Small intestinal bacterial overgrowth (SIBO) occurs when there's a disruption to the normal amount of bacteria found in your small intestine, with most bacteria located in your large intestine. Small intestinal methanogen overgrowth (SIMO), also known as IMO, is caused by archaea producing an excess of methanogens or methane gas. Research suggests that SIBO may play a significant underlying factor in irritable bowel syndrome (IBS). Given the similarities in presentation between SIBO and SIMO, proper diagnosis is critical for appropriate and effective treatment. So, could following a SIBO/SIMO diet and changing what you eat help manage symptoms? It can help and may be one of many things your healthcare provider suggests, in addition to antibiotics or other complementary therapies.
Understanding SIBO/SIMO
SIBO and SIMO are conditions characterized by an imbalance in the gut microbiome. SIBO is the result of bacteria producing an excess of hydrogen or hydrogen sulfide gas.
Symptoms of SIBO/SIMO
Individuals with SIBO/SIMO may experience a range of symptoms, including:
- Bloating (often described as looking pregnant)
- Nausea
- Gas
- Low appetite, constant feeling of fullness
- Abdominal pain and cramping
- Pain while passing stool
- Diarrhea (more common with SIBO)
- Constipation (more common with SIMO)
- Food intolerances
- Nutrient deficiencies/malabsorption of nutrients
- Impaired GI motility
- Inflammation
- Damaged microvilli (gut lining)
- Dysbiosis
- Impaired digestive capacity
Common Causes of SIBO/SIMO
Several factors can contribute to the development of SIBO/SIMO:
- Hypochlorhydria (low stomach acid)
- Dysbiosis
- Insufficiency of digestive or pancreatic enzymes
- Certain medications (especially antibiotics, immunosuppressants, and antacids)
- GI motility issues
- Impaired immune function
- Surgery or anatomical issues
Testing Options to Confirm the Presence of SIBO/SIMO
- Breath Test: This is the best way to determine SIBO/SIMO. To take this test you will drink a glucose or lactulose beverage and then take breath samples over a three hour period to determine whether you have elevated methane, hydrogen, or hydrogen sulfide.
- Comprehensive Stool Analysis: A comprehensive stool test looks at bacterial, viral and parasitic pathogens, fungus and yeast, and assesses the type and amount of opportunistic and beneficial bacteria, as well as markers for inflammation, immunity, and digestive capacity and health.
Dietary Strategies for Managing SIBO/SIMO
A key component to effectively addressing SIBO and SIMO is making dietary changes to reduce the growth of additional bacteria and methanogens, which in turn helps reduce the uncomfortable symptoms that come with SIBO/SIMO. These diets should be followed for 2-6 months under guidance from your healthcare practitioner. Afterwards, foods will slowly be added back into the diet. When 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. 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. 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.
Read also: The Hoxsey Diet
While there isn’t an official “SIBO/SIMO diet,” your healthcare provider may recommend an eating plan like the following. Two common dietary strategies are the low FODMAP diets and low fermentation diets.
Low-FODMAP Diet
“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. The idea is that avoiding high-FODMAP foods may slow bacterial overgrowth that happens when bacteria feed on these types of foods. This diet attempts to lower the ingestion of FODMAPs and in turn lower the symptoms associated with SIBO/SIMO. This diet is more appropriate for more severe cases of SIBO, or cases that did not resolve from a low fermentation diet alone.
Foods to Include on a Low-FODMAP Diet
Instead, you want to fill your plate with low-FODMAP foods that are less likely to trigger a bacterial growth spurt, like:
- 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
Foods to Avoid on a Low-FODMAP Diet
Foods to AVOID on a Low FODMAP diet:
- Vegetables: artichokes, asparagus, beets (raw), cauliflower, celery, garlic, bell peppers (green okay in small quantities), ancho chili, jalapeno, chipotle chili, broccoli, broccolini, savoy cabbage, cauliflower, celery, corn, fennel (bulb), leek, lotus root, mushrooms, onion, scallions (white part), snow peas, snap peas, green peas, delicata squash, acorn squash, butternut squash, pumpkin, tomatoes (roma and cherry), shallot
- Fermented Vegetables: kimchi, sauerkraut, pickles, all other fermented veggies
- Soy: natto soy milk, tofu (silken)
- Beans: all beans, lentils, hummus and chips/crackers that contain beans/bean flour
- Fruit: apple, apricots, avocado (no more than ¼ per day) blackberries, currants, cherries, cranberries, fig, goji berry, guava, jackfruit, lychee, grapefruit, mango, nectarines, peaches, papaya, pears, persimmon, plums, pomegranate, watermelon, any canned and dried fruit
- Grains: all gluten-containing grains including barley, rye, triticale, wheat (durum, farro, kamut, spelt), wheat products (bulgur, couscous, semolina)
- Dairy: milk, buttermilk, condensed milk, yogurt
- Drinks: coconut water, aloe juice, fruit juices, rum, fennel, chamomile and oolong tea, oat milk, coconut milk
- Condiments: onion salt/powder, garlic salt/powder, any condiments that contain a significant amount of onion/garlic
- Sweeteners: agave, artificial sweeteners (acesulfame-K, aspartame, saccharin, sucralose), erythritol, applesauce, high fructose corn syrup, honey, xylitol.
