If you are in a holding pattern to treat SIBO, following a low FODMAP or anti-SIBO diet can help to reduce symptoms temporarily. The best option is always to treat SIBO using herbs and sometimes pharmaceuticals but that is not always possible. Pregnancy, recovering from illness and extensive travel may prolong proper treatment but certain foods can be avoided in the meantime. Choosing foods that are easier to digest, do not ferment and most importantly do not feed overgrown bacteria will likely cause less gas production and less symptoms such as bloating, flatulence, constipation and diarrhea.
Breakfast should have the same components that other meals do – healthy fats, protein and carbohydrates. Yet many people are in a hurry in the morning and opt for a carb-rich meal and may even omit one of the other macronutrients. When following a low FODMAP diet, breakfast carbs are not allowed, making this a more difficult meal to plan around. Providing some extra time in the morning and thinking outside of toast and cereal, delicious and nutritious foods can be made quickly and not lead to gas and bloating the rest of the day.
What is SIBO?
Small intestine bacterial overgrowth (SIBO) is one of the main conditions behind IBS. In SIBO, colonies of bacteria from the large intestine migrate backwards and into the small intestine where new colonies form, grow and cause issues. The small intestine is healthiest without colonizations, the main functions are to digest food and absorb nutrients but when SIBO is present, inflammation lines the walls and makes it difficult to do so. The bacteria produce gasses just as humans produce and exhale carbon dioxide. These gasses cause bloating, abdominal discomfort, excess flatulence, belching, heartburn and change bowel movements to constipation and/or diarrhea.
SIBO can be tested for and treated. The SIBO breath test uses a lactulose sugar to feed bacteria and tubes of gas are used to capture gasses of exhalation which get analyzed. Methane and hydrogen gas should be present in little to no amounts, but bacteria that make up SIBO release excess of these gasses and a positive diagnosis is confirmed with elevated levels. Treatment with a trained professional is possible but sometimes if a delay of treatment is necessary, following an anti-SIBO diet is the temporary solution.
What Kind of Diet is Good for SIBO?
The bacteria that make up SIBO can use many types of food for energy. Fruits, vegetables, grains, sugars, dairy and even some nuts and seeds make up the energy and foods sources for SIBO as well as for humans. It can be very difficult to determine which foods cause worse bloating since such a variety will impact SIBO.
Sticking to animal-based proteins such as meat, fish and eggs will lower SIBO gasses. Vegetarian foods that do not get used by the bacteria include white rice, lactose-free dairy products, and a small amount of lentils. Nuts and seeds are tricky, depending on the amount of almonds, hazelnuts, macadamia, peanuts, pecans, pine nuts, pumpkin seeds, sesame seeds, sunflower seeds and walnuts are generally ok to consume in small amounts at a time.
What is a Low FODMAP Diet?
It all comes down to fermentability and the ability to be used as food to bacteria. If a food is highly fermentable, bacteria will well fed and produce gasses. Examples of high FODMAP foods include sauerkraut, potatoes, avocado, apples, soy products, all grains except white rice and cashews.
The anti-SIBO diet combines two diets, the low FODMAP and the SCD diet. For best results from diet alone, the anti-SIBO is generally recommended. A free app called the SIBO edit was created to help when cooking and grocery shopping. This takes into account portion sizes that are acceptable instead of removing foods entirely and makes it easier to have more of a variety of food.
Best SIBO Diet Breakfast Ideas and Recipes
Breakfast can be the hardest meal to plan when it comes to following an anti-SIBO diet. Many people chose quick options for the first meal of the day which could be cereal with milk, toast with jam, granola or a fruit smoothie. All of these options will feed SIBO and can start the day with bloating and gas. Planning ahead, shopping to have ingredients on hand and spending a few more minutes preparing can make a big difference to how digestion feels later on in the day.
What breakfast is good for SIBO?
Breakfast should always have some protein, fats and carbs if desired. Eggs will not feeds SIBO and can be consumed in any amount according to the anti-SIBO diet. Omelettes with vegetables such as ample amounts of red peppers, scallions, tomatoes and olives are the perfect SIBO friendly breakfasts. Even adding lactose-free cheeses is allowed and seasoning such as salt, pepper and hot sauce is unlimited.
