Carbohydrate fermentation is one of the enabling factors in SIBO and other gut problems. Without sufficient food supply, the bacteria simply cannot survive.

Given the prevalence of SIBO, it’s possible that some people just cannot properly handle the amounts of rapidly fermented carbohydrates common in Western diets. I don’t know what’s the case with you, but it’s possible that you may have to practice some form of fermentable carbohydrate restriction for the rest of your life.

On the other hand, studies clearly show that carbohydrate fermentation in the colon is healthy. The byproducts, such as short-chain fatty acids, reduce inflammation and keep harmful pathogens under control.

Studies have raised concerns about long-term health effects of diets that restrict fermentable carbohydrates. For example, low FODMAP diets have been shown to reduce the abundance of many beneficial bacteria in the gut. Though scientists still don’t know whether this will have any health effects.

More research is required looking at the long-term adherence as a low FODMAP diet may have a detrimental effect on gut microbiota shown in a study done by Staudacher et al.

Marsh, A., Eslick, E. M. & Eslick, G. D. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr (2015). https://www.ncbi.nlm.nih.gov/pubmed/25982757

Even the researchers who developed low FODMAP diet say you aren’t meant to stay on the diet your entire life.

Not to mention that fermentable carbohydrates, such as fruits and vegetables, have countless other health benefits.

We are again after that elusive balance. A diet that’s not too difficult to follow, minimizes the risk of relapse, and supplies the colon with enough fermentable carbohydrates.

I don’t have an exact dietary formula for you to follow. Just because no such thing exists. But here are guidelines that will help you to find the right balance for you:

• Watch out for excess FODMAPs, and especially onions, wheat, and garlic. FODMAPs are among the most rapidly fermentable carbohydrates and thus prone to fermentation in the small intestine. Keep an eye on your gut to figure out your tolerance to FODMAPs. More than likely you’ll find that you can tolerate certain categories better than others.
• Fructose is absorbed relatively slowly in the small intestine and thus potentially feeds small intestine bacteria. Fructose is absorbed much more rapidly when it’s combined with glucose in 1:1 ratio. This means that while most fruits have quite a bit of fructose, only those that have much more fructose than glucose tend to cause digestive problems. These include apples, pears, guava, honeydew, watermelon, papaya and star fruit. Dried fruits are another concentrated source of fructose. As are sweetened beverages, nectars, and syrups.
• Refer to the fermentation potential guidelines discussed earlier. Try to keep most of your meals in the medium bracket.
• Do food challenges to figure out what foods you can and cannot tolerate.

Once your gut is in order, you can get away with eating problematic foods now and then. Use the 80:20 rule. As long as most of your meals don’t contain highly fermentable carbohydrates, you can get away with eating them a few times a week.

Aside from diet, you should also support healthy fermentation in the colon by taking 1 to 2 tablespoons of acacia gum daily. Read more about it on the supplements section.