Modifying Paleo for Small Intestinal Bacterial Overgrowth

July 3, 2012 in Categories: , , by

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Small Intestinal Bacterial Overgrowth (or SIBO) is a chronic bacterial (and/or yeast) infection of the small intestine, characterized by excessive number and/or abnormal type of bacteria (and yeast) growing in a part of the gastrointestinal tract that normal contains relatively few microorganisms.  These bacteria can cause a variety of problems by interfering with digestion and absorption of nutrients and by damaging the lining of the gut, causing a “leaky gut” (I addressed the many health problems that can arise from a leaky gut in this post). 

The most common symptoms of bacterial overgrowth include abdominal pain, nausea, bloating, gas, belching, flatulence, chronic diarrhea, and chronic constipation.  These symptoms are due to the large volume of bacteria the digestive tract (alive and dead, as they read the end of their lifecycle) and the large amount of gas and metabolic waste that they produce.  Many more symptoms of SIBO are a direct effect of nutrient malabsorption.  This arises either from the bacteria metabolizing those nutrients before we can absorb them or by the bacteria causing enough inflammation in the lining of the gut that it the gut can’t work properly anymore.   For example, the bacteria preferentially consume iron and vitamin B12, causing anemia.  The bacteria decrease fat absorption by deconjugating bile leading to deficiencies of vitamins A & D and causing steatorrhea (fatty stools).  As the gut lining becomes increasingly inflamed and leaky, larger and not fully digested food particles enter the body, causing an immune reaction which leads to food allergies and food sensitivities.  Bacteria themselves can enter the blood stream causing systemic inflammation and immune reactions that can lead to autoantibody formation and autoimmune diseases (for a comprehensive review article see the footnote). 

SIBO was only described in the late 1990s and is still grossly underdiagnosed. This is partly because many patients don’t seek medical attention for their SIBO symptoms, because many doctors aren’t aware of its prevalence and don’t consider it in their differential diagnostics, and because the tests for SIBO still have fairly high false negative rates (where you have the disease but the test says you don’t).  As SIBO becomes more recognized, it is also becoming inextricably linked with many other diseases.  Many physicians and scientists now believe that Irritable Bowel Syndrome (the cause of which has never been properly defined) is actually a group of symptoms caused by SIBO (see the book The New IBS Solution).  SIBO is also often associated with Crohn’s disease, Celiac disease, short bowel disease, various liver diseases, fibromyalgia, some autoimmune diseases (such as scleroderma, diabetes, lymphoma, and chronic lymphocytic leukemia and the aforementioned Crohn’s disease and Celiac Disease) and even rosacea (for a fantastic summary of confirmed related diseases, see http://www.siboinfo.com/associated-diseases.html).  Whether SIBO is a causal factor or a symptom of these diseases remains to be determined.  Given how new all of this science is (and how prevalent SIBO actually is!), I suspect that over the next few years many more health conditions will linked with SIBO.

How do you know if you have SIBO?  If you have digestive symptoms, especially if they persist after adopting a strict paleo diet, SIBO is a possibility.  You can opt to get tested (there are several different test options which can be ordered by your primary care physician), however know that the current testing methods are not 100% reliable.  One of the easiest ways to determine whether you have SIBO is to see if diet modifications aimed at treating it make you feel better. 

How can you fix SIBO?  There are two diets (very similar to each other) that have been developed with the intention of starving the bacteria in the small intestine and healing the damaged lining of the gut.  These are the GAPS (Gut and Psychology Syndrome) diet(see Gut and Psychology Syndrome) and the SCD (SpecificCarbohydrate Diet) diet (see Breaking the Vicious Cycle).  The general approach to these diets is to eliminate any dietary sugars that are not monosaccharides.  Monosaccharides are simple sugars like glucose and fructose and are the most easily absorbed in the digestive tract.  More complex sugar molecules like sucrose (i.e., table sugar which is a disaccharide) and starches have to be broken down into monosaccharides before they can be absorbed.  This means that the sugar takes longer to be digested, which means it travels farther down the digestive tract before being completely absorbed, which means that some of it reaches the abnormal bacteria growing in the small intestine and provides a food source for them.  These diets also focus on consuming healing foods such as bone broth, conjugated linoleic acid found in the fats from grass-fed animals, and coconut oil.  I recommend combining one of these diets with a paleo diet for the most rapid and effective reversal of SIBO.

A standard paleo diet is typically not enough to treat and reverse SIBO.  Attention also needs to be paid to the amount and types of carbohydrates being consumed.  I recommend following a paleo diet with modifications disallowing starchy vegetables and high sugar foods as per the SCD and GAPS diets (see my post Fruits and Starchy Vegetables with SmallIntestinal Bacterial Overgrowth).  Many people may find taking Apple Cider Vinegar before meals (as outlined in TheStomach Acid Connection) is helpful.  For more severe cases digestive supplements may be beneficial (I am not familiar enough with these to recommend a particular brand, type or dose.  Recommendations can be found in The Paleo Solution, It Starts With Food, and this post from Chris Kresser.  If you need personalized recommendations, I suggest contacting Diane Sanfilippo at www.balancedbites.com).  You may also find some good information in my posts Repairing the Gut and What Should You Eat to Heal a Leaky Gut?  I also want to mention that stress management is very important (see my post How Mood and Gut Health Are Linked).  Homemade bone broth and a source of Vitamin D(sunshine, liver, supplement) are particularly important to promote healing.  A source of diverse probiotics (from fermented foods like Sauerkraut,coconut milk kefir, or Kombucha and/or from a high quality supplement) help to restore normal gut microflora (it’s better to keep the dose of these beneficial bacteria on the low side, at least at first, since they can add to the high volume of bacteria and increase symptoms if you’re too aggressive).  In extreme cases, a doctor may recommend a course of potent antibiotics followed by a gut-healing protocol (exactly what is outlined above) and probiotics.  For those with symptoms indicating the early phases of autoimmune conditions (see my post You May Have an Autoimmune Disease But Don’t Know It), following the Autoimmune Protocol for the first 1-3 months may be very beneficial.

Correcting SIBO can take up to 2 years.  However, you should see improvement in your symptoms fairly quickly with gradual and continuous improvement (if you don’t, it’s worthwhile considering a FODMAP sensitivity as a confounding factor, which I will be discussing in my an upcoming post).  Stress, poor sleep, infections and poor diet choices can all create setbacks.  It is always difficult to commit to more restrictive forms of a paleo diet (which can be tough enough as it is!).  I have what I believe is a mild case of SIBO.  Because I follow the Autoimmune Protocol, I rarely have issues now.  However if I slip and eat a high carbohydrate food, I fairly rapidly suffer intense bloating followed by days of gas pains and constipation.  It’s not fun to follow such a restrictive diet, but is it worth it!

