The Ultimate SIBO Diet Guide

Small Intestinal Bacterial Overgrowth (SIBO) Diet Guide – As Per Modern Perspective

1. Bi-Phasic Diet
2. Specific Carbohydrate Diet
3. Elemental Diet
4. Follow A Low FODMAP Diet

1. Bi-Phasic Diet

A unique diet developed by Dr. Nirala Jacobi, in which overgrown bacteria are starved. This dietary approach is designed for SIBO (Small Intestine Bacterial overgrowth) to restore gut healing, addressing digestive issues by systemic reduction of fermentable carbohydrates. Bi-phasic diet is classified into two types:-

1. Symptom Reduction (Phase – 1)
2. Microbial Repair (Phase – 2)

A) Symptom Reduction (Phase – 1): In Phase 1 SIBO symptoms are controlled by minimizing bacterial food sources. This phase is further divided into two types depending on the symptom’s severity:

1. Restricted Phase – 1
2. Semi-Restricted Phase – 1

Phase 1 focuses on gut-soothing options like low fermentable foods and also includes digestive-supportive food like asafetida, cumin seeds, etc., anti-microbial and anti-inflammatory food.

Duration of Symptom Reduction (Phase – 1):

Phase 1 typically lasts for 4-6 weeks, in this period symptoms should be monitored properly.

Example of Foods to Eat in Symptom Reduction (Phase – 1)

• Vegetables: Cucumbers, carrots, spinach, zucchini, etc.
• Fruits: Low fructose fruits, blueberries, strawberries, etc.
• Herbs: Cilantro, parsley, cumin, turmeric, ginger, etc.
• Non-veg: Fish. Eggs, grass-fed meat, chicken, etc.
• Oil: Avocado oil, coconut oil, olive oil, etc.

Example of Foods to Avoid in Symptom Reduction (Phase – 1)

• Grains: Grains such as rye, barley, and wheat should be avoided.
• Dairy Products: Dairy products like soft cheese, cream, etc should be avoided.
• High FODMAP Diet: Vegetables like cauliflower, garlic, onions, etc should be avoided.
• Legumes and Beans: Legumes and beans should be avoided.

B) Microbial Repair (Phase – 2)

In this phase, a variety of food is reintroduced to the individual while supporting motility and continuing the repair of the gut lining.

Duration of Microbial Repair (Phase – 2):

6-8 weeks or longer depending upon the severity.

Example of Foods to Eat in Microbial Repair (Phase – 2)

• Vegetables: In moderate amounts vegetables like pumpkin, sweet potato, etc. should be included.
• Fruits: In small portions fruits like kiwi, papaya, and ripe bananas can be included in the diet.
• Non-Veg: The non-vegetarian food that is taken in phase 1 along with pastured meats and fermented fish can be included.
• Grains: in small portions, gluten-free grains like rice, and quinoa can be added to the diet.
• Fermented Food: A small amount of lactose-free yogurt, kimchi, etc can be added to the diet.

Example of Foods to Avoid in Microbial Repair (Phase – 2)

• Previous intolerable food should be avoided as may result in allergic reactions or exacerbation of symptoms.
• Processed food should be avoided.
• Beverages and sugary snacks should be avoided.

2. Specific Carbohydrate Diet (SCD)

A specific carbohydrate diet is a diet in which complex carbohydrates that are difficult to digest are eliminated as they serve as a source for pathogenic bacteria. Instead of that in this diet for SIBO, easily digestible, nutrient-dense food is included which promotes gut healing, reduces bacterial fermentation, etc.

Rules of Specific Carbohydrate Diet:-

• Elimination: The prime rule of SCD is the elimination of the complex carbohydrates like disaccharides (lactose, sucrose), and polysaccharides like starches which ferment in the gut as they are harder to digest.
• Focus: The carbohydrates that are easily absorbed in the small intestine like monosaccharides (fructose, glucose), etc. should be included in the diet.
• Heal: Anti-inflammatory food and nutrient-rich food should be included so that they support the repair of the gut lining and reduction of symptoms that occur due to bacterial fermentation like gas bloating, diarrhea, etc.

Types of Specific Carbohydrate Diet:-

1. Introductory Phase
2. Maintenance Phase

1. Introductory Phase: In this introductory phase focus is on low-fiber food that is easily digestible. Such a transition of diet helps to achieve the goal of reducing the bacterial load and gut soothing.

Duration: Depending upon the severity this phase lasts for 3- 5 days.

2. Maintenance Phase: In this phase, the food with minimal fermentation potential, easy to digest is included. In this phase, there is reintroduction of the wide variety of SCD-legal food.

Examples of Specific Carbohydrate Diet (SCD) Legal and Illegal

I) Vegetables:-

SCD Legal Vegetables: Cabbage, broccoli, peas, peppers, carrot, cucumber, eggplant, squash, etc.

