The Low-FODMAP Diet Has Moved On: Why my Gentle, Personalised Approach Makes More Sense
If you have ever opened an older low-FODMAP book, you may have come away thinking that managing bloating, abdominal discomfort, wind or unpredictable bowel habits requires a long list of foods to avoid indefinitely. Happily, that is not where the evidence, or good clinical practice, has landed today.
The low-FODMAP diet remains one of the better-researched dietary tools for people with irritable bowel syndrome (IBS). But today it is understood as a short-term learning process, not a permanent restrictive eating plan. My gentle FODMAP approach is designed around that newer understanding: we reduce the likely dietary triggers without turning food into a source of anxiety, then systematically build variety back in as soon as possible.
What does “FODMAP” mean?
FODMAP is an acronym for certain short-chain carbohydrates that can be poorly absorbed in the small intestine:
Fermentable oligosaccharides
Disaccharides, mainly lactose
Monosaccharides, mainly fructose when present in excess
Polyols, such as sorbitol and mannitol
When these carbohydrates reach the large intestine, they can draw water into the gut and be fermented by gut bacteria. For people with a sensitive gut–brain connection, this may contribute to symptoms such as bloating, visible distension, excess wind, abdominal pain, urgency, loose stools or constipation.
Importantly, this does not mean that FODMAP containing foods are “bad,” inflammatory, or damaging to everyone. Many are nutritious, fibre-rich, affordable and culturally important foods, including onions, garlic, pulses, wheat-based foods, certain fruits, vegetables, milk and yoghurt. The question is not whether these foods are healthy in general; it is whether particular types and portions aggravate symptoms for a particular person at a particular time.
What the latest evidence says
The evidence for a low-FODMAP intervention in IBS is meaningful, but it deserves a balanced interpretation.
A 2026 umbrella review bringing together 16 meta-analyses, covering 141 studies and 9,904 people with IBS—found that a low-FODMAP diet reduced overall IBS symptom severity and improved quality of life. Across five meta-analyses involving 3,761 participants, symptom severity improved; quality-of-life scores also improved across five meta-analyses including 3,576 people. pmc.ncbi.nlm.nih
That supports using FODMAP reduction as a structured option for suitable people with IBS-type symptoms. However, the same review found less certain or inconsistent evidence for individual outcomes such as abdominal pain, stool frequency, stool consistency and bloating. It also highlighted an important limitation of nutrition research as it is very difficult to blind people to a diet change, so expectation, attention, regular meals and improved self-monitoring may contribute to some of the benefit. pmc.ncbi.nlm.nih
That does not make the diet ineffective. It simply means the best approach is one that combines food changes with the wider realities of gut health, like meal pattern, fibre tolerance, stress, sleep, movement, menstrual-cycle changes, medication, infection history and the gut–brain connection.
Why old-style FODMAP plans can be unhelpful
Many older books and online plans have unintentionally left people with the impression that the low-FODMAP diet means “cut out all high-FODMAP foods.” They often rely on static food lists, use a one-size-fits-all restriction phase, and give too little attention to reintroduction.
There are several problems with that approach.
It can be unnecessarily restrictive
A strict plan that lasts too long can make eating feel complicated and socially difficult. It may reduce dietary variety, lower overall fibre intake, complicate travel and meals out, and create a sense that everyday foods are risky.
The purpose of FODMAP work is not to create the lowest possible FODMAP intake. The purpose is to identify the smallest amount of restriction needed for meaningful symptom relief.
Food lists quickly become out of date
FODMAP content is not a simple “yes” or “no” property of food. It depends on the food, the variety, ripeness, preparation and crucially portion size. A food can be tolerated in one serving and troublesome in a much larger one.
This is why a simple printed list can become misleading. It may label a food as completely “safe” or completely “forbidden,” when the more useful question is: What portion works for you, in the context of your whole meal and day?
It can encourage fear around healthy foods
Garlic, onions, beans, lentils, wheat, apples, pears and dairy foods can all feature in a nutritionally balanced diet. During a targeted trial, some may need adapting temporarily but they should not automatically be treated as permanent problems.
