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The Best Diet for SIBO + Why Diet Alone Won’t Fix It

What is SIBO, how do you get tested, and how do you treat it? What’s the best diet for SIBO? Get answers to all these and more, plus how to book an appointment for one on one help from a registered dietitian. 

The Best Diet for SIBO, and why diet alone won't fix it. Plus, how to test for SIBO, the latest in natural treatments, and what to do to keep it from coming back! | Back To The Book Nutrition

Note from Dena: I’m excited to share this guest post on such an important topic. It was written by Marla Ramos, Dietetic Intern, as part of a new research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.  

Bloating. Gas. Abdominal pain. Belching. Diarrhea. Constipation.

We all suffer from these from time to time, but if you’re one of many people who are experiencing one or more of these symptoms on a weekly – or even daily – basis, you may have SIBO. In fact, if you’ve been diagnosed with Irritable Bowel Syndrome (IBS), you’re almost guaranteed to have SIBO (Source). 

What is SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth, and it can occur when either too many or the wrong type of bacteria multiply in the small intestine. In fact, an official medical diagnosis of SIBO defines it as an infection where 1,000 times more bacteria than normal are present in the small intestine. (Source) 

What Causes SIBO?

The root causes of SIBO are still being understood, but it seems as though risk factors are similar to those for other gut disorders.

Contributors to SIBO

  • Inflammation
  • Poor immune function
  • Insufficient stomach acid
  • Dysmotility (slowed passage of digested food through the small intestines). (Source)  

These factors can lead to an overgrowth of bacteria in the small intestine in one of two ways:

  1. Small intestinal bacteria “feed” on food matter that doesn’t move through the small intestine as quickly as it should, allowing the bacteria to proliferate. 
  2. Bacteria from the large intestine travel to the small intestine and proliferate (more common than #1).

This may not sound like a big deal. But it can wreak havoc on the GI system and, if it isn’t treated, can lead to other health complications.

Health Complications Related to SIBO

  • Osteoporosis (due to vitamin D deficiency)
  • Neuropathy (due to vitamin E deficiency)
  • Night blindness (due to vitamin A deficiency)
  • Anemia (due to iron and vitamin B12 deficiency)
  • Weight loss (due to malabsorption)
  • Irritable Bowel Syndrome (78% have SIBO)
  • Rosacea (46% have SIBO)
  • Fibromyalgia (100% have SIBO)
  • Obesity (41% have SIBO)

How Do I Know if I Have SIBO?

If you have any of the following symptoms and are not getting better with treatment or diet changes, consider testing for SIBO.

  • Bloating
  • Excessive Gas
  • Abdominal Pain
  • Excessive Belching
  • Diarrhea
  • Constipation
  • Fatigue
  • Depression
  • Rash
  • Eczema

How to Test for SIBO

Currently, there is no perfect test for SIBO. Scientists are hard at work exploring new methods of testing. Until then, the most common methods of testing for SIBO measure levels of methane and hydrogen in the breath after drinking a liquid solution of either lactulose or glucose.

These tests are simple, can be ordered online, and can sometimes be performed in your own home.

  • 3-hour Lactulose breath test – at-home or in-office test, must be ordered by a doctor, dietitian, or other licensed practitioner
  • Glucose breath test – at-home or in-office test, can be ordered by patient, but less accurate than lactulose test
  • Stool testing using PCR (DNA) technology – at home stool test to identify common SIBO organisms as well as other pathogens, overgrowths, yeasts/fungi, and markers for leaky gut and glucose intolerance (Note from Dena: this is my preferred test since it gives a much more comprehensive look at what’s going on in the gut)

Note from Dena:

If you don’t already have a practitioner who can order these tests and discuss the results with you, I’d be happy to help! Contact me here for details and pricing.

SIBO Test Results – Methane vs. Hydrogen Dominance

This can get a little technical, but not all SIBO is the same – it can be divided into two main categories, depending on breath test results: 

  1. Methane-Predominant SIBO – Caused by bacteria that produce primarily methane, giving rise to constipation, which is why this form is sometimes called SIBO-C.
  1. Hydrogren-Predominant SIBO – Caused by bacteria that produce hydrogen, which is associated with diarrhea or loose stools. Hence, this form is sometimes referred to as SIBO-D.

