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THE IBS DIETITIAN

Kirsten Jackson Consultant BSc Hons PG Cert RD

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The Low Fermentation Diet for SIBO

by Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert 7 Comments

The Cedars Sinai Diet, also know as The Low Fermentation Diet, was originally developed by Dr Mark Pimentel of Cedars Sinai Hospital in LA. The diet used to manage symptoms of small intestinal bacterial overgrowth (SIBO).

In this article I am going to outline the low fermentation diet and how it works to reduce SIBO symptoms. I am also going to give you my opinion and explain what I advise clients with SIBO.

low fermentation diet

What is SIBO?

SIBO stands for small intestinal bacterial overgrowth and occurs when an individual has a higher than normal level of bacteria living in the small intestine.

You can find out more about SIBO in my other article here.

What is the low fermentation diet?

The low fermentation diet has been designed to reduce symptoms of SIBO through changes in meal timings and avoidance of fermentable foods.

Foods which are low in fermentable carbohydrates are easy for our gut to digest and do not create excess gas. In contrast, when we eat ‘fermentable carbohydrates,’ bacteria breaks them down in a process known as fermentation, producing excess gas.

Below are some examples of foods allowed and should be avoided on the diet (1).

Foods allowed on the low fermentation diet

  • Sweet potato
  • Rice
  • Regular potatoes
  • Healthy fats
  • Animal proteins
  • Most fruits
  • Some vegetables
  • Protein powders (including vegan proteins)

Foods not allowed on the low fermentation diet;

  • Beans and pulses
  • Oats
  • Some dairy
  • Gums
  • High FODMAP sweeteners
  • Fiber supplements 

Meal Patterns on the low fermentation diet

On the diet, it is advised that you at least a 4 hour gap between each time you eat and that you should not eat close to bedtime (1).

This is because the gut has a ‘cleaning process’ called the migrating motor complex or MMC. The is a type of nervous system reaction that sweeps your gut every so often to clean it out but it does not work if you are eating.

You can read more about the MMC is my article on fasting and gut health.

In theory, if you are a snacker and eat every hour of the day, this process does not work and could lead to or worsen bacterial overgrowth.

The MMC is said to more active at night, hence the no eating before bed time rule.

The research on the low fermentation diet

There is no research on this specific diet protocol yet but the elements of the diet are theories based on other areas of similar research.

The Dietitian Verdict

Some of the principles around the diet, such as avoiding fermentable carbohydrates and snacking are likely beneficial to those trying to manage SIBO symptoms.

We know from studies in IBS that an intake of fermentable carbohydrates increases hydrogen gas production in the gut (2).

The 4 hour gap between eating could also be beneficial to allow the gut to ‘clear’ itself. BUT I wouldn’t be so strict with this as the time we fast overnight could be adequate alone for this function, we just don’t know yet.

So, if someone was struggling with this element, it would not be my primary focus. BUT, if you are able to have 4 hours gaps between your meals without causing any real problems then why not try it would be my advice.

The concerns I would have with this is diet are the following;

  1. There is no research to suggest this protocol is useful in SIBO. 
  2. There is no specific time suggested for the diet. When we know that SIBO can be caused by poor gut health it would be detrimental to suggest that someone should avoid fermentable carbohydrates (which are also prebiotic foods) for long-periods of time.
  3. Some of the ‘allowed foods’ contain high levels of fermentable carbohydrates such as vegan protein powders, sweet potato and mushrooms.
  4. It is a very restrictive diet and could cause nutritional deficiencies longer-term.
  5. It doesn’t address bowel function or gut health which are both issues that can cause SIBO.

Overall, this diet does have some good elements to it but I would advise anyone reading this that they only do this diet alongside a dietitian to prevent damage to their gut health.

Summary

The low fermentation diet is often recommended to manage SIBO symptoms but has not been researched before. The diet is also restrictive and information appears to be contradictory at times which may leave you confused and at risk of nutritional deficiencies.

I recommend that if you are diagnosed with SIBO that you should work with a GI doctor and dietitian team to have a more tailored approach for your symptoms. This tailored approach would look at reducing your SIBO symptoms and improving your gut health to help avoid repeated SIBO issues.

Filed Under: SIBO Tagged With: how to treat SIBO, low fermentation diet

About Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

Previous Post: « Stress, Anxiety, Depression and IBS: Managing Mental Health to Help IBS
Next Post: 35 Vegan Low FODMAP Recipes »

Reader Interactions

Comments

  1. em says

    at

    Ts a very good summary on basics of Sibo Low Fermentation Diet. I have had GI issues for several years with what i call ” The GI Unknown Zone” quick diagnosis w typical offers of invasive endoscopy or colonoscopy offered in my opinion way too often If we are in fact “we are what we eat” i would think the best approach would be start w diet and general blood work w general gastro history( like bowel movement types) move from there before patient get procedures which many times leaves them still w little to no problem resolution. Here’s to the Dieticians feeding the humans and the billions of critters inside w consideration to all membersl :).

    Reply
    • Kirsten Jackson Specialist Dietitian says

      at

      Thank you Em! We could not agree more! There are many unnecessary invasive tests going on and mostly any requirement for further testing would be shown in first line blood markers. We hope to raise awareness of this going forward. Thank you!

