Is your SIBO diet too restrictive? Or not restrictive enough?

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August 17, 2017 by Amy Hollenkamp

There was nothing that made me want to pull my own hair out more than trying to decide on what diet to follow during SIBO treatment. It seemed like many of the popular SIBO diets contradicted each other.

I latched on to the popular notion that the more I could starve the bacteria the faster I would beat the SIBO. So, I religiously followed a low carb SCD/FODMAP combo for 4 months. It seemed like my whole life revolved around avoiding fiber! But the more energy I spent making my diet as “SIBO friendly” as possible, the worse I seemed to feel.

When I spent all of my time and energy restricting my diet, I was setting myself up for failure in a number of ways. First, SIBO can’t be starved! (Unless you are doing an elemental diet, which I view as more of a treatment rather than a diet)

Second, SIBO is primarily a motility problem not a diet problem. You won’t have SIBO success until you start treating the root causes that are disturbing movement of food through the GI tract.

Overly restrictive diets don’t just set you up to fail, they can make you feel like a failure too! You start to measure your ability to beat SIBO by the amount of foods you can avoid. When I didn’t feel much better on SCD/Low FODMAP combo, I assumed it was a problem with my diet. I concluded that I must be eating too many carbs, so I restricted even further! Boy was I wrong!

It can be easy to fall into this downward spiral of increased restriction to control symptoms. But, looking back, I should have viewed these symptoms as an indication that I wasn’t addressing the underlying root causes of my issues. My symptoms were a result of hormone dysfunction, brain-gut axis issues and large intestine imbalances not a problem with my diet.

Restricting would not correct these underlying issues and it actually exacerbated them. When I started focusing on treating my root causes, I started to make progress.

In my opinion, we need to retire this idea that the more restrictive the SIBO diet is the better. I would even argue that being too restrictive can be harmful.

Too much restricting can lead to nutrient deficiencies, large intestine imbalances, undesirable weight loss, social isolation, chronic stress from the restrictions and hormone imbalances. These risks need to be weighed against the benefits when deciding how restrictive you want your SIBO diet to be.

I do want to be clear that some people may do well or even require a highly restrictive diet for a short period of time to heal or to manage symptoms. But the overall goal should be to broaden your diet as soon as possible to avoid developing any of the problems associated with restrictive diets.

In these cases, it becomes crucial to work with a functional medicine practitioner to make sure you play some defense to prevent any of the potential problems to develop while you are restricting.  This may involve:

  • Nutritional supplementation to ensure you are meeting your needs
  • Probiotics and other gut support to preserve integrity of colonic bacteria
  • Hormonal support (especially if you are restricting carbs)
  • Stress management exercises (meditation, breath work, yoga, etc..)
  • Controlling your weight by making sure you are eating enough calories
  • Support through restriction and reintroduction process

But can your diet not be restrictive enough?

While being too restrictive can hinder recovery, not restricting enough can also cause problems. You can’t beat SIBO eating a Standard American Diet.

Beating SIBO and repairing the breakdowns in your GI tract will require some dietary changes. A diet high in processed and refined foods will generate inflammation that disrupts gut function. When your gut is on fire, you won’t make any progress to heal. Even if you do clear the bacteria, relapse is inevitable.

Breaking dietary patterns can be very hard. I think it becomes even harder when all the SIBO diets seem to contradict each other. You may be discouraged from embarking on dietary changes when you see people not making progress on the popular restrictive diets. Or maybe your doctor said dietary changes won’t make a difference and why would you bother changing your diet when apparently it doesn’t matter!

You also may be on a restrictive diet and still may be eating foods that you are reacting to simply because they fall into the “yes” food column of the diet you are following. Just because a food is allowed on the FODMAP diet, doesn’t necessarily mean it is right for your body! (On the contrary, you may tolerate many of the “no” foods just fine!)

You are going to have a unique list of foods that you need to avoid based on varying genetics, level of immune dysfunction and the root causes of your  SIBO. Sometimes that requires trusting your body and bravely eating outside of the confines of any of the SIBO diets.

