Wednesday, November 13, 2013

HOW TO CURE SIBO, Small Intestinal Bowel Overgrowth: Step #2 Eat Resistant-Starch-Rich Tubers, Grains, Legumes and Pulses

The second step in Dr. BG's 7-Steps Paleo* Gastro IQ SIBO Protocol is:

"Ancient heirloom potatoes, tubers, roots that are low glycemic index (or high if good insulin sensitivity) and ancient heirloom grains, legumes, lentils/dal that are low glycemic index (or high if good insulin sensitivity), prepared the ancient way (soaked, fermented, etc)"

Potatoes, tubers, roots, grains, legumes, and lentils have been alongside man throughout our evolutionary past. Eating these foods is very important in keeping our gut microflora in top-notch condition. You saw in the Fat Burning Beast blogpost that a digestive system starved of carbohydrates, fermentable fiber, and butyrate leads to a high risk of colon cancer, but it also leads to a dysfunctional and less prolific gut microbiome.

The Standard Western Diet leads to a Standard Western Microbiome, one that has been starved of healthy, fermentable fibers, flooded with antibiotics, and allowed to proliferate with pathogenic bacteria. This leads to inflammation, metabolic syndrome, and auto-immunity. On the other hand, A paleo diet, with near complete avoidance of refined sugars, flours, gluten, and vegetable oils and plenty of starchy, fibrous plant matter will produce a functional microbiome, replete with beneficial bacteria, flooded with short-chain fatty acids, and ensure immune system homeostasis, glucose regulation, vitamin and mineral uptake, and production of vital hormones and neurotransmitters.

Often times when starting a paleo diet, one restricts carbs. This is an effective strategy for weight loss and may help eliminate unhealthy sugar cravings, but in the long run carb restriction will most certainly lead to a dysfunctional gut microbiome.  Both the Perfect Health Diet or Mark's Daily Apple Diet outline the optimal amount of starch that one should include in their diet. A daily food intake that is roughly half plant matter, including up to one pound of starchy foods is highly recommended.

[Grace~~ Dispelling fairy tales: I love Paul and Mark. (Particularly Mark's pectorals and gluteals and how he recognizes a good thing like RESISTANT STARCH for the gut microbiota and insulin metabolism) We have all evolved but I'm not certain if their respective diets entirely have.

What I like about PHD is the 150 grams per day advice for adrenal dysregulation because ketosis/VLC will instigate susceptible adrenals into hypercortisolism, and subsequent low adrenal and low T3 thyroid syndromes. PHD can heal this. However, the reliance on white rice and not the whole grains, whole legumes and RS-rich tubers will lead to gut dysbiosis for those who are vulnerable. Adding these back in are thus imperative. If I consumed 150 grams of high GI (glycemic index) white rice daily, I'd be T2DM within two seconds.  But if I consumed 150-200 grams of low glycemic index carbohydrates that included RS-rich starches, grains, and tubers, ME AND MY MICROBIOTA ARE GOLD *wink wink*.  And the net carbs are 75-100 grams/day.

MDA has two (ancient) popular posts which offend my gut ;) and the microbiota... (1) The Primal Carb Continuum and (2) All Grains are Unhealthy.  Fiber IS INDEED good for us (and Mark says so HERE).  They feed your microbiota and heal SIBO and promote gut longevity, proper processing requires soaking and fermentation of whole grains, legumes and pulses to make them edible.  So Mat Lalonde has already banished the lectin myths. Please see his AHS 'Invalid Inferences'...  How to make our legumes and whole grains work for us? Soak, soak, soak which ferments the starches. Soaking brings alive the microbes that reside on the grain or legume/pulse.  If Gluten Small Grass Grains and unsoaked legumes wiped out the Neanderthals, then it is perhaps food technology that brought Anatomically Modern Humans to the Great Leap Forward 40,000 to 50,000 years ago.]

If 'carb restriction' means eliminating gluten, industrially processed flour, and refined sugars, that is perfect! If it means eliminating potatoes, rice, and most other whole, starchy foods that's a problem.

The purpose of this blog is to teach you how to chose and prepare starchy, fibrous food in a way that will lead to a high Paleo* Gastro IQ.

