Embarking on a journey to manage digestive health, particularly concerning Small Intestinal Bacterial Overgrowth (SIBO) and Irritable Bowel Syndrome (IBS), involves dietary adjustments. A low fermentation diet, sometimes used in conjunction with a low-FODMAP diet, can be a helpful strategy. This article provides a comprehensive guide to understanding and implementing a low fermentation diet, including food lists, principles, and considerations for various audiences.
Understanding SIBO and IBS
SIBO occurs when there's an overgrowth of bacteria in the small intestine, leading to uncomfortable symptoms. IBS manifests as a chronic condition affecting the large intestine, causing abdominal pain, bloating, and changes in bowel habits. Both conditions underscore the importance of dietary adjustments to alleviate symptoms and regain control over your digestive well-being.
Why Diet Matters: The Gut-Health Connection
Changing your diet becomes a crucial aspect of managing SIBO and IBS, because certain foods can exacerbate symptoms by promoting bacterial overgrowth or triggering inflammation. Adopting a Low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) and Low Fermentation diet helps minimize the intake of carbohydrates that can ferment in the small intestine, contributing to the proliferation of bacteria. This dietary shift aims to create an environment in which your gut can thrive, reducing the discomfort associated with SIBO and IBS.
The Low Fermentation Diet: Principles and Purpose
The low fermentation diet is a dietary approach that aims to reduce the production of gas and other byproducts from the fermentation of undigested carbohydrates in the gut. These byproducts, such as hydrogen, methane, and hydrogen sulfide, are thought to contribute to the bloating, pain, and altered bowel habits experienced by IBS sufferers. By minimising the fermentation process, the low fermentation diet may help alleviate these symptoms.
The Cedars-Sinai diet, also known as the low fermentation diet, was originally developed by Dr. Mark Pimentel of Cedars-Sinai Hospital in Los Angeles, California. It is a structured eating plan designed to limit fermentable carbohydrates that feed intestinal bacteria and to modify the timing of mealtimes to help manage symptoms associated with small intestinal bacterial overgrowth (SIBO). Through selective eating, the Cedars-Sinai diet aims to reduce the food supply for bacteria in the gut.
Read also: Delicious Low Fermentation Recipes
The goal of LFE is to limit how favorable the gut environment is to bacterial overgrowth. It consists of foods that bacteria aren’t likely to metabolize and ferment-without restricting carbohydrates entirely so that patients can maintain the protocol long-term.
Key Principles of the Low Fermentation Diet for IBS
Low fermentation eating has two essential rules:
- Limit the intake of foods that contain high levels of carbohydrates or ingredients in food that humans can’t digest, and therefore are digested by gut bacteria
- Space meal out four to five hours apart
Another important aspect of the Cedars-Sinai diet is the emphasis on the timing of meals. Avoiding snacking and designating distinct meal times may help promote small intestinal motility and cleansing of the small intestine. Individuals may be advised to space meals during the day by 4-5 hours and to eat their last meal at least two hours before bedtime.
Spacing meals out is an essential rule of the low fermentation diet because it allows the digestive system to efficiently process and absorb nutrients while minimizing the potential for fermentation. When meals are spaced out, it gives the gastrointestinal (GI) tract time to clear out food from one meal before introducing the next. This can help prevent an overload of fermentable substances in the gut, which could otherwise lead to increased gas production, bloating, and abdominal pain.
The migrating motor complex (MMC) is another crucial factor in understanding the importance of spacing meals. The MMC is a series of coordinated contractions that occur in the stomach and small intestine during fasting periods. These contractions help clear undigested food particles, bacteria, and other substances from the GI tract. By allowing adequate time between meals, the MMC can function optimally and reduce the likelihood of bacterial overgrowth and fermentation.
Read also: Understanding the Low Fermentation Diet
Spacing meals can also help regulate the amount of food consumed at each meal, preventing overeating and reducing the strain on the digestive system. This can further aid in minimising fermentation, as the body is better equipped to break down and absorb smaller portions of food.
Foods Allowed in the Low Fermentation Diet
Embracing a Low FODMAP and Low Fermentation lifestyle doesn't mean sacrificing flavor or variety. Here's a list of low fermentation foods that are typically well-tolerated in a low fermentation diet. Remember, individual tolerances may vary, so it's essential to tailor your diet to your specific needs.
