Dr. Paul Deglmann
Meghan Feir Walker
Are you regularly experiencing bloating and gas after eating, bowel movement issues, abdominal pain, nausea, and other troublesome and concerning digestive symptoms? There may be a chance that you have small intestinal bacterial overgrowth (SIBO). Perhaps you’ve already been diagnosed, but you’re unsure which SIBO diet is right and how you should eat to support your gut health without encouraging bigger bacterial imbalances.
In this article, we’re covering the most popular SIBO diet and what to eat, what to avoid, and how to support your gut health with food as a supplementary help to your practitioner’s SIBO treatment plan.
What is SIBO?
Before we jump into the SIBO diet, it’s important to know what SIBO is. SIBO is a condition that occurs when bacteria that are supposed to stay in the large intestine/colon begin to travel into the small intestine. The bacteria begin to feed on the food in your small intestine, creating a fermentation process that can lead to significant symptoms.
SIBO symptoms often include:
- Bloating/gas (especially after eating)
- Abdominal pain
- Constipation
- Diarrhea
- Heartburn
- Indigestion
- Nausea
- Fatigue
- Brain fog
- Malnutrition
- A sense of fullness after eating a small amount of food
- And more
What is the SIBO diet?
As with everything gut-related, your diet plays a critical role in managing SIBO symptoms. The SIBO diet’s main goals are to:
- Reduce fermentation within the gut
- Alleviate symptoms
- Support gut health
How the SIBO diet works
The SIBO diet works by removing foods that would typically feed opportunistic bacteria in the gut and promote fermentation. The most common SIBO diet recommended is called the Low FODMAP diet. FODMAPs stand for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These specific carbohydrates are known to feed bacteria and microbes in the gut, which then causes fermentation that leads to symptoms.
This phased approach involves:
- Elimination (with strict adherence to your chosen SIBO diet)
- Reintroduction
- Maintenance
Foods to avoid or reduce on the SIBO diet
High-FODMAP Foods
Vegetables and Legumes:
- Artichoke
- Asparagus
- Beetroot, fresh
- Broad beans
- Butter beans
- Cassava
- Cauliflower
- Celery
- Garlic
- Kelp / Kombu
- Leek bulb
- Mange tout
- Mixed vegetables
- Mushrooms
- Onions
- Pickled vegetables
- Savoy cabbage
- Scallions
- Shallots
- Taro
- Baked beans
- Black-eyed peas
- Falafel
- Haricot beans
- Kidney beans
- Lima beans
- Mung beans
- Red kidney beans
- Soybeans
- Peas, sugar snap
- Split peas
Fruits high in fructose:
- Apples
- Apricots
- Avocado
- Bananas, ripe
- Blackberries
- Blackcurrants
- Boysenberry
- Cherries
- Currants
- Custard apple
- Feijoa
- Figs
- Goji berries
- Grapefruit
- Guava, unripe
- Juniper Berry, dried
- Lychee
- Mango
- Nectarines
- Paw paw, dried
- Peaches
- Pears
- Persimmon
- Pineapple, dried
- Plums
- Pomegranate
- Prunes
- Raisins
- Sea buckthorns
- Sultanas
- Tamarillo
- Tinned fruit in apple/pear juice
- Watermelon
Nuts:
- Almond meal
- Cashews
- Chestnut flour
- Pistachios
Grains:
- Wheat
- Amaranth flour
- Barley
- Bran cereals
- Bread
- Cous cous
- Einkorn flour
- Freekeh
- Gnocchi
- Granola bar
- Muesli cereal
- Muesli bar
- Rye
- Rye crispbread
- Semolina
- Spelt flour
Dairy:
- Buttermilk
- Cheese, ricotta
- Cream
- Custard
- Gelato
- Ice cream
- Kefir
- Cow milk
- Goat milk
- Evaporated milk
- Sheep's milk
- Sour cream
- Yogurt
Sweeteners:
- Fructose
- High-fructose corn syrup
- Honey
- Molasses
- Sugar-free sweets containing polyols - usually ending in -ol or isomalt
- Sweeteners
- Inulin
- Isomalt
- Lactitol
- Maltitol
- Mannitol
- Sorbitol
- Xylitol
Processed and Inflammatory Foods
- Processed sugars
- Artificial sweeteners
- Alcohol
- Fried foods
Foods to Eat on the SIBO Diet
Low-FODMAP Foods
Note: If you see any food items listed on both the high and low FODMAP food lists, this is because those items should only be eaten in small amounts, if tolerated. Keep in mind that all food should be rotated often. Diversity is your microbiome’s friend.
