Fruit and Starchy Vegetables with Small Intestinal Bacterial Overgrowth

April 21, 2012 in Categories: , , by

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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):

Artichoke, French
Artichoke (Jerusalem)
Ripe Bananas
Bitter/Black Gourd
Green Bananas
Celeriac (Celery Root)
Ginger root
Olives (preserved without sugar)
Sweet Potato
Summer Squash (like zucchini)
Winter Squash (like butternut or acorn)

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.


Thank you, thank you, thank you!
I do have a question about whether or not I should avoid butternut and/or acorn squash?

Now I’m going to partake in one of my very ripe bananas that I was thinking I should avoid.

The official diagnostic test is to collect proximal small bowel aspirate through an endoscopic procedure and count the number and type of microorganisms growing there (they stick a very long tube down your throat and collect a sample). It’s a fairly invasive procedure, so I would only suggest going through it if knowing “for sure” would change how you proceed. It’s also possible to get a false negative if you have SIBO but have it farther down the digestive tract than they sample. I personally only suspect that I have SIBO based on symptoms and am going from there. I hope this helps!

The standard test is the SIBO Hydrogen Breath Test. It’s very easy, you just do some diet preparation and then breathe in some tubes for three hours. Ask your doctor for it, or look up labs online.

What is the reason behind the fact that, when following a strict diet, a lot of people seem to become very sensitive to stuff they weren’t before?

In my case, I used to eat tons of gluten without much problem, and now since I switched to paleo I’m VERY sensitive to wheat. What’s up with that?

I think there’s two things going on. First, I don’t think it’s so much a change in sensitivity so much as it’s easier to notice a sudden change in how you feel when you normally feel really good all the time. It’s kinda analogous to getting used to a bad smell. You go into the monkey house at the zoo and when you first go in, it smells terrible. But, then you get distracted and you stay in there for a while and you stop noticing the smell. When you leave and then come back in, the smell is terrible again. Second, your body has adaptive mechanisms for dealing with chronic exposure to anything. For example, you might have had more mucus production in the lining of your gut to deal with chronic gluten exposure. Your body doesn’t need that now, so it doesn’t have it, so it gets blindsided when you do eat some, hence the extra digestive symptoms.

The explanation I was given was basically that if you get sick gradually over time you start off not noticing symptoms because you haven’t accumulated much damage yet, but once you do get sick you have so overloaded your system that it can’t respond properly. It is too weak to tell you “hey, don’t eat that!” and eject the offender from your system.

Gluten specifically is tricky. No one is born with Celiac Disease, they are born with the genetic propensity towards it. Exposure to gluten gives them the disease.

There is another possible explanation: Enzymes are chains of amino acids (proteins) that are created by our cells using our DNA as a template. These enzymes act as microscopic factories that speed up chemical reactions, therefore they are catalysts. All food we eat requires specific enzymes for breakdown and absorption for each component of the food we eat. For example, starch is broken down into the simple sugar of which its made (glucose) by the enzyme amylase, while lactose in milk is broken down into its simple sugars (one galactose and one glucose) by the enzyme lactase. Our cells have been “designed” (either by evolution or by G-d, depending on your belief) to not waste resources, therefore if you don’t eat a certain food, like the lactose in milk, your body will slowly stop making the enzyme lactase that is needed to metabolize the lactose. So if you haven’t eaten any dairy in a long time, you may not have any lactase in your body. If you suddenly load up on dairy in your diet, without any lactase available, not much lactose will be metabolized, which means it will pass down into your lower digestive tract to (over) feed the bacteria there (as well as increase the osmotic pressure), resulting in gas, bloating, diarrhea and many other unpleasant symptoms. This could happen with wheat protein (gluten) as well if you stop eating wheat for a while, although its not going to feed the bacteria in the same way. Keep in mind that “dietary fiber” is nothing more than starch but that its glucose units are bonded together in such a way that we cannot break that bond easily as we do not have the necessary enzymes. Just like in the lactose example above, dietary fiber results in undigested and unabsorbed sugars passing down into the lower gut that overfeeds the bacteria there and can result in gas, bloating etc. Vague, uncomfortable, digestive symptoms like these are characteristic of hundreds of diseases and cannot be used as a definitive diagnosis for any single disorder.

Why are sweet potatoes “allowed” in some Paleo diets and not allowed in others? I understand here it is about SIBO, but I keep coming across this discrepancy on site after site.
We are just getting started with Paleo. Our family has a number of food sensitivities, so we are deleting nightshades, all dairy and eggs. I am trying to find out if sweet potatoes could be a nightshade so we don’t have an accidental exposure.
Thank you so much for this site. It is giving me a handle on how to address a variety of concerns.

Sweet potatoes are not the only controversial veggie. The reason for the controversy is the huge disparity in opinions regarding carbohydrate intake, with ketogenic diets on one end of the extreme and eating a large amount of carbohydrates from “safe starches” on the other end of the extreme. My own opinion on carbohydrates is that it’s highly individual what works for different people. I especially don’t like the idea of limiting carbohydrates for children. Sweet potatoes are a nutrient dense, complex carbohydrate. While starchy vegetables aren’t great for those with SIBO, they are a great source of slow-release carbohydrates for everyone else. I can only eat a small serving myself (because I’m recovering from SIBO) but I make sweet potatoes frequently for my family. They are not nightshades.

Thank you so much for all this great info 🙂 I’m heading towards a paleo AIP diet (about 80%) there. I have coeliac and AI hypothyroidism together with loads of other symptoms, including digestive, very likely SIBO. As I’m borderline underweight and hungry all the time and have low blood sugar issues, the one thing I really struggle with, is getting enough calories. I eat loads of protein and the good paleo fats, but I really struggle with getting enough food if I cut out starchy veg as well as grains. I’m intolerant to most cruciferous veg and can only eat squash in small amounts before I bloat up. Any suggestions would be very gratefully received! I’m loving this website…really inspiring me to keep going with cleaning up my diet 🙂

You might be stuck with proteins and fats as your dominant calorie source. How do you handle fruits, especially the higher glucose ones like bananas, plums, figs and date? Those ought be a good source of some extra calories without causing bloating.

I’m going to be honest and admit that internally I’m throwing a tantrum fit for a frustrated toddler over here right about now 🙁

I’m one of those for whom Paleo hasn’t proven to be a miraculous cure; without gluten my celiac/dermatitis herpetiformis is better, sure, but IBS stuff, arthritis, & acne (lovely) remain. I had thought FODMAPs were my issue, but removing/reducing those hasn’t resolved the gut issues either. Hypothyroidism rounds out my issues, though I’ve accepted the fact this will likely mean meds for life (& versus the horror that is life without them, I can deal with that). I discovered the AIP, here, earlier this weekend – and will implement it.

The missing piece to this jigsaw is SIBO, I believe – I’ve been in denial about that for months if honest with myself. The abdominal distension is my clue – as hard as a rubber ball, that’s exactly how it feels to the touch. At its worst it even makes breathing deeply difficult, there no room for my diaphragm to expand fully. Hence I know the answer is to trial the diet changes above … and the thought of everything I need to cut out is just overwhelming. I’m scared to eat; went grocery shopping earlier and was just so damn lost, and sad. I bought sardines and came home (it’s almost funny now, in hindsight),

Just venting, sorry – because the bottom line is that I’m incredibly grateful to have found you. Again, you’re an amazing resource. Thank you for what you do here. Eager to keep reading, and to hear your personal updates in particular.

Oh Sarah! I completely understand your frustration and anger! And dealing with SIBO through diet can be a slow road (but, I think probably more effective in the long run than using antibiotics). It does get easier as you go. You can eat non-starchy vegetables, as much as you want, better if cooked if you are having IBS symptoms. You can have some fruit, but don’t go nuts. And avoid any paleo baking. With all the other stuff you are dealing with, you might want to look at the autoimmune protocol, but if that is just too overwhelming right now, try this first. I find myself often making extra as supper for either my breakfast or lunch the next day (had a leftover hamburger patty for breakfast this morning with some vegetable juice). It does get easier, I promise! And especially once you start to feel better, sticking to it feels worth it, which also makes it easier. Be prepared for some die-off symptoms like diarrhea and stomach cramps. Eating antimicrobial foods like raw garlic (try and swallow a clove whole or cut into small bits with water), coconut oil (either cook with it or by the spoonful), oregano (you can supplement with a drop or two of oregano oil in a glass of water twice a day) can help speed the process too (and increase die-off symptoms, just as a head’s up). Bone broth and an L-glutamine supplement can help speed healing. Keep me posted on how you’re doing!