Bures J. et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 June 28; 16(24): 2978–2990.

Comments

Thank you for pointing that out! I think I was just getting list enthusiastic there! Fibro is associated with SIBO (and often seen in conjunction with autoimmune diseases) but is not one itself. I will correct that mistake! :)

There are theories that Fibro is autoimmune but nothing decisive yet. For me it appeared at the same time as gluten intolerance which is also thought to be autoimmune so I can’t help wondering if there’s something to it.

Hey Sarah, great article, I am fairly sure my wife still has SIBO despite us following a fairly strict paleo diet so a few more tweaks and a few less ‘safe’ starches.

It’s certainly my opinion that when looking to heal, Paleo is not enough and whether it is the autoimmune protocol or some other additions then the diet has to be tailored to the specific requirements of the individual.

Hi Sarah…

just skimmed through this article on SIBO
and found it really interesting as my friend HelenMarie
has recently developed a lot of the symptoms of SIBO.

Question — in your opinion, can SIBO appear
when little or nothing has changed in the persons’s diet and
life habits…?

Thanks as always for the outstanding work!

==>Jim

Yes, SIBO can appear when nothing else seems to change. Very small changes in sleep quality, stress, and diet can tip the balance one way or the other. Something as simple as a course of antibiotics can tip the balance too. According to my research for this article, chances of having SIBO just plain old increase with age too. I seem to remember reading the statistic that 50% of people living in extended care facilities have SIBO.

I think I am in loooove. Where have you been these past three years! I’ve googled and read, dieted and supplemented, interviewed and harassed all sorts of doctors, and have came up with the much of the same information. I found that once I was able to ‘heald’ enough *that’s what I called it to eat veggies, a paleo diet was PERFECT for me. Now, I’m not as strict with it, but have no pain any more-but other than treats, am paleo.

I’m still healing and can’t stress enough how this blog summarizes what I’ve spent YEARS trying to work out. I hope everyone listens to you and can spare themselves the pain of being their own lab rat. :)

~m

I had stomachs on and off for several years. Finally my GP recommended I be tested for SIBO. I tested positive, using the hydrogen breath test. After 10 days on a special antibiotic, the stomach problems were completely gone. That was over a year ago. I know of many people who have been diagnosed with IBS and I now believe that many of them have SIBO. The difficult part is convincing their doctors. Read more here:

http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/article.htm

Wow Wow Wow Wow! I can’t seem to say wow enough!! This is insane! I have been searching and searching for a way to heal from what dr’s say is IBS. I tested negative for Celiac but no answers other than “watch what you eat” with no real answers! The dr’s couldn’t tell me what to eat or any diet suggestions at all. I have started a probiotic regimen and that has definitely helped me, but I am trying to discover what else I can do. No dr has ever mentioned SIBO but after reading this, it definitely seems to be the most pertinent answer. I definitely intend to do more research. I stumbled upon your site through a pin on pinterest, as my boyfriend and I are beginning Paleo as he is starting his Crossfit journey. I can’t wait to read more and learn more. This is so exciting to hear that there may be true relief for this paralyzing condition that I seem to suffer from. I also fully believe Paleo is going to help me as well because as a sufferer of Ehler’s Danslos Syndrome, there are already a lot of barriers but diet is what I fully believe will help. Thank you so much for this site and your information. Thank you thank you!

The medical literature shows that at least half of all cases of IBS are actually SIBO. I think paleo will also be very helpful with Ehler’s Danslos Syndrome. Even though it isn’t an autoimmune disease, it is caused by a dysfunctional immune system, so if you don’t see dramatic improvement in a few months, consider tackling the autoimmune protocol. Good luck and keep me posted on how you’re doing!

Hi P-Mom (don’t mean to make you sound like a gangster!),
this is a really good article. AI Paleo is pretty similar to the GAPS intro. I have candida/sibo, they showed up in an organic acids test. I was just wondering how you know your case of sibo is mild? From testing or just symptom-wise?
I wish I could do coconut oil, but can’t at the moment because of salicylate sensitivity.
Thanks!
Denise

How long did it take for your symptoms to subside? I’ve got a pretty severe case of bacteria/yeast in my upper GI. If you don’t mind me asking what AI do you have? I was convinced, from all the toxins in my body from the reactions I have, that I’d developed an AI. All tests show otherwise, but I’m worried that the longer it goes on (it’s been years), that it’ll do irreparable damage.

There are no definitive tests for AI disease, and for some AI diseases, there are no tests at all. Many AI diseases have to be very advanced before they can be diagnosed, so if you feel like you have one, I would listen to your instincts. I would say it took about 2-3 weeks for the bloating to go away and for me to feel comfortable and symptom free. But, I still get bloated and constipated quickly if I eat something with inulin fiber in it (like sweet potatoes) or overdo to starchy vegetables so I haven’t fully healed yet and am basically still going with my diet modificaitons.

Thanks. How long have you been doing your protocol? A few weeks is speedy for any healing, well done! Did you do the GAPS intro? I’m about to try it because my stomach & intestines are in a dire state. I react to & can’t digest anything at all – meat, fat, veg.
What’s your opinion on stool testing? I had one that showed NG for e coli, which I know is bad, I take Mutaflor now but it hasn’t taken hold yet or there’s just too much bad bacteria, keeping it from flourishing. Were you diagnosed with an AI or again just go with your symptoms? They do say trust your guts..!
Thanks

I was diagnosed with an autoimmune disease (lichen planus). While my gut symptoms improved quickly, my disease has been a slower process. I’ve been playing with this protocol and figuring out exactly what I need to do for about 15 months. It took me about 10 months to really come to terms with some foods that I have to cut out, so really I’ve only been super strict the last 7 months or so. I’ve seen the most dramatic improvement in the last 3 months… I never did GAPS intro.

(it won’t let me reply to the last comment) I’m glad you’re healing on it, that’s really great. It’s crazy how some people will never have gut issues, or ever hear of/need kefir etc! Do you rely on foods for probiotics? I know bifid’s are bad for SIBO but lactic ones make me feel stiff so it’s hard to know what to put in there, and I do need them!
I actually met Dr Natasha Cambell McBride (lady who invented GAPS) at a seminar briefly the other weekend, she came to Ireland. She told me to stay on just stage 1 and 2 of the intro for 6 months because my gut is so bad and my weight is so low, and to have no plant fibre. I think I’ll need some veg to store the fat though? I have some ige allergies, but eggs (yolk, and white, and duck egg which I’ve never eaten..) were really high on an igg test. But I was having them everyday before I knew of leaky gut etc! Seems like yolks are really nutrient dense though, I hope I can have them again.
Have you ever tried soil based organism probiotics? Apparently they’re good for clearing out bad bacteria, if taken for a month twice a year, they maintain the good balance. I’m doing another stool test with my doctor next week then trying them, fingers crossed they help even a little.
I also want to be able to try all of your plantain recipes!