A low-FODMAP plan should make food feel more manageable, not more frightening.
Reintroduction is often skipped
This is the biggest issue. The restriction phase is only the beginning. Monash University, the research group that developed the FODMAP approach, describes it as a three-step process:
1. A limited low-FODMAP phase
2. A structured reintroduction of individual FODMAP groups.
3. Then long-term personalisation.
The initial low-FODMAP phase is generally intended to last only around two to six weeks, while reintroduction commonly takes around six to eight weeks. monashfodmap
Without reintroduction, people never discover what they actually tolerate. They may avoid foods unnecessarily for months or years.
My gentle FODMAP approach
My approach is not about pursuing dietary perfection or asking you to live from a “safe foods” list. It is a structured, practical and compassionate way to investigate whether FODMAPs are relevant to your symptoms, while protecting nutritional adequacy, enjoyment and flexibility.
We start with the whole picture
Before making food restrictions, we look at your symptoms, bowel pattern, current diet, meal timing, stress levels, sleep, lifestyle, medical history and the patterns you have already noticed.
For some people, a full low-FODMAP protocol may be appropriate. For others, a lighter-touch approach may be enough, such as trialling lower amounts of the most likely high-FODMAP contributors, adjusting portion sizes, reducing “FODMAP stacking” within a meal, or improving meal regularity and fibre balance first.
This avoids making major changes when a more targeted adjustment may be all that is needed.
We use swaps, not a “no-foods” mentality
A low-FODMAP phase should be built around satisfying substitutions, not deprivation. For example, rather than simply removing flavour from meals, we may use garlic-infused oil, chives, the green tops of spring onions, herbs, spices and suitable stock options. Instead of eliminating fruit entirely, we choose portions and varieties that fit your current tolerance.
We keep the restrictive period short
The aim is to create a clear enough symptom picture, not to keep tightening the diet. If symptoms are not improving after a short, well-supported trial, more restriction is rarely the answer. We pause, review adherence and portion sizes, and consider other contributors.
If symptoms improve, that is our cue to move forward, not to stay restricted.
We personalise through reintroduction
Reintroduction helps identify which FODMAP categories, foods and amounts you personally tolerate. You might react to a large portion of wheat-based food but tolerate modest servings; have no issue with lactose but be sensitive to onion and garlic; or tolerate foods well when eaten alone but not when several higher-FODMAP ingredients appear in the same meal.
The point is to find your own threshold, not to pass or fail a food challenge. During this phase, one FODMAP group is tested at a time while the overall background diet remains steady, making the result easier to interpret. monashfodmap
We build a flexible long-term diet
The destination is not “low FODMAP forever.” It is a varied, enjoyable way of eating that includes as many foods as you tolerate, limits only the specific triggers that matter to you, and leaves room for normal life.
Tolerance also changes. Stress, sleep disruption, hormones, illness, medication, portion size and the combination of foods in a meal can all affect how your gut responds. A food that was difficult during a flare may be fine later, so periodic re-testing can be helpful.
A realistic example
Imagine that you regularly experience bloating after evening meals. An old-style plan might tell you to avoid wheat, onions, garlic, beans, apples, dairy and sweeteners for an extended period.
A gentler approach asks more useful questions:
Are large evening meals, rushed eating or irregular meal times part of the picture?
Are onion, garlic, wheat pasta and dessert fruit being combined in the same meal, creating a higher total FODMAP load?
Do symptoms happen after all dairy, or only after larger portions of milk or yoghurt?
Is constipation, stress, a menstrual-cycle phase or poor sleep making the gut more sensitive?
You may begin by changing only the most likely contributors, using satisfying substitutes, recording symptoms simply and avoiding unnecessary restriction. If a more formal low-FODMAP phase is needed, it has a clear timeframe and a clear next step: reintroducing foods to widen the diet again.
That is the difference between following rules and learning what supports your gut.
