In this article, we are going to treat a syndrome of recent diagnostic appearance, the Bacterial Overgrowth of the Small Intestine (SIBO) and Irritable bowel syndrome (IBS).

Symptoms of SIBO Bacterial overgrowth:

As a consequence of the increase of bacteria in the small intestine, fermentation processes that generate gas and abdominal distension take place.

People with SIBO also experience belching, flatulence, nausea, abdominal pain, diarrhea or constipation, malabsorption of nutrients (iron, calcium and vitamins A, D, E and B12), steatorrhea (fat and shiny stools) and intestinal permeability that it may favor the appearance of autoimmune pathologies.

These symptoms are common to other pathologies, such as Inflammatory Bowel Disease -EII- (Ulcerative Colitis, Crohns), Irritable Bowel Syndrome -III-, Intestinal Dysbiosis, etc., so it is very important that a nutritionist assess your symptoms to establish the most appropriate dietary treatment.

Predisposing factors of bacterial overgrowth Achlorhydria, may be caused by chronic gastritis or by taking many years of omeprazole or other proton pump inhibitors. Alterations of intestinal motility, such as constipation, diarrhea, post-radiotherapy colitis, intestinal obstructions, tumors, diverticulitis, adhesion’s, fistulas, etc.

Immunodeficiency, due to IgA deficiency, HIV, post-coursing complications (stenosis, loss of intestinal motility …) or derived from chronic or autoimmune diseases, deficiency of proteolytic enzymes (proteases).

Excessive consumption of alcohol, analgesics or opioid drugs. There are some systemic diseases that alter motility and are associated with SIBO, such as Parkinson’s, Systemic Sclerosis, Hypothyroidism, Cirrhosis, Celiac Disease, Morbid Obesity and Diabetes Mellitus.

Diagnosis of SIBO increases with age. The bacterial count in the small intestine can only be done through an endoscopy and subsequent culture. That is why we usually resort to breath tests.

Breath tests measure the exhaled gas (hydrogen and methane) by the bacterial metabolism after the ingestion of lactose, glucose, sucrose, xylose or lactose.

Some authors believe that this test frequently gives false positives for lactose intolerance in patients with SIBO.

Before the test, patients should be free of antibiotics for 2 weeks, avoid fiber-rich foods the day before and be fasting from 12 hours before the test. An elevation of between 15 and 20 ppm from one measurement to the other is considered positive. If the hydrogen curve is positive and that of the negative methane, the treatment of choice is Rifaximin. If the positive curve is methane or gives the two positive, the treatment of choice is Rifaximin +Neomycin or Rifaximin + Metronidazole.

It is important to know that abdominal distension associated with steatorrhea may also indicate an Endocrine Pancreatic Insufficiency, an overgrowth of yeast, a parasite infection, or a hypo-chloride. Therefore it is important to make a good dynamic diagnosis.

Treatment of SIBO

Depending on the type of colonizing bacteria, antibiotic treatment is usually necessary, but nutritional treatment is key to reducing the foods that activate the bacterial overgrowth and to be able to repair the intestinal mucosa.

The antibiotic of choice is usually Ciprofloxacin 250 mg, every 12 h, for 7 days and if there is no improvement, Doxycycline, Amoxicillin / Clavulanic Acid, Metronidazole or Rifaximin can be administered. If the symptoms are reactivated less than three times a year, the treatment will be repeated (1 week per month for three months) and if they occur more than three times a year, the antibiotics will have to be alternated every month.

Probiotics do not always improve symptoms, especially if they are associated with prebiotics (insoluble fiber that activates the growth of bacteria). That is why it is very important that you put yourself in the hands of an expert, so that he prescribes the right probiotic strains. Bifidobacterium infantis works very well in my experience.

Recommended feeding in Bacterial overgrowth

First you must eliminate all sources of sugar and artificial sweeteners. Beware of the hidden sugar in your diet. In the bacterial overgrowth there is low activity of the enzyme lactase, so you should avoid lactose .

It is convenient to provide digestive enzymes to recover the acidity of the stomach and biliary and pancreatic function. You can also provide antibacterial herbal supplements such as 1 tablespoon of coconut oil at breakfast or essential oil of oregano (or spice) or thyme or pau de arco. I recommend that you follow a low diet in FODMAPS in the first phase to reduce the substrate from which the bacteria of the small intestine feed and thus facilitate the balance of the microbiota .

The acronym FODMAP comes from Fermentables, Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

At the beginning it is advisable to make three meals and as the symptoms improve, you can increase the intake. In a second phase, go with FODMAPs little by little, as they provide prebiotics that help to balance the microbiota.

