Ultimate Elemental Diet Food List to Effectively Manage and Beat SIBO

Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an excessive amount of bacteria in the small intestine. This overgrowth can lead to a variety of digestive symptoms and, if left untreated, can result in malnutrition and other complications. While antibiotics are the first-line treatment for SIBO, dietary interventions, particularly the elemental diet, play a crucial role in managing the condition.

Understanding SIBO and Its Symptoms

SIBO occurs when there's a disruption to the normal balance of bacteria in your small intestine, where a relatively low concentration of bacteria grows in a healthy digestive tract. Most of the bacteria in our gut is located in our large intestine. Risk factors for developing SIBO include taking proton pump inhibitors or opioids, gastric surgery, nerve damage to the small intestine, or a failure of the ileocecal valve.

Patients who have SIBO often complain of IBS-like digestive symptoms, such as:

Abdominal pain
Bloating
Gas
Abdominal distension
Flatulence
Diarrhea

It's also possible for SIBO to cause many other symptoms that may not necessarily be associated with poor gut health, such as headaches, joint pain, brain fog, fatigue, sleep disturbances, skin rashes, restless legs, and poor mood. Left untreated, SIBO can cause symptoms including pain, diarrhea, and malnutrition (due to the loss of the body’s main nutrients). In rare cases, a serious neurological condition called D-lactic acidosis can occur.

Research suggests that SIBO may play a significant underlying factor in irritable bowel syndrome (IBS).

The Role of Diet in Managing SIBO

Diet plays a major role in managing symptoms of digestive disorders. Diet is an important piece of the puzzle, but it is only one piece.

If you have SIBO, you want to limit or avoid foods that may increase the amount of bacteria in your small intestine. An increase in bacteria can lead to symptoms like bloating and abdominal discomfort, says functional medicine specialist Melissa Young, MD. Bacteria primarily consume carbohydrates, which results in the production of gases. Recommended diet plans aim to decrease certain groups of carbs to both reduce the bacteria and the gas they produce.

The goal is to make sure you’re eating the right combination of foods that supply the nutrients your body can absorb. Doing so can help starve excess bacteria and create a balanced gut.

The Elemental Diet: A Predigested Liquid Solution

When antibiotics alone do not help, the elemental diet is the only diet proven to treat SIBO. It is a predigested liquid diet prescribed by a doctor. The only proven diet for SIBO is the all-liquid elemental diet, which should only be embarked upon under a doctor’s supervision.

The elemental diet (ED) is a hypoallergenic and anti-inflammatory liquid meal replacement beverage. It is often used in clinical practice as a medical formula to treat severe inflammatory digestive disorders, such as Crohn's disease. The ED differs from other meal replacement formulas because it is "nutritionally complete" - it contains all the necessary nutrients humans need to live - and the ingredients are broken down into their most basic ("elemental") forms. Proteins, fats, and carbohydrates are broken down into their simplest building blocks: amino acids, short-chain triglycerides, and simple carbohydrates (glucose or maltodextrin). The formula also contains vitamins and minerals.

Read also: DIY Elemental Diet Guide

The semi-elemental diet is a variation of the full ED. Its formula contains partially hydrolyzed proteins (amino acid chains) and medium-chain triglycerides. This composition makes semi-elemental diets more palatable and easier to tolerate than EDs while still offering the benefit of reduced digestive workload.

How the Elemental Diet Works for SIBO

The ED treats SIBO by feeding the affected patient but starving the overgrown bacteria. The nutrients are absorbed quickly within the first portions of the small intestine before bacteria can ferment (digest) them for their own benefit. During an ED protocol, the patient will use the ED as their only source of nutrition for 2-3 weeks.

Compared to prescription or herbal antibiotics, ED prescriptions are far less common in clinical practice, likely due to their associated cost and restrictive nature. However, a 2016 primary care review suggested the ED as a plausible SIBO treatment option, given its association with improved SIBO breath test results and gastrointestinal symptoms in patients who followed it.

