SIBO Diet: What it is, how to get started, and how it can help you heal

The best nutritional approach to manage those symptoms differs from person to person. Fortunately, there is a process to discover what foods to eat and avoid in order to manage your SIBO symptoms. Ahead, we discuss the process to find SIBO triggers and actionable strategies to manage bacterial overgrowth in the small intestine. 

What is small intestinal bacterial overgrowth (SIBO)?

SIBO is exactly what it sounds like: an overabundance of bacteria in the small intestine. Our guts thrive on healthy bacteria in the right quantities and places. When our guts are operating business as usual, the large intestine has more (and more diverse) bacteria than the small intestine. 

When more bacteria—good or bad—end up in the small intestine than there should be, SIBO occurs. “There’s often a misconception that SIBO is an overgrowth of ‘bad bacteria’ in the gut,” explains Kaitlin Voicechovski, MS, RDN, LDN, Lead Registered Dietitian at Oshi Health. “It’s more accurate to think of it as bacteria simply hanging out in the wrong neighborhood.”

Getting gut bacteria out of the wrong neighborhood usually requires a multi-pronged approach: antibiotics prescribed by a gastroenterologist or GI provider alongside lifestyle changes. Making nutritional changes is also important for treating and preventing future bacteria overabundance in the small intestine—but more on that later. 

SIBO signs & symptoms 

When too much bacteria moves into the small intestine, it can have far-reaching impacts on our health. Common SIBO symptoms include:

• Abdominal pain and/or swelling
• Bloating
• Constipation
• Diarrhea 
• Feeling too full after eating
• Gas
• Loss of appetite
• Mood changes
• Unintentional weight loss 

If you read that list of symptoms and thought they sounded similar to other gastrointestinal conditions, you would be correct! Diagnosing SIBO is tricky, since symptoms overlap with those stemming from other GI conditions. 

Some research suggests over one third of people with other GI conditions experience SIBO, too. Other risk factors for SIBO include being older, a history of abdominal surgery or cancer, and a weakened immune system. 

If experiencing the above symptoms (whether you have any, all, or none of the aforementioned risk factors), you should consult a team of GI specialists.

SIBO is not something you can self diagnose, and DIYing treatment won’t end well, either. Before your appointment, this GI diagnostic quiz from Tamara Duker Freuman, MS, RD, aka the Bloated Belly Whisperer, may provide useful talking points. 

SIBO diet fundamentals

While nutrition alone can’t cure SIBO or address its root cause, what you eat can help with symptom management. For those diagnosed with SIBO, eliminating food triggers may help to reduce uncomfortable GI symptoms. To find these triggers, many turn to an elimination diet such as the low FODMAP diet.

Low FODMAP diet for SIBO

“FODMAPs are carbohydrates that are fermentable by our gut bacteria,” explains Voicechovski. The term is actually an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols (aka four carbohydrate groups that often  trigger GI symptoms). 

Although, she says, “eating high FODMAP foods, carbohydrates, or any other food does not increase the likelihood of developing bacterial overgrowth,” reducing the amount of FODMAPs may reduce symptoms that are exacerbated by the  fermentation of FODMAPs in the gut. “It’s important to note that the low FODMAP diet cannot treat SIBO, rather it can be used as a symptom management tool before and/or alongside treatment,” says Voicechovski. 

Don’t just cut out FODMAPs without guidance, though. For one, identifying high and low FODMAP foods without guidance from a registered dietitian (RD) is a tall order. Second, the FODMAP diet is an elimination diet with specific steps to follow. That’s why our clinical team at Oshi only recommends completing the low FODMAP diet under the guidance of an RD.

Foods to eat and avoid

When managing SIBO symptoms, you’ll want to avoid any trigger foods and ingredients, and instead rely on gut-friendly foods. Of course your individual triggers will vary, and you can pinpoint them with the help of your RD. That said, foods that may exacerbate symptoms associated with SIBO include: 

Common trigger foods and ingredients

• Apples
• Avocados
• Barley
• Brussels sprouts
• Cashews
• Highly processed meats, especially those that contain high FODMAP ingredients
• Pasta
• Soy beans
• Watermelon
• Wheat bread

Gut-friendly foods

Swap trigger foods for gut-friendly options. Popular options include:

• Almond milk
• Blueberries
• Green beans
• Lactose-free milk
• Oatmeal
• Oranges
• Rice
• Strawberries
• Tomatoes 
• Walnuts

Other dietary approaches

Other dietary approaches, such as the elemental diet, are sometimes recommended to manage SIBO symptoms. The elemental diet consists of liquid meals with the basic “predigestive nutrients” our body needs to function (i.e. amino acids, vitamins, short-chain triglycerides, minerals, electrolytes, and short-chain maltodextrins). 