Diet for SIBO

You should avoid the following foods: 

Fructans: artichokes, asparagus, beets, chicory, dandelion leaves, garlic (in large quantities), leeks, onions, chives (white part), broccoli, cabbage, brussels sprouts, escarole, fennel, peas, persimmon, banana, cherimoya, watermelon, peach, wheat (in large quantities), rye (in large quantities), inulin, shiitake mushrooms.

Fructose: apple, apricot, mango, peach, pear, watermelon, cherries, blackberry, fig, pomegranate, persimmon, canned fruit, fruit juices, sweeteners with fructose, agave and corn syrup, jam without sugar, honey, coconut sugar, nuts.

Lactose: milk and dairy products, ice cream, custard, dairy desserts, kefir, cream, milk cream, condensed and evaporated milk, milk powder, yogurt, margarine, unripened soft cheese (ricotta, cottage cheese, cream, mascarpone) and milk chocolate.

Galactans: legumes and peanuts. Cooked pot lentils are better digested. Chickpeas are worse but always better than if you put them to soak and cook them at home.

Polyols: apple, apricot, peach, cherries, pear, watermelon, lychee, nectarine, plum, avocado, cauliflower, mushrooms, sweet corn, sorbitol (420), mannitol (421), isomalt (953), maltitol (965) and xylitol (967).

What can I eat for irritable bowel syndrome?

Irritable bowel syndrome is a functional disease of the digestive system. Therefore, diet plays a crucial role in the treatment .

The impact of diet on irritable bowel syndrome has not been adequately controlled by controlled clinical trials. Many irritable bowel sufferers have their own subjective theories about which foods they tolerate and which they do not. In terms of proper nutrition in irritable bowel syndrome. There are therefore discrepancies and sometimes also misinformation.

About one in every two irritable bowel patients believe that they suffer from a certain food allergy or intolerance, although these can often not be detected medically.

More than 60 percent of sufferers limit their diet due to their own presumption of allergy or intolerance. Malnutrition can be the result. Hope make current knowledge about fermentable carbohydrates, so-called FODMAPs.

Decreasing these FODMAPs in the diet relieves the symptoms of many sufferers. It is also important to eat in quiet, attentive circumstances.


A nutritional therapy should be carried out together with professional experts, this is also reimbursed by the health insurance.

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Which diet is irritable?

With irritable bowel syndrome, it pays to put your own diet to the test. For this purpose, nutritional protocols with a symptom diary (nutrition diary) are suitable .

If you note over a certain period of time which foods you consume and how you feel afterwards, this can provide valuable information for a balanced individual diet for irritable bowel syndrome. Irritable bowel patients have a sensitive digestion, which is why a gentle diet is recommended.

It is not only relevant what you eat, but also how, when and where .

The following general instructions should be observed in the diet:

  • small meals
  • do not eat too large portions at once mindful food
  • slow eating, conscious chewing, no distraction hydration
  • reduce alcoholic beverages, coffee and black / green tea as much as possible
  • avoid spicy, very salty, sweet, spicy, or greasy foods

What does a FODMAP-poor irritable bowel diet look like?

FODMAPs are special sugars (carbohydrates) found in certain foods.

FODMAPs include non-absorbable F ermentierbare O ligo-, D i and M onosaccharide and (and) Polyols, which are found mostly in gluten-containing foods.

It is likely that about one-third of patients with IBS are also at risk for FODMAP. FODMAPs are inadequately absorbed into the blood through the intestinal wall (resorbed) and are therefore fermented in an oversupply of the bacteria in the colon.

This leads to the formation of gases. In addition, FODMAPs are osmotic, so they draw water into the intestine, which in addition to the gas formation in addition to irritation of the intestine leads.

The interaction of these factors can lead to the typical irritable bowel symptoms, such as flatulence .

A low-FODMAP-diet can help relieve the symptoms.

Dietary fiber is recommended to incorporate non-fermentable fiber into the diet, such as psyllium .

Download now for free How to deal with food intolerance and carbohydrate malabsorption (lactose, fructose or sorbitol), if you additionally suffer from irritable bowel syndrome?

Food intolerance’s are a major nutritional challenge in irritable bowel syndrome. If there is evidence of intolerance to certain foods, they should be diagnosed with a qualified physician .

After confirming the intolerance’s, an individual’s diet can be put together. In so-called carbohydrate malabsorption, certain sugars (carbohydrates), such as lactose, may not be properly broken down in the intestine and therefore poorly absorbed into the body via the intestinal wall. This is the case, for example, with lactose intolerance and fructose intolerance .

