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The

SIBO/Histamine

Bi-Phasic Diet

©

Dr. Nirala Jacobi,

BHSc, ND (USA)

www.thesibodoctor.com

Heidi Turner,

MS, RDN

www.foodlogic.org

4–6 week dietary protocol for managing histamine

intolerance and SIBO

Health care disclaimer: This treatment protocol is not intended as

medical advise and is best used with the guidance of a health care

professional. Please ask your doctor if this protocol is appropriate

for your condition before starting.

WHAT IS SIBO?

Small intestine bacterial

overgrowth is a condition

where bacteria which are

normally found lower in the

large intestine have overgrown

in the small intestine instead.

Abnormal amounts of these bacteria

cause a number of problems

1.

They damage the microvilli

— the absorptive

surface of the small intestine. This can lead to

malabsorption of nutrients. Microvilli are also

responsible for the digestion of small starch molecules

from food. When the microvilli are not working, the

bacteria use these small starch molecules to cause

fermentation. This bacterial fermentation produces

methane and hydrogen gas. Not only is this

uncomfortable, but causes further damage to the

microvilli.

Research has now shown that SIBO is a major cause of

intestinal permeability, or ‘leaky gut”, a condition

where partially digested food particles are absorbed

through the lining of the small intestines where they

can cause an immune reaction. Leaky gut also causes

bacterial by-products to be absorbed — a major trigger

for infammation.

2.

Leaky gut can also cause

malabsorption of nutrients

from your food which can cause a wide variety of

symptoms such as restless legs at night, fatigue,

skin rashes, muscle aching as well as a host of

digestive symptoms.

3.

The bacteria cause the

motility

of the small intestine

to slow down or work improperly, causing further

fermentation. Restoring proper motility in the small

intestines is a major focus of eliminating SIBO for good

and your practitioner is likely to prescribe a “prokinetic”

supplement or medication.

4.

Many people who test positive for SIBO will also have

a co-infection with fungal organisms, a condition known

as

SIFO

(small intestine fungal overgrowth) — the SIBO

Bi-Phasic diet helps to address this as well.

Visit

www.TheSIBODoctor.com

for more information

HISTAMINE INTOLERANCE

Histamine is a substance that is made inside the body as well

as found in certain foods. In many cases of SIBO, other foods

besides fermentable carbohydrates can be problematic. The

most common reactions are to foods containing histamine.

Histamine is a substance found in certain foods which can

cause symptoms in those with severely disrupted mucosal

lining of the small intestines. The depletion of the histamine-

digesting enzyme, diamine oxidase (DAO), yeast overgrowth,

or the prevalence of histamine producing bacteria are

often to blame. As the overgrowth reduces and this lining

repairs, histamines typically become less problematic. This

food sensitivity is known as Histamine Intolerance, or HIT.

Histamine is also made in the body and stored in cells known

as Mast cells. Reducing histamine foods can lower the “total

load” of histamine.

SYMPTOMS OF

HISTAMINE INTOLERANCE

Not everyone with SIBO has histamine intolerance. Beyond

the typical gastrointestinal symptoms, those with HIT often

experience symptoms that resemble allergies including

runny nose, itchy eyes, sneezing, hives, asthma, and chronic

cough, as well as other symptoms including headaches,

joint pain, anxiety and insomnia. Not everyone with these

symptoms has HIT but if you do, eliminating histamines

from the diet may provide you some additional relief during

treatment.

HISTAMINES IN THE DIET

Histamines in food typically increase with age and

fermentation. Fermented foods (vinegars, 24-hour yogurt,

wine/beer/cider, sauerkraut, kombucha, kimchi), aged meats

(bacon, sausage, ham, canned meats/fsh, smoked salmon,

bone broths) as well as tomatoes, spinach, eggplant, spicy

foods and chocolate are typically the most problematic for

those with HIT. Histamines also increase as food ages in the

refrigerator, so leftovers can be an issue for some. There are

other foods considered “histamine liberators” (HL) found in

certain vegetables, fruits, nuts and eggs.

Histamine liberators do not necessarily contain histamine but

can trigger a histamine response. Tolerance to these foods is

dependent on the individual.

A note about seafood: While seafood can easily build

histamine as it ages, very fresh/frozen seafood may be well

tolerated. White fsh such as halibut, sole and cod, and very

fresh salmon are typically the best tolerated.

HISTAMINE TOLERANCE

Each person is difference in their tolerance and threshold to

histamine foods. Some fnd that histamine liberating foods

are not at all bothersome to them but high histamine foods

are. Others must avoid them all to keep their symptoms

controlled. Most, however, will have some tolerance to

histamine foods and simply need to stay under their own

personal threshold, or the point at which symptoms begin.