You made me cry … but good tears. Thank you, truly; you’re incredibly kind and that warmth really shines through your posts.

Today I will pull myself together, collate all your good advice, and make a plan to start tackling this more sensibly. Tantrums and sardines are no way to live!!

Hi Sarah,
Thank you so much for your blog – it’s great to have some science behind the recommended cures. Having followed a low starch diet for 6 weeks with no differnce I am now following the auto-immune, SIBO and FODMAP diets at the same time….. and I have a couple of questions about teas.

Can I still drink ginger tea? I know ginger is a starchy vegetable, but I was wondering whether just the juice would be a problem? You don’t mention licorice, but I was wondering about licorice tea too?

Can I still drink tea made with some of the banned AI spices such as cardamon or do you think I would still end up ingesting some of it?

Many thanks for your help,


I think ginger tea is awesome. Licorice root tea is reported to help protect the lining of the gut by thickening the mucous layers, which can then help promote healing. I haven’t looked into exactly how this works, but I’ve been drinking some with no ill effects (although nothing miraculous either). I think seed based spices (especially the ones that don’t have any heat) are the least likely to cause problems, so it’s definitely worth playing with. I seem okay with most seed based spices (jurry is still out on cumin and pepper). But, if you are having alot of symptoms right now, the cleanest version of this diet would be avoiding seed based spices even in tea form (if your sensitive, you could still have a reaction).

I have a problem with every food on the AVOID list (bloating and reflux as the usual consequences) and butternut squash and pumpkin if I have a large amount but strangely enough white regular potatoes (I have no idea about sweet potatoes- I don’t like them) don’t trigger anything with me- I have no idea why! I don’t regularly consume them because I prefer low carb for improving energy levels. I suspect I may have SIBO and am having a follow-up appointment with a gastroenterologist later today after having had a gastroscopy to work out why I still have occasional reflux (though it has reduced VERY significantly from every 10-15 minutes to once a day on a paleo, no-starch-flour, diet). I trialled arrowroot, white rice flour and tapioca flour as “safe starches” but they wrecked havoc on my digestive system and after the white rice flour trial, my throat was so damaged from my reflux that I ended up with tonsillitis. I’m just crossing my fingers that I don’t end up having Barret’s oesophagus (big cancer risk factor) or an autoimmune disease called Eosinophilic esophagitis.

I tried GAPS intro about a year ago (I wasn’t really ready for it mentally) and about 5 days in I was nauseous and violently ill as if I had terrible viral gastroenteritis. I couldn’t deal with it and I quit and a few minutes after having something non GAPS-intro compliant (probably a raw fruit or carrot or something) I felt 100% better. The ordeal gave me the sense that my reaction was confirming that I do likely have SIBO.

What do you think of this (from Paul Jaminet’s site) as a reason why white potatoes might seem to be ok and even sometimes make my digestive system feel better?

“Flour-based foods may be problematic for more reasons than their lack of water. Last year, Ian Spreadbury proposed that “acellular carbohydrates” – carbohydrates that are not surrounded by cell walls and embedded within a cytoplasm – may be unhealthy because the carbs can feed bacteria in the upper digestive tract which can then infect important organs like the pancreas, gallbladder, liver, and small intestine. Cellular carbohydrates would be digested lower in the intestine, helping to maintain an antiseptic and healthy upper small intestine.”

Thanks for all the information on SIBO that you provide! I haven’t found such a rich source of information anywhere else.

My gastroenterologist said nothing showed up in my gastroscopy tests. He said that if I have SIBO, it’s nothing severe and certainly nothing they’d treat with antibiotics. I mentioned the protocol you outlined here and he said to give it a go to see if it helps- he’s seen other people where this type of protocol has helped. We discussed HCl supplementation and he said that some people have found that it works but others who considered it to be working have come in to him for follow up gastroscopies and have had massive stomach ulcers aggravated by the supplementation because there is no reliable way to control dosing at the moment. He recommends against it.

He’s also sending me to an immunologist to get tested for food sensitivities because he said that even though the testing will over-diagnose, that it will be a good starting point for an elimination diet. I asked about probiotics that have particularly good evidence and I figure I’d put them here for other people to see: Lactobacillus GG and VSL-3.

At the same time, my genetic test says I probably have celiac disease (tested negative for other genetic and blood markers of autoimmune diseases) and combined with the symptoms I had prior to being gluten-free, I’ve received a diagnosis of celiac disease soooo here’s a weird question:

Celiac disease is an autoimmune disease- Should someone with celiac disease automatically try the autoimmune protocol?

Hi Sarah,
Thanks for this. I’m sure I have SIBO along with auto-immune disease and every little other thing that can go wrong. This will help me make more changes. I’m confused about the following. “Dried fruit, except dried apricots, dates, raisins and prunes, is restricted.” If I’m AIP all dried fruit is out, right? Would it be reasonable to assume these fruits are better choices when I’m more healed?

I am sooooo confused. I don’t know where to start to heal leaky gut. When do you introduce foods you dont tolerate back into diet? I am also having trouble digesting beef pork as well as all fruits and some veggies. If I cook my veggies will it slow down digestion?

Cooking veggies make them easier to digest, which may help regulate transit time. Once you figure out all of the things that you aren’t tolerating and get them out of your diet, give feeling good 3-4 weeks before you start adding foods back. Depending on exactly what is going on in your body, it can be as quick as a month or it can take 6 months up to about 2 years.

Hi! Love love love love your blog!!!

Just wondering, i have found jicama actually helped my SIBO since it acts as a “prebiotic” and also has some soluble fiber… is it something that i need to avoid? I thought jicama was a low starch vegetable, wondering if i am wrong?

thanks again for this terrific blog, and for helping me heal so many autoimmune related conditions 🙂

Can you tell me more about dates? I’m surprised that they are allowed because I perceive the fructose to be off the charts. I love dates, but I haven’t been eating them. Why should I eat, or not eat these? Thanks!

Dates are certainly high sugar, list most dried fruit. But, they actually have more glucose than fructose. And, they are actually much higher in monosaccharides compared to disaccharides and a good source of a number of vitamins and minerals. I think they are an excellent source of sugar for treats, you just need to be mindful of how much you’re eating.

Hi Sarah, I’ve left a couple of comments on your AI page (and thank you for your responses!!). I’m pretty sure I have leaky gut/dysbiosis, but one thing I’m STILL really confused on is whether I could have SIBO and/or FODMAPS issues. I don’t have coverage to get tested for SIBO but have some of the “symptoms.” But here’s the thing, the bloating I experience is in the lower area of my abdomen (more like beneath my belly button down to the hips/groin area) and not in the upper region (this is making me think I “just” have leaky gut and the laundry list of problems related to that, including perhaps FODMAPS but not SIBO). From what I’ve been reading on various “gut healing” sites, bloating, etc in the lower region is more of an enzymes/leaky gut issue and NOT SIBO. Don’t get me wrong, there are probably too many bad guys down there, but I pretty much never actually experience pain, bloating, etc in my actual stomach/lower intestine area (which I was told is in the upper region, closer to the belly button). If you could weigh in, that would be awesome. I’m trying to nail down which protocol to follow, which foods to eliminate and experiment with, etc. Again, thank you so much! I am so grateful to have found your blog.

