Swedish Egg

Swedish Egg

Saturday, June 20, 2015

The Main Idea: Ketogenic Healing and a No-Bloat Food List for Meaningful SIBO Reduction

Remember those reading comprehension tests in grade school where you had to identify the Main Idea of a story? That question always bothered me. The best stories have lots of main ideas! Narrowing it down to just one didn’t make sense.

Because I was an advanced reader, I only attended Second Grade for a couple weeks before the adults decided to skip me up to Third. Unfortunately, matronly Mrs. Williams, my new 3rd grade teacher, was a mean old beast and I was bullied on the playground by all the bigger-than-me girls. I had to go last at everything. “Respect your elders!” was the rule.

I pretty much cried my way through 3rd grade, so my parents took me out of the crowded New Rochelle public school system and off I went to Riverdale. (This is the Riverdale that Carly Simon attended, not the one with Betty and Veronica.) At the time, Riverdale was co-ed only through the 4th grade. After that, school tradition dictated that boys and girls be separated, all the way through to 12th grade graduation.

Interestingly, when I started Riverdale it was 1968, meaning cultural values were changing and sex segregation was on the outs. By the time I hit eighth grade, the entire school became fully coeducational for the first time.

But in 5th grade, my class was all girls and at some point in Spring, we had a special event. A heavy, lumbering film projector and squeaky expandable screen were wheeled into our small classroom and, with window shades pulled down and door closed tight, we got to see a movie!

The movie was called It’s Wonderful Being a Girl.

It’s Wonderful Being a Girl featured two new teenagers, Libby and Jane, and their experience around getting their periods. Mostly, the flick was about using menstrual napkins and how great they were. (I guess tampons weren’t invented yet, or maybe the sponsors of the film only made pads.) My favorite take-away from the entire short film was that a hot shower really helps when you feel crampy. This is true!

It’s also true that I was only 9 years old in 5th grade. Menarche was in the far distant future for me. So when the lights came up and our pretty, dark-haired teacher invited those of us with any personal questions about our bodies to come up to her desk for a private discussion, my question didn’t have anything to do with puberty. I did have something kind of embarrassing about my body that I thought maybe Mrs. Begelman could help me with, though.

“Sometimes I get a little gas bubble in my butt,” I confided, “and I don’t know what to do when that happens. It makes a funny noise when it comes out, and sometimes it even smells bad.”

To her credit, Mrs. Begelman succeeded in suppressing a nascent smile before responding. Her advice, basically, was that I just let the “gas bubble” come out. “Better out than in,” she said.

What’s remarkable about this story to me is two things. First Remarkable Thing: I didn’t know the word “fart” in fifth grade! What the hell?

Second, if intestinal gas was already a concern of mine by age nine, it can be assumed that IBS-C goes way back in my history.

I’m not sure which of these remarkable facts is the main idea—they kind of go hand in hand.

Anyway, when I started the Sexy Sibo blog, my main purpose was to chronicle my personal experience in dealing with—and hopefully solving—the digestive disorder which has plagued me for, evidently, decades. My primary goal wasn’t to “share my expertise,” let alone “hold forth” to my audience. But it is also true that I have some expertise to share, both as a person with lifelong digestive issues and as a trained clinician with a Master of Science degree in human nutrition who indulges a voracious appetite for research.

I’m not yet an expert in SIBO, though. No one really is, as each person with SIBO is so unique. Trial and error is the only way. But maybe my trial can save you some error down the road. That’s what I’m hoping for. We’re all in this together!

What I’ve been learning about SIBO is turning my world, and my diet, upside down. I started out in January (five months ago) giving up my vegetarian diet and embracing an approach that I believed would work, which I wrote about here.

