Fruit and Starchy Vegetables with Small Intestinal Bacterial Overgrowth

April 21, 2012 in FAQ, Gut Health, Paleo Modifications

Small Intestinal Bacterial Overgrowth (SIBO) is a condition in which bacteria, yeast and/or fungi that would not normally reside in the digestive tract thrive in the small intestine (usually the third segment called the ileum, but they can work their way higher up the digestive tract to the jejunum and, in extreme cases, even the duodenum).  They are usually mixed with your normal, beneficial bacteria who are also growing farther up the digestive tract than usual.  SIBO typically goes hand in hand with a leaky gut and can actually perpetuate a leaky gut even after an individual adopts a strict paleo diet (even with the autoimmunity protocol and an effort to eat gut-healing foods).  SIBO is also linked to gut-brain connection problems, especially in individuals who are stressed, depressed and/or not getting enough sleep (although which comes first is up for debate).  Symptoms of SIBO include upset stomach, nausea, acid reflux, heartburn, burping, vomiting, bloating, gas pains, trapped gas, flatulence, diarrhea, constipation, and stomach pain.  And it is very possible that the onset of symptoms was gradual enough that you might not even notice.  Aside from having the bacterial count of your jejunum tested, a good indication that you have SIBO is if you have continued health issues even after adopting a paleo diet (not just gastrointestinal symptoms but also things like arthritis, skin conditions like psoriasis, difficulty in losing weight, or continued mood and energy level issues).

If you have or suspect that you have SIBO, one of the dietary recommendations for treating this condition (besides going paleo) is avoidance of all complex sugars.  This means that starches and even disaccharides like sucrose are off limits.  I have touched on this subject in a couple of posts (How Mood and Gut Health Are Linked, Repairing The Gut, and most recently, Modifying Paleo to Treat Psoriasis), but I felt like further explanation on this aspect of treating SIBO is probably overdue.  The idea behind this recommendation is that by eating these more complex sugars, you are feeding the bad bacteria.  Monosaccharides, like fructose and glucose, are the most easily absorbed sugars we can eat, so they are typically already absorbed by the time that meal gets to the lower small intestine where the “bad” bacteria are growing.  Limiting yourself to monosaccharides helps to starve the bacteria in your small intestine.  By consuming healthy probiotics (either in supplement form or from fermented foods like sauerkraut and coconut milk kefir), you replenish the good bacteria that should be growing farther down your digestive tract.

Obviously paleo baking and anything high in sucrose is out.  But, what does this mean for consuming fruits and starchy vegetables?  There is actually alot of conflicting information out there.  Two great resources are the GAPS (Gut and Psychology Syndrome) diet and the SCD (Specific Carbohydrate Diet) diet, which both limit carbohydrate intake by the type of sugars present in the foods (the books associated with these diets are titled Gut and Psychology Syndrome and Breaking the Vicious Cycle, respectively).  These diets were not developed within a paleo framework, but many of the ideas behind these diets are compatible.  Both of these diets include stages in which you first abstain from nearly all carbohydrate sources and then you slowly add back more and more simple sugars into your diet.  My recommendation to treat SIBO is to use elements of these diets and incorporate them into your implementation of a paleo diet (and I suggest doing the autoimmunity protocol which additionally avoids egg whites, nightshades, nuts and seeds for anyone suffering autoimmune condition and/or skin conditions).

So first, let’s tackle fruit.  In GAPS and SCD, all fruit is restricted at first, but then added back in once the symptoms improve.  Most fruit tends to have the majority of its sugar as fructose and glucose rather than disaccharides like sucrose, which is why most people tolerate them.  Depending on what other health issues you are dealing with, you may want to try a few weeks without fruit or you may want to see if your symptoms improve by simply cutting out the more obvious sugars and starchy vegetables (see below).  If you’re going to leave fruit in your diet, I suggest not going to town on it (although Prof. Loren Cordain is a big fan of not limiting fruit in a paleo diet, he does not address SIBO in either The Paleo Diet or The Paleo Answer, both outstanding books BTW).  Try limiting to 1-3 servings a day and see how you feel.  Dried fruit, except dried apricots, dates, raisins and prunes, is restricted.

Now, let’s talk about starchy vegetables.  Starch molecules are basically long chains of sugar and while they are great for slowing down the blood sugar spike after a meal (especially when the vegetable consumed is also fibrous like sweet potatoes), this also means those sugars are still not fully digested by the time they reach the “bad” bacteria.  Again, all starchy vegetables are avoided in the first stages of both GAPS and SCD.  And again, it’s up to you whether or not you want to approach it this way.  In the symptom-free/maintenance phase, some starchy vegetables are allowed and some are not.  Whether or not a starchy vegetable is recommended has to do with exactly how long the starch molecules are and whether or not it contains other factors that slow down digestion (like alot of fiber).  Here is a table with the allowed and disallowed vegetables (plus a few extra that I thought you might be wondering about):

Okay
Avoid
Artichoke, French
Arrowroot
Avocados
Artichoke (Jerusalem)
Ripe Bananas
Bitter/Black Gourd
Beets
Green Bananas
Carrots
Chestnuts
Celeriac (Celery Root)
Jicama
Ginger root
Kohlrabi
Mushrooms
Okra
Olives (preserved without sugar)
Parsnips
Pumpkin
Plantains
Rhubarb
Sweet Potato
Rutabaga
Taro
Summer Squash (like zucchini)
Tapioca
Turnips
Yams
Winter Squash (like butternut or acorn)
Yucca

Like everything in the paleo diet, this is a starting place.  Really, you will probably just have to end up experimenting on yourself to figure out which foods you tolerate and which you don’t.  Now that my diet is so clean, it is abundantly clear when I eat something I shouldn’t.  For example, I can handle a small portion of fruit, but if I eat some paleo baking or a helping of sweet potato, I get very bloated, to the point where my stomach feels rock hard (and it’s sadly not all muscle, folks!).  I will usually also notice a big drop in energy level and a dip in my mood and patience as well.  Usually, my psoriasis will feel itchier and look redder too.  It can take days to pass the gas (I find a large quantity of ginger tea helps immensely) and recover.  This happens not when I binge on something horrible for me, but simply when I eat something that many people in the paleo community eat on a daily basis.  It can be very frustrating and very discouraging, but I try and focus on the positive:  I now know how to eat for my health issues and even if it’s sometimes hard to comply, I am no longer roaming in the dark taking scads of prescription medications.  I am healing.

 

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