There is actually a third type of SIBO – hydrogen sulfide SIBO – which has more recently been identified and is currently only able to be tested for in the research setting. 

Note: This post contains affiliate links. By making purchases through these links, you pay the same amount for products, but a small portion of the sale will be sent my way to help with blog expenses. Thanks!

If you think may have SIBO, you NEED this post - how to get tested, get treated, get on the best diet, and get on with your life! | Back To The Book Nutrition

I Have SIBO – How Do I Treat It?

There are a few different approaches to addressing SIBO, and the latest research indicates that a combination of medical + nutritional therapies are most effective.

But here’s where it gets interesting.

According to Dr. Mark Pimentel, MD, Director of the Gut Motility Program at Cedar-Sinai Medical Center and leading expert in SIBO, well-fed bacteria are easier to kill with antibiotics (both conventional and natural) than those that have first undergone a period of diet changes.

Because of this, some experts recommended basic diet changes (reducing sugars, refined grains, and dairy) rather than overly restrictive diets that were previously recommended for SIBO. The entire process of medical + nutritional therapy can take 6-12 months. (Source) It’s important to consult with qualified providers about which of the following medical treatments and dietary approaches might be best for you. 

Conventional Medical Treatments for SIBO:

Antibiotics, two in particular, have shown to have great results in the treatment of SIBO.

  • Rifaximin (brand name Xifaxan) for Hydrogen-predominant SIBO (Source)
  • Rifaximin + Neomycin combination for Methane-predominant SIBO (Source)

Prokinetic agents (such as Metoclopramide) are often given alongside antibiotics to help move things through the gut more quickly and reduce risk of feeding the bacteria. 

Natural Medical Therapies for SIBO:

If you prefer not to take prescription antibiotics, a recent study showed herbal therapies may work just as well, and usually with fewer side effects.

  • Allicin
  • Berberine
  • Oregano
  • Olive leaf
  • Neem
  • Cinnamon
  • Cat’s Claw
  • Atrantil (blend of several botanicals) – Works best on methane-predominant SIBO.

(Sources: 1, 2, 3)

Prebiotics and Probiotics for SIBO:

Recent studies have shown that prebiotics and probiotics may be an effective alternative to antibiotics in treating SIBO or, at the very least, can improve outcomes when added to antibiotics. (Source) Download your free Ultimate Guide to Probiotic Supplements here!

Neurological Therapy for SIBO:

Functional neurologist Dr. Datis Kharrazian suggests that many individuals with SIBO have a problem with their brain-to-gut connection, which allows the overgrowth to occur in the first place. He maintains that many of his patients with SIBO benefit from simple, at home therapies (such as aggressive gargling, inducing a gag reflex, etc.) that can be done several times daily to re-train the brain-to-gut connection. These therapies essentially repair the motility problem for which conventional doctors might prescribe prokinetics. Here is an excellent interview with Dr. Kharrazian in which he discusses a number of gut-brain issues. The entire hour-long interview is fascinating but, if you want to skip straight to the at home therapies and discussion of SIBO, they’re around minute 12 and 18, respectively. 

Best Diet for SIBO:  

There are several different diets recommended for the treatment of SIBO. Each of these uses similar principles and show success relieving symptoms. But, such restrictive diets can be difficult to maintain and, as mentioned above, may do more harm than good. It’s best to work with a registered dietitian to help determine whether a particular “SIBO diet” is best for you, and to help you make personalized adjustments along the way for the best results. (Sources: 1, 2)

  • Low FODMAPs Diet
  • Specific Carbohydrate Diet (SCD)
  • Gut and Psychology Syndrome Diet (GAPS)
  • SIBO Specific Diet
  • Elemental Diet
  • Cedars-Sinai Diet (Less restrictive and developed by Dr. Pimentel, the pioneer of the SIBO-IBS connection)

More info on each of these SIBO diets can be found here.

Will My SIBO Come Back?

Unfortunately, our understanding of SIBO and how to effectively treat it is still evolving. Even with effective treatment, SIBO has a recurrence rate of 44%. (Source)

To reduce the risk of recurrence, it’s important to also treat the underlying causes listed above, such as inflammation, poor immune function, insufficient stomach acid, and dysmotility.

