SIBO Diet: Best Food and Drinks

Medically reviewed by Robert Burakoff, MD

Small intestinal bacterial overgrowth, commonly known as SIBO, is a condition caused by an overgrowth of bacteria in the small intestine. Normally, the small intestine holds a very small number of bacteria. However, motility disorders, autoimmune conditions, low stomach acid, and other health conditions may cause bacteria from the large intestine to travel up into the small intestine, which causes an overgrowth of bacteria.

This overgrowth can lead to symptoms like abdominal pain, diarrhea, bloating, and the malabsorption of nutrients.

SIBO is treated with antibiotics, but diet changes may help, too. Eating—and avoiding—certain foods can sometimes help reduce or manage symptoms.

Foods To Eat if You Have SIBO

Though research is limited, some studies suggest dietary changes may help reduce symptoms and decrease the risk of SIBO-related nutrient deficiency. However, most researchers agree there’s currently not enough evidence to recommend any specific dietary treatment for SIBO.

That said, many people with SIBO also have irritable bowel syndrome (IBS) and may benefit from limiting certain foods and prioritizing others. Also, some foods and ingredients are known to make SIBO-related symptoms, such as bloating and gas, worse.

Most studies investigating the influence of diet on SIBO have focused on low-fiber and gluten-free foods.

Also, people with SIBO are more likely to develop deficiencies in certain nutrients, such as vitamin D and B12, and may benefit from focusing on foods rich in these nutrients.

Low FODMAP Foods

If you have SIBO, your healthcare provider may recommend prioritizing foods low in FODMAPs. These are a group of short-chain carbohydrates known as Fermentable Oligo-, Di-, Mono-saccharides, and Polyols.

FODMAPs are readily fermented by gut bacteria and may make symptoms like bloating, gas, and diarrhea worse. Some researchers believe following a low-FODMAP diet "starves" bacteria in the small intestine by depleting the nutrition required for bacteria's growth and reproduction, which may help treat SIBO.

The effectiveness of following a low-FODMAP diet for SIBO has not been confirmed in a clinical setting. However, low-FODMAP diets have been shown to be helpful for people with IBS, who are more likely to have SIBO.

Some low-FODMAP foods and drinks that may be helpful for SIBO include:

• Protein sources, like eggs, fish, and chicken

• Some fruits and vegetables, such as cantaloupe, strawberries, carrots, cucumbers, potatoes, and green beans

• Nuts and seeds, such as macadamia nuts, walnuts, and pumpkin seeds

• Gluten-free grains, like oats and quinoa

• Dairy alternatives, like almond milk and lactose-free milk

If you’re interested in trying a low-FODMAP diet, it’s best to work with a healthcare provider familiar with digestive diseases and FODMAPs, as the diet can be challenging to execute on your own.

Foods High in Vitamins

Some research suggests people with SIBO are more likely to be deficient in several nutrients, such as iron and vitamins A, B12, E, and vitamin D. These deficiencies are more likely to develop in people with more severe cases of SIBO who are experiencing malabsorption and chronic diarrhea.

Malabsorption and diarrhea impact nutrient levels and can lead to low or deficient levels of essential vitamins and minerals, which may cause various symptoms such as fatigue and anemia.

Here are some foods to focus on if you have SIBO:

• Vitamin A foods: Organ meats, salmon, goat cheese, eggs, and sweet potato

• Vitamin B12 foods: Fish, meat, poultry, and eggs

• Vitamin D foods: Sardines, salmon, beef liver, vitamin-D-fortified foods
  

• Vitamin E foods: Nuts, seeds, avocado, and fatty fish like salmon and trout

Many people with SIBO need to take dietary supplements in order to reach and maintain healthy nutrient levels. In some cases, dietary changes may not be enough to treat or prevent low or deficient nutrient levels.

Foods to Avoid

There’s currently not enough evidence to suggest all people with SIBO benefit from excluding specific foods from their diet. However, some SIBO specialists recommend limiting or avoiding certain foods and drinks, such as foods high in FODMAPs and foods that might fuel bacterial growth in the intestine.

If you have SIBO, your healthcare provider is the best resource for specific dietary recommendations, including foods to avoid. Since there are no universal dietary recommendations for everyone with SIBO, dietary changes should be specific to your individual needs and health background.