You might react poorly to sweet potatoes while someone else thrives on a starchy diet. You may thrive on an AIP style diet versus any of the SIBO diets! We are all unique!

Finding Your SIBO diet Sweet Spot

There seems to be a fine line when it comes to the appropriate restriction level during SIBO recovery and remission. Too much or too little restriction will cause issues!

The goal of diet restriction should not be to starve bacteria, but rather to minimize symptoms and reduce GI inflammation. In my experience, trying to starve the bacteria was a fruitless goal.

Reducing symptoms while only restricting foods that you need to will lead to what I refer to as the “sweet spot”. As a former analyst, I tend to visualize this concept in my head as a U-shaped curve. So, I decided to make an actual U-shaped curve!

SIBO SWEET SPOT FINAL.PNG

The graph demonstrates the consequences of falling on either end of the restrictive spectrum and how the “sweet spot” falls somewhere in the middle.

This “sweet spot” is going to be different for each person and should change as you move through treatment. While you may have periods that your diet is more restrictive, I believe the goal should always be to keep your diet as broad as possible without exacerbating symptoms.

Instead of jumping straight into a very restrictive diet right out of the gate, I wish I would have started broad and then moved narrower if I needed to. I was so scared to feed the beast, I avoided foods that I didn’t need to.

If I could do it all over again, I would try this broad to narrow template to figure out what worked for me:

SIBO sweet spot flow chart

SIBO SWEET SPOT FLOW chat 2

As I mentioned earlier, if your symptoms are forcing you into a very restrictive diet for a long period of time, it may be an indication that your SIBO isn’t cleared or that you have other problems that need to be addressed (large intestine imbalances, hormone issues, brain-gut axis problems). In either of these cases, more restricting is most likely not the answer.

Don’t focus solely on diet to beat SIBO!

It can be easy to neglect other important aspects of treatment when you are spending all your time and energy restricting your diet. Diet should only be one part of your SIBO treatment. A multifaceted treatment approach is required to clear the overgrowth and address the root causes for you to make progress.

When I was very restrictive, I had no energy to address the stress, hormone issues, brain-gut axis problems and large intestine imbalances that were at the root of my SIBO. It was kind of like I was putting all my eggs in the SIBO diet basket. But when I only invested my energy and resources in perfecting my diet to treat SIBO, there was no payoff.

My payoff skyrocketed when I started to diversify my treatment strategy. Allowing some slack in my SIBO diet freed up energy and resources to address my root causes!

Pillars of SIBO treatment.PNG

Diet is just a small part of the SIBO solution

Bottom Line:

While some restrictions are crucial for healing, too many restrictions can become detrimental. Finding your sweet spot can help you reduce symptoms and inflammation so that you can address the root causes of your SIBO.

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If you liked this post, please check out these related posts:

Why I don’t believe in SIBO diets?

Is the pursuit of diet perfection making you sicker?

The Many Root Causes of SIBO

Until next time!!

15 thoughts on “Is your SIBO diet too restrictive? Or not restrictive enough?

  1. Hi! I have been on a no sugar, no caffeine, no alcohol, no dairy, no fruit, no gluten diet for about 3-4 months now (basically paleo). Testing has shown I have low stomach acid and dysbiosis but my doc thinks it could be SIBO. I’ve shown sensitivities to a number of fruits / veggies such as avocados, tomatoes, potatoes, and bananas and have avoided that as well. It leaves me with a pretty restricted diet of mostly lettuce/spinach/kale, broccoli, cauliflower, zucchini, onions, cucumbers and bell peppers (plus meat, eggs, coconut cream, almond milk. I’ve recently stopped eating any nut flours/nuts). But I’m so sick of eating the same stuff. I’ve been on a new probiotic for about a month and have started grapefruit seed extract as well. I take digestive enzymes, a yeast cleanse which includes pao de arco and some other good stuff, and adrenotone for my hormones. Basically, I’m wondering if I should try branching out into fruit at this point and starchier veggies like sweet potatoes to broaden my food choices. I have stayed so far away from them fearing that it’ll make everything worse, but I am miserable on this protocol as well. It seems like I’m always bloated regardless of what I’m eating anyway. It does seem like I’m mildly less bloated the past month, but it’s constantly still
    there morning/day/night. Some foods seem to give me more acid reflux so I stay away from them, but as far as the bloating, it’s always there. Any suggestions would be helpful!! I was having mild reflux with ACV before meals and HCL betaine, but hopefully after my gut heals a little more I can handle it.

