So You Have SIBO: Here’s How Certain Foods Might Impact Your Symptoms
If you struggle with gas, bloating, abdominal pain, diarrhea, and/or a nasty combination of all four, there's a chance you may be suffering from small intestinal bacterial overgrowth (SIBO), a condition in which too much of the wrong type of bacteria inhabit your small intestine.
Not only is SIBO unpleasant—and in some cases, extremely painful—but it’s difficult to both diagnose and treat, says Tara Menon, MD, gastroenterologist, assistant professor in clinical medicine in the gastroenterology, hepatology, and nutrition division at The Ohio State University Wexner Medical Center.
Commonly confused with and misdiagnosed as irritable bowel syndrome (IBS), SIBO was only recently identified as its own, separate condition, which means it’s still surrounded by question marks.
“There’s so much that’s unknown [about SIBO],” says Sunit Srivastava, MD, specialist in internal medicine and geriatrics at Florida-based Legacy Health Medical Group, LLC. “This is a very, very important condition that we're finally starting to learn about and appropriately diagnose people, instead of just labeling them as IBS.”
As research about SIBO continues to progress, doctors are learning a particularly promising piece of information: You may be able to reduce your symptoms by following a specific diet.
To be clear, antibiotics are the first line of treatment for SIBO, says Ali Rezaie, MD, medical director, gastrointestinal motility at Cedars-Sinai, and food alone is not recommended as treatment. But avoiding certain foods may help reduce the horribleness of your symptoms, and your doctor may suggest a specific diet if your symptoms are still bothersome despite antibiotics and other forms of treatment.
Here, with the help of Menon, Srivastava, and Rezaie, we explain the relationship between SIBO and food.
FODMAP Elimination Diet
Following a specialized diet known as the FODMAP elimination diet may be a way to ID which foods (if any) are triggering your SIBO symptoms, explains Menon. (Of course you should always talk to your doctor before starting a new diet, especially if you have a diagnosed medical condition like SIBO.)
FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. In layman’s terms, this describes a certain class of carbs that aren't digested well by the small intestine. Foods that contain FODMAPs include lactose products, apples, pears, mushrooms, beans, onions, wheat, cauliflower, and many other foods that we typically classify as healthy. (To learn more about FODMAPs from a validated source, visit this resource page from King’s College London.)
The way the diet works is that SIBO sufferers eliminate all FODMAP foods for three to four weeks, explains Menon. From there, you’d introduce food items back into your diet, one at a time and over the course of several days for each food, to see if any specific item(s) triggers SIBO symptoms. If it does, you’ll know to avoid that food going forward.
That said, there are a few caveats to this approach. The first is that because the diet is very restrictive, it can increase your risk of developing nutritional deficiencies (especially Vitamin B12), which is why it’s important to do the elimination diet under the supervision of a physician. Secondly, know that while the diet may help alleviate some of your symptoms, there isn’t enough evidence (yet, at least) that shows it can prevent or manage SIBO, says Menon. On top of that, in order for the elimination diet to work, you need to be serious about avoiding all FODMAP foods in the beginning and diligent about tracking your daily eating habits and SIBO symptoms.
“It takes a lot of dedication because it's hard to, one, cut off all those foods, and then two, methodically record each item and the effect that it has on their symptoms,” explains Menon. But if your SIBO symptoms are painful enough, this diet may be worth a try.
Beyond the FODMAP elimination diet, it’s generally recommended that SIBO sufferers steer clear of probiotics. Why? The main goal in treating SIBO is to reduce the number of bacteria in your gut. Taking probiotics, on the other hand, reintroduces “bacterial strains and that may not be helpful in general in SIBO,” says Menon.
Sugar Alcohols and Artificial Sweeteners
Another general no-no for SIBO patients is reduced-calorie sweeteners, including sugar alcohols (like xylitol and erythritol) and artificial sweeteners (like sucralose, acesulfame potassium, neotame, and saccharin), says Rezaie. Consuming these sweeteners is thought to fuel the excess bacteria residing in your small intestine, which can trigger a bout of symptoms, he explains.
Lactose, a sugar found in milk and other dairy products, is a high-FODMAP food. But unlike other FODMAP foods, it’s more widely recognized as a common trigger for both SIBO and irritable bowel, explains Menon. That’s why she advises SIBO and IBS patients in general to avoid products with lactose, which include milk, cheeses, yogurt, ice cream, and other dairy products.
As for food that may potentially alleviate versus aggravate your symptoms, certain herbs, like peppermint and oregano, naturally contain antibiotics that can potentially help combat SIBO symptoms, says Rezaie. Consuming these herbs may help reduce your symptoms, though they won’t magically cure SIBO, he caveats.
The Bottom Line
While diet alone likely won’t cure your SIBO, avoiding specific foods—and eating others—could help make your life with SIBO more bearable. Be sure to chat with your doc before you make any changes to your diet, and keep them in the loop on your symptoms.