A low fodmap diet for SIBO is used as a dietary intervention to reduce the symptoms of SIBO and bacterial overgrowth in the small intestine.
High fodmap foods contain fermentable short-chain carbohydrates that provide food for bacteria to ferment upon and are problematic when small intestinal bacterial overgrowth or IBS symptoms are present.
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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 and SIBO 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.
Benefits of a low FODMAP diet for SIBO
SIBO and IBS are interconnected, with the common denominator of high fodmap foods aggravating digestive symptoms by 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.
The overgrowth of bacteria in the small intestine is measured using a hydrogen breath test.
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 prevalent when symptoms of diarrhea are present.
By removing the high fodmap foods that are rapidly fermented less gas is produced. The bacteria are deprived of their fuel source needed to thrive. Thus, symptoms of SIBO improve when using a low fodmap diet.
So, what does fodmap mean?
Fodmaps are known as fermentable and poorly absorbed short-chain carbohydrates. These indigestible sugars 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 two sugars
M – Monosaccharides, such as fructose, which is one 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. Simple sugars and oligosaccharides contain 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 to avoid with SIBO include the fructan fodmaps such as:
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. These foods are best avoided on the SIBO and low FODMAP diet.
Only one disaccharide can potentially act as a fodmap in food with is lactose found in milk from cows, goats, 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 crucial to eventually bring fodmaps back into the diet when symptoms ease to prevent healthy bacteria loss in the colon. Fodmaps are prebiotics for our probiotic gut bacteria as well. In the long term, fiber is essential for gut health.
Benefits of digestive enzymes while following the FODMAP diet for SIBO
Taking a broad digestive enzyme supplement can help to reduce symptoms of bloating and gas.
Seeking Health’s Pro Digestion Intensive contains three carbohydrate specific enzymes, four sugar specific enzymes, including lactase to break down the fodmap lactose, and six 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?
Here are some low FODMAP recipes to check out as well!
The Complete Low Fodmap Diet by Sue Shepard and Peter Gibson