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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.

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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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Questions & Answers

Can I Catch SIBO From Someone Else?

Is SIBO a contagious disease?

No, not at all. It’s a digestive condition in which there is an overgrowth of bacteria in the small bowel. SIBO can’t be passed from one person to another.

Many people worry about contagion when it comes to digestive disorders. Helicobacter pylori can indeed be passed by sharing utensils, but it very rarely happens unless someone is immunosuppressed. However, SIBO is not contagious under any circumstances.

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Samuel Hahnemann, the founder of homeopathy, believed that people attracted disease to them a little bit like iron. A magnet and iron are attracted to each other. For you to attract illness, you have to have a certain susceptibility. His idea is that if your energy is vibrating at a certain level, your body will reject rather than attract a disease. It follows from this theory that if you keep yourself in pretty good shape, you’re less likely to get sick. Healthy people have a much lower chance of getting sick than someone who is already unhealthy.

SIBO, inflammatory bowel disease, and constipation are all examples of GI conditions that are not contagious. You don’t “catch” these illnesses. However, when your body is susceptible, you’re much more likely to develop a health condition.

Stress often contributes to reduced resistance to illness. It’s stress and a lowered resistance rather than catching SIBO from someone else that should worry you.

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Questions & Answers

The Best Gut-Health Tests

The lactulose breath test and the comprehensive stool analysis are two tests used to determine what’s going on in your gut.

Many people these days are quite keen on doing breath tests such as hydrogen tests, methane tests, and lactulose tests.

Are breath tests better at telling you what’s going wrong in your gut and what to do about it? Or, does the comprehensive stool analysis have more to offer?

In my opinion, a comprehensive stool analysis (CSA) is the gold standard in gut investigations. With a CSA, you not only get the species but the levels of each. The CSA provides a measure of the diversity of the gut flora while the breath test just tells you whether a specific bacteria is present or absent. A breath test tells you a little, not a lot.

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In contrast, the CSA also provides measures of inflammation and your immune system. Because the CSA provides so much more information than a breath test, it allows for a much more evidence-based treatment plan.

Finding someone to interpret the CSA shouldn’t be too difficult.

If I were to start my career again as a naturopath, I’d probably only focus on stool testing and do nothing but, because that test has given me more results than all of the other tests put together. I genuinely believe a CSA is worth every penny.

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Questions & Answers

Ten Thing To Know About The Fodmap Diet

FODMAP refers to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The FODMAP diet was developed by a doctor several years ago in the belief that it would be helpful for people with irritable bowel syndrome.

I’m not a big fan of the diet. Many patients that I’ve worked with have been on FODMAPs. I’ve seen some successes, but they’re very limited. I’ve seen more failures than anything. Here are ten things to keep in mind about the FODMAP diet.

1. The FODMAP diet is not a cure-all for IBS or any other kind of gut problem. What you would be doing is taking aggravating carbohydrates out of the diet. You are removing a trigger but not the underlying cause.

2. The FODMAP diet is not a gluten-free diet. Some people seem to think that the FODMAP diet is gluten-free. That’s incorrect.

3. You don’t’ need to eliminate all fiber on a FODMAP diet: Some people think the point of the FODMAP diet is to reduce your fiber intake as much as possible. But fiber is not really the issue; it’s the sugars. However, many FODMAP foods are also high in fiber, so when you cut them out, you lose out on that valuable component of the diet. Make sure you get enough fiber while you’re on a FODMAP diet. For example, kiwi fruit, a small amount of oats, pumpkin seeds, and quinoa are all allowed on the FODMAP diet and can provide the fiber that is so important to your GI tract.

4. The FODMAP Diet should be a short-term approach. Do not go on the FODMAP diet for months at a time. When it was first introduced, it was designed as a two to six-week solution to reduce IBS symptoms.

5. Oils and fats are permissible on the FODMAP diet. I still get emails from people who have come to believes that being on the FODMAP diet means taking butter, oils, and other fats out of the diet. FODMAP is not a low-fat diet.

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6. Think about social events and plan in advance, so you know there will be food for you to eat.

7. If you’re considering going on the FODMAP diet, don’t do it until you’ve had a comprehensive stool analysis. In my experience, over 50% of IBSD cases have levels of harmful bacteria that need to be addressed. It could be Citrobacter, Klebsiella, or Pseudomonas. There could be a problem with yeast as well. Clean up your gut, and it may be that you don’t even need to go on the FODMAP diet.

8. Don’t become the FODMAP police. That means don’t walk around telling people what they should or should not be eating.

9. Work out was causing the IBS before going on a FODMAP diet. Was it too much alcohol? A stressful lifestyle? Antibiotics?

10. Customize the FODMAP diet to your likes, dislikes, and symptoms. If you’ve treated the findings on the stool test and still have symptoms, a trial of the FODMAP diet is a reasonable option. But, focus on removing the foods that give you the most trouble. It’s fine to be on a partial FODMAP diet if that’s what works for you.

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Questions & Answers

Why Your Stomach Growls

Let’s talk about stomach growling.

What the heck causes all that growling coming from your stomach? Does it mean you’re hungry all the time?

People sometimes jump to the conclusion that something bad is happening if they feel sensations in their gut.

It turns out the growling and movement you feel in the stomach have nothing to do with hunger pains. The noise is being generated by the migrating motor complex (MMC). The MMC is a collection of nerves responsible for the wave-like peristaltic movements in your GI tract. The smooth muscle in your gut is contracted, creating a sweeping-like action that clears out the contents of the GI tract between meals.

Growling is a good sign. It means that your body is doing the proper “housecleaning” of the gut. Automatically jumping to the conclusion that a growling stomach needs food is not a good idea. It interferes with the valuable actions of the MMC. Throwing food into your GI tract prematurely means that the passage of food slows down, allowing for gases and toxins to be produced. It can even give harmful bacteria and yeast the opportunity to significantly increase in number and trigger the beginnings of SIBO.

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Be careful not to misinterpret the actions of the MMC as evidence of hunger.
When you get growling and the sensation of movement in your abdomen, rejoice. Your body is working as it should. Many of the clients with constipation that I saw over the years never really had the sensations associated with a working MMC.

Often people with constipation will try and take something to get the bowels working. But the best thing to do for constipation is to be patient, wait, drink some water, and wait some more. The MMC will kick in, especially if you’ve got good levels of beneficial bacteria in your gut. The MMC is very effective if you have a three or four level of lactobacillus and bifidobacteria and a generally balanced microbiome.

A good way to keep the MMC in working order is to not constantly snack on food throughout the day. The best idea is to have a regular breakfast, lunch, and supper. If you need a snack, a piece of fruit is the best option.

So, there you have it. The growling sensation is a sign that the body’s housekeeping system is in working order. If you want to live a long, healthy life, you want a healthy MMC.

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