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Alexandra is a Functional Medicine Certified Health Coach & Holistic Nutritionist specializing in IBS, SIBO, and Gut Health. She helps her clients identify the root causes of their chronic gut issues with functional testing, supporting their bodies holistically and implementing the necessary lifestyle changes long-term to regain control of their bodies and enjoy food freedom. Book your FREE SIBO Assessment call now >>>

The most popular SIBO diets pros and cons PART 2

Many different diets are recommended when you are dealing with SIBO (Small Intestinal Bacterial Overgrowth). Knowing the difference and choosing one diet could already be a challenging step. There is no right or wrong type of diet; each individual has various needs, metabolism, underlying reasons, and sometimes it may take a trial and error process to find the best fitting one. But I am here today to give you more information about these SIBO diets.

In my previous blog post, I wrote about the roles the diet plays in the treatment process and >> the most popular SIBO diets, specifically about the pros and cons of the low-FODMAP diet, the Elemental diet, and the SCD diet.

In this post, I am going to cover the other commonly used SIBO diets:

  • The SIBO Specific Food Guide (SSFG),
  • Bi-phasic diet,
  • Cedars-Sinai low fermentation diet,
  • Fast Tract Diet.
Blog: The most popular SIBO diets pros and cons PART 2.

SIBO diet#4: The SIBO Specific Food Guide (SSFG)

The SSFG diet was created by Dr. Allison Siebecker ND, who is passionately teaching about SIBO and participating in summits.

Dr. Siebecker combined the Specific Carbohydrate Diet (SCD) and the Low-FODMAP diet and classified foods into different categories between "SCD legal"/low-fodmap and SCD "illegal." It contains several modifications to the original diets based on her clinical expertise in SIBO treatment. The diet aims to reduce a variety of fermentable carbohydrates to achieve symptom relief. It restricts foods and also defines the allowed quantities for certain foods.

You can >>download the SSFG diet from Dr. Siebecker's website to learn more about the allowed and not recommended foods.

What are the Pros?

  • It can help reduce digestive symptoms such as bloating efficiently
  • It was created explicitly for SIBO treatment
  • It can be a great choice in case of severe symptoms

What are the Cons?

  • It is considered to be a very restrictive diet
  • Possible nutrient deficiencies or weight loss if the diet is not designed well
  • It can be challenging to follow the guidelines
  • It may trigger food fears contributing to disordered eating
  • There is no guideline for reintroducing foods, so many people may get stuck in the strict phase
  • No clinical trials have been done yet

SIBO diet#5: The Bi-Phasic Diet

The Bi-Phasic Diet was created by Dr. Nirala Jacobi, a SIBO Specialist. She further developed Dr. Siebecker's SIBO Specific Food Guide and split it into two phases. This diet protocol contains a particular gut healing phase and a phase for treating SIBO with antimicrobials.

The first phase is the most restrictive one because it removes all grains, dairy, sugar, legumes, and many vegetables as well as fermented, processed foods. Some of the foods can be reintroduced in Phase 2.

According to the plan, the first phase is typically recommended to follow for 4-6 weeks to reduce the bacterial overgrowth by removing fermentable carbohydrates and giving a chance for the gut lining to heal. Besides, practitioners can prescribe gut-healing nutrients, specific probiotics to boost the process. Phase 1 is divided into two sub-phases to manage the strictness of the diet, which are the "Phase 1 restricted diet" and "Phase 1 semi-restricted diet". This phase can efficiently help reduce symptoms such as bloating.

In the second phase, which is also recommended for 4-6 weeks, the focus is on further reducing overgrowth using antimicrobials. In this phase, the diet is a bit more permissive to feed the bacteria to avoid them going dormant. It also gives a great emphasis on avoiding relapse by using prokinetics to restore motility.

Based on clients' request, Dr. Nirala Jacobi and nutritionist Anne Criner created the Vegetarian version of the SIBO Bi-Phasic Diet, allowing more soaked/sprouted grains and soy products as the original version was quite heavily meat-based.

She has also developed another version of the diet with dietician Heidi Turner, the Histamine SIBO Bi-Phasic Diet for people suffering from histamine intolerance besides SIBO. The diet aims to remove not just fermentable carbohydrates but also high-histamine-containing (histamine liberating) foods. The diet is recommended for short-term use. Read more about the >>SIBO and histamine connection.

>> Download the Bi-phasic Diet here

>> Download the Vegetarian SIBO Bi-Phasic Diet here

>> Download the Histamine SIBO Bi-Phasic Diet here

What are the Pros?

  • It can help reduce digestive symptoms such as bloating efficiently
  • It was created explicitly for SIBO treatment
  • It can reduce the side effects of bacterial/fungal "die-off"
  • It has a very structured format – more straightforward to see what is allowed and should be avoided
  • It has more versions (Vegetarian, Histamine)

What are the Cons?

  • It is considered to be a restrictive diet
  • Possible nutrient deficiencies or weight loss if the diet is not designed well or followed too long
  • It can be challenging to follow the guidelines due to the different phases
  • It may require a Practitioner for a better outcome
  • It may trigger food fears, contributing to disordered eating
  • No clinical trials have been done yet
best sibo diet pros and cons

SIBO diet#6: Cedars-Sinai Low Fermentation Diet

The Cedars-Sinai Low-Fermentation Diet was created by Dr. Mark Pimentel from Cedars Sinai Hospital to help people with IBS and SIBO manage symptoms and prevent relapse with SIBO.

The diet primarily focuses on removing complex carbohydrates that bacteria might ferment and more difficult to digest, therefore creating gas, bloating, etc. It allows simple carbohydrates that are quickly digested. It also emphasizes that meal spacing is crucial to allow the clearing wave of the gut (Migrating Motor Complex) to kick in and sweep the remaining food particles and bacteria towards the colon. So giving up snacking and sticking to the 3 main meals can be essential to prevent relapse.

