SIBO and Weight Loss
My main concern with SIBO right now is weight loss. How can I follow the Fast Tract Diet and gain some weight? I eat larger portions of the suggested menu.
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Ankylosing Spondilitis, Klebsiella pneumoniae and Fiber
I have been applying the principles of SIBO diet to my auto Immune Ankylosing Spondilitis (AS). I have dramatic results with NO starch, no dairy (without lactase), including going off all meds, reducing stiffness and pain most of the time.
When I have a relapse, I need to avoid ALL fiber (no vegies, no fruit, just protein foods and a very low fiber homemade strained juice). Somewhere I read that Klebsiella pneumoniae does not feed/grow on veggie fiber, however I have a hard time believing that. Can you shed some light on this?
I agree, limiting starch, particularly amylose starch is a good strategy, but you should limit fiber as well. K. pneumonia can also degrade pectin, rafinose, stachyose, fructose oligosaccharide and other soy oligosaccharides. Here’s an old study.
Also, even if K. pneumonia could not use other forms of fiber, the breakdown of complex carbs is a collaborative activity where a wide variety of organisms – Clostridia, Bacteriodes, Klebsiella, Bifidobacteria, etc. work together to break apart these complex carbs and jointly use the partial or complete breakdown products.
Limiting overall carbs, particularly the hard-to-digest carbs (i.e. implementing the Fast Tract Diet) is the best way to reduce inflammation, leaky gut and overgrowth of gut bacteria including non desirable organisms such as K. pneumoniae.
SIBO Negative Reflux and IBS
I have reflux and IBS and take PPIs. I did a hydrogen breath test, but the result for SIBO was negative. You talk about SIBO being the cause of reflux and IBS. Does the Fast Tract Diet work for SIBO negative reflux and IBS?
That’s a great question. SIBO, as you might imagine is always in a state of flux. Your body’s control mechanisms (stomach acid, efficient digestion of food, bile, immunity, motility, etc) are always working to keep intestinal bacteria in check, especially in the small intestine. But bacteria from the large intestine are often trying to work their way back into the small intestine where more nutrients are available.
I believe you can test negative yet still have periodic bouts or blooms of SIBO.
Other possible contributors to false negative results are:
1. Eliminating fiber and high residue foods from your diet well before the test. By doing this, you are actually beginning an intervention diet that helps control SIBO. I would like to see this practice adjusted to only limiting fiber the night before the test.
2. Using glucose instead of lactulose in the test. Glucose is absorbed very quickly and may not detect SIBO in some cases, but lactulose is not digested at all so can detect SIBO throughout the length of the small intestine.
My advice is to give the Fast Tract Diet a try. There is good reason to believe it will work for you.
Probiotics and Fermented Foods
I am taking Lactobacillus Plantarum probiotic supplement. Is this a good idea when having SIBO or would you recommend other strains of beneficial bacteria?
According to one recent placebo-controlled study, L plantarum was associated with improvements in pain, bloating and feeling of complete evacuation.
Keep in mind, this study enrolled more vegetarian men and the same results might not be realized in Westerners on different diets. But the paper references some other studies that also show some benefits (see discussion section), although one smaller crossover study showed no benefit.
All in all, there is enough here in my view to give this probiotic a try. This probiotic is well tolerated. Another more natural way to get L. plantarum along with other lactobacilli is consuming kimchi, sauerkraut and other lacto-fermented veggies.
Quinoa and Fermentation Potential
I am a vegetarian with SIBO. I did not see quinoa listed in the Fast Tract Digestion (FTD) IBS book. Can you tell me the Fermentation Potential (FP) for quinoa?
We will continued to add more foods in the FTD books when we update them. But, here is the quick answer. ¼ cup of dry quinoa (43 grams) has 14 FP points based on glycemic index of 35.
Note that the glycemic index was determined on cooked, cooled and microwave reheated quinoa. Freshly cooked quinoa would likely have a higher GI and hence, lower FP. But the bottom line is consume quinoa with a good degree of caution. If you do have some, make it fresh, limit the quantity to 1/2 cup, eat slowly and chew well. If you have symptoms, switch to a lower FP starch.
Klebsiella and Red Potatoes
In the Fast Tract Diet, red potatoes are considered low in symptom potential. But, they would fuel an overgrowth of Klebsiella, wouldn’t they?
If the gut becomes leaky, Klebsiella pneumonia can stimulate antibodies that cross react with types I, III, and IV of collagen and HLA-B27 antigen through molecular mimicry in people susceptible to ankylosing spodylitis and rheumatoid arthritis. In these cases, limiting the growth of K. pneumonia is a good idea.
