Right now, an estimated 70 million Americans are living with undiagnosed SIBO. Unfortunately, SIBO is one of the most misdiagnosed GI conditions, causing severe constipation, bloating, IBS, and indigestion, and can lead to even more severe health issues like osteoporosis, kidney stones, poor absorption of critical carbs and proteins, and more. Until now, SIBO-sufferers’ only food options were the Low-FODMAP diet, which is not meant to exceed three months, and the Elemental Diet, which strips one’s diet of food altogether. Well, move over to low-FODMAP. There is a new diet in town. We spoke to the authors of The Good LFE Cookbook: Low-
What is Low Fermentation Eating, and How Can It Help Your Diet?
What is SIBO?
SIBO is an acronym for Small-Intestinal Bacterial Overgrowth. SIBO is an increased number of bacteria in the small intestines contributing to excess fermentation, bowel malabsorption, or inflammation. The small intestine is the section of the gut where most of the nutrient absorption occurs. Therefore, when these areas are concentrated with bacteria, there is a competition for food between the bacteria, trying to survive, and the host, trying to absorb its meal. In SIBO, this excessive quantity of bacteria is not an infection but rather an over-colonization of specific bacteria in an area where they don’t belong.
SIBO symptoms include abdominal distention, bloating, early satiety, nausea, abdominal discomfort/pain, fatigue, brain fog, weight loss/weight gain, constipation, and diarrhea, which occur because bacteria ferment food to produce gas. These symptoms are not universal. Each person can have some or all these symptoms. Since SIBO individuals have elevated bacterial levels, they produce excessive gas, which is believed to affect the gut’s motility indigestion. In extreme cases, SIBO may also lead to malabsorption of nutrients by the body itself, leading to nutrient deficiencies.
What is Low Fermentation Eating? Why is it beneficial?
Low-fermentation eating is not just about what you eat but also about when and how you space meals. Low Fermentation Eating eliminates products that contain high levels of carbohydrates or ingredients in the food that humans can’t digest and therefore are digested by bacteria. The goal with Low Fermentation Eating is to consume foods that decrease gas production in the gastrointestinal tract. The body naturally produces enzymes to break down complex molecules for absorption, but certain foods still cannot be properly digested. Leftover, undigested molecules can become food for intestinal bacteria, using these nutrients to produce gas. This ultimately leads to bloating. Therefore, Low Fermentation Eating tries to combine science and nutrition to find foods that are easier to digest by the body itself, to maximize absorption by the host and minimize gas fermentation by the bacteria in the gut.
This lifestyle is intended for anyone hoping to improve gut health and microbiome balance, but it mainly aims to benefit individuals suffering from SIBO. Bacteria in our gut thrive and grow from the nutrients we provide through our daily meals. Therefore, by following a Low Fermentation Diet, the goal is to reduce SIBO symptoms and enjoy food with lots of variety and diversity.
Compare and contrast LFE and low FODMAP?
The Low FODMAP diet limits fermentable oligosaccharides, disaccharides, monosaccharides, and polygons. A FODMAP diet is a 3-step process used to help manage the symptoms of medically diagnosed IBS patients. The Low Fermentation Diet is targeted for patients who are diagnosed with SIBO. The goal of the low-FODMAP diet is to restrict fermentable nutrients from ingested food, as reducing fermentable foods may reduce gas, distention, pain, and diarrhea in those with IBS with diarrhea. The Low Fermentation diet is less restrictive than the Low FODMAP diet and stresses that the timing of your eating is as important as what you eat.
The low-FODMAP diet is not easy to follow. It is a 3-stage diet that involves an elimination stage, reintroduction stage, and maintenance stage. Often patients eliminate food and do not reintroduce foods as they don’t want to risk a return of negative symptoms. For example, many SIBO patients can tolerate small amounts of garlic and avocados. Both foods have tremendous nutritious properties such as anti-inflammatory and antioxidant, and avocados are full of omega three fatty acids. Some patients with IBS and SIBO eliminate garlic and avocados because they think they shouldn’t eat them at all because they are banned from the low-FODMAP diet.
