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Bi-Phasic Diet for SIBO: Is it Right for You?

Are you curious about the Bi-Phasic Diet? Did your doctor recommend this diet when you were diagnosed with SIBO? You might have done some research yourself, and are wondering if this is the right way to go.

Before you start a complicated food regimen, you want to know that it can help.

Most importantly, is the Bi-Phasic diet the right diet for YOU?

Let’s find out what the Bi-Phasic Diet is, how it works, and some of the pros and cons of following this diet.

What is the Bi-Phasic Diet?

Dr. Nirala Jacobi designed the Bi-Phasic Diet to provide a structured approach to treat her own SIBO patients. It combines the Low FODMAP diet used to treat IBS, and the Specific Carbohydrate Diet developed as a treatment for Celiac Disease.

The Bi-Phasic Diet is a temporary diet. It restricts the nutrients that you can eat, so you should not follow it long term. You can follow this diet for up to three months. Each individual’s response to the foods determines how long they spend on the diet.

How the Diet Works

The goal of the Bi-Phasic Diet is to curb the growth of bacteria in the small intestine. But wait, you say, isn’t it good to have bacteria in your gut? Yes it is, but the bacteria should be in your large intestine. 

In the large intestine, the bacteria feast on indigestible food fibers from plants. Nutrients like sugars, proteins and fats are mostly absorbed.

When bacteria take up residence in your small intestine, they start eating foods, mainly carbohydrates and sugar molecules, before your body has a chance to absorb them. The bacteria produce gas, which begins to expand your gut. You know the rest of the story.

SIBO stands for small intestinal bacterial overgrowth, and the Bi-Phasic Diet aims to get rid of these bacteria, or push them down into the colon where they belong.

As the name implies, this diet has two phases. The purpose of the phased approach is to let the bacteria die off more slowly. Those little bacteria don’t always go gracefully, and sometimes “die-off” can provoke a lot of uncomfortable side effects.

Phase One: Reduce and Repair

Phase one of the Bi-Phasic Diet lasts for about six weeks. This phase eliminates all grains, legumes, sugar and dairy. Garlic, mushrooms, white and sweet potatoes, onions, starch powders and canned vegetables are off limits. 

The only fruits allowed are lemon and lime. In phase one, you avoid canned, processed and fermented foods. This phase restricts most beverages, except black coffee or tea and herbal tea. You must also stay away from chia, flax, peanuts, palm and soybean oil.

In phase one, you start out in a restricted category, and when your symptoms begin to improve you can move to semi-restricted. Some people might start out on a semi-restricted diet if they need more energy or calories. Your doctor or nutritionist can give you some guidance here. The semi-restricted diet allows some starches like rice or quinoa, has a few more options for fruits, and you might even be able to imbibe in clear spirits occasionally.

At this stage you might take some supplements that can help your gut lining to heal, or enzymes to kickstart the digestive process.

Phase Two: Remove and Restore

In phase two, we ramp up the war on the bacteria in the small intestine. You have reduced the amount of bacteria in phase one by starving them of their food, and now you move in for the kill with antimicrobial and / or antifungal preparations. 

This is not a prescription antibiotic. It is an herbal preparation which is going to be more gentle, but still highly effective in culling the bacterial population in your small intestine. There are several preparations that you can take. This where a professional can help you sort out the best one for you.

In phase two you might also take a prokinetic to improve the movement in your digestive tract. This can help to move bacteria and undigested food down into your colon. 

Phase two of the diet allows more foods. You can eat butter, aged cheese and homemade yogurt. Everyone can have rice and quinoa in phase two. 

In phase two you can eat lentils, lima beans and some added sweeteners. You have the green light to drink clear spirits if you really must, although we strongly recommend no alcohol at all.

Phase two of the diet lasts another 4-6 weeks. After this you will want to keep adding foods back slowly and testing to make sure that they are not triggering your symptoms. The process of adding foods can go on for a while, depending on how sensitive you are.

FAQs for the Bi-Phasic Diet

Who should go on the Bi-Phasic diet?

The Bi-Phasic Diet is designed for people who have been diagnosed with SIBO.

How long do you stay on the Bi-Phasic diet?

If all goes well, you will be on the Bi-Phasic Diet for about three months.

Can you drink alcohol on the Bi-Phasic diet?

Alcohol is damaging to the gut lining. You should avoid alcohol when your gut health is compromised. That being said, the Bi-Phasic Diet allows clear spirits like gin or vodka in the semi-restricted part of Phase One, and also in Phase Two. This is not a green light to drink as much alcohol as you want, but permission to have a drink in social situations, or important times like celebrations.

Can I do the Bi-Phasic Diet if I am vegetarian? 

