Does the FODMAP Diet Work for SIBO?

by Dr. Nick Zyrowski May 10, 2021

SIBO, an acronym for small intestinal bacterial overgrowth, is a common condition that occurs when bacteria that normally grow in your colon or other sections of the digestive tract accidentally migrate to the small intestine.

Because the bacteria are not meant to be there, they can replicate out of control and cause a variety of uncomfortable symptoms, like diarrhea, abdominal pain, constipation, cramping, and even malnutrition since your digestive system won’t be absorbing nutrients as usual.

To treat SIBO, many doctors recommend particular diets, including paleo diet, the specific carbohydrate diet, and the low-FODMAP diet most of all. Let’s take a closer look at the low-FODMAP diet and examine whether it’ll be a good choice for tackling your SIBO symptoms.

What is the Low-FODMAP Diet?

In a nutshell, the low-FODMAP diet is a diet that seeks to minimize your consumption of:

·         Fermentables

·         Oligosaccharides

·         Disaccharides

·         Monosaccharides

·         Polyols

These are groups of carbohydrates that are difficult for your body to digest. Normally, these fermentable carbohydrates ferment in the large intestine and are slowly digested with time, providing your body – and helpful bacteria called probiotics – with valuable nutrients and energy. 

Unfortunately, sometimes bacteria can get into your small intestine and will gather these FODMAPs for energy. Fermentation can't occur here, so this contributes to SIBO and can cause symptoms like bloating, stomach pain, gas, nausea, and more.

By reducing your intake of FODMAPs, the low-FODMAP diet seeks to gradually starve the bacteria in your small intestine. Eventually, your intestine is left without the harmful bacteria, although you will have to endure some uncomfortable side effects until the bacteria are fully flushed from your gastrointestinal system.

The low-FODMAP diet will have you eliminate high-FODMAP foods from the following groups:

·         Oligosaccharides from foods like wheat, legumes, rye, and several fruits and vegetables like onions and garlic, which all have glucose

·         Disaccharides from foods like dairy products, as lactose is the primary disaccharide carbohydrate molecule

·         Monosaccharides from foods like mangoes, figs, honey, and agave nectar, as fructose is the primary carbohydrate

·         Polyols from foods like blackberries and low-calorie sweeteners in many products like gum

Additionally, the low-FODMAP diet will have you eliminate other potentially problematic foods like gluten, sorbitol, and more.

In exchange, you’ll replace these carbs with low-FODMAP foods that do not include many or all FODMAPs, including lean meats, leafy green vegetables, artichokes, eggs, and certain fruits like blackberries and strawberries. Your gut health should improve as a result.

How Can the Low-FODMAP Diet Work for SIBO and IBS?

The low-FODMAP diet can work for both SIBO and similar conditions like irritable bowel syndrome or IBS or celiac disease.

In SIBO’s case, the low-FODMAP diet works by slowly eliminating the food sources of bacteria that collect in your small intestine. By getting rid of FODMAPs, the harmful bacteria are gradually flushed from your body over time, eliminating the symptoms of SIBO along with them.

Many people also experience relief from IBS symptoms when they follow low-FODMAP or other diets intended to treat SIBO. This is likely because many irritable bowel syndrome symptoms are caused by bacterial imbalances in either the large or small intestines (or both).

In some ways, the low-FODMAP diet is a kind of reset for your digestive tract.

Furthermore, the low-FODMAP diet will have you follow two phases in any complete diet plan:

·         The elimination diet phase, where you eliminate all FODMAPs you can

·         The reintroduction diet phase, where you reintroduce one FODMAP at a time to see if that particular carbohydrate type is responsible for SIBO, IBS, or other issues

Through this method, you can gradually build up a knowledge of food sensitivities and incorporate healthy or neutral FODMAPs back into your diet with time. FODMAPs that cause problems can be safely eliminated from your diet in perpetuity.

The FODMAP diet takes time to kick in, especially if you follow the above two phases (which are completed in cycles) and follow a low-FODMAP food list closely.

Is it Safe to Follow the Low-FODMAP Diet for a Long Time?

No. Remember, FODMAPs are just fermentable carbohydrates and are crucial for feeding the probiotics or beneficial bacteria in your large intestine. They play a key role in overall bodily nutrition and many FODMAP foods are excellent sources of protein, energy, vitamins, and minerals.

Therefore, you should not expect to follow the low-FODMAP diet for very long. It’s best used as a short-term tool to tackle SIBO, IBS, and other digestive disorders or conditions.

If you were to follow the low-FODMAP diet for too long, your body will eventually lose stores of certain nutrients and you might experience other harmful side effects due to your gut bacteria dying off.

Furthermore, the low-FODMAP diet has been known to cause weight loss in individuals who follow it for months. Therefore, it’s a bad SIBO solution for people who are already underweight. Note that the low-FODMAP diet is not necessarily meant for weight loss, but due to eliminating so many foods, this side effect often occurs unintentionally.

What Else Works for SIBO?

Alongside following a specific diet, you and your doctor might decide on alternative therapies or SIBO treatments.

These include the use of antibiotics, especially rifaximin. This antibiotic is one of the most commonly used to tackle SIBO.

An antibiotic can be used to treat SIBO because it eliminates the bacteria in your small intestine: the root cause of SIBO symptoms in the first place. However, antibiotics are also short-term solutions just like the low-FODMAP diet.

If taken for too long, antibiotics can also kill the helpful or beneficial bacteria in your large intestine. When this occurs, you might experience other digestive disorders or side effects. Antibiotics are best used as targeted solutions when prescribed by your doctor.

Some individuals also decide to use herbal antimicrobials, which have the same overall effect and which must only be taken for specific time frames only to prevent the decimation of your microbiome overall.

Bottom Line: Is Low FODMAP a Good SIBO Diet?

It can be. Studies do show that the low-FODMAP diet is successful at reducing SIBO symptoms across the board, particularly when followed correctly and for a short period of time.

However, you have to use the diet as it is intended and eliminate all FODMAPs possible from your diet in order to reap the expected wellness benefits. Furthermore, to take full advantage of the low-FODMAP diet, you’ll want to practice both the elimination and reintroduction phases so you can gradually bring FODMAPs into your diet as quickly as possible.

As with all diets or lifestyle changes, be sure to speak to your doctor or a dietitian before starting the low-FODMAP diet. They’ll be able to tell you whether this diet is a good choice for treating your SIBO symptoms or if you should pursue alternative solutions, like antibiotics.

Dr. Nick Zyrowski
Dr. Nick Zyrowski

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