SIBO Part C: The Trauma of Food.
Why are we here?
This blog will compare some of the main SIBO diets available online.
Why diet matters so much to the chronically ill.
Diet is the one thing us sufferers of chronic illness can control. This is more significant than it sounds. In a life that often feels out of control, being able to have something we can control is more important to our sanity, self-esteem and quality of life, than ‘normal’ people understand.
Some of our specialist health carers might understand. Some of us have friends and family that understand. Others are really lost and adrift in this wasteland of chronic illness and complex food choices. I also realise I am not alone in having multiple illnesses, so trying to follow a SIBO diet, an Interstitial Cystitis diet and an endometriosis diet is actually not entirely possible.
Another huge challenge is trying to communicate our complex diet choices to others in social settings involving food, when often all you want to do is run home and hide in bed. When you feel mentally and physically awful, being in bed is rough, being out and about can be hell. The worst is often having to explain why you can’t have x or y, but can have z, but only if it is made from x and not y…and yes you know last week your rules were different… things change….for good reason …. mostly….but sometimes yes out of sheer desperation and huge desire for control.
I have great support networks – yet I am lost and adrift in this diet choices wasteland. My way to get some control back is to research and document. Hence I am going to cover some of the SIBO diets I have found and/or tried and their basic principles, differences and similarities. Then I am going to zero in on the differences that are stressing me out and maybe you too.
Here goes …..
What we know
First off – The good news! There is pretty clear agreement that foods that ferment slowly feed SIBO (think whole grains, think sugar, think all the good things in life). Which means eating protein, low sugar, some vegetables and maybe some high Glycemic Index (GI) carbohydrates such as white rice and white bread (if gluten is tolerated). Why these “nasty” carbs, these horrible unfashionable throw-backs from the 70s? Thing is, they digest fast and don’t hang around and feed the bacterial overgrowth.
Now for the bad news – The problem is the research has not been done on what foods SIBO really likes or how much or what exact carbs it can handle. The research certainly hasn’t been done on individual differences, our bacterial ‘blooms’ tend to have personalities as different as us. What is tolerated by one, might be a disaster for another. One mans X is another mans Y.
What little science tells us
A search in academic databases of “SIBO and diet” brings up one (unfindable) reference linked to one diet – the Specific Carbohydrate Diet (SCD). Let me just tell you how shocking this is. Here are some facts:
- At 5:26 pm on the 12 November 2016 the world population was 7,463,789,183
- The international foundation for Functional Gastrointestinal Disorders estimate between 10-15% of the world’s population have IBS
- So let’s take that at 12.5% that is 938 million people
- Research indicates the majority of IBS sufferers have SIBO, even if it is just a small majority of 51%, although realistically it may well be closer to 80%. So like 480-750million SIBO sufferers on the planet.
How shocking is the lack of research given the incidence of this?
Some practitioners have risen up to do what they can, some have self-funded a little research (not yet published) others have figured it out with their patients along the way or looked to clues from related research.
Below are some of the diets I have seen and or tried from reliable sources – there are many more from less sources, let’s not waste our time there.
Diet: Cedars Sinai Diet
Development/Background: Dr Pimentel is the major founder of this one. He is a research gastroenterologist and a bit of an advocate for patients’ rights – he is one of those doctors that ‘gets it’. He has written this great book.
Summary of Diet:
- Avoid mannitol/sorbitol/Splenda/lactose
- Avoid high residue foods (legumes, peas, soy products)
- Avoid diary for lactose (use almond, rice or lactose free milk)
- White bread, rice, pasta OK, only ½ cup per meal
- Fruits in moderation (2 per day)
- Cooked vegetables preferable to raw
- Moderate tea and coffee
- Alcohol not discussed (surely that means fill your boots?)
Important NON food protocols: Only eating 3 times per day – ensuring a fast of 3-5hrs between meals. Enough Water (for motility). This diet is part of a medical protocol that includes antibiotics rifaximin & neomycin and medication to restore normal cleansing waves of the small intestine. Also involved is breath testing and retesting.
Diet: Specific Carbohydrate Diet (SCD)
Development/Background: Dr Siebecker ND, has worked with many SIBO patients and developed her own sort of hybrid diet from some of the others. It has a traffic light system available (as a very basic app) in app stores. She also provides great free information here.
Summary of Diet:
- Some fruits appear to be freely allowed and some limited
- Some allowable legumes
- Nuts vary – some green some red and some in the middle
- Butter, Cheese, sour cream and yogurt ok.
- Rest of dairy amber or red
- Honey/Glucose and some artificial sweeteners ok
- Certain alcohol ok (very much in moderation)
Diet: Dr Nirala Jacobi’s Bi-Phased Sibo Diet
Development/Background: Dr Jacobi is a naturopath and Natural Doctor based in Australia of German background. The diet is based on the SCD diet and patients combined experiences and refined over time. This diet is very strict and prescriptive, she has done this on purpose (she is German after all, by her own admission) because it takes the stress away for patients. I really think she is onto something here. You can purchase Rebecca Coomes books based entirely on this diet.
Summary of Diet: A phased approach – Phase I:
- No grains
- No legumes
- No diary
- No potatoes, pasta etc.