Foods High in FODMAPs

People who have SIBO often find relief when cutting back on or avoiding foods high in FODMAPs. Limiting these foods may also help improve symptoms in people with IBS, a condition that’s commonly associated with SIBO.

Many foods and drinks are high in FODMAPs, including:

• Fruits and vegetables, such as apples, pears, mangos, cherries, figs, pears, watermelon, plums, artichokes, garlic, leeks, onions, mushrooms, cauliflower, and snow peas.

• Dairy products, such as soft cheeses, milk, and ice cream

• Sweeteners and sugar alternatives, such as honey, high-fructose corn syrup, and sugar alcohols like sorbitol, xylitol, and erythritol

• Some nuts, like cashews and pistachios

• Beans and lentils 

• Grains and grain products, like wheat, rye, and wheat-based snacks

Not everyone with SIBO will react to FODMAP-containing foods in the same way. Some people may be able to tolerate small amounts of moderate FODMAP foods, while others may be much more sensitive.

Also, complete elimination of FODMAPs from your diet isn’t meant to be used as a long-term dietary protocol. Foods that you can tolerate should be reintroduced into your diet. Work with your healthcare provider to come up with a plan that works best for you.

Meal Ideas for SIBO

People with SIBO have different health needs, so it’s not possible to make broad diet recommendations for everyone with SIBO. For example, a person with IBS and SIBO may have very different nutrient needs and dietary restrictions compared to someone who has SIBO and hypothyroidism or diabetes.

However, eating nutrient-dense meals low in high-FODMAP foods and beverages may be helpful for reducing SIBO symptoms in some people.

Breakfast

Breakfast options include:

• Omelet made with two eggs, chopped zucchini, and parmesan cheese, and served with sliced cantaloupe and a cup of herbal tea

• Oatmeal topped with blueberries and walnuts

• Smoothie made with almond milk, strawberries, and raspberries

Lunch

Lunch options include:

• Thai peanut butter noodles made with brown rice noodles, low-FODMAP peanut butter sauce, sautéed bell peppers, cucumbers, carrots, grilled chicken, and crushed peanuts

• Grain bowl made with quinoa, kale, winter squash, tofu, and pumpkin seeds

• Salad with lettuce, tomatoes, cucumbers, radishes, hard-boiled egg, and chicken

Dinner

Dinner options include:

• Grilled salmon served with a baked potato and green beans

• Roasted chicken with sweet potato and sautéed eggplant

• Gluten-free pasta (made with rice, corn, or quinoa flour) with shrimp, tomato, and spinach

Snacks

Snack options include:

• A handful of salted macadamia nuts and a mandarin orange

• Banana with almond butter

• Carrots and a few slices of hard cheese, such as cheddar or asiago

Diets for SIBO

There are currently no specific diets recommended for SIBO. However, some studies suggest an elemental diet may be helpful for people with SIBO who don’t respond to or who can’t tolerate antibiotic treatment.

An elemental diet is a diet that provides amino acids, fats, carbohydrates, vitamins, and minerals in a form that is easily absorbed by the digestive tract. Elemental diets are composed of liquid formulas that are nutritionally complete and easy on the gastrointestinal system.

The nutrients contained in elemental formulas are already broken down, so they are readily absorbed by the small intestine. This limits nutrition to the bacteria that have overgrown in the small intestine.

Though research is limited, some evidence suggests elemental diets are highly effective for treating SIBO, with some studies showing a remission rate of over 80%.

However, elemental diets can be hard to stick to and are often unpalatable.

Your healthcare provider may be able to recommend dietary changes that could help reduce your SIBO symptoms and improve your overall quality of life. They can also discuss other treatment methods, such as herbal supplements, that have been shown to be helpful for people with SIBO.

A Quick Review

SIBO is a condition caused by an overgrowth of bacteria in the small intestine. Though research investigating the effects of diet is limited, eating low-FODMAP and high-vitamin foods may help improve SIBO symptoms like bloating and diarrhea.

There are currently no universal dietary recommendations for SIBO, meaning that diet and supplement regimens should be specific to your individual health needs and underlying medical conditions.

If you’re interested in learning more about dietary modifications that may be helpful for SIBO, contact your healthcare provider for advice.

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