What are the Pros?

  • It is less restrictive than other diets
  • A leading IBS researcher created it
  • Recommendation on the eating habits (such as avoiding snacking) is beneficial
  • It may help reduce symptoms
  • It allows simple carbohydrates

What are the Cons?

  • In case of severe symptoms, the diet might not work
  • No instructions on how or when to reintroduce foods back to the diet
  • Being long-term on a low fermentation diet may have a negative effect on the gut microbiome (long term avoidance of prebiotic foods can lead to the decrease of beneficial bacteria in the colon)
  • Some of the allowed foods might be high-FODMAPs and may trigger symptoms in specific individuals (mushrooms, sweet potato)
  • No clinical trials have been done yet

Download the Low Fermentation diet handout to get more information about this diet.

SIBO diet#7: Fast Tract Diet

After looking for a solution for his reflux symptoms, the Fast Tract Diet was created by Dr. Norm Robillard, a microbiologist, founder of the Digestive Health Institute. The diet aims to help reduce symptoms for IBS, SIBO, reflux, and other digestive conditions.

He developed a flexible point system, and a particular point value ("Fermentation Potential" (FP)) is assigned to each food based on their symptom potential (Low, Moderate, High). It means if you eat food with a low(er) "FP," then it is less likely to cause any symptoms.

You can find more information in Dr. Robillard's book: Fast Tract Digestion or on his website.

He has also developed an app for Fast Tract Diet to help you achieve your health goals more easily.

What are the Pros?

  • It can help resolve SIBO and other digestive symptoms
  • Very structured
  • There is an app that can help with the implementation

What are the Cons?

  • Possible nutrient deficiencies or weight loss if the diet is not designed well or followed too long
  • It may trigger food fears contributing to disordered eating
  • No clinical trials have been done yet for SIBO

Which SIBO diet should you choose?

I wish I could give a simple answer to that question, but unfortunately, it is very individual. There is no one-size-fits-all solution when it comes to SIBO. Each of us has various symptoms, metabolism, underlying causes, genes, etc. What might work for one person might not work for you. We also have different mindsets and personalities – some people like eating more intuitively, while others like a structured system.

Finding the best diet could be a trial and error process. I have also tried at least 5 different types of diet until I landed the one I preferred the best.

 

This post is only for informational purposes and is not meant to diagnose, treat or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

The most popular SIBO diets pros and cons PART 2 Read More »

The most popular SIBO diets pros and cons PART 1

If you are diagnosed with SIBO (Small Intestinal Bacterial Overgrowth), you must have been advised to follow a "SIBO diet" for a while (hopefully, not forever!).

The most popular SIBO diets pros and cons

What is SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth and is defined as the presence of excessive bacteria in the small intestine. Bacteria start fermenting carbohydrates, starches, and fibers and produce gases, which can cause damage to the small intestines' wall and lead to various symptoms. (1)

These symptoms could be bloating and gas, diarrhea and/or constipation, abdominal pain, nausea, belching, reflux, rashes, food intolerances, and many more. The whole process would be expected if it occurred in the large intestine, where it is supposed to happen. (2)

SIBO is categorized into different subtypes:

  • Hydrogen
  • Methane (technically not a bacteria, but archaea)
  • Hydrogen sulfide

The main difference between these three types of SIBO is the gases produced by the bacteria or other organisms residing in the small bowel. It is also possible that someone has a mixed type of SIBO, meaning multiple types of gases are present simultaneously. (3)

To get diagnosed with SIBO, you need to do a 3-hour lactulose/glucose breath test.

 

 

What are SIBO diets?

Many practitioners recommend a SIBO diet as an additional tool next to antibiotics or antimicrobial treatment for SIBO.

SIBO diets aim to decrease the number of fermentable carbohydrates in your diet. These diets may help you:

  • relieve uncomfortable or extreme symptoms of gassiness, bloating, diarrhea,
  • reduce "die-off symptoms" during a treatment,
  • reduce inflammation,
  • prevent a possible relapse after treatment.

These fermentable carbohydrates serve as food for the bacteria. Each diet removes/allows specific carbohydrates to address carbohydrate malabsorption issues.

The following diets are mainly used as a SIBO diet:

  • Elemental diet,
  • Low-FODMAP diet,
  • Specific Carbohydrate Diet (SCD),
  • The SIBO Specific Food Guide (SSFG),
  • Cedars-Sinai low fermentation diet,
  • Bi-phasic diet,
  • Alternatively, GAPS, Fast Tract, Paleo, and Ketogenic diet.

It is important to note that currently, there is no evidence that these diets alone can eliminate overgrowth, except the Elemental diet.

Some practitioners have more of a liberal dietary approach based on the client's situation, meaning they don't restrict the intake of fermentable carbohydrates that much. The reason is that they believe that bacteria may form and hide behind biofilms. This protective layer saves bacteria from the effect of antimicrobials or antibiotics, making them resistant to the treatment. Feeding the bacteria may prevent that they hide behind biofilms. (4)

popular sibo diets pros and cons

Let's look at these diets one by one:

SIBO diet #1: Elemental diet 

An Elemental diet is the only exception in terms of using a diet as a treatment option. This diet is one of the most restrictive diets as you are not allowed to eat any solid food for 2-3 weeks. But this is not the same as fasting!

An Elemental diet is considered to be a medical food beverage, a liquid formula composed of proteins (as amino acids), fats (as medium-chain triglycerides), carbohydrates (as glucose or maltodextrin without any fiber), vitamins, and minerals that can be used for symptom management and treatment. (5)

It can help

  • starve the bacteria as nutrients are absorbed before bacteria has a chance to feed on
  • your body get nourished with the pre-digested formula
  • when you have malabsorption issues
  • give the digestive system a break from digestion, so it has finally an opportunity to heal

What does the research say? A 14-day long Elemental Diet has been found to have an 80% success rate in SIBO treatment by normalizing the breath test. (6) So it seems to be highly effective.

