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So, you’ve been diagnosed with Small Intestinal Bacterial Overgrowth (SIBO) and have been told you need to follow a SIBO diet plan. But which diet should you choose and how long should you follow it for? Today we review the best SIBO diet plans and who they are suitable for. Plus, we look at when you should consider swapping to a different diet and why a SIBO diet alone is not enough to cure SIBO.
WHAT IS A SIBO DIET?
The purpose of a SIBO diet is to temporarily reduce the amount of fermentable carbohydrates in your diet to help improve your SIBO symptoms. By its very nature, a SIBO diet should not be followed long-term and most doctors recommend the maximum amount of time spent on a SIBO diet plan should be 6 months.
To understand how a SIBO diet plan can be useful at calming down your painful and embarrassing SIBO symptoms, let’s look at what happens when you eat food and how the bacteria in your small intestine interact with it.
HOW A SIBO DIET PLAN WORKS TO REDUCE SYMPTOMS
When you have SIBO, you have normal bacteria living in your small intestine, which should actually be living in your large intestine. The small intestine is not equipped to deal with large volumes of bacteria living there, because the role of the small intestine is to absorb the nutrients in our food through our villi and microvilli.
Conversely, the large intestine loves having trillions of bacteria there. Their job is to ferment the remaining food and to help extract the final nutrients out of it before we pass the waste as stool.
When bacteria overgrow in our small intestine (hello SIBO!), the bacteria continue doing their job, and ferment the foods we eat. The problem is, they’re doing it in the wrong location, and one of the by-products of fermentation is gas. When we have gas in the small intestine, this can cause a host of uncomfortable symptoms, such as bloating, pain, burping, flatulence, damage to the lining of the small intestine and more. You can see the full list of SIBO symptoms and what it does to us here.
By temporarily reducing or removing the foods our bacteria love to eat, such as fermentable carbohydrates, we reduce the amount of gas they produce, thus reducing the symptoms we feel, while we are simultaneously treating the overgrowth and repairing the health of our gut.
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SHOULD YOU FOLLOW A SIBO DIET?
Deciding whether to follow a SIBO diet plan or not should be a decision made between you and your practitioner. A SIBO diet can be beneficial if your symptoms are unbearable or even just uncomfortable. It can give you the opportunity to clean up your diet if you have found junk food slipping in. And, it can give you the chance to reconnect with your body, by watching and listening to your symptoms. My Food and Mood Diary is a great tool for tracking the way your body reacts to foods.
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However, if you have ever experienced disordered thinking when it comes to food, such as obsessing over what to eat or when to eat, or if you have an eating disorder, following a SIBO diet can be detrimental. Because the diets are restrictive in their nature, this can be a major trigger for someone with a history of disordered eating.
The best thing to do is be honest with your practitioner and ask for help. They might prefer to start you on a treatment protocol first, or might recommend close supervision by working with a qualified SIBO nutritionist, dietician or an eating disorder psychologist.
A SIBO diet is also intended to be a guide and not a bible. What works well for you, won’t work well for the next person. You may need to modify the diet while you work out your personal tolerance levels to certain foods. Also, as your gut heals and your microbiome changes, your tolerance to foods and quantities will change over time.
"A SIBO diet is not a static thing, instead being fluid as you heal and recover from SIBO. Working with a SIBO dietician or nutritionist can be a great investment, as they can help guide you through this process."
Rebecca Coomes
PROS AND CONS OF A SIBO DIET
There are many pros and cons of following a SIBO diet plan. Ultimately, it is your choice as to whether following a SIBO diet is right for you.
Pros
Short term relief of SIBO symptoms
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Several diets to choose from
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Can support improved health from removing junk foods
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Desired weight loss can occur in overweight patients
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A SIBO diet can be all that’s required for mild SIBO
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Can provide clear guidelines on what to eat
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Can be useful in preventing a relapse
Cons
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Diets may still need to be modified to suit your unique requirements
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Can trigger disordered eating or an eating disorder in at-risk patients
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Undesired weight loss can occur in underweight patients
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SIBO diets are only one component in your SIBO treatment
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People can become fixated on their diet, to the exclusion of everything else
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Long term SIBO diets can damage/alter the microbiome
DIETS SPECIFICALLY DESIGNED FOR SIBO
SIBO SPECIFIC FOOD GUIDE BY DR ALLISON SIEBECKER
The SIBO specific food guide was developed by leading SIBO practitioner Dr Allison Siebecker for her patients after years of clinical experience treating thousands of SIBO patients.