A few important cautions
A low-FODMAP approach is not appropriate as a self-diagnosis tool for every digestive symptom. It is designed primarily for IBS and IBS-type symptoms, not as a universal “gut-healing” diet. The strongest evidence base relates to IBS, and research outside that setting is more limited. pmc.ncbi.nlm.nih
Please speak with your GP or a registered dietitian before restricting your diet if you have:
Unexplained weight loss
Rectal bleeding or black stools
Persistent vomiting
Fever, anaemia or waking at night because of symptoms
New bowel symptoms later in life
A family history of bowel cancer, coeliac disease or inflammatory bowel disease
A history of an eating disorder, or significant anxiety around food
Pregnancy, breastfeeding, or a need for a highly individualised therapeutic diet
The bottom line
The low-FODMAP diet can be a valuable, evidence-informed tool for managing IBS symptoms, but it works best when it is temporary, targeted and personalised.
The newer research does not support fear-based, blanket avoidance of healthy foods. It supports a more thoughtful model:
1. Identify likely triggers
2. Use a short and nutritionally sound trial where appropriate.
3. Reintroduce methodically, and create the broadest, most enjoyable diet that your gut can manage.
That is the foundation of my gentle FODMAP approach: less confusion, less unnecessary restriction and more confidence in food.
Supporting Endometriosis Through Gut Health: A Nutritional Therapy Guide
Jayne Higgins explores the emerging science connecting the gut microbiome to endometriosis. Turning the latest science into something practical and helpful because for those living with this condition, actionable support matters. Knowledge without direction can feel like yet another dead end, and in this blog she offers more than that.
The research is clear that gut dysbiosis - an imbalance in the gut microbiome - is consistently found in women with endometriosis. This dysbiosis disrupts the estrobolome, the community of gut bacteria responsible for metabolising and regulating oestrogen, which can drive elevated circulating oestrogen levels and fuel the growth of endometriotic lesions. Gut imbalance also promotes chronic inflammation and compromises the body's own anti-inflammatory defences. In short: what happens in the gut does not stay in the gut.
These are not abstract findings. They point directly to areas where targeted nutritional support can make a genuine difference.
What You Can Do Right Now: Nutritional Therapy for Gut Health and Endometriosis
What I share here comes from both professional training and lived proximity to this condition. I have spent years alongside someone navigating it without adequate support, and that experience has profoundly informed the way I approach this work with clients. These are not abstract recommendations drawn from textbooks — they reflect what I have come to understand, through science and through life, about how the body can be genuinely supported.
These approaches do not replace your medical care - please see the disclaimer below - but they can make a meaningful difference to how you feel day to day.
1. Adopt an Anti-Inflammatory Dietary Foundation
Chronic inflammation is central to endometriosis. An anti-inflammatory diet provides the building blocks for a calmer internal environment. Focus on:
- Omega-3 rich foods: oily fish (salmon, mackerel, sardines), walnuts, flaxseeds, hemp seeds
- Colourful vegetables and fruits: particularly leafy greens, berries, broccoli, and beetroot — all rich in antioxidants and polyphenols
- Olive oil as your primary cooking fat
- Reduced red meat and processed foods, which promote inflammation and may worsen gut dysbiosis
2. Support Your Estrobolome with Fibre and Fermented Foods
A fibre-rich diet feeds the beneficial bacteria responsible for healthy oestrogen metabolism. Aim for a wide variety of plant-based fibre sources — vegetables, legumes, wholegrains, fruits, nuts, and seeds. Diversity is key: try to eat 30 different plant foods per week as a practical target.
Fermented foods introduce beneficial bacteria and support microbiome diversity. Include small, regular portions of live yoghurt (unsweetened), kefir, sauerkraut, kimchi, and miso in your diet.
3. Consider Targeted Probiotic and Prebiotic Support
Research points to specific bacterial deficits in endometriosis. A qualified nutritional therapist can help you identify appropriate probiotic strains and prebiotic fibres (such as inulin and fructooligosaccharides) that may help to address your individual microbiome imbalances. Supplementation should always be tailored rather than generic.