They often go together, because FODMAP intolerance can cause SIBO (starts as overgrowth in your large intestine but can then migrate up). However, as I research for the book, there’s a really good amount of literature supporting a low FODMAP approach for SIBO (and no studies supporting the low starch approach, although it is still used by clinicians). My general recommendation would be avoiding high inulin fiber foods (sweet potatoes, coconut, Jerusalem artichokes), not going nuts on fruit or starchy vegetables, and then adding digestive enzymes with each meal.

wonderful – thank you! I was thinking that I’d start with the major fodmaps (particularly the foods I already know I have some sensitivities too) and work on being 100% diligent in keeping out eggs and all nuts and working on keeping sugary fruits/foods low. I guess at the end of the day, even if I have sibo-like symptoms in a different region of my body (so it’s technically not sibo), it’s still unpleasant and I want to heal and get things back in proper working order! Thanks again 🙂

– Sarah, have you heard of the “Buteyko Breathing Technique” ? I wanted to bring this up in the future but a comment on this page concerning SIBO and diaphragmatic breathing made me curious.

Basically it has been researched that almost over 60% of all people hyperventilate without knowing (breathing heavily, fast trough the chest. Shallow breathing). Since o2 is basically a toxin in the blood, the more and heavier you breath the LESS actual Co2 reaches your body and brain. What this means is that your body become acidic , has a decreased immune system and becomes a source of potential diseases.

I really recommend taking a look into it since it has been helping me 🙂

– I would like to point out that my energy levels went up dramatically after introducing more carbs in my diet. In my case this was “Sweet potato” (cooked). I have to note here that it was essential for me to increase my carb because my weight reached the “underweight” position. It could have been that I felt better not because of the extra carbs itself but the result of me gaining weight from it.

However, I would get bloating and inflammation from a single Banana (on empty stomach). Just shows how everybody has to experiment for themselves.

– I *highly* suspect I have SIBO also. The autoimmune protocol has helped me a bit but it is VERY hard to combine with a weight gaining diet. I am almost certain that my 4 meals a day (1 time fish, 2meat, 1 soup) isn’t helping my SIBO but than again I do not have a choice (have to gain weight).


Thanks for all of this great info. I have recently been diagnosed with SIBO and I am also Lactose Intolerant, and I am pretty sure I have a super strong wheat/gluten intolerance (but NOT Celiac). The part I am most confused about is blood sugar levels. If one is potentially pre diabetic, then how does the style of eating for SIBO affect this? I feel like I am starving all the time and have lost weight because of no carbs. If the goal is to keep blood sugar levels stable as well as starve the bacteria for SIBO, how do these work together? I hear you should eat 3 big meals, but that goes against the thinking of eating more often for blood sugar stability. Thanks so much!

Even for prediabetes, it is better for insulin sensitivity to eat bigger meals spaced farther apart. Make sure you are eating lots of non starchy veggies, good fats and good proteins. I’ve been researching the recommendations from this post for my book, and there’s actually no scientific literature to support it (although plenty of annecdotal evidence). What has been well researched is a low FODMAP approach, so that’s actually where I would recommend starting, which means including some starchy vegetables with your meals is something you could do.

Sarah, thanks for this great website: I have been devouring it all morning 🙂

A couple of yes/no food questions: In your Autoimmune article you mentioned to avoid raw cruciferous veggies, radishes, spinach, etc. Are you saying that I shouldn’t eat raw radishes or spinach either, or is it just the cauliflower, broccoli that need to be cooked?

Second question: in your chart, I don’t see carrots, celery stalks or hearts of palm.

Third: I’ve been taking a tincture which is alchohol based, for liver support. Should I avoid this on for SIBO? You mentioned that even just a little alchohol is like a little wheat for celiacs.

So, the autoimmune protocol has been updated. I do not recommend avoiding cruciferous veggies at all anymore. Carrots, celery and palm hearts area all okay. The amount of alcohol in a tincture is probably fine.

Thanks so much for your site and support. Didn’t see mangoes on your list above – wondering if they are to avoid for any reason?

Over past months I’ve made amazing progress with symptoms by eliminating foods but still have a ways to go (I have Hashimoto – not tested for anything else). Currently almost 4 wks on AIP but surprised to find I get terrible reactions to meat and fish – except wild salmon, which I therefore eat every day. (Until 6 mths ago, always happily ate meat & fish –presently take 2 days to recover.) Now being entirely grain and bean free combined with this meat problem, I’ve lost too much weight. Really need to put some back on. Any advice?

-Apart from vit D, I’m not taking any supplements/probiotics – am willing but don’t wish to take the wrong thing/amounts as Dr not on board.
-Recently discovered coconut butter in hope of adding calories, but suspecting coconut is not my friend 🙁 Will try smaller servings.

I personally don’t do well with coconut (I get very bloated). I would suggest trying some new meats you haven’t had in a long time (emu, bison, goat, duck, rabbit, whatever is new for you). Sensitivities are common with a very leaky gut.

I’m actually getting ready to retract my recommendations to hold back on starchy vegetables during the AIP, so I would suggest playing with adding those back in. Mangoes should be fine, but they are high fructose, so don’t eat too much.

Other ways to increase calories is fats (avocadoes, olives, avocado oil, olive oil, pastured lard, grass-fed tallow, red palm oil, coconut oil, etc.). Increasing starchy vegetables should help too.

The only two supplements you may want to consider are digestive support supplements (specifically digestive enzymes) and probiotics (I like Prescript-Assist). If sleep is an issue for you, you could also try a magnesium supplement before bed (I use magnesium glycinate from premier labs). But, if you’re seeing good results, you might not need any supplements.

Thanks so much for your response – will help me keep moving forward. Really appreciate it. Do I still look for non-grain fed (100% grass-fed/pastured/wild) for other meats too? Also if something only makes me bloated (nothing worse) is it still best to drop it for now? And is it a good idea to get ‘tested’ for a leaky gut? Thanks. Looking forward to your book.

Yes, although you’ll actually find it easier to source those other meats grass-fed or pasture-raised.

Depends on why the bloating and how much there is. For now, it would be better to avoid those foods (or cut the amount you eat down). If its just excess gas production, it’s not as damaging as if its actual bacteria overgrowth, but since you generally can’t really tell one way or the other, trying to minimize foods that make you bloated is the only way to go.

It’s only worth getting tested for leaky gut (or related things like SIBO or fructose malabsorption) if that’s going to change what you do. There are treatment options for SIBO (strong non-absorbable antibiotics followed by probiotics and a strict Paleo diet) and fructose malabsorption (low FODMAP diet), but you are kind of already doing everything you need to for leaky gut.

Um ok, I’m at a complete loss… What should I eat??

No to nightshades.
No to a calorically significant amount of fruits.
No to grains/pseudo-grains/nuts/seeds and pulses.
No to most veggies.
No to the few remaining fruits/veggies unless they’ve been cooked.

So then what… an essentially very low-carb diet?
But that has it’s own list dangers including depletion of water and glycogen stores in the short term, completely screwed up metabolism, and many others in the long term.
I’ve experienced the first 2 within days of starting a low-carb diet. I was literally peeing every 1 hr., and many times during the night. And was experiencing extreme lethargy. At the end of the week I had an episode where I nearly passed out, it was scary. Plus I started having breakouts on my face.

I have hypothyriod, Raynauds syndrome, PCOS, and the worst of all chronic constipation and bloating due to SIBO. Gluten/dairy/refined sugar free cleared up eczema, fibro pain, migraines, stomach pains, and helped with heartburn.
I’ve also been able to identify tomatoes contribute to eczema, and possibly peppers, also to heartburn. For sure onions, garlic, cruciferous veggies cause bloating and worse constipation. For sure allergic to honeydew and watermelon. Citrus irritates my skin and causes rashes but eating oranges does seem to help with constipation, but only if I eat a very large amount.

I need to exercise in order to help with insulin sensitivity but in order to do so I need to get in enough calories. Plus I need bulk to help w/ constipation.

Xifaxan did nothing whatsoever for me. VSL#3 did nothing for me. Align and Fem-dophilis helped for a while but then stopped. I’m up to taking 2000+mg of magnesium per day and even that doesn’t always help. Saline enemas give some relief but I don’t want to get habituated to them. Interestingly, I was taking Fem-dophilis last Oct.-Dec. and I thought I was cured, even had a period, stopped taking the Magnesium, but it didn’t last.