Vegetables and Legumes:
- Alfalfa
- Bamboo shoots
- Bean sprouts
- Beetroot, canned and pickled
- Black beans
- Bok choy/pak choi
- Broccoli in small amounts
- Broccolini in small amounts
- Butternut squash
- Cabbage, common and red
- Callaloo
- Carrots
- Celeriac
- Celery - less than 5cm of stalk
- Chicory leaves
- Chick peas
- Chilli - if tolerable
- Chives
- Cho cho
- Choy sum
- Collard greens
- Corn/sweet corn - if tolerable and only in small amounts
- Courgette
- Cucumber
- Eggplant/aubergine
- Fennel, bulb and leaves
- Fermented cabbage e.g. sauerkraut
- Green beans
- Green pepper / green bell pepper / green capsicum
- Ginger
- Kale
- Karela
- Kumara, sweet potato, purple and white
- Leek leaves
- Lettuce:
- Butter lettuce
- Iceberg lettuce
- Radicchio lettuce
- Red coral lettuce
- Rocket lettuce
- Romaine/cos lettuce
- Marrow
- Okra
- Olives
- Parsnip
- Peas, snow
- Pickled gherkins
- Pickled onions, large
- Potato
- Pumpkin
- Pumpkin, canned
- Radish
- Red bell pepper
- Scallions/spring onions (green part)
- Seaweed/nori
- Silverbeet/chard
- Spaghetti squash
- Spinach, baby
- Squash
- Sun-dried tomatoes
- Swede
- Swiss chard
- Sweet potato
- Tomato - canned, cherry, common, roma
- Tomato, canned
- Tomato, common
- Tomato, cherry
- Tomato juice
- Tomato paste/concentrate
- Tomatillo, fresh
- Tomatillos, canned
- Turnip
- Water chestnuts
- Water Spinach
- Yam
- Zucchini
Fruit:
- Ackee
- Applesauce
- Bananas, unripe
- Bilberries
- Blueberries
- Breadfruit
- Carambola
- Cantaloupe
- Cranberry
- Clementine
- Coconut, cream
- Coconut, flesh
- Coconut, sugar
- Cranberry juice
- Dates
- Dragon fruit
- Lingonberries
- Grapes, red and white
- Guava, ripe
- Honeydew and galia melons
- Jackfruit
- Kiwifruit
- Lemon, including lemon juice
- Lime, including lime juice
- Mandarin
- Orange
- Passion fruit
- Paw paw
- Papaya
- Pineapple
- Plantain, peeled
- Prickly pear/nopales
- Raspberry
- Rhubarb
- Strawberry
- Tamarind
- Tangelo
Meats, Poultry, and Eggs:
- Beef
- Chicken
- Chorizo
- Foie gras
- Lamb
- Pork
- Prosciutto
- Turkey
- Eggs
Fish and Seafood:
- Canned tuna
- Fresh fish
- Cod
- Haddock
- Plaice
- Salmon
- Trout
- Tuna
- Seafood (ensuring nothing else is added)
- Crab
- Lobster
- Mussels
- Oysters
- Prawns
- Shrimp
Nuts and Seeds:
- Almonds
- Brazil nuts
- Chestnuts
- Hazelnuts
- Macadamia nuts
- Peanuts
- Pecans
- Pine nuts
- Walnuts
- Flax seeds/linseeds
- Flaxseed oil
- Buckwheat (a pseudocereal)
- Chia seeds
- Dill seeds
- Egusi seeds
- Hemp seeds
- Poppy seeds
- Pumpkin seeds
- Sesame seeds
- Sunflower seeds
Grains:
- Wheat and gluten-free breads
- Bread:
- Corn bread
- Rice bread
- Spelt sourdough bread
- Potato flour bread
- Wheat and gluten-free pasta
- Buckwheat (technically a seed)
- Brown rice/whole grain rice
- Cassava flour (please note that most cassava flour can be high in lead)
- Cornflour/maize
- Corn, creamed and canned
- Corn tortillas
- Crackers, plain
- Millet
- Oatmeal
- Oats
- Polenta
- Popcorn
- Quinoa
- Rice:
- Basmati rice
- Bomba rice
- Brown rice
- Rice noodles
- White rice
- Wild rice
- Starch, maize, potato, and tapioca
- Sorghum
- Tortilla chips/corn chips
Dairy:
- Butter
- Milk:
- Almond milk (note that inorganic options can be high in glyphosate)
- Hemp milk
- Lactose-free milk
- Macadamia milk
- Oat milk (note that this can be high in glyphosate)
- Rice milk
- Sorbet
- Whipped cream
- Yogurt:
- Coconut yogurt
- Greek yogurt
- Lactose-free yogurt
- Goat yogurt
- Soy yogurt
Herbs, Spices, and Oils:
- Herbs: Basil, Bay leaves, Cilantro, Coriander, Curry leaves, Fenugreek, Gotukala, Lemongrass, Mint, Oregano, Pandan, Parsley, Rampa, Rosemary, Sage, Tarragon, Thyme
- Spices: All spice, Black pepper, Cardamon, Chili powder (check ingredients, sometimes has garlic added), Chipotle chili powder, Cinnamon, Cloves, Cumin, Curry powder, Fennel seeds, Five spice, Goraka, Mustard seeds, Nutmeg, Paprika, Saffron, Star anise, Turmeric
- Oils: Avocado oil, coconut oil, olive oil, sesame oil
- Garlic-infused oil
- Onion-infused oil
- Acai powder
- Baking powder
- Baking soda
- Cacao powder
- Cocoa powder
- Cream
- Gelatine
- Ghee, clarified butter
- Lard
- Matcha Powder
- Nutritional yeast
- Salt
- Tahini, hulled
Gut-supportive foods
- Bone broth
- Fermented foods (if tolerated)
- Coconut products
***On a side note, we find that even the “accepted” grains on the list can be triggers for gut inflammation and can often contribute to SIBO symptoms.