I take PrescriptAssist soil based probiotic and really like it. Even with all the stress I’m under and not getting enough sleep, I’m still seeing improvement in my autoimmune disease and I think I have fermented cod liver oil and PrescriptAssist to thank for that. I do eat fermented foods too.

I also just came across this post by chris kresser http://chriskresser.com/treating-sibo-cold-thermogenisis-and-when-to-take-probiotics#comment-43294 (yours and his are by far the best sites about this stuff!), and how d-lactate can be a real issue with SIBO (also CFS and ME), which could explain my stiffness symptoms with lactobacillus strains? Most diets though, like GAPS and SCD are heavily reliant on sauerkraut/yogurt etc, but this seems to recommend the opposite. I prefer to get what my body needs from foods, but if this is a problem it seems like sauerkraut/fermented foods are out of the question? Or at least until SIBO is under control? I’d like to be able to have them some day, for maintenance and they’re a lot cheaper than buying probiotics!
Thanks a lot for your help p-mom :)

So, my reading on D-lactic acid is that symptoms of excessive production are things like brain fog, trouble concentrating, tripping over words, lack of coordination and balance. It’s really only been described in people with short bowel syndrome, with one study in chronic fatigue syndrome showing overgrowths of gram-positive bacterial strains that produce D-lactic acid and the authors speculate that that could contribute to the symptoms. So, yes it’s possible, but there really isn’t a lot of science to back it up at the moment. The other, what I think is more likely, possibility is a food sensitivity to yeast, since there is yeast in all fermented foods. Either way, the answer is yes, you should be able to eventually reintroduce fermented foods for maintenance one day. As I already mentioned, I do really like Prescript-Assist and have been taking it since last summer.

Oh, wow. Those are a lot of symptoms I’ve been having. I’ve been spending a lot on probiotics to feel worse I guess..I feel that way on just acidophillus even, so I don’t think it’s the yeast, I take s.boullardi sometimes too which I’m ok on. I do get some swelling in my legs when I take the probiotics too but I’d just been ignoring it, which can be an issue with small bowel…But I’ve had an MRI, gastroscopy, barium swallow with follow-through tests, I presume someone would have picked up on that by now if I had it? I know from a colonscopy result that I have a long colon!
Ok, so, I’ll get on the PA and Mutaflor for now, which will hopefully help. Do you take 1 or 2 PA a week now for maintenance? When I get my stool test back it might shed some light on what bugs are in there..But I really hope the SBO’s will help. Thanks, I really appreciate your help.

Overgrowth is not necessarily the easiest thing to diagnose (and not on a lot of physician’s radars). The tests you had done also wouldn’t show whether or not you have it (the test is an aspirate, so stick a tube down your throat and get a sample from your upper small intestine). I was taking PrescriptAssist every 5 days, but I’m back up to every day with the stress of the book.

sorry, I meant those tests would show if I had short bowel syndrome or not? I did the organic acids test for the overgrowth, it showed yeast and bacteria in my upper GI, along with mitochondria malfunction etc., maybe from no good e coli, and the bad bacteria. I did that test with my doctor, he’s the only one who doesn’t just accuse me of having an eating disorder or think it’s all in my head. Is it ok to take PrescripAssist a lot? I’ve only read that they recommend it for a month twice a year. congratulations on your book by the way, you deserve it. I actually read a lot of dr seuss when I get stressed out, maybe you could try it :)

Thanks. Funnily enough, I destress by listening to the Circus Remix of I Like To Move It from the movie Madagascar 3. It always makes me feel better. LOL!

Have you had a bowel resection?

Ha, I must try that sometime!
I haven’t, the only surgery I’ve ever had is appendix removal (which is apparently your reservoir of good bacteria..). Besides the long colon I’ve never been told anything about the any results except that they’re fine, though my gastroscopy did show mild chronic gastritis and bile reflux, presumably because of the SIBO. Prescript-Assist is kind of my last hope, since I can’t do the other probiotics, and things are so bad, symptom and weight wise. I don’t want to put all of my eggs in one basket but I’ve run out of other options. My blood tests all show really high levels of b12, folate and iron etc, my nutrients are just all unavailable. I do have some heavy metals too, again, because of the lack of good bacteria..

Hey, I added prescript-assist the other day, but when I take it I feel like it just goes down as far as my small intestine, is there any chance it could contribute to SIBO the way some probiotics do? I read in the GAPS book that they’re transient strains, but someone else says they’re colonising. Just wondering if you know which is true?
Thanks!

Most scientific studies show that probiotics don’t substantially change your gut microflora and the bigger effect is diet. Probiotis work more by interacting with the immune system on their way through. But, if you don’t feel it’s working for you,then it’s worth stopping for a few weeks and see how you do. You can always start again later.

Okay, thanks. I know you do recommend starting slow with probiotics to avoid aggravating the situation and doing the diet for a bit first. I just started taking 2caps a day right away.

There are a lot of options and this is probably something better to discuss with your doctor. Rifaximin is the best studied, but it’s also often used in cocktails with others.

Thanks so much. I do have oral/systemic candida and roundworms too so not sure where to start with them, I might give thd rifixamin a try. I’ve avoided antibiotics for do long. My doc also wants me to try an elemental tube feed because its gotten so bad.

Desperate times. When you say a cocktail do you mean sometimes they’ll give rifixamin and something like diflucan for candida too? Did you take antibiotics? I’m trying to see it as something I have to go through like chemo, then total nutritonal balancing, detox and broths/probiotics after. Do you take probiotics at the same time as the antibiotic (but later in the day) or wait til the course is over? I also thought the usual dose for rifixamin was over 10 days but my doc said it’s three a day for 5 days? Think I’d prefer the ten! But yes should I wait til the course is over to start the probiotics? Thanks so so much for your help. Will be using your healing/ AIP/ weight gain methods after if they work fingers crossed!

I have chronic constipation by the way do do you think neomycin would be better than rifixamin? Definitely let me know whether you think it’s best to wait til after the antibiotic to start taking probiotics or to take them during it as well?

Dear Sarah,

Thank you for your wonderfully written, meticulously researched posts. They offer a great deal of support and wisdom to those of us who are wading through the challenges of healing our guts.

