SIBO Part III: Diet and Recovery
It always comes down to food. While a proper diet is important for any condition, it is especially important when it comes to SIBO. Our good bacteria are intended to live off the indigestible foods we eat such as the fiber in vegetables and the starches in grains. This is why fiber and prebiotics have become popular, instead of introducing new bacteria through probiotics and fermented foods, you are providing the bacteria in your gut with a healthy meal instead. Bacteria will jump on the chance to feed on sugars broken down from carbohydrates and processed foods, it is quick energy to them. Overtime this creates gas in the form of methane and hydrogen as a metabolic byproduct leading to typical SIBO symptoms such as bloating and diarrhea. If your diet is high in carbohydrates and sugars, you are continually feeding the bacteria in your gut, especially if you are a constant snacker or get regular sugar cravings. Once those bacteria multiply, they get hungry and need you to feed them. So, the cycle continues, sugar and carbohydrate cravings, snacking, and always feeling like you can eat dessert or that piece of bread even when you couldn't eat another bite of your dinner. This is how the good bacteria begin to overgrow in your gut leading to SIBO, as opposed to the introduction of bad bacteria. While sugar cravings can be due to other things such as blood sugar handling issues, if you have symptoms of SIBO in addition to cravings, you need to look at your gut. Even if your diet wasn’t the thing that caused the infection, it most definitely making it worse.
It is vital to correct your diet so that you stop feeding the bacteria in your gut, at least temporarily. FODMAPS is a common diet that allows you to deduce what may be exacerbating your symptoms after you eat. To simplify, you eliminate all foods that may potentially be feeding gut bacteria, as these food groups are typically indigestible or produce sugars contributing to the problem. FODMAPS stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polys. Typically these food groups would not pose a problem, as they should end up in the large intestine to be consumed by our bacteria. But when our bacteria is now present in the small intestine, where it should not be, this consumption and fermentation will occur in the small intestine and cause your SIBO symptoms. Common foods that are found on this list include grains (such as wheat), lentils, beans, most fruits, dairy (lactose), sugar (due to sucrose), probiotics or fermented foods, few vegetables and nuts, and sweeteners such as sorbitol, xylitol, and agave. Once you have been on this diet for about 2-4 weeks, monitor your symptoms to see if you feel any better. If your symptoms have gone away, you know that something you were consuming previously was causing gastric distress and feeding the infection. Slowly you can start to reintroduce one food group at a time and determine which one brings on the return of your previous symptoms. This diet is great to maintain while healing from SIBO, but after treatment may not have to be resumed depending on the person.
The diet that I recommend to patients is to eat Paleo. This is a good starting point for most people, and they can adjust what they eat to make it as strict or loose as they want. The basics stay the same though, a diet high in protein and fats, reduced carbs, and big on vegetables. I usually advise patients either omit or greatly reduce fruits as most people with SIBO do not handle them well anyway. I recommend patients stay on grains, as we need carbohydrates, especially for brain power, but removing gluten (wheat) from the diet is beneficial. Cooked vegetables are great for the gut as they are easier on digestion, especially when digestion is compromised in most people today. The loss in minerals is minimal compared to the bioavailability of cooked vegetables – the best way to cook them are steaming or pressure cooking until soft but not mushy. Lightly baking or sauteing is also acceptable. A diet rich in a variety of cooked vegetables is great for the gut as it feeds the bacteria in a healthy way, not through sugars, while also providing great nutrition.
While treatment for SIBO includes cleaning up the diet, it also consists of fixing the thing that caused SIBO in the first place. As discussed, the reasons for this can include a poor diet or introduction of bad bacteria in the gut, but it can also include a food allergy or an improper medication or supplement. It is possible that a food allergy or medication is screwing up the gut so bad that it leads to an altered environment causing an overgrowth of good bacteria. Most commonly it is the former, but everyone is different and what causes SIBO for one person may not be the cause for another person, even when their symptoms are identical. Typically, specific herbs with antimicrobial properties are given that assist the body in clearing an infection. We use many herbs in the office that have specific properties, but there is no herb or protocol that works for everyone. Each patient is given a specific herb or supplement that works for them based off of muscle testing, so it is very specific, there is no shotgun approach hoping that something works. Common herbs include astragalus, artemisia, berberine, and others. Supplements that may help heal the gut from an infection include glutamine and St. John's wort. Reach out to a practitioner in your area to start treating your SIBO.