Research Supporting the Elemental Diet for SIBO

This recommendation is backed by a combination of empirical and scientific evidence that supports using the ED to treat SIBO in clinical practice. The most widely referenced study used in support of the ED for SIBO is a 2004 study that involved 93 people with IBS and positive SIBO lactulose breath tests (LBT). After adhering to the ED for 14 days, 80% of patients had a normal LBT. Those who still had abnormal LBT results continued the diet for an additional week and repeated the LBT. At the end of the 21-day trial, 85% of participants had normal LBT results, indicating an eradication of SIBO. Normalization of the LBT also coincided with symptom improvement.

Implementing the Elemental Diet: A Practitioner's Guide

Implementing the elemental diet in clinical practice involves several key steps to ensure patient safety, compliance, and effectiveness. Here is a guide for practitioners:

Read also: The Hoxsey Diet

Step 1: Patient Assessment

Determine if the ED is appropriate for the patient. Screen for any contraindications that would disclude the ED from being a reasonable treatment option for your patient. These include:

Diabetes
Fungal overgrowth
History of an eating disorder

Step 2: Patient Preparation and Education

Educate the patient on the purpose and process of the elemental diet. Explain that this liquid-only diet involves drinking a formula of pre-digested nutrients designed to minimize digestive effort and absorption issues. Despite these digestive benefits, following a liquid-only diet for an extended period presents mental and emotional challenges that the patient should be prepared for. Additionally, one of the major drawbacks that patients report with the ED is its unpalatable taste, which can make it difficult to adhere to.

Patients should continue taking all essential medications during the protocol. Supplements are optional and can be used as needed to manage side effects. For example, electrolytes can be added to prevent dehydration if they begin to experience diarrhea, and Vitamin C and magnesium can be used to treat constipation.

Step 3: Diet Selection

Recommend a prescription or nonprescription commercial ED formula. Alternatively, patients can make their formula themselves at home, which tends to be less expensive than the commercial options.

Calculate the patient's daily caloric needs based on their age, weight, activity level, and clinical condition. This determines how much formula the patient will need to drink daily to meet their daily caloric goals.

Step 4: Monitoring and Support

Healthcare providers should be readily available to their patients during the ED protocol to monitor their clinical response, including symptom improvement and side effects, and address any questions that arise. Common side effects of the ED include:

Increased hunger and weight loss, when not drunk in sufficient amounts
Digestive symptoms: bloating, diarrhea, abdominal pain, nausea, less frequent bowel movements
Headaches
Fatigue
Muscle and joint pain
Mood swings
Fungal overgrowth

Step 5: Assess Treatment Efficacy

The 2004 study referenced above set the ED's standard treatment timeframe of 14-21 days. Once the ED is completed, SIBO status can be evaluated by repeating the SIBO breath test or assessing the patient's clinical symptoms. When treating based on symptoms, many doctors will continue treatment until the patient reports an 80-90% improvement.

Transitioning Off the Elemental Diet

The ED is not designed to be a long-term diet. Once the patient has completed their protocol, they should be guided in gradually reintroducing solid foods back into their diet to prevent digestive upset. Here is an example of a 3-day transition diet that I will recommend to my patients:

Day 1: eat a low-fiber diet consisting of meats, eggs, fats, white rice, and (if tolerated) lactose-free dairy
Day 2: add cooked low-FODMAP vegetables, such as green beans, green bell peppers, and carrots
Day 3: add low-FODMAP fruits, such as melon, blueberries, or oranges
Day 4: return to regular diet

An alternative approach would be to follow a half-elemental diet, which involves replacing one to two meals per day with an elemental shake, providing approximately 50% of daily caloric intake. The remaining meals consist of a healthy, whole-food diet. This approach better allows for long-term use of the ED and offers a balanced way to support digestive health while maintaining the benefits of regular whole foods.

