Why we don't recommend low FODMAP for SIBO

Treatment of Irritable Bowel Syndrome (IBS) and Small Intestinal Bacterial Overgrowth (SIBO) with a low FODMAP diet has become very popular over the last 5-10 years, with most practitioners who specialise in gut health recommending a low FODMAP diet to relieve symptoms. At the Well Belly Health Clinic, the low FODMAP diet is something that we do not ever recommend to our clients. 

When clients come to our clinic already following a low FODMAP diet, they will usually report that they felt immediately better with a big reduction in symptoms when they first moved to the low FODMAP diet. They then report a rapid decline within a few weeks to a month of following the diet, resulting in an overall worsening of symptoms and increase in their intolerances, making them more sensitive than before they started. 

The issue with low FODMAPs (and also the reason that it provides initial relief) is that the FODMAP foods are the foods that feed our gut bacteria. So when we remove them, there is initial relief as there is a reduction in overgrowth of pathogenic bacteria in the small intestine. Over time, the starving of bacteria reaches a point where the microbiome begins to degrade, and impact on our ability to digest even more foods. So although the low FODMAP diet can have a short term gain, it is at the cost of long term damage to the microbiome. In clinic we find that the longer someone has been following a low FODMAP approach, the longer it takes to raise their ecosystem and improve their microbiome.

How we treat IBS at the Well Belly Health Clinic: 

IBS is a very generalised label for a range of symptoms involving the digestive system. There is no ‘one way’ that we treat all cases of IBS, as they are all different. We focus on each person individually, and work on what we believe to be the root cause of their symptoms. We do this by getting a thorough health history, then we start to put the puzzle pieces together and assess what needs to be addressed first. If there is constipation, we will work on getting the bowel emptying, and assess if other symptoms point towards the liver functioning, or perhaps the migratory motor complex in the bowel. If there is diarrhoea, we will also look at liver function and bile reabsorption, as well as stomach acid and digestion. Overall we work on bringing in principles from the GAPS protocol at a comfortable pace that is easy to implement, which focus on improving the health of the digestive system. 

How we treat SIBO at the Well Belly Health Clinic: 

SIBO is an overgrowth of bacteria in the part of the small intestine that is not meant to have much bacteria at all, the part close to the stomach in the upper quadrants of the abdomen. In a healthy digestive system, the acidity of the stomach is quite high. This keeps the stomach healthy and free of pathogens, and also aids in the digestion of food. When the food moves from the stomach to the small intestine, it is fairly acidic from the mechanical mixing in the stomach of the food with the stomach acids. This means that the start of the small intestine is quite acidic as well, and starts to lose its acidity as we move to the distal end closer to the colon. This is where the bulk of the gut bacteria are found that help with the digestion and absorption of nutrients. If the stomach acid is low, that means that the start of the small intestine is low in acidity as well. This creates a situation where the bacteria at the distal end of the small intestine (near the colon) can move up through the small intestine as there is no acidity to stop them. They then overgrow in the area of the small intestine closer to the stomach where they start breaking down the food to early, causing uncomfortable symptoms like bloating, gas, pain and discomfort, as well as food intolerances. The way we treat SIBO is not by starving bacteria with a low FODMAP diet, as this does not treat the root cause. We focus on improving digestion, increasing the stomach acidity, stimulating movement of the bowels so they are clearing adequately, and working on the health of the microbiome and using particular probiotics and ferments to help shift the SIBO out. We also work on introducing principles from the GAPS protocol to heal and repair the digestive system and raise the whole ecosystem. 

The Well Belly Approach:

The Well Belly Health Clinic approach is focussed on taking the first step to treat the root cause. We approach health in a way that reduces stress and overwhelm, so you can find your sustainable approach to your health and the health of your family. 

Live Q&A SIBO and FODMAPS:

Join Elyse Wednesday November 10th, 2.30pm (AEST)/3.30pm (AEDT) for a live Q&A all about SIBO and FODMAPS.