Processed or cured meat is not recommended in the anti-SIBO diet. Bacon is allowed if is good quality from the butcher and sugar-free or if made with honey. A ground turkey scramble with seasoning to taste and the same vegetables as above in the omelette can be delicious and not cause bloating.
Generally fruit should not be the main component of any meal. Fruit contains a lot of sugars and will get processed quickly. One serving of 1/2-3/4 cup with a meal can help boost Vitamins and give a nice flavour. Opting for a plain sugar-free, lactose-free yogurt (even better if homemade) and adding some mixed berries, kiwi or banana is ok. Be sure to include some healthy fats such as a small amount (less than 1 tablespoon) of flax seed, shredded coconut, 1 tablespoon of slivered almonds or about 10 walnuts.
Cream of Rice
Since white rice does not feed bacteria types found in SIBO, cream of rice can be a soothing option for breakfast. With the addition of a 1/2 cup of berries such as blueberries, a pinch of cinnamon, almond slivers and a 1/2 tablespoon of ground flax, a well-rounded, delicious and nutritious meal is easily made. If desired, lactose-free milk or a dairy alternative such as almond milk can be used for a creamier texture.
Oatmeal
Oatmeal is a tricky one. It technically is a grain and can ferment and feed bacteria. Some people will have symptoms with oatmeal and others won’t. Because it is not allowed on the anti-SIBO diet, looking at options involving white rice or grain-free meals is recommended.
Rice Cereal
White rice cereal that is sugar free and minimally processed can be consumed for breakfast. Eating healthy means each important macronutrient should be consumed with each meal. Fats, protein and carbs should each be found at breakfast and rice cereal is only carbohydrate-based. Adding nuts and seeds will improve the healthy fat content and add some protein, but also eat a hard-boiled egg to get the full nutrient spectrum.
Best Fruits for SIBO
When it comes to fruits and SIBO, there are do’s and don’ts. Remember that some fruits are much more fermentable than others so it is possible to list out fruits to avoid and those to consume.
The best fruits (low FODMAP fruits) include bananas, berries of all types, citrus of all types, grapes, kiwi, cantaloupe, papaya and pineapple. Moderate FODMAP fruits such as cherries (only eat 3 per serving!), lychee and honeydew melons.
Fruits to avoid while following an anti-SIBO diet would be apple, apricot, avocado, all dried fruits, mango, nectarine, peach, pear, persimmon, plantain, plum, and watermelon. So embarking on an anti-SIBO diet would be challenging in the summer with the temptations of summer fruits!
Frequently Asked Questions
Sugar is always the enemy when it comes to bacterial and fungal overgrowths in the digestive system. This applies to many natural sugars too such as agave, brown rice syrup, coconut sugar, maple syrup and molasses. Keto sugars such as erythritol and xylitol can trigger symptoms yet stevia is generally a safe choice. Honey, if derived from alfalfa, cotton, clover or raspberries is allowed up to 2 tablespoons when following the diet.
Some of the highest sources of food for SIBO come from grains and beans. Interestingly, people who treat their SIBO are often surprised that gas associated with consuming high amounts of beans resolves. Lentils at 1/4 cup per serving appear to be SIBO-safe and all other beans in any portion are considered high FODMAP/SIBO.
When treating SIBO, herbal extracts in very high doses are used to kill the overgrown bacteria. Using herbs in cooking will not have the same therapeutic effect, since it is a dose-dependent treatment, just as antibiotics require a minimum dose to be effective.
Oregano, garlic and thyme should be used to some extent when eradicating SIBO. Other herbal extracts such as berberine, myrrh and grapefruit seed extract usually round out a strong protocol. Sometimes a very specific antibiotic is also required so it is always best to complete a SIBO breath test and see a Naturopathic Physician for a well-rounded plan. Diet isn’t always required either, so before embarking on an anti-SIBO diet, seek out a SIBO doctor as it might save the hassle of eliminating many common foods.