Yes, a vegetarian can do the Bi-Phasic Diet. The vegetarian version of the diet includes limited amounts of soy products, and sprouted and soaked legumes. 

Can I do the Bi-Phasic Diet if I am histamine intolerant?

Yes, a person on a low histamine diet can do the Bi-Phasic diet. Many people with SIBO cannot tolerate foods with histamine. The low histamine version eliminates these foods.

What about other special dietary needs?

The Bi-Phasic Diet addresses oxalate and salicylate sensitivities with lists of foods that contain these substances. This will be an even more restrictive diet when you eliminate these foods on top of the foods that you have already taken out.

A nutritionist can evaluate your special needs and see how they fit in with this type of diet.

What are the side effects of the Bi-Phasic Diet?

You might experience some symptoms when the bacteria in your gut begin to die off. These symptoms are called a Herxheimer’s Reaction. The diet is designed to minimize these symptoms.  However they can still happen in some people.

Herxheimer’s Reaction can show up as 

  • Fever and chills
  • Nausea and vomiting
  • Headache
  • Irregular heartbeat
  • Hypotension
  • Hyperventilation
  • Flushing
  • Skin lesions
  • Muscle aches

Pros and Cons of the Bi-Phasic Diet

Good Things

Instead of just listing the fruits and vegetables that you are allowed to eat, the Bi-Phasic Diet gives actual amounts of these foods. This allows you to eat a greater variety of foods, as long as you stay within the recommended serving size.

The Bi-Phasic Diet gives an alternative to the conventional treatment for SIBO, which is prescription antibiotics. It provides a more natural solution to get rid of those bacteria in your small intestine.

Vegetarian or low histamine peeps have the resources to tailor the diet to their own special needs.

The diet is temporary. You should not end up on a long-term regimen that restricts your nutrients and possibly leaves you malnourished.

Not So Good Things

This diet is more restrictive than the low FODMAP diet.

If a person is already malnourished, a restrictive diet is going to make that condition worse and could be damaging to their health. A surprising number of people are malnourished because they are already restricting calories.

A diet that eliminates large categories of food can trigger an eating disorder in certain people who have a history of this condition. If you know you have struggled with an eating disorder in the past, a nutritionist who is trained to work in this area can find an alternative for you.

The timing of the antimicrobials might run interference with adding foods back in phase two. Both the antimicrobials and adding back the foods might cause symptoms, and it could be difficult to sort out which is which.

The diet does not detail how to add foods back when you are finished with phase two. If you just start eating everything again all at once, you have not learned anything about which foods are your triggers.

The Bi-Phasic Diet is not evidence based. There is no research showing that this diet is effective against SIBO. Neither of the diets it is based on – FODMAP or the Specific Carbohydrate Diet – have evidence they can be effective against SIBO (1).

Why Work With a Nutritionist?

It is important to work with a health professional if you follow this diet. This can be a functional or naturopathic doctor, or a nutritionist. They will be able to help you personalize the diet and help you understand how long to follow each phase, which foods you need to avoid, and which supplements can help you get to your end goal.

A nutritionist can help you determine:

  • Which foods you need to avoid, and which are ok for you to eat.
  • Whether you need the restricted or semi-restricted diet.
  • Whether you might be sensitive to histamine, oxalates or salicylates.
  • How long you need to stay in each phase of the diet.
  • Meal planning and recipes to make the whole thing easier for you.
  • Supplements and antimicrobials that will be safe and effective for you.
  • How to reintroduce foods at the end of the diet.
  • The root cause of your symptoms, so that you do not go right back into bacterial overgrowth once you stop the diet.

If you don’t eliminate the root cause, any special diet or treatment will be temporary.

In a Nutshell

Dr. Nirala Jacobi designed the Bi-Phasic Diet as an alternative to the other choices that are out there for treating SIBO. It aims to get rid of bacteria in the small intestine without triggering a die-off reaction. 

There are two phases to this diet, which move from restrictive to semi-restrictive to less restrictive. Each phase includes supplements to heal the small intestine, kill off the bacteria living there, and increase the motility of your digestive tract.

This diet accommodates vegetarians, histamine intolerant people and other special nutritional needs, but these can make it even more restrictive.

While this diet has reportedly worked for many people, there is no research showing that it can be an effective treatment for SIBO. 

If you are already restricting foods and calories, or have an eating disorder, an elimination-type diet may not be right for you. Be sure to check with a nutritionist or doctor who is knowledgeable about these conditions.

If you do not find the root cause of your SIBO, any diet you follow will only give you temporary relief.

Would you like to talk more about the Bi-Phasic Diet, or how to manage your SIBO symptoms and look for the root cause? Just click the button below to set up a free phone call with a Certified Nutrition Specialist.

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