4. Identify and Reduce Dietary Triggers
Certain foods consistently worsen gut dysbiosis and systemic inflammation:
- Ultra-processed foods and refined sugars, which feed pathogenic bacteria and promote LPS production
- Alcohol, which is both pro-inflammatory and disruptive to the gut lining
- Gluten and dairy, which some women with endometriosis find exacerbate their symptoms — an elimination and reintroduction protocol, guided by a practitioner, can help identify individual sensitivities
- Excessive caffeine, which may worsen oestrogen metabolism and disrupt sleep
5. Prioritise Gut Lining Integrity
A compromised gut lining allows bacterial endotoxins — including LPS from Gram-negative bacteria — to enter the bloodstream and trigger systemic inflammation. Nutrients that support gut lining integrity include L-glutamine, zinc, vitamin D, and omega-3 fatty acids. These are best taken within a personalised, practitioner-supervised plan.
You Deserve Support — and You Are Not Alone
If you have spent years being told your pain is normal, being dismissed by the very people who should have helped you, or managing a complex condition largely on your own - please know that your experience is valid, your pain is real, and you deserve so much better.
I know something of what it means to sit beside a person you love and feel helpless. To watch years pass without answers. To witness the toll that dismissal, trial-and-error prescribing, and the absence of a clear plan takes - not just on the body, but on a person's sense of themselves. That experience did at times leave me feeling totally helpless. But it drove me to understand this condition as deeply as I can, and to offer the kind of support I wish had been available sooner.
The research emerging around gut health and endometriosis is not a cure, and I want to be clear about that. But it does open genuinely meaningful avenues for support - and it reinforces what nutritional therapists have long understood: that food, the gut, hormones, and inflammation are deeply, inseparably connected.
At Jayne Higgins Nutrition, I work with women navigating exactly this kind of complex, chronic condition. This is not simply a specialism I have chosen - it is work I feel compelled to do. If you would like to explore a personalised nutritional therapy plan as part of your broader management of endometriosis, I would be glad to work with you. You can find out more about working with me [on the services page].
Disclaimer: Nutritional therapy is a complementary approach and is not a replacement for medical diagnosis, treatment, or the care of your GP, gynaecologist, or other healthcare professionals. If you are experiencing symptoms of endometriosis, please seek medical advice. The information in this article is intended for educational purposes only and does not constitute medical advice.
Sources and further reading:
- Pérez-Prieto et al., BMC Medicine (2024) — Gut microbiome signatures in endometriosis
- Wang et al. (2025) — Firmicutes/Bacteroidetes ratio in endometriosis
- Hearn-Yeates et al., Reproduction & Fertility (2024) — Gut-brain axis and endometriosis
- Huang et al. (2021) — Ruminococcus as a diagnostic biomarker
- Frontiers in Cellular and Infection Microbiology (2025) — Fusobacterium, LPS and immune microenvironment
Endometriosis and the Gut: What the Latest Research Tells Us
If you have endometriosis, you already know what it feels like. You know the kind of pain that does not respond to paracetamol and a hot water bottle. You know the cancelled plans, the days lost to bed, the invasive tests that come back "normal", hours in A&E unable to stand to be given morphine and sent home and the calls to the GP where your concerns are minimised or dismissed and often not even allocated appointments by the triage system. Emma Barnett described it as "bone-grinding agony." That language matters. It names an experience that too many women have been told is simply part of being female.
I watched this happen first-hand. Years of being told it was period pain. Antibiotics issued as a precaution rather than with purpose. The suggestion, implicit and sometimes explicit, that the pain was being exaggerated. What I observed across those years was not unusual, as the data we are now seeing makes painfully clear.
Gut Reset & Restore; why my 12 week plan?
Navigating a low FODMAP or low histamine diet can feel overwhelming, so my gentle 12‑week plan focuses on calming symptoms first, then rebuilding your gut and widening your food choices in a sustainable way. Across the three phases, we work together to match the right approach to your symptoms, history, and food preferences, so you are never following a generic “IBS” or “histamine” list.
Why a 12‑week gentle plan?