- Other: carob, leather, molasses, processed food products made with gluten containing grains and corn
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. Following a low-FODMAP diet long term isn’t recommended, as many of these highly fermentable foods feed your gut microbiome.
Read also: Walnut Keto Guide
Low Fermentation Diet
This diet is far less complicated and restrictive in comparison to the low FODMAP diet. This diet attempts to lower the fermentation of foods in the gut as well as reducing sulfur rich foods which can often contribute to fueling SIBO/SIMO.
Foods to Avoid on a Low Fermentation Diet
- Fermented Foods/Drinks: yogurt, kefir, sauerkraut, kimchi, fermented vegetables, miso
- Legumes: lentils, beans, hummus, and bean dips
- Cruciferous vegetables: cabbage, broccoli, cauliflower, brussels sprouts, kale
- Sugar alcohols: xylitol, sorbitol, erythritol, maltitol, anything ending in “-ol” that is added to make something sweet
- Refined sugars: cane sugar, white sugar, brown sugar, corn syrup
- Highly processed foods and snacks
- Gluten
- Dairy (okay in moderation - ideal to avoid if possible)
Elemental Diet
You may want to consider the elemental diet for SIBO, especially if you and your healthcare provider choose not to use antibiotics or other complementary therapies, like a course of herbal therapy recommended by your provider. This purely liquid diet comes in powder or liquid form. You’ll stay on the diet for about two to three weeks if you’re being treated for SIBO. It is an effective treatment option for SIBO. The formula is easy to digest and contains essential nutrients your body needs in a “predigested” form containing amino acids, fatty acids, vitamins, and minerals. With the elemental diet, the dietary building blocks and nutrients are more easily digestible and absorbed sooner in the digestive tract, so it’s much less likely to make it to the bacterial source in your small intestine. Research shows the elemental diet works. But it only works if you stay with it. That can be a challenge for reasons ranging from the way the formula tastes to being hungry, bored, or frustrated because you can’t participate in family or social events that center around food. Working with a registered dietitian or health coach while following the elemental diet can be helpful.
Preventing SIBO/SIMO Recurrence
After 2-6 months of following a specialized diet, along with incorporating supplemental and lifestyle recommendations given to you by your medical provider, you should see an improvement and be feeling better. Once your medical provider has determined that your SIBO/SIMO has been eradicated it is paramount to then work on repopulating your microbiome and prioritizing gut health. We do know that it is possible for SIBO/SIMO to return, therefore it is important to put things into place to optimize gut health and prevent recurrence from rearing its ugly head.
Strategies to prevent recurrence include:
- Eat a diverse nutrient dense diet rich in vitamins & minerals (enjoy a variety of colors, textures, and a combination of raw vs.
- Ready to work with Dr.
The Importance of Individualized Nutrition Therapy
Refer adults living with type 1 or type 2 diabetes to individualized, diabetes-focused MNT at diagnosis and as needed throughout the life span and during times of changing health status to achieve treatment goals. The National Academy of Medicine (formerly the Institute of Medicine) broadly defines nutrition therapy as the treatment of a disease or condition through the modification of nutrient or whole-food intake (7). To complement diabetes nutrition therapy, members of the health care team can and should provide evidence-based guidance that allows people with diabetes to make healthy food choices that meet their individual needs and optimize their overall health. The Dietary Guidelines for Americans (DGA) 2015-2020 provide a basis for healthy eating for all Americans and recommend that people consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level (8). (9-12). Essential components of MNT are assessment, nutrition diagnosis, interventions (e.g., education and counseling), and monitoring with ongoing follow-up to support long-term lifestyle changes, evaluate outcomes, and modify interventions as needed (9,10). ○ Improve A1C, blood pressure, and cholesterol levels (goals differ for individuals based on age, duration of diabetes, health history, and other present health conditions. The unique academic preparation, training, skills, and expertise make the RDN the preferred member of the health care team to provide diabetes MNT and leadership in interprofessional team-based nutrition and diabetes care (1,9,13-18). Although certification (such as Certified Diabetes Educator, Board Certified-Advanced Diabetes Management) is not required, ideally the RDN will have comprehensive knowledge and experience in diabetes care and prevention (9,17). Detailed guidance for the RDN to obtain the expert knowledge and experience can be found in the Academy of Nutrition and Dietetics Standards of Practice and Standards of Professional Performance (12). Health care professionals can use the education algorithm suggested by ADA, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics (1) that defines and describes the four critical times to assess, provide, and adjust care. The