This dietary approach was a great place to start, but ultimately it didn’t do enough. I’m talking about the classic SIBO-safe diet (per Dr. Allison Siebecker, et al.) consisting of:

• animal protein (eggs, fish, seafood, poultry, beef)
• lactose-free dairy (aged cheese, 24-hour yogurt, heavy cream)
• healthy fats (coconut oil, EVOO, butter)
• low-FODMAP vegetables
• low-FODMAP fruits (including bananas, berries, oranges, pineapple)
• honey
• nuts and seeds (small servings)
• treats: dark chocolate, peanut butter, potato chips, blended frozen banana “ice cream”
• rarely: low-FODMAP starches (potatoes, rice, gluten-free bread/crackers)

It turned out that this diet was successful in significantly reducing the belching and farting that had previously accompanied me through life 24/7, which was great. But my motility didn’t improve, and my uncomfortable belly distension, i.e. bloating, continued. Not surprisingly, the more I strayed into the fruits, “treats” and “rarely” segments of the above list, the worse my suffering.

So last week, I decided to try something new: a 3-4 day “ketogenic” diet, followed by a stricter version of the above. A friend of mine on Facebook suggested this to me, and guess what? It worked! For the first time in over a year: no bloat. It’s a miracle.

Actually, though, it’s not a miracle. It’s just common sense. Bloating comes from gas. Gas comes from microbial fermentation of sugars and starches. If you don’t eat sugars and starches, the microbes don’t have anything to ferment. If the microbes don’t have anything to ferment, they can’t make gas as a byproduct, hence no bloating. Keep the sugars and starches out for long enough and eventually, the microbes will die off.

It’s that simple. In fact, I’d say it’s even the main idea in understanding SIBO:

If you don’t feed your SIBO, your microbes don’t eat and you don’t bloat. As long as you have bloating, you are not making a dent in your SIBO reduction.

So what the hell is a ketogenic diet, you might ask. A ketogenic diet (keto for short) means you stop using glucose as the primary energy source for your body by taking all sugars and carbohydrates out of the diet. In this way, you force the body to get its energy from fats which produces “ketone bodies”, a breakdown product of fatty acids burned as an alternate energy source when glucose is not available.

The process is called ketosis and, despite all the hype on the internet about keto diets, it’s not really a great idea to do long term. Metabolic acidosis and a weird fruity kind of bad breath, known as “acetone” breath, are two reasons. (Acetone is a type of ketone.)

Short term, however, a ketogenic approach can be very healing for people with digestive disorders because it removes all fermentable foods (sugars and starches) from the diet, cutting off gas and bloating at the source.

Practically speaking, a keto diet for SIBO means you only eat animal protein, fat and cooked low-FODMAP green vegetables. (Always avoid salads and raw veggies when your gut is inflamed—they won’t help.)

My SIBO Keto Diet List looks like this:

• animal protein (eggs, fish, seafood, poultry, beef)
• lactose-free dairy* (aged cheese, heavy cream)
• pure fats (coconut oil, EVOO, butter)
• low-FODMAP GREEN vegetables (spinach, chard, bok choy, zucchini, green beans)

*If you want to try this diet, include dairy only if tolerated. I am lucky in that hard, aged cheeses digest beautifully for me, especially raw milk cheese from goat or sheep milk. I only use heavy cream in small quantities, for coffee or tea. Plain lactose-free yogurt with no additives (24-hour yogurt or Greek style) also could be on the list but I don’t do as well with yogurt, so I’m keeping it out for now. The cheese is a lifesaver, though!

My plan was to do this for 3-4 days but when I woke up the morning of Day 4 with a flat stomach for the first time in maybe a year, I didn’t want to stop! So today, I am essentially on Day 10 of this very low carb approach. I’ve had a small salad twice and have tested two low-FODMAP orange veggies—roasted butternut squash and raw grated carrots—once each. I did okay with both but am not in a rush to repeat. Even though the squash tasted SO SWEET my tongue thought it was in heaven, I think it’s good to keep coming home to baseline. It feels safe at baseline and I have to say, I really like not having symptoms!

Jasmine rice might be the next thing I test. But (referring back to the original list) I’m going to stay away from most everything below the low-FODMAP vegetables line, including most fruit with a few exceptions (lemons and limes for sure, and possibly avocado and coconut which I will test when I am solidly symptom free.)

