Can a dietitian help with SIBO?

Key Points

• SIBO is a complicated gut health issue that can be difficult to diagnose and treat.
• Registered dietitians are the most qualified health professionals to help you heal your gut.
• An RD can help develop a sustainable plan to help resolve your SIBO symptoms. 

Gut issues are difficult to face. They often cause physical discomfort and may compromise your overall lifestyle. It can be difficult to diagnose them or their underlying cause, and traditional healthcare hasn’t yet caught up to all the gut problems facing people today.

SIBO is a common gut issue characterized by a set of symptoms. When it comes to treatment, you may be wondering: Can a dietitian help with SIBO?

Learn more about SIBO and how registered dietitians can support SIBO diagnosis and treatment.

What is SIBO?

SIBO stands for small intestinal bacterial overgrowth. It is characterized by excessive bacteria in the small intestine - but there is no consensus definition of the disorder. People with SIBO typically experience excessive bloating and gas due to carbohydrate malabsorption. The digested carbohydrates ferment in the gut and cause gas, as well as other digestive issues.

SIBO has significant overlap with irritable bowel syndrome (IBS). Most people with IBS have SIBO due to the fact that gut dysbiosis – an imbalance of microorganisms in the gut – causes IBS symptoms.

What are the symptoms of SIBO?

Typical SIBO symptoms include boating, flatulence, abdominal pain and distention, cramping, diarrhea, and constipation. The excessive gas is a result of the intestinal fermentation process and the water drawn through osmosis.

SIBO is more common in women, those with diarrhea-predominant IBS, those with proton pump inhibitors, people with higher narcotic intake, people with low hemoglobin, and those with disordered eating tendencies.

Many people with SIBO experience worse symptoms with certain foods. You may find certain foods lead to greater bloating and discomfort than others.

What kind of doctor should I see for SIBO?

A gastroenterologist can give a formal SIBO diagnosis. The diagnosis will likely be based not just on a test, but also on your symptoms. Because IBS is a broad diagnosis, you may have all the symptoms of SIBO but not actually have the disorder, and vice versa.

The doctor will ask you about your gut motility (how quickly food moves through your digestive tract – AKA how long it takes you to digest food), your bloating patterns, if you have acid reflux, if you have any food intolerances, your general diet, other digestive symptoms, and more.

There is no widely agreed-upon method to diagnose the disorder, but a breath test is the most commonly used. This test measures levels of hydrogen and methane, gases produced by carbohydrate fermentation in the gut, in the breath. The theory is that human cells do not typically produce these gases, so if they are detected, it is an indication of SIBO.

The test is popular due to its noninvasive nature. But the criteria for SIBO classification are nonspecific and the test is often considered inaccurate, producing both false positives and false negatives. Discuss with your doctor if the SIBO breath test is right for you.

Another SIBO test uses small bowel cultures during endoscopies. This is less common due to how invasive and expensive it is to administer but is considered more accurate. However, other small bowel sample tests are being explored and developed.

What is the treatment for SIBO?

Antibiotics

Similar to SIBO testing, SIBO treatment is still being developed and there is no singular approach. Antibiotics are the most common form of SIBO treatment. Which antibiotic is prescribed will depend on which gas (hydrogen or methane) was high in your test results, as well as your antibiotic history. Common SIBO antibiotics include tetracycline, doxycycline, and rifaximin.

SIBO frequently returns after a course of antibiotics, so it’s not uncommon to be prescribed a second course following the first.

Probiotics

Probiotics may help alleviate SIBO symptoms by modulating gut microbiota – but they may also make symptoms worse by introducing more bacteria.

As you can tell, the understanding and treatment of SIBO is ongoing, so what works for one person might not work for another. This is why it’s so important to work with a qualified professional, like a registered dietitian, who can help you navigate treatment to find the right solution for you.

Lifestyle changes

Many doctors and dietitians will recommend dietary adjustments and other lifestyle changes to improve symptoms. One of the most popular options is to reduce fermentable carbohydrates – the source of the SIBO bacteria. This is achieved through the low FODMAP diet, which we’ll explore further below.

What is the most effective diet for SIBO?

Research is ongoing into the most effective dietary treatment for SIBO. The most frequently recommended diet for SIBO is low FODMAP. FODMAP stands for fermentable oligo-, di-, monosaccharides and polyols. Features of this diet include:

• eating low fiber
• avoiding alcohol sugars and fermentable sweeteners
• avoiding prebiotics like inulin
• cutting out certain fruits and vegetables, lactose, wheat products, legumes, and more

This regime is administered as an elimination diet, meaning you initially cut out all high FODMAP foods, then slowly reintroduce them in a measured fashion to test which might cause you the most distress. With this approach, you may discover certain foods cause more discomfort than others.

The idea isn’t that you stay on the low FODMAP diet forever but find a sustainable way to enjoy food while minimizing or eliminating SIBO symptoms.

Some find relief from a general gluten-free diet but, like everything else surrounding the condition, research is still inconclusive on how effective that is.

Do dietitians help with gut health and SIBO?

A registered dietitian is one of the best professionals you can work with when dealing with SIBO. They are uniquely qualified to guide you through dietary adaptations and help monitor your symptoms. While a gastroenterologist is the only one who can give you a formal diagnosis, an RD or RDN is the best person to help you through SIBO treatment since it can be a lengthy process full of trial and error.

Resolving digestive health issues is often complicated, and SIBO is no exception. With so many different ways to diagnose and treat it, SIBO requires a professional to oversee the progress of symptoms as you test different methods. Your RD will make suggestions based on patterns they identify and help you develop a sustainable meal plan.

The diets that can help alleviate SIBO symptoms are complicated. Your RD can help:

• create an easy-to-follow elimination diet
• provide a list of foods to avoid
• provide a list of foods you can eat
• share meals and snacks you can prepare during the protocol
• facilitate food reintroduction
• support gut health during and after antibiotic treatment
• adjust your protocol as needed based on results

Perhaps most importantly, your dietitian will be there to coach you during the whole process, not just offering their knowledge but also their support as you take on this complicated treatment. Having a professional who has facilitated this process before is invaluable, and RDs are the most qualified ones to do it.

What are some benefits of a dietitian?

In addition to providing all of the above, it’s clear how helpful a dietitian can be with gut health. But you might still be wondering: What is the difference between a nutritionist and a dietitian? Which should you work with to heal your gut?

Registered dietitians are board-certified health professionals recognized by the Commission on Dietetic Registration. They have thousands of hours of experience and access to the latest literature and research, making them the best-equipped dietary counselors.

Nutritionists, on the other hand, are not regulated in the same way. As such, their scope is more limited and they are less qualified.

When it comes to your health, you want to work with the most experienced, qualified provider. RDs and RDNs are the best choice for supporting your gut health.

RDs are also covered by health insurance, whereas nutritionists are not. You can find a board-certified dietitian near you using Fay Nutrition. Fay can connect you with a dietitian who specializes in gut health and SIBO who is also covered by your insurance.

All you have to do is put in your plan information, filter by specialty, and get connected with an RDN. Click here to get started.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.