Combining the Low FODMAP Diet and Specific Carbohydrate Diet, Dr Siebecker uses a traffic light system to segment foods that are low (green), moderate (yellow and amber) and high (red) in fermentable carbohydrates. As this diet was designed specifically for SIBO patients, it can be beneficial for those who are currently suffering from moderate to severe symptoms. It restricts both foods and quantities of foods (eg. ¼ cup butternut squash).
However, the green, yellow/amber and red colour code system and words ‘legal’ and ‘illegal’ can be triggering for people who are disordered with food. Plus, it requires people to self-regulate and decide when to move onto higher fermentable foods. SIBO patients can get stuck in the green column for too long, causing further damage to their microbiome. Dr Siebecker hasn’t updated the diet since its inception, so doesn’t include current practises around some food groups.
SIBO BI PHASIC DIET BY DR NIRALA JACOBI
Australia's leading SIBO specialist, Dr Nirala Jacobi, took the SIBO Specific Food Guide and divided it into two phases, hence the name 'Bi-Phasic', as she wanted more structure and guidance on what to eat and when to eat it for her patients. SIBO diet Phase 1 is the most restrictive, and is used to help calm digestive symptoms. This phase is used prior to treatment commencing. Phase 2 introduces more fermentable carbohydrates and allows for greater quantities of certain foods, and is used in conjunction with antibiotic or herbal antimicrobial treatment. This is the protocol my SIBO Cookbooks are based on. This protocol works well for people who prefer structure and rules to their treatment plan, and who like to be told what to do.
One risk is that SIBO patients can stay in Phase 1 for too long, which can be damaging to the broader microbiome. The strict rules around this SIBO diet plan can also be triggering for anyone with disordered eating. It is a meat-heavy protocol, so is not suitable for vegetarians and vegans.
VEGETARIAN SIBO BI PHASIC DIET BY DR NIRALA JACOBI AND ANNE CRINER
Following many requests to develop a vegetarian version of the SIBO Bi Phasic Diet, Dr Nirala Jacobi joined forces with nutritionist Anne Criner to develop a vegetarian version of the protocol. Using soaked and sprouted grains and legumes, this diet also includes some soy products, such as tofu and tempeh to provide non-animal protein sources for vegetarians and vegans.
HISTAMINE SIBO BI PHASIC DIET BY DR NIRALA JACOBI AND HEIDI TURNER
For many people with SIBO, histamine intolerance is also part of their healthcare puzzle. Dr Nirala Jacobi and Dietician Heidi Turner joined forces to create a low histamine version of the SIBO Bi Phasic Diet. This protocol is intended to be used short-term to help calm down a histamine flare and is very restrictive.
LOW FERMENTATION DIET BY DR MARK PIMENTEL
The low fermentation diet by Dr Mark Pimentel from Cedars Sinai is a great diet for people who require flexibility and freedom with their foods. It is less structured than the previous two diets, and includes things like table sugar, white bread, potato, cereal, pasta, onions, garlic, grains and lactose-free dairy.
The premise of this SIBO diet plan is around including foods that are absorbed quickly in the small intestine, thus reducing the ability for the bacterial overgrowth to ferment the carbohydrates coming through.
This diet is good for people who need more flexibility in their diet, or whose symptoms are mild. There are also more options for vegetarians and vegans on this SIBO diet.
If you have more extreme SIBO symptoms, this diet might not be restrictive enough for you nor provide you with relief.