So for those of you who are still reading, here’s my new food list for the next three months. By the way, this list functions in tandem with Dr. Norm Robillard’s Fast Tract Digestion: IBS system, a quantitative approach which utilizes the fermentation potential (FP) values of different foods to reduce IBS symptoms. Dr. Robillard is the one who figured out the FP of Jasmine rice is zero, making it safe for many SIBO peeps.

No-Bloat Food List for Meaningful SIBO Reduction

• animal protein (eggs, fish, seafood, poultry, beef)
• lactose-free dairy (aged cheese, heavy cream, 24-hour or pure Greek yogurt)
• healthy fats (coconut oil, EVOO, butter)
• low-FODMAP vegetables: primarily cooked, mostly green plus some orange
• Jasmine rice (limit to ½ cup serving per meal)
• lemons and limes
• allowed sweeteners: liquid stevia drops, pure stevia, erythritol

With this plan, I hope to make some REAL progress in getting my symptoms and my SIBO under control. It sounds tough, but actually, it’s not so bad. To paraphrase Kate Moss, “Nothing tastes as good as symptom-free feels.”

I guess that’s the point for me, the bloody Main Idea, if you will: I want to feel better ALL THE TIME. Feeling better calls for figuring out through trial and error what works, and being mature enough to actually do it.

This is where I’ve gotten stuck, repeatedly through the years. The maturity thing. I’m a rebel at heart. I don’t like to follow rules, even rules I make for myself.

But I’m not a kid anymore. I’m not like Libby and Jane, navigating a turbulent adolescence. Au contraire, I’m the mother of two young men in their 20s! A full-grown woman who hasn’t had a monthly cycle since October! I’m navigating menopause now, and the sea is calming. I love myself and I want to heal. I think I’m finally ready. Wish me clear skies, fair winds and a steady rudder, will you? Wish me bon voyage, and feel welcome on board.

xo Diana


  1. First of all, thank you for your candor and sense of humor re your experience with SIBO. Your blog is definitely a breath of fresh air. I am currently organizing my plan of attack via herbal antimicrobials and biofilm disruptors but am conflicted re the type and amount of carbs to consume during my eradication phase. There seems to be two camps: those that starve the bacteria and those that feed it and I've read that well-fed bacteria are more sensitive to antibiotics so I'm wondering if some highly fermentable carb presence is best during this phase? Once my SIBO is cleared up, I'll be implementing a low-fermentation diet.

    1. Hi Kelly, I'm glad you are enjoying my Sexy Sibo blog while acquiring some useful tips and information - thank you! As for your question RE: how many fermentable carbs to include during your eradication phase, as you have seen there is no one right answer. It seems that both approaches must work—either severely limiting the fermentable carbs, or intentionally including some. If not, we wouldn't have two distinct camps each claiming success!

      Personally, I wanted symptom relief and I wasn't able to achieve that with foods like sweet potatoes, nuts and bananas in my diet—as much as I loved and even relied on those foods when I was starting out on this journey. The microbiome is so huge and complex, not to mention hidden and even secretive, with the ability to hunker down and hide out in a biofilm for who knows how long—days? Weeks? Months? Therefore, my focus has been on improving how I feel. How one feels seems to be the greatest measure of health and well-being on a tangible, practical level. So feeling calm and comfortable in my belly is the goal I use to guide my choices.

      That said, my personal experience in limiting the fermentable carbs as much as possible, namely by eliminating simple sugars and starches (as outlined in this post on Ketogenic Healing) has been successful. I recommend trying it! I never gave up vegetables altogether, so my SIBO bugs always had some carbs and fiber-containing foods to munch on, i.e. carrots, green beans, zucchini, jasmine rice, etc. In August I started adding in more carbs—a few low-sugar fruits here and there, butternut squash once a week, things like that. In time, I am sure the microbial numbers are being reduced and I get to enjoy little to no gas and bloating. Win-win.

