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Confused about what to eat while you and your healthcare provider are treating your SIBO?

Sifting through all the “SIBO diet” information on the internet and feeling overwhelmed?

Or maybe you’re afraid you’re going to eat the “wrong” thing and it’s going to derail your progress or trigger a relapse?

Regardless of how you’re feeling, you have probably come across the Bi-Phasic Diet at least once during your research. Like any elimination diet, there is a lot of misinformation and misunderstanding around how this diet is supposed to be used. 

This article is going to breakdown what the Bi-Phasic diet is and how it came to be, what makes it so controversial, and finally, it will provide best practices for treating/managing your SIBO long-term.

So buckle up, we’re about to get REAL!

What is The Bi-Phasic Diet?

Dr. Nirala Jacobi, a leading doctor in SIBO research and treatment, created the Bi-Phasic Diet. It is based on another naturopathic doctor’s guide, the SIBO Specific Food Guide, and is designed to get rid of all the unwanted bacteria in the small intestines.

The best SIBO treatment plan is designed to take you through phases of treatment. The first phase is the eradicate/kill phase. The second phase is to repair the damage in the gut that caused the overgrowth to begin with (remember, SIBO is symptom not a root cause). The third phase is all about sustainability and preventing a SIBO relapse.

The Bi-Phasic Diet Protocol has two phases of its own and is designed to be implemented alongside an herbal/antibiotic treatment. 

Bi-Phasic Diet Phase 1 (4-6 weeks):

This phase is designed to starve the bacteria that are growing out of control in the small intestine by limiting fermentable starches and fiber. You and your healthcare provider should also focus on repairing the intestinal lining (i.e., leaky gut) and restoring proper digestion. Two of the most common underlying issues are slow gut motility and low stomach acid.

Depending on the severity of your symptoms, you will either follow the phase 1 restricted diet or the phase 1 semi-restricted diet. The semi-restricted diet allows for a few more foods to be included based on your tolerance.

Here are the basics of what’s not allowed during Phase 1 (go here for a complete list):

• Dairy
• Starchy vegetables (i.e., white or sweet potatoes)
• Onions, garlic, mushrooms
• Canned fruit in fruit juice
• Legumes/pulses
• All grains (except if practitioner OK’s rice and quinoa)
• Peanuts, chia or flax seeds
• Agave nectar and maple syrup, xylitol
• Palm oil, soybean oil
• Soft drinks and energy drinks
• Wine, beer, dark liquors/spirits

Bi-Phasic Diet Phase 2 (4-6 weeks):

This is when antimicrobials/antibiotics will come into play. The goal is to kill off any remaining bacteria that were not starved to death in Phase 1. The diet protocol will become a little more lenient so that the remaining bacteria can grow slightly and the antimicrobials/antibiotics will be more successful. You will also continue to work on addressing the underlying conditions and repairing the gut.

Additional foods allowed during Phase 2 include:

• Homemade yogurt, butter, and aged cheese (i.e., parmesan and pecorino)
• Small amounts of red, green or brown lentils and lima beans
• Raw cacao
• Tamari, miso, fish sauce

So there you have it, those are the basics. But there is no-one-size-fits-all treatment for SIBO (or for any health condition for that matter). The next step is to put our critical thinking caps on and to analyze whether this is the best treatment plan for us.

The Bi-Phasic Diet Controversy

The controversy is similar to what surrounds any elimination diet, the diet is very restrictive and is often mistaken to be long-term or even life-long.

Many people, myself included, have spent years living in digestion misery, struggling to identify the cause and how to treat it. So it’s understandable that once you find out that you have SIBO, you are willing to follow any diet or suggested treatment plan to find relief. However, as outlined above, this diet is meant to only be followed for about 8-12 weeks depending on the severity of the overgrowth.

It is also meant to be followed under the supervision of a gut health specialist. This is a critical piece because of the risk of nutrient deficiencies. It is important to remember that nutrient deficiencies don’t present themselves overnight. You also need to know what you’re looking for.

For example, a vitamin D deficiency results in less calcium being absorbed. If this deficiency is long-term it will result in a bone mineralization defect called osteomalacia, or soft bones. This isn’t going to be noticeable to the untrained eye and can have a lifelong impact on your health.

Your practitioner should be monitoring your blood labs and may recommend certain supplements to take while following the treatment plan based on those labs.

Another point to remember is that following a strict elimination diet long-term can take its toll on your relationships. It can be challenging to participate in family gatherings or nights out with friends and can feel very isolating. Believe it or not, your social/emotional wellbeing is just as important as your physical wellbeing when it comes to resolving your gut issues.

The Healthy Way of Treating Your SIBO

Follow the 3-step process:

1. Eradicate
2. Repair
3. Sustain

Step 1: Eradicate

Per the direction of my practitioner, I started the herbal antimicrobials while following my “normal” diet. The length of time I took the antimicrobials was based on my SIBO breath test results, which was about 4-5 weeks. This initiated the kill phase.

Step 2: Repair

This step is crucial because the fact of the matter is, if you don’t address what allowed your SIBO to develop in the first place, it will come back again, and again, and again, and again…

Low stomach acid and slow gut motility are two of the most common culprits, but hypothyroidism is another potential cause. The gut plays an integral role in regulating the body’s hormones, so it’s worth looking into if you’re having a hard time getting to the bottom of your issues.

Repairing the gut should be done in conjunction with an elimination diet to starve off what’s left of the “bad guys”. I followed a combination of the low-FODMAP and Candida diets for about 12 weeks. While I was following this diet, I was also working with my practitioner to repair my underlying cause, which was VERY slow motility.

There are a variety of diet plans that can work for this step, including the Bi-Phasic diet. Work with your gut health specialist to figure out which one is best suited for you.

Step 3: Sustain

Remember, this does not mean you will be following this diet plan forever. In fact, this step is kind of a misnomer. Maybe a better title would be “identify your triggers and learn how to manage them while still eating as diverse a diet as possible,” but that’s little long.

The point is, please, please, please don’t skip the reintroduction phase. This is the phase of all elimination diets where you slowly and strategically reintroduce the foods you’ve cut out to identify which ones are your triggers. Because – reality check time! – it is highly unlikely that all the foods you’ve eliminated cause you problems.

This is another reason why it’s soooo important to work with gut health professional. Because they will know how best to navigate the reintroduction phase while minimizing symptoms and reducing the risk of a SIBO relapse. The end goal should always be to be able to comfortably enjoy as diverse a diet as possible.

Lifestyle Changes to Consider

Diet isn’t everything when it comes to cultivating a healthy gut. There are easy lifestyle changes that can make a big difference in your gut health journey.

• Slow down and remove the stress while eating. Your body needs to be in a “rest and digest” state for best digestion.
• Do 3 rounds of square breathing before each meal.
• Chew food until it reaches an applesauce consistency.
• Drink 75-100 oz water/day.
• Aim for 30g of fiber/day.
  • Try cooking veggies for better tolerance
  • Kiwis and chia seeds are great low-FODMAP sources of fiber
• Limit alcohol if you find it triggers symptoms.

Final Thoughts

All in all, the Bi-Phasic diet can be incorporated into a healthy and effective SIBO treatment plan, but it’s not going to work all on its own. Find a trusted gut health specialist to help guide and support your journey and stay focused on the big picture.

The overarching goals should always be to give yourself the tools needed to confidently manage your symptoms, to release yourself from the constant cloud of “food fear” and body distrust, and to enjoy eating with loved ones again.

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