Over time, your microbiome may shift in a bad direction with the low-FODMAP diet. The microbiome of your stool becomes less diverse, and it’s been recently documented that having lower microbiome diversity is an unhealthy situation. If you’re on a low-FODMAP diet for a long time, you may be malnourished, and consequently your microbiome is malnourished as well. The low fermentation diet is easy to follow and stresses what you can eat. It allows for flexibility, making eating out easy and an extensive diverse ingredient list. As with any diet, diet therapy should be individualized and less restrictive, when possible, to maintain a good quality of life with balanced nutrition.
What are your favorite recipes from The Good LFE Cookbook? How do they benefit readers/folks from a nutritional standpoint?
It is tough to pick one favorite! It really depends on my cravings. However, I can share some of my go-to’s! On days when I feel like choosing something filling and bread based, I love the Gruyere and Parmesan Pizza. Preparing the pizza is always so fun and it’s such a great dinnertime treat. If I am craving seafood, the Seafood Paella and the White Wine Halibut with vegetables (you can swap any fish for this recipe and it’s a winner.) Both are delicious, easy SIBO-friendly options. I try to use lunchtime as an opportunity to consume veggies and get in extra greens in the day, so I often turn to the Insalate Tricolore recipe for my noontime meal. I add some protein such as left-over chicken or fish. Then, on nights when I want to make something special, I love pairing the Carrot Romesco and Cast-Iron Chicken with Caper Lemon Croutons recipes, which offers wonderful, healthy alternative to comfort food! I really enjoy these recipes because they are tasty, balanced, filled with so many micronutrients, and, most importantly, healthy for my body and my gut.
One of the things I love most about following a low fermentation diet is how easy it is to eat a wide range of foods while consuming balanced, fun, and healthy meals. I have many clients who, after being diagnosed with SIBO, turned to unhealthy options daily just to avoid bloating, which can lead to long term vitamin deficiencies, etc. Therefore, we wanted to create balanced meals that protect the gut while also supplying your body with all the essential vitamins, minerals, and macronutrients it needs to function at its best. As a nutritionist, I worked with Krystyna to ensure that these recipes heal both the body and the gut, making this cookbook unique from others previously published.
What are some ways to get creative with the LFE list of ingredients
We view the LFE ingredient list as building blocks to construct from, so there are many ways to explore new recipes while still following an LFE diet. One way to get creative is to try recipes from our new cookbook at random! All are LFE-approved and vary in skill level, so feel free to challenge yourself! Explore meals from the book that you have never tried before! Beyond our cookbook, you can search for recipes online and find ways to make them LFE-approved by using our LFE ingredient list and replacing ingredients with SIBO-friendly alternatives. There are many ways to get creative AND stay healthy!
Can alcohol be consumed?
Yes! Alcohol can absolutely be consumed on the low fermentation diet. Spirits are generally tolerable among people with SIBO, and they are considered low-fermentation products. However, I do recommend being cautious with sugary mixers. Oftentimes, they contain non-digestible sweeteners, such as agave syrup, sucralose, or stevia. If you order a drink mixed with soda, make sure there’s no artificial sugars in the soda. Bitters are usually well tolerated. Lastly, many IBS and SIBO patients take the less hoppy and lighter beers if you like beer.
Can those eating the LFE diet ever stray from it? Do they risk a flare-up?
Our gut microbiomes are as diverse as we are, varying by diet and physical activity, genetics, and environment. Therefore, certain foods may trigger SIBO symptoms in some and not in others. It is essential, above all else, to find what works for you. The LFE diet is based on scientific discovery and is a great template to follow and fall back on to promote gut health. The LFE ingredient list is restrictive to accommodate variations of intolerance among all people with SIBO. However, if there are certain foods you know you can eat without flare-up that do not fall under the LFE restrictions, you shouldn’t feel a need to avoid them just because they are “not LFE-approved.” Your diet should still be individualized, based on both histories, experiences, and science, from the LFE ingredient list!
However, eating foods that are not considered low fermentation may flare-up up symptoms. If you experience a flare-up, take note of the ingredients to avoid in the future, and practice a more restricted, LFE-only diet until your symptoms have resolved.