I know it’s all individual but I don’t even know where to begin?
Do have any advice for me? I’d be most appreciative.

Okay, so first, I am not a doctor and I can only give you my ideas of where to start. Second, I will be updating the Autoimmune Protocol soon, but that if you haven’t read that page yet, that’s the best place to start. Basically, eat meat, fish, shellfish, organ meat, veggies of all kinds (except maybe FODMAPs since you know that onions and garlic cause bloating, but I recommend starting with inclusion of starchy vegetables exactly because of the problems that can be caused by going too low card), 2-4 servings of fruit per day (keeping fructose below 20g per day), fermented vegetables, healthy fats (grass-fed and pasture-raised animal fats, fatty fish, avocado, olive, coconut), glycine-rich foods like bone broth. You could try a mix of raw and cooked veggies, which works for most people. If you are getting a lot of intact identifiable raw veggie matter in your stool, then switch to all cooked. I would definitely suggest trying digestive enzymes with your meals (and talk to a doctor about other digestive support supplement options like betaine HCl and ox bile) and trying Prescript-Assist as a probiotic. Sleep and stress management are also critical.

Thank you. I’m sort of in the same boat as jessie… Looking forward to any more details about this in the future. Like, what kind of starchy vegetables, and how much, if you believe you have SIBO and some FODMAP foods cause difficulty? I’m looking forward to your book. I know it will be great!

Thanks PaleoMom for your reply! Your suggestions seem to be a sensible place to start.
On a side note, I just listened to a podcast on FODMAPs/SCD/GAPS given by a Dr. who ONLY treats people for SIBO and nothing else.. she mentioned that nearly all of her patients have issues digesting starches and only a moderate amount of patients have problems with fructose.

After hearing this I considered getting a fructose malabsorbtion breath test (so far I’ve only had the lactulose test), but even if I do FM, I’d still have to test to see how much I can tolerate so I don’t think it’d be worth it. I think it’s probably best to stick to small amounts throughout the day, 2-4 servings as paleomom suggests, and stick to low fructose fruits.

I will try out some starchy veggies, just enough to prevent VLC symptoms. I will let you know know, Rachael, which ones. I’m glad for this comments section so we can communicate what works/doesn’t work and maybe help others with similar issues.

I too am looking forward to the book and also the updated auto-immune page.

Thanks again!

Hi Sarah,

You’ve got great info on your site, I’ve been perusing it following a recent digestive upset. I may have SIBO, I’ve had persistent diarrhea for a couple of years, though sometimes it’s fine for weeks.

My question is about post workout nutrition. I’m a weight-lifter, so after workouts I usually eat either rice crackers or sweet potatoes. I follow a paleo diet, apart from the rice crackers.

Some kind of carbohydrates is required for the type of exercise I do (heavy barbell lifting). Sweet potatoes are the standard recommendation for restoring glycogen.

Can you think of something that would make a good substitute, while being more gut friendly? And, is this protocol for life, or is SIBO something that can eventually be beaten and things like sweet potatoes will be tolerated again?

Thanks so much,

– Graeme

p.s. Am currently fasting + eating broth, raw garlic, coconut oil, apple cider vinegar, and glutamine. Have noticed diarrhea, which I understand is normal if I’m experiencing die-off. Am going to give it a few more days and see if things stabilize.

Well, diarrhea is normal for die-off, but if you’ve had it for years, that might not be what’s going on. In fact, you are more likely to have an undergrowth than an overgrowth with diarrhea (so, more generally gut dysbiosis). The two diet factors that have the most profound corrective influence on gut bacteria are high omega-3 intake (lots of fish) and insoluble fiber (non-starchy vegetables). I would suggest taking plant enzymes to help digest the fiber. I would also suggest adding a probiotic and/or fermented foods to your diet. And, have a very critical look at foods in your diet since diarrhea is a common food sensitivity reaction (any dairy? occasional gluten exposure? could be the rice too). As for post-workout nutrition, I think it would be fine to stick with sweet potatoes for now (you may want to read up on FODMAP intolerance, which I think is a better starting place than low starch approaches if the above suggestions don’t help). Other good starches to think of would be plantains, lotus root, taro root, and parsnips. Bananas or grapes are probably a good choice too since they are high glucose.

Hi, I am trying to ‘bulk up’ and I am weight training and increasing the calories in my meals. I eat two large sweet potatoes a day, which I’ve started boiling in a meat stew as I thought that this would lower the concentration of their sugars?

I also add 100g per day of beef/lamb tallow to my meals, could I increase the fat and lower the sweet potatoes in order to eat less starch?

I feel great at the moment! Just wondering if it’s OK to continue for a long period?

The slower you bulk up, the more likely it will be muscle you’re putting on. I would generally just recommend you eat more of everything, rather than focussing on one particular macronutrient. Boiling sweet potatoes in a stew only lowers the concentration of their sugar if you eat less of them at one meal. They don’t have a high glycemic load, so you shouldn’t have to worry about eating them straight or however you like them. It will be easier to put on mass if you. are eating more starch rather than less. It’s hard for me to answer whether you are eating a good amount of fat versus carbohydrate without knowing a whole lot more about you, but I would say that if you are feeling great, then you should stick with what you’re doing.

Thanks PaleoMom, I’ll try to diversify a bit and add some other starchy vegetables to my stew. I currently eat 219g of carbs per day, from sweet potatoes and veggies combined, and 100g of pure beef fat plus whatever fat is in my meat (mainly fatty cuts such as breast of lamb or salmon).

I do have one last question regarding fat actually. I’ve heard many people say that if you eat more calories than you burn you will put on weight. I eat 2864 cals a day whilst following the above diet. Could I simply eat more pure fat if I want to increase my calorie intake and gain weight quickly?

I used to have Chron’s disease, I don’t consider myself to have it anymore, as I’ve had complete remission of all my symptoms since I’ve been Paleo. So long as I stick yo auto-immune protocol.

Wow, you really know exactly what you’re eating! Do you measure everything? Fat is twice as calorie dense as protein or carbs, so yes, it’s an easy way to increase your energy intake. Eating it with some carbs will make it easier for your body to store it.

That’s great that your Crohn’s is in remission!

“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.” That was the quote that got me. I am still at a loss for what my body reacts to. I wish i knew what made me feel better! As for SIBO, i’ve been considering it more. I am usually constipated, feel crampy and bloated and my stomach has been distended and bloated for MONTHS. I’ve also gained weight, despite eating less and really sticking to a paleo diet. I am not so inclined to do the test because I’ve spent thousands on tests and they haven’t revealed much for me. The only starches I am really eating are sweet potatoes… I just love them! But I eat them regularly… wondering if it could be that? I also eat some fruit as well (apples, pears, berries, banana and some in smoothies as well). Think it’s worth a shot?

Funny, the only starch that I really have to be careful with is sweet potatoes. Pretty much anything else my body is happy with. The other food that causes me to be bloated and constipated is coconut, and to a lesser extension other nuts. I feel less enthusiastic about cutting out starchy vegetables than I did when I wrote this post, in part because this hasn’t been validated in the scientific literature (although low FODMAP approaches have been very well studied and I think the reason why low starch worked for me initially was actually because of cutting down FODMAPS).

I would recommend two things. First, checking out my FODMAP post since that has been very conclusively shown to be helpful for IBS-type problems. Second, I would recommend adding digestive enzymes. I take plant enzymes which are very helpful in digesting fiber. You could also do pancreatin (pancreatic enzymes from pig or cow) or both.

Also, its not always helpful to eat less. I’m not sure how much you are eating, but its stressful to your body if you aren’t eating enough.

