A Comprehensive Guide to Diet and Management

By Aliza Beer MS, RD, CDN

Small Intestinal Bacterial Overgrowth (SIBO) is a digestive disorder characterized by an abnormal increase in the population of bacteria in the small intestine. This condition can lead to various uncomfortable symptoms, such as bloating, abdominal pain, diarrhea, and malabsorption of nutrients. However, with proper management and an appropriate diet, individuals with SIBO can alleviate their symptoms and improve their overall health.

What is SIBO? The small intestine typically has a relatively low concentration of bacteria. However, in SIBO, an overgrowth of bacteria occurs in the small intestine, disturbing the normal digestive processes. This overgrowth can happen due to various factors, including impaired motility of the small intestine, anatomical abnormalities, or changes in the gut’s natural defense mechanisms. Certain medical conditions that may trigger or be associated with SIBO are hypothyroidism, cirrhosis of the liver, diabetes, celiac disease, Crohn’s dis- ease, and IBS (irritable bowel syndrome). Risk factors that increase your risk of SIBO include old age, female gender, alcohol use, previous bowel surgery, and certain medications such as antibiotics.

The overgrowth of bacteria in the small intestine can interfere with the proper digestion and absorption of nutrients, leading to uncomfortable symptoms. The bacteria can ferment carbohydrates, producing excess gas and leading to bloating, abdominal pain, and altered bowel movements.

The primary goal of the SIBO diet is to reduce the intake of fermentable carbohydrates, which provide fuel for the overgrown bacteria. By limiting these carbohydrates, you can help reduce symptoms and create an environment less favorable for bacterial overgrowth.

Here are some key dietary recommendations

• Low FODMAP Diet

Certain foods can aggravate symp - toms in individuals with SIBO. These may include high-FODMAP foods (e.g., onions, garlic, wheat), legumes, some fruits (e.g., apples, pears), and sweeteners like sorbitol and mannitol. It is essential to identify trigger foods and avoid them. Following a low fermentable carbohydrate diet, such as the Low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, is often recommended for individuals with SIBO. This diet restricts specific carbohydrates that are prone to fermentation, such as lactose, fructose, certain fibers, and sugar alcohols. It focuses on reducing the intake of fermentable carbohydrates that can exacerbate symptoms. The Low FODMAP diet consists of three phases:

1. Elimination Phase : During this phase, high-FODMAP foods are restricted for a specific period, usually 2-6 weeks. Common high-FODMAP foods include onions, garlic, wheat, rye, certain fruits (e.g., apples, pears), certain vegetables (e.g., cauliflower, asparagus), and legumes. However, it’s important to note that the diet should be followed under the guidance of a registered dietitian or healthcare professional to ensure nutritional adequacy.

2. Reintroduction Phase: After the elimination phase, individual FODMAP groups are gradually reintroduced one at a time, while closely monitoring symptoms. This helps identify specific FODMAPs that trigger symptoms in each person, allowing for a more personalized diet plan.

3. Maintenance Phase : In this phase, a personalized and less restrictive diet is developed based on the individual’s tolerance for specific FODMAP groups. This phase aims to achieve longterm symptom management while maintaining a balanced and varied diet.

Examples of Beneficial Foods/Meals: While the Low FODMAP diet restricts certain high-FODMAP foods, there are still plenty of delicious and nutritious options available. Here are some examples of beneficial foods/meals for individuals with SIBO:

1. Proteins: Lean meats, poultry, fish, eggs, tofu, tempeh.

2. Grains: Gluten-free options like rice, quinoa, oats (if tolerated), and gluten-free bread and pasta.

3. Vegetables: Low-FODMAP options such as spinach, lettuce, zucchini, carrots, bell peppers, and green beans.

4. Fruits: Low-FODMAP fruits like strawberries, blueberries, oranges, grapes, and kiwi.

5. Dairy Alternatives: Lactose-free milk, almond milk, coconut milk, lactose-free yogurt.

6. Snacks: Rice cakes, gluten-free pretzels, low-FODMAP nuts (e.g., almonds), lactose-free cheese.

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Eat Small, Frequent Meals

Consuming smaller, more frequent meals instead of large meals can help ease the burden on the digestive system. Smaller meals promote better digestion and reduce the likelihood of triggering uncomfortable symptoms.

• Medication Therapy

In addition to dietary modifications, medication therapy may be used in conjunction with the Low FODMAP diet for

SIBO management. The most common medications prescribed include:

1. Antibiotics: Rifaximin is an antibiotic commonly used to treat SIBO. It targets the overgrown bacteria in the small intestine, reducing their numbers and alleviating symptoms.

2. Herbal Therapy: Herbal therapy help restore a healthy balance in the gut microbiota. While the use of probiotics in SIBO is still debated, some strains, such as Lactobacillus and Bifidobacterium, may be beneficial. Prebiotics, on the other hand, are fibers that promote the growth of beneficial bacteria. In SIBO, the use of prebiotics should be suspect you have SIBO, it is crucial to consult a physician to receive an accurate diagnosis and develop a personalized treatment plan that suits your needs. The Low FODMAP diet, along with medication therapy and herbal options, can be effective in managing SIBO symptoms. Working with a registered dietitian or healthcare professional specializing in gut health is crucial to tailor the diet to individual needs, ensure nutritional adequacy, and monitor progress. Each person with SIBO may have different triggers and tolerances. Working with a registered dietitian can help create an individualized plan appropriate for your specific needs and symptoms. SIBO management requires a comprehensive approach, addressing both diet and any necessary medications or herbal therapies for optimal results. is an alternative approach that some individuals explore for SIBO management. Herbal antimicrobials may be used to help reduce bacterial overgrowth in the small intestine. Common herbal options include oregano oil, berberine, garlic extract, neem, and wormwood.

3. Probiotics and Prebiotics: Probiotics are beneficial bacteria that can approached cautiously and under the guidance of a healthcare professional.

SIBO is a complex digestive disorder characterized by an overgrowth of bacteria in the small intestine. By adopting a carefully planned diet and lifestyle modifications, individuals with SIBO can effectively manage their symptoms and improve their quality of life. If you

Aliza Beer is a registered dietitian with a master’s degree in nutrition. She has a private practice in Cedarhurst, NY. Patients’ success has been featured on the Dr. Oz show. Aliza can be reached at alizabeer@gmail. com, and you can follow her on Instagram at @alizabeer