What is the Best Diet for SIBO

What is the best diet for SIBO? There is none, but there are a few key strategies to help you find the best diet for you and the needs of your gut.  Let’s discuss how you can quickly find the best diet for optimal gut and overall health.


Dr. Michael Ruscio, DC: Hey, everyone. This is Dr. Ruscio. Let’s discuss what is the best diet for SIBO or for small intestinal bacterial overgrowth. If you haven’t heard of small intestinal bacterial overgrowth, it may be an overgrowth of bacteria that underlies a proportion of irritable bowel syndrome or IBS.

So, in truth, we could ask the question and answer the question of, “What is the best diet for SIBO?”  and/or, “What is the best diet for IBS?” because there’s a lot of overlap in between the two. And, in short, there is no best diet for SIBO or for IBS. And I would encourage you simply to eat the diet that you feel best on for that condition. Now, I know that’s not very helpful. I’m going to give you some very specific guidelines in a moment. But one thing I’d like to start off with pointing out or advising you on is not trying to pick a diet based upon the diagnosis or based upon the lab finding because in my experience, that oftentimes distracts you.

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Dr. R’s Fast Facts Summary

The best diet for someone with SIBO is the diet on which they are feeling the best!

  • A diet that allows you to have and maintain a healthy environment in your gut (will be different from person to person)
  • First you want to find a diet that works for you (see diagram) and try it for 2-3 weeks
  • When you find a diet that works best for you, ride that wave for 6-10 weeks
  • Once you plateau, stay there for a few weeks, then start to bring in foods you previously cut out

If diet alone is not helping, follow the steps in my book Healthy Gut Healthy You to take further steps down the path of healing your gut and addressing any tougher issues.

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DrMR: So if someone, let’s say, has small intestinal bacterial overgrowth, they may have read that they have to avoid…Let’s say that they’ve read that they have to avoid many forms of carbohydrate. And they avoid all of these foods that they only then later come to realize were actually fine for them. So they actually put themselves on a restrictive diet just because they’ve heard that, “Because I have SIBO, I shouldn’t eat X.” So they avoid X. But they haven’t done—what we’ll go over in a moment—a short, simple experiment to figure out what your ideal diet is. And this can be much more accurate and much more beneficial. So if you have SIBO, again, don’t only treat based upon the diagnosis of SIBO or what your labs show.

So another example would be if someone has H. pylori, they may say, “Well, I’ve read that certain foods are good or bad for H. pylori.” And, again, the gut is actually…It’s simple, but it’s not that simple. So the best diet for someone’s gut is a diet on which someone feels the best. And what this should do is it should allow you to have the healthiest gut environment, which causes healthy bacteria and healthy fungus and a healthy balance in the ecosystem that is your gut. So the diet that’s best for the host is best for the ecosystem. Now, that best diet can be different from person to person, or for person to person.

Experimenting with Diet

diet pyramidSo I’ll put up here on the screen something that I essentially develop in my book Healthy Gut Healthy You, which walks you through a series of short experiments to determine what the best diet for you is. So at the bottom, you have the Paleo diet. If you haven’t tried the Paleo diet, a 2- to 3-week trial on the Paleo diet is definitely advisable. The Paleo diet pulls out of your diet many inflammatory foods. The most notable would be grains, dairy, soy, and processed food.

Now, that’s a good starting point. But if that doesn’t provide an adequate resolution, then you can move up the pyramid here to potentially Paleo plus low-FODMAP or the standard low-FODMAP. And these two are very similar, but there’s some subtle differences. Now, if you responded partially to Paleo by pulling out some of the grains and dairy, but not fully, then you may want to go a step further in that direction, stay Paleo, but also combine along with Paleo the low-FODMAP plus ending up with the Paleo low-FODMAP diet.

And, by the way, handouts for all these diets can be found on our website. I’ll put a link here in the show notes. And if you go to DrRuscio.com/gutbook, you can find a redirect page to take you to all these resources. So that’s the one path you may go.

Now, if you go Paleo and you don’t notice any improvement at all, then the issue for you may not be the removal or needing to undergo the removal of some of the inflammatory foods like grains and dairy, as an example. But you may do or you may benefit from reducing the highly-fermentable foods that feed gut bacteria that can cause gas and bloating and abdominal distension and pain, as is laid out by the low-FODMAP diet. So you could undergo the standard low-FODMAP diet. So each one of these can be determined with about a 2- to 3-week experiment. So start on Paleo, 2 to 3 weeks. If you’re improving, you could potentially ride that a little further to Paleo/low-FODMAP. If you notice no improvement, you could go to standard low-FODMAP. You could also go to the Paleo plus low-FODMAP. But it’s just that diet is a little bit more restrictive. So if you haven’t gotten any benefit from Paleo, there’s no need to go any further in that same direction. We may want to change our track a little bit.

“When you find a diet that works best for you, ride that wave and see…”tweet e1540485375388

And then finally if you’re not getting ideal improvement from either one of those diets, two final considerations are the autoimmune Paleo diet, which is a stricter version of Paleo, which also cuts out eggs, nightshade vegetables, and a few others. But those are the main differences. Or you could do the low-FODMAP with SCD diet, which is essentially going further in the direction of low-FODMAP. And it’s also a very restrictive diet. But it can be helpful for a 2- to 3-week experiment to see if you gain benefit from that.

Now, all of the experiments are only about 2 to 3 weeks in duration. When you find a diet that works best for you, ride that wave and see, “Okay, I’m feeling good at 3 weeks.” Ride that wave. See, at week 6 or ten, where do you plateau? Once you’ve plateaued, I’d stay there for a few weeks and then start to bring in some of the foods that you previously cut out to try to personalize the diet to you so that you can get the broadest diet possible.

fodmapUsing the low-FODMAP diet as an example, it cuts out many foods that feed bacteria, like avocado, asparagus, broccoli, onions, and garlic, which are healthy foods. They’re seemingly healthy on the surface, but may not work for some people. But not everyone has to avoid all those foods. So you’d reintroduce those one at a time to determine what works for you and what doesn’t work for you.

And most people notice that probably the majority of foods they’re okay with, but there’s a small handful they have to at least not overdo it on. So that’s how you use these restrictive diets in the short term to then get you to a broader version of the diet in the longer term.

Other Supports

Now, if diet doesn’t produce satisfactory improvement, then you may need to use other supports for your gut to get you all the way there. And that is, again, what we detail in Healthy Gut, Healthy You. It gives you a very personalized action plan, a series of steps to apply the available gut treatments in the most logical, efficient, and effective sequence. And so I’d start off with this dietary pyramid, so to speak, that’s also detailed in Healthy Gut, Healthy You. But if you don’t see adequate resolutions from that, then the book Healthy Gut, Healthy You gives you more strategies that you can employ to get you to a point where you’re feeling healthier.

So there is no ideal diet for SIBO. The question is better asked, “What is the best diet for you, your individual gut, and your gut ecosystem’s needs?” And we talked about a model you can work through for that. And, remember, if that doesn’t get you there, then you may need to undergo non-dietary steps to finally get you to a point where you’re fully improved.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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