    • Awww man! Ive been exactly where you are at! Did you react to fruit and starches before you started restricting?? Also, in my opinion, if you are bloating no matter what you are earing, there are probably some underlying root causes that need to be addressed.

      • My biggest issue is that I don’t really know what makes it better or worse. I know I have low stomach acid so nothing is properly digesting, and I know certain foods will cause acid reflux, but anything else just kind of sits in my stomach. It’s not really that certain foods I’m eating now make the bloating worse at this point, it’s just that the bloating is always there if that makes sense. I’m never hungry. I never noticed anything happening with fruits though. I just don’t really know what to look for to see if what I’m eating is making anything worse??

  2. This is SO well written. THANK YOU. I was diagnosed with SIBO a few months ago and since then have been working with a naturopath to try and heal. I’ve hard 2 relapses so far. My diet has been extremely restrictive as your post reflects what I’m going though so well… anxiety over food, weight loss, low energy, social isolation… I need to try and find my sweet spot.

  3. izrabotkasait says:

    Reading blogs like this – i tried to eat fruits and vegs and restrict animal products – result is disaster – so this talks that carbs are not bad are just dreams of some people – if meat makes me feel bad this does not mean at all that i can eat fruits. ANd actually i can tell you that SAD diet is one of the best for sibo – just read fast tract diet and Mark Pimentel and you will wee why. I tried super restrictive and healthy diet – SCD, low fodmap, alkaline and raw vegan – cucumbers, peppers and grapes – result – total disaster – i guess because of fructose in grapes. I bet that 90% of sibo sufferers will feel better eating white bread than raw fruits and vegs – and all claims about vitamins and minerals in fruits and vegs are BS – modern fruits are almost as bad as sucrose.
    There are only 2 diets that work for sibo – elemental and fast tract – SCD, GAPS, FODMAPS, SIBO specific diet from ALison Siebecker – just don’t work. SCD is absolutely idiotish diet – it forbids glucose – glucose is the main source of carbs in elemental diets – and it s proven to work after 2-3 weeks.

    • First, thanks for responding with your experience. It seems that we both did not do well on very restrictive diets. I just want to be clear that I am not suggesting a raw vegan diet. I believe meat is very nutrient dense and is a crucial to maintaining the integrity of the GI tract. I also think cooking fruits and vegetables can be a lot easier on the GI tract. I personally found that sauteeing apples in coconut oil was really soothing on my GI tract (but this may not work for everyone). Second, while eating white bread may decrease symptoms in the short term, it may exacerbate inflammation in the GI tract, especially if someone has gluten issues. Third, I don’t believe that there are “only 2 diets that work for sibo.” SIBO is very complex and usually requires finding the diet that works best for you. And like I mentioned in the article, I think the Elemental Diet can be very effective at starving the bacteria for some people but it should be viewed more as a treatment than a diet. But, ED doesn’t work for every person just like Low FODMAP doesn’t work for every person.

  4. Angela says:

    I am newly attempting the Fast Tract Diet as a way to potentially get my reflux under control and wean off PPI’s. I’m just wondering if there’s any hope of eventually coming off a diet so restrictive? I’m reading a lot of responses that make me think no, that it is something you must do for life. It just requires so much analyzing and thought, am I dreaming that I could eventually potentially reach a place of healing where I could return to where I was and my intestines could again digest foods without bloating like they did before everything went south six months ago?

    • Amy Hollenkamp says:

      Hi Angela! There is definitely still hope! I was in a very similar place as you about a year and a half ago…planning out every meal and my life revolving around “not feeding the beast”. But, I found that when I focused on the underlying causes of my SIBO (hormones, brain-gut axis and large intestine imbalances) I started to progress from a symptoms and food tolerance perspective. I think one of the biggest things I have learned through my SIBO journey is that DIET is a small part of SIBO treatment….when it starts to consume your life and become the primary treatment/management strategy it can really lead to a road block in your recovery. Hang in there and keep digging to your root cause!