algorithm is intended for use by the RDN and the interprofessional team for determining how and when to deliver diabetes education and nutrition services. In addition to diabetes MNT, DSMES is important for people with diabetes to improve cardiometabolic and microvascular outcomes in a disease that is largely self-managed (1,19-23). Reported hemoglobin A1c (A1C) reductions from MNT can be similar to or greater than what would be expected with treatment using currently available medication for type 2 diabetes (9). Strong evidence supports the effectiveness of MNT interventions provided by RDNs for improving A1C, with absolute decreases up to 2.0% (in type 2 diabetes) and up to 1.9% (in type 1 diabetes) at 3-6 months. Cost-effectiveness of lifestyle interventions and MNT for the prevention and management of diabetes has been documented in multiple studies (12,17,24,25). The National Academy of Medicine recommends individualized MNT, provided by an RDN upon physician referral, as part of the multidisciplinary approach to diabetes care (7). The strongest evidence for type 2 diabetes prevention comes from several studies, including the DPP (26-28). The DPP demonstrated that an intensive lifestyle intervention resulting in weight loss could reduce the incidence of type 2 diabetes for adults with overweight/obesity and impaired glucose tolerance by 58% over 3 years (26). Diabetes Prevention Program Outcomes Study (DPPOS). Substantial evidence indicates that individuals with prediabetes should be referred to an intensive behavioral lifestyle intervention program modeled on the DPP and/or to individualized MNT typically provided by an RDN with the goals of improving eating habits, increasing moderate-intensity physical activity to at least 150 min per week, and achieving and maintaining 7-10% loss of initial body weight if needed (14,17,33,34). To make diabetes prevention programs more accessible, digital health tools are an area of increasing interest in the public and private sectors. Although numerous studies have attempted to identify the optimal mix of macronutrients for the eating plans of people with diabetes, a systematic review (45) found that there is no ideal mix that applies broadly and that macronutrient proportions should be individualized. It has been observed that people with diabetes, on average, eat about the same proportions of macronutrients as the general public: ∼45% of their calories from carbohydrate (see Table 3), ∼36-40% of calories from fat, and the remainder (∼16-18%) from protein (46-48). Regardless of the macronutrient mix, total energy intake should be appropriate to attain weight management goals. Emphasizes a variety of vegetables from all of the subgroups; fruits, especially whole fruits; grains, at least half of which are whole intact grains; lower-fat dairy; a variety of protein foods; and oils. Emphasizes vegetables, fruits, starches (e.g., breads/crackers, pasta, whole intact grains, starchy vegetables), lean protein sources (including beans), and low-fat dairy products. Emphasizes vegetables low in carbohydrate (such as salad greens, broccoli, cauliflower, cucumber, cabbage, and others); fat from animal foods, oils, butter, and avocado; and protein in the form of meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds. Some plans include fruit (e.g., berries) and a greater array of nonstarchy vegetables. Avoids starchy and sugary foods such as pasta, rice, potatoes, bread, and sweets. There is no consistent definition of “low” carbohydrate. Similar to low-carbohydrate pattern but further limits carbohydrate-containing foods, and meals typically derive more than half of calories from fat. Often has a goal of 20-50 g of nonfiber carbohydrate per day to induce nutritional ketosis. Emphasizes vegetables, fruits, and low-fat dairy products; includes whole intact grains, poultry, fish, and nuts; reduced in saturated fat, red meat, sweets, and sugar-containing beverages. Emphasizes foods theoretically eaten regularly during early human evolution, such as lean meat, fish, shellfish, vegetables, eggs, nuts, and berries. Carbohydrate is a readily used source of energy and the primary dietary influence on postprandial blood glucose (8,49). Foods containing carbohydrate-with various proportions of sugars, starches, and fiber-have a wide range of effects on the glycemic response. Some result in an extended rise and slow fall of blood glucose concentrations, while others result in a rapid rise followed by a rapid fall (50). The amount of carbohydrate intake required for optimal health in humans is unknown. The regular intake of sufficient dietary fiber is associated with lower all-cause mortality in people with diabetes (51,52). Therefore, people with diabetes should consume at least the amount of fiber recommended by the DGA 2015-2020 (minimum of 14 g of fiber per 1,000 kcal) with at least half of grain consumption being whole intact grains (8). A few studies have shown modest A1C reduction (−0.2% to −0.3%) (53,54) with intake in excess of 50 g of fiber per day. However, such very high intake of fiber may cause flatulence, bloating, and diarrhea. The use of the glycemic index (GI) and glycemic load (GL) to rank carbohydrate foods according to their effects on glycemia continues to be of interest for people with diabetes and those at risk for diabetes. As