SIBO is a bacterial overgrowth in the small intestine. Some people with SIBO use an elimination diet to look for connections between the foods they eat and their SIBO symptoms.

Small intestinal bacterial overgrowth (SIBO) occurs when bacteria that usually grow in one part of your digestive tract, like your colon, are growing in your small intestine.

Risk factors for developing SIBO include taking proton pump inhibitors or opioids, gastric surgery, nerve damage to the small intestine, or a failure of the ileocecal valve.

Left untreated, SIBO can cause symptoms including pain, diarrhea, and malnutrition (due to the loss of the body’s main nutrients). In rare cases, a serious neurological condition called D-lactic acidosis can occur.

Antibiotics are the first line of treatment for SIBO.

In some cases, your doctor may also prescribe a liquid diet called an elemental diet. An elemental diet temporarily replaces all foods and beverages with a nutrient drink that’s easy for your body to absorb. This diet must be carried out with a doctor’s supervision.

No other diet is proven to treat SIBO. However, some people claim that limiting certain types of foods or changing your eating pattern can stop SIBO from coming back after treatment.

Your doctor or a registered dietitian may suggest trying an elimination diet to find out if particular foods are contributing to your digestive symptoms.

To look for links between foods and SIBO symptoms, some people follow a short term elimination diet followed by careful gradual reintroduction of eliminated foods.

The reintroduction of foods to the diet should be carefully guided by a registered dietitian who understands SIBO conditions.

An elimination diet is a tool that can help you learn if certain foods are associated with your SIBO symptoms. However, it cannot replace other treatments prescribed to you to manage SIBO or other associated conditions.

According to the American College of Gastroenterology, most diets proposed for SIBO reduce your intake of foods that are fermented by gut bacteria. These may include:

One option is a diet low in FODMAPs, which are difficult-to-digest carbs that are fermented by gut bacteria in the colon.

You should work with a registered dietitian to create a diet plan that is appropriate for your individual symptoms and nutritional needs.

Restrictive diets such as elimination diets are intended to be temporary. In the long term, a highly restrictive diet may make digestive conditions worse and harm your healthy gut bacteria.

If you decide to pursue an elimination diet, the foods you need to avoid will be specific to your personal diet plan. A registered dietitian can work with you to develop this plan.

In some cases, your doctor or dietitian may recommend temporarily eliminating a type of carbs called FODMAPs.

Certain symptoms of irritable bowel syndrome (IBS) can improve with a low-FODMAP diet. Studies have shown reductions in abdominal bloating and pain.

Because many people with IBS also have SIBO, a low-FODMAP diet is sometimes suggested for people with SIBO.

The main categories of FODMAPs include:

  • fructose, simple sugars commonly found in fruits and some vegetables, honey, and agave nectar
  • lactose, a sugar molecule in dairy products
  • fructans, a sugar compound found in gluten products, fruits, some vegetables, and prebiotics
  • galactans, a compound found in some legumes
  • polyols, sugar alcohols often used as low-calorie sweeteners

Foods that contain higher amounts of FODMAPs include:

  • high-fructose corn syrup
  • agave nectar
  • honey
  • soda and soft drinks
  • garlic
  • onions
  • asparagus
  • butternut squash
  • cauliflower
  • artichokes
  • beans
  • apples
  • dried fruits
  • sausage
  • flavored yogurt
  • ice cream
  • sweetened cereals
  • barley
  • rye
  • grains
  • peas
  • mannitol
  • sorbitol

Everyone reacts to these foods differently. Even if some FODMAPs cause symptoms for you, other FODMAP-containing foods may not.

A low-FODMAP diet is only one example of an elimination diet for SIBO. Remember, it’s best to take an individualized approach when planning a SIBO elimination diet.

Although the low-FODMAP approach is popular, there is little evidence to show that a low-FODMAP diet can help with SIBO.

Plus, restricting FODMAPs has been linked to potentially harmful changes in the types of bacteria growing in the gut. This effect was seen in people with IBS who followed a low-FODMAP diet for a prolonged period of time.

People with SIBO already have an overabundance of unhealthy gut bacteria, so some researchers caution that a low-FODMAP diet may not always be beneficial.

If you decide to try an elimination diet for SIBO, it’s important to plan it out with the help of a registered dietitian. They can help you build a list of foods to eliminate temporarily, and a plan for gradual reintroduction of foods.

If you’re avoiding FODMAPs during your elimination diet, the list of foods you should avoid can be restrictive. But there are still a number of foods you can enjoy while on this temporary diet.

Some foods contain low amounts of FODMAPs in small servings but may be limited because larger servings would increase the FODMAPs. Some of the acceptable foods for a low-FODMAP diet include:

To help you plan meals and make the right food choices, your dietitian may recommend using a FODMAP app like the one created by Monash University or Fast FODMAP.

Antibiotics are the primary treatment for SIBO. These medications get rid of the bacteria that’s overgrowing in the small intestine.

For some people, successfully treating the bacterial overgrowth does not eliminate digestive symptoms. If your symptoms continue after treating SIBO, you may have another digestive condition that requires treatment or management.

For example, lactose intolerance can cause symptoms similar to SIBO, such as bloating, gas, and diarrhea. If a food intolerance is causing digestive symptoms, you may need to make changes to your diet. These changes should be guided by your doctor or a registered dietitian.

In other cases, treating SIBO provides temporary relief, but not a long-term solution. In about 44% of cases, SIBO symptoms come back within 9 months after the first treatment.

When antibiotics alone do not help, the elemental diet is the only diet proven to treat SIBO. It is a predigested liquid diet prescribed by a doctor.

There are many diets that claim to stop SIBO from coming back. But there is little evidence to support their use. In fact, following a restrictive diet over a long period of time could make it harder to sustain a healthy balance of gut bacteria.

Probiotic supplements are often claimed to benefit digestive health. Some studies suggest that probiotics may limit bacterial overgrowth, lower scores on the hydrogen breath test, and reduce abdominal pain with SIBO.

However, a 2021 systematic review concluded that large, high-quality studies are needed to understand the effects of probiotics on SIBO. Some experts believe probiotics could make SIBO worse.

You may find that drinking more water can help reduce pain and ease digestion.

Before making any changes to your diet or implementing new treatment, discuss the risks with your doctor or dietitian.

An elimination diet for SIBO may help you identify foods that bring on your digestive symptoms. However, an elimination diet is not a treatment for SIBO. Traditional treatment methods shouldn’t be ignored.

Prior to incorporating any dietary changes to your treatment plan, discuss your options with your doctor.

To benefit from an elimination diet, it’s important to work with a registered dietitian with training in SIBO conditions. They can help you conduct the diet safely and effectively.

If your symptoms begin to worsen with a change in diet, seek immediate medical attention.