SCD Illegal Vegetables: Corn, okra, sweet potato, turnip, water chestnut, yam, tapioca, etc.

II) Legumes:-

SCD Legal Legumes: Brown lentil, green lentil, etc.

SCD Illegal Legumes: Chickpea, Soy, Fava, etc.

III) Fruits:-

SCD Legal Fruits: Banana, blueberry, raspberry, strawberry, dragon fruit, kiwi fruit, passion fruit, melon, pineapple, grapes, guava, etc.

SCD Illegal Fruits:  plantain, commercially made jam, and jelly, mango, plum, prunes, persimmon, pera, etc.

IV) Meats:-

SCD Legal Meats: Beef, eggs, lamb, pork, fish, eggs, seafood, etc

SCD Illegal Meats: Bacon, Deli / processed meat.

V) Nuts:-

SCD Legal Nuts: Almonds, peanuts, sunflower seeds, walnuts, etc.

SCD Illegal Nuts: Chia seeds, coconut milk with thickeners, etc.

VI) Dairy:-

SCD Legal Dairy: Butter, cheese, sour cream, yogurt, etc.

SCD Illegal Dairy: Cheese, cream, cottage cheese, sour cream, etc.

VII) Seasoning:-

SCD Legal Seasoning: All spices can be used except garlic and onion, Garlic infused oil can be used, etc.

SCD Illegal Seasoning: Chicory root, asafetida, soy sauce, onion, garlic powder, etc.

3. Elemental Diet

Elemental diet is a special kind of nutritional intervention diet mentioned for SIBO and other gastro-intestinal disorders. In this diet, pre-digested food in the liquid form is given under medical supervision which results in starvation of the bacteria of fermentable substrates and also allows rest to the gut. As easily absorbable nutrients are given in this diet it effectively reduces food to the bacteria and due to starvation, their overgrowth is reduced.

In this diet, various macronutrients like free amino acids (protein) eg: L- alanine, L-glutamine, etc, carbohydrates like dextrose, glucose (monosaccharides), medium chain triglycerides (MCTs) fats, etc are given. Along with this various micronutrients like vitamin A, C, D, E, K, B-complex, minerals like zinc, calcium, potassium, etc are given.

Types of Elemental Diets:-

1. Standard Elemental Diet
2. Semi-Elemental Diet
3. Homemade Elemental Diet

1. Standard Elemental Diet: In this diet, fully predigested nutrients are given, this diet is especially given in severe cases of SIBO which require rapid symptom control. Eg: commercially available standard elemental diets are Absorb Plus, Vivonex, etc.

2. Semi-Elemental Diet: This type of diet is given to individuals who need a less restrictive but low-fermentation diet. This diet included simple carbohydrates, partially digested proteins like peptides, etc.

3. Homemade Elemental Diet: This elemental diet is cost-effective or used when commercial formula is not used as an option. This can be customized as needed. This diet recipe is formed with the combination of 50 grams of free-form amino acid, 40g of monosaccharides like dextrose or glucose, 20 g of MCT oil, multivitamins, electrolytes, and water.

Duration of Elemental Diet

2-3 weeks. 

How to Use an Elemental Diet?

Elemental diet can be used alone, or it can be combined with treatment like antimicrobial treatment.

Transitioning Off the Elemental Diet

First, introduce low-fermentation food like steamed vegetables, then followed by a low-FODMAP diet, bi-phasic diet, SCD, etc as a maintenance phase.

Elemental Diet in Ayurveda

In the Ayurveda Light diet (Laghu Ahara), the digestive fire stimulating diet (Pachana Aahara) principle aligns with the elemental diet. Non-irritating food like rice gruel (Kanji) and buttermilk (Takra) can be included in the diet which reduces toxins (Ama), supports healing of gut lining, and during reintroduction various digestive aids can be included like Jeera Arka, Trikatu, Pippali, etc.

4. Follow a Low FODMAP Diet

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. FODMAP is a carbohydrate that is difficult to digest as it pulls more water to the bowel and increases bloating, gas, pain, diarrhea, etc. Intake of a low FODMAP diet may decrease your symptoms associated with Irritable Bowel Syndrome (IBS).

Food that is Low in FODMAP are:-

• Eggs
• Meat
• Rice
• Quinoa
• Fruits like blueberries, grapes, strawberries, oranges, etc.
• Vegetables like eggplant, green beans, pumpkin, carrot, zucchini, etc.

Foods to Avoid:-

• Fruits like Mango, plum, apple, watermelon, and peach.
• Vegetables, like broccoli, onion, asparagus, and artichokes.
• High fructose corn syrup.
• Legumes like lentils, kidney beans, chickpeas.
• Lactose should also be avoided if you are lactose intolerant.