Flatulence, diarrhea, bloating, abdominal pain. Sounds a bit like a Pepto-Bismol ad, right? It’s actually a list of some of the primary symptoms of small intestinal bacterial overgrowth, or SIBO. A regularly functioning small intestine can flush out organisms that shouldn’t be there, but in cases of SIBO, the bacterial composition of the small intestine and the colon are more similar than they should be. Close to 60 percent of irritable bowel syndrome (IBS) patients suffer from SIBO, but it is not known how common it is among the general population.

Most physicians use antibiotics like rifaximin to treat SIBO, but because of the possibility of negative side effects, others opt for more herbal remedies. For example, Gerard Mullin, M.D., gastroenterologist at Johns Hopkins medical center in Baltimore treats SIBO patients with oregano oil, wild garlic, and berberine. Some people have also heard of a SIBO diet that is supposed to help. But does it really cure SIBO?

People with SIBO do need to modify their diets, says Dr. Mullen, but dietary changes alone are not going to actually cure the condition. SIBO sufferers should avoid high fructose corn syrup above all, and try not to eat foods that contain fructose, like honey, agave, apples, pears, watermelon, and many other types of fruits and fruit-based products. Fructans, a similar-sounding thing to avoid, are the carbohydrates commonly found in wheat, rye, and the fructo-oligosaccarides that are often added to foods as a fiber supplement. Fructans are also found in cruciferous vegetables and legumes, so SIBO patients ought to limit their intake of such produce. If you’re wondering what that leaves to eat, rest assured that you don’t have to cut back on these foods forever, just cut back on the most problematic ones, which for most people are wheat, apples, pears, and raw onions.

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