Steps to Reduce Risk of SIBO Recurrence

  1. Eat a nutrient dense, SIBO-preventive diet, such Pimentel’s SIBO Diet or another diet listed above.
  2. Minimize intake of inflammatory foods like processed vegetable oils, refined foods, and added sugars.
  3. Manage stress.
  4. Get adequate sleep.
  5. Exercise regularly, but not excessively.
  6. Avoid unnecessary antibiotics and other medications that disrupt gut flora.
  7. Consider regular probiotic use. 

Get Help with SIBO Today!

Want help with  your SIBO, IBS, or other gut health issues? Schedule a free, 10 minute Discovery call and let’s talk details!

Schedule your free, 10 minute call now!

About the author: Marla Ramos is a Dietetic Intern, with a B.S. in Human Nutrition and Foods from the University of Houston. She has a particular interest in gut health due to her own personal experience with Crohn’s Disease.

 

 

Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here. 

Holistic Nutrition Coaching with Dena Norton, MS, RD, LD can transform your health from the inside out!

Reader Interactions

Comments

  5. Raia says

    February 28, 2017 at 1:53 pm

    I’ve heard of SIBO before, but never really understood what it is, or what to do about it. Thank you for providing such a comprehensive and helpful resource!

    Reply

    • Dena @ Back To The Book Nutrition says

      March 9, 2018 at 3:49 pm

      Hi Evelin,
      That’s a great question. Yes, historically, Flagyl (Metronidizole) has been a common choice. However, it seems to be less effective than the medications listed in the article. There was a 2016 study published in the Brittish Medical Journal that confirmed Rifaxamin was was significantly better (80% effective) than Metronidizole (50% effective) at treating SIBO. Dr. Pimentel, a leading expert in SIBO, prefers Rifaximin alone or in combination with Neomycin, though he admits he will sometimes substitute Metronidizole for the Neomycin. I use some of the natural herbal products mentioned in the post with my clients and have seen good results with those too. I hope that clarifies a bit – let me know if you have other questions!

      Reply

  9. Bernadette says

    July 19, 2018 at 8:35 am

    I’ve done two rounds of rifaximin and neomycin and only the methane levels went down. My hydrogen levels doubled. My doctor is now treating with herbals. Why didn’t my hydrogen levels respond to the rifaximin if it’s supposed to be so effective? It’s worrisome to me.

    Thank you.

    Reply

    • Dena @ Back To The Book Nutrition says

      July 19, 2018 at 9:54 am

      Hi Bernadette,
      I’m sorry to hear you’ve had a tough time getting over SIBO. It’s important to remember that no treatment – herbal or prescription – is 100% effective. That said, there are some things to consider: (1) You may need a higher dose and/or longer coarse of treatment than usual if you have a particularly severe case; (2) I don’t typically advocate for a super strict SIBO diet. But, in severe cases, reducing intake of FODMAPS may be a good idea just to reduce the amount of “food” available to the bacteria; (3) You can also talk to your doctor about whether motility agents and/or digestive aids like Betain HCl could be helpful to address any slow motility/poor digestion of foods that often contribute to SIBO and may be keeping you from making progress.

      I hope that helps – hang in there!

      Reply

  10. Gladys Parker says

    November 10, 2018 at 3:30 pm

    Having read your entire article I realize I just might have SIBO and neither I or my Dr are aware of it. I have many of the symptoms! I will be going to my Dr next week anyway and will ask him about it.

    Reply

  11. Ruth says

    November 10, 2018 at 4:52 pm

    I’d actually never heard of SIBO before reading this post! Really interesting information and I have actually had phases where I’ve had a few of these symptoms… maybe I’ve discovered what it is.

    Reply

  13. Melanie Frost says

    November 11, 2018 at 12:31 pm

    I have never heard of SIBO, but I’m sure I probably have it. I have had digestion issues my whole life and have been diagnosed with IBS. I am definitely going to look into those diets you suggested.

    Reply

  14. Kisha says

    November 11, 2018 at 4:28 pm

    I’d never heard about this, but this sounds like a stomach complication I’ve heard people complain about before. I’m glad you listed natural remedies for relief– that’s always the way I look to go.