  5. Leigh says:

    Hi Angela,
    Thanks so much for this post! I feel like there’s no hope of recovery. I’ve been battling Sibo for the past 5 months, with both elemental and herbals and it still hasn’t even gone away once. I have MS and have found that AIP works best but I agree with you about the diet restrictions. When I was trying to combine AIP with FODMAP/SCD, it became impossible. I’m on meds for motility but I’m wondering about other causes that aren’t being addressed. Can you elaborate on specific treatments you did to correct hormones, brain-gut axis and large intestine imbalances? I would appreciate any extra input! Thanks so much!

  6. Jocelyn says:

    Hi Amy, I read you also have thyroid issues. I actually don’t know where to start. It seems I’m in a vicious circle. I definitely have HPA-axis issues due to youth trauma and also IBS since age 14 (now 55). I started to have more serious health issues after 4 yrs of lots of stress in 2002/2003. It started of with sleeping issues and a fes years later I was diagnosed with Hashimoto’s. I also have gut imbalances, although 2 test in 2005 and 2008 showed different results. Although I’m on thyroid hormones sinces 2007, it is clear to me that it is not having any effect. And I am constantly bloated, no matter what I eat although some times it may be worse. But it is almost impossible to link it to specific foods. After having done 2-3 anti candida protocols over the years I still have slightly elevated levels in organic acid test. I have at least 3 active virusses, have low cortisol, am low in iodine, too low or on low side of (essential) amino acids. Have 23 intolerances, but leaving them out does nog seem to have any effect. I cleaned up my diet not eating gluten, virtually no dairy, eat lots of veggies (and legumes). Also been taking lemon with water before eating, digestive enzymes, beatine HCL (which makes me smell of fish 😝), to no avail. I also now seem to have methane SIBO. So, where to start? SIBO is a result of many other problems like thyroid, but not being able to get my thyroid to work because of low immune system due to dysfunctional gut and virusses, I wonder what you did having Hashimoto’s as well……

    • Amy Hollenkamp says:

      Hi Jocelyn! I know that it can be so confusing when you have multiple health issues going on! Everything seems like the chicken or egg situation doesn’t it! I did have hypothyroidism, but it appeared to be secondary to HPA axis issues and some poor dietary choices (low iodine, low carb and too many goitrogens) and not autoimmune in your case. What meds are you on for Hashimotos? NDT or synthroid? Sometimes people do better on NDT because it has T3 and not just T4 (but you seem like you have dug deep so maybe you have already considered this). I would definitely focus on optimizing thyroid hormones if they are not optimized already. Once you get those squared away, I would try to work on your HPA axis and any remaining motility issues (through vagus nerve stimulation). I believe that chronic stress and weak vagus nerve functioning go hand in hand. Working on stress management through meditation or hiking would be a good step! Meditation has done wonders for my GI tract. Along with some vagus nerve exercises (singing, humming, gagging, gargleing, etc) to help boost MMC function! I would worry about dietary changes last since nothing really seems to help! Best of luck!

      • Jocelyn says:

        Thank you for your reply, Amy. I indeed have tried natural dissected thyroid hormone (Armour). Did also not help 😬. Here we don’t have synthroid. I’m now on Tirosint (which is a capsule, ie no fillers), Cytomel (T3) and some Armour. When I draw blood without having taken meds, my T3 is too low. However, even taking T3 does not make me feel better. (And TSH is already pretty fast with the too low T3).
        I think I need to work on the nervus vagus part. Hopefully that will get things moving in the right direction…. hopefully this also helps getting my digestion in better shape.

      • Amy Hollenkamp says:

        Sounds like a good plan!!! I’m wishing you the best of luck Jocelyn! Keep us updated on how you are doing 🙂

  7. Jocelyn says:

    Thanks, Amy. If anything changes for the postive I will let you know!

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