      I hope you find this answer helpful and I wish you the greatest and fastest results in getting your digestion and health to a place that feel comfortable and healthy for you!

      Best, Diana

  2. Could you please provide a sample daily menu of what you would eat during those 10 days of no bloat?!? I am soooo frustrated with all of these symptoms, I have changed my diet but it has only gotten rid of the extreme gas, not the bloating. I am so skinny but look like I am 5 months pregnant... my self esteem is at an all time low! :(

    1. Hello Anonymous ;-)

      Sure, I'm happy to share some daily menu ideas with you here. See below, and check the "eat and drink" menu tab at the top of this blog for a whole page of ideas. I generally eat 2 meals a day, but some people need three. Consider booking a session with me to come up with a custom plan. Your personal SIBO history, individual needs and preferences all make a difference in your rate of progress and outcome. Wishing you great success! Diana

      BREAKFAST - Usually black tea, sometimes coffee, with heavy cream added. I sweeten tea with erythritol. (See my April 30, 2015 post on erythritol for more info.) I often have a little hard, raw goat cheese mid-morning, maybe with a raw carrot, cherry tomatoes or some red bell pepper slices. If you need to eat more food in the morning, try one of the breakfasty lunch ideas in next section.

      LUNCH - A breakfasty lunch could be something like a cheese omelet with spinach and red peppers, or "bacon and eggs" with sauteed mushrooms and chard on the side. Use uncured, sugar-free bacon. Natural chicken sausage is good, too.

      A more lunchy lunch could be a big bowl of homemade chicken soup. I make mine with carrots or butternut squash and plenty of herbs like oregano, basil and thyme, all of which have antimicrobial properties. When reheating soup, I like to add baby spinach or chopped chard leaves at the end and heat until they are bright green and just wilted. With this meal, have some sliced aged cheddar or other hard cheese for dessert. (Raw sheep Manchego is one of my faves.)

      When I am out for lunch, I often get a deconstructed sandwich or burger, which basically means "hold the bread". Add a side salad if you've advanced to raw (cooked veg easier to digest at first) plus gorgonzola & avocado—yum.

      DINNER - Here are 3 ideas: 1) Baked chicken thighs with steamed zucchini and carrots. 2) Roasted chicken with baked acorn squash and broth-braised spinach or chard. 3) Pan fried salmon topped with scallions, ginger green beans (cooked in coconut oil) on the side.

  3. Hi Diana. I just found your site and like it. I recently read a new book called Brain Maker by Dr David Perlmutter, MD. In it, he discusses the power of gut microbes to heal and protect your brain. Fascinating and related to your research I think. Are you familiar with the book? Keep up the great work here!

    1. Hi Curtis - Thanks for stopping by! Yes I am familiar with that book; it's a good one, and definitely related. I think microbiome research is really going to take off in the next few years. You even could say it's an exciting time to have SIBO. LOL

  4. Hi Diana. How are you doing? I also have SIBO and I bloat. My numbers have come down quite a bit, but I had to take a break from treatment while I treated h pylori. So now it's back to treating the SIBO. I haven't found the magic eating plan for me that keeps the bloating away. So I may be trying keto, but I have to say I can't imagine what I'm going to eat. So few foods on the list. Have you been able to add more foods?

    1. Hi Patty, Nice to hear from you! Yes, I am now able to add more foods in, but not too many all together in a row, or I have to drop back to keto-style (as outlined here) because bloating comes back. I can't tell you how great it is to have a safe zone to recover in, and more good news is there's plenty to eat within the limitations. Let me know if I can support you with ideas on meal and snack planning - you might find it helpful to do a consult. Best wishes, xo Diana

    2. Thank you SO much; I feel I "found" you by divine guidance��

    3. You are welcome, dear one. Glad to be of service. <3

  5. Trying this on Monday! Fingers crossed :)

    1. Hi Ryan, I'm excited for you, and hope you have wonderful results when you remove/reduce the carbs (fermentable sugars and starches) from your diet. :)diana

  6. Hi Diana, Thank you for the great post! It is really informative. I think I have SIBO, I have had IBS for years but the symptoms are at an all time high. It's driving me crazy. I was wondering, did you try any herbal anti-biotics such as Berberine, Oregano, etc? I just started using some but am wondering if I should try the Keto route for a few days too. Thanks!