How to best accomplish this is the question. Avoiding all starch (and other carbs) is certainly the best dietary option. I have communicated with AS expert Dr. Alan Ebringer in UK extensively on this topic.
But the idea behind the Fast Tract Diet is that easier to digest amylopectin starch has a better chance of being fully digested and absorbed compared to amylose starch.
For that reason, low FP starches (with high glycemic indexes and higher amylopectin / amylose ratios) are preferred if you want to consume some starch in your diet. And red potatoes are more waxy, higher GI and lower amylose than other varieties. Of course, any starch that is malabsorbed can feed this bacterium.
One strategy is to omit all potatoes early on and then reintroduce low Fermentation Potential potatoes like red potatoes gradually being sure to follow the pro-digestion strategies discussed in the Fast Tract Digestion books.
5 Hard-to-Digest Carbohydrates and SIBO
The Fast Tract Diet limits 5 hard-to-digest carbohydrates. Can some people tolerate some of these better than others or do we all need to avoid all five types?
Yes, some people can tolerate some of these carbs better than others. Northern Europeans rarely experience lactose intolerance. They have evolved in this regard. Their lactase genes are stuck in the on position. Approximately 80% of the rest of the world remains lactose intolerant.
Also fructose intolerance, though prevalent, it is not a problem for everyone.
There is also variability in people’s ability to digest starch based on amylase gene (needed for starch-digesting amylase enzyme) copy number. People with more copies of this gene can digest starch better than someone with few copies.
Lastly fiber digestion depends on each person’s complement of fiber fermenting gut microbes.
Given all that, my strategy is to limit all five carb types using the Fermentation Potential (FP) point system to control SIBO and symptoms. When symptoms are under control, people can add each carb type back in a controlled manner, thus determining their specific intolerance profile.
Digestive enzymes including amylase, lactase and xylanase offer an additional tool to improve carbohydrate digestion.
SIBO, Elemental Diet and Fast Tract Diet
I have SIBO. My dietitian advised me to do the Elemental Diet, but I can not find good information on it. What is your view on the diet compared to the Fast Tract Diet?
The elemental diet has been shown to be quite effective (80-85 percent cure rate) for people with SIBO because the only carbohydrate in elemental diet products is glucose which is easy to absorb and less likely to fuel SIBO.
Elemental diet products also contains predigested protein (free amino acids), and small amounts of fat in the form of easy-to-digest medium chain triglycerides. Lastly, the products contain essential minerals and vitamins.
But I would not recommend staying on the diet for more than two or three weeks as a whole foods diet is the healthiest in meeting our (complex) nutritional needs.
I recommend transitioning to the Fast Tract Diet after a couple of weeks. Keep in mind that full recovery depends on identifying and addressing any additional underlying factors that contributed to SIBO in the first place. The Fast Tract Digestion books and our consultation program can help with this process.
Red Potatoes and Symptom Potential
Re. the Desiree and Pontiac potatoes, they are red potatoes that are low in Fermentation Potential (FP) / symptom potential, but when I got to a store, none of the red potatoes are labeled. Are any red OK?
While I can’t guarantee that all red potatoes will have the exact same FP, red potatoes are considered “waxy” meaning they have less amylose (hard to digest) and more amylopectin (easier to digest) starch.
I recommend trying the ones you have access to. Make sure you cook them well (baked is best), consume them fresh. Eat slowly, chew well, limit serving size and don’t consume leftovers.
Flatulence, Cause and Dietary Solution
I have had horrible flatulence for over two years. What could be the cause and how to fix it?
Intestinal gas is produced by gut bacteria that ferment complex dietary carbohydrates and / or sugar alcohols as well as sulfur-containing amino acids from protein.
This could also be a sign of an imbalance in your gut microbiota or simply consuming too many complex carbohydrates.
The Fast Tract Diet should address this issue effectively because it is specifically focused on reducing excessive fermentation and the gas that goes along with it.
Inulin and Inulin Containing Supplements
Regarding the inulin in the products on gutsense.org, I am wondering if it is okay or must all people with reflux avoid all inulin.
Great question. Inulin, a prebiotic dietary fiber from plants such as chicory root, is not digested or absorbed. But it is fermented by gut bacteria.
As you know, I recommend limiting the fermentable carbs for people with IBS, GERD or other SIBO-related conditions. This supplement is no exception.
Though inulin, like lactulose may have mild laxative effects, the side effects (bloating, gas, belching, flatulence, reflux, cramps, etc.) are not worth the benefit.