- Limit certain vegetables
- Fruit 2 small servings per day (only from specific list)
- Nuts and coconut products acceptable (serving size controls provided)
- Almond milk OK
- Home made broths OK
- No tinned vegetables (for histamine)
- Stevia OK
- No palm oil or soybean oil
Overtime some more introductions:
- ½ cup of rice per sitting OK (must be Jasmine or Basmati)
- Certain Alcohol OK (moderation i.e. a small sniff at a funeral or your own wedding)
- Glucose/Honey – 3 tbsp. per day.
- Home made yogurt
Here is the full diet sheet.
Diet: The Fast Tract Diet
Development/Background: Dr Norm Robillard is a microbiologist and personal sufferer (or was before this) who created a formula for how fermentable foods are i.e. more fermentable = more growth of SIBO. He has created an app and several books.
Summary of Diet:
This is a point system so nothing is off limits however a blueberry muffin will set you back most of your daily allowance. The focus is on five groups are high fermentation things namely; resistant starch, fibre, sugar alcohols, fructose, lactose.
Interesting points about this diet:
- Protein, some (lactose free) diary and jasmine rice and glucose/dextrose are all zero points.
- Some white rice varieties are very high points. Dr Robillard describes the chemical structure of different types of rice and why these differences exists.
- Cooled starches are higher points.
- Alcohol ranges in points widely (moderation i.e. a glass or two). Awesome news -> dry white wine is 1 point.
Important NON food protocols: Occasional fasting to rest digestion. Chew well. Try and get at underlying causes.
Diet: The Robyn Berlin Method
Development/Background: Robyn Berlin is an American dietician who works in association with Dr Pimentel. Hers is a personalised and updated version of the Cedars Sanai Diet.
Summary of Diet:
- Sweeteners in moderation – e.g. honey, table sugar, glucose
- High GI carbs OK, in small amounts per meal, better quality is better e.g. sourdough
- Certain vegetables not OK e.g. broccoli, cabbage, cauliflower, pea pods
- Meat, fish, eggs etc OK avoid tofu, legumes beans
- Lactose free milk and hard cheese OK – avoid lactose
But wait there is more:
There are some other diets mentioned around the place. It is common for folks to create their own hybrid. It is very common to add FODMAP restrictions to some of the above diets.
- GAPS (Gut and Psychology Syndrome Diet)
- FODMAP (Sue Sheppard out of Monash University, good quality research, taking off around the world)
- Paleo (also trendy with non sick people – clearly not with environmentalists)
- Elemental (usually reserved for stubborn cases – liquid diet)
Now for the drama
So there is lots of choice, perhaps too much choice, but also many conflicts, here are just some that are doing my head in:
- The (Dr Nirala) phased SIBO diet allows lots of carrots, and moderate amounts of coconut flour. The Fast Tract Diet gives really high points to these things.
- Can you have anything processed at all or should you always keep it totally natural / organic/raised with love and sunshine and killed facing Mecca? Some diets allow zilch processed items others put zero points on some processed foods.
- Bananas – Do they feed SIBO? Slow transit time? or indeed work as a great pre-biotic and help stuff? If you brave bananas should you have them green-ish or ripe-ish? These differences change FODMAP levels, prebiotics, starch etc.
- To gluten or not to gluten – my word that is as contentious as a US presidential election.
- OK to cool and reheat rice (due to it getting more starchy) or should it always be had hot and fresh?
- Dairy – it seems clear that lactose free is best, but is that OK or should it be avoided altogether?
- Broccoli, Cauliflower, cabbage, peas. Not OK in the Robin Berlin Method, Cauliflower is high Fodmap. But these are OK in other diets.
- Basmati rice – OK or disaster? It’s OK on the SIBO phased diet, super high points on the FTD.
- Splenda – the devil (Dr Pimentel) or just fine (Dr Robbillard)
- Cooked versus raw
- Sourdough – in or out?
The universal answer to this seems to be – watch your individual tolerance…keep a diary.. pay attention – as if you were not already obsessed enough with food.
This is does not work well for me (I think you’ll trust me when I say I have tried) – given the number of illnesses I have that flare in different ways at different times, the delayed food responses (sometimes up to several days) and the fact that it isn’t just foods it’s subsets of foods or certain sugars within foods etc. So aside from a bit of bloating on certain FODMAPS (which Monash themselves say might be a good thing on twitter recently) and a question mark over gluten. I have not much of a heads up. With one exception if I eat high points by the fast tract diet my reflux/gastritis flares. But if I eat low points my constipation worsens.
So what did I do?
Well ……I obsessed and I mean totally obsessed. I spoke to anyone who might listen including a Dr, a Pharmacist, A Naturopath (actually 2) and a Microbiologist. I know how did I casually manage to track them down? …. as only one of them was a professional consult. It was just me lingering on the phone or at the compounding pharmacy etc….that’s how you track ‘im down. Commitment, tenacity and very little self-consciousness.
Of course they had little to offer, well lots but not on this topic….because as mentioned the research isn’t there.
So if in doubt, build your own. Which is what I have done, it’s my own sort of hydrid. HimIndoors is keen to commercialise it, he is a marketer he can’t help himself. I’d rather get funding for the research and put mine head-to-head with those above. I wouldn’t know where I would put my money.
Until we meet again
Please do remember everyone is different and don’t get all evangelical if you find your golden ticket, cause it just might not let others in.
Go cautiously and with lots of reflection (ideally journal-ed) in the direction of your dreams.
Yours as ever,
Back from the future
It is several years later and I am rereading this