I hope you can answer a question that I have been grappling with. Due to severe SIBO, and a cascade of other problems that resulted from compromised digestive health (thyroid and adrenal issues + nutrient deficiencies), I abandoned several years of veganism and switched instead to a strict Paleo diet. I have been following this strict protocol for about 15 months. At this point, I avoid gluten, dairy, soy, grains, legumes/beans, eggs, corn, nightshades, nuts, vinegar (apart from ACV), caffeine, alcohol, nuts, sugar, fruits, and starchy vegetables. I take digestive enzymes and other gut-healing remedies, and have started to consume bone broth. I took two courses of Rifaximin. The bacteria seem to like my intestines, since they’re still resolutely camped out, and if I take an antibacterial like berberine, or if I eat something amiss, my belly can bloat out to extraordinary proportions, leaving me to look six months pregnant. I have seen–and continue to see–a number of doctors.

My question is this: I long to increase my physical activity. I suspect that regular exercise will go a long way in boosting my health. But I don’t know how to do this if my body cannot tolerate carbohydrates outside of non-starchy vegetables. (Fruits and starchy vegetables like butternut squash and sweet potatoes have left me bloated and tired.) Right now I am incorporating gentle yoga into my day. But I would love to do something more intense–go running, play soccer, do more challenging yoga or Pilates sequences. I don’t want to be sedentary; I want to be active. How do I refuel on my restricted diet? How do I avoid the danger of glycogen depletion? Last summer, already on the SIBO-modified Paleo diet, I began to visit the gym, and I felt more revitalized, but I developed insomnia and dark undereye circles and stopped my activity. Now I’m concerned about muscle cramps. Do you have any suggestions for me?

Many thanks for your kind help.

Warmly,
Elizabeth

P.S. I am 23 years old.
P.P.S. I am Catholic and try to attend daily Mass. For the last two years, I have been receiving Communion multiple times a week. My faith is the most important thing to me; it is my source of joy and strength, and I depend on the Eucharist for sustenance. I have been lately wondering, though, why my gut has not healed after 1 1/4 years on a very restricted, very clean diet. I worry that the gluten in the Communion Host might be complicating the healing process. The thought of abstaining from sacramental Communion makes me very sad, but I also long to return to physical health. Do you think my daily reception of Communion might be a factor in my continued digestive illness?

Hi Elizabeth,

There are gluten-free Communion wafers. These still aren’t ideal since they have potato flour, but vastly preferable to eating gluten. Have you asked for them? Here’s a link if that helps: http://www.celebratecommunion.com/gluten-free-communion-wafers-130.html?gclid=CNGq9rb1_7UCFQbonAodLTgA1g I don’t think you should have to give up Communion, especially if you feel that it gives you strength and joy–that is so important for healing. Yes, that daily dose of gluten is almost certainly completely undermining your other efforts and I would be very surprised if you didn’t notice a remarkable difference by taking Communion with the allergy-free wafers.

As for exercise, I think you did the exact right thing pulling back when you stopped sleeping. I would recommend building up the intensity and duration very slowly, maybe add some walking to your day or swimming or slowly building up your level of intensity in your yoga classes. Exercise can be a very powerful hormone regulator but if its too intense (typically aerobic exercises like running would be considered intense) or too long in duration, that causes a spike in cortisol that causes more problems than the exercise helps. I would also recommend some short-chain fats like coconut oil to help with energy stores during exercise, and make sure you’re hydrated and sleeping tons. Also, muscle cramps might be a sign of low magnesium, so it would be good to look into a supplement. Other things that can help your gut bacteria get back to normal more quickly is eating lots of fish and shellfish (for the omega-3s) and making sure you’re getting some leafy greens in if they don’t upset your digestion too much.

I hope this helps,
Sarah

Hi Sarah,
I have had a stool test and it came back with no parasites or yeasts. All looked good and I was shocked due to my horrible symptoms. I do have a low count of good bacteria and take good probiotics to help. Could I still have SIBO even though my stool test came back that way? i have a host of symptoms and issues (hashimotos, SEVERE eczema, SEVERE food intolerances and more… Have been doing GAPS for a month and a half) but want to know if I should do SIBO protocol or Autoimune protocol mixed with gAPS? It is hard to figure out could you help? Blessings, Jenn B

SIBO is just one form of gut dysbiosis. What you describe of having low good bacteria is another form and could definitely be contributing to your symptoms. With Hashi’s I would definitely recommend AIP, working around your food intolerances and still making sure you’re getting plenty of veggies (I typically suggest avoiding sweet potatoes, jerusalem artechoke and suggest keeping whole coconut products like coconut butter or flakes to a minimum, then keeping the quantity of other starchy vegetables on the low side with much more of a focus on non starchy vegetables).

Thank you for your response. I do all of those things you mentioned. Some symptoms have improved but my itchy, cracked, bleeding arms, hands and neck keep me up at night in tears. I am so depressed. I eat bone broth filled with veggies, usually bacon fat, and grass fed beef everyday. Sometimes I do organic chicken or wild fish but usually have a reaction. I can’t even tolerate onions or garlic or coconut in any way. coconut oil on my skin about sent me to my death bed. i have such a fear of food because of what it causes that I have gotten to under a hundred pounds and I should be around 125. i am 5’4″. My skin is just not improving and if I Cut any more out I will literally starve to death slowly. the veggies I eat now are down to kale, zucchini and cauliflower. i season with celtic salt only. i dont cheat with anything ever. I have been doing this for a long time and my skin won’t clear. i am at my wits end. I also have No starch and No sugar at all. My cycle is even messed up now. I just dont even know what to do. Your website helps me understand the science in a huge way and I am grateful I just haven’t started feeling better with GAPS and don’t know how to implement AIP with it since food is such a problem described in this post and my above one. Blessings, Jenn B

Jenn, I’m in the same boat as you, a scary amount. Only my weight is much lower, keep it on if you can! it’s really hard and really lonely, but hopefully things will even start to look up for both of us soon.

Hey Sarah, I was listening to your interview on the Balanced Bites podcast about a month ago (I’m so behind on them, but i’m getting caught up), and you talked about SIBO. I have had IBS-C symptoms for over 10 years with doctors only giving me stool softeners to help me. I didn’t take them b/c I was convinced they were treating the symptom not the problem. All the while, after a colonoscopy, my doctors still told me nothing was wrong with me. After listening to you talk about SIBO, I decided to make another appointment with my PCP and get a referral to a GI doc. My PCP treated me like I was an idiot (this is why I hate most military doctors who are not used to educated spouses) dismissing my stacks of scientific journals about SIBO that I brought in, but still referred me anyway to a GI doc. I finally saw my GI doc about 2 weeks ago, suggested that I might have SIBO (she hadn’t even of thought of that as being an issue, but still agreed to test me to appease me), took a breath test a week ago where my methane levels jumped from 20 ppm to 110ppm only after 20 minutes of taking the glucose. I know that this is only one piece of the puzzle as Dr. Pimentel points out in his book “A New IBS Solution” BUT at least this is a step in the right direction of getting my digestive system to work properly. I just wanted to thank you for being one of the catalysts to getting this solved. This condition has taken over my life, and I’m hoping to be able to move forward!!