What are the Pros?

  • As the research says, it is highly effective to treat SIBO
  • The treatment duration is relatively short (2-3 weeks) comparing to other diets or treatments
  • It is still considered a natural approach that many people like
  • It can help relieve symptoms and improve GI functions
  • It can be beneficial for clients who failed other treatment options in the past
  • For those who don't want to be bothered with cooking

What are the Cons?

  • It can be expensive if it is purchased from a company/brand
  • Homemade elemental diets can be a bit challenging to assemble
  • It usually has an unpleasant taste
  • Emotionally challenging as no solid food can be eaten for 2-3 weeks (no eating out)
  • There is a risk for weight loss if the daily calorie is not reached
  • It may be high in carbohydrates that not ideal for diabetic clients
  • It has to be used cautiously if a fungal overgrowth is suspected

In my opinion, this shouldn't be the first line of treatment but rather the last when all other treatment options have failed. It is best to be used under a Practitioner's supervision.

You can find more information about the Elemental diet on Dr. Siebecker's website.

SIBO diet#2: Low-FODMAP diet

The Low-FODMAP diet is another popular dietary approach that is commonly used among IBS and SIBO patients. It was created by the Monash University (in Australia) for IBS (Irritable Bowel Syndrome) symptom management.

FODMAP is an acronym for "Fermentable Oligo-, Di-, Mono-saccharides And Polyols." (7) These are short-chain carbohydrates and sugar alcohols that are poorly absorbed in the body. The bacteria ferment these carbohydrates and create gases, resulting in abdominal pain and bloating.

It includes:

  • oligosaccharides, including fructans and galactooligosaccharides
  • disaccharides, including lactose
  • monosaccharides, including fructose
  • polyols, including sorbitol, xylitol, and mannitol.

A low-FODMAP diet is recommended for patients with IBS to help reduce digestive symptoms of IBS, including bloating, flatulence, and diarrhea. According to clinical trials, the diet effectively improves symptoms in up to 70% of IBS patients. (8)(9)

A low-FODMAP diet is used for 2 to 6 weeks as an elimination diet to remove foods considered high FODMAP to find out whether these foods are causing a problem for the person with a digestive disorder like IBS to relieve symptoms. Then a reintroduction and a personalization phase should follow.

Here is a brief overview of the low and high-FODMAP-containing foods:

low and high fodmap food list

You can find the exact information about the FODMAP content of foods on Monash University's app.

So, I mentioned that this diet is beneficial for people with IBS, but how about SIBO? Well, there is a connection between IBS and SIBO. Research showed that up to 78% of patients with IBS have SIBO. (10) This explains why the low FODMAP diet is often utilized for SIBO patients, especially when symptoms are identical to IBS.

What are the Pros?

  • Useful for symptom management in clients with IBS (11)
  • It helps reduce IBS symptoms in patients with IBD (Inflammatory Bowel Disease) (12)
  • There is tons of information and an official app that can help with shopping, meal planning, cooking
  • It is less restrictive than other SIBO diets
  • It can help identify possible triggers

What are the Cons?

  • A long-term low-FODMAP diet may have a negative effect on the gut microbiome (as fructans and galacto-oligosaccharides have prebiotic properties – they can feed the good gut bacteria, long-term avoidance of these can lead to the decrease of beneficial bacteria in the colon) (13)
  • Possible nutrient deficiencies if the diet is not well-designed
  • Many people develop food fears and get stuck in the elimination phase for too long, contributing to disordered eating
  • Sticking to the framework can be challenging
  • It can have a negative impact on social events (including eating out)

Many people see improvement in their IBS & SIBO symptoms with the low-FODMAP diet, but some will not see 100% symptom improvement. So, it is good to keep in mind that this is happening because food is not the only factor that affects the gut.

SIBO diet#3: Specific Carbohydrate Diet (SCD)

The Specific Carbohydrate Diet (SCD) is a typical elimination diet that restricts complex carbohydrates, completely eliminating grains. The diet allows monosaccharides but excludes disaccharides and most polysaccharides, which might feed the bacteria without proper absorption and digestive function (enzyme production), resulting in inflammation and digestive symptoms. Removing troublesome carbohydrates may help lower gas production, inflammation, and gut permeability.

Dr. Sidney Haas developed the SCD diet to treat patients with celiac disease, then later Elaine Gottschall published her book "Breaking the Vicious Cycle," and the diet became popular and successfully used for Inflammatory Bowel Disease (IBD) such as Ulcerative Colitis, Crohn disease. (14)

Here is a brief overview of the allowed and not allowed foods on the SCD diet:

scd diet food list

You can find detailed information about the complete list of allowed foods and implementation stages in Elaine Gottschall's book "Breaking the Vicious Cycle."

What are the Pros?

  • It can help reduce the digestive symptoms (especially in IBD controlling acute flare and maintaining remission) by reducing fermentation in the gut (15)
  • Decrease inflammation (16)
  • It can positively influence the microbiome and decrease dysbiosis (17)
  • It can reduce the need for medications (in IBD patients) (14)

What are the Cons?

  • It is a very restricted diet
  • Possible nutrient deficiencies if the diet is not designed well (whole food groups are removed)
  • It requires a lot of preparation, meal planning, cooking
  • It can have a negative impact on social events

What is the relationship with SIBO? There is currently no research proving that the SCD diet is efficient for SIBO, but it certainly may have the potential to help with inflammation and limit the food for bacteria. Therefore, the SCD diet is commonly used among SIBO patients as it removes the complex carbs that bacteria commonly feed on in the small bowel. It can also be helpful for people with a deficiency of carbohydrate enzymes.

In many cases, practitioners combine the SCD diet with the low-FODMAP diet.

The Bottom Line

Whatever diet you may choose, it is essential to know that everyone has a unique mixture of bacterial species that makes food tolerance varied, so diet modification is always required.