      Reply
  2. gretchen says

    at

    I’m confused. If I am vegan but eat fish 3 times a week, can I eat tofu or tempeh while on the Cedars-Sinai Low Fermentable Diet? Cedars Sinai Low Fermentation diet does not say, it just says no beans or legumes, but FODMAPs, that also excludes beans says tofu and tempeh or ok. Cedars Sinai Low Ferm diet works better for me than fodmaps, so could i include tofu and tempeh for protien?

    Reply
    • Kirsten Jackson Specialist Dietitian says

      at

      Hi Gretchen, the cedars-sinai diet does not outline if this is allowed or not. However, we advise a low FODMAP diet and some forms of soy are allowed. You can find out more info on this here: Is Soy Low or High FODMAP?

      Reply
  3. Pamela szczesniak says

    at

    I have SIBO methan. I also have colitis which causes diarrhea sibi am never constipated. It states not to use fiber but i must. Why no fiber, fermantation?
    ..

    Reply
    • Serena Bansal says

      at

      Hi Pamela! I am afraid we cannot give personalised advice without further assessment. If you would like help with this, please do not hesitate to email us on admin@thefoodtreatmentclinic.com.

      Reply
  4. Pat Armstrong says

    at

    I love your write up on the low fermentation diet and agree totally with your comments on concerns surrounding the diet. I have just cleared both hydrogen and methane sibo which led me to your page, looking for further info on low fermentation diet, this being paramount to prevent relapse. The diet suggested is very unhealthy and yes, mustn’t be followed very long, however, Dr Mark Pimentel suggests 3 months, this being the highest window for relapse. I just wish there was more information right now when I need it the most.