    1. Hi Eliza ~ You're very welcome :) Yes I have tried herbal antibiotics; here's my post about it where you can read more: https://sexysibo.blogspot.com/2015/04/treating-sibo-with-herbal-antibiotic.html

      Before starting treatment with herbs, you might consider doing a breath test to obtain a baseline reading and confirm the SIBO diagnosis. It's not necessary, but it would give you a way to track your progress going forward if that makes sense for you.

      Wishing you great luck, perseverance and success! Diana

    2. Hello and thank you for your blog! My 14 yr old son has been plagued with SIBO for almost 1 yr now and his pain/nausea has prevented him from going to school (not at all since last November), exercising/playing with friends, and going to summer camp. His symptoms (pain/nausea) are basically constant, ranging from 8-9.8 on the pain scale. I know adults just deal with the pain and carry-on, but there is no way I can physically make him go to school, or do school work because he is in so much pain. He does not have bloating. We have done Rifaximin (2 rounds, each followed by 60 days of LDE); gluten-free, dairy-free diets for months; low Fodmap diet for months; and brain-gut pain techniques with medicines (not to mention numerous tests and procedures!!). I purchased Fast Tract Diet and am hopeful that Dr. Robillard's plan will give him some relief. Does anyone else's pain bring them to the point of not being able to function daily? How do you deal with it? Thank you!

    3. Hi Nancy, I am really sorry to hear about your son. Is there anything else going on? Any food he can eat without symptoms? Sounds like a complicated case... Do let me know if you would like to set up a session so we can discuss further, by emailing me directly at eat2evolve@gmail.com - Wishing you both peace and healing, Diana

  7. Hi Diana,
    Like you. I have found the ketogenic diet really eases my SIBO issues. I have endured close to 30 years of ever increasing symptoms related to a damaged intestinal tract. Food and airborne allergies, chemical sensitivities, leaky gut issues, Hashimoto auto-immune, fibromyalgia, neuropathy, restless leg, eczema, reflux, insomnia, IBS-D... the list goes on. Through the years I have been able to control a lot of the symptoms via diet and supplements, but was not able to heal my gut.
    Being diagnosed with SIBO in May 2017 was like being given a gigantic piece of the puzzle. Since May, I had been following a combination of the SIBO / Fast Track / FODMAP diets with some significant success. It occurred to me I was very close to a ketogenic diet with just a few tweeks. Was also prescribed a course of Ryfaxin, which did not reduce my hydrogen levels at all, still scored a 143 on the breath test after treatment. In August, my doc prescribed a two week course of Alinia. We also discussed diet again at that time and he said keto was a great idea. So, I focused on ketogenic foods. And recently I took out fruits, coconut meat, seeds and nuts. I had a huge, huge, huge improvement. My neuropathy and restless leg disappeared almost immediately. I'm sleeping better and have a lot of energy. I eat lots of healthy fats, moderate protein, SIBO/FODMAP veg and lots of water. My September SIBO breath test hydrogen level was 33, down from May/July results of 143. My doc says this is because of the Alinia. I think that the keto diet also has a big part in the results.
    I plan on staying on the ketogenic diet for awhile. In my opinion, ketogenic diet is the winter portion of the paleo diet, if we were cavemen. So perfect timing to go ketogenic through the winter. Come April we'll see if I can tolerate spring vegetables and then later, summer fruits. Fingers crossed!
    Thank you for your great blog! Lots of helpful info.