OTHER DIETS THAT CAN BE USED FOR SIBO
LOW FODMAP DIET BY MONASH UNIVERSITY
The Low FODMAP Diet was developed by Dr. Sue Shepherd and Dr. Gibson from Monash University as a dietary treatment for people suffering from Irritable Bowel Syndrome (IBS). It restricts certain types of carbohydrates: Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols (FODMAPs). They are found naturally in many foods and are a collection of short-chain fatty carbohydrates that are not absorbed easily in the gut, which can trigger symptoms.
While not designed specifically for SIBO, it can be used successfully by SIBO patients who have mild symptoms, as it is less restrictive than the other SIBO diet plans. It does still include starches, resistant starches and fibre though, which can be problematic and symptom-inducing for SIBO patients. It is a great diet for vegetarians and vegans, as there are plenty of options for them to eat.
Monash University have released a Low FODMAP app, which contains the most current and accurate information on the diet protocol. There is a fee to download the app, but it is worth the investment to ensure you have the most current information.
The app uses a traffic light system to show low, moderate and high levels of Fructose, Lactose, Mannitol, Sorbitol, GOS and Fructans by serving size. This is handy when determining how large a portion size needs to be, or if you need to avoid only one of these carbohydrates.
FAST TRACT DIET BY DR NORM ROBILLARD
The Fast Tract Diet was developed by Dr Robillard in response to his own experience with debilitating heartburn and acid reflux. He was suffering from very painful heartburn and reflux, living a life on proton pump inhibitors, but not having any symptom relief. So, he started to look at the fermentation potential of food and realized that there were some foods that were more fermentable and those that were less fermentable.
Today, his diet guides people on following the fermentation potential (FP) of foods, and decreasing the amount of fermentable foods they consume until they experience relief from their heartburn and acid reflux symptoms. While not developed specifically for SIBO, Dr Robillard reports that he has seen SIBO symptoms improve in some people who follow his protocol.
He has developed a handy app that is kept up to date with the latest research on the fermentation potential of a wide list of foods. You can hear more about the Fast Tract Diet in my interview with him on The Healthy Gut Podcast.
SPECIFIC CARBOHYDRATE DIET (SCD)
Originally developed for children with coeliac disease, the Specific Carbohydrate Diet was brought to the limelight in Elaine Gottschall's book Breaking the Vicious Cycle. While not specifically a SIBO diet, some patients may find symptomatic relief when following it. It can be used by patients with moderate SIBO, Inflammatory Bowel Disease, Coeliac Disease or diarrhoeal disease.
GUT AND PSYCHOLOGY SYNDROME (GAPS)
The Gut and Psychology Syndrome (GAPS) Diet was developed by Dr Natasha Campbell-McBride, after her son suffered from autism and was greatly helped by the Specific Carbohydrate Diet. The GAPS Diet has been further modified from the SCD Diet, and can be particularly helpful for autistic patients. It works in a phased approach, with the first stage restricting foods and having specific ways of cooking and eating foods. This diet has not been developed for SIBO specifically so is more beneficial for people with mild SIBO symptoms.
PALEO DIET
The paleo diet is followed by people who believe in eating as our ancestors ate during the paleolithic stage of human evolution. This dietary approach can be useful for someone at the start of their journey to health, as it removes common irritants, such as gluten and dairy, which may help alleviate SIBO symptoms. However, as it is not a SIBO-specific diet, it is unlikely to provide relief for patients with moderate to severe symptoms. Check out this great Paleo recipe website by Irena Macri, who has a heap of delicious recipes freely available.
KETOGENIC DIET
The ketogenic diet is a low carbohydrate, moderate protein and high fat way of eating. It works on counting macros each day to ensure a ratio of fats, proteins and carbs are achieved. By the very nature of removing carbohydrates from the diet, it can provide relief from symptoms for people with a more mild case of SIBO. However, a high fat diet is not suitable for people with methane-dominant SIBO, as this provides fuel for the methanogens.
GENERAL RESTRICTION DIETS
For some SIBO patients, all they need to do to eliminate or reduce their SIBO symptoms is to remove common irritants, such as gluten, dairy, lactose, egg, grains or sugar. Before removing these foods, it is wise to be checked for conditions such as Coeliac Disease to ensure your symptoms are not as a result of this bowel disease. Dr Lisa Shaver specialises in gluten sensitivity and shares on The Healthy Gut Podcast why we should test for Coeliac Disease before removing gluten from our diets.
