SIBO Diet: What Does ‘The SIBO Bi-Phasic Diet’ Look Like?
Content
1. What is SIBO?
1.1 SIBO Diagnosis
1.2 SIBO Treatment
2. The Role of Diet in SIBO
3. What SIBO Diets Are There?
4. Bi-phasic Diet
4.1 Phase 1 of the Bi-Phasic Diet
4.2 Phase 2 der of the Bi-Phasic Diet
5. Conclusion of the Bi-Phasic Diet
1. What is SIBO?
SIBO (Small Intestinal Bacterial Overgrowth) is one of the most frequently misunderstood conditions affecting the gut. It occurs when bacteria excessively colonize the small intestine, an area that normally has low microbial levels. This overgrowth produces excessive gas, leading to a wide range of symptoms including constipation, abdominal pain, bloating, and diarrhea. These symptoms are almost identical to those of Irritable Bowel Syndrome (IBS), which makes SIBO one of the key differential diagnoses for suspected IBS.
1.1 SIBO Diagnosis
SIBO is diagnosed through breath testing, which measures elevated levels of hydrogen or methane in the breath—gases that human cells do not naturally produce. Common test substrates include lactulose, glucose, and fructose (1). If elevated gas levels are detected at specific times during the test, this is a positive indicator of bacterial overgrowth.
For methane-dominant cases, the diagnosis may shift toward IMO (Intestinal Methanogen Overgrowth), which involves archaea rather than typical bacteria.
1.2 SIBO Treatment
Treating SIBO involves a combination of diet, antimicrobial therapies (herbal or conventional), and probiotics. The right approach depends on the type of overgrowth, the severity of symptoms, and whether the patient is hydrogen-, methane-, or hydrogen-sulfide dominant.
In IMO cases, specific antimicrobial strategies may be necessary, as archaea respond differently to treatment than typical bacteria.
2. The Role of Diet in SIBO
Diet plays a central role in managing SIBO-related gut issues. Bacteria thrive on fermentable carbohydrates, especially those found in high-FODMAP foods such as onions, garlic, apples, dairy, and grains. The breakdown of these substances produces hydrogen, methane, and other gases that can lead to bloating, abdominal pain, and discomfort.
While dietary restriction does not eliminate the bacterial overgrowth itself, it helps patients by significantly reducing symptoms. When combined with other approaches, dietary intervention becomes a positive step toward restoring gut health.
3. What SIBO Diets Are There?
Dietary therapies suitable for SIBO include the Low-FODMAP diet, the Specific Carbohydrate Diet (SCD), the SIBO-specific food guidelines (SSFG), the Bi-Phasic Diet (BPD), and the low-fermentation diet. This article focuses on the Bi-Phasic Diet.
4. „The SIBO bi-phasic diet“
Developed by Dr. Nirala Jacobi, the Bi-Phasic Diet is a two-stage nutritional protocol designed to reduce bacterial overgrowth and support the rebuilding of a healthy gut environment (2). It should be followed under the guidance of a qualified practitioner to ensure safe and effective implementation.
Dr. Nirala Jacobi developed the Bi-Phasic Diet based on her extensive experience as a naturopath, specializing in gastrointestinal disorders, particularly SIBO. Her motivation to create a specialized diet stemmed from the need for an effective and structured nutritional strategy that caters to the individual needs of patients with SIBO.
4.1 Phase 1 of „The SIBO bi-phasic diet“
The first phase, often called the elimination phase, is designed to starve the bacteria by restricting fermentable carbohydrates, also known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). Those FODMAPs are significantly restricted in that phase to inhibit bacterial growth and effectively alleviate symptoms.
The goals of the first phase can be broken down into three main points:
- Reduce the fuel supply to gut bacteria, lowering gas production: Bacteria in the small intestine thrive on fermentable carbohydrates. By reducing these foods in the diet, the bacteria’s food source is removed, hindering their growth
- Alleviate symptoms like bloating, abdominal pain, and irregular bowel movements: Typical symptoms of SIBO, such as bloating, abdominal pain, diarrhea, or constipation, should be alleviated by the targeted dietary changes
- Prepare the gut for further treatment with a positive therapeutic response: The elimination phase prepares the body for the next phase of the diet and possible accompanying treatments.
High-FODMAP foods such as apples, pears, onions, garlic, and legumes are avoided. Instead, patients are encouraged to eat low-fermentation foods like zucchini, spinach, carrots, and small amounts of berries. Lactose-containing foods are excluded to prevent negative reactions.
This phase usually lasts between 2 to 6 weeks, depending on individual symptoms and levels of overgrowth. (3)
The duration of the elimination phase varies depending on the severity of the symptoms and individual progress but typically lasts between two to six weeks. During this time, it is important to closely monitor the symptoms and adjust the diet if necessary.
4.2 Phase 2 of „The SIBO bi-phasic diet“
After a noticeable reduction in symptoms, Phase 2 begins. This stage involves carefully reintroducing foods and observing how the body responds. In Phase 2, the so-called re-introduction phase, the tolerance of various foods is tested. This helps to develop a long-term adapted diet that supports the gut and prevents a recurrence of SIBO. In this phase, prebiotic and probiotic foods, as well as supplements, are introduced to strengthen the gut microbiome and promote healthy digestion.
The goals of the second phase can also be divided into three main points:
- Expand the diet to avoid nutrient deficiencies: In this phase, the strict elimination diet is relaxed, and various foods are slowly reintroduced to expand the range of foods in the diet and counteract potential nutrient deficiencies.
- Identify individual negative triggers by slowly testing food tolerance: By systematically reintroducing certain foods, it is tested which foods are well tolerated and which might still cause symptoms. This helps to identify and avoid individual triggers.
- Support long-term gut health using prebiotic and probiotic approaches: Phase 2 supports the rebuilding of a healthy gut microbiome and the long-term regulation of digestion. Prebiotic and probiotic foods are gradually integrated to promote a healthy bacterial balance in the gut.
During the re-introduction phase, foods from the previously restricted groups are slowly and systematically reintroduced into the diet. It is important to introduce each new food separately and observe the body’s reaction. This helps develop a better understanding of which foods may still be problematic. If a food causes negative reactions, it is removed from the diet and tested again at a later time.
5. Conclusion of „The SIBO bi-phasic diet“
The Bi-Phasic Diet is not a permanent solution but rather a therapeutic approach to manage SIBO symptoms and improve overall gut function. It offers patients a clear structure to identify triggers, reduce bacterial levels, and transition back to a balanced, healthy diet.
For long-term success, it’s important to maintain contact with a qualified practitioner, as every case is different and requires personalized care.
References
- Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, Schmulson M, Valdovinos M, Zakko S, Pimentel M. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017 May;112(5):775-784. doi: 10.1038/ajg.2017.46. Epub 2017 Mar 21. PMID: 28323273; PMCID: PMC5418558.
- Small Intestinal Bacterial Overgrowth – Home – The SIBO Doctor; latest check 28.10..2024
- FODMAP-Tabelle-Blog.jpg (761×1200) (fodmap-info.de); zuletzt geprüft 28.10..2024; modifizierte Tabelle aus „Der Ernährungsratgeber zur FODMAP-Diät“ von Prof. Dr. med. Martin Storr