What is everyone’s thoughts on coconut butter and if its ok for someone with SIBO to eat or is it too high in fiber to be uncomfortable for most individuals with SIBO?

How long do you recommend following the low carb Paleo diet? I was diagnosed with SIBO in September and followed a no carb diet for 6 weeks. Then I switched to the Paleo AI and now have about 1 to 2 fruits a day (usually apple or pear) and also have sweet potatoes in my diet in addition to plenty of greens. I no longer have symptoms and am now just working on healing my leaky gut. Thanks!

Hi Sarah and Elizabeth,

I am a Catholic struggling with this issue too. You can receive the Precious Blood it is the full sacrament and not receive the Eucharist. It is my understanding that gluten free wafers are not approved for sacramental use. However there is an alternative and here is some information about that: http://www.catholicceliacs.org/Options.html

Hi Sarah,
What type of probiotic do you recommend? I was diagnosed with SIBO about a month ago, and took Xifaxan for 10 days, but I actually don’t feel any improvement. According to the breath test, my SIBO is caused by the Methane producing bacteria. (There are 2 kinds, Methane producing and Hydrogen producing) and each require their own type of treatment. I have been trying out different Probiotics. Recently, i started Align becaues the Dr. recommended it, but I feel more bloated and low energy. Been on Align for 10 days now. I have been reading contravertional info on what Probiotics are good/not good for SIBO. One study says that any Probiotic that contains lactic acid or has a bacteria that can produce lactic acid is actually harmful to those with SIBO …. Another product I am looking at trying is Prescript-Assist …. anyways, what are your thoughts on Probiotics for SIBO? .. thanks so much … Peyton

I have been taking Prescript-Assist myself for almost a year and really like it. Lactic acid producing bacteria can be a problem for some people, but not everyone with SIBO. Also, you just can’t beat the diversity in raw fermented vegetables, especially homemade since you’ll have probiotics in every batch. Upping your omega-3 intake can be very helpful and also making sure to eat plenty of fruits and vegetables but maybe also taking plant enzymes as digestive enzymes to help break down the fiber.

Thanks so much for your reply …… I just recently heard about Prescript-Assist, but have not tried it yet. Currently I am on Align (day 11) and I have to say I don’t feel better at all. In fact, I feel more bloated and some white coating on the tong that was not there before… How can I find out if the bacteria in Align is Lactic acid producing or not?

If it’s lactobacillus based (which I believe it is), then those are lactic acid producing. Most probiotic supplements contain some lactobacilli strains (prescript-assist does not).

Hi again, Hope you had a nice 4th. May I ask how many capsules of Prescript-assist do you take now and how many did you take when you first started? Thanks so much.

I gave Prescript to my sister and mom plus I take it too but lately, I read where this type of prebiotic from soil can create a pathinogenic problem in your gut if you do not have enough “good bacteria” to balance. What do you think?

The concern was over strains that used to be used in another brand. Those strains have been taken out of most (of not all) SBO probiotics now and were never in prescript-assist.

Bananas, Strawberries, Nectarines for sure. I do okay with grapes and apples. Watermelon is okay if I eat a little, if I eat a lot I hurt. I used to drink smoothies every morning for breakfast and then I started getting this pain every morning. I went to the doctor, they did blood tests and an ultrasound and didn’t see anything. So I stopped eating fruit and the pain went away. Since then I’ve experimented with a few.

Thanks for the info. I keep searching for an easy answer. I have celiac disease, adrenal fatigue, Hashimoto’s Disease and still have symptoms. I struggle to commit to a diet as each article I read suggests something different. Ive been to several nutritionist who also provide conflicting advice. This is so frustrating!

Thank you for the information. I was searching for info for my 4 year old, she frequently gets a skin infections since she was 1 (oddly enough when she had started drinking cow’s milk). The doctor’s would just prescribe us an anti-biotic type cream and tell us to wash her with antibiotic wash. That worked the first time but then it made it worse. We stopped feeding her milk a year ago because she complained of stomach pains and realized she was lactose intolerant. The rash still comes back and I now feed her kefir from time to time (we now eat paleo too) and that helps it from growing but hasn’t gone all the way. She always complained that it hurt when she pees but the UTI tests were always negative. At this point I’m not sure where to go or what to do. The doctor’s refuse any further testing claiming it’s just that she picks up infections from playing outside (sounds crazy to me). I will ask about SIBO but doubt that they will pursue it. Are there any protocols you suggest or tests I should request we try for her? Thank you!

Oh, how awful! So, I think you’re on the right track with Paleo (no matter what is going on). You could ask for a SIBO breath test and/or a Fructose Malabsorption breath test. In the case of SIBO, if it was positive, the doctors would recommend non-absorbable antibiotics (after the course, you would focus on probiotic foods, and lots of fruits and veggies to help restore normal gut flora levels). In the case of fructose malabsorption, you would adopt a low FODMAP diet. But, I’m not sure that’s necessarily the right way to go. With fructose malabsorption, you would typically see GI symptoms (abdominal pain, constipation, diarrhea, gas, flatulence…). You may or may not see that with SIBO, but if it was severe enough for antibiotics, typically you would. I’m just not sure what could be causing the pain when she pees. Have you seen a paediatric urologist yet? And the skin rashes may or may not be linked to the urination pain, so I think you need to pursue both of these.

I have more ideas on things to try for the rashes. Topically, I would suggest trying probiotic soaps and moisturizers (Chrysal is a good brand and works really well even though their soaps have SLS in them–they even have a bubble bath–and their home cleaning products are fantastic too, although not cheap). The best moisturizer would be grass-fed tallow (you can mix it with half tallow and half olive oil and its not the greatest smelling, but I don’t think there’s anything better for restoring skin barrier function… Also check out Vintage Traditions which makes one with essential oils that does smell nice). The vitamins in the tallow and antioxidants in the olive oil are just amazing for the skin. Internally, high omega-3 intake (from seafood and pasture-raised meat), lots of fruits and veggies are very helpful for restoring normal gut flora, as are organ meat (again, the vitamins are critical for healing). Probiotic foods would be awesome if you can get her to eat them, otherwise, talking to your doctor about a brand of probiotic supplement is a great idea. And I know its tough with a kid, but sleep and stress management (which basically for a kid means having fun and laughing lots) are really important too. Other possible things to look at here are chemical exposures or sensitivities to things like laundry detergents. Sun exposure is helpful for most skin conditions.