Practitioner Tips for Maximizing Success

Here are tips that can help your patients successfully follow an elemental diet:

Take the time to properly prepare your patients before they start the ED: Before your patient begins their ED, have them schedule an appointment with ample time for you to explain the procedure and answer all of their questions.
Modify the ED: Consider prescribing a semi-elemental diet or prescribing a shortened ED protocol to kick-start SIBO treatment. Then, use antibiotics or herbal antimicrobials to finish eradicating SIBO.
Prevent fungal overgrowth: Because intestinal fungal overgrowth is a common side effect of the ED, many practitioners will prescribe prophylactic antifungals for their patients during the ED protocol. Drinking the formula through a straw can also help prevent oral thrush (yeast overgrowth in the mouth).
Make the ED more palatable: To improve the taste of the ED formula, one of its major deterring factors, recommend a flavored commercial ED or semi-elemental formula to your patient. Drinking the beverage cold, such as by blending the formula with ice, can also help improve taste.
Make the ED more affordable: Patients can save money by homemaking their ED formula instead of buying commercial products.
Regulate blood sugar: The ED's high glucose load can lead to fast peaks and dips in blood sugar, contributing to symptoms like fatigue, headache, and irritability. To help stabilize blood sugar, instruct patients to sip on their elemental shake throughout the day instead of drinking three "meals."

Other Dietary Approaches for SIBO Management

While the elemental diet is the only diet proven to treat SIBO, other dietary approaches may help manage symptoms and prevent recurrence. These include:

Low-FODMAP Diet

One option is a diet low in FODMAPs, which are difficult-to-digest carbs that are fermented by gut bacteria in the colon. Because many people with IBS also have SIBO, a low-FODMAP diet is sometimes suggested for people with SIBO.

“FODMAP” stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are foods that you may have trouble digesting when you have SIBO. A low-FODMAP diet focuses on limiting or eliminating high-FODMAP foods, like beans, lentils and wheat-based snacks. The idea is that avoiding high-FODMAP foods may slow bacterial overgrowth that happens when bacteria feed on these types of foods.

The main categories of FODMAPs include:

Fructose, simple sugars commonly found in fruits and some vegetables, honey, and agave nectar
Lactose, a sugar molecule in dairy products
Fructans, a sugar compound found in gluten products, fruits, some vegetables, and prebiotics
Galactans, a compound found in some legumes
Polyols, sugar alcohols often used as low-calorie sweeteners

Foods that contain higher amounts of FODMAPs include:

High-fructose corn syrup
Agave nectar
Honey
Soda and soft drinks
Garlic
Onions
Asparagus
Butternut squash
Cauliflower
Artichokes
Beans
Apples
Dried fruits
Sausage
Flavored yogurt
Ice cream
Sweetened cereals
Barley
Rye
Grains
Peas
Mannitol
Sorbitol

Instead, you want to fill your plate with low-FODMAP foods, like proteins, vegetables, fruit, grains and dairy, as well as nuts and seeds, that are less likely to trigger a bacterial growth spurt.

Some foods that are considered low-FODMAP include:

Fruits like grapes, oranges and strawberries
Vegetables like carrots, cucumbers and tomatoes
Nuts and seeds like walnuts and pumpkin seeds
Dairy alternatives like almond milk and soy milk
Protein options like eggs and plain, cooked meats, poultry and seafood
Gluten-free grains like quinoa and oats

Everyone reacts to these foods differently. Even if some FODMAPs cause symptoms for you, other FODMAP-containing foods may not. A low-FODMAP diet is only one example of an elimination diet for SIBO. Remember, it’s best to take an individualized approach when planning a SIBO elimination diet.

After the initial elimination phase of about three to four weeks while you’re being treated for SIBO, you’ll then slowly reintroduce food from one high-FODMAP group at a time,” says Dr. Young. Following a low-FODMAP diet long term isn’t recommended, as many of these highly fermentable foods feed your gut microbiome.