A SIBO diet should be followed for no more than a few months. Long-term usage may deplete the beneficial bacteria in the gut, causing more harm than good (especially in the case of the low-FODMAP diet).

These therapeutic diets are meant to help you reduce inflammation and symptoms in a short period. After an elimination phase, a reintroduction phase should follow when you add back foods one at a time and check for any symptoms.

I have also met clients stuck in the elimination phase for too long due to food fear. They saw the nutritious foods as their enemies! That is a dangerous pathway as this might interfere with their recovery process.

Once you have identified your worst triggers, the long-term goal should be to extend your diet as much as possible.

However, the ultimate focus during a SIBO treatment should be on finding the underlying causes that contribute to SIBO.

Check out my next blog post about the other popular SIBO diets, where I reviewed the pros and cons of the SIBO Specific Food Guide (SSFG), the SIBO Bi-phasic diet, the Cedars-Sinai diet low fermentation diet, and the Fast Tract Diet.

 

This post is only for informational purposes and is not meant to diagnose, treat, or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

The most popular SIBO diets pros and cons PART 1 Read More »

5 SIBO myths that may hinder your healing

Suppose you have been diagnosed with IBS (Irritable Bowel Syndrome). In that case, you must be familiar with the awful symptoms of IBS, such as abdominal pain, bloating, diarrhea or constipation, nausea, anxiety, and so on. But did you know that these symptoms are similar to SIBO (Small Intestinal Bacterial Overgrowth) symptoms?

A study showed that up to 78% of IBS cases are actually SIBO. (1)

SIBO myths and truths

What is SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth and is defined as the presence of excessive bacteria in the small intestine. Bacteria start fermenting carbohydrates, starches, and fibers and produce byproducts, such as gases, which can cause damage to the small intestines' walls and lead to various symptoms. (2)

These symptoms could be bloating and gas, diarrhea and/or constipation, abdominal pain, nausea, belching, reflux, rashes, food intolerances, and many more. The whole process would be expected if it occurred in the large intestine, where it is supposed to happen. (3)

SIBO is categorized into different subtypes:

• Hydrogen-dominant

• Methane-dominant (Intestinal methanogen overgrowth / IMO)

• Hydrogen sulfide-dominant

The main difference between these three types of SIBO is the gases produced by the bacteria (or other organisms) residing in the small bowel. It is also possible that someone has a mixed type of SIBO, meaning multiple types of gases are present simultaneously.

 

SIBO Myths and Truths

If you have been tested or even treated for SIBO, you might be aware that there are various theories on how to solve this condition. Many of my clients come to me frustrated after trying different medications or approaches that didn't work and feeling lost that they have to learn to live with SIBO forever. I can relate to these feelings as I was also in the same position once.

Even doctors sometimes get confused about why their treatment plan doesn't work. In the case of SIBO, sometimes you need to be a health detective.

Below are 5 misconceptions I gathered that I often hear from clients or read on social media platforms and wanted to shed light on them.

SIBO Myth #1: SIBO can be diagnosed with a stool test

A stool test can be beneficial if we want to see any fungi (Candida) growth or bacterial imbalances present in the large intestine, but it is not the right tool to test for SIBO. Although some markers may indicate SIBO in the stool test (like Klebsiella or Methanobrevibacter smithii), the most commonly accepted diagnostic methods are:

  • The 3-hour hydrogen and methane breath test is the most widely used, simplest non-invasive test with lactulose and/or glucose substrate
  • Duodenal aspirate cultures (invasive test) (4)
  • Alternatively, the IBS Smart (blood) test (as long as it comes back positive for anti-CdtB and anti-vinculin antibodies) to confirm IBS diagnosis and previous food poisoning event as a cause of your symptoms. (5)

All of these tests should be evaluated together with your symptoms and health history.

SIBO Myth #2: SIBO is the cause of all the symptoms

Of course, many clients are happy when they finally get diagnosed with SIBO after years of suffering from IBS symptoms. Unfortunately, SIBO is primarily a consequence of an underlying condition or dysfunction that makes your small intestine hospitable to excess bacteria. Just simply treating SIBO without addressing the contributing factors will cause relapse.

The body has its defense mechanisms to protect itself against bacterial overgrowth. Some of these defense barriers are:

  • Adequate stomach acid (6), bile (7), and pancreatic enzyme production (8)
  • Well-functioning immune system (9)
  • Intact ileocecal valve (10)
  • Proper gut motility (or Migrating Motor Complex – a clearing motion of the gut to transfer remaining food particles and bacteria towards the colon) (11)
  • Healthy gut microbiome

Anything that negatively influences these barrier functions increases the risk for SIBO. Other contributing factors such as medications (especially PPIs), environmental toxins, or abdominal surgeries (C-section, endometriosis, gallbladder removal) may predispose someone to develop SIBO. (12)

SIBO myths and truths

SIBO Myth #3: Antibiotics are enough to get rid of SIBO

Many doctors prescribe Xifaxan (Rifaximin) as the most popular antibiotic for SIBO for hydrogen overgrowth, as well as additional antibiotics such as Neomycin/ Metronidazole in the case of a methanogen overgrowth. (1) These indeed reduce bacterial overgrowth, but most clients relapse as soon as they come off the medications. Why is that happening so often?

I believe the main reason is that antibiotics don't address the underlying causes. Other reasons can be that some people may need several rounds of antibiotics to see results; some may not even react to the meds. The same goes for herbal antimicrobials. Biofilm formation also needs to be considered, which means that bacteria hide behind a protective layer that makes them resistant to any medications. (13)

SIBO Myth #4: Diet alone can cure SIBO

So far, I haven't found any evidence that would show that diet alone can cure SIBO. The only exception is the 14-day-long Elemental Diet, which has an 80% success rate in SIBO treatment. An elemental diet is a liquid formula composed of amino acids, fats, sugars, vitamins, and minerals that can be used for symptom management and treatment. (14)

There is a lot of information and discussions about the different diets that can be used for SIBO. The following diets are mainly recommended for SIBO: Low-FODMAP, Gut And Psychology Syndrome diet (GAPS), Specific Carbohydrate Diet (SCD), SIBO Specific Food Guide (SSFG), Bi-phasic diet, Fast Tract Diet, Paleo and Ketogenic diet, and so on. So overwhelming, right?