SIBO DIET PLAN CHECKLIST
| SIBO Specific Food Guide | Y | Moderate to severe | Restrictive | Y | Minimal | 6 months |
| SIBO Bi Phasic Diet | Y | Moderate to severe | Restrictive | N | Y | 6 months |
| Vegetarian SIBO Bi Phasic Diet | Y | Moderate to severe | Restrictive | Y | N | 6 months |
| Histamine SIBO Bi Phasic Diet | Y | Severe | Restrictive | N | N | 4 weeks |
| Low Fermentation Diet | Y | Mild | Flexible | Y | N | 6 months |
| Low FODMAP Diet | N | Mild | Flexible | Y | Y | 6 months |
| Fast Tract Diet | N | Mild | Flexible | N | N | Indefinite |
| GAPS | N | Mild to moderate | Restrictive | N | Y | 6 months |
| Paleo | N | Mild | Flexible | Y | Y | Indefinite |
| Keto | N | Mild | Restrictive | Y | Y | Indefinite |
NEED HELP WITH YOUR SIBO DIET?
If you are struggling to get back on track, why not join my free Facebook SIBO Recipes Group, where you can ask other SIBOers what yummy, gut-friendly foods they're eating.
I also have a range of SIBO recipe resources for you to choose from. Check out my free SIBO diet recipes, SIBO cookbooks, SIBO meal plans, SIBO cooking classes and SIBO cooking show.
SIBO Causes and Risk Factors Guide
Need help plotting the underlying cause(s) or risk factors to you developing SIBO? Perhaps you would like a handy tool that you can share with your Practitioner? Download this simply SIBO Causes and Risk Factors Guide today.
Hello I have been on the restrictive sibo diet now for 3 weeks and just recently adopted a few meals that were semi restrictive due to lack of energy and dehydration as I’m travelling in remote Africa and the heat and lack of availability of variety of foods has impacted the cooking… but I am a bit concerned as I have not been able to pass stools for about 5-6 days – I don’t even feel the need ? Am I contstipated and should I stop the diet or just continue on the semi restricted diet?
Hi there
Passing stool daily is important. You may need to add more carbohydrates and fibre into your diet to support healthy elimination of your stool. Using a stool softener such as magnesium, and a prokinetic to support the motility of the small intestine may also be helpful.
Rebecca
Hello,
thanks for all your work it is really interesting and helpfull to read !
I am in France ans had some food disorders by the past. I ask to my practinioner to not do a diet and he told me it was impossible to cure SIBO whithout diet, what do you think about that ?
I start the diet but it is very challenging for me ..
Bonjour Daph
The diet is there to help control symptoms but it doesn’t treat the overgrowth. The treatment options include antibiotics, herbal antibiotics or the elemental diet. You can read more about treatment options here.
This was super helpful and informative. Thank you! I’ve been treating, with multiple doctors, for many years now and still have frequent relapses. I haven’t found a way to eat yet that really keeps those from happening (I have some ongoing underlying issues as well that I’m working on). This was helpful to find a plan that may work better for me!
Thank you for this concise explanation of all the diets that someone with SIBO might choose to utilize. It is very informative. Do you know of anyone who is working on a diet specifically for those who suffer from SIBO + methane (IMO)? Also, I was wondering whether your recipes have an indication as to which diets they would complement. Do they all work for the low fermentation diet?
At this point in time, there aren’t specific diets for methane or hydrogen dominant SIBO. People just use the standard SIBO diets (eg. SIBO Specific Food Guide, SIBO Bi Phasic Diet, Dr Pimentel’s Low Fermentation Diet). Nutritionist Kristy Regan specialises in helping SIBO patients with their SIBO diets.
Where can I do the SIBO testand how much it cost?
Thank you
In Australia you can do it with SIBO Test. In the US you can do it with Aerodiagnostics.
Wow– complicated.
Good Job, Rebecca.
Is there a reason SCD is omitted from your chart?
The main reason is it isn’t commonly used for SIBO patients.