When well-tolerated, this diet can help manage symptoms of multiple GI conditions, including SIBO. However, the diet’s rate of intolerance is over 40%, not to mention a liquid only diet isn’t always accessible or socially acceptable. 

That’s why Voicechovski notes that strict dietary approaches like this one aren’t ideal for managing SIBO symptoms. She instead recommends finding and eliminating any food triggers (aka trying out the low FODMAP diet) and swapping them for foods that can help manage symptoms.

Managing gut bacteria

Since SIBO involves an overgrowth of bacteria in the small intestine, treatment focuses on reducing the excess bacteria rather than simply rebalancing the gut microbiome. To do so, there are a few must-haves to add to your plate (or supplement line-up): 

• Vitamin B-12: “Individuals with SIBO are at a higher risk for B12 deficiency, so focusing on foods rich in B12 such as fish, beef and nutritional yeast or supplementing as needed until levels return to normal should be considered,” says Voicechovski. 
• Fiber: Fiber is your gut’s best friend. It can support healthy gut bacteria and can reduce symptoms of many GI conditions. A soluble fiber supplement may be recommended to reduce SIBO symptoms. A registered dietitian can help you choose which type of soluble fiber may work best for your body.

When it comes to supplements, however, you and your RD should be discerning. “There are many supplements on the market touted as a solution for SIBO, and while they may sound enticing, evidence to support them falls short,” says Voicechovski. 

One supplement she points out? Probiotics. While probiotics can prevent or treat other GI conditions, including IBS and IBD, most strands are unlikely to help treat SIBO. Some bacteria-based strands may put you at risk of a SIBO recurrence. 

Lifestyle and SIBO management

Other SIBO management strategies include improving  meal hygiene, starting a food diary, and staying hydrated.

Improve meal hygiene

When Voicechovski works with individuals diagnosed with SIBO, she not only focuses on what they eat, but how they eat. Good meal hygiene can improve digestion and reduce GI symptoms. More specifically, she recommends staying present while eating. 

Mindful eating hygiene can include:

• Listening to hunger and fullness cues 
• Sitting down to eat
• Not watching TV while eating
• Focusing on the smell and taste of what you’re eating
• Chewing food slowly
• Setting down utensils between bites
• Eating from a well-portioned plate

“While these changes sound simple, they can often be really effective for better digestion and management of unwanted symptoms,” says Voicechovski.  

Keep a food diary

When one of Oshi’s patients undertakes a new nutrition program, our RDs often recommend starting a food diary. A food diary is a great way to track when SIBO symptoms occur and which foods you ate around that time. 

This food and symptom log can help identify patterns.

You can write in your food diary at each meal or once a day, depending on your preference. Logging intake of food/ beverages and GI symptoms daily (or multiple times a day) is a great way to increase awareness of your symptoms and what you eat. 

Stay hydrated

Hydration is key, especially if you have SIBO. A 2022 study looked at how water origin and daily intake impacted gut health in the US and the UK. The researchers’ conclusion: drinking ample water and opting for tap, filtered, or bottled water over well water supports strong gut health. It’s also important to avoid drinking contaminated water (which can include tap water in certain regions in the U.S. and abroad). 

Drinking “enough” water can be difficult to define. While there’s a common myth that you should drink 64 ounces a day, one size doesn’t fit all. Instead, the amount of water you need depends on your gender, activity levels, and age.

Sugary drinks and caffeine may also be triggers for SIBO symptoms. If this is the case for you, consider swapping your afternoon coffee or coke out for something more hydrating, like water or tea. 

SIBO recovery and relief

As we’ve discussed, nutritional changes alone won’t treat SIBO. Your GI provider may also recommend antibiotics, the first line of defense against SIBO. Talk to your GI provider about which antibiotic may be right for you. 

These antibiotics are a short-term, quick fix, not something you’ll utilize for months or years. To complement these temporary solutions, a provider may also recommend the nutritional and lifestyle changes mentioned above.

However, there isn’t one SIBO treatment plan; instead, SIBO recovery should reflect your individual needs and take into account the many aspects of your life and what you eat.

Final takeaways

“SIBO can be successfully treated and gut microbial balance can be restored, though there is risk of recurrence,” concludes Voicechovski, “A GI-focused care team can help individuals with a history of SIBO better understand and address their risk factors to decrease the chance of recurrence.” 

If you’re looking for a GI-focused care team, consider signing up for Oshi Health. Our specialists take a whole-person approach to SIBO, which results in 87% of our patients reporting an improved quality of life in less than three months.