The Cedars-Sinai diet emphasizes the inclusion of foods that are low in fermentable carbohydrates. Low-fermentable carbohydrates are sugars that are more easily digested in the human gastrointestinal tract. Consuming foods with little or no fermentable carbohydrates may help reduce the predominant food source for small intestinal bacteria and limit the amount of gas produced in the digestive tract after eating.
Fruits:
- Berries (strawberries, blueberries, raspberries)
- Citrus fruits (oranges, lemons, limes)
- Kiwi
- Pineapple
- Grapes
- Cantaloupe
- Honeydew
- Watermelon
Fruit is an important part of a healthy, balanced diet. When eating to manage SIBO, one serving at a time is recommended. Shoot for one serving at a time of apricots, berries, melon, cherries, citrus, kiwi, mango, peaches, nectarines, persimmons, papaya, plums, and pomegranate.
Read also: The Hoxsey Diet
Vegetables:
- Spinach
- Carrots
- Bell peppers
- Zucchini
- Cucumber
- Green beans
- Eggplant
- Potato
- Tomatoes
- Pumpkin
- Lettuce
- Kale
- Chard
- Rocket
- Parsnip
Noncruciferous vegetables are encouraged: peppers, tomatoes, carrots, cucumber, zucchini, squash, eggplant, peas, mushrooms, potatoes, sweet potatoes. Greens (arugula, kale and spinach are best.
Proteins:
- Chicken
- Turkey
- Seafood (shrimp, scallops, etc.)
- Eggs
- Beef (lean cuts)
- Pork
- Fish (salmon, tuna, cod, etc.)
Meat and eggs are allowed.
Grains:
- White rice
- GF pasta (avoid those made from quinoa and brown rice)
- Gnocchi
- Tortilla (corn or flour)
- Popcorn
- Potato Bread
- Cereal, Refined (Rice Krispies, Original Special K, Cornflakes)
- Sourdough bread
- Gluten free pasta made from white rice or corn
Refined carbohydrates are allowed: white bread (e.g., sourdough, French bread, potato bread), white rice. It's important for SIBO patients to be mindful when it comes to carbohydrate portions at each meal.
Dairy & Alternatives:
- Almond milk
- Coconut milk
- Rice milk
- Hemp milk
- Oat milk
- Hard cheeses (cheddar, parmesan, asiago)
- Butter (in moderation)
- Ghee (in moderation)
- Yellow cheeses (parmesan, cheddar, manchego, gruyere)
- Lactose-free milk
- Alt-milks and low-lactose dairy. Ghee, lactose-free milk and cottage cheese, and small amounts of butter are okay.
If eating cheese, choose a hard, aged cheese that has a much lower lactose content.
Fats:
- Almonds
- Walnuts
- Pistachios
- Pumpkin seeds
- Sunflower seeds
- Peanuts
- Macadamia nuts
- Chestnuts
- Oils (avocado, canola, coconut, grapeseed, olive, sesame, sunflower, and vegetable)
- Nut butter (all-natural, no additives)
- Olive oil
- Coconut oil
- Avocado oil
Nuts and seeds are allowed.
Sweeteners:
- Agave syrup
- Honey (small amounts)
- Sucrose (table sugar)
- Glucose
- Maple syrup
Sugars: sucrose (table sugar), glucose.
Beverages:
- Coffee
- Tea
- Water
- Broth
- Seltzer without high-fructose corn syrup
- Herbal tea
- Green tea
- Black tea
Most drinks, including broth, coffee, seltzer, teas, and alcohol, are okay.
Condiments and Spices:
- Mustard with allowed ingredients
- Vinegar (pure, without additives)
- Chile paste
- Mayonnaise
- Pickled ginger
- Ketchup without high-fructose corn syrup
- Coconut aminos
- Soy sauce
- Basil
- Oregano
- Thyme
- Rosemary
- Parsley
- Chives
- Cilantro
- Ginger
- Peppermint
- Cinnamon
Snacks:
- Popcorn
- Rice cakes
- Sorbet with approved fruits
Other:
- Flavorful last minute pasta sauce.
Foods to Limit in the Low Fermentation Diet
Here's a list of foods that are typically avoided or limited in the low fermentation diet due to their high-FODMAP content or potential to promote fermentation. Keep in mind that individual tolerances may vary, and it's essential to tailor your diet to your specific needs.
