microbes in our gut and are indigestible to us) to allow your gut to heal faster alongside the supplements and antimicrobials prescribed to you.
When it comes to low FODMAP diet, the important thing to remember is that you should follow the diet for exactly as long as prescribed because more than a few months of Low FODMAP diet can start having an adverse effect on your ecosystem in the colon and can cause some long-term damage (some of the good bacteria which keeps you healthy will starve and die off). So, it is important not to go on this diet for longer than advised and get the support from your nutritionist how to re-introduce high FODMAP foods at the end of the SIBO treatment.
However, the low FODMAP diet alone may not be enough and may not work for people with more advanced cases of SIBO where they feel nauseous, dizzy, pain in the ribcage/lower back, irregular heartbeats, bloated after a few bites and don’t have appetite and are losing weight continuously or react to pretty much all foods and have signs of nutrient deficiencies: thinning hair, dry skin nails and hair, fatigue, change of skin colour, etc.
So, here are a few suggestions for people with an advanced case of SIBO who are not getting an improvement on the low FODMAP diet alone to try and see if these might relieve the pain in the intestines and all other side effects in the first 2-3 weeks of treatment. Please discuss with your nutritionist/functional medicine practitioner if they might be suitable for you as everyone’s case is different and has different medical history so do not try these suggestions below without discussing with your practitioner first.
I have listed them based on the level of severity of your SIBO so when you try option 1 and if no help after a few days, then try the next one and so on. Hopefully, these suggestions would give you relief for the first few weeks of your treatment while waiting for the antimicrobials to reduce the level of overgrowth in the small intestines and allow your body to start absorbing nutrients again and improve your ability to tolerate more foods.
If the gluten free and dairy free low FODMAP diet has not worked for you so far, it is time to review a few other things that might be causing your SIBO to flair up:
1) SUGAR AND SWEETENERS – I know that maple syrup and all types of sugar (except for coconut sugar) are listed as low FODMAP but all sugary and sweet foods including honey would need to be cut out while dealing with SIBO. As a rule of thumb, anything which tastes sweet, stay away!
2) LOW FRUCTOSE FRUIT – stay away from all fruit in the first few weeks of dealing with SIBO as fructose is a form of sugar and feeds those bugs in the small intestine. So, hold on until you have treated it before you can re-introduce fruit. These are some fruits with lower fructose content which are safer to eat during your SIBO treatment if you are not reacting to them: kiwi, blueberries, papaya, dragon fruit, etc. Try and have no more than 2 portions a day (a portion is roughly a handful).
3) GLUTEN FREE BREAD/PASTA AND POTATOES – I know they are low FODMAP, however, they get converted easily into sugars in the gut (like all starchy foods!) so reduce the quantities, try to have no more than a few spoons of potato mash or no more than a slice of gluten free bread a day or less if you are reacting to them. Or cut them out completely if you can for a few weeks and you may get faster results (low FODMAP root vegetables are amazing substitute for grains!). Remember, it is only a temporary diet, soon you will be able to re-introduce them as the bacterial load in the small intestines is reduced and your reaction to foods improves.
4) NO GRAINS – most people with SIBO have SIFO (small intestinal fungal overgrowth) and the grains are hard to digest foods and they get fermented in the intestine by bacteria, yeasts and fungi creating a lot of gas and discomfort. For a few weeks, try cutting them out and you should hopefully feel a huge relief from bloating. You can substitute these carbs with low FODMAP root vegetables instead. Be careful with white potatoes, use in tiny amounts and mix with other veg. Introduce as many low FODMAP leafy greens as you can tolerate to bulk up the meals so you dont feel hungry, increase protein and healthy fats. If you are not able to digest raw vegetables well, make lots of blended soups and drink small doses of vegetables juice (always add ginger to the juices as it is very good for SIBO healing). Remember as a rule of thumb to eat your fruit and juice your vegetables. Vegetable juices are low in sugars, fruit juices are like a feast for SIBO bugs so dont feed them.
5) LOW FODMAP/NO GRAIN/LOW CARB MEALS – if none of the above have worked for you, then time to try something more radical which you need to discuss with your nutritionist. After going on low FODMAP and no grains, try having a low carbohydrate diet for breakfast and lunch only (which is higher protein and healthy fats and low in carbs). Then at dinner, you could try introducing larger quantity of root vegetables (carrot and swede mash is amazing, parsnip chips, etc). This would help regulate your glucose levels during the night so you can sleep better and yet starve the SIBO during the day on the lower carb diet.