HISTAMINE REDUCING FOODS

Try to keep this limited diet as anti-infammatory as possible

by including as many allowed plant-based foods as you

can and continue to test HL foods in as you are able. Use

anti-infammatory and mast cell-stabilizing herbs and spices

such as black seed oil/spice, turmeric, cilantro, parsley

and watercress, and DAO-stimulating olive oil to favor

foods. Try to eat as organically as you can afford to reduce

pesticides which can add to the histamine load for some.

Some with severe histamine intolerance fnd a diet high in

animal protein can trigger their histamine response. We do

not recommend avoiding animal protein as this can limit the

diet even further. Just make sure you are focusing on plant-

based fats, herbs, spices, vegetables, and fruits. If you are

early in treatment and plants are not well tolerated, cooking,

blending or juicing them may be better tolerated.

WHAT IS THE SIBO/HISTAMINE BI-PHASIC DIET?

This protocol has been developed for those suffering from SIBO and histamine

intolerance. It is not intended for long term use, but rather as a starting point for those

who have SIBO and food reactions. This diet protocol eliminates histamines and

fermentable carbohydrates. Once symptoms are controlled, moving into the SIBO

Bi-Phasic Diet is recommended.

Please consult with your practitioner before initiating

this protocol.

FERMENTED FOODS

Fermented foods such as cultured vegetables, sauerkraut,

kimchi, as well as miso and yogurt are wonderful for the

digestive tract as they contain high amounts of probiotics

or benefcial bacteria. But since these foods are high

in histamine, they may not be tolerated and it is best to

eliminate them from the diet for now. They can be introduced

back in as your symptoms improve and your practitioner

allows. Introduce no more than one tablespoon in any given

meal and increase only as tolerated.

GENERALLY AVOIDING ALCOHOL

Alcohol is a known gut irritant and disrupter of the normal

microbiome of the intestinal tract. It also reduces the amount

of DAO you produce and, if fermented (ie. beer, cider and

wine), contains high amounts of histamine. It is strongly

recommended to avoid all alcohol while on the Bi-Phasic

Diet. This is sometimes diffcult in social situations. In these

instances, clear spirits like vodka and gin are preferred over

beer and wine as they do not contain histamine, sulftes or

yeast. Please limit alcohol consumption even in these cases.

HISTAMINE ELIMINATION

AND REDUCTION

Combining a low fermentable diet with a diet that is low in

histamine can be challenging as the list of foods is narrow.

While all foods high in histamine and histamine liberators

have been eliminated from the diet in Phase 1, once your

symptoms have calmed, you are encouraged to test in

histamine liberating foods in an effort to expand the variety

and balance of the diet. Histamine containing foods are

noted with an “H” and should be avoided until later in the

treatment process. Histamine liberating foods are noted with

a “HL” and should be introduced and maintained in the diet

to your personal threshold. A food with an “F/HL” indicates

it is both a fermentable carbohydrate and a histamine

liberating food and should be avoided until you are ready

to add more fermentable carbohydrates back into the diet,

unless otherwise noted.

HISTAMINE ELIMINATION

AND RE-INTRODUCTION

IN THREE STEPS

STEP 1

Phase 1 of the Bi-Phasic Diet lasts two–four weeks. You

should avoid all fermentable carbohydrates, histamines and

histamine-liberating foods for at least two weeks before

considering expanding the histamine liberators (HL) into the

diet. Follow the food guide as to which foods to choose.

STEP 2

After two weeks on phase 1, and only once symptoms have

reduced, you can start testing HL foods if you wish. Use the

Phase 2 “Allowed” list as a guide for foods to introduce. Add

in one serving of a new HL food for three consecutive days.

If you tolerate, you can keep that food in the diet and layer

in another HL food in the same manner. Repeat, as tolerated.

If you start experiencing symptoms, reduce to previously

tolerated histamine load. Know that you may tolerate one

HL food over another, so if you do react to one, wait for the

symptom to calm and then continue testing with another. If

you do not tolerate a particular food, avoid it until you are

further into your treatment and test it again later, as you may

gain tolerance as the gut heals. If introducing any of the HL

foods creates a return of symptoms, you should return to the

baseline diet and wait until Phase 2 before testing again.

STEP 3

Your practitioner will advise you on when you are ready to

fully move on to the Phase 2 diet. This will involve adding in

higher histamine and histamine liberating foods, as you are

ready. When determining which foods to add in frst, always

consider which foods you miss the most and what will make

the diet more enjoyable. In this phase, you will also be able

to expand more fermentable carbohydrates into the diet, as

noted.