And lastly, if you feel like you just aren’t getting anywhere with your doctor, you might want to see if you can find a functional medicine specialist.

Thank you so much for all your research and articles!! I have read many of them(!) this weekend alone and am truly happy to finally put some pieces together.

I am still a little confused about where to start. My daughter (7) and I both have dealt with digestion issues for some time. Mine got dramatically better after going gluten and dairy free, but we haven’t noticed much difference for her. (We both were tested and found some genes that make celiac but not the disease). We’ve tried to do some more digging but our general gut health labs came back pretty clean, especially hers: no inflammation, pretty balanced microflora, no parasites, etc. The Dr suggested elimination diet or food sensitivity testing. It’s hard to think she’s even allergic to any foods, as she never has any telling reactions, other than general gut pain.

I myself have been diagnosed with SIBO, but we didn’t check her yet, nor check for FODMAP sensitivities. She’s also having major tooth issues, so I connect this ALL to gut health, malabsorption, and leaky gut issues. Other than the SIBO for me, I feel like there are a lot of questions still about what could be causing the gut issues for both of us. All of your information on SIBO, FODMAPs, leaky gut, Autoimmunity, etc has all been great; but how do you know which one to try first? Especially when you don’t know which one(s) is the culprit?

Thanks so much. I really appreciate finding you and your website; so much great, real information.

I’m going to be writing a post soon pulling back on my support for GAPS and SCD style diets due to a lack of studies validating them. But, low FODMAP is very well studied and would be an excellent place to start. The ideas behind the autoimmune protocol are also good to keep in mind, especially the focus on nutrient density. You could actually treat the AIP as your elimination diet), especially since gut issues can be linked to foods sensitivities. I would definitely at least limit nuts and seeds, if not omit them altogether. And I would suggest talking to the doctor about digestive support supplements for both of you (I don’t know what would be appropriate for kids, so please please please check with your doctor on this one first). Most importantly, I would suggest a focus on nutrient dense foods, especially making sure to get those fat soluble vitamins (seafood, pasture-raised animal fats) and bone broth or other glycine rich foods.

I have multiple food allergies and I really had no specific symptoms just headaches. And because of that it took 30 yrs to get sent to the allergist.

Hello, Thanks for your post.

I have been diagnosed with IBS, because the doctors have done many test and could not find much of an issue…although in the past I had on the verge of a peptic ulcer and I was told I had hiatus hernia from one gastroenterologist, although recent cat scans state I don’t have hiatus hernia…so I am not sure which one is correct!

Anyway, I just want to say I have had always had IBS issues and I went to a gastro and a dietitian to try and get my symptoms under control.

I was put on the FODMAP diet, but then within that time I got sicker and sicker, then the dietician put me on an even stricter diet, because she thought it might be chemical related within certain foods, as the FODMAP diet was still making me ill. I continued to get worse! Ten times worse than before I went to the specialists. Something didn’t add up! I was getting flu like symptoms, dizziness, puffy face, nausea all day every day, bone aches around my ribs, very tired, hair loss, getting diarrhea, becoming more and more sensitive to any foods. And so I was like this can’t possibly be the foods I am eating, this is insane! I am not eating anything! And then I looked out to other factors which I hadn’t thought of and so I said what else do I take that is not food. I take panadol, vitamin D supplements and probiotics…and then it hit me, I almost instantly knew the culprit and it was the probiotics. I knew almost instantly that the probiotics was the issue a) because it was introduced when I started these diets b) I had issues with it a few years before, just much milder symptoms (only diarrhea from my recollection).

So I just don’t understand why probiotics would do that to me? I understand my stomach was not well to begin with, but the probiotics was slowly killing me.

Everyone touts probiotics as this amazing beneficial prodcut but I am very skeptical now, based on what I have been through.

Oh and two weeks after going off the probiotics all those nasty symptoms went away (I was sick for about 3 months in total). I am not saying I am cured, I still have major IBS issues, but the probiotics just made things 10 times worse.

Very interesting! Definitely not all probiotics are considered equal and since you can have overgrowth of what are normally considered beneficial strains, there are definitely situations where a probiotic supplement can make things worse. I’m curious to know which one you were on.

It’s one of the biggest probiotics brands in Australia called Inner Health Plus http://innerhealth.com.au/. It needs to be refrigerated. On top of that their packaging and website, does state anywhere that probiotics can have bad side effects for some people. In fact it doesn’t give any warnings at all!

Hi Sarah!

I recently found this article through a post by Mark Sisson:

http://eatingoffthefoodgrid.blogspot.com/2013/10/resistant-starch-and-sibo.html

Basically, they’re saying that people with SIBO might benefit from eating resistant starch. It’s a good read too with a lot of compelling evidence. I haven’t been able to successfully re-introduce FODMAPs or any starch in the past 10 months and I’m concerned about not getting any prebiotics, but whenever I do try adding any my skin breaks out a few days later and my anxiety gets a lot worse. I’m not sure what to do. What do you think about the resistant starch / SIBO thing?

Thanks,
James

Have you read the new posts about insoluble fiber? Resistant starch is classified as an insoluble fiber but is highly fermenatable. There really isn’t much research to go on in terms of autoimmune disease or SIBO or IBS, but there’s some compelling anecdotal reports. I would definitely go the green plantain route and make dehydrator plantain chips (FreeTheAnimal.com has written about this quite a bit lately) if you’re going to try it (and not do the potato starch thing).

Okay thank you, yeah I’ve read and I’m loving the new fiber posts!! Last time I had any starch (I had butternut squash) I felt pretty horrible the whole next week, do you think that will still happen with the dehydrator plantain chips? Should I start with just a tiny amount and work my way up? Thanks a lot Sarah.

Also if I’m on AIP but unable to successfully re-introduce starch from things like squash or sweet potatoes, would it be possible that I would do okay with white rice? I’ve been on AIP now for 9 months, would it be a bad idea to try rice?

Hi there

I have been sick for awhile now. Mostly started with diarreah. I was on antibiotics and Prilosec. I got tested for candida and its stable in the environment however I have no beneficial bacteria. My tummy grumbles and if I take a probiotic I feel drunk. Im nausea most of the time and have gas. I feel like im dying and nobobody can tell me whats wrong. Why do I feel drunk if Im not???My brain in foggy and I cant keep my head off a pillow. If I take aprobiotic my leg gets heavy. If its not candida can this be SIBO If so im in too deep for only homepath I think. Please some info?

