SIBO Was Destroying My Gut. Here's What I Wish I'd Known

If you'd asked me back in 2017 if I ate a gut-friendly diet, I would have given an emphatic yes.

I'd recently come off a yearlong odyssey healing my Hashimoto's one lifestyle change at a time, and as part of it had learned the do's and don'ts of living with my microbiome in mind. I was eating plenty of fiber, dousing my grain bowls in kefir green goddess dressing and kimchi, and washing it all down with homemade kombucha.

After I decided to see a doctor for a full work-up, the diagnosis I received was SIBO: small-intestinal bacterial overgrowth.

Small-intestinal bacterial overgrowth is exactly what it sounds like: a type of dysbiosis1, which simply means an imbalance in the trillions of bacteria that take up residence in your gut. In the case of SIBO, however, the issue is not necessarily the ratio between good, beneficial bacteria and bad, pathogenic bacteria (though that could be part of it). Rather, the main problem is location, not type.

Though critters colonize all sections of our alimentary canal, the majority of it is found in the large intestine (also known as the colon), where it assists in the final step of the digestive labyrinth and prepares for evacuation.

The small intestine, on the other hand, is where your food intermingles with digestive juices, nutrients are absorbed into the bloodstream, and your body reaps the rewards of what you've just put in it. It's not a place where bacteria have much of a function. In fact, as is the case with SIBO, their increased presence causes a host of issues.

With SIBO, I quickly learned there are numerous contradictions and unknowns. But as I hopped down the rabbit hole and began honing a game plan—even starting a podcast on the subject!—I learned some best practices that helped me inevitably kick this complex condition.

The most common approach for a SIBO diet is one that's low in FODMAPs. Some of the more restrictive versions also limit grains and other refined carbohydrates. These diets can help reduce the number of bacteria in your small intestine by effectively starving them out. But unless you eat a completely carbohydrate-free diet, it's unlikely that you will completely eradicate the population.

1. Begin your antimicrobials, and toward the end of the treatment, begin your low-FODMAP diet, knowing that it will take a few weeks to get the hang of the restrictions anyway.

2. Try the diet for a few weeks until your symptoms are more under control and your gut has had a chance to heal, then begin reintroducing small quantities of high-FODMAP foods or grains in tandem with starting your medication. This will stir up some of the remaining critters at the same time as you begin taking pills to kill them.

The level of restrictiveness of a SIBO diet can breed some unhealthy food tendencies. I get it: For many people, limiting FODMAPs was the first time in many years that their IBS symptoms dissipated. It can make you feel empowered. It can make you grateful that your food is one thing you can control. But it can also lead to unhealthy perfectionism. 

The goal of any SIBO treatment–diet, supplements, or otherwise–is to get you eating a diverse, nutrient-rich array of vegetables, no matter how many fermentable sugars they contain. Staying on a restrictive diet long term is not necessary for prevention, and may in fact—according to studies on the low-FODMAP diet—be damaging to the overall health of your bacterial ecosystem in the large intestine. When you starve bacteria in one place, you do so everywhere.

As I mentioned, the root cause of SIBO oftentimes has to do with structural issues or a failure of the migrating motor complex2 (MMC), not an imperfect diet. Just as important as what you're eating is how you're eating it. Make sure you're chewing your food thoroughly.

Since your MMC kicks in during a fasting state of 90 minutes or more, it's important not to snack between meals. Consider light intermittent fasting—12 to 16 hours overnight. (For more information, check out our complete guide to intermittent fasting). Drinking lemon water or apple cider vinegar before meals may stimulate stomach acid, which helps kill bacteria coming into your system and prevents more of a buildup in the small intestine. And most importantly, enjoy your food.