Embarking on a journey to manage small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) involves a keen awareness of your digestive system. SIBO occurs when there's an overgrowth of bacteria in the small intestine, leading to a range of uncomfortable symptoms. Similarly, 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. This article dives into the principles of the low fermentation diet and how it may help alleviate IBS-SIBO symptoms.
Why Diet Matters: Unraveling the 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.
Understanding the Low Fermentation Diet
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.
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 meals out four to five hours apart.
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.
Read also: Delicious Low Fermentation Recipes
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.
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.
In summary, spacing meals out is essential in the low fermentation diet because it:
- Allows the digestive system to efficiently process and absorb nutrients
- Minimises the potential for fermentation
- Supports the optimal functioning of the migrating motor complex
- Helps regulate portion sizes and prevent overeating
Low Fermentation Diet vs. Low FODMAP Diet
A low fermentation diet and a low FODMAP diet share some similarities but are slightly different.
- 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. Foods allowed on the Low Fermentation Eating diet are much broader, even including ingredients like onion and garlic, in moderation.
- 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.
Read also: Foods for a Low Fermentation Diet
Foods to Choose on a 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.
Fruits
- Berries (strawberries, blueberries, raspberries)
- Citrus fruits (oranges, lemons, limes)
- Kiwi
- Pineapple
- Grapes
- Cantaloupe
- Honeydew
- Watermelon
- Avocado
Vegetables
- Spinach
- Carrots
- Bell peppers
- Zucchini
- Cucumber
- Green beans
- Eggplant
- Potato
- Tomatoes
- Pumpkin
- Aubergine
- Courgette
- Lettuce
- Kale
- Chard
- Rocket
- Parsnip
Proteins
- Chicken
- Turkey
- Seafood (shrimp, scallops, salmon, tuna, cod, etc.)
- Eggs
- Beef (lean cuts)
- Pork
Grains
- Cereal, Refined (Rice Krispies, Original Special K, Cornflakes)
- White rice
- GF pasta (avoid those made from quinoa and brown rice)
- Gnocchi
- Tortilla (corn or flour)
- Popcorn
- Potato Bread
- Gluten free pasta made from white rice or corn
- Sourdough bread
Dairy & Alternatives
- Almond milk
- Coconut milk
- Rice milk
- Hemp milk
- Oat milk
- Hard cheeses (cheddar, parmesan, asiago, yellow cheeses like parmesan, cheddar, manchego, gruyere)
- Butter (in moderation)
- Ghee (in moderation)
- Lactose-free milk
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)
- Hazelnuts
- Pecans
- Brazil nuts
Sweeteners
- Agave syrup
- Honey (small amounts)
- Sucrose (table sugar)
- Glucose
- Maple syrup
Beverages
- Coffee
- Tea (Herbal tea, Green tea, Black tea)
- Water
- Broth
- Seltzer without high-fructose corn syrup
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
- Dark chocolate
Foods to Limit on a 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.
Vegetables
- Garlic (though cooked is typically better tolerated)
- Onions
- Leeks
- Asparagus
- Artichokes
- Brussels sprouts
- Cauliflower
- Broccoli
- Cabbage
- Beans and lentils
- Peas
- English peas
- Fennel (root only)
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
Sweeteners
- Sucralose
- Inulin
- Agave syrup
- High-fructose corn syrup
- Sorbitol, mannitol, xylitol, and other sugar alcohols
The Value of an IBS Diagnosis for Dietary Modification
A positive result on an antibody blood test for IBS can indicate that a diet low in fermentable foods could be effective in relieving your symptoms. An antibody blood test for IBS measures the levels of two antibodies that are IBS biomarkers: anti-CdtB and anti-vinculin. If these antibodies are elevated, IBS can be diagnosed with up to 100% positive predictive value.
Crafting Your Path to Wellness: Delicious and Digestive-Friendly Choices
Navigating the challenges of SIBO and IBS through a mindful diet empowers you to make choices that prioritize your digestive health. Experiment with delicious recipes that align with the Low FODMAP and Low Fermentation principles, gradually discovering what works best for you. Remember, this journey is about finding a balance between nourishing your body and enjoying the pleasures of food. By making informed and friendly choices, you can pave the way for a more comfortable and flavorful digestive experience.
The Cedars-Sinai Diet: A Low Fermentation Approach
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. 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.
Read also: The Hoxsey Diet
Meal Timing
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.
Who Could Benefit from the Cedars-Sinai Diet?
The Cedars-Sinai diet was designed for individuals with SIBO. Individuals diagnosed with irritable bowel syndrome (IBS) may also find a low fermentation diet helpful. It is now understood that up to 80% of individuals with IBS may have an underlying SIBO contributing to their symptoms. This is likely why dietary modifications aimed at reducing fermentable carbohydrates may result in symptom improvement for many IBS patients.
Functional Medicine Tests
Various functional medicine tests can be utilized during a holistic patient evaluation to gather information that helps doctors personalize gut-supportive plans:
- SIBO Breath Test: SIBO may be suspected in a patient whose digestive symptoms improve by removing fermentable carbohydrates from the diet. SIBO can be confirmed and subtyped by using a diagnostic breath test.
- Comprehensive Stool Test: Large intestinal dysbiosis, intestinal infections, digestive enzyme insufficiencies, and intestinal inflammation are also common contributing factors to digestive symptoms and can be assessed and monitored with a comprehensive stool test.
- Food Sensitivity Testing: Foods other than fermentable carbohydrates may contribute to a patient's digestive symptoms. A food sensitivity panel can help identify immune-mediated responses to food proteins.
- Nutritional Assessment: Given the structured nature of the Cedars-Sinai diet, nutritional deficiencies may occur when a patient begins the elimination diet. A nutritional assessment screens for nutrient imbalances and can be ordered before, during, or after the patient follows the Cedars-Sinai diet.
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