Everyone knows potatoes and rice, but there is a whole host of other foods that fit the bill for exceptional gut health and getting a variety of these foods is extra-important when healing a broken gut. It would be a very wise move on anyone's part to seek out some of these:

Green Bananas
Mt Uncle's Raw Ladyfinger-Banana Flour (high resistant starch content)
Jobs tears/Adlay/croix
Brown rice
Purple rice
Red rice
Black rice
Fermentation/Soaking Tips
Journal Source: HERE
Basmati white rice
Basmati red rice
Mung beans
Green beans
Red beans
Kidney, black, fava, navy, etc beans
Steel cut oats
Chana dal
Okinawan purple potatoes
Andean purple potatoes
Nagaimo (Chinese white mountain yams)
Raw or Roasted Potatoes

The list goes on and on, but you get the picture--no need to rely only on potatoes and rice! Each different variety packs a different punch. Beans and lentils are often frowned upon in paleo circles, but when properly prepared, they are one of the most nutritious foods on the planet.

When it comes to grains and legumes, one of the biggest problems is phytates. An exceptional write-up on phytates and how to remove them can be found here. "...phytic acid does indeed bind with minerals such as calcium, phosphorus, iron and zinc. If you depend on grains and legumes for a high portion of your diet, then those phytates (phytic acid) could lead to mineral deficiences." Fortunately our ancestors found ways to remove phytates and these methods can be used today to make these evolutionary important foods safe. It would be of great benefit for you to learn the techniques of sprouting and fermenting to increase your range of healthy foods.

A very interesting grain known as Job's Tears, Chinese Pearl Barley, or Adlay has some remarkable properties including effectively alleviating osteoporosis, leukemia, and rheumatism. Oats are an interesting topic of much debate, and don't let a Gluten-Free label fool you! Dr. BG said of Gluten- Free foods in 2010:

"Personally I believe gluten-free is not enough for an ultimately optimal lifespan and health. Gluten-free products often still are refined, vastly processed and full of high carbohydrates and problem oils (oxidized, pesticide-laden crops of omega-6 canola, safflower, cottonseed, etc) which spike and increase blood glucoses (BG) and promote silent inflammation. Chronic silent inflammation leads to cancer, obesity, fibromyalgia, mood disorders, arithritis, weight gain, osteoporosis, diabetes, heart attacks and strokes.

Gluten free however alone improves stomach and GI symptoms including bloating, constipation, bloody stools, iron deficiency anemia, chronic fatigue, IBS (irritable bowel syndrome), and gut dysbiosis."

The best advice we can give you is to include plenty of starchy carbs in your daily menu planning and learn to broaden your horizon. The more variety in your diet, the better profile your gut microbiome will develop.

If you have any questions or concerns about our food list or want to see any added, please comment!


Aaron said...

Hello Tim,

I have a question. You say 'The more variety in your diet, the better profile your gut microbiome will develop'. This makes intuitive sense, but Dr. Ayers of the Cooling Inflammation blog gives the opposite opinion in his latest post stating 'If the diet is fairly constant, then the diversity of the population (of gut bacteria) gradually increases'.

I'm sure you're aware of Dr. Ayers and that he knows his stuff about gut bacteria. How do you reconcile his take with your advice?


Tim Steele said...
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Anonymous said...

Agree with you entirely, Tim. Dr. Ayers has to evolve and read some current research. I'm sure he was blindsided by studies linking rheumatoid arthritis and T1 diabetes with disbacteriosis of microbiome. Who would have thought: Prevotella copri!

It's like putting a predatory snakehead fish into your neighborhood pond.

Anonymous said...

Tim/Dr. BG,

1) From what I've read here and personal experience, I'm pretty convinced that RS is therapeutic for people with messed up gut biomes, and generally beneficial to all. But can it really be a prereq for good gut health? There must be plenty of people who don't consume much RS and have in tact guts. How else to explain the near-carnivorous Mr. Pottenger's bionically badass biome?

2) Are lacto-fermented foods really such a good idea for people with SIBO? SIBO involves an overgrowth of even normally beneficial organisms, especially D-Lactate producing ones. How does adding more of these help?

Tim Steele said...
This comment has been removed by the author.
Alison said...