Fermentable carbohydrates are limited from the diet because these are more poorly absorbed, pull water into the intestine, and are quickly fermented by bacteria, which may lead to digestive symptoms such as gas, bloating, burping, abdominal discomfort, and changes in bowel habits. Short-chain, fermentable carbohydrates are often referred to as FODMAPs, standing for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
Vegetables:
- Garlic
- Onions
- Leeks
- Asparagus
- Artichokes
- Brussels sprouts
- Cauliflower
- Broccoli
- Cabbage
- Beans and lentils
- Peas
- Fennel (root only)
- English peas
Fruits:
- Apples
- Pears
- Banana
- Prune
- Fig
- Date
- Dried fruits
- Fruit juice concentrates
Grains:
- Brown rice
- Oats
- Whole wheat pasta, breads and cereals
Dairy & Alternatives:
- Cow's milk
- Soft cheeses (e.g., ricotta, cottage cheese, cream cheese)
- Yoghurt
- Soya milk
- Cheese (soft, not aged)
- Cream cheese (lactose-free cream cheese and lactose-free sour cream made by Green Valley has live cultures.
Sweeteners:
- Sucralose
- Inulin
- High-fructose corn syrup
- Sorbitol, mannitol, xylitol, and other sugar alcohols
- Agave syrup
Other:
- Breaded or processed meats
- Marinated steak (i.e.
The Low Fermentation Diet vs. The Low FODMAP Diet
A low fermentation diet and a low FODMAP diet share some similarities, but are slightly different. Here's a brief comparison of the two diets:
- Low Fermentation Diet: The primary goal of a low fermentation diet is to reduce the production of gas in the gut by limiting the intake of foods that feed gut bacteria. A low fermentation diet emphasises consuming easily digestible carbohydrates and proteins, and avoiding foods that are high in resistant starches, fibers, and other hard-to-digest carbohydrates. This diet may include some food restrictions similar to the low FODMAP diet, but the focus is specifically on limiting the intake of foods that feed gut bacteria.
- Low FODMAP Diet: The low FODMAP diet aims to alleviate symptoms in individuals with IBS and other gastrointestinal issues by reducing the intake of specific types of carbohydrates known as FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). These carbohydrates are poorly absorbed in the small intestine, leading to fermentation in the large intestine, and resulting in symptoms like bloating, gas, abdominal pain, and diarrhoea. The low FODMAP diet involves eliminating or reducing high-FODMAP foods, such as certain fruits, vegetables, dairy products, legumes, and sweeteners, and replacing them with low-FODMAP alternatives. It is often implemented in three phases: elimination, reintroduction, and personalization, allowing individuals to identify and manage their specific food triggers.
In summary, while both diets aim to alleviate gastrointestinal symptoms by limiting the intake of fermentable carbohydrates, the low fermentation diet focuses on reducing foods that feed gut bacteria, while the low FODMAP diet specifically targets FODMAPs as the primary source of concern.
Navigating the Low-FODMAP Diet: A Detailed Look
What is a low-FODMAP diet? FODMAP is an acronym for a certain class of carbohydrates, called fermentable short-chain carbohydrates, which are more difficult for people to digest. (The full acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.) The low-FODMAP diet temporarily restricts these carbohydrates in order to relieve uncomfortable symptoms and give your digestive system a rest. Removing irritants gives your gut lining a chance to repair itself and can help restore a healthy balance of gut flora. If your symptoms improve, you can use the low-FODMAP diet to figure out which foods to limit in the future.
What are FODMAPs?
FODMAPs are:
- Fermentable. These are all foods that your gut bacteria feed on, converting them to gasses in a chemical process called fermentation.
- Oligosaccharides. These are soluble plant fibers known as prebiotics, which feed the beneficial bacteria in your gut. Oligosaccharides include onions, garlic, beans/lentils and many wheat products. Sensitivity to oligosaccharides may help explain some cases of non-celiac gluten sensitivity. Since gluten-free grains are lower in fermentable sugars than grains that have gluten, some people who think they are sensitive to gluten may actually be sensitive to the oligosaccharides residing in wheat products.
- Disaccharides. Lactose is the fermentable sugar in this group, the sugar in dairy and breast milk. Lactose intolerance is one of the most common food intolerances worldwide.