Over roughly 12 weeks, we move through three broad stages: calm, rebuild, and personalise. In the calm phase, we use either a modified low FODMAP or low histamine frame (or a blend) to reduce pain, bloating, bowel changes, rashes, or headaches without making your diet unnecessarily restrictive. The rebuild phase focuses on gut barrier support, microbiome diversity and energy, so we are not simply “stuck” in elimination mode. In the final personalise phase, we test and reintroduce foods in a structured way, so you understand your own triggers and safe foods, rather than fearing whole food groups.
Low FODMAP vs low histamine – choosing the right tool
Low FODMAP is an evidence‑based, short‑term strategy for IBS and sometimes SIBO, helping many people reduce bloating, pain and urgency when used in a 3‑step framework (restriction, reintroduction, personalisation). Low histamine is typically used when symptoms such as flushing, headaches, hives, insomnia or “mystery” reactions point towards histamine intolerance or mast‑cell–type issues. Rather than guessing, we look at your symptom pattern, medications, test results and food diary to decide whether FODMAPs, histamine, or both are likely players, and we adjust the plan so you still meet your nutrient needs. For some clients, that might mean a gently simplified low FODMAP framework; for others, it’s more about reducing fermented, cured or very aged foods that drive histamine load.
Lifestyle strategies that support your gut
Food is just one part of the picture, so we also build in simple lifestyle habits that calm the nervous system and support digestion. Gentle, regular movement (like walking, yoga or light strength work) can help bowel motility and support microbiome health, especially alongside a tailored diet. Nervous‑system regulation is central: practices such as breathwork, meditation, paced breathing or short relaxation breaks can ease visceral hypersensitivity and reduce stress‑related flares. I also encourage practical routines around sleep, mealtimes and hydration, so your gut has predictable rhythms and you feel more in control day to day.
Targeted supplements – what we might consider and why
Supplements are always personalised, but there are some that frequently feature in a gut‑focused low FODMAP or low histamine plan. L‑glutamine is often used to fuel the cells lining the intestine and may support barrier integrity, particularly in periods of stress or gut inflammation. Zinc carnosine has emerging evidence for supporting mucosal repair and tight junctions, and is sometimes paired with L‑glutamine as a gut‑lining “team”. Depending on your case, we might also consider specific probiotics (for IBS, post‑antibiotic support or histamine balance), alongside nutrients such as vitamin D, omega‑3s or quercetin to support immune regulation and inflammation.
Within the 12‑week framework, we layer these elements carefully: adjusting your FODMAP or histamine load, adding in lifestyle tools you can actually stick to, and introducing supplements stepwise so you can clearly see what is helping. The aim is a calm, more resilient gut and a way of eating that feels both liberating and sustainable, not a life sentence of restriction.
Supplement Trends to Expect in 2026 and a Recap on 2025 Highlights
I’ve had the opportunity to assess a wide range of nutrition-led products in recent years, and one clear shift stands out: the move towards “food as function.” From advanced supplements to microbiome-focused innovations and elevated everyday staples, the most compelling products are those that bridge the gap between clinical nutrition and real-life use.
Looking ahead, I expect this space to evolve further, with more inventive formats and a stronger emphasis on bioactive-rich foods that integrate seamlessly into daily routines.
Key trends observed across product evaluations
From an evaluation perspective, three themes consistently stand out:
Targeted health outcomes
Innovative delivery formats and combinations
A “food-first” approach
There has been a strong presence of microbiome and gut health products, including multistrain probiotics, fermented foods, and collagen-rich broths. While this reflects the growing mainstream understanding of the gut’s role in immunity, mood, and metabolic health, the evidence supporting broad-spectrum probiotic formulations remains variable. Benefits tend to be strain-specific and condition-dependent, and many products still lack clarity around clinically relevant dosing and outcomes.
Foundational nutrition products, such as electrolyte blends and broad-spectrum formulas, perform best when they combine evidence-based ingredients with thoughtful formulation. However, their relevance is often context-dependent. For example, electrolyte products may be useful in cases of significant fluid loss or high physical demand, but are not universally necessary for the general population. Similarly, “broad-spectrum” positioning can sometimes prioritise marketing breadth over targeted efficacy.