This is the most informative blog I have found on the whole SIBO/pale/carb debacle. After years of no gluten, sugar/fruit and basically zero carb, I wound up with the most damaged gut and toxic liver a person could have and was wasting away. Couple that with loads of stress, an iatrogenic steroid overdose and everything crashed - gut, immune system, hormones. I've been wracked with gut infections, SIBO, parasites and fungal species for the last 4 years. I have been doing ALL the wrong things - a completely carb free a la GAPS, FODMAPS and SCD (but no fruit or honey) has only served to further my decent into Hell and crash my adrenals. As a former athlete, this has been devastating. Everything you have said makes sense, especially when I see almost no butyrate on my stool tests but a lot of other pathogenic critters.Where can I get some more info on the proper way to ferment grains and vegetables? Do you have any instructions available on this blog or elsewhere? Thanks so much for your invaluable and very possibly life saving suggestions.

Dr. B G said...

Hey Alison,

I hear ya. I've done many of the things that you've done as well (and being BLINDO, I didn't see the adverse effects on my athletic performance and should've stopped immediately).

Sandar Katz has amazing books for fermenting foods. Have you read him?

Please keep us updated with your progress! I'm so pleased that you are using the integrative medicine stool testing to figure out what is going on. UR SO ADVANCED~!!

Webraven said...

Dr .BG and Alison,
Me too!

Stress ( all types; emotional, surgical, antibiotics..-> disgruntled gut. In my attempts to fix it and it's attendant sequel are I've screwed myself up more every step of the way. Poor T3-T4 conversion was treated with meds instead of gut/stress treatment. I've SCD'd (( could never get out of the intro stage, but 3 months of it left me unable to digest any fruits and veggies, basically) and VLC'd and IF'd myself from tried with a bad gut to adrenals exhausted and a very screwed up and learn, right?

I suspect that a lot of the VLC and IF advice should at the very least be significantly adjusted for women. Especially stressed women, which is most of us -what with the dual and triple responsibilities women have both biologically and socially.

Grace, following your story on your fantabulous blog, am I assuming correctly that your fantastic weight loss attained in part with the prolonged cardio regimen you describe came before (lead to?) your adrenal problems? So many people, again women especially, seEm to be walking ( or rather, running :-)) right into this booby traps seduced by success stories ( with no long term follow up, btw) r dramatic body composition improvements from VLC Paleo, IF and the whole nine.

Thanks for sharing, it is encouraging to feel one isn't alone in this boat!

Dr. B G said...

Hey Webraven,

I totally concur "I suspect that a lot of the VLC and IF advice should at the very least be significantly adjusted for women. Especially stressed women, which is most of us -what with the dual and triple responsibilities women have both biologically and socially."

Actually the great majority of my wt loss was VERY SLOW and by doing long distance running eating croissants, sprouted wheat and peanut butter and jelly all day. It would've been faster on rice and glutenfree -- but at the time I didn't know better. Frankly I became too skinny at 110-112 Lbs and found Xfit that raise my muscle mass and I gained wt to 122# which was much more normal.

VLC was VERY VERY VERY bad for adrenals after I attempted and failed (and subsequently had a horrific biking accident) to ketoadapt for 9 months. You are right on, hawwt grrl. Women perhaps are not genetically built or in modern times our lame, sucky adrenals preclude extremes like VLC or IF'ing.

Webraven said...

Thanks for commenting drBG-
Yeah, if it's true that even HG men eat more protein than the women (easy to see how this would have developed from their different roles in procuring food), and women being gatherers probably are/were nibbles, too, it makes sense even from that perspective that women wouldn't have developed to need and tolerate VLC and IF the same way men would.

bTW, I can't find a way to subscribe to comments here, what am I missing?

Mistress Distress said...

Hi, is there a list of low glycemic tubers and grains appropriate for the insulin resistant? Also how do you find ancient heirloom versions of these?

Tim Steele said...
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Mistress Distress said...

Thanks Tim, I'm starting to experiment, and its hard to not want very specific rules and guidelines but I guess that s not very realistic. I've been through many diets over the years trying to address IBS-D, leaky gut, and possible SIBO. the more I tried the worse I seemed to feel and I could never go long without cheating with cookies or chips or chocolate, etc. Chips (potato or corn) always seemed to normalize my bowel movements the new next day (it I often diarreah) and I wonder if it's because of the starch. I'd been scared away from starch from the paleo and primal crowd, and also learned this year I'm prediabetic.. but I'm willing to give this a shot. Unfortunately my soaked stone ground oats cooked this morning did not agree at all. I've got soaked lentil and sprouted quinoa waiting for further experimentation. Should I incorporate SBO probiotics right away (I haven't taken them before) or do each of the 7 SIBO steps require waiting?

