Questions & Answers

SIBO And Low Fermentation Diets: Yes Or No?

I read an interesting paper about using a low-fermentation diet for SIBO. This diet comes out of a laboratory at Cedars-Sinai Medical Center.

I don’t agree with all of the recommendations out of this diet. For example, it recommends against yogurt, and yet, in my experience, yogurt is one of the best foods to help clean up the gut. Of course, I’m talking about high-quality, sour, Greek yogurt, not the artificially sweetened industrial type that fills the supermarkets. The yogurt I eat contains plenty of beneficial bacteria. Most of the lactose has already been digested by bacteria.

I’ve yet to meet a sick person whose gut can’t tolerate a teaspoon of yogurt. I’ll often start with that dose. If even that amount is hard to tolerate, we’ll work on cleaning up the diet in a different way.

The low-fermentation diet describes rice, potatoes, and sweet potatoes as the best carbohydrates for SIBO. That’s true but they should also clarify that it is best to cook these carbs first and then bake or fry them the next day. This allows the starch to become more digestible. If you have a gut issue, baked rather than boiled or mashed potatoes are much more tolerable.

Further readings:

Peanut butter is compatible with a low-fermentation diet. I beg to differ as I consider peanut butter to be an unhealthy food choice. The mold and aflatoxin found in peanut butter pose a risk to liver health. In my experience, peanuts are particularly allergenic for people with SIBO or leaky gut. If you want a gut-healthy nut, have a serving of almonds or Brazil nuts.

Although chocolate is deemed acceptable on the low-fermentation diet (with a warning to watch out for milk chocolate), I disagree. Dark chocolate is fine for healthy people, but if your gut is giving you any trouble, I’d stay away.

What really surprised me was reading that Rice Krispies are considered an ideal breakfast on the low-fermentation diet. I would never recommend refined, starchy rice. Oats or eggs are definitely better breakfast options to my mind.

There’s a warning to watch out for butter, but I personally have never seen clients run into problems from using a high-quality butter.

If you have SIBO, my recommendation is to follow a common-sense diet. If a particular food causes you distress, eliminate it from your diet. Once your gut has improved, you can always rechallenge yourself.

I’ve been working in the field for over thirty years, and I’ve seen hundreds of diets. In my experience, they aren’t individualized enough to help people. The best diet for Mary Jo is Mary Jo’s diet. Our guts are unique, which is why I recommend avoiding cookie-cutter, one size fits all diets. I’ve yet to meet two people with SIBO who have identical microbiomes.

Please don’t fall for the line that we all have to be gluten-free, lactose-free, and dairy-free. Modify your diet to meet the needs of your gut, particularly if you have SIBO or inflammatory bowel disease.

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