defined by Brand-Miller et al. (56), “the GI provides a good summary of postprandial glycemia. It predicts the peak (or near peak) response, the maximum glucose fluctuation, and other attributes of the response curve.” Two systematic reviews of the literature regarding GI and GL in individuals with diabetes and at risk for diabetes reported no significant impact on A1C and mixed results on fasting glucose (9,50). There is limited research in people with diabetes or prediabetes without kidney disease on the impact of various amounts of protein consumed. Some comparisons of protein amounts have not demonstrated differences in diabetes-related outcomes (57-60). A 12-week study comparing 30% vs. 15% energy from protein noted improvements in weight, fasting glucose, and insulin requirements in the group that consumed 30% energy from protein (61). A meta-analysis from 2013 of studies ranging from 4-24 weeks in duration reported that high-protein eating plans (25-32% of total energy vs. The National Academy of Medicine has defined an acceptable macronutrient distribution for total fat for all adults to be 20-35% of total calorie intake (49). Eating patterns that replace certain carbohydrate foods with those higher in total fat, however, have demonstrated greater improvements in glycemia and certain CVD risk factors (serum HDL cholesterol [HDL-C] and triglycerides) compared with lower fat diets. The types or quality of fats in the eating plans may influence CVD outcomes beyond the total amount of fat (63). Foods containing synthetic sources of trans fats should be minimized to the greatest extent possible (8). The body makes enough cholesterol for physiological and structural functions such that people do not need to obtain cholesterol through foods. Although the DGA concluded that available evidence does not support the recommendation to limit dietary cholesterol for the general population, exact recommendations for dietary cholesterol for other populations, such as people with diabetes, are not as clear (8). Whereas cholesterol intake has correlated with serum cholesterol levels, it has not correlated well with CVD events (65,66). Large epidemiologic studies have found that consumption of polyunsaturated fat or biomarkers of polyunsaturated fatty acids are associated with lower risk of type 2 diabetes (67). Supplementation with omega-3 fatty acids in prediabetes has demonstrated some efficacy in surrogate outcomes beyond serum triglyceride levels. In a single-blinded RCT design in Asia, 107 subjects with newly diagnosed impaired glucose metabolism and coronary heart disease (CHD) supplemented with 1,800 mg/day of eicosapentaenoic acid (EPA) experienced improved postprandial triglycerides, glycemia, insulin secretion ability, and endothelial function over a 6-month period (68). The intervention in the PREvención con DIeta MEDiterránea (PREDIMED) study, comparing a Mediterranean-style eating pattern supplemented either with extra-virgin olive oil or with nuts versus a control diet, reduced incidence of type 2 diabetes among people without diabetes at high cardiovascular risk at baseline (69). The Malmö Diet and Cancer cohort study examined specific food sources of saturated fat and found that intake of saturated fat from dairy products, coconut oil, and palm kernel oil were associated with lower diabetes risk (70), whereas saturated fat intake was associated with higher risk of diabetes in the PREDIMED study (71). Other meta-analyses of observational studies have not shown an inverse relationship with full-fat dairy intake and diabetes risk (72,73). An eating pattern represents the totality of all foods and beverages consumed (8) (Table 3). This section emphasizes evidence from randomized trials of eating patterns in people with type 1 diabetes, type 2 diabetes, and prediabetes and was limited to those trials with at least 10 people in each dietary group and a retention rate of >50%. The most robust research available related to eating patterns for prediabetes or type 2 diabetes prevention are Mediterranean-style, low-fat, or low-carbohydrate eating plans (26,69,74,75). The PREDIMED trial, a large RCT, compared a Mediterranean-style to a low-fat eating pattern for prevention of type 2 diabetes onset, with the Mediterranean-style eating pattern resulting in a 30% lower relative risk (69). Several large type 2 diabetes prevention RCTs (26,74,83,84) used low-fat eating plans to achieve weight loss and improve glucose tolerance, and some demonstrated decreased incidence of diabetes (26,74,83). Given the l… 0% found this document useful (0 votes)232 views13 pagesThe document discusses nutrition strategies and principles for gym goers and weightlifters. It covers topics like calculating energy expenditure, optimizing macronutrient intake for weightli…0% found this document useful (0 votes)232 views13 pagesSimoThe document discusses nutrition strategies and principles for gym goers and weightlifters. It covers topics like calculating energy expenditure, optimizing macronutrient intake for weightlifting, the role of proteins and carbohydrates, as well as supplements like creatine and whey protein.0% found this document useful (0 votes)232 views13 pagesSimoThe document discusses nutrition strategies and principles for gym goers and weightlifters.
Read also: Weight Loss with Low-FODMAP