By Dr. Nirala Jacobi, BHSc, ND (USA)
As most SIBO patients know, the dietary restrictions are an important part of the success of the treatment. Travelling or eating out can be daunting occasions which can easily throw off the diet. In addition, patients with post-infectious SIBO (SIBO which occurred after a case of food poisoning) are 5 x more likely to contract another case of food poisoning! Prevention of food poisoning is therefore extremely important to prevent further damage.
What to eat
We recommend patients follow the SIBO Bi-Phasic diet whilst being treated for SIBO (a more stricter version of low FODMAP diet). Please consult with your practitioner as to which phase of the Bi-phasic diet you are to follow. If this proves too hard, download the Monash FODMAP app which gives green lights on foods with low fermentable fibres. This is not a specific diet for SIBO, but it will do in a pinch.
- Consult with your airline for any travel with meal service. Though none currently have a low FODMAP diet, all airlines cater to certain diets and these can differ. For starters, request no dairy and gluten and see how amenable they are for specific food requests.
- Take ample snacks in case you can’t eat much of what they serve: boiled eggs, nuts, almond meal pikelets, and rice cakes with almond butter, cut vegetables are all good travelling foods. (Note: many countries have strict custom laws which prohibit bringing fresh food into the country, so you may have to throw out your left overs upon arrival)
On the ground
- Drink bottled water vs tap water
- Avoid raw salads (unless cleanliness of restaurant is assured)
- Wash fruit well
- Avoid lemon or lime wedges from the bar
- Eat well cooked meat, chicken, fish
- Avoid foods from street vendors or “finger foods”
- Wash your hands often (do not rely on hand sanitisers)
One of the best ways to prevent food poisoning is to enhance the natural antimicrobial activity of stomach acid (HCL), bile, and enzymes which are produced to help us digest foods and kill food borne bacteria. The following suggestions are good adjuncts to your relapse prevention plan whilst travelling. Note: it is not necessary to take all of them, pick one from each category
- Herbal Bitters – very effective to improve these digestive juices. If you cannot find a good one, you may be able to have one made up at a health food store with a herbal dispensary. Dr Jacobi’s formula is equal parts of Oregon Grape/Gentian/Baical Skullcap/Dandelion root. Take 3 whole droppers in water 15 minutes before meals
- Betaine HCL – supplemental HCL to increase the acidity of the stomach. Not recommended for those with known history of gastritis.
- Berberine containing antimicrobial products: Berberine-500 and Bactrex are good examples. Take 1-2 capsules of either formula daily for prevention, increase to 2 caps 3x daily for acute illness (ideally berberine content of around 2-4 grams)
- Rifaximin 200-500mg daily – this is prescription medication specific for SIBO. Dr Mark Pimentel (SIBO researcher and gastroenterologist) suggests this dose daily whilst travelling to prevent food poisoning. Can be increased to 550mg 3x daily for active flare.
- Saccharomyces boulardii – a beneficial yeast with many digestive benefits. It is a great aid in the prevention of travelers diarrhoea. It increases the gut’s immune response. Though also helpful for candida, it is not recommended for those with allergy to yeasts. SB Floractiv is a good product in Australia – take about 500mg daily preventatively
- Melatonin (by prescription in Australia) – great for prevention of jet lag but also considered a prokinetic (keeps the small intestines moving) – take 2-5mg nightly.