The FODMAP diet (Fermentable, Oligo-, Di-, Mono-saccharides, and Polyols) has gained popularity among IBS and even SIBO patients as a dietary approach to managing functional digestive disorders. (15) It is excellent for symptom management, reducing the uncomfortable symptoms of bloating, gas, and diarrhea by removing certain carbohydrates, but these foods are rarely the root cause of the issue.

Maybe you start strictly cutting out all of the high-FODMAP foods, but several months later, you still get stuck on the low-FODMAP diet, and you keep restricting more and more foods that lead nowhere good. FODMAPs are actually beneficial for good bacteria in the colon, so long-term use of this diet might not be the best idea.

Generally, all of these diets can help reduce symptoms and inflammation and identify triggering foods by removing certain carbohydrates, but they won't solve the root causes of the overgrowth. Deliberately starving bacteria may cause them to be inactivated and dormant.

Many people get stuck on the elimination phase of diets for too long due to food fear or think they might relapse. A reintroduction phase should follow every elimination phase to expand the diet as much as possible.

A general anti-inflammatory food plan can be beneficial, but remember, what works for one will not work for all.

SIBO Myth #5: Probiotics are a cure for SIBO

Probiotics for SIBO are pretty controversial.

Some practitioners say they are necessary, and some say no because they feed the bacteria! So, where is the truth?

The truth is – what many of you hate hearing – it depends! As this can be individual. Some clients feel better when adding probiotics later, which I call 'in the gut-healing phase.'

High-potency multi-strain probiotics tend to worsen the symptoms, while certain specific bacteria strains can be beneficial. It is especially true when somebody has histamine intolerance, for instance, where strains matter a lot!

There are more and more studies coming out on the effects of specific probiotic strains on SIBO. One example is Lactobacillus reuteri (DSM 17938). According to a study, Lactobacillus reuteri was found to lower methane production and reduce chronic constipation, but no effect was seen on lowering hydrogen levels. (16)

A meta-analysis published that "the present findings indicated that probiotics supplementation could effectively decontaminate SIBO, decrease H2 (hydrogen) concentration, and relieve abdominal pain, but were ineffective in preventing SIBO." (17)

Generally, Saccharomyces boulardii (a beneficial yeast) (18) and soil-based organisms (19) are well tolerated as they are less likely to colonize the small intestine.

The Bottom Line

Finding out what type of SIBO you have can be a good start, as different SIBO types require different approaches.

SIBO is a complex functional disorder in many cases. It requires a holistic approach, such as customized food plans, lifestyle changes, healthy sleep hygiene, conventional or herbal treatments, prokinetics, vagus nerve stimulation, etc. But the most important thing is to find the 'why", the root cause(s) behind your condition.

In addition, I want to highlight that there is no one-size-fits-all approach to defeating SIBO. Some clients improve on herbal antimicrobials; some may get better after taking probiotics and prebiotics, while others may improve after they work on their digestive function, gut motility, or nervous system.

Just because one approach hasn't worked for you, don't give up! Keep going and try another one. Trust your body that it can heal.

 

This post is only for informational purposes and is not meant to diagnose or treat any disease.  I advise consulting with your healthcare practitioner regarding any treatment options or dietary changes.

5 SIBO myths that may hinder your healing Read More »

Ileocecal Valve Syndrome in SIBO

ileocecal valve dysfunction and SIBO

What is the Ileocecal Valve?

The ileocecal valve is a sphincter located in the last section of the small intestine (ileum), connecting to the first portion of the large intestine (cecum). It opens to allow digested food to pass downward and closes to prevent the backflow of colonic contents or waste into the small intestine (ileum). (1)

What is the connection between the Ileocecal Valve and SIBO?

In one of my previous blog posts, I wrote about SIBO (Small Intestinal Bacterial Overgrowth); a digestive disorder when an 𝗶𝗻𝗰𝗿𝗲𝗮𝘀𝗲𝗱 𝗮𝗺𝗼𝘂𝗻𝘁 𝗼𝗳 𝗯𝗮𝗰𝘁𝗲𝗿𝗶𝗮 𝗽𝗿𝗲𝘀𝗲𝗻𝘁 𝗶𝗻 𝘁𝗵𝗲 𝘀𝗺𝗮𝗹𝗹 𝗶𝗻𝘁𝗲𝘀𝘁𝗶𝗻𝗲𝘀. Generally, in the small intestine, there should be less amount of bacteria, but when an overpopulation happens, it leads to different symptoms such as bloating, gas, diarrhea/ constipation, abdominal pain, skin issues, food intolerances, etc. (2)

To get diagnosed with SIBO, you need to perform a 3-hour lactulose /glucose breath test.

There are many root causes and risk factors that can cause SIBO. Your body has its own defense mechanism to prevent overgrowth; however, when structural problems (adhesions, blind loops), gut motility disorders (impaired migrating motor complex, medications), or biochemical abnormalities (poor bile flow, low stomach acid, low immunity, thyroid dysfunctions) occur then, it gives the green light to SIBO. An impaired Ileocecal valve function is one of the risk factors that fall under structural issues. (3)

 

What does it mean that the valve is impaired?

