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What Foods Should Be Avoided With SIBO?

Written by Dr. Michael Ruscio, DC on October 16, 2020

Written by Dr. Michael Ruscio, DC on October 16, 2020 — Reviewed by Heidi Turner

By focusing on gut health, most foods don’t have to be avoided forever

SIBO and Your Diet|
Diet Options|
Foods to Avoid|
Foods You Can Eat|
Tips|
Diet and SIBO Treatment|
SIBO Treatment Benefits|
Do You Know Your Food Triggers?|

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Small Intestinal Bacterial Overgrowth and Your Diet

If you have tested positive for SIBO by taking a breath test, it’s important to understand what foods may aggravate your symptoms and what foods you can safely eat. The right diet can help you to manage unpleasant SIBO symptoms like bloating, abdominal pain, diarrhea, and constipation. 1 2 3 4. Diet is also an important part of a SIBO treatment plan.

Since SIBO is a bacterial overgrowth of the small intestine, dietary changes are meant to reduce bacterial populations in the digestive system. This is done by reducing the foods that feed gut bacteria.

While there are several options for a SIBO diet, it’s important to understand that the bacterial makeup of your digestive tract is unique. The goal of any SIBO diet is to figure out which foods trigger your symptoms and to develop a dietary approach that works for you.

Some SIBO patients believe they need to follow restrictive diet guidelines forever and live in fear of eating the wrong foods. This is a big mistake. Instead, use the guidelines for what to eat and not eat as a starting point only. Be strict about eliminating foods for the first 2-4 weeks and monitor your symptoms. Once your symptoms have improved, you can try some reintroductions.

Ultimately, you want to be able to eat as broad a diet as possible while still managing your symptoms.

SIBO Diet Options

When bacteria consume carbohydrate foods in your digestive tract, they produce gases as a byproduct. This process is known as fermentation. The best diets for SIBO are designed to feed you while starving your gut bacteria, thereby keeping fermentation levels low. This is done by lowering the fermentable carbohydrates in your diet.

There are three diets that research has shown to be helpful for gut conditions:

Low FODMAP diet 5
Specific Carbohydrate Diet (SCD) 6
Elemental diet 7

The GAPS diet and the Fast Tract diets follow similar principles, but there is no research yet to support their use.

Each of these diets is an elimination diet designed to remove fermentable foods that may trigger symptoms. The low FODMAP diet is the least restrictive of the diets. The most restrictive is the elemental diet, which replaces all normal foods with a liquid meal replacement. However, the elemental diet is the most short-term option, with a 2–4 day gut reset being enough for some to quell symptoms.

While it’s possible to get detailed guides and apps for each of these diets, let’s start with a simple overview of the types of foods you should consider restricting with SIBO.

What Foods Should Be Avoided With SIBO?

I often recommend the low FODMAP diet to patients with digestive conditions because it is supported by research 8 9 10 11 12 and is less restrictive than some other dietary choices.

FODMAP is an acronym for these categories of foods: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These categories are all high in fermentable carbohydrates and are the most likely to cause digestive symptoms.

Some examples of high FODMAP foods include:

Lentils and beans
Wheat and rye
Natural and artificial sweeteners, including agave syrup, xylitol, sorbitol, and high fructose corn syrup
Dairy products like cottage cheese or ice cream
Certain vegetables, including onions, garlic, artichokes, cabbage, and cauliflower
Certain fruits, especially apples, pears, and stone fruits (peaches, plums, apricots)
Dried fruit and fruit juices
Prebiotic fiber (supplements intended to feed beneficial bacteria)

For a complete FODMAP food list, read How To Use the Low FODMAP Diet to Improve IBS Symptoms.

It’s important to remember that a low FODMAP diet isn’t meant to be forever. In fact, it’s often effective in as little as 30 days. By quelling SIBO with an elimination diet like low FODMAP, foods can often be reintroduced later with little or no symptoms, especially when food is reintroduced in moderation. A diet is meant to support your health and living well, so it’s about getting to a place with as few symptoms and restrictions as possible.