Minimally processed, plant-forward convenience foods are also gaining ground. Products that deliver fibre, phytonutrients, and healthy fats—without relying on ultra-processed shortcuts—demonstrate that convenience and nutritional integrity can coexist.
Functional drinks continue to evolve, with formulations targeting energy, focus, and immune support. The most credible options are those grounded in plausible mechanisms, such as polyphenols, B vitamins, and well-studied botanicals, rather than vague or exaggerated claims.
What ties these products together is their ability to align clear health needs with realistic, well-formulated solutions that fit into everyday life.
What defines credible health claims
Across product assessments, the strongest formulations are those that prioritise scientific credibility over marketing hype.
Gut, immune, and energy claims are most convincing when linked to recognised nutrients or mechanisms, such as fibre, specific live cultures, postbiotics, vitamin C, or zinc
Cognitive and mood support is more credible when based on studied ingredients like L-theanine, B vitamins, or specific botanicals used at effective doses
Sports and recovery products perform better when they go beyond protein alone, although the inclusion of electrolytes should be justified by use case rather than assumed as a default
Skin and healthy ageing formulations are strongest when aligned with known physiology, such as the role of vitamin C in collagen synthesis or the antioxidant effects of polyphenols
Overall, the most effective products translate established nutrition science into something practical, enjoyable, and transparently communicated.
Emerging formats to watch
Innovation in delivery formats continues to accelerate, particularly where it enhances both compliance and user experience.
Functional frozen formats and “supplement-meets-food” concepts are emerging, particularly in clinical or appetite-compromised settings, and may expand into more mainstream wellness products
Chewable and gummy formats remain popular, but there is increasing scrutiny around sugar content, dosing accuracy, and third-party testing
Functional hot drinks, including matcha blends and mushroom-based beverages, are growing as daily rituals that deliver bioactives such as polyphenols and beta-glucans in a familiar format
The most successful formats are those led by formulation integrity—ensuring stability, effective dosing, and realistic usage—rather than novelty alone.
The rise of functional everyday foods
One of the most promising areas is the development of “hyper-functional” pantry staples.
High-polyphenol olive oils, for example, provide compounds such as hydroxytyrosol and oleuropein, which are associated with antioxidant and cardiometabolic benefits. Regulatory bodies such as the European Food Safety Authority recognise the role of olive oil polyphenols in protecting blood lipids from oxidative stress when consumed at appropriate levels.
More broadly, there is a shift towards everyday foods—oils, spreads, broths, and grains—being designed to deliver meaningful levels of beneficial compounds such as fibre, omega-3 fatty acids, and plant polyphenols.
This approach supports both practitioners and consumers by making it easier to achieve evidence-aligned intakes through normal eating patterns, rather than relying solely on multiple standalone supplements.
Looking ahead
Based on current innovation patterns, several directions are likely to shape the next phase of nutrition-led product development:
Continued growth in gut–immune–brain axis formulations, with greater emphasis on strain specificity and clinically relevant outcomes
Greater personalisation, with products tailored to life stage, health goals, or specific needs
Expansion of functional chilled and frozen formats designed for both clinical and general wellness use
Increased development of functional oils, condiments, and staple foods with quantified bioactive content
Ongoing demand for clean-label products with transparent sourcing, sustainable packaging, and evidence-based claims
Ultimately, the most credible developments will be those that combine robust nutritional science with practicality and restraint—focusing not just on what can be added, but on what is genuinely needed to support health through everyday choices.
What is SIBO?
Small Intestinal Bacterial Overgrowth (SIBO) happens when too many bacteria build up in the small intestine, leading to uncomfortable gut symptoms and, in some cases, nutrient deficiencies.
I work with clients to help them understand what is driving their symptoms, calm inflammation, and make practical changes so you can eat with more confidence again.
What is SIBO?
