What we eat every day nourishes not only us humans, but also our gut microbiome. When the small intestine is overpopulated, single-celled organisms like bacteria or archaea metabolize nutrients before we can absorb them. This bacterial metabolism produces gases like methane and hydrogen, which lead to typical SIBO symptoms such as bloating, belching, constipation, or diarrhea.
In addition to treatment with conventional antibiotics or antibiotic herbs, nutritional therapy is another important pillar of Siberian ovarian disease treatment. There are basically two different approaches:
1.) The bacteria are deliberately fed so they don't develop defenses against antibiotics or antibiotic medicinal plants. With this approach, patients often experience worsening symptoms because the single-celled organisms produce a lot of gas.
2.) The second approach aims to feed the bacteria and archaea as little as possible. This reduces their proliferation and supports antibiotic therapy. It also alleviates patient symptoms because the bacteria produce less gas.
In my work, I follow the second approach, as it usually brings rapid symptom relief. What do the bacteria and archaea in the small intestine prefer to eat? Carbohydrates! That's why almost all diets used for sibo reduce the amount of carbohydrates. There are now a whole host of nutritional therapies used for small intestinal bacterial overgrowth: SSFG, SCD, Low FODMAP, Bi-Phasic Diet, Low Fermentation Diet, and others like GAPS, paleo, or ketogenic. Here are the most important ones, along with their similarities and differences:
Low FODMAP
The abbreviation stands for "fermentable oligo-, di-, monosaccharides and polyols" – fermentable carbohydrates and sugar substitutes. In a low FODMAP diet, these specific carbohydrates are reduced. These include lactose, fructose, fructans, galactans, and polyols (sugar alcohols).
Since gluten-free grains such as rice, quinoa, corn, buckwheat, and even oats are permitted, this diet still contains relatively high amounts of carbohydrates. It is therefore well-suited for mild cases of gluten intolerance and is also easily implemented by vegan patients. It is less restrictive than the other diets and also a good transitional diet for the period after sib therapy.
Specific Carbohydrate Diet – SCD
This diet, developed by Sidney Valentine Haas, reduces many difficult-to-digest carbohydrates and was originally designed to treat chronic inflammatory bowel disease. The carbohydrate content is very low, and no grains or starchy vegetables are allowed. To ensure satiety, the diet relies heavily on animal products.
Sibo-specific food guide – SSFG
For these guidelines, Dr. Allison Siebecker combined the SCD with the low-FODMAP diet. It's a relatively restricted diet for initial symptom relief, but shows good results for many patients. Jasmine or basmati rice and potatoes can be added for augmentation.
Biphasic Diet
The two-phase diet is based on the Sibo-specific Food Guide. However, Dr. Nirala Jacobi divides it into two phases. While the diet is very low in FODMAPs and carbohydrates for the first four to six weeks, carbohydrates and other FODMAPS are increasingly introduced in the following weeks. Dr. Jacobi has also published a vegetarian version of this diet.
Low Fermentation Diet, also known as Cedars Sinai Diet
Developed by Dr. Mark Pimentel, this diet, similar to the Low FODMAP Diet, reduces hard-to-digest carbohydrates such as fructose, lactose, and fiber found in whole grain products and legumes. Overall, it's easy to follow and well-suited as a transition to a "normal" diet.
Conclusion
With all diets, it's important to remember that not all SIBOs are the same. Since the breath test tests for gases rather than specific bacterial strains, many sufferers have very individual tolerances. While onions, garlic, tofu, bananas, or nuts trigger symptoms in many people, these foods are well-tolerated by others. Therefore, it may be worthwhile to try different diets or expand your diet to include individual foods. Experienced SIBO therapists can help with this.