  8. Oh gosh, I think I just fell in love with you! First of all, I love your writing style (probably because it´s suspiciously like mine). And secondly, I WAS HAVING THE EXACT SAME THOUGHTS over the past few days - I´ve just come off the elemental diet, which made zero difference (homemade version, which tells you to have 2 tbsps of honey with each shake - sounds like fuel for an awesome bug party to me). So back to the drawing board I thought. Read the Fast Tract Diet book (where he says that honey is poo, or bloat rather) and started looking into keto and thought of combining it but was a bit unsure. I´m so stoked to see that this working for you!! I´d love to hear how you´re doing now, 2 years down the track? Thanks and all the bestest to you and everyone else hosting a bug party in all the wrong places x

    1. Hi Dani! ♥︎ Thanks for your super sweet comment. Feels like finding treasure, to meet a kindred on the wire. Sorry to hear your Elemental Diet journey was unsuccessful. You were very brave to try it in the first place...and I am glad you found my blog.

      YES! The low carb (LC), keto approach has made a huge improvement in my symptoms over time. Even when I stray (see My Cheating Fart post) it's always there as a baseline, giving me a degree of control that I desperately missed when *nothing* was working. Best of all, when I go off-program (hello Thanksgiving) I know how to reset.

      I also became a huge fan of Dr. Norm's Fast Tract Diet once I got over my aversion to point-counting, a necessary evil at the beginning. He really knows what he's talking about and is so. darn. sensible. I consider FTD and LC/keto to be Primary Tools for maintaining a low symptom level, which is my goal: feeling good in my body. Let me know how it goes for you!

      xo Diana

  9. I too have been using keto diet to help my SIBO with excellent results. And actualy keto is the winter portion of paleo if you live in a northern climate. So if one eats seasonally and in line with true paleo principles, one will naturally cycle in and out of keto every year from late November through end of March.
    Thank you so much for your blog. I feel like we are kindred spirits! I too, have been dealing with all the same cnditions you have, for 30 years now. Being diagnosed with SIBO and changing my diet to keto relieved so many of my symptoms, such as restless leg, neuropathy, reflux, fibromyalgia, bloating... I'm hoping to one day heal up some of the food allergies too.

    1. Thanks for your comment! I like your "winter Paleo" idea; it's very true. Am currently figuring out what "summer Paleo" foods will work for me, trying more salads and even a bit of fruit. Or not. Quantity seems to be a big piece of the puzzle...as in I may have success with a little bit, but bloating with a lot of, say, blueberries. Sometimes none is easier than some. Glad that your symptoms are clearing up - what a relief!

  10. This blog is wonderful, thank you for all of your information.
    I was just wondering, above you say Keto isn't a great diet to do long-term... You have now been doing keto for a while now since writing this post - do you now recommend it as a long-term approach for SIBO?

    1. Hi there Unknown... thanks for your note. It is true that I wrote this post after eating keto-style for 10 days, but please don't think I've continued following a strict keto diet since then, i.e. for the past 3 years. Oh no! I regularly include many more starchy and carby foods in my diet: winter squash and carrots, certain grains off and on, low-FODMAP fruits and even, in season, a peach or two. (Did that peach make me bloat? Yes. Was it worth it? I think so.)

      As a long-term approach to SIBO, I recommend learning what works for YOUR body and honoring your needs each day. It's important to have access to something like a 3-4 day Keto Reset to fall back on, because there will be times that you REALLY need relief. It's also important to have pie once in a while. Finding the balance and learning to adapt is the journey we are on here. Because low-FODMAP diets are so well researched for IBS, I tend to rely on low-FODMAP foods most of the time. If I flare, I drop back to keto.

      Personally, experience has taught me that if I restrict my diet too much or for too long, I tend to binge. That is a miserable cycle. So, after 5 years of dealing quite intensively with my SIBO, I have loosened the reins. My focus today is on finding balance with my diet, digestion and lifestyle using an informed, intuitive eating approach.

      I hope that helps!

      P.S. Please check out my official website www.eat2evolve.com to learn more about my work, outside of the Sexy Sibo forum.