ALLOWED

AVOID

PROTEIN

must be fresh

Beef (organic, not aged), Lamb, Turkey (organic

if available), Skinless chicken (organic),

Wild/game meats

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Eggs (HL)

Pork (HL)

Seafood (H / HL)

see “Histamines in Food” for info.

Seasons/aged meats (ham, bacon, sausage,

canned or smoked fsh and meats) (H)

FERMENTABLE CARBOHYDRATES

Legumes, Meats seasoned with garlic/onion

DAIRY

PRODUCTS

Avoid all dairy

Avoid all diary

VEGETABLES

unlimited

Alfalfa sprouts, Bamboo shoots, Bok choy,

Capsicum/bell peppers (not spicy), Carrot,

Chard/Silverbeet, Chives, Cucumber, Ginger,

Kale, Lettuce, Parsnip

,

Radicchio, Radish,

Rocket/arugula, Spring onion (green part only),

Sunfower sprouts, Witlof

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum (spicy/chili) (H)

Eggplant (H)

Olives (H)

Spinach (H)

Tomato (red) (H)

green or yellow cherry tomato

may be OK

FERMENTABLE CARBOHYDRATES/STARCH (F)

Caulifower, Corn, Garlic, Mushroom, Onion,

Sweet Potato, Starch powder: arrowroot, corn,

rice, tapioca

VEGETABLES

one serve per

meal

Asparagus – 2-3 spears

Artichoke hearts –

1

/

8

cup

Beetroot – 2 slices

Broccoli – 1 cup

Brussels sprouts – ½ cup

Cabbage – ¾ cup

Cabbage, savoy – ½ cup (

wombok)

Celery – ½ stick

Celery root – ½ cup

Fennel bulb – ½ cup

Green beans – 12 ea

Leek – ½ ea

Peas (green) – ¼ cup

Potato (white) – 1 med size

Pumpkin – 1 cup

Snow peas – 5 pods

Tomato (green or yellow cherry only) –5 ea

Zucchini – 1 cup

FRUITS

two serves

per day

Blueberries – ½ cup

Cantaloupe/Rockmelon – ½ cup

Grapes – 10 ea

Lime (to favour, fresh squeezed)

Lychee – 4

Honeydew melon – ½ cup

Kiwi – 1 ea

Lychee – 5

Papaya – ½ cup

Passion fruit – 1 ea

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Avocado (F/HL) – ¼ fruit

can test in with HL but

limited to recommended amount

Banana (H)

Kiwi (HL) – 1 ea

Lemon (HL) (fresh squeezed, likely tolerated)

Orange (HL)

Raspberries (HL)

Strawberries (HL)

Tangerine (HL)

PHASE 1 A

VOID FERME

N

TABLE C

A

RBOH

YDRATES, HISTAMINE AND HISTAMINE LIBERATING FO

All listed

quantities

are per

meal

ALLOWED

AVOID

FRUITS

(CONT’D)

two serves

per day

Paw paw – ½ cup

Pomegranate – ½ small or ¼ cup of seeds

Rhubarb – 1 stalk

FERMENTABLE CARBOHYDRATES (F)

Apple, Apricot, Blackberries, Canned fruit in

fruit juice, Custard apple, Fig, Jam, Mango,

Nashi, Nectarine, Peach, Pear, Persimmon,

Plum, Watermelon

GRAINS,

STARCHES,

BREADS AND

CEREALS

Avoid all, but if practitioner allows, can limit to:

Quinoa – ½ cup

White rice (basmati, jasmine only) – ½ cup

cooked

Avoid all, but if practitioner allows, can limit to:

Quinoa – ½ cup

White rice (basmati, jasmine only) – ½ cup

cooked

LEGUMES

lentils, beans

Avoid

Avoid

SOUPS

Freeze large batches in single servings to

reduce histamine production

Homemade broths (organic only): chicken,

beef, lamb, turkey, 2-hour broths only

Bone broth (H/F)

Canned soups and soup bouillon (H/F)

BEVERAGES

Tea (herbal)

Water (fltered only)

(All H): Alcohol, Beer, Cider, Club Soda, Coffee,

Energy drinks, Fruit juices (H/F), Kombucha,

Liqueurs and spirits (dark), Seltzer water, Soft

drinks, Tea (black, green), Wine

SWEETENERS

Yeast overgrowth: limit /avoid all except Stevia

Dextrose/glucose, Organic honey (clear) — max.