What Foods Are Safe To Eat With SIBO

Perhaps more important than what you can’t eat is what you can eat. Here is a list of low-FODMAP foods that you should be able to eat freely:

Meat, poultry, fish, seafood, and eggs (without standard gravies, breading, or marinades)
Rice, oats, corn meal, quinoa
Many types of vegetables, including green beans, zucchini, tomatoes, lettuce, and cucumbers
Most starchy vegetables, including potatoes, yams, parsnip, and taro root
Many types of fruits, including blueberries, strawberries, grapes, cantaloupe, and oranges
Lactose-free dairy products

It’s a good idea to eat fresh, whole foods with a SIBO diet, as this eliminates the many problematic ingredients found in processed foods.

Tips for Successfully Navigating SIBO Dietary Changes

Keep it simple to start. Choose a few basic recipes and use them to develop a simple food list. Be willing to repeat meals a lot at first. Don’t be tempted to try fancy recipes right away. Once you are comfortable with your dietary changes and know which foods trigger your symptoms, explore new recipes and expand your menu options.

Be prepared. Stock your pantry with ingredients you need for your basic menu plan and remove all high FODMAPs foods that may be tempting for you. Make a few big batches of staple low-FODMAP meals and load up your freezer.

Be as strict as possible about the diet for 2-4 weeks. This will help you to resolve symptoms quickly and give you a good baseline for food reintroductions.

Don’t stay on any diet too long if it’s not working. If you don’t notice any benefit after a few weeks, consider a different approach.

Reintroduce foods slowly and one at a time. The best food to reintroduce first is the one you missed the most. Pay attention to your symptoms for at least two days after the reintroduction. If a reintroduction goes well, you can follow with another after a few days. If your symptoms flare up as a result of a food reintroduction, wait until your symptoms are under control before you introduce an additional food.

The purpose of any elimination diet is to reduce symptoms and identify your trigger foods. Over time, you should be able to expand your diet while avoiding the foods that you know cause problems.

Diet as a Part of Your SIBO Treatment Plan

When it comes to treatment of SIBO, quick fixes don’t always work. Diet is an important part of an overall SIBO treatment plan and can help you manage SIBO symptoms.

A combination of treatments that address overall gut health is the best approach for long-term success. This may include probiotics, 13 fasting periods, 14, digestive supports 15, and herbal antimicrobials 16.

Probiotics can be very effective for treating SIBO, improving both symptoms and lab values 17 18 19 20. A low FODMAP diet combined with high-quality probiotics can reduce symptoms in a matter of weeks for many patients.

You have a unique intestinal microbiome and the best combination of SIBO treatments for you may not be the same for someone else. Learning what works for you is a process of personal experimentation.

The Benefits of Treating SIBO

If you have been struggling with digestive symptoms, getting them under control is a big win. Plus, by treating SIBO, you may experience beneficial effects on other health conditions.

Research shows a significant connection between SIBO and irritable bowel syndrome (IBS), with more than one-third of IBS patients testing positive for SIBO. 21 Both conditions are the result of an unbalanced gut microbiome and benefit from similar treatment approaches.

Research also shows when SIBO treatments are successful, a number of non-digestive symptoms may also resolve. SIBO treatments have been shown to improve:

Rosacea 22
Restless leg syndrome 23 24
Blood sugar, cholesterol, and potentially weight 25 26 27
Depression (improved by probiotics) 28 29 30
Rheumatoid arthritis 31
Non-responsive Celiac disease 32

Research shows that SIBO is associated with other health conditions, including: hypothyroid 33, coronary artery disease 34, diabetes 35, chronic kidney disease 36, chronic pancreatitis 37, and Parkinson’s disease 38. We still need more research to identify if SIBO treatments can help to resolve these conditions.

Do You Know Your Food Triggers?

Knowing what foods trigger your symptoms is a powerful tool for restoring your good health.

Don’t be reluctant to try an elimination diet. With a bit of planning and preparation, following a low FODMAP diet doesn’t need to be difficult. Keep in mind you only need to follow the strictest version of the diet for a few weeks before you can start reintroducing foods.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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