If you’ve recently been diagnosed with Small Intestinal Bacterial Overgrowth (SIBO) or if you suspect you may have SIBO, you may wonder about your diet’s impact, particularly sugar.
So what’s the connection between sugar and SIBO? Do you really need to give up sweeteners (including “natural” ones)? What’s the deal with sugar cravings? Today, we’ll take a closer look at how sugar interacts with SIBO.
What Is SIBO—and Why Does Sugar Make It Worse?
If you’ve done cursory research on sugar and SIBO, you’ve probably stumbled across something telling you to watch your sugar intake. While this is a good idea in general, you may be curious about what the science says.
Can changes to your diet, like a low-FODMAP diet, help you feel better, without giving up everything you love to eat, forever?
To understand the sugar and SIBO connection, it’s essential to understand a little about SIBO, or small intestinal bacterial overgrowth. If you have SIBO, you have a condition where high numbers of bacteria begin to grow in the small intestine instead.
When the bacteria grow and your gut biome changes, you may experience some of the common SIBO symptoms like:
- Gas and bloating
- Abdominal pain and cramps
- Diarrhea
- Constipation
- Nausea, especially after eating
- Feeling overly full
- Fatigue and other signs of nutrient malabsorption
It’s important to note that these symptoms can be similar to many other stomach and digestive issues, so the first and most crucial step is to visit a trusted practitioner to ensure SIBO truly is the cause of your discomfort.
What causes SIBO? Most of the time, SIBO occurs due to disruptions to your gut motility (movement). Food poisoning, low stomach acid levels, antibiotic use, or digestive structural issues (surgery, adhesions, or scarring) exacerbate the condition.
Once bacteria begin over-colonizing in the small intestine, they ferment carbohydrates (sugars) that you consume. As the sugars ferment, hydrogen and methane gas are released, resulting in SIBO symptoms.
The Link Between Sugar and SIBO: Fuel for Fermentation
Bacteria love sugar. It’s how we get delicious fermented foods. However, in the case of SIBO, the bacteria are in the wrong place at the wrong time (and in high quantities).
Multiple studies have confirmed that carbohydrate fermentation is key to SIBO symptoms. A foundational study by Pimentel et al. (2000) discovered that sugar fermentation inside the small intestine causes excessive gas production and can lead to many symptom flare-ups.
What about natural sugars? Are they still okay?
Unfortunately, even “natural” sugars such as honey, agave, maple syrup, and coconut sugar feed bacteria. The most significant problems are high-fructose corn syrup (HFCS) and standard table sugar (sucrose).
It’s also important to remember that many foods contain hidden sugars—even foods that don’t taste or seem “sweet.” Common sugar sources include salad dressings, sauces, condiments, beverages, and even healthy (but sweetened) snacks.
SIBO and Sugar Cravings: Why You Still Want What Hurts
You’d think that if sugar were leading to this much discomfort, ditching it would be easy, right? Well, anyone who has tried to quit sugar knows it can be a tough breakup.
You aren’t imagining it or longing for forbidden fruit, either. SIBO can actually intensify sugar cravings (yes, even if you feel terrible after eating sweets). Why is this? There are a few theories, but the most likely reason is due to a combination of:
- Dysbiosis: Bacteria in your small intestine are signaling your brain to crave and consume more sugar so they can thrive.
- Blood Sugar Fluctuations: Malabsorption and inflammation in your system can hinder your insulin response.
- Habits and Reward Loops: Sugar gives you fast energy and boosts your dopamine. This makes sugar especially tempting when your SIBO symptoms are running you down.
One key to getting through the cravings is to give yourself a little understanding. The cravings are biological (not a sign that you’re weak or failing at eating the right way). You are outnumbered by bacteria in your system, and they’re overriding your sense of control.
How do you get rid of this frustrating invasion? Starve them out gently and gradually! Typically, the best guideline is to work with the support of your physician, practitioner, or dietitian. Overall options are antibiotics, herbals, dietary changes or a combination depending on your healthcare providers plan of attack.
Alcohols and SIBO
Alcohol can be even tougher to avoid than sugar, but generally it’s a good idea to eschew alcohol during SIBO treatment. Specifically, avoid sugary cocktails, sweet wines, ciders, and beers.
Dry wines and clear liquor (like vodka) may be okay in small amounts later in your treatment. It’s important to recognize that all alcohol can disrupt your gut motility, weaken your intestinal lining, and, not to mention, your resolve. Because of this, it may be more challenging for your body to heal itself when you consume alcohol.
It’s best to be safe and avoid alcohol entirely while you try to reduce the bacterial growth in your system.