Hi! Thank you for the wealth of information that you share on your blog…I am looking forward to your book! I have struggled with my digestion since I can remember! It’s improved over the years through dietary adjustments and I find that a paleo diet helps, as well as GAPS. I’m still trying to figure out what foods I can/cannot tolerate, but am especially challenged since I am nursing…two kiddos. My oldest of the three (age 5) also suffers from eczema, bloating, gas, stomach pains and loose bowels. I suspect that me and my oldest both suffer from SIBO (I get the trapped, fermenting gas and bloating). As you can imagine, my body requires a great deal of calories right now. I am eating grains right now…no dairy (besides butter) or legumes, because I find that I am SO hungry when I eliminate grains. Do you have any advice for nursing mamas and little children who are suffering from SIBO? It seems almost impossible to get the calories that I need to feel satiated and to not cause my milk production to go down. Another question I have is in regards to a test that our Naturopathic doctor had my daughter take from Entero labs that analyzes intestinal specimens for food sensitivities to proteins. She came up positive as having food intolerances to gluten, soy, dairy, eggs, pork, tuna, potatoes, grains and nuts. I’m a bit skeptical of this test because 1). wouldn’t most, if not all, people test positive because these are inflammatory foods that cause our bodies to produce antibodies and 2). the doctor who owns this site is a raw vegan who eats seeds and nuts for protein (I asked). I’m just trying to figure out the best diet for my family for optimal health and how to safely figure this out. Your site is extremely helpful…I just need guidance in relation to implementing an autoimmune protocol type diet while I’m breastfeeding two children and for my 5 year old. Thank you so much for your time and support!

Are you eating gluten-containing grains? or limiting to gluten-free ones?

I’m not familiar with the particular lab that did your daughter’s test, but foods being inflammatory is different than foods causing immune reactions. The immune reactions to so many foods is a symptom of having a leaky gut (which fits with her symptoms too). I don’t think you need to go to the work of GAPS or autoimmune right now, just so much as transition to a full standard paleo diet. Also, a very important aspect of correcting gut bacteria levels and types is increasing omega-3 fatty acid content (from animal sources like fish, shellfish, grass-fed meat, grass-fed ghee). Incorporating broth, fermented foods (like raw sauerkraut, kombucha) and nutrient dense foods like organ meat and a variety of fruits and vegetables should help healing. The other major diet factor that influences gut bacteria is fiber, which she would get from fruits and vegetables.

As for calories during nursing, I suggest starchy vegetables, healthy fats like avocado, olives, coconut oil, quality meats, and fruit. And of course, protein too. But, you don’t need to be low carb or low fat. I don’t think that limiting starchy carbs is appropriate for you or your daughter (maybe if she had chronic constipation, but not with loose stools). If she isn’t seeing a substantial improvement in 1-2 months, I would also eliminate the foods she tested positive for.

I’m very uncertain about SIBO. What do you think based on the following? I’ve been on a Paleo diet for four months. In that time I’ve had a UTI and did a round of antibiotics. That week I experienced a tremendous amount of gas which I normally have basically none. Bowels are moving classically. And for the last Few weeks I’ve been even more restricted with a cleanse which eliminates nuts, fungi, yeast, and high sugar fruits. Everything about my body, mood, mental state is healed except bloating. I’ve lost 15lbs. I’m very slim. Yet I have this stomach that looks to be about 4 months pregnant. Like you mentioned, firm. I’m also taking digestive enzymes for carbohydrates before each meal (iberogast) and I’m on a laundry list of supplements from my Naturopathic Dr. They include additional enzymes, high does of probiotics, and herbal mixes. All of which are mentioned in this thread. With the only possible symptom being bloating, and no gas issues with regular bowel movements, could I still have SIBO???? Do eat the occasional apple, peach, and okra. And spinach salad.

It could be, but it’s not the only possibility. The test for SIBO is pretty straight forward. It’s called a hydrogen (and sometimes methane) breath test, in which you drink a sugary drink and then they test the hydrogen in your breath over the next few hours (fructose malabsorption is tested the same way as is the test for H Pylori). I think getting tested would be a good idea before modifying your diet or taking supplements to treat SIBO given that you don’t have other symptoms.

The other strong possibility that occurs to me is stress. Having a UTI makes me think that you might be eating too low carb (which is hard on the kidneys), which can increase cortisol and cause you to keep some extra weight in your mid section (the problem is really being too low carb on top of having stress in your life, especially if you don’t sleep enough). That weight is typically kept around your organs (as opposed to normal weight gain which is under the skin), so if you have some good ab muscles, that might still feel hard. The solution is to increase carb consumption and prioritize sleep and stress management, including avoiding excessively strenuous workouts.

Hi, Thank you for your great blog, very detailed and concise information.
I was diagnosed with fructose malabsorbtion 2 weeks ago, after 3 months of pulling my hair out. However all my symptoms do not align with frucmal as i respond badly to all carbs not just fructose. This has led me to believe that i may be suffering from SIBO not frucmal. Can SIBO be treated or at least partially treated with Anti-biotics? I know dietary changes are required as well but anything to help kick start the process would be really helpful. I’m struggling to eat anything other than protein and leaves.

Yes, and many people benefit from doing a course of non-absorbable antibiotics (rifaximin is the most common, but some doctors will give cocktails) along with diet changes and probiotic foods. You’ll want to do another breath test for SIBO first (instead of fructose, you drink glucose or lactulose).

Hi Sarah, i completed a round a H2 and methane breath tests. Unfortunately the results were not conclusive for anything. I have sent you an email with a copy, hopefully you have some time to pass an experienced eye over them.

Hi Sarah, I am a dedicated follower of your site and have also been doing the autoimmune diet and it just about helped in all areas I was having problems with.I have undiagnosed celiacs only because I went gluten free before confirming.To make a long story short after starting the autoimmune protocol I found that pretty much the only foods that I could eat were on the autoimmune protocol.Every food I tried to add in except for a select few didnt work out which led me to conclude that I must also have leaky gut.The problem Im having now is after trying to add a few foods in my stomache went off the chain. I began having chronic unrelenting acid and pain in my upper stomache. I realized I needed to perhaps incorporate a bit of SCD or GAPS as well and started over with an intro diet to help heal my lining. Ive done it all right, but for the past eight days its been the same. I will get acid from even chicken broth.I thought one of my organs was messed up and even went to the hospital but they found nothing and sent me home with acid reducers as expected. I know they are no good so out of desperation I got betaine hcl to see if maybe my acid was too low but I can barely handle it and the also got something called mastic gum for the acid.

The mastic gum really works for the GERD but some say it isnt good to take if you think you have sibo. Others say it works for cases of perpetual GERD, but I also think it can kill good bacteria which concerns me. Anyways, I dont know whats wrong with me but it seems that docs cannot help me in this.In your opinion, if I had SIBO, if you are familiar with mastic gum, is it is safe for me to be taking it and have you ever heard of this happening to anyone even after starting a GAPS diet?Thanks so much, any insight you have to offer I will greatly appreciate!

I’m not very familiar with mastic gum, but other gums are gut irritants, so I would be cautious. If HCl isn’t working for you, you could try digestive enzymes (pancreatic enzymes, also could add ox bile) to see if that improves digestion. Some of the best things you can do are increase long chain omega-3 fats (seafood), eat vegetables (take plant enzymes which is a type of digestive enzyme if they are upsetting your digestion, or stick with cooked veggies), limit fructose (keep under 20g of fructose per day which is 2-5 servings of fruit depending on the fruit), and get tons and tons of sleep. Going too low carb, a la SCD/GAPS, can cause undergrowths (after overgrowth dies back, you don’t have enough starch to support normal gut bacteria) and can be very hard on the thyroid. I usually recommend a SCD/GAPS style approach for only about 2-3 weeks. Vitamin A is super important for healing the lining of the gut, and it’s best to get this from animal sources (so your body doesn’t have to convert it before it’s useable), which means liver and other organ meats, and fat from seafood and pasture-raised animals. A collagen supplement (I like Great Lakes brand) might be soothing too. And, I know I already said it, but sleep as much as you can.

Thanks so much for the reply. You know I never thought about that. If a diet starves off the bad bacteria it makes sense that it might do the same to the good as well if we stay on it too long.I have actually found myself feeling the effects of a very low carb diet a bit already and had to restrain myself from breaking into the honey jar a couple of times. I think max three weeks on this diet might be wise for me.