I’m not a doctor so I’m really not the best person to help you. From your symptoms, it could be a huge range of things from D-lactic acidosis, to histamine sensitivity, to run of the mill food sensitivity (are you eating gluten? dairy?), to severe leaky gut. Correcting undergrowth is more about prebiotics (vegetables) than probiotics, so maybe skip the probiotic and try eating more veggies, maybe try a digestive support supplement. But really, i think you need to find a health care provider to help here. Have you tried paleophysiciansnetowrk.com and primaldocs.com? I think someone with functional medicine training will probably be the best help.

In an earlier post, you said to go the green plantain route if not wanting to go the potato starch route to incorporate resistant starch – is that because for AI folks, we should avoid the nightshades (including white potatoes)? I guess I’m a bit confused and hoping we get more solid information/studies about the new talk recently of resistant starches decreasing intestinal permeability.

Yes, that is to avoid nightshades. Green bananas are also great sources. But the data on resistant starches isn’t really very solid. I’m more a fan of insoluble fiber in general from lots of different sources (resistant starches included), for which I think the data is stronger. I definitely recommend checking out my Fiber Manifesto series.

Thanks Sarah – I can’t tell you how much I appreciate your site. I’ve been slowly incorporating the basics of AIP (meaning slowly eliminating foods to avoid and incorporating the “healing” foods). It’s been a few weeks and I’m not quite sure yet, but it seems some of my Psoriasis spots are “thinning”, less scaly, but just some of the spots, not all. I guess I’ll keep at it. I will definitely read up on your Fiber series. For now, I won’t worry too much about the Resistant Starch stuff; sometimes the more I read, it’s like information overload, so I will try to stick with what I can handle and see how my body responds. :) Thanks again!

Hi Sarah,

I have been struggling with IBS-C for 6 years (following parasitic infections and antibiotic treatment abroad) and will have been Paleo for one year in March. I continue to experience incredible water retention, rashes, swelling of the lower extremities, and eye-twitches in addition to my GI symptoms. My white blood cell count is also low. (I’m only 24, so a bone marrow biopsy was thought unnecessary.) I spent one month at the Mayo Clinic where little was concluded except that I have “chronic dyspepsia” and a GI motility disorder. A breath test came back negative, however endoscopies still show non-H. pylori ulcers in the stomach and erosive inflammation in the duodenum.

I switched to the Autoimmune Protocol (combined with the Specific Carbohydrate Diet) two weeks ago. Things got much worse at first, but then much better. In the last few days, however, all my symptoms have returned in full force. (I had been eating both coconut butter and shaved unsweetened coconut, and wonder if the inulin fiber is to blame.) My doctor has finally prescribed Rifaximin + Neomycin for suspected SIBO. I already take a probiotic and fermented Cod Liver Oil, so I will continue on those while I take the antibiotics and hope for the best.

My question is this: My doctor has suggested going on a prokinetic drug after antibiotics to prevent the recurrence of SIBO. I’m nervous about this and wonder if it is even necessary given my diet (AIP + SCD). Do you have any thoughts on prokinetic therapy for maintenance after the treatment of SIBO?

Thank you for all your help. The work you do means so much to so many people.

THANKS FOR THE INFO / SUPPORT. I HAVE SBS (NO I C V ) – IT GOT CUT OUT W/ APPENDIX AND SURROUNDING AREA. HAD TO GO GLUTEN FREE and recently cut out FRUCTOSE- went on the FODMAP SAFE DIET , BUT NO FRUIT AT ALL. GREAT RELIEF OF IBS PAIN.
MY DIET is low fat- good fats when i do eat them. Have tried probiotics , herbal anti bacterials and so many things and the only real difference in my IBS has been the fodmap program – and am leaning more toward Paleo. I am just so happy to be out of pain and as long as I can eat something, i am happy.
Have not taken any of my supplements yet but will add my b vitamin back soon and see how that goes- don’t want to have any set backs, and energy is back , so no need. As long as I don’t have the big D all the time, i have energy. not absorbing minerals is my guess but doing ok. any suggestions for SBS folks is appreciated. keep up the good work, Ele

you should really check out Dr. Robillard with the digestivehealthinstitute for an evidenced based method of eliminating SIBO through diet… it has to do with the potential of different foods to ferment in the gut… it works.

YES, thanks , have done that- Dr. R’s books were helpful, as well as others and have read lots of good info on line , and have an understanding of what all contributes to the feeding of the bacteria in the colon – causing the pain /fermenting/bloat- my guess is that once the bad bacteria in my lower colon increased , it also went to small intestine- due to no I C V – so my whole gut is a big party area for the bacteria. Not feeding them as much as possible. Ignorance is not bliss! I am taking oregano oil after one meal again . Energy is good, sleeping much better, legs don’t hurt as much, etc. Life is good! Ele

Has anyone had an ultra high level of hydrogen on a lactulose breath test? Mine was off the chart in samples 5 and 6; the chart went to 80, but my level was 151 plus 3 for methane on sample 5 and they put in 152 for sample 6 because the amount exceeded their ability to measure. My doctor gave me a specific protocol for Argentyn 23 (professional silver hydrosol) plus aloe vera juice and a probiotic (which I’m afraid to take because of previous bad reactions to probiotics), but BOTH of the main products I ordered were damaged in shipping (could that be telling me something?). Right now I’m very limited in what I’m eating – all clean meat, organic eggs, and limited vegetables. No fruit, grain, or sugar. But I’m 44 years old, have had 8 children (between the ages of 11 months and 23 years), am 5′ 4 1/2″ and am down to 94 lb – 20 pounds below my last pre-pregnancy weight. I’m taking Peppermint Plus, NAC, serrapeptase, and Tri-Phos-B (b-1, b-2, and b6, all reduced forms) between meals and Pure Encapsulations Mineral 650 (w/o copper and iron), magnesium glycinate, zinc monohydrate, and sockeye salmon oil after meals. I also use coconut oil (which is a medium, not short-chain fat, don’t know where I saw that on here), grass fed beef tallow, EVOO, and ghee. But I’m struggling with tachycardia, sporadic high blood pressure (frequently spikes to 158/128 just from a little time in the sun, taking a bath, or walking to the bathroom), hyperglycemia, and PAIN. WHAT can I do to gain weight without aggravating my GI symptoms or making my blood sugar go crazy??? I feel like I’m slowly starving and I’m scared. I’m trying a little potato mixed with turnip as it’s listed as a “safe” starch on FODMAPs this morning…

TIA

You mentioned that many people get SIBO after starting a restricted Paleo diet. Can you elaborate on that for me? I started AIP Paleo in May and June/July was diagnosed with yeast or fungus, hookworm, H Pylori and parasites, they gave me a one day compounded antibiotic for the hookworm and then heavy duty probiotics to repair the gut, GI Revive for repair also, and then a remedy for candida. I just feel like my health began tanking at that point. I am sure I have SIBO and need to find direction. I am trying to treat myself as best I can. Thanks!

