Low Sugar, Low Fiber Diet for

Symptomatic Small Bowel Bacterial Overgrowth

What is small bowel bacterial overgrowth (SBBO or SIBO for short)?

We all have bacteria in our intestines, but some people have too much. These
extra bacteria can cause problems. Good movement of food through the small
bowel helps avoid this problem, and so does having normal amounts of stomach
acid. People with slow bowel motility or who do not make enough gastric acid are at
risk for bacterial overgrowth.

What are the symptoms?

Symptoms can include gas, abdominal pain, distention, bloating, fullness, diarrhea,
nausea, or pain after eating foods that are high in sugars (like sodas, sweets and
desserts) or high in fiber (such as pinto beans, kidney beans, bran cereals, etc).

How does what I eat make my symptoms worse?

When there are too many bacteria high up in your intestine near your stomach,
they get “first dibs” on the food that you eat – instead of you! The bacteria use
your food for fuel, and they make gas in the process. This is what makes you
uncomfortable.

Foods that do not contain carbohydrates or fiber do not usually cause problems.
This includes meats (beef, pork, lamb, venison), poultry (chicken, turkey, duck),
fish and shellfish, eggs, hard cheeses, butter, and oils.

How to best use this diet:

Look over the list of foods below and cut out the foods and drinks you eat a lot of.
Start by at least cutting out concentrated sugars and sweets. If you feel a lot
better, that may be all you need to do. Then add back a small amount of one food
at a time if you want. You should wait 3 days before adding back a second food
again. If your symptoms come back, then that may be a food you need to just
avoid.

Additional Information:
Visit www.GInutrition.virginia.edu and go to link to Nutritional Articles. Find the
article: DiBaise JK. Small Intestinal Bacterial Overgrowth: Nutritional Consequences
and Patients at Risk. Practical Gastroenterology 2008;(12):15.

7-2019 CRP www.GInutrition.virginia.edu

KEEP EATING THESE FOODS: CUT OUT THESE FOODS:
Protein Foods (meat, fish, poultry)
 Beef, pork, lamb, chicken, turkey,  All allowed!
duck, fish, shellfish, eggs, milk
Plant protein foods
 Tofu, tempeh  Beans such as black, pinto, kidney,
 unsweetened peanut butter, refried, lima, lentils, etc.
unsweetened almond butter  Nuts and seeds in servings bigger
 Nuts and seeds (1 tablespoon or less than a tablespoon
per serving)  Sweetened peanut or nut butters like
Skippy®, Jif®, etc.
Grains
 Breads: sandwich, pita, rolls, biscuits,  Sweetened cornbread
naan, bagels, English muffins, corn  Bread with a sugar glaze
bread, tortillas, bread sticks  High fiber cereals (any that contain 2
 Starches:pasta, noodles, rice, stuffing or more grams of fiber per serving):
 Unsweetened breakfast cereals: All-Bran, oatmeal, granola, any whole
Cheerios, Corn Flakes, Total , Rice
® grain cereal
Crispies, Chex , Special K , Kix
® ® ®  Cereals with dried fruits, coconut,
 Hot unsweetened cereals: oatmeal, nuts or seeds
Cream of Wheat /farina, cream of
®  Sweetened oatmeal and hot cereal
rice, grits  Sweetened cereals and kids’ cereals
 Breakfast breads: pancakes and such as: Honey Nut Cheerios™, Cocoa
waffles (without syrup—both regular Puffs™, Frosted Flakes®, Fruit
and sugar free), plain, corn, and Loops™, and many others
English muffins, rice cakes  Bran, faro, barley, brown rice, wild
 Snack foods: crackers (saltines, club, rice, quinoa
soda, matzo), cheese nips, Goldfish®  Bran muffins, granola bars, fiber bars
crackers, potato chips
Fruits
 No more than ½ cup unsweetened  All dried or candied fruits (raisins,
applesauce or other canned fruit daily dates, Craisins®, figs, banana chips,
OR 1 small piece of fresh fruit daily. mango, pineapple, prunes, etc.)
 Talk to your Registered Dietitian  All fruit juices and fruit drinks
about whether you should cut fruit  Blended smoothies with fruit such as
out altogether when starting this diet. Odwalla®, Naked®, or freshly
prepared smoothies
 Canned fruit in its own juice or syrup
Vegetables
 Starchy vegetables (no more than ½  High fiber or sugar vegetables:
cup at a meal): white potato, artichokes, asparagus, beets,
butternut squash broccoli, Brussels sprouts, cabbage,
 Non-starchy vegetables (no more cauliflower, corn, fennel, garlic, green
than ½ cup at a meal): green beans, peppers, leeks, okra, onions, peas,
carrots, spinach, kale, greens, tomato shallots, sweet potato, tomato paste