There’s another type of alcohol—sugar alcohols. These “no-calorie” sweeteners are found in many foods, especially “diet-friendly” foods. You’ll see them named xylitol, erythritol, sorbitol, and mannitol on food labels. We may often think those foods are safe because they’re labeled as diet or sugar-free.
Unfortunately, sugar alcohols can also be a common trigger amongst those with SIBO. The alcohols don’t spike blood sugar like traditional carbohydrates and sugars, but they are poorly absorbed in the small intestine, where hungry bacteria often ferment them. The result is an increase in bloating and discomfort.
Sugar alcohols are mainly classified as FODMAPs, and you should avoid them during your SIBO treatment.
Is a Low-FODMAP Diet the Answer?
This brings us to low-FODMAP diets. Many SIBO patients discover relief by following a “low-FODMAP” diet or eating plan.
FODMAP stands for: Fermentable oligo-saccharides, disaccharides, mono-saccharides, and polyols, a bit of a mouthful. FODMAP refers to fructose, lactose, and other substances that fuel bacteria.
When the bacteria are deprived of their preferred food for a few weeks, they can starve off the overgrowth, reducing symptoms, and letting the gut lining heal.
Studies have shown that a low-FODMAP diet can significantly reduce IBS symptoms (many of which overlap with SIBO). The connection seems to be the fermentable sugars and how they exacerbate symptom severity.
While a low-FODMAP diet isn’t a cure for SIBO, it’s often a way to relieve and manage symptoms. Generally, low-FODMAP diets should only be followed for 4-6 weeks. Long-term restriction can lead to nutritional deficiencies and cause gut dysbiosis (starving bacteria and intense cravings). It’s essential to reintroduce tolerated foods to rebuild your gut microbiome slowly. View FODMAP eating as an elimination phase.
In severe and treatment-resistant cases of SIBO, some practitioners advise their patients to follow an “elemental diet.” An elemental diet consists of liquid nutrition formulated to absorb nutrients without fermentable content fully. In other words, the diet starves the bacteria.
In a 2004 study by Pimentel et al., a two-week elemental diet helped to normalize breath tests in roughly 80% of SIBO sufferers. Hydrogen and methane levels also declined significantly.
While the elemental diet is an effective option, it’s an intense process that should only be followed under close medical supervision. The elemental diet is typically only recommended to those who can’t tolerate antibiotics or herbal antimicrobials.
What About Lactose and Sucrose Intolerance?
Many patients suspect lactose intolerance when they’re actually dealing with SIBO. The symptoms of SIBO and lactose intolerance include bloating, gas, and cramping, so it’s clear why people may overlap the two diagnoses.
But with SIBO, the problem isn’t the lactose; instead, it’s the bacterial fermentation of lactose that occurs in the small intestine.
Sucrose intolerance is another culprit of GI distress overlapping with SIBO. Experts recommend reviewing a sucrose intolerance food list and eliminating high-sugar foods temporarily to identify triggers.
At QuinTron, we recommend SIBO testing first when patients report vague or overlapping GI symptoms. Once SIBO is ruled out or treated, you can explore additional tests for fructose, lactose, sucrose intolerance, and other digestive disorders.
So… Do You Have to Give Up Sugar?
Short-term? Probably. Long-term? Not necessarily.
Eliminating sugar during SIBO treatment can help reduce bacterial overgrowth and ease symptoms. Once your treatment is complete, you can reintroduce small amounts of well-tolerated sweeteners and whole foods with your practitioner’s guidance.
Here’s a general timeline to follow for SIBO recovery. This timeline is good if you are utilizing the diet method, but some healthcare providers may use various antibiotic treatments to help speed up the process. You may still talk to your doctor about incorporating diet as part of your treatment and post treatment lifestyle.
- Weeks 1–6 Symptom control: Eliminate sugar, high-FODMAP foods, and alcohol.
- Weeks 6–12 Gut healing: Gradually reintroduce tolerated carbs and fermented foods
- Long-term Microbiome support: Follow a whole-food-based diet with minimal added sugar
The link between sugar and SIBO is clear: sugar feeds bacteria, and in the case of SIBO, that’s the last thing you want. But, you don’t have to fear sweet foods forever. By working with a knowledgeable healthcare provider, following a strategic elimination and reintroduction process, and understanding what your body needs, you’ll get your symptoms under control and enjoy food again.
If you’re experiencing ongoing bloating, discomfort, or sugar-triggered symptoms, talk to your provider about getting tested for SIBO. At QuinTron, we offer the industry’s leading non-invasive breath tests to help you uncover the root of your digestive concerns.