Anonymous said...


I have been reading this blog with much interest and wondered if you could point me in the right direction. I have been on the GAPS diet for the last 10 months due to the extreme bloating, gas and constipation I have been experiencing. This has helped greatly however I am now sensitive to some GAPS foods which are all high FODMAP foods. Would you advise moving straight into the 7 steps to cure SIBO diet (to get Resistant Starch into my diet) or should I do a FODMAP diet first to try and dispel the existing intolerances? After 10 months of very little starch on GAPS I am wondering if I should just dive right in and get some RS into my system.
Thank you for your wonderful blog!

Unknown said...

Hi Dr. BG / Tim,

I get joint / skin symptoms when I eat fructans or digestible starch - but not when I eat extremely unripe plantains. Do I need to "weed" first? How do I go about "weeding"?

I've yet to try unmodified potato starch because I'm worried about nightshades (I stopped eating them since getting diagnosed with an autoimmune disease).

Unknown said...

Also, am I not ready to start this 7-step SIBO plan if I can't tolerate starch?

Lisa and Savannah said...

Are any SIBO sufferers finding that legumes make there symptoms worse, even when properly soaked and prepared? I've been following the RS steps on this blog and have experienced great results. However, I still can't have beans or dairy (fermented or not). Both seem to exacerbate the SIBO. While many of my ailments resolve with RS (i.e. dandruff, acne, keratosis pilaris, weak nails, etc.), once I eat certain foods like beans, dairy and cruciferous veggies, the symptoms return. I'm wondering how I can get over the hump and heal my gut for good, so I can enjoy these foods again.

Unknown said...


I saw on your food list 'Steel cut oats'. Do you think this is a good food to eat? I know it has a good RS content eaten raw but I thought it was unhealthy in other ways?

I'd appreciate your comment on this and love your blog.



Dr. B G said...


Like all fiber or new foods, the gut requires time to respond and acclimate.

James L.

I discuss weeding on this post

Have you done testing? Gut testing reveals what needs to be weeded.

Oats are mainly beta glucan and other fiber which are fantastic for the microbiota. Some people do not tolerate if there is gluten cross contamination. The RS content is high when raw but after cooking it goes to almost 1 g or less per serving. Raw oats are problematic for lectins and phytates which bind iron and other vital minerals and cause deficiencies in human trials.

Anonymous said...

Has anyone tried lotus root as a source of RS? It's pretty lowcarb and tastes great fried!

Anonymous said...

Has anyone tried lotus root as a source of RS? It's pretty lowcarb and tastes great fried!

Dr. B G said...

Love lotus roots in Shanghai! Love the crunchiness and versatility blanched in salads or stuffed with meat or sweet glutinous rice as a dessert. Beautiful holes. did you get fresh ones in the USA?

Lisa and Savannah said...

Any SIBO sufferers ever tried Silver Hills' sprouted ancient grain bread? I'm wondering if this would be safe because the grains are sprouted. I'd really love to get the health benefits of the ancient grains.

Dan said...

You guys seem to really know your stuff! I commented on another post here, but then read alot more and now have some more specific questions.
I have Ankylosing Spondylitis, so I am following a no starch diet. But I do beleive the key to really healing is a healthy gut biome. How do you guys think I should procede, regarding RS? Meaning how can I incorporate it without feeding the Klebsiella or whatever it is that is causing an immune response, and consequently, flares of intense join pain?
I am also interested in getting a stool test to determine what bugs I do have in my gut. I saw in one post the author asked if anyone wants to get tested - I do.



Dr. B G said...

Hi Dan

You sound like you read part 5 of when to avoid RPS? The sooner you can get on potato starch or other roasted tubers if you can seed the gut with good flora and weed out potentil starch eaters and RS eaters in the uppergut that cause sibo. AS like nearly all western civ diseases is sibo

If you click on my name I'll let you know how to order testing soon