What is the Best Diet for SIBO

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.

[Continue reading below]

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

So 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…”

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

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

20 thoughts on “What is the Best Diet for SIBO

  1. I am so grateful to have your book and weekly newsletters as a resource. The information has been so valuable that I quickly passed along your website link and book title to a number of friends, as well as my healthcare providers!

    After many months of inconclusive/irregular lab tests, bloating, nausea, appetite loss (something that NEVER was an issue for me) and lack of energy, I had breath testing conducted and a diagnosis of fructose malabsorption and SIBO. I have since made great progress and my diet has become more manageable/closer to “normal.” I am maintaining a healthy body weight and energy level, with far less gas and bloating (typically only triggered when I make dietary changes). Now I have you/your book with a wealth of information to keep me on a healthy path! (If only, I had that info a year ago when this started.)

    Tho my history has many factors which could have led to this diagnosis, I am wondering if this piece makes any sense? Lab results were the first indicator that something was amiss, followed by the symptoms previously described. A few weeks later, it was discovered that bacteria in an old root canal tooth had caused bone loss in my jaw. The tooth was extracted two weeks later.

    My symptoms improved somewhat for a short time after the extraction, however things significantly deteriorated over time. After months of ineffective dietary adjustments, I received the malabsorption and SIBO diagnosis. That led to a very restrictive diet, a round of Xifaxan and relief from my symptoms.,

    When looking for a cause…It seems to me that the tooth bacteria had likely invaded my entire system by the time bone loss was an issue, and that would have triggered bacterial overload in my gut! Just curious if you have heard of something like this?

    Thank you, thank you, thank you for the wealth of knowledge you have provided. I particularly like the setup of your book…having key points listed at the end of every chapter makes it an efficient reference.

    1. Hi Christine,
      My pleasure, glad you like the book. Yes! Investigate further into your oral health! This is the first section of the gut. Oral dysbiosis is outside my area of specialty, but we have had two dentists on the podcast to date; Mark Burhenne and Steven Lin. They might be able to point you in the right direction.

  2. I am so grateful to have your book and weekly newsletters as a resource. The information has been so valuable that I quickly passed along your website link and book title to a number of friends, as well as my healthcare providers!

    After many months of inconclusive/irregular lab tests, bloating, nausea, appetite loss (something that NEVER was an issue for me) and lack of energy, I had breath testing conducted and a diagnosis of fructose malabsorption and SIBO. I have since made great progress and my diet has become more manageable/closer to “normal.” I am maintaining a healthy body weight and energy level, with far less gas and bloating (typically only triggered when I make dietary changes). Now I have you/your book with a wealth of information to keep me on a healthy path! (If only, I had that info a year ago when this started.)

    Tho my history has many factors which could have led to this diagnosis, I am wondering if this piece makes any sense? Lab results were the first indicator that something was amiss, followed by the symptoms previously described. A few weeks later, it was discovered that bacteria in an old root canal tooth had caused bone loss in my jaw. The tooth was extracted two weeks later.

    My symptoms improved somewhat for a short time after the extraction, however things significantly deteriorated over time. After months of ineffective dietary adjustments, I received the malabsorption and SIBO diagnosis. That led to a very restrictive diet, a round of Xifaxan and relief from my symptoms.,

    When looking for a cause…It seems to me that the tooth bacteria had likely invaded my entire system by the time bone loss was an issue, and that would have triggered bacterial overload in my gut! Just curious if you have heard of something like this?

    Thank you, thank you, thank you for the wealth of knowledge you have provided. I particularly like the setup of your book…having key points listed at the end of every chapter makes it an efficient reference.

    1. Hi Christine,
      My pleasure, glad you like the book. Yes! Investigate further into your oral health! This is the first section of the gut. Oral dysbiosis is outside my area of specialty, but we have had two dentists on the podcast to date; Mark Burhenne and Steven Lin. They might be able to point you in the right direction.

  3. Good for you, Christine! I too had a badly infected root canal and jaw bone (undetected for many years by my conventional dentist). In my case it was the functional cause of three heart attacks, the last one nearly fatal. It was on my first visit to a holistic dentist, who knew nothing about my health history, when he told me about the infection and said, “You had better have that dead tooth removed and the infection in the jaw bone above it cleaned out before it causes you to have a heart attack.” My old dentist was fully aware of all three of my heart attacks, but because of his traditional ADA training he never even thought to check for an infected root canal as the cause of them. The ADA is still in total denial about the connection. And of course my cardiologists never thought to ask, “Greg, have you ever had a root canal?” They were, by dint of their training, as clueless as my old dentist.

    Anyway, I just hope that you had that old root canal removed by a holistic dentist who was trained to do it correctly. Most conventional dentists do not do it right and the end result of doing the job wrong can be to produce a secondary infection called a cavitation. If that happened to you it could be the reason why your symptoms eventually returned. It might be a good idea to get that possibility checked out, preferably by a properly trained holistic dentist.

