What we eat every day not only nourishes us humans, but also our microbiome in the gut. If there is a miscolonization of the small intestine, protozoa such as bacteria or archaea metabolize the nutrients before we can absorb them. This bacterial metabolism produces gases such as methane and hydrogen, which lead to typical Sibo symptoms such as bloating, belching, constipation or diarrhea.
In addition to therapy with conventional antibiotics or antibiotic medicinal plants, nutritional therapy is another important pillar of Sibo treatment. There are basically two different approaches:
1.) The bacteria are fed on purpose so that they do not build up protective mechanisms against antibiotics or antibiotic medicinal plants. With this approach, patients often have increased symptoms because the protozoa produce a lot of gas.
2.) The second approach aims to feed the bacteria and archaea as little as possible. On the one hand, their proliferation is reduced and antibiotic therapy is supported. On the other hand, the symptoms in patients are also alleviated because the bacteria produce less gas.
In my work, I follow the second approach, as it usually brings rapid symptom relief. What do the bacteria and archaea in the small intestine like to eat? Carbohydrates! Therefore, almost all forms of nutrition used by Sibo reduce the amount of carbohydrates. There are now a whole range of nutritional therapies that are used to treat small intestine overgrowth: SSFG, SCD, Low FODMAP, Bi-Phasic Diet, Low Fermentation Diet and others such as GAPS, Paleo or ketogenic. Here are the main ones with their similarities and differences:
Low FODMAP
The abbreviation stands for "fermentable oligo-, di-, monosaccharides and polyols" - fermentable carbohydrates and sugar substitutes. With the low FODMAP diet, these specific carbohydrates are reduced. These include lactose, fructose, fructans, galactans and polyols (sugar alcohols).
Since gluten-free cereals such as rice, quinoa, corn, buckwheat and oats are allowed, this diet still contains a relatively large amount of carbohydrates. It is therefore well suited for slight miscolonization and can also be easily implemented by vegan patients. Compared to the other forms of nutrition, it is less restrictive and also a good transitional diet for the period after sibotherapy.
Specific Carbohydrate Diet - SCD
This diet according to Sidney Valentine Haas reduces many hard-to-digest carbohydrates and was originally designed to treat chronic inflammatory bowel disease. The proportion of carbohydrates is very low, no cereals or starchy vegetables are allowed. In order to get full, the focus here is increasingly on animal foods.
Sibo-specific food guide – SSFG
dr Allison Siebecker combined the SCD with the low-FODMAP diet for these guidelines. It is a relatively restricted diet for initial symptom relief, but shows good results in many patients. For expansion, add jasmine or basmati rice and potatoes.
Biphasic Diet
The two-phase diet is based on the Sibo-specific food guide. dr However, Nirala Jacobi divides it into two phases. While the diet is very low in FODMAP and carbohydrates for the first four to six weeks, carbohydrates and other FODMAPS are increasingly introduced in the following weeks. dr Jacobi has also published a vegetarian version of this diet.
Low Fermentation Diet, also known as Cedars Sinai Diet
The one from Dr. Mark Pimentel reduces hard-to-digest carbohydrates such as fructose, lactose and fiber in whole grain products and legumes, similar to the Low FODMAP diet. Overall, it's easy to follow and a good transition to "normal" eating.
Conclusion
With all diets, one should remember that not all sibo are the same. Since the breath test is used to test gases and not specific strains of bacteria, many of those affected have very individual tolerances. While onions, garlic, tofu, bananas or nuts cause many symptoms, these foods are well tolerated by others. It is therefore worth trying out different forms of nutrition or adding individual foods to them. Experienced Sibo therapists help with this.