- Monosaccharides. Fructose, the sugar in fruit, is the fermentable sugar in this group. But only in certain quantities and proportions, so not all fruits are affected.
- Polyols. These are sugar alcohols, commonly used as artificial sweeteners. They are also found naturally in some fruits.
Why are FODMAPs difficult to digest?
FODMAPs are fermentable short-chain carbohydrates. Translated, that means two things: They are sugar molecules that are linked together in chains, and they are fermentable by the bacteria in your gut. Molecules in chains need to be broken down into single molecules to be absorbed through your small intestine. But FODMAPs can’t be broken down, so they can’t be absorbed there. Your small intestine draws in extra water to help move the FODMAPs through to your large intestine. There, the bacteria living in your colon have a field day fermenting them (eating them). This produces gasses and fatty acids as byproducts inside your gut.
Are FODMAPs bad for everyone?
Not at all. In fact, our digestive systems are designed to process some foods that we can’t fully digest ourselves - for example, dietary fiber, which has an important place in digestive health. And feeding the bacteria in our gut is part of our symbiotic arrangement with those bacteria. But some people with sensitive guts experience a level of indigestion from these foods that significantly impacts their quality of life. For these people, the byproducts of fermentation cause chronic symptoms of gas, bloating, abdominal pain and distension. The extra water drawn by the small intestine may cause diarrhea in excess, or constipation if there isn’t enough.
Who might benefit from a low-FODMAP diet plan?
The low-FODMAP diet is often prescribed for limited periods for people diagnosed with irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). Studies show that a majority of people living with these conditions benefit from the diet. It can also be used as a short-term elimination diet for anyone who has digestive problems and wants to try and isolate the foods that are causing them. An elimination diet removes common problem foods and then adds them back in systematically to observe how your system reacts. The low-FODMAP diet is just one of many elimination diets that you can use to discover food sensitivities.
What does a low-FODMAP diet consist of?
The diet has three phases: an elimination phase, a reintroduction phase and a maintenance phase that’s customized to you. During the elimination phase, you'll avoid all of the high-FODMAP foods - a list of specific fruits, vegetables, dairy products and grains. At first glance, the elimination phase of the diet may seem very limited. But there’s still a good list of foods in each category that you can eat. It takes some mental discipline to follow, but you won’t go hungry on the diet. After two to four weeks, you’ll begin the reintroduction phase, in which you systematically add foods back in. The third phase keeps what works for you and leaves out what doesn’t.
What can I eat on the low-FODMAP diet?
Certain fruits, vegetables, grains and proteins are higher and lower in FODMAPs. Some are OK to eat in limited amounts but will bother you in larger amounts. For example, most legumes and processed meats are high in FODMAPs, but plain-cooked meats, tofu and eggs are low-FODMAP protein sources. Apples, watermelon and stone fruits are high in FODMAPs, but grapes, strawberries and pineapples are OK. A ripe banana is high in fructose, but you can have up to a third cut up in your cereal, or you can have a whole one if it’s not quite ripe. Your dietitian can help provide you with these kinds of specific guidelines for your diet.
Which high FODMAP foods are the best to avoid?
This is the question that you’ll need to answer for yourself during the process of the low-FODMAP diet. The answer will be different for everyone. The point of the diet is not to deprive you of “bad” foods but to find out if your symptoms are related to FODMAPs or not - and if they are, which ones. Some people may not improve at all on the elimination phase. If you don't, there’s no reason to follow through to the next phase. But if you do, it will be very important to reintroduce foods in a systematic way to separate the real offenders from foods that you can tolerate. Many people find in the end that it’s only one or two of the FODMAP food groups that bother them.
Who Could Benefit from the Cedars-Sinai Diet?
The Cedars-Sinai diet was designed for individuals with SIBO. SIBO is characterized by an overgrowth of bacteria within the small intestine. When SIBO occurs, the resident bacteria in the small intestine are exposed to easily digestible "bacteria food" (fermentable carbohydrates and fiber). As the bacteria digest these foods, in a process called fermentation, excess gases are produced, which may contribute to symptoms associated with SIBO. Common symptoms associated with SIBO include abdominal discomfort, bloating, gas, and changes in bowel habits.
tags: #low #fermentation #diet #food #list