SIBO Pt 5 - Treatment: Diet

Question 1

Which dairy foods are lactose free?

Answer 1

• Homemade 24 hour yogurt/sour cream
• Aged cheese (30d+) & Dry Curd Cottage Cheese
• Ghee/butter
• Lactase enzyme treated cream in small amts
• Commercial lactose-free dairy
– Milk (SCD Illegal but OK if tolerated)
– Yogurt- (Green Valley: pectin added but OK if tolerated)
– Sour Cream, Half & Half

Question 2

What are Dr. Campbell-McBride’s 4 key description points of the Gaps diet?

Answer 2

1. No processed food, natural, OG, no GMO, properly-fed animals- see WAPF
2. Home cooked, fresh food- make extra for leftovers
3. 90% animal foods- meat, organs, dairy, fish, eggs
4. Easy to digest

Question 3

What troublesome food groups does the Low Fodmap Diet address?

Answer 3

F & A are not food groups
• F= Fermentable (& osmotically active)
• O= Oligosaccharides (FOS/fructans, GOS/galactans)
• D= Disaccharide (Lactose)
• M= Monosaccharide (Fructose)
• A= and
• P= Polyols (sugar alcohols: Mannitol, Sorbitol)

Question 4

After the Intro Diet, are any foods definitively excluded on the Low Fodmap Diet?

Answer 4

no food is excluded, unless it’s not tolerated at any amount (not tolerated= sx)

Question 5

Which High FODMAP vegetable mentioned in class is used ubiquitously in cooking?

Answer 5

onion, garlic, avocado, asparagus, cauliflower

Question 6

Does the Cedars-Sinai Diet allow refined grain or whole grain?

Answer 6

Refined grains? Not whole grains.

Question 7

When is the best time to start a SIBO diet for a patient desiring symptom relief as soon as possible?

Answer 7

• For fast Sx relief- start after SIBO test, but before other tx
• If they’re not desperate- start after tx. Diet can be less strict if tx reduced sx

Question 8

What are the strategies for weight gain in SIBO?

Answer 8

• Reduce bacteria with tx: Abx, HAbx
Caution: Elemental Diet can cause wgt loss (10-15#) if full cal not drunk
• Eat more food, more often: set a timer (it’s a job)
• Eat more allowed CHO: honey, squash, fruit, nuts, beans, glucose
• Eat Lactose free dairy (esp high fat varieties)
• Shakes: HM 24 hr ½ & ½ ygt/lactose-free whole milk/coconut/nut milk; nut butter; egg yolks, fruit; fruit juice; honey; oil; cinnamon, vanilla (as tolerated)
• Eat refined CHO (white- rice/potato, bread/pasta- if gluten is tolerated) or Whole CHO if tolerated (whole grains/tubers/beans)
• Heal brush border (absorb), take Enzymes (digest)

Question 9

Why use the SIBO Specific Food Guide?

Answer 9

• Created for SIBO sx relief
– Most of my pt’s still had sx on SCD, esp bloating
– LFD excellent results for bloating= excludes oligo’s SCD didn’t know about
• Combines the best of SCD & LFD & includes my clinical input (not a strict combination)
• Created for SIBO sx relief
• Intro is optional since Abx/HAbx/ED often used to reduce bact
• Better sx relief than SCD or LFD alone, esp bloating
– decreases oligosaccharides which SCD didn’t account for/know about
– includes fructose malabsorption which SCD didn’t account for/ know about
• Not as strict- if a food is tolerated= it’s OK

Question 10

What factors should be considered when choosing a SIBO diet for your patient?

Answer 10

Active SIBO or preventative Tx?
Pick a SIBO Diet - Then Start Customizing It… Trial & Error takes time but is necessary
• SCD= 1. Moderate SIBO 2.IBD/Celiac/diarrheal disease
• GAPS= GI issues that coexist with mood/brain disorders (Autism, ADD, depression , anxiety, bipolar, dyslexia, narcolepsy)
• SIBO Specific Food Guide=
1. Severe SIBO (less foods tolerated)
2. Inadequate relief from other diets
• LFD=
1. Prevention once tolerances have expanded
2. Underweight patients
3. Mild SIBO (those that tolerate grains/starch/fiber/sucrose)
4. Vegetarians/Vegans
• C-SD= same as LFD + 5. those that can’t/won’t do other diets (it’s the easiest to follow)