SIBO is essentially an overgrowth of bacteria in the small intestine, where normally only relatively low numbers of microbes should be present. This overgrowth can interfere with digestion and absorption, leading to gas production, irritation of the gut lining, and problems with how you process fats, carbohydrates, and some vitamins.
• The excess bacteria ferment carbohydrates, producing hydrogen and/or methane gas, which drives bloating, pain, and changes in bowel habits.
• Over time, SIBO can contribute to malabsorption of nutrients such as vitamin B12, fat-soluble vitamins (A, D, E, K), and minerals like calcium.
Common SIBO symptoms
SIBO symptoms can overlap with IBS and other digestive issues, which is one reason it often goes undiagnosed for a long time.
Typical digestive symptoms include:
• Bloating and visible abdominal distension, often worsening after eating
• Excess gas, belching, and flatulence
• Abdominal discomfort or cramping
• Diarrhoea, constipation, or alternating between the both at differing times
• A feeling of fullness very quickly or discomfort after eating small amounts
Possible whole-body symptoms include:
• Unintentional weight loss or difficulty maintaining weight.
• Fatigue, weakness, and “brain fog” linked to nutrient deficiencies.
• Signs of low B12 or vitamin D over time, such as tingling, low mood, or bone health issues.
What causes SIBO?
SIBO is usually the result of something affecting how food and bacteria move through the small intestine or how well the gut’s natural defences are working.
Key contributors can include:
• Sluggish gut motility (slow movement of food), which might be linked to diabetes, connective tissue conditions, hypothyroidism, or nerve issues.
• Structural changes in the gut, such as adhesions, diverticula, strictures, or previous abdominal surgery that creates “pockets” or slows transit of food.
• Reduced stomach acid or bile flow, which would normally help keep bacterial numbers in check.
• Long-term use of certain medications, such as some acid-suppressing drugs, which can alter the gut environment.
• Co-existing conditions like coeliac disease, Crohn’s disease, or scleroderma that change how the small intestine functions.
How SIBO is usually diagnosed
Diagnosis is typically done by a gastroenterologist or specialist, and a nutritional therapist will often work alongside this medical process.
Common approaches include:
• Breath testing (usually lactulose or glucose) to measure hydrogen and methane gases produced by bacteria in the small intestine.
• In more complex cases, small bowel aspirate and culture, or investigative endoscopy, to directly sample small intestinal contents.
• Blood tests for nutrient levels (like B12, iron, and vitamin D) and markers of malabsorption if symptoms suggest deficiencies.
What to expect from working with me
Working with me when you have a SIBO diagnosis is not just about “what to eat” but about understanding your underlying triggers, supporting medical treatment, and helping you rebuild a more resilient gut over time.
The process:
• Firstly, I take a detailed health and symptom history: looking at your digestion, energy, previous diagnoses, medications, stress levels, and diet to identify patterns and possible root causes.
• I support you with access to testing if necessary and explain any results you already have that may be complicated and confusing: I help you understand breath test options, timing, preparation, and how test results might link to your symptoms (while diagnosis itself remains medical).
• I make a phased nutrition plan for you: starting with a plan to reduce symptoms (often adjusting fermentable carbohydrates, meal timing, and texture), then gradually re-expanding your diet to avoid long-term unnecessary restriction.
• Gut motility and digestion support: using food timing, fibre types, hydration, and sometimes carefully selected supplements (where appropriate) to support stomach acid, bile flow, and the migrating motor complex.
• Nutrient repletion: identifying where SIBO may have led to low B12, iron, or fat-soluble vitamins and using food-first strategies, with supplements if needed, to rebuild levels safely.
• Longer-term relapse prevention: gradually I will help you to broaden your diet, to support gut microbiome balance in the large intestine, and I will also work with you on lifestyle factors such as stress, sleep, and gentle movement, which all influence gut motility.
For many people, the most valuable parts of this process are having a clear plan, feeling understood, and no longer guessing which foods are “safe” day to day. I can help you move from constant firefighting of symptoms to a more stable, flexible way of eating that supports both your gut and overall health.