If you cannot go all day without carbs, then discuss with your nutritionist to try the diet for breakfast only (one meal per day without carbs) and slowly build up to two. Alternatively, you can try tiny amounts in each meal, whatever works for you. Just remember that it is the carbohydrates that get fermented in the intestines and cause excessive gas and discomfort/pain so if you have done intermittent fasting (at least 12-14 hours gap between dinner and breakfast) and low carb/low FODMAP/no grain breakfast, you are extending your window of healing and reducing inflammation so it would work faster. Sometimes trial and error are what we need to fine tune to our bodies and see what foods make us feel best so having a food diary and writing down what works for you and what triggers your symptoms is great during this healing period.
I would not suggest "keto diet" or specific carbohydrate diet (SCD) during your healing from SIBO as they either use dairy or vegetables which are high FODMAP, so you need to create your own diet by removing FODMAPS, grains and going low on the carbs temporarily. You need the energy and nutrition to heal from the infection so only try and reduce carbs for breakfast or breakfast and lunch if you can.
This is a very limited diet already and the keto and SCD diets have foods which are not suitable for SIBO sufferers. Try not to limit your nutritional intake any further as you need energy and nutrients to heal. This is only a temporary diet for the first few weeks and should only be done while you are taking your antimicrobials because diet alone cannot cure SIBO, it only provides relief from the symptoms when you reduce the carbs/grains/FODMAPs.
You don’t want to run out of energy while trying to heal so eat as many low FODMAP foods as you can tolerate to keep a good variety in your diet. Because quite often SIBO causes blood glucose dysregulations, you may have difficulty going on low carb diet which can make you feel rather unwell. Please work with your nutritionist to find the right diet for your SIBO and the stage where you are at as the low carb may not be the right one for you to add if you have glucose fluctuations.
6) LIQUID DIET – if none of these work, than this is a diet for people who are not able to digest food and may be in pain all the time, so at the extreme side of the spectrum. Juicing low FODMAP vegetables (only veg, not fruit!) and cook some low FODMAP soups and blend them and drink rather than eat your food.
Try this for a day or two to reduce swelling and pain. Best to do this on a weekend when you are not working and have lots of rest, clear your schedule to get lots of down time and allow your body to heal. Again, I would not recommend you try this without a suitably qualified nutritionist who has experience in SIBO as your glucose regulation may need to be monitored.
If you are on the liquid diet where you cannot tolerate many foods and your gut needs a re-set, you can also sip once or twice a day on bone broth (with added turmeric, black pepper and sea salt) and add some helpful herbal teas to relieve pain and discomfort: liquorice tea, mint tea, green tea. You can also make your own home made jellies by using veg juice and gelatine, it is very healing to the sore mucosal lining.
USEFUL TIPS:
- Coffee and alcohol are very acidic and irritating to the gut lining, they need to be cut out while healing from SIBO. You can re-introduce them later when you feel better.
- While trying the above dietary suggestions, please remember that snacks are very bad for SIBO sufferers so stick to 2-3 healthy well balanced meals a day! A balanced meal means you have protein, healthy fats and carbohydrates including suitable low FODMAP friendly veg and fruit. You need to leave 3-4 hours between meals to help your migrating motor complex so that you can heal from SIBO. See root causes of SIBO for more information: Root causes of SIBO (Small Intestinal Bacterial Overgrowth) (nutritionjourney.co.uk)
- Intermittent fasting is great for SIBO allowing your gut to heal! Please talk to your nutritionist how to start slowly and build up to a longer gap between dinner and breakfast. It works wonders so definitely a good one to try to support your healing.
- Pre-plan your meals the day before so you don’t end up eating the wrong foods when your glucose levels are low and you feel shaky and you don’t have the energy to cook.
- Cooked food is pre-digested and easier for your body to process, lots of soups and stews would be great during this period. Also, try making your own bone broth at home, it has a lot of amino acids and collagen which are healing to your gut (season with salt, black pepper and turmeric for extra anti inflammatory benefits). You can use it as a stock for cooking or just sip on it in a cup.
- While treating SIBO, your practitioner has mostly likely given you digestive enzymes to allow your body to breakdown your food, so don’t forget those as they will greatly improve your ability to absorb nutrients, give you energy to heal and reduce swelling in the stomach.
- If you don’t have one already, ask your practitioner for nutrient support, a good quality multivitamin and mineral complex to correct the nutrient deficiencies associated with SIBO. This will help you heal faster.
PLEASE REMEMBER TO DISCUSS THESE OPTIONS WITH YOUR NUTRITIONIST/FUNCTIONAL MEDICINE PRACTITIONER BEFORE TRYING THEM AS EVERYONE HAS DIFFERENT MEDICAL CONDITIONS AND SOME OF THESE SUGGESTIONS MAY NOT BE SUITABLE FOR ALL. BEST OF LUCK IN YOUR HEALTH JOURNEY!
If you are looking for a personalised diet from a Nutrition Coach, feel free to get in touch with us for more information: info.nutritioncoaching@gmail.com
