This week is all about food during SIBO treatment and beyond. Most of my clients struggle with this before we work together. There is no right way, but this episode I explain some of the different approaches.

🥦 Exploring SIBO diets: low FODMAP, specific carbohydrate, SIBO-specific, biphasic, and elemental diets.

👩‍⚕️ The importance of working with a knowledgeable SIBO nutritionist for tailored guidance.

🚫 The perils of remaining on a restrictive diet for too long. You want to eat as broad a diet as your symptoms allow.

🍎 Balancing symptom management and nutritional needs during SIBO treatment and maintenance.

🔄 Reintroduction of diverse, nutrient-rich foods post-treatment for long-term gut health.

If you've learnt anything or enjoyed the podcast - Please leave me a review to support this podcast.

Links

• What to eat with SIBO blog post - https://www.goodnessme-nutrition.com/sibo/whats-the-best-sibo-diet-for-treating-and-getting-rid-of-symptoms/
• Risk factors for SIBO - https://www.goodnessme-nutrition.com/sibo/four-risk-factors-for-sibo/

Relevant episodes

• Ep 11 - SIBO
• Ep 12 - SIBO treatments
• Ep 31 - Supplements for SIBO

Work with me

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

Email - info@goodnessme-nutrition.com

What should you eat when you've got SIBO?

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This question is very confusing, so I

thought I'll dedicate a whole episode to

3

explaining a bit more about what to eat

when you've got SIBO, what should you

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eat when you're going through treatment,

and what to do longer term when you're

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trying to get back to a maintenance diet.

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Should you go low FODMAP and cut

out all the fermentable fibres

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or do you need to go even further

and go on one of the strict SIBO

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diets to remove all carbohydrates?

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If you're struggling with small

intestine bacterial overgrowth and

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just no clue about what to eat, going

from one diet to another, I hope this

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episode will give you some answers.

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Welcome to episode 40 of The Inside

Knowledge with me, Anna Matson.

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This episode is going to be

all about eating with SIBO.

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The diets are very confusing and

all the diet advice is conflicting

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sometimes, so I'm going to dig a little

bit into the research and explain

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where some of these contradictions

come from and how to navigate it if

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you're trying to do this on your own.

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Now first up, I really do suggest if

you've got diagnosed SIBO and you can

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work with a nutritionist, then that

is going to be your easiest way to get

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the best diet that is tailored for you.

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And I also want to say not just

any nutritionist, but someone

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who really understands SIBO

or IBS, like that whole area.

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I've had a couple of clients come to me

recently who've been working with other

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nutritionists and they might have had

the best of intentions but they really

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don't understand the symptoms, the

diet that's needed, or the treatment.

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So they've been advising people to

take the wrong kind of supplements

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, or not treat SIBO at all and

just go on a very strict diet.

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And this has led to my clients kind

of coming to me and feeling even

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more confused because they tried

what the other nutritionist said

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and it didn't help, it didn't get

better, and in one case it got worse.

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And so, I would Stress.

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If you're looking for somebody, make

sure that they are talking about SIBO

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on their website and when you speak to

them before you sign up, that you get a

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good sense that they really have worked

with a lot of people who've got different

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types of SIBO and that they're experienced

as well, not just talking the talk.

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So.

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That is just a little preface

to the content for today.

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just as a quick reminder, SIBO stands

for Small Intestine Bacterial Overgrowth,

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which is an excessive amount of bacteria

or microbes in your small intestine where

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we shouldn't have loads of bacteria.

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For some background on SIBO, listen

to episode 11 about what is SIBO,

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episode 12 of how to treat SIBO and

episode 31 which covers different

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supplements for treating SIBO.

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This episode is going to be all

assuming that you know you've got SIBO.

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We're not going through that

like, is it, isn't it thing.

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This is for people who have got a

diagnosis and had a positive test and

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then are in the realm of treating it

with some supplements or antibiotics.

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There are two schools of thought

really when it comes to what

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to eat when you've got SIBO.

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And it differs slightly when you're

going through treatment or whether

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you have finished your treatment

and you're like in between rounds.

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The challenge for getting a really

good sort of scientific evidence

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based position on this is that there

is just really not very good research

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data to support any of the positions.

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So one school of thought thinks

that you should treat SIBO by

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removing all the fermentable foods,

so all the fiber from your diet

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that Bacteria would love to eat.

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If you take them out, then that

would help to starve the bacteria

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and reduce down their numbers.