It may have been a pre-existing condition and eliminating the problems caused by your diet when you went AIP made the symptoms more clear. Maintaining good gut flora and getting rid of infections is quite difficult for autoimmune patients due to leaky gut and poor immune function, so must of us run into problems like SIBO. – Christina, Sarah’s assistant

I’d just like to report that I’ve been consuming Dr. BG’s recommended concoction of potato starch, green powder, psyllium, soil-based probiotic and homemade kefir. It’s not bad tasting. I have also been eating starchy vegetables such as sweet potato and butternut squash daily along with a basic Paleo diet that I think is very clean. Only “bad” stuff might be dark chocolate, stevia and half & half in the coffee. Constipation is much improved to the point where I may not even be constipated. If you’re going every day, but the results don’t conform exactly to the Bristol chart, but there is zero diarrhea – what does that mean?

I remember your saying if you have autoimmune disease you will always have it, the symptoms can be controlled only. So, I have low T3, high cholesterol (high HDL too), rashes that come and go. I wonder if I will just continue to heal, and how, since my symptoms aren’t acute, can I know without extensive testing?

By the way, I lost 80 about 25 years ago, and have maintained it – eating horribly until the past year or so. So, I did a lot of damage.

I love your blog – thanks so much.

I was diagnosed yesterday with SIBO. Starting 10days of Cipro and difucian (always get bad yeast infections all over with antibiotics) . My dr said no probiotics during treatment. I also read somewhere to not do the SCD while being treated because you want the bacteria to be at their peek so the antibiotic can get to them.

This is so incredibly helpful. I’ve been reading articles on your blog here and there in my journey but something really “clicked” when I read about SIBO. I’ve given up gluten (99.9% at least, I know that’s not ideal but it’s my reality) but I still get a “baby bump” (bloated, hard belly that looks and feels like a pregnant belly) after eating foods like corn or rice. I was wondering if I was cross-reacting to gluten but I think it might be SIBO. I don’t have too much money to spend on alternative doctors so I’m trying to do my own research. I’d never heard of SIBO before but reading about it really strikes a chord. Thank you, thank you, thank you for doing all this work and offering us the fruit of your labor!!!

I suffered with sever SIBO for 7 months before reading an article you posted, reading up about the condition and showing my doctor before finally being diagnosed. It got so bad at one point that doctors were worried about intestinal cancer and I was sent for various tests and to various different doctors to try and find a solution. Probiotics and a carb/sugar restricted diet really improved my symptoms but I did have to take antibiotics to truly become comfortable again . And after another stressful month the awful symptoms have returned but at least this time, mainly down to your blog, I sensed it straight away and can get it treated faster! Thank you so much! You have no idea how much you have helped!

[…] Bacterial Overgrowth (SIBO). (For a great explanation of SIBO and it’s symptoms, check out this post from The Paleo Mom.) She and I decided to treat it with a round of very specialized antibiotics, and though the […]

One word of advice for people who are following GAPS or SCD would to be very careful with all the onions and/or garlic in the beginning stages of the diet. Onions and garlic and inulin (chicory root) are similar to wheat in that they are all highly fermentable fibers in the GI tract – they are all fructans. It may be that a person can handle some onions later on once a person has done some healing, but both of these diets, as wonderful as they are, aren’t up to date with the most recent advances when it comes to highly fermentable foods, and these are the ones SIBO and/or bacteria in the gut feed upon. Onion and garlic are water soluable, so if you want the flavor of onion and garlic in your foods, sautee them in your oil of choice, and then toss the remaining part of the onion and garlic, and just use the oil for flavoring foods. Once the gut has had time to heal, a person can try adding the onion and garlic back in to see how they do in smaller amounts.

Hi! I worked with a functional doctor who diagnosed me gluten intolerance, pre-celiac, pre-diabetes, and adrenal fatigue. Prior to that I was diagnosed with interstitial cystitis, vulvodynia and uterine ureaplasm. I made some progress after a year but still had chronic yeast infections, brain fog, sluggish digestion, etc. I am now seeing a naturopath who use Autonomic Response Testing (ART) to diagnose toxicity and diseases, which I’m not completely confident in since I’ve always relied on bloodwork or sample testing for diagnosis. Using this method she diagnosed me with SIBO, parasites and Candida, with no labwork. I believe the diagnosis is likely, I’m just wary of the method.

I tried strict AIP for six weeks and while my digestion symptoms reduced overall, I noticed bloating after sweet potatoes (nooo!), coconut butter and other high FODMAP items. This leads me to believe I likely have SIBO. None of my other foggy symptoms have improved.

I tried the Christa Orrechio Candida Cleanse spit test and that’s been positive for months despite going on the cleanse for 4 weeks.

So, my questions are:
- A second opinion on ART for diagnosis of conditions like SIBO, parasites and yeast?
- Thoughts on dietary direction? I am considering Intro to GAPS and then GAPS, but as dkaj mentioned above, onions and garlic could be an issue. I’m having trouble keeping weight on even with sweet potatoes, beets and other starches and am concerned my blood sugar will tank. Also I’m confused about the yeast sensitivity with relation to fermented vegetables which I know are a cornerstone of the GAPS diet, but I don’t want to exacerbate my yeast infection.
- Does your team collaborate with patient’s naturopaths as part of the service? Trying to assess all of my options.

Thank you from the bottom of my heart for all you and your team do, TPM!!

Sarah recommends a low-FODMAP approach in addition to the AIP if you have been diagnosed with both autoimmune disease and SIBO or FODMAP intolerance. Yeast sensitivity does not cause yeast infections and vice versa. Sarah’s book, The Paleo Approach, discusses how dietary yeast can actually help prevent yeast overgrowth. However, if you are sensitive to yeast, you will need to avoid those foods (and any other food likely to contain high amounts of yeast, like certain fruits and canned goods). The Paleo Mom Consultants, particularly Anne, can recommend testing and treatments your naturopath may be able to provide and answer these questions in more depth. – Christina, Sarah’s assistant

Right, I did the combo for a few weeks and felt marginally better, but soooo deprived at the same time. I’m having trouble cutting out the carbs and cruciferous veggies, it leaves so little left available to eat and keep my energy up. I will definitely give Anne a try, thanks so much for the advice!

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