It means the valve opens for too long and allows waste to flow back into the small intestine, resulting in ileocecal valve syndrome (ICVS), which may predispose an individual to SIBO (Small Intestinal Bacterial Overgrowth). (4)

Ileocecal valve syndrome occurs when the valve becomes stuck in an open or closed position. An open ileocecal valve may lead to SIBO or diarrhea, whereas a closed valve can cause constipation. Besides, gas production by the bacteria may also put further pressure on the valve. (5)

Other symptoms of Ileocecal Valve Syndrome:

  • Nausea
  • Flu-like symptoms
  • Chronic fatigue
  • Dizziness
  • Ringing in the ears
  • Headache
  • Right shoulder pain
  • Low back pain
ileocecal valve syndrome in sibo

What causes the Ileocecal Valve Syndrome?

  • Dehydration
  • Irritant foods: popcorn, chips, pretzels, nuts, seeds, whole grains
  • Stimulants: caffeine products (coffee, black tea), cocoa, chocolate
  • Alcohol
  • Strong spices: chili, black, and cayenne pepper, hot peppers
  • Infections (parasitic, fungal, bacterial, viral) – post-infectious IBS that occurs after a food poisoning event, and toxins are released by bacteria that interfere with MMC (migrating motor complex, which is a cleansing wave of the gut)
  • Gut dysbiosis (low levels of beneficial bacteria that also have an effect on gut motility)
  • Chronic stress, emotional trauma, and nervous system dysregulation are impacting the vagus nerve function
  • Unhealthy eating habits (not chewing your food well, eating too fast, too frequently)
  • Adrenal imbalances
  • Medications(6)

A study has suggested that dysfunction of this valve can contribute to symptoms such as bloating, gas, abdominal pain, constipation/diarrhea, heart symptoms, insomnia, nerve pain, muscle pain, stiffness, etc. (5)

How to maintain a properly functioning ileocecal valve?

  1. Chiropractic or acupressure treatment
  2. Ileocecal valve massage
  3. Mindful eating habits (chewing well, eating slowly)
  4. Following an anti-inflammatory diet and eliminating the irritating foods from your diet (as mentioned above)
  5. Using natural supplements such as liquid chlorophyll, HCl with pepsin, choline, calcium, and adrenal support (7)
  6. Treating bacterial overgrowth and other possible infections
  7. Repopulating the gut with good bacteria using fermented foods or specific pre-and probiotics

 

 

This post is only for informational purposes and is not meant to diagnose, treat, or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

Ileocecal Valve Syndrome in SIBO Read More »

Is SIBO causing your histamine intolerance symptoms?

Do you experience symptoms such as:

  • itchy eyes, skin, ears, nose,
  • hives, flushing,
  • vertigo or dizziness,
  • heart palpitations; low or high blood pressure,
  • sleep disturbances, anxiety or panic attacks,
  • runny nose – congestion,
  • headaches, migraines? (3)

These symptoms can be frustrating, especially when you do not know what causes them. Maybe you even had allergy tests, but they all came back negative.

Now that is the time to think about histamine intolerance.

The topic of histamine intolerance remains close to my heart because I had been suffering from this condition for several years until I could identify the cause of my weird symptoms, so I know how bad it can be!

sibo and histamine intolerance symptoms

What is histamine?

It is a chemical made by your body that has quite a few roles. Most importantly, it helps the body to get rid of allergens. It is part of the inflammatory response. Histamine allows the white blood cells to fight against pathogens, viruses, allergies. It is also involved in digestion. This component can also be found naturally in many foods. (1)

What is histamine intolerance?

We usually can break down histamine by two enzymes: DAO (Diamine Oxidase) and HNMT (Histamine N-methyltransferase). The problem occurs when these enzymes don't work correctly. DAO enzyme is made in the intestines, and when there is inflammation (which can be caused by many things such as Leaky gut, and SIBO), breaking down histamine will not happen properly. Excess histamine will lead to various symptoms. (2)(3)

Is it always histamine intolerance?

The short answer is no. It is always crucial to talk to your healthcare practitioner to rule out allergies, digestive disorders, or even mast cell disorders.

It is important to note that histamine intolerance is a consequence, not an actual cause in itself. It is associated with different digestive conditions such as IBS (Irritable Bowel Syndrome), SIBO (Small Intestinal Bacterial Overgrowth), IBD (Inflammatory Bowel Disease), Celiac disease, etc. (4)(5)

How to diagnose histamine intolerance?

Some doctors like measuring the DAO enzyme activity in the blood and using a stool test to check histamine levels. Low DAO enzyme levels and high levels of histamine may point to the direction of histamine intolerance, but the results are not always correlated with the symptoms. (3)(6)

The most accurate strategy is to use a low histamine diet as an elimination diet by removing high histamine-containing foods and see if symptoms start improving on the diet. (7)

What about foods in terms of histamine intolerance?

Since it is considered an intolerance, symptoms might not appear right after consuming a triggering food, as in an allergic reaction. Everyone has a certain "threshold," and you may start experiencing various symptoms if that is reached.

It is often recommended to follow a low(er) histamine diet to reduce the symptoms and help you identify some of your triggers.

There are different food categories that you may need to avoid:

Histamine-rich foods such as fermented foods (sauerkraut), aged, cured, processed meats (bacon, salami), cheese, dairy products, vinegar, and certain vegetables: eggplant, spinach, avocado, ripened fruits.

Histamine liberating foods: alcohol, bananas, citrus, tomatoes, legumes, walnuts, wheat germ, chocolate, etc.

Foods that block the DAO-enzyme production, such as alcohol, green and black tea, energy drinks.

You can try to include more whole foods in your diet: fresh (possibly grass-fed) meat and freshly caught fish, rice, quinoa, nut or rice milk, fresh vegetables, leafy greens, healthy oils, pasture-raised eggs, or quail eggs. (8)

sibo and histamine intolerance connection

How is SIBO and Histamine intolerance connected?