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Then the other way people do it is to try

to eat fiber whilst treating it because,

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as the bacteria are replicating, you've

got a chance to attack them with your

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antimicrobial treatment or antibiotics.

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Either way, there is just a lack

of good studies that show clinical

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applications so that we can sort

of translate into day to day use.

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But from my experience of working with

hundreds of people who've got IBS and

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SIBO, the diet is mostly about Helping

you with your symptoms and the diet

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is not going to treat your SIBO.,

Diet alone is not going to reduce down

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your numbers effectively to the extent

that your SIBO will not come back.

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Okay, so you need to have antibiotics

or antimicrobial treatments that

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are effective at reducing SIBO and

make sure that you're taking them

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at the right times, the right level,

you know, the dosage is correct.

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So.

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We have got more evidence about

how to treat it, but the diet I

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would say is mostly about how to

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manage your symptoms, which

will hopefully allow you to

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keep going with the treatment.

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And that's what we can dive

into a little bit today.

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But if you have that mindset, that

actually what you eat is not the be all

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and end all of getting rid of the SIBO.

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So if you Decide to eat something that

you know will trigger your symptoms and

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maybe cause more bloating But actually

you just want to have that meal you want

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to eat with your friends or something

It's not ruining your SIBO treatment in

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eating food that has got fiber in it or

food that's got sugar in it Okay, it's

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not going to completely invalidate the

treatment that you've already been working

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on, and I think that's what I want to

give you out of this episode as well,

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is reassurance that if you are eating to

meet your taste requirements sometimes,

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not just thinking about nutrition, not

just thinking about the SIBO and getting

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rid of it, but you're also thinking about

what you enjoy eating, then it's really

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important to To feel okay about that.

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One of the reasons I do focus on

diet with my clients though is to

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get those symptoms under control.

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People come to work with me and they

are just desperate and want to reduce

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the bloating that is making you take

your clothes off by the end of the day.

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To reduce that nausea every time

you eat or you get up in the

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morning and you're feeling sick.

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Maybe it's frequent toilet trips or

urgent toilet trips that mean actually

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you've had instances of incontinence.

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These are all common symptoms of people

who have IBS and SIBO and by maintaining a

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diet that reduces some of these symptoms.

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You tend to get more energy, tend

to start to feel better, and then

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you can focus more on the treatment.

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It's really hard to just do it through

the antimicrobial or antibiotic treatment.

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I thought I'd take you through a few of

the options that are on the internet.

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If you look for SIBO diet, you will come

up with a couple of suggested options.

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So the main purpose of all of these diets

is to reduce down your intake of fiber

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that can be fermented by the gut bacteria.

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And then the hope is that it

will reduce your symptoms.

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Commonly discussed diets might be

the specific carbohydrate diet,

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which was created for people with.

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Celiac disease, and it's actually,

used in inflammatory bowel disease to

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reduce down some of the disaccharides,

these are like two sugar elements stuck

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together, so you can eat foods that have

got monosaccharides, like one type of

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sugar, which includes most vegetables

and fruits, but it doesn't include

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any grains, for example, any dairy, or

any starchy veg, like root vegetables.

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So, It hasn't really been proven much

in the SIBO world, but some people

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started off using it as an approach

to reduce down the fermentation and

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some of the bloating, for example.

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That is the specific carbohydrate diet.

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Then there's also the low FODMAP

diet, which you will have probably

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heard me talk about a lot.

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This is a really well tested

IBS dietary intervention.

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Again, there's not much evidence for

using it in SIBO, but we know that

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in three out of four people who've

got IBS, some benefit will be shown.

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So a lot of people do feel

better on the low FODMAP diet.

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The key thing with it is you

have to go through the retesting

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process and take some time to bring

the foods back into your diet.

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It's not about restricting it.

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So that's, that is one diet

that's probably the most common,

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iBS diet that's out there.

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Then there are two other diets that have

been created by key SIBO practitioners.

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So one is called the SIBO

specific food guide by Dr.

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Alison Siebecker.

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She is like the main

SIBO doctor, in America.

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She created a diet based a little

bit on the low FODMAP diet,

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but also taking elements of

the specific carbohydrate diet.

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She's also just adapted it

based on hundreds of clients

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that she's worked with.

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So it's very restrictive because

it's cutting out even more things

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than the low FODMAP diet, and then

there's another doctor called Dr.

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Nirala Jacobi who took Dr.