    Reply

  17. Kermilia says

    November 12, 2018 at 1:17 pm

    Wow I’ve actually have never heard of this. Such an informative post for people suffering with SIBO! Thanks for sharing!

    Reply

  18. Lex says

    November 12, 2018 at 2:16 pm

    My first time bearing about sibo. Good read and very informative. Thanks for sharing big light on this. Always good to keep to good health and this i will study more on.

    Reply

  19. Kylie says

    November 12, 2018 at 7:05 pm

    Really Interesting blog post! I’ve never heard of SIBO but because I have many stomach issues I might explore it further!

    Thanks for the post!

    Reply

    • Dena @ Back To The Book Nutrition says

      November 14, 2018 at 5:43 am

      Yes, kids can definitely have SIBO. But “excessive gas” can be hard to define since the younger the children are, the less socially aware they are about passing gas in public so it can seem like they’re extra gassy when they’re just not holding it in like adults do. 🙂 If they’re complaining more of stomach upset or you notice they’re burping or passing more gas than they have in the past, it may be something to look into.

      Reply

  24. Ellie Plummer says

    November 13, 2018 at 3:11 pm

    I have never heard of SIBO before and it sounds like you really have to do a trial and error of different foods that trigger it.

    Reply

  26. Kelsey says

    January 2, 2019 at 12:25 pm

    Thanks for this article Dena! I was diagnosed with SIBO several years ago after having intensive appendectomy surgery. I’ve taken 3 or 4 rounds of rifaximin and it seems to always cycle back. I seem to also be stuck in a rut since I was tested and diagnosed with SIBO through the hydrogen breath test. Insurance doesn’t want to pay for it and doctors have to write the prescription in a certain way to get it covered for SIBO, which I don’t think is long enough to kill the bad bacteria. I went to the leading G.I. in my area and he doesn’t know much about it. What I really want is a course of treatment for the underlying issue, not to just mask the problem. Could you please send me info. on the pricing of your coaching calls? I’m really interested in seeking your advice. Thanks!

    Reply

    • Dena @ Back To The Book Nutrition says

      January 2, 2019 at 1:20 pm

      Hi Kelsey,
      I’m sorry to hear you’ve been battling SIBO. It can be tricky to get rid of for some people. I definitely take a root cause/whole person approach so we address the overgrowth head on while also identifying and correcting what allowed it to develop in the first place. I’ll email you some details now about my coaching services and testing.

      Reply

  29. Amy Nyiri says

    June 21, 2019 at 6:22 pm

    Thank you for this article! This is the first time I’ve seen that 100% of people with fibromyalgia have SIBO. That’s adds up for me. I was diagnosed with it long before I found out about the SIBO. I participated in a stool testing and when analyzing the results realized I had the methane SIBO which also added up since I’m a life long constipation sufferer. I’ve gone thru the herbal antimicrobial regiment and feel much better but I can’t get the constipation under control. Any tips on the best probiotics? And any other discoveries on how to beat the “C”?

    Reply

    • Dena @ Back To The Book Nutrition says

      June 23, 2019 at 7:57 am

      Hi Amy, Isn’t that an astounding statistic? It was a smaller study (42 patients) published by a leading SIBO researcher (Dr. Pimentel) several years ago, and I think the findings shocked everyone. I’m so glad you’ve gotten some relief from your antimicrobial treatment. You may want to consider: (1) Spore forming probiotics (i.e., MegaSpore) – these seem to be especially helpful for those with constipation. I always suggest people start at a lower dose and increase gradually to the recommended 2 capsules/day, and be aware that, for some people, symptoms may actually increase for a couple of weeks before they get better. In my experience, the people who have this initial response tend to be the ones who need them the most and see the most relief once they adjust to them. (2) Digestive Enzymes with or without HCl (I’d say more SIBO-C sufferers than not benefit from the HCl)…lower stomach acid levels seems to be a precursor to SIBO in many cases, which can suppress enzyme production. And SIBO itself also suppresses enzyme production. (3) If those aren’t sufficient, a motility agent to get things moving through the GI tract at little more quickly may be helpful – there are supplement versions of this (i.e., Ginger, Melatonin, etc.) as well as prescriptions. I hope that helps!

      Reply

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