A low fodmap diet for SIBO is used as a dietary intervention as high fodmap foods contain fermentable short-chain carbohydrates that provide food for bacteria to ferment upon and are problematic foods when small intestinal bacterial overgrowth or IBS symptoms are present.
The SIBO diet is a temporary elimination diet that eliminates high fodmap foods in the diet to reduce bacterial overgrowth in the small intestine.
IBS is a common gut problem with symptoms including stomach pain, bloating, gas and changes in bowel habits such as alternating between diarrhea and constipation.
If there is bacterial overgrowth in the small intestine bacteria begin to ferment the carbs too early thus causing many symptoms.
SIBO and IBS are interconnected with the common denominator of high fodmap foods aggravating digestive symptoms and providing food for bacteria that has overgrown in the small intestine which worsens symptoms of IBS.
A high fodmap diet increases gas production which can be measured by a breath test that measures the amount of hydrogen gas in the breath.
A hydrogen breath test is also used to diagnose SIBO which is where bacteria have overgrown in the small intestine.
SIBO can cause and worsen IBS symptoms as the overgrowth of bacteria in the small intestine causes excess fermentation resulting in bloating and gas. Hydrogen dominant SIBO is also connected to symptoms of diarrhea.
By removing the high fodmap foods that are rapidly fermented less gas is produced and the bacteria are starved of their fuel source needed to thrive thus symptoms of IBS can be reduced by using a low fodmap diet.
So, what does fodmap mean exactly?
Fodmaps are known as fermentable and poorly absorbed short-chain carbohydrates. Simply put fodmaps are indigestible sugars that provide fast food for bowel bacteria.
Fodmap stands for
F – Fermentable and rapidly broken down by bacteria in the bowel
O – Oligosaccharides (GOS), which are a few sugars but less than 10
D – Disaccharides, such as lactose which is 2 sugars
M – Monosaccharides, such as fructose which is 1 sugar
A – And
P – Polyols which are sugar alcohols such as sorbitol, mannitol, maltitol, xylitol, polydextrose, and isomalt
Characteristics of fodmaps
Fodmaps are poorly absorbed in the small intestine and instead pass through into the colon. Everyone differs in their ability to digest and absorb various fodmaps but none of us can digest fructans and galacto-oligosaccharides
Fodmaps are "fast food" for the bacteria that live in the colon and are quickly broken down which produces gases such as hydrogen, methane and carbon dioxide.
Oligosaccharides and simple sugars are fermented very rapidly compared to fiber which contains much larger chains of molecules called polysaccharides.
Oligosaccharides are fructans and galacto-oligosaccharides.
The fructans are chains of fructose with a glucose molecule at the end and the most common fodmap to cause symptoms as no one can digest fructans.
High fodmap foods that contain fructans include:
Grains: wheat products, rye, and barley
Vegetables: inulin, garlic, onions, leeks, artichokes
Fruit: persimmon, tamarillo, watermelon, white peaches
Legumes: chickpeas, lentils, black beans, kidney beans, and butter beans
Nuts: pistachios and cashews
Raffinose and stachyose are the most common GOS found in legumes such as beans, lentils, and chickpeas and cannot be digested or absorbed by anybody and should be avoided with IBS.
Only one disaccharide can potentially act as a fodmap in food with is lactose found in milk from cows, goat or sheep, ice cream, yogurt and soft cheeses such as cottage cheese, cream cheese, and ricotta.
High lactose foods contain over 4 grams of lactose per serve but hard cheeses such as cheddar, parmesan, camembert, and gouda are virtually lactose-free.
Fructose is the only important monosaccharide that can potentially act as a fodmap. It is the excess of fructose in comparison to glucose that becomes problematic.
High fodmap foods high in excess free fructose include:
apples, pears, boysenberries, cherries, figs, mangoes, tamarillo, watermelon, asparagus, and artichoke.
Polyols are sugar alcohols that are problematic for IBS sufferers if the foods contain 0.5 grams of polyols per serve.
High fodmap foods high in polyols include:
Fruits – apples, apricots, pears, blackberries, nectarines, peaches, plums, prunes, and watermelon
Vegetables – cauliflower, mushrooms, snow peas
Additives – sorbitol, mannitol, maltitol, xylitol, polydextrose, and isomalt
High fodmap foods can worsen IBS symptoms by drawing water into the bowel which in turn can cause diarrhea. By reducing the intake of high fodmap foods and following a low fodmap diet diarrhea can be reduced.
Following a low fodmap diet for SIBO can help to reduce symptoms associated with both SIBO and IBS. A low fodmap diet should be used in conjunction with a SIBO protocol that addresses the various underlying causes of SIBO.
Optimizing the terrain and improving the upper digestive function by supporting the primary organs involved in digestion is also crucial to prevent small intestinal bacterial overgrowth.
It is also important to eventually bring fodmaps back into the diet when symptoms ease to prevent healthy bacteria loss in the colon as fodmaps are also prebiotics for our healthy gut bacteria as well.
Utilizing a broad digestive enzyme supplement to help break down various sugars and starches so that they are better absorbed by the body instead of being fermented upon can help to reduce symptoms of bloating and gas.
Seeking Health’s Pro Digestion Intensive contains 3 carbohydrate specific enzymes, 4 sugar specific enzymes including lactase to break down the fodmap lactose and 6 plant fiber specific enzymes. Many digestive enzymes only contain amylose as a carbohydrate specific enzyme but Pro Digestion Intensive is a blend of 20 different enzymes.
When sugars, and starches are not properly digested and absorbed they can be fermented upon by pathogenic organisms or gut bacteria in the wrong place thus worsening IBS and SIBO symptoms.
Digestive enzymes are designed to be taken with main meals to help with the break down of the food. I like to utilize digestive enzymes with the foods that are most difficult for someone to digest.
Do you notice specific high fodmap foods aggravating digestive symptoms or IBS?
The Complete Low Fodmap Diet by Sue Shepard and Peter Gibson
How to Stop Bloating
Underlying Causes of SIBO No One is Talking About
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