    1. Thanks for your feedback. Fortunately, had the support of a great oral surgeon and chiropractor, so am moving forward. Followup CT scan and kinesiology has confirmed that bacteria issue is resolved. Thanks for validating what I have learned.

  4. Like the pyramid. But for those of us with a positive CdtB antibody test and relapsing SIBO the top of the pyramid might actually be “Low Fodmap/AIP”

    Chris C.

  5. Like the pyramid. But for those of us with a positive CdtB antibody test and relapsing SIBO the top of the pyramid might actually be “Low Fodmap/AIP”

    Chris C.

  6. I am sure I have SIBO. This started almost 2 yrs ago. I took a round of antibiotics for flu and shortly thereafter began with GI issues. I already have IBS with constipation. I have Hashimoto, Fibromyalgia, Psoriasis, PsA, Anxiety, Depression that comes and goes. Now I find I have a very low Vit D level 12 (30-100). I can have diar. for an entire day and then it goes back to constipation, gas, abdominal distention. I also have GERD and LPR. So I was taking PPI and Acid Reducer. That sure did not make SIBO better. I was taking VSL 3 and realized that the 2 bacterium you should not have in a Probiotic was loaded with it as the main types in VSL. I have histamine intolerance as well. Headaches, sinus issues, and the list goes on. I have had many labs but the doctor would not order the breath test. He did not even know what SIBO was. But he did ok to have an Organic Acid test and that was normal. I have gained 20 lbs or more in a yr. I went from running and being 122 to being overweight, not active and feeling horrible. I have to be my own doctor. He is useless. I had to beg for a Vit D level for 9 mo. knowing I was probably deficient and I was. This stomach issue is really taking over my life. I wake up with a flat stomach and by mid day I can feel it expanding until bedtime it goes down and I feel fine. Then the cycle starts over again. I belch, have gas , reflux and the LPR just makes it worse cause I already have sinus issues and the acid just goes up into my sinuses. I feel hopeless. I have tried all the natural protocols that they say to do. I have every symptom of SIBO. My stomach just gurgles and moves and makes noises and although I do not have serious pain it is uncomfortable when it bloats out and gets distended. I do not want to do anything at that point. I feel the motility in my stomach is so slow and having low stomach acid from taking the PPI and acid reducers just makes it worse. Where do I go from here? Does this sound like SIBO ? It sure does to me. I wish the doctor had knowledge of what it was so he could help me.

    1. Hi Linda,
      This could be SIBO, but that is actually good new because SIBO can be improved with diet, probiotics and herbs. Healthy Gut, Healthy You walks you through a step-by-step treatment guide. You should check in with a local doctor to be on the safe side, but the Healthy Gut, Healthy You protocol can be applied as a do-it-yourself protocol.

  7. Great info,

    I had a total colectomy, no cecum left. literally, 6 inches of colon attached to small bowel in 2009. took on the AIP Paleo diet was symptom-free until Dec 2018. I had a small bowel blockage that after hospitalization and liquids cleared. Only too continued to keep getting blocked and unblocked for 3 months. Doctors wouldn’t touch me said I wasn’t sick enough CTs were unremarkable. Because of my new insurance plan I could not see my regular surgeon. This would have been addressed right away. So surgery finally happened after 3 month of chronic blockages and liquid diets, to find that a loop of small bowel had slid into a pocket of my omentum and was swollen and pinched on 2 sides. Surgeon released it never treated me for inflamed swollen small bowels until I went to a gastro 6 months later to find that I had Bad Sibo infection. After several treatments with xifaxxan , herbs. AIP diets and all diets here you discuss and repeat. I still can’t seem to get any healing. It is this cycle that keeps repeating. This has gone on for a year. I am thinking it could be the loop of bowel that was left to heal and it has not healed. Food seems to get stuck in the same area and I have to manually push it through. I feel this is causing me not to heal from the SIBO. I am very frustrated and dont feel well most of the time. Any advice?

    1. Hi Karen,

      I’m sorry you’re dealing with this, it can be frustrating to feel like you’re not getting the help you need from your doctor. You may want to consider doing a round of the elemental diet. This liquid-only diet will hopefully starve any SIBO you have while making sure not to contribute to any blockages. Dr Ruscio lays out a protocol in his book “Healthy Gut, Healthy You” that you might want to check out (you can find it here: https://www.drruscio.com/getgutbook). You may also want to look into visceral manipulation. We have a podcast on that coming soon, so stay tuned. Good luck!

