Diet for Those with Symptomatic Small Bowel Bacterial Overgrowth

www.GInutrition.virginia.edu CRP 11/2016

What is small bowel bacterial overgrowth (SBBO or SIBO for short)?

We all have bacteria in our intestines, but some people have too much. These extra bacteria can

cause problems. Good movement of food through the small bowel helps avoid this problem, and

so does having normal amounts of stomach acid. So, people with slow bowel motility or who

make too little gastric acid are at risk for bacterial overgrowth.

What are the symptoms?

Symptoms include gas, abdominal pain, distention, bloating, fullness, diarrhea, nausea, and/or

pain after eating foods that are high in sugars, like sodas, sweets and desserts, or high in fiber,

such as pinto beans, kidney beans, bran cereals, etc.

How does what I eat make my symptoms worse?

When there are too many bacteria high up in your intestine near your stomach, they get “first

dibs” on the food that you eat – instead of you! The bacteria use your food for fuel, and they

make gas in the process. This is what makes you uncomfortable.

Foods that do not contain carbohydrates or fiber do not usually cause problems. This includes

meats (beef, pork, lamb, venison); poultry (chicken, turkey, duck); fish and shellfish; eggs; and

butter, oils, and hard cheeses.

How to best use this diet:

Look over the list of foods below and cut out the foods and drinks you eat a lot of. Start by at

least cutting out concentrated sugars and sweets. If you feel a lot better, that may be all you need

to do. Then add back a small amount of one food at a time if you want. You should wait 3 days

before trying a second food again. If your symptoms come back, then that may be a food you

need to just avoid.

Additional Information:

Visit www.GInutrition.virginia.edu and go to link to Nutritional Articles. Find the article:

DiBaise JK. Small Intestinal Bacterial Overgrowth: Nutritional Consequences and Patients at

Risk. Practical Gastroenterology 2008;(12):15.

www.GInutrition.virginia.edu CRP 11/2016

KEEP EATING THESE FOODS:

CUT OUT THESE FOODS:

Protein Foods (meat, fish, poultry)

 Beef, pork, lamb, chicken, turkey, duck,

fish, shellfish, eggs, milk

 All allowed!

Plant protein foods

 Tofu, tempeh, unsweetened peanut butter,

unsweetened almond butter, nuts and

seeds (1oz or less per serving)

 Dried beans such as black, pinto, kidney,

refried, Lima, lentils, etc.

 Nuts and seeds in servings bigger than

1oz (a small handful)

 Sweetened nut butters like Jiffy, etc.

Grains

 Breads: sandwich, pita, rolls, biscuits,

naan, bagels, English muffins, corn bread,

tortillas, bread sticks

 Starches: pasta, noodles, rice, bread

stuffing

 Unsweetened breakfast cereals: Cheerios,

Corn Flakes, Total, Rice Crispies, Chex,

Special K, Kix

 Hot unsweetened cereals: oatmeal, Cream

of Wheat/farina, cream of rice, grits

 Breakfast breads: pancakes and waffles

(without syrup—both regular and sugar

free), plain, corn, and English muffins,

rice cakes

 Snack foods: crackers (saltines, club, soda,

matzo), cheese nips, goldfish, potato chips

 High fiber cereals (any that contain 2 or

more grams of fiber per serving): All-

Bran, oatmeal, granola, any whole grain

cereal

 Cereals with dried fruits, coconut, nuts

or seeds

 Sweetened cereals and kids’ cereals such

as: Honey Nut Cheerios, Cocoa Puffs,

Frosted Flakes, Fruit Loops, etc.

 Bran, faro, barley, brown rice, wild rice,

quinoa

 Bran muffins, granola bars, fiber bars

Fruits

 No more than ½ cup applesauce daily OR

1 small piece of fresh fruit daily.

 Talk to your Registered Dietitian about

whether you should cut fruit out altogether

when starting this diet.