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Seebecker's diet and has kind of turned it

into a timed and phased approach to eating

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and that is called the SIBO biphasic diet.

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This again is very restrictive and it

has a two week restriction where you're

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really stripping things out a bit like

the low FODMAP restriction phase and then

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you expand the diet a little bit more

for another sort of six to eight weeks.

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The final diet I want to mention

is called the elemental diet.

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Now this is a liquid only diet for

two to three weeks and you just

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basically have shakes instead of meals.

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You have no food at all.

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Now it's a Properly, like,

put together meal in a shake.

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The problem with it is that you're not

eating at all and that's really hard

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mentally So you literally have no meal

times with your family or your partner

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or however you will not be chewing

anything which is quite challenging

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people have told me and It's also More

of a treatment for SIBO rather than

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a dietary intervention, so it's more

Something to reduce down the microbes.

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Now again, people do see some

reduction similar to a round of

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treatment Alongside the elemental diet.

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This is one diet that you should not

also be taking antibiotics with, you

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do it separately So it's not a diet

that you follow with treatment as well.

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In the UK, it has to be prescribed

by a doctor and I think that's right.

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I would suggest that you don't

source it off the internet and

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try and do it yourself because You

don't know that you'll be getting

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all the right quality ingredients.

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And also I do think it's appropriate that

you have a proper assessment as to whether

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mentally and physically you actually

need it because it's quite challenging

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to cut out all food from your diet.

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So those are the different options

for like what you can eat or what

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people suggest that you eat with SIBO.

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As I said, the other approach is just

to eat normally and keep eating the

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same foods that you've always eaten

alongside taking your treatment.

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What you won't get with that though

is perhaps the same reduction in

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your symptoms and sometimes you need

to get your symptoms under control.

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in order to feel better and to

start, like, noticing a difference.

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So, just to be really clear, the

options are eat normally and take your

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SIBO treatment, eat a reduced fibre

diet, like one of the ones, one of

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the approaches I've mentioned, and

take your treatment alongside it.

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And then the third option is to

get the elemental diet prescribed

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for you as a treatment but then you

have to go back to eating normally

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after the elemental diet anyway.

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The problem with going on a reduced

fiber diet, let me just start with

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that now, is that you are Reducing

the fiber for your large intestine

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bacteria, which are the good guys.

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We want more of these

good beneficial bacteria.

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And if you are following a low FODMAP

diet or a very restrictive SIBO type

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diet for a long time, there is a danger

that you will become deficient in key

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nutrients or that you will reduce down

the good bacteria in your large intestine.

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Now the bacteria.

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there are key for supporting and

like training up our immune system,

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interacting with your digestive

motility, helping you absorb key

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nutrients like iron from your diet.

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So the bacteria have got a

massive role to play in lots of

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different physiological processes.

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It's not just nonsense happening

at the end of the digestive tract

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that you don't need to worry about.

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It really is.

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important to feed these

good bacteria with fiber.

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So what happens and what the danger

is, is that you go on a restrictive

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diet, like the low FODMAP diet for

six weeks, you feel a bit better and

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you carry on treating it with your.

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Treatment plan, whatever that is

with your doctor or nutritionist.

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And you have a little break from your

treatment round and then maybe you go

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and you're still on this restrictive

diet and then maybe you go on another

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round of treatment for another six weeks

and then you have another little break

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and then maybe you need another round.

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During that time, it could be up to a

year that you will be on a low FODMAP

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diet because you're not re challenging

your diet and re testing any of the foods.

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Now, I completely understand why

you wouldn't want to do that.

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You don't want to get those symptoms back.

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But what I encourage my clients to do is

to be very cautious in re testing foods.

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as quickly as possible.

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So what we want to do is eat the broadest

amount of foods that you can whilst

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keeping your symptoms under control.

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The other important thing that you

should know is if you go on a low

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FODMAP diet and you don't feel better,

like your symptoms are no better, then

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there's no point in staying on it.

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It's not helping your SIBO

to be on a low FODMAP diet.

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So if you don't feel better on it and

you're If you're still on this restrictive

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diet and your symptoms are really bad,

then you definitely need to start eating

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more different foods and introducing

that variety back to your diet again.

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Two previous episodes that I've done

about food reintroduction is episode 15

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about how to reintroduce, like, any foods

to your diet and episode 18 specifically

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about the FODMAP reintroduction process.

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So those episodes might be helpful

to you if you're struggling with how

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to reintroduce foods to your diet.