I have do have a promising update however, I had the idea of trying lemon juice because I remember it working very well for my acid reflux and digestion in the past and it has seemed to almost miraculously end my symptoms. I now really think that some of my problems must be due to low stomache acid and then of course very possibly sibo.Maybe for now the betaine hcl was just a bit too much for me. I will definately try those others you suggested and start eating more seafood and getting more sleep. I so agree,sleep is sooo important for me ( and of course for everyone but for autoimmune conditions, it is so vital). I find that my digestion is 1000 times better when I sleep well and total crap when I dont.Do you think I could incorporate sweet potatoes back in after a few weeks or continue leaving them out? I never noticed a problem with my digestion with those so I was just wondering.

I definitely think adding sweet potatoes back in in the near future is worthwhile trying. They are pretty high in soluble fiber, so you might want to try some other dense carbs first (my favorite is green plantain, since its so high in magnesium).

I’m so glad you said that, hha.I also love plantains. While I’m doing whatever it takes to heal, eating the same foods and having chicken soup for breakfast is getting just a little tiresome.I am feeling much better now though so I really shouldn’t complain.Now I just need to stay the course. As I said, your blogs have been extremely helpful in not only helping me to learn to heal myself, but in explaining why something does or does not work which has been so important (especially when explaining things to my family who at times have probably thought I was nuts). I don’t know what many of us would do if we only had standard western medicine to treat us, because it seems on these types of issues that they have fallen a bit behind on the research or something so thanks again for the great work, it is very much appreciated!

Hi Sarah, I just have one more quick question for you that I forgot to ask. I have noticed that I am not properly digesting fat at all. I wont get into how I know but you can imagine,lol. Im going to have a biopsy of my intestines but my question is does this mean I should increase my fat intake, reduce it or do you think once I find the right supplement to help with my acid levels this might go away?

So happy to stumble upon you! I was diag. with SIBO and eating Low FODMAP (not so much during the holidays!). At the same time I was told I have IBS-C and have been taking Amitiza to keep me regular. I would prefer not to take anything but slow transit is my name.
Going low FODMAP was a night and day difference, I cannot even explain 🙂

Thank you for all of your work!!

Eating lowcarb/lowFODMAPs/paleo for 2 years for weight loss and IBS. Lost weight and symptom free unless I eat out of home. ( Onions/garlic impossible to avoid out of home). Including bone broth and fermented foods to heal gut and improve SIBO/dysbiosis?? Weight creeping up again. Question..dont know whether to go the intermittant fasting/ketosis approach or whether I am too low carb and need resistant starch etc to feed my bacteria/help gut mucous production. Any thoughts? My current knowledge has me confused!

Well, a stool test would give you some guidance, but it’s my general feeling that you’re more likely dealing with undergrowth than overgrowth at this point (or undergrowth of beneficial organisms while still dealing with overgrowth of the wrong kinds of bacteria). Also, being low carb can be very tough on the thyroid, so if you’re also stressed or not getting enough sleep, that could explain the weight gain (as could leptin resistance). My general recommendation would be to increase non-starchy vegetables for the insoluble fiber as much as you can, while slowly increasing starchy vegetables for starch/carbs and soluble fiber (if you’re leptin resistant from being low carb for so long, you’ll minimize reflexive weight gain by going slow). You could also add foods like greenish bananas for the resistant starch.

Actually did get stool test and you are correct. No e.coli, lactobacillus or bifidobacteria. Trying to recolonise them and slowly increasing starchy veg and resistant starch. Also hac thyroidectomy few years ago.

I have transitioned just recently for about two months now to a paleo diet. I did so after being done with being a vegetarian after noticing odd times of extreme vomiting after eating meals consisting of beans and grains. Since doing so, I no longer ever feel nausea like I did before. I have been dealing with digesting issues for a long time now (blood in stool, which still occurs sometimes), also I used to have MAJOR stomach pains and bloating, left side of my lower stomach and I’ve had heartburn as well (all of these issues besides the occurrence of blood in stool still occurs). I have mucus in my stool, not every time but pretty frequently. I’m not sure why, I still deal with a mix of constipation and loose stools. Any type of dairy makes me extremely gassy (with the exception of ghee). I noticed that fruit high in fructose doesn’t agree with me and also bananas make me run to the bathroom after consuming them. I can tell that nuts and seeds irritate me for sure but I never stopped eating them. I used to consume sweet potatoes as a carb dense source until I noticed after eating them in large quantities I would bloat like crazy and immediately want to sleep. Any low-sugar energy sources I can eat? Are carrots lower in sugar than beets? Should I avoid fruit?
I have also been dealing with a hormonal imbalance for quite sometime now. I still have hormonal acne, which is WAY better than it was when I ate loads of problematic foods. I haven’t had my period for a long time now.
Hoping you might know why I’m having these issues,

Sorry, I mean’t to say that I ONLY still have blood in stool, not nearly as bad as before I went paleo and mucus occurs pretty frequently in stools. All of the pain I used to have doesn’t occur anymore.

Oh. That maybe helps a bit. Is it fresh blood or dark? (Dark usually means the bleeding is higher up and is typically indicative of more serious conditions). And no stomach pains at all now?

Okay, so I still want you to see a doctor. And to talk to a doctor about digestive support supplements (really really do this before taking them because some, like HCl, can be very dangerous if you have ulcers, which it sounds like is a distinct possibility). I would suggest low FODMAP for 2-3 weeks, then very slowly ramping up veggie intake (low, moderate and high FODMAP), which can help healing by feeding the right kinds of bacteria and reducing inflammation. But, you’ll want to do this slowly. Mix of cooked and raw if you can tolerate raw, otherwise stick with cooked at first. Carrots do have less sugar and less fructose than beets. Also, lots of seafood (helps control what kinds of bacteria like to grow, helps with healing) and organ meat and bone broth.

And really really talk to a doctor.

Have you talked to a doctor about the blood and mucus in your stool? That definitely seems investigation by a medical professional-worthy. It certainly sounds like you’re dealing with a damaged gut and FODMAP sensitivity, but I’m afraid it’s really hard for me to point you in the direction of “safe foods” without a diagnosis into what’s causing that bleeding and the severe stomach pain.

My daughter and I are in our fifth week of SCD. I have bought several cook books (including yours, of course) and, unfortunately, a large number of the recipes for baked goods include arrowroot starch in the ingredients. Is there anything I can substitute? I’m trying to be as faithful to SCD as possible in order to relieve my daughter’s IBS pain. So far, that hasn’t happened. Sorry to be so graphic, but the bowel issues have improved greatly; the pain persists. So, the arrowroot is a problem. Any suggestions?

Sorry to say this but so nice to know that im not suffering alone. ive been struggling with my guts since as long as I can remember. My diet has been up and down my entire life. Was diagnosed with candida years and years ago and cut the wheat and dairy then. From time to time i kind of forgot and would eat some or just got lazy.

I started paleo about 3 weeks ago as I have decided at a young age of 38 its time to start changing my eating instead of dieting one week, eating the next, diet pills a week after and so on.

im working out hard with crossfit 4 times a week and can feel my bodyshape changing and fitness increasing.

However, by 1pm everyday the bloating starts. by 3pm my left side hurts and when i massage my stomach hard i can feel gas bubbles shifting until it passes. but it doesnt stop. its there until i go to bed.

Might I add im newly married and its depressing to think he can hear my guts bubbling 🙁

I wake and it all starts again. Ive cut out the eggs, i eat lots of veggies, not much fruit as i know with candida its not good, i exercise regularly, consume organic coconut oil and yet its still there. I feel like its been a battle all my life and i try harder than anyone i know to be healthy. Its just so frustrating.

I used to take anti fungal tablets to kill of the candida overgrowth. Found that I was taking so many different supplements that i was just getting confused and spending alot of money. So i stopped everything.

Im getting desperate and do not want to stop paleo. Should I be taking some kind of probiotic? maybe the antifungals again???

I once read eat right for your blood type. Im A+ which says I shouldnt be eating meat. I think my head may explode.

Oh, i had some tests done too and was told im intolerant to wheat, dairy, carrots, eggs yolks, sesame seeds, bananas, tomatoes and cucumbers.

Its all becoming a big bore!!!