Low Fermentation Eating (LFE)

Due to the limitations and nutritional concerns associated with indefinite adherence to the Low-FODMAP Diet, renowned gastroenterologist Dr. Mark Pimentel and his team at Cedars-Sinai developed a more sustainable dietary approach: Low-Fermentation Eating (LFE). LFE focuses on reducing fermentable foods while emphasizing consistent meal timing and limiting problematic foods to minimize bacterial overgrowth.

LFE reduces fermentable substrates for gut microbes, while also focusing on maximizing healthy spacing between meals. Spacing meals four to five hours apart allows your Migrating Motor Complex (MMC) to more thoroughly and rhythmically sweep bacteria out of the small intestine between meals.

SIBO Biphasic Diet

The SIBO Biphasic Diet is a structured eating plan developed by Dr. Nirala Jacobi, ND, focused specifically on people diagnosed with SIBO. It’s a phased dietary protocol designed to limit foods that are more likely to ferment in the small intestine, such as certain fibers, legumes, and high-FODMAP fruits.

The “Biphasic” part of the name refers to the diet being structured into two phases. In the first phase, restricted foods are reduced or eliminated to help minimize bloating, gas, and abdominal discomfort. The phased design is intended to both address the symptoms in the short term and make the diet more sustainable over time. By removing fermentable carbohydrates during phase 1, the diet reduces the fuel needed for bacterial overgrowth. Phase 2 then broadens the Foods to Choose categories by gradually reintroducing foods, with adjustments dependent on individual tolerance and symptom response. Because of the complex nature of the SIBO Biphasic Diet, it is generally not recommended without the supervision and guidance of an appropriate healthcare provider.

Carnivore Diet

The Carnivore Diet is an extreme elimination diet that removes all plant-based foods and focuses exclusively on animal-based products such as meat, fish, eggs, and some dairy. Although not created for people with SIBO or IBS, it has gained some popularity among people experimenting with ways to reduce bloating, gas, or other gut symptoms.

The idea is simple: if fermentable carbohydrates are the main fuel for gut microbes, removing them entirely should reduce fermentation and gas. With only animal proteins and fats on the menu, there’s less fuel left for bacteria or archaea to break down.

Anti-Inflammatory Diet

An Anti-Inflammatory Diet isn’t a single, rigid plan, but rather a way of eating that emphasizes foods believed to calm inflammation in the body. It sometimes resembles the Mediterranean diet, which highlights fruits, vegetables, olive oil, fish, legumes, and whole grains. Some people also try variations which remove gluten or dairy from their diets as well, since these have also been linked to inflammation and gut distress in some people.

The theory here is that reducing chronic inflammation can help soothe the gut environment and improve overall health. While these diets don’t target microbial overgrowth directly, they may decrease gut irritation, improve nutrient intake, and support a broader approach to digestive wellness.

Additional Considerations

Probiotics: Probiotic supplements are often claimed to benefit digestive health. Some studies suggest that probiotics may limit bacterial overgrowth, lower scores on the hydrogen breath test, and reduce abdominal pain with SIBO. However, a 2021 systematic review concluded that large, high-quality studies are needed to understand the effects of probiotics on SIBO. Some experts believe probiotics could make SIBO worse. Before making any changes to your diet or implementing new treatment, discuss the risks with your doctor or dietitian.
Food Intolerances: If your symptoms continue after treating SIBO, you may have another digestive condition that requires treatment or management. For example, lactose intolerance can cause symptoms similar to SIBO, such as bloating, gas, and diarrhea. If a food intolerance is causing digestive symptoms, you may need to make changes to your diet. These changes should be guided by your doctor or a registered dietitian.
Recurring SIBO: In about 44% of cases, SIBO symptoms come back within 9 months after the first treatment.

Foods to Include and Avoid

If you decide to try an elimination diet for SIBO, it’s important to plan it out with the help of a registered dietitian. They can help you build a list of foods to eliminate temporarily, and a plan for gradual reintroduction of foods.

