Case Study: a vegan SIBO Diet challenge

by sue

A Vegan SIBO Diet Challenge

by Sue Kira, Naturopath & Clinical Nutritionist

Client name and identifying information changed

SIBO is the abbreviation for Small Intestine Bacterial Overgrowth, which involves a very restrictive Phase 1 diet for the first few weeks, followed by a less restrictive Phase 2 diet for a period of time.

But for vegetarians or vegans, there are special challenges because the standard diets for SIBO exclude much of what they eat.

Mary was the first vegan I worked with who needed a vegan SIBO diet, so it was a bit of a challenge for both of us. But this was good, because it helped me to come up with some vegan friendly SIBO recipes to help pave the way for other vegans who needed to do the same.

Unfortunately, Mary had previously kicked her toe on a metal chair and had to have antibiotics because her toe was not healing. After that episode, she never felt right and over the next two years she developed digestive complaints such as bloating, diarrhoea and fatigue. She thought that it would settle in time, but it didn’t go away. Her doctor found low levels of iron and B12, but he didn’t check her stools.

When Mary saw me I arranged some tests to work out why she had these symptoms. My suspicions were either parasites or SIBO, so we checked for both which revealed she had SIBO, leaky gut and some inflammation. It seemed that the antibiotics may have upset the balance of bacteria in her gut and then started a cascade of effects leaving her with SIBO and the effects of SIBO.

The SIBO was irritating her digestive system, but further tests showed she was intolerant to gluten grains, which had been a big part of her vegan diet. While the grains may have been all right to eat before, once she developed ‘leaky gut’ from the original infection, molecules of gluten crossed over into her blood stream and set up a reaction. It wasn’t celiac but it showed she was intolerant to gluten foods and was slightly intolerant to other grains.

We compiled a meal plan that would work for Mary and her food preferences, while omitting the grains, legume and pulses. This meant she needed to get her protein and fats from nuts and seeds for the time being, and later she could reintroduce the legumes and pulses and possibly some grains.

Because the SIBO diet restricts the quantity of nuts and seeds, we decided to keep to this restriction for the first week, but it proved to be almost impossible to satisfy Mary. As she was already quite slim, especially with the diarrhoea, she couldn’t afford to lose more weight. For the next two weeks, we decided to double the quantity of nuts and seeds and add quite a bit more coconut oil to keep her calories up.

This was tricky as there was a fine line between consuming adequate coconut oil to provide enough calories and too much to make her diarrhoea worse. She was sensitive to herbs so we couldn’t use them to kill off the bad bugs, but she was able to tolerate loads of dairy free probiotics which made a big difference to keeping diarrhoea at bay.

This diet plan was much better for her and by the third week she was feeling more like her normal self, but still a bit hungry for more food options. Because she responded so well, we didn’t need the full six weeks on the Phase 1 level of her SIBO diet and Phase 2 gave her more options to choose from.

After three weeks on the Phase 2 SIBO diet, she had regained her energy and felt great, so we decided on a trial to introduce legumes and pulses, just a little at a time, and she was fine. Later we introduced a few grain-seeds like quinoa, buckwheat and amaranth and included a lot more vegetables. Mary then had a diet that she felt good about.

Although Mary didn’t normally have a sweet tooth, when she had the SIBO she craved sweet foods. Yet once SIBO was under control, she didn’t feel a need to eat sweet things, which would help her body to remain stable and in balance.

I haven’t heard from Mary since, so no news is great news!

Click for more information about SIBO and SIBO Diets


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