In my practice, I see patients that are doing well but I also see many patients who are suffering when it comes to dietary intervention and their SIBO. I can honestly say that there is no clear regimented certified diet protocol – certain diets work for certain practitioners and certain patients, and others fail to work as well. When it comes to the literature, it is clear that feeding the SIBO, the small bowel bacteria, while you are undergoing treatment is important for ultimate success. By feeding these bacteria, you are ensuring that they are thriving ,while you’re hitting them with either antibiotics, such as Rifaximin or nutraceuticals from either Metagenics or Biotics Research that are specifically created to decrease or change the microbiome in the small bowel.
After undergoing the treatment, you can go on a low FODMAP trial for a few weeks in order to starve out the bacteria by not providing them with specific types of foods. The reason that a FODMAP diet works is because the foods eliminated, the FODMAPs, contain nutrients that are absorbed earlier in the small bowel. With both a low FODMAP or an elemental diet, nutrients are absorbed more proximately (further up) in the small bowel, don’t migrate down to the distal small bowel. The SIBO bacteria are not being fed resulting in you not having any symptoms. Having said that, these diets are usually short term. Most studies run between 3 and 6 weeks after which you need to slowly reintroduce foods.
There are certain types of foods that are important for your microbiome long term, such as resistant starches, soluble fibers and glycans that are important for motility and mucus production. These nutrients are found in whole grains, fruits and vegetables. Eating these in the long term is important and avoiding them forever is not optimal.
While you are undergoing treatment, you can feed the bacteria with FODMAPs. It is also possible to treat your microbiome simply with diet: the low-FODMAP and possibly elemental diet. After the treatment, you enter into a low phase for a few weeks in order to help your symptoms. It is best to work with a specialist, either nutritionist or dietician to reintroduce these good foods, fermented foods, soluble fibers, resistant starches, in order to help your microbiome in the long term.