Any advise greatly received

Yours going crazy, Kelly

ps, sorry i have thrown so many things in there. kept thinking of more to say 🙂

im sorry. i forgot to mention. i live in the middle east (bahrain) so find some things that might help are not as easy to get here

Are you familiar with the Auto Immune Protocol? All posts related to the AIP are here: Sarah’s book, The Paleo Approach mayalso be of interest to you. You can read about the book here: You can read excerpts from the book here: Sarah is not a medical professional, so she cannot give medical advice. For further medical guidance, Sarah recommends both and as excellent directories for finding qualified health professionals in your area (and many of which can work with patients long distance). You may also want to join our new The Paleo Approach Community group on Facebook and ask for support there. The group has over 4,000 members, you can request to join here: —- Tamar, Sarah’s assistant

I just hear you on Balanced Bites talking about FODMAPS. I seem to have issues, but calming down w/ avoidance and I can sort of get away w/ some things if careful. I really need FODMAPS veggies, as I also have thyroid issues that I don’t know how to proceed with, but I’m at least trying to avoid goitregens. I am also very low carb to deal w/ my type I diabetes. When I eat too many starchy carbs my BG soars. I already take HCL to deal w/ digestion. Should I use an enzyme as well? What brand would you reccommend?
I’ve had Chronic Fatigue for over a decade. HELP!!!
Can’t wait to get your book when I have more cash and not so overwhelmed w/ other stuff to read. I should probably give up nuts and eggs for awhile, but super overwhelmed! Also nightshade sensitive.
All of my antibody tests come back negative. I think that somethings going right. I work my tail off to stay healthy, but cannot currently work more than 7 hrs/a week.
Thanks For Your Work!!

You can read why thyroid patients don’t need to avoid goitrogens here: You may also want to consider the full autoimmune protocol: You can read about Sarah’s digestive enzyme recommendations here: – Christina, Sarah’s assistant

I am so grateful to have discovered you! I have suffered for YEARS with bloating, RA symptoms (although I don’t have RA), brain fog (the worst), moodiness, etc. About two months ago I saw a ND and she quickly figured out what I had, SIBO. Cutting out all sugars has been helpful (I had a very clean diet prior to diagnosis). I had a week or two that I had clear thinking and lots of energy. Currently I am having brain fog again, moodiness and I am so sleepy. I just ordered your book and I am looking forward to the release of your cookbook this August. I look forward to meeting you at your book signing in Corte Madera, CA.

I found that apple cider vinegar helps A LOT after I’ve “cheated” and eaten polysaccharides, leading to gas and/or constipation. At least 2 table-spoons of it in a glass of water, and down with it. Most people put a teaspoon of honey in there, but I do that only when my blood sugar is already too low. AFAIK it works by stagnating the growth of overgrown bacteria (or killing some, I guess), and letting the foam that’s the root of the bloating collapse.

I suspect SIBO. I did a breath test and still waiting for the result… Already 1,5month on the AIP diet. Is it ok to do oilpulling or better not (with coconut oil)? I did it yesterday and the day before (first time) and since yesterday I feel even more tired and have a headache. Should I continue or better stop?
Thanks a lot!

I have the gut bacteria treated with probiotic and AIP but still feel real weak after 7 weeks the Dr, is still doing tests I guess it takes along time I lost 23 lbs which I could not loose for years .I do exercise T-Tap great for getting rid of toxins and detox baths.Thank you for all the great info my husband says I,m indefagagble or something lie that means nothing can stop me no matter how hard it is.Any article on vertigo and dyslexia?

Sarah hasn’t written about vertigo or dyslexia, but they can certainly be associated with AID and the attendant food intolerance, hormone imbalances, or dysbiosis. Healing does take time, especially if you have been diagnosed with SIBO. Sarah recommends a low-FODMAP diet in addition to the AIP to best address that. – Christina, Sarah’s assistant

Would this elimination diet be appropriate for small children (1 to 9 years old) if SIBO is suspected but not confirmed? Two of my six children have confirmed Celiac disease and two more had a positive genetic screen for Celiac genes (along with my self and my husband). My two youngest (the only ones in our family that had a negative genetic screen) have digestive issues though such as constant abnormal stool and my baby also has eczema. My celiac kids seem to be doing well, although my celiac son struggles with impulse/anger control occasionally and my celiac daughter belches repeatedly any time she eats. My two oldest had a positive genetic screen for celiac, but were negative for the celiac disease antibody blood test (my oldest also had an upper endoscopy that was negative to further rule out Celiac because he was anemic despite eating a pretty balanced diet). I’m having ongoing health issues as well, primarily digestive, mood, hormonal, and energy related (and have been struggling with these since I was very young). We’re already mostly doing the Autoimmune Protocol (I have been allowing minimal sunflower and pumpkin seeds) but I’m really struggling with knowing if we should be eating starches and certain fruits. I have an appointment for my youngest with our pediatric GI to discuss testing for SIBO, etc. If it’s not a good idea to apply this plan to young children, could you point me in the right direction of some good recommendations for young children? If their is someone in the Paleo Mom Consulting group that could help with our group of mixed ages, please let me know (if I go that route I hope to find one person who can help me with my kids and myself).

We got our celiac diagnoses almost 4 years ago and have been strictly gluten free since then and slowly moved away from processed gluten free food to grain free with dairy and rice to total Paleo and now to the AIP (we were paleo without dairy, eggs, or nightshades for the past few months and just last week eliminated nuts and cocoa). My children are thriving overall but over these past four years, in addition to the issues I mentioned above, all the kids have dry, rashy skin on arms and legs (my youngest has eczema) and all are pale and lethargic (they need to spend more time outside but complain they’re too tired). I don’t know if I’m being paranoid because of the known autoimmune disease in our family or if all this adds up to being signs that I should being doing more to improve our health.

Any ideas of what direction I should go in would be appreciated.

The AIP and a low-FODMAP diet should be fine for all ages, provided they are eating a wide variety of the allowed foods. Sarah does not recommend starting a low-FODMAP diet unless SIBO has been confirmed. For help troubleshooting problems that linger on the AIP, you could refer to the troubleshooting guide in The Paleo Approach or might consider talking to any one of ThePaleoMom Consultants (any one of whom is qualified to address your concerns about your children). – Christina, Sarah’s assistant

Here is what Sarah had to say about resistant starch in an earlier comment: “I think the research is still very preliminary on resistant starch itself. It binds bile salts and cholesterol similarly to soluble fiber, so I think supplementing with large amounts could potentially lead to the same problems as supplementing with soluble fibers (discussed in my Fiber Manifesto series). There’s some interesting anti-inflammatory effects, but no one has looked at this head-to-head with other fiber types and all fiber is anti-inflammatory. It’s been shown to provide no benefit to cancer risk (whereas other fiber types have) but does benefit in IBD (both soluble and insoluble do too). I think that the research showing insoluble fiber in general is very important (resistant starch is a type of insoluble fiber) and an essential corrective influence on the gut microbiome is very convincing. I just feel uncomfortable will all fiber supplements… as soon as you isolate one type of fiber, you preferentially feed certain types of bacteria. I think that especially when you’re talking about supplements geared at the microbiome, eating real whole foods is the safest strategy.” – Christina, Sarah’s assistant

I’m confused. I have been on SCD a long time– maybe two years, though I never really was able to do the intro portion. My diet has been very dependent on nuts (for a long time I used a lot of roasted but not soaked/sprouted nut butter– I have laid off that for the last 3 months or so) and eggs and I have continued to have problems with gas, diarrhea, constipation and moderate acne. I have started to think that maybe I need to try AIP, but it doesn’t seem possible without plantains, which are not SCD legal. I seem to tolerate the plantains with no problem (though I get symptoms if I eat potatoes or sweet potatoes, or any grain, even rice). (I just had some of your plantain pancakes, btw, which were delicious!) Do you think I should go back and do the SCD intro for real or try AIP and forget about some of the SCD prohibitions, like green plantains?