I was looking at the supplements on the Gutsense page and notice that some (Ageless GI Recovery for instance) contain inulin, but the amount is very tiny – only 250 mg or 1/4 of a gram. This amount is very unlikely to cause any significant unwanted GI reactions.
If you are following the Fast Tract Diet and your daily FP points were 35 grams, taking this supplement twice a day would increase your FP points to 35.5 grams. No biggie.
“Fermentable Carbs” vs. “Fermented” Foods
What are the differences between fermentable carbohydrates vs. fermented foods? I am a bit confused.
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Fermented foods and its benefits for digestive health
I have been hearing that fermented foods are good for digestion. Can you explain why?
Fermented foods include yogurt, kefir, cheese, pickles, sauerkraut and other vegetables. The bacteria that drive the fermentation process are mostly lactic acid bacteria, though other types of bacteria can be used, for instance Bacillus subtilis for natto from soy beans and even molds, for instance for tempeh from soybeans.
Since fermented foods have already been fermented in the pickle or sauerkraut jar or yogurt culture etc., they are lower in carbohydrates and higher in short chain fatty acids (SCFAs), mostly lactic acid.
Here are some potential benefits from consuming fermented foods:
1. Fermented foods are low Fermentation Potential (FP). They have few remaining fermentable carbs so you can expect fewer symptoms such as bloating, cramps, altered bowel habits, reflux, etc.
2. Fermented foods contain lactic acid, butyrate and other SCFAs which are healthy fats our body can utilize for energy.
3. Fermented foods still contain many nutrients including vitamins – early American settlers depended on fermented foods to survive the winters.
4. SCFAs are acidic which is beneficial for our small intestine. Lactic acid is a natural preservative that bacteria in our small intestine also produce which helps ward off bad bacteria. Note: Acidic SCFAs also helps to extend the shelf life of fermented foods.
5. Fermented foods include some of the same species of bacteria that live in our intestines, especially small intestines. These bacteria can fortify our existing healthy small intestinal microbiota and help compete with bad or pathogenic bacteria.
6. Fermented diary helps with lactose intolerance because the bacteria produce the enzyme lactase.
Rice Mike and Fermentation Potential
I can’t eat soy, how about rice milk? Is it gut friendly?
Rice milk is a gut friendly choice having relatively few Fermentation Potential (FP) points. I would suggest unsweetened because it is easier to digest compared to the varieties with sugar added. You can add your choice of low FP sweetener if needed.
Here are the Fermentation Potential (FP) points based on the FP calculation:
- Rice Dream Unsweetened Rice Milk (per cup):
- Rice Dream Original Rice milk (per cup):
- Australia’s own natural rice milk (per cup):
- Vitasoy rice milk (per cup):
Thanks to all our readers for the continued questions and feedback, we continue to add more foods and beverages to be included in new editions of Fast Tract Diet books and a new Fast Tract Diet Implementation Guide due out this summer as well as a Fast Tract Diet mobile app due out this fall.
Cooked vs. raw veggies
Is there a big difference in Fermentation Potential points (i.e. symptom potential) between cooked vs. raw vegetables?
I don’t think it matters that much for lower carbohydrate veggies. For example cooked vs. raw carrots, the difference is only a couple of Fermentation Potential (FP) points as listed in the books, which indicates symptom potential.
But, it does matter for starchy vegetables such as peas, corn, plantains, grains, most root vegetables, and tubers. These have to be cooked really well to aid digestion.
If you do notice that certain raw veggies give you problems, I recommend either switching to cooked veggies, or reducing serving size.
Constipation, SIBO and Methane
I suffer from chronic constipation and recently tested positive for methane by breath test. What does methane have to do with constipation and do you think the Fast Tract Diet will help?
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GERD, H. pylori and Low Stomach Acid
Since I was diagnosed with GERD, I started reading a lot about it. What is your view on H. pylori & Low Stomach Acid being the cause?
This is an interesting question. I also wondered about this myself and dug into it.
H. pylori and low stomach acid are not a common cause of acid reflux, but may contribute to something called atypical non-acid reflux in some people. This article has the details.
Splenda and SIBO
I don’t like Splenda because it’s not natural and I have SIBO. This study suggests a negative effect on gut bacteria. What is your view?
I totally respect your view. The Fast Tract Digestion books also suggest several natural alternatives to sugar including stevia for instance.
The most important thing for SIBO is to limit fermentable carbohydrates in your diet which include sucrose (i.e. sugar which contains fructose) and fructose (i.e. fruit sugar) itself.
As for the study, I view these results with a pretty big grain of salt for the following reasons:
1. The study was paid for by the sugar industry (who doesn’t like competition)
2. It was done in rats (is it relevant in humans?)
3. It has conflicting data (lack of a dose response)
Also, the study was discredited by an expert panel of scientists which concluded that “The study conclusions are not consistent with published literature and not supported by the data presented.”