  • Small intestinal bacterial overgrowth (SIBO) can cause histamine intolerance symptoms.SIBO is an overgrowth of normal or even bad bacteria in the small intestines, where there should only be a low amount of bacteria present compared to the large intestine.  The body has its defense mechanisms (like gut motility, adequate stomach acid levels, intact ileocecal valve, etc.) to prevent overgrowth. (9)
  • Certain species of bacteria (such as L. casei and L. bulgaricus) in your small intestine may produce histamine. (10)
  • The DAO enzyme, which is responsible for reducing histamines in your intestines, tries to break down the excess histamine from external sources: food, drink, and internal sources such as bacteria.
  • SIBO and other digestive dysfunctions can cause damage to the intestinal wall and brush border enzymes.
  • If the DAO enzyme function is compromised, then it won't be able to keep your histamine levels in check.
  • Excess histamine level contributes to digestive dysfunctions, leaky gut, and food intolerances by causing inflammation.
  • Histamine gets absorbed through your intestines into your blood and increases the circulation of histamine throughout the whole body, reaching many organs: the brain, gut, heart, lungs, skin, and many others.
  • A high level of histamine in these organs leads to symptoms (as mentioned at the beginning). (11)(12)

Besides SIBO, other factors can block the process, such as environmental toxins, infections, stress, medications, hormonal imbalances, thyroid dysfunction, yeast overgrowth, etc.

How to overcome Histamine intolerance and SIBO?

To overcome histamine intolerance, you first need to focus on gut healing. Getting rid of SIBO or infections can help you say goodbye to histamine issues.

  • Removing the triggering foods from your diet that may feed SIBO and inhibit DAO-enzyme production for a few weeks can help ease the symptoms. This can mean an anti-inflammatory diet combined with a low-histamine diet.
  • The necessary cofactors (vitamin B6, vitamin C, Magnesium, copper) can support DAO-enzyme production and DAO-enzyme supplements to reduce symptoms. (13)(14)(15)(16)

  • Certain herb extracts, such as Quercetin, can act as a natural antihistamine and have anti-inflammatory, immunomodulating, and antioxidant properties. (17)(18)

  • Using probiotics can support the gut healing process by resolving SIBO and reducing symptoms and inflammation. (19)(20) Some practitioners claim that probiotics should be chosen wisely to avoid histamine-producing strains.
  • Apply lifestyle changes like fixing your circadian rhythm, working on stress management, and practicing mindful eating habits.
  • Address the root cause of your SIBO and focus on prevention and supporting your body's natural defense mechanisms.

 The Bottom Line

When your body cannot effectively break down histamine, you may experience all sorts of (digestive, neurological, cardiovascular, allergy, etc.) symptoms. In many cases, it takes a while to identify if histamine intolerance indeed contributes to the symptoms. One of the best ways to find out is to follow a low histamine diet and check how your body reacts.

It is crucial to note that histamine intolerance is likely caused by certain digestive dysfunctions, dysbiosis, infections, or inflammation, and it is highly associated with SIBO.

There are natural remedies and lifestyle changes that can support the healing process. Focusing on finding the underlying causes and reducing symptoms with the right food plans can provide significant improvements.

 

This post is only for informational purposes and is not meant to diagnose, treat, or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

Is SIBO causing your histamine intolerance symptoms? Read More »

SIBO and IBD connection

What is IBD?

Many IBD (Inflammatory bowel disease) patients experience symptoms such as fatigue, bloating, abdominal pain, loose/watery bowel movements frequently with passing blood, weight loss, joint pain, etc. (1)

IBD refers to the inflammation of the digestive system, causing severe gut symptoms. The two most common types are Crohn's disease (CD) and Ulcerative Colitis (UC). Although they have similarities in terms of the symptoms and treatment, they affect various parts of the digestive system. (2)

Crohn's disease can affect any part of the digestive tract between the mouth and anus, while Ulcerative Colitis only causes changes in the lining of the colon, starting at the rectum area and moves upward. (3)

Stool tests can rule out IBD; blood tests seek for elevated inflammatory and antibody markers. Doctors may order a colonoscopy to have a closer look.

sibo ibd connection crohns colitis

How is IBD connected with SIBO?

Many IBD patients have IBS (Irritable Bowel Syndrome) symptoms due to SIBO (Small Intestinal Bacterial Overgrowth). According to research, IBD patients have a 9x more significant risk of SIBO than the overall population. (4).

SIBO (Small Intestinal Bacterial Overgrowth) is defined as excessive bacteria in the small intestine. There are too many and/or the wrong type of bacteria present in the wrong place that should generally be found in the large intestine. The overgrowth of bacteria in the small bowel may cause digestive symptoms such as bloating, gas, reflux, diarrhea or constipation, abdominal pain, etc. (5) Read more about the different types of SIBO in my previous blog post.

The body has several protective mechanisms to prevent a potential bacterial overgrowth, such as:

  • Adequate pH of stomach acid is required not just for digesting food and absorbing minerals but also for killing any harmful organisms found in our food, such as parasites, bacteria, etc.
  • Bile flow – which also has an antibacterial effect on the intestines
  • A well-functioning migrating motor complex – that gets activated during fasting periods and clears any remaining food or bacteria out of the small intestine towards the colon. If you constantly snack, then you inhibit this clearing motion. (6)
  • Intact ileocecal valve -is a sphincter located in the last section of the small intestine (ileum), connecting to the first portion of the large intestine (cecum). It opens to allow digested food to pass downward and closes to prevent the backflow of colonic contents, waste, and bacteria into the small intestine (ileum). (7)
  • a healthy microbiome, etc. (8)

In IBD, some of these protective barriers may be compromised, creating a pathway for SIBO. If you have undergone abdominal surgery or had strictures, your risk may be increased.

SIBO and IBD symptoms may produce similar symptoms, so it is better to test for SIBO! According to a study, IBD patients with positive SIBO tests experienced more severe gut symptoms, such as bloating, gassiness, and more frequent loose stools than their SIBO-negative peers. (9)

IBD may be linked to an abnormal immune response triggered by environmental factors, gut dysbiosis, leaky gut, and genetics. (10)

natural remedies for ibd sibo

How to deal with IBD symptoms naturally?

