Remission Cycle
Within 9 months of entering remission, up to 44% of SIBO patients experience a recurrence of their disease. Because of this, repeat rounds of treatment may be required. There are, however, methods available to best maintain remission and extend the time between recurrences if the underlying cause of SIBO cannot be remedied. These include Dietary Methods, Promotility Drugs and Lifestyle Changes.
Low Fermentation Eating (LFE)
Developed by SIBO and microbiome specialists, Dr. Mark Pimentel and Dr. Ali Rezaie, Low Fermentation Eating has two components: what you eat and when you eat it. When you have SIBO, your gut’s motility is impaired and you have an overgrowth of bacteria (SIBO) or archaea (IMO) in your bowel. In order to allow your body’s natural “housekeeping” waves (the Migrating Motor Complex) to move food effectively through your digestive system, it is necessary to leave time between eating as your MMC can only occur during periods of fasting. This is why snacking can be so adverse for SIBO patients. LFE recommends 4-5 hours between meals and 8 hours fasting overnight to allow your MMC to do its job.
As for foods, LFE was developed to be a less restrictive approach than Low FODMAP while still being mindful of foods that lead to excess fermentation in your microbiome. Overall, it is based on restricting foods that are difficult to digest and therefore become a food source for “disruptor” bacteria in your small intestine. These foods include milk and dairy products, high fiber foods, food high in inulin and non absorbable (typically artificial) sugars such as sorbitol, stevia, monk fruit. For a comprehensive list visit www.GoodLFE.com and download the food list.
Low Fermentation Eating is a long term and nutritionally stable option for SIBO patients looking for a dietary method of maintaining remission.
Low FODMAP Diet
Developed by Monash University, the low FODMAP diet is a popular but restrictive diet for the management of various gastrointestinal disorders. It focuses on limiting the intake of a specific class of carbohydrates: Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs). FODMAPS include soluble fiber, lactose, fructose, and sugar alcohols, which are all common GI irritants. Temporary restriction of these carbohydrates has been reported to provide relief in IBS symptoms. The Low FODMAP diet is somewhat complex however there are multiple apps available to help you determine if your food has FODMAPS and some packaged foods are certified as Low FODMAP which can remove the guesswork. The low FODMAP diet can be a useful tool for short term maintenance however it is not nutritionally stable beyond the intended 6 weeks, and is therefore not a viable long term solution for maintaining SIBO remission. Learn more at Monash FODMAP
Promotility Drugs
Promotility drugs, such as prokinetics, may be prescribed to help maintain remission. By aiding in keeping the gut’s cleaning waves regular, prokinetics aid in the clearance of excess bacteria and as such can be particularly useful when your motility is impaired. There are no clinical studies of their use in SIBO specifically. We recommend speaking with your healthcare provider about the potential benefits of adding promotility drugs into your maintenance regimen.
Lifestyle: Exercise & Hydration
Stay Hydrated
Hydration plays a key role in promoting healthy gut motility through many mechanisms. Water is needed for digestion, as it acts as lubricant and keeps the walls of the digestive tract smooth and flexible. Water also helps to flush waste from the body, soften stool and aids in the balance of the gut microbiome.
Get Moving
Unsurprisingly exercise promotes a host of benefits not just for overall health but also for gut motility. Regular physical activity, particularly moderate-intensity, can stimulate muscles in the digestive tract, creating stronger contractions that move food along the digestive tract. Exercise can also help reduce stress which is a known trigger for many GI issues.