At the end of the day, science is the judge. I continue to monitor studies on Splenda and other sweeteners and will post on these as they are published.
Jasmine rice and Fermentation Potential
There are two kinds of Jasmine rice, brown and white. Which one would you recommend?
I recommend white jasmine rice because the Fermentation Potential (FP) points are very low.
About brown jasmine rice, the FP is unknown because glycemic index data is not available as far as I know, which makes difficult to derive its FP points.
But, because brown rice is less processed in general, fibrous carbohydrates (bran and germ layers) will impede digestion over white jasmine rice.
FP Calculator and Glycemic Index
I want to use the free online FP calculator, but can not find Glycemic Index (GI) for the food I am interested in. What would you suggest?
Here are a couple of websites where you can look up GI values: Mendosa.com and The University of Sydney website.
Though GI values exist for approximately 3000 different foods, many are culturally specific. Unfortunately, a GI value is not available for every single food in the market place.
The reasons being:
1. There are so many foods to test.
2. The test is expensive as it requires extensive testing on 10 people.
3. Testing of some lower carbohydrate foods is difficult because the test subjects must ingest a serving size with 50 grams net carbs.
If you can’t find a GI value, I recommend plugging in an average GI value of 50 for an estimate of the FP. For lower carb foods, the GI doesn’t actually matter that much and higher carb foods generally have been tested for GI.
The Fast Tract Digestion books list the Fermentation Potential (FP) or symptom potential for over 350 common foods including 60 vegetables. The books also give daily allowances of FP as part of a complete dietary solution. The Fast Tract Diet mobile app is another great resource, which has greatly increased the number of low FP food choices and included meal planning, point and symptoms tracking, voice recognition to look up foods on the fly and a built in FP calculator
IBS and Gut Microbiota
The Fast Tract Diet seems to starve all types (good & bad) of gut bacteria for my IBS. The ultimate goal to re-balance the microbiota is to use fermented foods and sometimes even antibiotics and antifungals, isn’t it?
The diet does not “starve” gut bacteria. The diet limits (not eliminates) hard-to-digest fermentable carbs that feed gut bacteria. Gut bacteria are also fed by fermentable animal-based foods as well as fermentable mucus carbohydrate side chains that our own body produces.
People with IBS have been shown to have less diverse gut bacteria with an overabundance of gas-producing carb-loving firmucutes bacteria. In other words, too many fermentable carbs can actually decrease the diversity of your gut microbiota.
Another way to dramatically disrupt the microbiota is taking antibiotics which do not discriminate between healthy and unhealthy gut bacteria. Seems we have quite different views on this subject.
This diet strikes at the underlying imbalance not just the symptoms. The Fast Tract Digestion IBS book also dedicates an important chapter to evaluation and correction of other potential underlying contributing causes.
I believe the single most important underlying cause of IBS in most people is the modern Western diet.
SIBO and Resistant Starch
Can you comment on resistant starch? I have been on the Paleo diet and I learned that resistant starch should be helping small intestinal bacterial overgrowth (SIBO).
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How come honey which is high in fructose is allowed on the Fast Tract Diet (FTD)?
The FTD actually recommends limiting fructose-containing foods including sucrose, honey and maple syrup. But technically no food is illegal.
It’s all about counting the Fermentation Potential (FP) grams for the serving sizes of any food and making sure the overall FP points are within the limits for individual meals and overall daily totals.
For example, if you have one teaspoon of honey in your tea, you will add relatively a small amount of FP. Not too bad, but it can add up if you use too much.
SIBO Diets and Half and Half
Question: Most diets for SIBO say don’t eat milk products. If I take half and half in tea with a lactase pill, am I going to be OK?
Answer: Yes, you should be fine. But milk and milk products also contain several oligosaccharides that behave as dietary fiber, which can be problematic in higher quantities. Therefore even lactose-free products still have fermentation potential (FP).
But since only a small amount of half and half is needed for tea, the FP value would be fairly low, particularly if you take a lactase pill.
Psyllium Husk and IBS / SIBO
What is your opinion on taking psyllium husk for my IBS / SIBO?
Above what you get from green stalked and leafy vegetables, I don’t think fiber is needed. In many people, fiber supplements make symptoms worse.
Also, some fiber supplements contain lots of sugar which is half fructose. Symptomatic fructose intolerance is very common.
Lastly the FDA has warned of choking and intestinal blockage risks associated with fiber supplements. I don’t recommend these supplements, but if you try them, experiment with small amounts and drink lots of water.
