SIBO and the FODMAP Diet

Heather_Carrera_NutritionGuest Post: Heather Carrera, MS, Dr. James’ Functional Nutritionist with a passion to utilize nutrition to prevent and heal disease, and promote a healthy, active lifestyle. Contact Heather today for your first consult.

Back in October, I posted about IBS, SIBO, and the test you need to do once you suspect you have SIBO. Now, let’s assume that you already have a diagnosis. What do you do now?

How do you eradicate the overgrowth of bacteria and bring functionality back to your digestive tract?

Introduce the 5 R’s

Any time we talk about healing the gut, we always have to think back to the 5 R’s. These are 5 essential steps that have been developed as a protocol for healing dysfunction of the gut, and would definitely apply in the case of SIBO. Working with a skilled practitioner who is familiar with this protocol and restoring functionality to the digestive tract will help ensure your success.

SIBO and the FODMAP Diet

1. Remove

In the case of SIBO, this refers to correcting dysbiosis, or the overgrowth of bacteria. Remember, infections can cause damage to the specialized cells in the intestines that are responsible for keeping food moving through at a steady rate. Once this damage is done, it can create an environment that plays host to the further growth of bacteria. Clearing an overgrowth of bacteria, and correcting dysbiosis is an essential and first step to the treatment of SIBO.

There are both pharmaceutical, and herbal treatments for the eradication of SIBO. Just because herbal treatments bring to mind a more natural, and gentle therapy, do not be fooled! Many of the herbal protocols are just as, if not more effective than the antibiotic treatments available, and this has been demonstrated in scientific studies (1). You would work with your practitioner to determine the best option for your particular case.

2. Replace

Here is where you would add back the essential components of optimal digestion and absorption that may be lacking, which may have contributed to the development of SIBO. This may include digestive enzymes, hydrochloric acid, or bile salts, which are all required for proper digestion. Your need for specific supplements can be determined based on your degree of nutrient depletion (trace mineral deficiency indicates low stomach acid), or based on your symptoms.

3. Repopulate

Restoring a proper balance of good bacteria is a critical part of re-establishing a healthy microbiome after the SIBO is eradicated. You can do this both by taking a high-quality probiotic supplement and by eating fermented foods. Probiotics are also natural stimulators of the migrating motor complex, which would help promote motility and prevent reinfection. You can also positively influence the microbiome by eating foods that contain prebiotics, the fuel for probiotics, regularly.

4. Repair

Once the SIBO infection is removed, and missing digestive constituents are replaced, the final step is to repair the damage to the gut lining caused by the infection. Several nutrients are absolutely necessary for the gut to begin healing itself. One of these is l-glutamine, an amino acid that serves as the fuel for enterocytes (cells lining the gut wall). There are several other soothing herbs, vitamins and minerals that serve to rejuvenate the gut lining, and restore the integrity of the intestinal barrier.

5. Rebalance

While the other steps do have a specific order, this step can be addressed throughout your SIBO clearing journey. The mind-gut connection is a very real, two-way street. What is happening in your gut affects your mood, and your thoughts and feelings affect what happens in your gut. Work on ways to effectively manage stress, such as practicing gratitude, mindful eating, and meditation, to establish an internal environment that is conducive to healing. One cannot expect to fully heal the gut without working on healing the mind.

What is the FODMAP diet, and where does it fit into the 5 R’s for SIBO?

Anyone doing research on SIBO has most likely come across information on the FODMAP diet. It is a well-documented diet that has been studied specifically for its effectiveness in reducing the symptoms of IBS, specifically those of gas, bloating, cramping and abdominal pain.

What about this diet makes it so effective?

FODMAP stands for fermentable oligo-di-monosaccharides and polyols. Put in another way, FODMAPs are the carbohydrates that we eat that are incompletely absorbed in the gastrointestinal tract, and instead become fermented by gut bacteria. FODMAPs are the food of bacteria. So of course, it would follow that by removing the bacteria’s source of fuel on a low FODMAP diet, IBS sufferers would experience less symptoms- especially when you consider that up to 84% of IBS sufferers’ symptoms are caused by SIBO (2).

Where does the FODMAP diet fit in with a SIBO protocol?

After a SIBO diagnosis, it is tempting to go straight on a low FODMAP diet. Patients feel better, almost immediately, and are elated that their stomachs are finally flat again! But the FODMAP diet is not a cure for SIBO. As soon as you reintroduce high FODMAP foods back into the diet, symptoms return again, almost immediately. This is one of the reasons why we wait on using the FODMAP diet. Another reason is that bacteria are much easier to kill when they are “fed”. If you are continuing to eat FODMAPs during your treatment, bacteria are nice and fat, and a much easier target than they would be if shriveled up and starved. FODMAP diets are best utilized after SIBO has been eradicated, for a limited period of time, and under the supervision of a knowledgeable practitioner.

Keep in mind that unless the underlying dysfunction was addressed during your treatment, SIBO reinfection is almost a certainty. It is important that both the patient and the practitioner understand that treating the SIBO is not the same as correcting the dysfunction that led to the SIBO; both steps must be achieved.


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