Sarah does not recommend combining diets unless medically necessary. The AIP is an excellent place to start to try troubleshooting some of those lingering problems. – Christina, Sarah’s assistant

I suspect that I may have SIBO for many of the reasons Sarah mentions – digestive/mood/energy level issues after having done Paleo for several years, plus a worsening of these issues when I eat sugars. I’m considering doing a coconut/MCT oil-only cleanse for a week to see what the effects will be. Does Sarah recommend this and are there any risks I should be aware of?

Sarah recommends speaking to your healthcare practitioner to actually diagnose SIBO before adopting any dietary/lifestyle changes to treat it. If you are diagnosed with SIBO, she recommends a low-FODMAP, low-inulin diet with plenty of coconut oil. – Christina, Sarah’s assistant

There’s some disagreement on this, but most experts would say you need to clear the SIBO (verified by retesting) BEFORE introducing probiotics, otherwise it can worsen the condition. I was diagnosed with a bad case of SIBO and every probiotic I’ve tried has made me worse. I’m getting ready to retest shortly.

Hello I suspect I have SIBO. I have been doing AIP for 6 months and still have extreme bloating. Can you tell me where I might be able to get tested for SIBO? Where can I get a breath test? GP or Gastro? Thanks!

SIBO uses a breath test, requires a referral, and found avail in many medical centers. Most referrals come from GI MDs but I have heard of primary care docs referring as well. Hope this is useful.

I’m glad to see that I’m not the only one bothered by sweet potatoes. The reaction/pain is fairly new to me, but I have narrowed it down to those yummy spuds. The latest reaction is the worst, off work, pain and nausea, and I ate them over 18 hours ago. I do have low thyroid, so perhaps there is more to this, I’m slowly learning!

I am diagnosed SIBO – does Sarah recommend low FODMAP as the diet of choice to treat? Or SCD, GAPS, auto-immune etc.?

Currently on low FODMAPS but am finding I also react to nightshades 🙁

This chart Avoid and Okay is in direct contrast to AIP Low-FODMAPS diet by Christina Feindel.

She says parsnips are Low-FODMAP and okay. Beets, butternut squash, avocados not okay. I have been following her diet for AIP IBS/FODMAPS. And I know personally avocados and beets are horrible IBS trigger foods. Many IBS-ers are suspected of having SIBO.

With all the conflicting charts out there, there is no way to know what to eat and not. It is frustrating to the max. I have many food sensitivities, gluten/dairy/soy free, and trying to avoid IBS/SIBO foods. There is very little left to eat when you take out IBS foods and oral antibody foods like me (no carrots, green beans, nuts, many fruits and veggies). I wish there was a doctor that had a definitive SIBO/IBS chart!

Hi Mary! Christina Feindel here! The reason for the conflicting information is that as new research comes out, sometimes we have to revise our food lists. This particular post is from 2012, so both The Paleo Approach (2014) and my Low-FODMAP e-book (also 2014) contain more recent information. The best source for up-to-date FODMAP lists is Monash University. They have an app available in iTunes that has complete FODMAP lists. – Christina, Sarah’s assistant

Yes i know exactly what you mean. I have the same thing. it’s contradictive and not helpful at all. It gets confusing and i am really not in the position to start buying all these books.. I guess we just need to figure it out ourselfs.

Hi I have recently been diagnosed having SIBO by my functional medicine doctor. I have battled major depression/anxiety and chronic sinusitis for about 16 years now so prob have been having this for a very long time. The doctor has me on a very strict diet along with having me do a round of serious antibiotics, gentamicin, rifaxamin, then a week of berbemycin, and now a month of nystatin. I am on loads of supplements to restore my gut as well from designs for health. This info from you all had been very helpful and would like to know if what I am doing is ok bc I am very concerned with the conflicting info out there as well. The doctor also has me on 2 different forms of intense powder probiotics each having a lot of different strains of bacteria and both having about 225 billion in them. Please let me know if this is going to possibly make things worse or if it is ok since I have done so many antibiotics over the past month or so. I only have a few days left on the nystatin and then we are going to do another breath test to check results. Thanks in advance! Shelly

If I had SIBO when I was pregnant can I pass that (or other gut problems) to the baby? At 4 months old he has a dairy & soy allergy (I nurse and have cut those foods out) but still suffers from gas. My SIBO symptoms are coming back again when I eat carby things now. So I’m wondering if I can alter my diet or SIBO and will that give us both relief ya think?

It has been almost 4 years since this article was written. During that time, have you experienced more healing and been able to tolerate fruit, sweet potatoes, or paleo baking any better?

Thank you for this article. I too have flare ups with my Sibo symptoms when I eat certain foods, even though I follow a paleo diet. Sugar is a huge trigger, but I didn’t understand the sweet potato problem until this explanation. It helps me feel less crazy. Another trigger is poultry, does anyone find this an issue with Sibo?

Have you tried Hydrozyme? I am able to eat chicken if I have several of these tablets. As you generally have low stomach acid if you have SIBO it’s hard to break down something like chicken. I have no problems with it now. For years I was told I had reflux or too much acid when in fact it was not enough. These tablets have helped enormously.

When you say poultry, do you mean poultry in general, no matter how it’s prepared? I find I can’t have bone broth as it makes my SIBO symptoms unbearable – chicken broth seems to be the worst and it contributes to severe bloating, cramping and nausea. Through my research I’ve discovered bone broth has a high histamine content and as a result not everyone can tolerate it.

Histamine could be a problem with Chicken broth, bit the main issue for SIBO sufferers is cartlidge, which is everywhere in a chicken carcass. cartlidge contains glucosaminoglycans which are released during cooking. Glucosaminoglycan are a polysaccharide which feed SIBO. This in turn causes bloating. The answer is to either make chicken broth using just the meat (with no bones at all), or make a broth (stock) using beef or lamb bones, ensuring there are no knuckle joints and or no cartlidge.

Please let us know if you have experienced any healing. I know I, and I’m sure others, would like to know that there’s hope. Can you eat more foods now and how has your diet changed or are you on AIP forever? I’m Thanks!

Hi. I read the book called “The Paleo Cure” and it listed a couple of vegetables that are on your avoid list. Chris Kresser listed these for people who are suffering from gerd and digestive problems. So i am a little confused about this. You talk about sugars and he’s talking about Soluble and Insoluble fibers. I understand you have to avoid certain things if you want to heal a leaky gut, but that is very contradicting.
And it makes my list even shorter.. I can’t even get all these vegetables here and let’s not talk about grass-fed meat. Instead i need to buy everything on a budget and survive. They put me on a PPi for years and never looked back. Here i am with no way to stop without a lot of trouble but i’ll sure will try. As soon as i stop with the PPI i can’t eat nothing i thought, now i am trying only meat,fish, vegetables (on a budget) and maybe add some HCL with pepsin if it doesn’t work. So what should i do? Eat soluble or eat Monosaccharides? I read some articles saying to avoid fruits.


I was also offered PPIs from my doctor after having both a colonoscopy and endoscopy operation that both showed according to these tests my insides were perfectly healthy. I knew they weren’t so had a breath test which showed I have SIBO. I have changed my diet to eating smaller meals and the main sources of carbs I have found success with are bananas, dextrose and small amounts of brown rice as they contain insoluble fibre which to my understanding the bacteria feed on a lot less than soluble fibre. I am wary of fruits but have noticed my stomach has become less inflamed after having a portion of pineapple every day for 2 weeks as well as blueberries and grapes in small amounts. The vegetables I can stomach with little to no bloating are spinach, carrots, kale and green beans. I will gradually start introducing more foods but these have been working very well for me. I am also about to start a dual course of herbal antibiotics for 4 weeks that will hopefully kill off the bacteria for good. In case you’re interested the antibiotics are called Candibactin AR and Candibactin BR.

I’d love to see a post on Alan Ebringer’s work on IBS, klebsiella, and no- or low- starch diets.
I suspect, although I don’t know of any research that has looked at this, that low-carb diets are simply a way of eliminating starch and that their elimination of fruit (as a sort of form of collateral damage) is not helpful.

I love your posts, you really know your stuff, thanks for keeping the rest of the world up to date with such useful helpful information here.

One question, would Raw Organic Honey be suitable as it’s a mixed of Glucose/Fructose and no Sucrose?

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