If you’re avoiding FODMAPs during your elimination diet, the list of foods you should avoid can be restrictive. But there are still a number of foods you can enjoy while on this temporary diet. Some foods contain low amounts of FODMAPs in small servings but may be limited because larger servings would increase the FODMAPs.

Acceptable foods for a low-FODMAP diet include:

Meat
Fish
Eggs
Crackers, gluten-free
Oatmeal
Unsweetened cereal (made from low FODMAP grains)
Spaghetti squash and summer squashes
Broccoli (heads only, less than 3/4 cup)
Leafy greens
Carrots
Rice or gluten-free noodles
Olives
Peanuts
Potatoes
Pumpkin
Quinoa
Seeds
Some fruits (blueberries, grapes, oranges, and strawberries)

To help you plan meals and make the right food choices, your dietitian may recommend using a FODMAP app like the one created by Monash University or Fast FODMAP.

Foods to avoid:

If you have SIBO, you may want to consider reducing or avoiding the following high-FODMAP foods:

Fruits like apples, pears and cherries
Vegetables like onions, cauliflower and mushrooms
Dairy options like milk, ice cream and soft cheeses
Beans and lentils
Grains like wheat and rye
Certain nuts like pistachios and cashews
Sweeteners like honey and sugar alcohols like xylitol and sorbitol

Addressing Common Questions

Can you eat potatoes on a SIBO diet? Generally, yes. But it can depend on the type of potato and how it’s prepared. White potatoes are generally considered low in FODMAPs when eaten in moderation and are often well-tolerated. Sweet potatoes contain more fermentable carbohydrates and may cause symptoms in some people. Fried potatoes in any form are usually discouraged. Because tolerance varies, experimentation with portion size and types of potatoes may be necessary to determine if they are appropriate for you.
Is a Carnivore Diet good for SIBO? The Carnivore Diet eliminates all plant foods, which may reduce fermentable carbs that bacteria feed on. However, it lacks fiber and key nutrients, and it’s generally not recommended as a first-line SIBO therapy. Medical guidance is strongly recommended when considering your nutritional choices, especially one that may adversely impact your overall health.
Can I eat popcorn on a SIBO diet? Popcorn is usually avoided because it is high in insoluble fiber and can be difficult to digest, potentially worsening symptoms.
Can you cure SIBO with diet alone? No, diet alone is generally not considered sufficient to cure SIBO. Dietary changes can ease symptoms, support recovery, and possibly help you to avoid a SIBO recurrence, but antibiotics or other medical treatments are usually needed to eradicate bacterial overgrowth.
Can you eat chia seeds on a SIBO diet? Chia seeds are usually avoided because their soluble fiber can ferment in the small intestine and worsen bloating or gas.
Can you eat corn on a SIBO diet? Corn is generally avoided because it contains fermentable carbs and fiber that can trigger symptoms in SIBO patients.
Can you eat eggs on a SIBO diet? Yes, eggs are usually a well-tolerated protein source on nearly all SIBO diets and do not contribute significantly to fermentation.
Does the Elemental Diet cure SIBO? Research shows that a properly administered elemental diet can potentially resolve SIBO in some cases, but it should be medically supervised due to its restrictive nature. Since the elemental diet process can be difficult for some patients, it is generally not utilized as a first-line treatment for SIBO, and is more often reserved for patients for whom antibiotics and other therapies are not tolerated or have proven ineffective.
Is Diet Coke Low FODMAP? Yes, Diet Coke is considered Low FODMAP because it contains no fermentable carbs.
Is avocado OK for SIBO? Avocados were once thought to be rich in sorbitol, a type of sugar that is limited in the low FODMAP diet. However, recent research has discovered that this early finding was in error and avocados are actually far lower in FODMAPs than once thought. Nevertheless, further research is needed.
What is SIBO poop like? SIBO can affect your stools, making them fatty or greasy, light, soft, and unusually foul-smelling. This is an indication you should see a doctor and be tested for this condition.

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