  8. Great info,

    I had a total colectomy, no cecum left. literally, 6 inches of colon attached to small bowel in 2009. took on the AIP Paleo diet was symptom-free until Dec 2018. I had a small bowel blockage that after hospitalization and liquids cleared. Only too continued to keep getting blocked and unblocked for 3 months. Doctors wouldn’t touch me said I wasn’t sick enough CTs were unremarkable. Because of my new insurance plan I could not see my regular surgeon. This would have been addressed right away. So surgery finally happened after 3 month of chronic blockages and liquid diets, to find that a loop of small bowel had slid into a pocket of my omentum and was swollen and pinched on 2 sides. Surgeon released it never treated me for inflamed swollen small bowels until I went to a gastro 6 months later to find that I had Bad Sibo infection. After several treatments with xifaxxan , herbs. AIP diets and all diets here you discuss and repeat. I still can’t seem to get any healing. It is this cycle that keeps repeating. This has gone on for a year. I am thinking it could be the loop of bowel that was left to heal and it has not healed. Food seems to get stuck in the same area and I have to manually push it through. I feel this is causing me not to heal from the SIBO. I am very frustrated and dont feel well most of the time. Any advice?

    1. Hi Karen,

      I’m sorry you’re dealing with this, it can be frustrating to feel like you’re not getting the help you need from your doctor. You may want to consider doing a round of the elemental diet. This liquid-only diet will hopefully starve any SIBO you have while making sure not to contribute to any blockages. Dr Ruscio lays out a protocol in his book “Healthy Gut, Healthy You” that you might want to check out (you can find it here: https://www.drruscio.com/getgutbook). You may also want to look into visceral manipulation. We have a podcast on that coming soon, so stay tuned. Good luck!

  9. I am sure I have SIBO. This started almost 2 yrs ago. I took a round of antibiotics for flu and shortly thereafter began with GI issues. I already have IBS with constipation. I have Hashimoto, Fibromyalgia, Psoriasis, PsA, Anxiety, Depression that comes and goes. Now I find I have a very low Vit D level 12 (30-100). I can have diar. for an entire day and then it goes back to constipation, gas, abdominal distention. I also have GERD and LPR. So I was taking PPI and Acid Reducer. That sure did not make SIBO better. I was taking VSL 3 and realized that the 2 bacterium you should not have in a Probiotic was loaded with it as the main types in VSL. I have histamine intolerance as well. Headaches, sinus issues, and the list goes on. I have had many labs but the doctor would not order the breath test. He did not even know what SIBO was. But he did ok to have an Organic Acid test and that was normal. I have gained 20 lbs or more in a yr. I went from running and being 122 to being overweight, not active and feeling horrible. I have to be my own doctor. He is useless. I had to beg for a Vit D level for 9 mo. knowing I was probably deficient and I was. This stomach issue is really taking over my life. I wake up with a flat stomach and by mid day I can feel it expanding until bedtime it goes down and I feel fine. Then the cycle starts over again. I belch, have gas , reflux and the LPR just makes it worse cause I already have sinus issues and the acid just goes up into my sinuses. I feel hopeless. I have tried all the natural protocols that they say to do. I have every symptom of SIBO. My stomach just gurgles and moves and makes noises and although I do not have serious pain it is uncomfortable when it bloats out and gets distended. I do not want to do anything at that point. I feel the motility in my stomach is so slow and having low stomach acid from taking the PPI and acid reducers just makes it worse. Where do I go from here? Does this sound like SIBO ? It sure does to me. I wish the doctor had knowledge of what it was so he could help me.

    1. Hi Linda,
      This could be SIBO, but that is actually good new because SIBO can be improved with diet, probiotics and herbs. Healthy Gut, Healthy You walks you through a step-by-step treatment guide. You should check in with a local doctor to be on the safe side, but the Healthy Gut, Healthy You protocol can be applied as a do-it-yourself protocol.

  10. Good for you, Christine! I too had a badly infected root canal and jaw bone (undetected for many years by my conventional dentist). In my case it was the functional cause of three heart attacks, the last one nearly fatal. It was on my first visit to a holistic dentist, who knew nothing about my health history, when he told me about the infection and said, “You had better have that dead tooth removed and the infection in the jaw bone above it cleaned out before it causes you to have a heart attack.” My old dentist was fully aware of all three of my heart attacks, but because of his traditional ADA training he never even thought to check for an infected root canal as the cause of them. The ADA is still in total denial about the connection. And of course my cardiologists never thought to ask, “Greg, have you ever had a root canal?” They were, by dint of their training, as clueless as my old dentist.

    Anyway, I just hope that you had that old root canal removed by a holistic dentist who was trained to do it correctly. Most conventional dentists do not do it right and the end result of doing the job wrong can be to produce a secondary infection called a cavitation. If that happened to you it could be the reason why your symptoms eventually returned. It might be a good idea to get that possibility checked out, preferably by a properly trained holistic dentist.

    1. Thanks for your feedback. Fortunately, had the support of a great oral surgeon and chiropractor, so am moving forward. Followup CT scan and kinesiology has confirmed that bacteria issue is resolved. Thanks for validating what I have learned.

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