 All dried or candied fruits (raisins, dates,

Craisins, figs, banana chips, mango,

pineapple, prunes)

 All fruit juices and fruit drinks

 Blended smoothies with fruit such as

Odwalla, Naked, or freshly prepared

smoothies

 All canned fruit in its own juice or syrup

Vegetables

 Starchy vegetables (no more than ½ cup at

a meal): white potato, butternut squash

 Non-starchy vegetables (no more than ½

cup at a meal): green beans, carrots,

spinach, kale & other greens, tomato

 High fiber or sugar vegetables:

artichokes, asparagus, beets, broccoli,

Brussels sprouts, cabbage, cauliflower,

corn, fennel, garlic, green peppers, leeks,

okra, onions, peas, shallots, sweet

potato, tomato paste

www.GInutrition.virginia.edu CRP 11/2016

Dairy

 Plain milk, plain yogurt, plain kefir,

cottage cheese, hard cheeses, soft cheeses

 Sweetened milk drinks: chocolate milk,

strawberry milk, Yoo-hoo, Ovaltine

 Carnation Instant Breakfast or store

brand equivalent

 Hot cocoa such as Swiss Miss

 Flavored yogurts such as Yoplait or

similar, sweetened kefir

Beverages (nondairy)

 Water!

 Diet sodas

 Unsweetened tea or tea sweetened with

Splenda, Equal, Sweet N Low, or Stevia

 All fruit juices and fruit drinks like

Kool-Aid or Gatorade (including G2)

 Regular soda, sweet tea made with sugar

 Blended smoothies with fruit such as

Odwalla, Naked, or freshly prepared

smoothies

 Ensure, Boost, or store brand equivalents

 Flavored (such as vanilla) soy or other

cow’s milk alternatives

 Sweetened coffee drinks such as vanilla

lattes or Starbucks Frappuccinos, etc.

 Hot cocoa such as Swiss Miss

Sweets

 Avoid all.

 Cakes, cookies, candies, pies, donuts,

pastries, chocolate

 Ice cream, sherbet, popsicles, Italian ice,

frozen yogurt

 Jell-O or gelatin desserts (regular and

sugar free), Cool Whip

 Trail mix (dried fruit, seeds, nuts,

coconut, granola, chocolate, etc.)

Condiments and sweeteners

 Mayonnaise, mustard, salad dressings that

do not contain any of the ingredients to the

right, oil, vinegar

 Splenda, Equal, Sweet N Low, Stevia

 Jams and jellies (regular and sugar free)

 Honey, agave, Karo syrup, molasses,

brown rice syrup, granulated (white)

sugar, brown sugar, maple syrup,

pancake syrup (including sugar free and

fruit flavored)

 Ketchup made with high fructose corn

syrup

 Tomato paste

www.GInutrition.virginia.edu CRP 11/2016

Other words that mean “sugar”

Check the ingredients list for these, especially in processed or packaged foods

 Avoid all.

 High fructose

corn syrup

 Crystalline

fructose

 Granulated sugar

 Agave nectar

 Brown sugar

 Brown rice syrup

 Pure maple syrup

 Corn syrup

 Honey

 Evaporated cane

juice

Other words that mean “sugar alcohol”

Check the ingredients list for these, especially of diet or diabetic foods!

 Avoid all.

 Sorbitol

 Isomalt

 Lactitol

 Maltitol

 Mannitol

 Xylitol

 Erythrytol

 Lactatol

Avoid Medications or Supplements with Sugar or Sugar Alcohols

 Liquid medications often have sugar alcohols for flavor, especially those for diabetic

people. Check labels for any of the ingredients listed above: cough syrups, liquid Tylenol

or ibuprofen, codeine.

 Lactulose—talk with your physician before restricting this—there are some patients who

will need to keep taking this medication.

 Stop taking these Fiber supplements: Metamucil, Benefiber, Perdiem, Citrucel

SAMPLE MENU

Breakfast

 Cornflakes or Oatmeal with unsweetened

milk alternative (soy, almond, rice, etc)

 Coffee or tea with or without an allowed

artificial sweetener and/or unsweetened milk

alternative

 Turkey sausage patty

 Small banana

Lunch

 Ham sandwich on wheat bread with

mayonnaise and pickles

 ½ cup baby carrots with ranch dressing made

without high fructose corn syrup

 Handful of potato chips

Dinner

 4-6 oz of poultry, lean meat, or fish

 ½-¾ cup white rice or pasta

 ½ cup green beans

Snack

 Plain rice cake with unsweetened nut

butter with a glass of water or

unsweetened tea