Conventional medicine uses several medicines and immunosuppressants to decrease inflammation and the autoimmune process that might be necessary.

While it is crucial to reduce the symptoms, it is equally important to identify possible root causes of IBD.

In terms of dealing with SIBO and IBD, the main focus should be on:

1. Following an anti-inflammatory diet

Diets may play an essential role in reducing symptoms and inflammation by removing triggering foods and giving a chance for the intestinal wall to heal.

Different dietary approaches have been used for managing the symptoms: Paleo diet, Vegan diet, Specific Carbohydrate Diet (SCD), GAPS diet, low-FODMAP diet, etc. (11)

LOW-FODMAP DIET

The low-FODMAP diet has also been reviewed in the literature as a potential dietary approach for IBD patients. (12)

FODMAP is an acronym for "Fermentable Oligo-, Di-, Mono-saccharides And Polyols." These are short-chain carbohydrates and sugar alcohols that are poorly absorbed in the body. The bacteria ferment these carbohydrates and create gases, resulting in abdominal pain and bloating. Some examples of high-FODMAP-containing foods are cauliflower, mango, apples, onions, wheat, sweeteners like xylitol, and so on. (13)

Generally, a low-FODMAP diet is recommended to help reduce digestive symptoms, including bloating, flatulence, abdominal cramping, and diarrhea. (14) This diet can be beneficial if IBS or SIBO is also diagnosed and other dietary approaches haven't provided improvement. (15) It also has drawbacks because the diet removes some beneficial prebiotics that would improve dysbiosis in IBD patients.

SCD DIET

SCD (Special Carbohydrate) diet is one of the most popular dietary approaches to reduce symptoms and inflammation in IBD patients. (16) (17) Originally, it was created by Dr. Sidney Haas as a treatment for celiac disease, and later, in 1987, Elaine Gottschall published her book "Breaking the Vicious Cycle" as a treatment plan for IBD.

SCD is used as an elimination diet, which aims to remove complex carbohydrates that contribute to the overgrowth of harmful bacteria. The growth of these bacteria produces byproducts that cause inflammation in the digestive tract. In this diet, bacteria's food sources are excluded ( disaccharides and most polysaccharides), such as potatoes, grains (rice, millet, quinoa, wheat, etc.), most dairy products, processed foods, and most legumes, and so on. (18)

SCD is also commonly used among SIBO patients as it removes the complex carbs that bacteria commonly feed on in the small bowel. It can also be helpful for people with a deficiency of carbohydrate enzymes.

The diet also has some pitfalls as it allows dairy, which is often not well-tolerated by many. According to a study, approximately 70% of patients with IBD have lactose intolerance. (19) The diet can be high in nuts, which may cause adverse reactions in some who have oxalate sensitivity.

You can read more information about this diet in Elaine Gottschall's book "Breaking the Vicious Cycle."

ELEMENTAL DIET

When some of the anti-inflammatory diets fail to reduce symptoms, especially when someone is in the middle of a flare-up, then the Elemental Diet can be an excellent reset tool.

An elemental diet is an anti-inflammatory meal replacement formula that is quickly absorbed in the first section of the small intestine and includes all the necessary macronutrients, minerals, and vitamins in a broken-down form. This way, the gut has some pause from digesting whole foods and time to heal. Research showed that it could effectively reduce intestinal inflammation and maintain remission. (20)

An elemental diet is usually used for 2-3 weeks in case of severe digestive symptoms, such as IBD (21), IBD or SIBO (22), or Celiac disease (23).

2. Lifestyle modifications

Stress, especially chronic stress, puts a massive burden on the body by activating the sympathetic nervous system and getting us into the fight-or-flight response. Getting stuck in the fight-or-flight response shuts down digestion and the immune system, among other organs' functions.  Healing the body is only possible when you are in the rest-and-digest response, when the parasympathetic nervous system is activated.

Flare-ups usually happen when somebody goes through a stressful period. Managing stress & shifting the mindset should be crucial elements in achieving optimal wellness.

According to studies, applying relaxation or stress management techniques can improve the quality of IBD patients' lives and reduce inflammation, anxiety, and pain. (24)

Some of these techniques involve:

  • Meditation
  • Breathing techniques
  • Gentle exercises, yoga, tai chi
  • Aromatherapy
  • Music or art therapy
  • Massage
  • Biofeedback therapy

3. Supporting the gut with specific supplements

  • High-potency probiotics – different strains were found to be effective in the active phase of IBD and in maintaining remission. (25)
  • Saccharomyces boulardii, which is a beneficial yeast, showed a decrease in symptoms. (26)
  • Omega-3 fatty acids coming from sources such as fish oils were found to reduce inflammation effectively. (27)
  • Vitamin D – In IBD, low vitamin D levels were associated with increased inflammation (higher fecal calprotectin and higher CRP levels), flare-ups, and medical treatment. (28)(29)
  • Curcumin is a potent antioxidant and has anti-inflammatory properties that can be found in turmeric roots. Curcumin used at a high dosage (3g/day) in Ulcerative Colitis patients with mild/moderate disease activity was shown to reduce inflammation and achieve remission. (30)

Conclusion

Many IBD patients may suffer from symptoms similar to IBS. Studies showed that SIBO (Small Intestinal Bacterial Overgrowth) is more common among people with IBD than the general population due to the compromised protective mechanisms.

It is essential to determine whether SIBO contributes to symptom severity by ordering a lactulose breath test.

A variety of diets can help IBD patients control their digestive symptoms. SCD or low-FODMAP are among the most popular diets. However, these dietary approaches might not be suitable for everyone with inflammatory bowel disease. Unique health history, intolerances, and sensitivities need to be considered to find the best customized diet plan.

IBD symptoms can also be reduced with the right lifestyle changes and supplements.

 

*This post is only for informational purposes and is not meant to diagnose, treat or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

SIBO and IBD connection Read More »