Sample SIBO diet meal plan
Breakfast:
Scrambled eggs with spinach and olive oil
Lunch:
Grilled chicken salad with mixed greens and lemon vinaigrette
Dinner:
Salmon with quinoa and sautéed zucchini
Snacks:
Berries and almonds
Tracking your progress and common mistakes
One common mistake SIBO patients make is being on the low FODMAP diet for far too long. This can create ongoing, prolonged food intolerances. Make sure your healthcare practitioner is helping you monitor how long you should appropriately be on the low-FODMAP diet before slowly reintroducing higher FODMAP foods.
Typically, patients are on a strict low-FODMAP diet for 2-6 weeks. Most people shouldn’t be on the diet for more than 6 months before reintroducing foods, but always consult with your healthcare provider to find out what’s best for you.
Remember, this diet isn’t meant to demonize foods higher in FODMAPS. It’s to help rebalance your gut microbiome so you can heal your gut and enjoy these foods once again.
One of my patients had previously been on the low-FODMAP diet for a year and a half, per the instructions from her practitioner. This further complicated her microbiome health, led to greater food intolerances, and, on her own, it took years for her to be able to eat higher FODMAP foods like garlic and onions without experiencing major symptoms. To top it off, her SIBO returned almost immediately after treating it.
This is why it’s important for a practitioner to understand the SIBO diet and its timeline and purpose well.
Common questions about the SIBO diet
What is the best diet to be on if you have SIBO?
There are several dietary options for SIBO, such as:
- Low-FODMAP Diet
- Elemental Diet
- Specific Carbohydrate Diet (SCD)
- Low-Fermentation Diet
Depending on your unique situation, your practitioner may believe one will be more effective than another in your specific case.
Scientific evidence behind the SIBO diet
Researchers have found that close to 80% of IBS cases could also be experiencing SIBO. With the prevalence of SIBO only growing, it’s important for practitioners and patients alike to understand the importance of having a healthy and balanced microbiome and how to rebalance the gut when it becomes imbalanced.
In other studies, such as this one, research has shown that the low FODMAP diet is a helpful therapy for those with IBS and/or SIBO, reducing symptoms in up to 86% of patients.
While SIBO is one of the most common digestive imbalances, your practitioner needs to take into account your history, lifestyle, other health conditions, and other factors when determining the best route forward.
This diet is usually paired with an herbal or antibiotic SIBO treatment plan to try and fully solve the bacterial imbalances at hand. However, the recurrence of SIBO is very common, which is why it’s so important to look at multiple variables that may be contributing to poor gut health.
Be sure to consult with your healthcare provider to see which diet is best for you.
When to seek professional guidance
If you are experiencing symptoms related to SIBO, it’s important to see a practitioner and get tested. Testing helps you get to the root cause of your health problems, while guessing can waste both time and money. We personally suggest seeing a functional medicine practitioner who specializes in gut health. They can give you the best chance of helping you discover what’s imbalanced, why it may have happened, how to get over SIBO effectively, and how to avoid it from coming back again.
Find healing from SIBO with RHS
If you’re ready to learn more about your gut health and the RHS approach to SIBO, schedule your free 15-minute consultation with Dr. Paul. We offer a personalized approach for a helpful and effective path to healing.
After running through your health history and symptoms, we test and look at your test results before making a specific protocol with specific dietary recommendations.
The tests we use to help make the dietary suggestions are:
- Food testing (genetic testing for gluten sensitivity predisposition, food allergy panels, and food sensitivity panels)
- Microbiome/stool testing
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