GERD with Hiatal Hernia
Does the Fast Tract Diet work for GERD with hiatal hernia?
Having a hiatal hernia is a bit like wearing tight clothes or being pregnant. Because the hernia is essentially the top part of your stomach being pinched above the diaphragm.
There is often extra intragastric pressure (pressure in your stomach) that can trigger reflux. The Fast Tract Diet (FTD) is designed to reduce this intragastric pressure at the source, gas produced by overgrowing bacteria in your intestines which is fed mostly by unabsorbed carbohydrates.
There is every reason to believe that the FTD will help even in the presence of the hernia, but you might have to be extra diligent reducing FP points even more and following the proabsorption behaviors in the Fast Tract Digestion Heartburn book.
Pregnancy and GERD
I am 9 weeks pregnant and having a terrible time with GERD. Is the Fast Tract Diet safe?
The Fast Tract Diet (FTD) is based on whole healthy foods and is fine for pregnancy. I am aware that gestational diabetes can arise half way into pregnancy sometimes. But, that is not an issue with FTD as the daily carbohydrate count of its meal plans is approximately 75 grams per day.
GERD and Asthma
The Fast Tract Diet helped my GERD and asthmatic symptoms. Why does the diet work for asthma?
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Fermentation Potential (FP) and FP Calculator
What is Fermentation Potential (FP) in the Fast Tract Diet and how does it work?
FP is a mathematical formula that measures the symptom potential of foods. High FP foods are more likely to drive small intestinal bacterial overgrowth (SIBO) and other SIBO related conditions including acid reflux, gastroesophageal reflux disease (GERD), laryngopharyngeal Reflux Disease (LPR) and irritable bowel syndrome (IBS).
The Fast Tract Diet is based on the idea that certain carbohydrates are difficult digest because of their molecular structures in food chemistry. Difficult-to-digest carbs are more subject to malabsorption (a failure to be fully absorbed from the gastrointestinal tract). And they tend to persist in the small intestine, which potentially feeds blooms of SIBO.
Unless you are a nutritionist, it’s hard to know what types of carbohydrates are in each food and how much. The Fast Tract Diet solved this problem with FP. Give the free online FP calculator a try to see how it works
Specific Carbohydrate Diet
In the book, Breaking the vicious cycle, apple and banana are listed as legal foods. What is your view?
Breaking the Vicious Cycle (Specific Carbohydrate Diet, SCD) is a groundbreaking book that helped bring to light the connection between diet and gut microbes in digestive health.
That being said, the SCD does not limit fructose or fiber consumption, but the Fast Tract Diet (FTD) does. Both apples and bananas have high Fermentation Potentials (FP) because of fructose in both fruits, and also resistant starch (up to 37%) in the case of bananas. Therefore, they have significant symptom potential.
You can still consume apples and bananas on FTD, but adjust the amount. For instance, start with one quarter of an apple or 1/3 of a ripened banana once your symptoms are under control. For more info. on the difference between SCD and FTD, refer to my blog article on SIBO Diets.
I feel hungry being on the Fast Tract Diet. What do you suggest?
The diet reduces fermentable carbohydrates: therefore, you need to replace calories with low fermentation potential (FP) foods, proteins and fats.
I am a little concerned about the lack of fiber for long term in the Fast Tract Diet, especially for my constipation. Thoughts?
There is much more fermentable material (both from plants and animals) in our diet than we realize.
30-45 grams of fermentable carbs (FP points) per day is plenty to keep our microbes happy but not enough to make those of us with lower tolerance ill.
Unfortunately, the many health claims on dietary fiber are not supported by current research. And the dark side for digestive health is real.
As for constipation, a recent study reported that stopping or reducing dietary fiber intake actually reduced constipation.
FODMAPs vs. Fast Tract Diet
I want to try the Fast Tract Diet, but I have grown so confused dealing with all of the conflicting food advice. FODMAPs suggests avoiding onions, garlic, artichokes, asparagus, avocado, beets, broccoli, green beans, mushrooms yogurt etc.
The FODMAP diet is an elimination diet. But, the Fast Tract Diet uses a quantitative approach based on Fermentation Potential (FP). For this reason, reasonable sized servings of vegetables that contain small amounts of FODMAPs are still acceptable as long as you keep your overall FP levels in line with recommendations.
For example, a few small cloves of garlic do contain a FODMAP (fructose oligosaccharide) but only a couple of grams which is also reflected in the FP value. So by following the low FP approach, you are also controlling FODMAP levels, but in a quantitative manner as opposed to just eliminating any food with even a trace of FODMAPs.