2
 Dairy
 Plain milk,  Sweetened milk drinks: chocolate
 Plain yogurt, plain kefir milk, strawberry milk, Yoo-hoo®,
 Cottage cheese Ovaltine®
 Hard cheeses  Carnation Breakfast Essentials® or
 Soft cheeses store brand equivalent
 Hot cocoa
 Flavored yogurts, sweetened kefir
Beverages (nondairy)
 Water  All fruit juices and fruit drinks,
 Diet sodas including Kool-Aid®, Gatorade®
 Unsweetened tea or tea sweetened (including G2) and others
with Splenda , Equal , Sweet N
® ®  Regular soda
Low®, or stevia  Sweet tea made with sugar
 Any sugar-free/calorie-free drink  Blended smoothies with fruit such as
Odwalla®, Naked®, or freshly
prepared smoothies
 Ensure®, Boost®, or store brand
equivalents
 Flavored (such as vanilla) soy,
almond, or other cow’s milk
alternatives
 Sweetened coffee drinks such as
vanilla lattes or Starbucks
Frappuccino®, etc.
 Hot cocoa
Sweets
 Avoid all  Cakes, cookies, candies, pies, donuts,
pastries, chocolate
 Ice cream, sherbet, popsicles, Italian
ice, frozen yogurt
 Jell-O® or gelatin desserts (regular
and sugar free), Cool Whip®
 Trail mix (dried fruit, seeds, nuts,
coconut, granola, chocolate, etc.)
Condiments and sweeteners
 Mayonnaise, mustard  Jams and jellies (regular and sugar
 Oil, vinegar, salad dressings that do free)
not contain any of the ingredients to  Honey, agave, Karo syrup, molasses,
the right brown rice syrup, granulated (white)
 Ketchup or BBQ sauce without high sugar, brown sugar, maple syrup,
fructose corn syrup pancake syrup (including sugar free
 Splenda , Equal , Sweet N Low ,
® ® ® and fruit flavored)
stevia  Ketchup or BBQ sauce made with high
fructose corn syrup
 Tomato paste

3
 Other words that mean “sugar”
Check the ingredients list for these, especially in processed or packaged
foods
 Avoid all  High fructose  Brown rice syrup
corn syrup  Pure maple syrup
 Crystalline  Corn syrup
fructose  Honey
 Sugar--ALL  Evaporated cane
 Agave nectar juice
 Brown sugar
 Powdered
sugar
Other words that mean “sugar alcohol”
Check the ingredients list for these, especially of diet or diabetic foods!
 Avoid all  Sorbitol  Mannitol
 Isomalt  Xylitol
 Lactitol  Erythrytol
 Maltitol  Lactatol
Avoid Medications or Supplements with Sugar or Sugar Alcohols
 Liquid medications often have sugar alcohols for flavor, especially those for
people with diabetes. Check labels for any of the ingredients listed above: cough
syrups, liquid Tylenol or ibuprofen, codeine.
 Lactulose—talk with your physician before restricting this—there are some
patients who will need to keep taking this medication.
 Stop taking these fiber supplements: Metamucil®, Benefiber®, Perdiem®,
Citrucel®, etc.

SAMPLE MENU
Breakfast Dinner
 Cornflakes or oatmeal with milk or  4-6 oz of poultry, lean meat, or
unsweetened milk alternative (soy, fish
almond, rice, etc.)  ½-¾ cup white rice or pasta
 Coffee or tea with or without an  ½ cup green beans
allowed artificial sweetener and/or  Roll with butter
unsweetened milk alternative Snack
 Turkey sausage patty  Plain rice cake with unsweetened
 Small banana nut butter with a glass of water
Lunch or unsweetened tea
 Ham sandwich on wheat bread with
mayonnaise and pickles
 ½ cup baby carrots with ranch
dressing made without high
fructose corn syrup
 Handful of potato chips