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Another reason for reintroducing

foods is a lot of people I work with

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have a very low body weight because

of the significant food restrictions.

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And we know that when you're not eating

enough food, that can also contribute

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to slow motility, slow digestion, which

is what we want to get over in SIBO.

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We want to re regulate your digestion.

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Eating three proper meals a

day with sufficient portions

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is also really helpful.

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So it's not just about variety, but

it's also about eating enough food.

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I'm going to do a couple of

episodes on how to gain weight with

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IBS and SIBO later in the year.

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I've just done the episodes on how to lose

weight and the challenges around that.

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I also really want to acknowledge

a lot of people struggling

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with the opposite problem.

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I would Suggest that my overall

approach for you, if you're trying to

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do this by yourself, is to, wherever

possible, focus on whole, natural foods.

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Consider your biggest triggers from

the high FODMAP foods list that might

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be really exacerbating your symptoms,

and perhaps reduce those down.

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For example, some key things

that might be triggers for you

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might be, um, beans and pulses.

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Maybe it's things like Watermelon.

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That's quite a common thing that

people are sometimes surprised about.

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It's high in lots of

the different FODMAPs.

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And if there are a couple of foods

that you just can't eat, it's okay

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to remove those from your diet.

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If you know that these

are really clear triggers.

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But when you're removing whole

food groups, like going gluten free

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unnecessarily, or removing multiple food

groups, then you Just need to be aware,

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I suppose, that there is a potential

for you to be low in key nutrients.

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And some of the things that people

are commonly low in with IBS,

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through restrictive dieting, are B

vitamins, iron, zinc, and calcium.

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Those are often low in people who are

cutting out lots of different foods,

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and There are a couple of different

research studies showing that people

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with IBS tend to eat less fiber.

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Again, there's not many studies for

people with SIBO, but for IBS, we know

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that people tend to eat less fiber, tend

to eat more foods repetitively, so less

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variety in their diet, and blood tests

have shown that people who've got IBS tend

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to be lower in those nutrients, so it's

not just that they're not eating them,

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their bodies are low in things like zinc,

B vitamins, and particularly in SIBO, we

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know that there are nutritional impact

of having an overgrowth of bacteria,

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so the bacteria can interfere with your

ability to process B12 with iron and

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other B vitamins as well, but also fat

soluble vitamins like A, D, E and K.

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If you've got over SIBO and you've treated

it, you've retested, your levels are low,

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you're worried about SIBO coming back,

one of the best things you can do is to

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try and eat a normal diet as possible, and

eat a normal amount of food as possible.

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So, gradually reintroducing higher fibre

foods if you've been on a restrictive

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diet, making sure you've got a good

balance of complex carbohydrates, healthy

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fats, you know, proteins, proteins.

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You can slowly reintroduce some of

those higher fiber foods and really

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monitor your body's response to how

you're getting on and just gradually

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expanding back your diet to include a

variety of different nutrient rich foods.

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It helps so much when

you can eat normally.

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You can socialize more, you can

just be freer without reading

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ingredients for every

product that you buy.

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You could even go on to take prebiotic

and probiotic foods like sauerkraut

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and kefir and kimchi and all of these

things that are high in beneficial

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bacteria as well as fruits and

vegetables that feed the good bacteria.

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Like try to think about

your long term gut health.

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So if you're in that place where

you have got your SIBO down, what

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you definitely don't want to do

is stay on a restrictive diet.

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You want to try to eat As much as you can

and as much variety as you can So I hope

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this episode focusing on food for SIBO has

plugged a little hole in the episodes that

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i've done so far Obviously i've talked

about treatment for SIBO and that included

287

supplements and antibiotics and things

and they are key really important to your

288

Removal of the bacteria from your small

intestine you need to get on top of that,

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but it Hopefully, we'll give you some

ideas in this episode about how to eat

290

and what to eat whilst you're doing that.

291

I can help you with this individually

if you want to get in touch.

292

I run a three month gut reset program.

293

I'd love to hear from you.

294

My email is in the show notes if

you want to get in touch and work

295

with me one to one or in a group.

296

And if you've enjoyed this podcast

or if you've learned anything, please

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will you rate and review the podcast?

298

It helps me so much and I'd love

to hear your feedback as well.

299

Plus any questions that you

want me to cover in future

300

episodes, drop me an email.

301

I do read all my emails and I

try to respond to them as well.

302

Okay.

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See you next week.

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Goodbye.