2 tbsp per day, Stevia (100% pure, no inulin)

Artifcial sweeteners (avoid completely) (HL),

Cane sugar, Chocolate cocoa, Cacao (H/F),

Maple syrup, Sugar alcohols (xylitol, mannitol,

sorbitol)

NUTS/SEEDS

Coconut four/shredded – ¼ cup

Coconut milk (no thickeners) – ¼ cup

Coconut cream — 2 tbsp

Macadamias – 20 ea

All other nuts/seeds (HL) —

can introduce upon

practitioner’s approval to low FODMAP guideline

recommendations

CONDIMENTS

All fresh and dried herbs and spices except

those noted in ‘Avoid’

Green salsa (without onions/garlic)

– 1-2 tbsp

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum/peppers (spicy): chili, cayenne and

their sauces (H)

Allspice, Cardamom, Cinnamon, Cloves,

Nutmeg (HL)

Fermented sauces (such as fsh, soy, coconut

aminos, oyster, tamari) (H)

Fermented foods (such as kimchi, sauerkraut,

pickles) (H)

Mayonnaise (H), Mustard (H), Vinegar (H),

Tomato sauce/ketchup (H), Salsa (H)

FERMENTABLE CARBOHYDRATES/STARCH (F)

READ LABELS! No Asafetida, Chicory

root, Garlic, Gums/carageenan/thickners,

Maltodextrin, Starches, Sugar, Onions,

FATS/OILS

Butter, Coconut, Flax (low lignin) Ghee,

Grapeseed, Infused (garlic,lemon, onion), Olive,

MCT, Sunfower

Palm, Soyabean, Pumpkin, Sesame (HL), Walnut

ea = each tsp = teaspoon tbsp = tablespoon

PHASE 1 A

VOID FERME

N

TABLE C

A

RBOH

 

ALLOWED

PROTEIN

must be fresh

Beef (organic, not aged), Chicken (organic),

Eggs (HL), Lamb, Pork (HL), Seafood (H/HL)

see

“Histamines in Food” for info,

Turkey (organic if

available), Wild/game meats

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Seasons/aged meats (ham, bacon, sausage,

canned or smoked fsh and meats) (H)

FERMENTABLE CARBOHYDRATES

Legumes, Meats seasoned with garlic/onion

DAIRY

PRODUCTS

Butter, Ghee

Homemade yoghurt (plain, organic) (H)

this is

often well tolerated — reintroduce upon your

practitioner’s advice

Avoid all other diary not on allowed list

VEGETABLES

unlimited

Alfalfa sprouts, Bamboo shoots, Bok choy,

Capsicum/bell peppers (not spicy), Carrot,

Chard/Silverbeet, Chives, Cucumber, Ginger,

Kale, Lettuce, Parsnip

,

Radicchio, Radish,

Rocket/arugula, Spring onion (green part only),

Sunfower sprouts, Witlof

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum (spicy/chili) (H)

Eggplant (H)

Olives (H)

Spinach (H)

Tomato (H)

green/yellow cherry tomato may be OK

FERMENTABLE CARBOHYDRATES/STARCH (F)

Canned vegetables, Corn, Garlic, Mushroom,

Onion, Sweet Potato, Starch powder: arrowroot,

corn, rice, tapioca

VEGETABLES

one-two

servings per

meal

Asparagus – 2-3 spears

Artichoke hearts – ¼

cup

Beetroot – 2 slices

Broccoli – ½ cup

Brussels sprouts – ½ cup

Cabbage – ½ cup

Cabbage, savoy – ¾ cup (

wombok)

Caulifower – ½ cup

Celery – 1 stick

Celery root – ½ cup

Fennel bulb – ½ cup

Green beans – 10 ea

Leek – ½ ea

Peas (green) – ¼ cup

Potato (white) – 1 med size

Pumpkin – 1 cup

Snow peas – 5 pods

Tomato (green or yellow cherry) – 5 ea

Zucchini – ¾ cup

FRUITS

two servings

per day

Avocado (F/HL) – ¼ cup

Blueberries – ½ cup

Cantaloupe/Rockmelon – ¼ cup

Cherries – 3 ea

Grapes – 10 ea

Honeydew melon – ¼ cup

Kiwi (HL) – 1 ea

Lemon (HL) – use to favour, fresh squeezed

Lime (HL) – used to favour, fresh squeezed

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Banana (H)

Orange (H)

Tangerine (H)

FERMENTABLE CARBOHYDRATES (F)

Apple, Apricot, Blackberries, Canned fruit in fruit

juice, Custard apple, Fig, Jam, Mango

PHASE 2 TEST HISTAMINE LIBERATING (HL) FOODS

ALLOWED

AVOID

until further notice

FRUITS

two servings

per day

(CONT’D)

Lychee – 5 ea

Passion fruit – 1 ea

Paw paw – ¼ cup

Pineapple (HL) – ¼ cup

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