    Reply

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👉So you tried the low fodmap diet with the hopes and promises that it would fix your IBS. You stuck with the relentless restrictive diet for what felt like weeks…but yet achieved no results 😞 Leaving you feeling hopeless and defeated. 
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👉 but I’m here to tell you that the low FODMAP diet doesn’t work for everyone and thats OKAY! There are other options that we use for individuals who follow the Take Control Programme. There is hope so please hold on in there 🙏🏻.
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HAVE YOU HEARD SOMETHING LIKE THIS BEFORE? 🥺​ HAVE YOU HEARD SOMETHING LIKE THIS BEFORE? 🥺​​​​​​​​
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☹️ IBS is often belittled as a condition that 'isn't that bad'. by friends, by family and even by healthcare professionals. It leaves you feeling frustrated but also second guessing your own pain and struggles... ​​​​​​​​
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💪I am here to tell you that you have every right to advocate for your own health - if you won't, no one else will. Surrounding yourself with people who understand what you're going through, and defying those who belittle it is key. Social support is a key element of my Take Control Programme.​​​​​​​​
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Have you been impacted by this? 😔 ❤️​​​​​​​​
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😞As I’m sure lots of you can relate, IBS has a close link with our mental health, including the link between IBS and depression. Poor mental health can lead to worsening of our symptoms, and our IBS symptoms can lead to worse mental health…it’s a vicious circle 😥. ​​​​​​​​
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🙏🏻 the good news is there are multiple ways to help manage your mental health. Adopt the Take Control Approach and prioritise your mental health. Not tomorrow, not next week but now as it is a core element to IBS management ❤️. ​​​​​​​​
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🥵We all know exercise is good for us, but the thought of intensive HIIT workouts doesn't exactly appeal to all of us...in fact intense exercise can actually contribute to IBS symptoms for some.​​​​​​​​​​​​​​​​
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🤔But what if it didn't have to be so complicated? Instead of seeing movement as a scary and intense activity, why not try walking? - this counts as movement and has so many fabulous benefits for IBS as listed above  Movement is one of the KEY pillars of IBS management that we tackle in my Take Control Programme.​​​​​​​​​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS with guidance? Book a 15 minute enquiry call with me or my colleague (link in bio). 🤩 
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🤔 Have you ever tried to eat intuitively? ​​​​​​​​
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🤝 Myself and @wholistic_health_and_wellness have teamed up to look at how intuitive eating could help you with your IBS. Because there is such a strong relationship between IBS and disordered eating behaviors, it’s important to look at our relationship with food when working to reduce IBS symptoms.​​​​​​​​
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🥰Learning to eat intuitively is a great way to improve your relationship with food, remove guilt and stress from the eating experience, reconnect with hunger and fullness cues, and find the foods that work best with your body!​​​​​​​​
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DO YOU DO ANY OF THESE? 😔 ​​​​​​​ DO YOU DO ANY OF THESE? 😔 ​​​​​​​​
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👉 In IBS, there are a lot of subtle behaviour changes that we make in order to hide our struggle 😕. We are scared if the judgement and we are scared of being singled out 😭. ​​​​​​​​
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👉 Instead of making behaviour changes to mask your symptoms, why not try making small changes to reduce your symptoms? In the Take Control Method we encourage individuals to be open about their problems, instead of hiding them from others so that they can receive the the support they need to put these changes in place ❤️. ​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS with guidance? Book a 15 minute enquiry call with me or my colleague (link in bio). 🤩 ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
WHICH ONE ARE YOU? Comment below!​​​​​​​​​​​​​​​​
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👉I will say it time and time again... IBS is SO individualised and personal. No 2 clients ever look the same. This is why generic IBS advice often does not lead to the results that you are hoping for. Taking a random probiotic, eating more fibre or even trying the low FODMAP diet (without professional help) can leave many IBS sufferers no nearer to symptom relief than they were...​​​​​​​​​​​​​​​​
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🤩This is why working with an expert in the field of IBS is so crucial in order to get that specific advice that you need to achieve your symptom relief - we value that everyone is different and it is not a one size fits all world❤️.​​​​​​​​​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS? Book a FREE 15 minute discovery call with me or my colleagues. 🤩​​​​​​​​
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Do you suffer with any of these other symptoms? CO Do you suffer with any of these other symptoms? COMMENT BELOW.
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🤦‍♀️Your 'IBS' may actually be a histamine intolerance as some symptoms are similar. Additional symptoms include headaches, itchy skin and sinus problems - symptoms vary though.
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🤦‍♀️A histamine intolerance is caused by a lack of the enzymes which would normally break histamine down. Leading to an overload of histamine in the body.
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🤦‍♀️Histamines are found naturally occurring in certain foods and how a food is processed can impact the histamine quantity.
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🤦‍♀️This intolerance is diagnosed by symptoms improving whilst avoiding histamines and these symptoms then come back with the reintroduction of histamines (to confirm). Please note though that you should always visit your doctor first to rule out other conditions that can also cause these symptoms.
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🤔Having a histamine intolerance is not like having an allergy. You will have a certain tolerance level and it is important to work this out in order to avoid an overly restrictive diet. 
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🤩We cover histamine intolerances in my NEW histamine intolerance E-Book! 
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #mumlife #dubaimom #constipation #chronicpain #chronicallyunwell #women'shealth #histamine #foodchemicalintolerances
👇Do you get any symptoms of histamine intoleran 👇Do you get any symptoms of histamine intolerance? Comment below?​​​​​​​​
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🤓Histamine intolerance impacts 1-3% of the population (more than coeliac disease which you would have been tested for as part of your IBS diagnosis).​​​​​​​​
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🙃The symptoms of histamine intolerance do have some overlap. If you have IBS but have seen no relief with typical IBS treatments you may well have histamine intolerance.​​​​​​​​
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🎉Check out our new E-Book all about this condition, how to diagnose it and how to manage it (link in bio).​​​​​​​​
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#histamineintolerance #ibssymptoms #guthealthdiagnosis #histamineguide
🎉 Histamine Intolerance E Book - on sale now 🔗 link in bio.​​​​​​​​
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→58 pages​​​​​​​​
→Histamine intolerance diagnosis protocol​​​​​​​​
→Meal plan​​​​​​​​
→Recipes​​​​​​​​
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‼️ A step by step guide based on scientific facts to help people get accurately diagnosed with histamine intolerance.​​​​​​​​
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#histamineintolerance #ibs #guthealth #dietitians #refractoryibs #itchyskin #foodintoleranceguide
Anyone investing in this?🤷‍♀️ comment bel Anyone investing in this?🤷‍♀️ comment below 👇 ​​​​​​​​​​​​​​​​
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​​​​🤩🤩Fed up of being fed up with your IBS? Download my free top 10 IBS mistakes! - link in bio!​​​​​​​​​​​​​​​​
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#onions #elonmusk #ibs #ibsmemes
WHAT IS YOUR BINGO LOOKING LIKE? 😔 comment belo WHAT IS YOUR BINGO LOOKING LIKE? 😔 comment below 👇 ​​​​​​​​
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😥 IBS can be unpredictable in nature and it can feel like you never know if you’re going to have a good or bad day…You try to pinpoint a trigger but gosh is it hard 😫.​​​​​​​​
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😊 But what if you could predict the future? Identifying YOUR personal triggers and how to manage these is key to Taking Control of your IBS and is an integral part of the Take Control Programme. Why not try filling out a food and mood diary this week to see if you can pinpoint if what you eat and/or your feelings play a role? ​​​​​​​​
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🤩🤩Fed up of being fed up with your IBS? Download my free top 10 IBS mistakes! - link in bio!​​​​​​​​
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#ibs #ibsdiet #irritablebowelsyndrome #guthealth #guthealing #lowfodmap #lowfodmaprecipes #gutissues #healthygut
❤️As April is IBS awareness month, myself and ❤️As April is IBS awareness month, myself and @dieteticallyspeaking have teamed up to spread the word about the relationship between disordered eating and IBS.
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➡️Swipe for information about the overlap between these conditions and also how this relationship can go in either direction i.e. there’s s higher risk of gut issues with disordered eating or an eating disorder and a higher risk of disordered eating with IBS.
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🥰For more information go to @dieteticallyspeaking bio for a full article about this important topic! 
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#ibs #ibsawarenessmonth #guthealth #guthealing #disorderedeating #eating disorder
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