For the clarification of carbohydrate malabsorption , for example, a H2 breath test can be performed by a doctor. This indicates an insufficient intake of carbohydrates such as lactose, fructose or sorbitol in the intestine. If malabsorption is detected, specific carbohydrates can be targeted in the irritable bowel diet be omitted (elimination diet), which may relieve the symptoms of irritable bowel syndrome.

Should the irritable diet be wheat and gluten free?

People who suffer from Celiac disease (gluten intolerance), usually do not tolerate products that contain wheat gluten (gluten) since childhood.

Gluten is part of many common cereals , including wheat, rye, barley, spelled, and emmer and einkorn. People with Celiac disease lack certain enzymes in the gut that help digest wheat protein.

So you have no allergy to wheat, but do to their intolerance do not digest certain substances, much like people with lactose intolerance.

Nevertheless, if they take these substances to themselves, there is a sometimes dangerous intolerance reaction. In Celiac disease, the intestine can be permanently damaged by a wrong diet. In addition to gluten intolerance, in rare cases, there are people who develop symptoms directly on wheat components or through some other mechanism.

The extent to which wheat allergy or non-Celiac allergy wheat sensitivity (non-Celiac gluten sensitivity, NCGS) play a role in irritable bowel syndrome has not been fully elucidated.

What role does wheat allergy play in the irritant-friendly diet? Wheat allergy causes a reaction against various wheat proteins, such as  gliadins Amylase trypsin inhibitors (ATIs) thioredoxin Lipid transfer protein.

Some of these proteins are also contained in wheat gluten, so that after gluten and wheat products have been detected by an allergist (eg by a blood test (IgE), a skin prick test or by dietary methods), the wheat gluten-free products are dispensed with should.

However, many people with irritable bowel syndrome also report the success of a wheat and gluten-free diet, even without proof of wheat allergy, because they probably suffer from wheat sensitivity.

How is non-Celiac, non-wheat allergy, wheat sensitivity related to irritable bowel syndrome? Although both wheat allergy and Celiac disease have been excluded, there may still be incompatibilities with wheat constituents. In this case, one speaks of a wheat sensitivity, in which a close connection with the irritable bowel syndrome is suspected.

To date, however, there are no diagnostic tests for wheat sensitivity, so that the diagnosis, as in irritable bowel syndrome, an exclusion diagnosis. It is believed that gluten itself is not responsible for non-celiac non-wheat allergy wheat sensitivity.

Instead, two wheat constituents are suspected to trigger the hypersensitivity reaction, both of which are commonly associated with gluten. On the one hand, these are the so-called amylase trypsin inhibitors (ATIs) , which can lead to a hypersensitivity reaction via the innate immune system.

On the other hand, new research suggests that some people are sensitive to the so-called FODMAPs

A recent study has shown that the symptoms of irritable bowel cancer patients who have been excluded from Celiac disease are better improved by a low-FODMAP diet than by a gluten-free diet.

This has triggered a rethink in nutrition in irritable bowel syndrome.  How do I make my diet more suitable for irritable use if I react sensitively to wheat? If wheat allergy and celiac disease have been ruled out and there are still symptoms of irritable bowel syndrome after consuming wheat, many people do not dare to integrate wheat into their diet. In this case, it is worth the diet with a symptom diary (Food diary) to accompany and possibly targeted wheat into the diet and to observe the provoked symptoms (re-exposure).

Only then can it be found out if the wheat really is responsible for the symptoms. About one in five, whose symptoms improve with a wheat-free diet, is not at all sensitive to wheat itself but to the FODMAPs.

FODMAPS are found not only in different cereals, but also in pod pests, fruits and vegetables. For this reason, irritable bowel syndrome may be worthwhile to include the low-FODMAP diet in the diet. How do I recognize intolerable foods in the irritant-friendly diet?

It is not always easy to detect food intolerance’s. However, it is important not to lose heart for questioning intolerance hypotheses.

Many irritable bowel patients are prone to discomfort to make their diet very one-sided. This carries the risk of an unbalanced diet. For example, patients report that they have only fed on zucchini and rice for weeks for fear of symptoms.

Many intolerances reveal themselves promptly to the admission and are therefore easy to recognize.

However, other individual intolerances are more subtle and show up only after a considerable time interval. Certain foods, such as FODMAPs, stay in the colon for two to three days before causing symptoms. To detect such intolerances, it helps to keep a symptom diary (food diary) for a limited time.

Only then can the very personal intolerance’s be recognized.

Because unlike many food allergies , no diagnostic tests are available for incompatibilities .