THE SIBO/HISTAMINE BI-PHASIC DIET � 1

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
Abnormal amounts of these bacteria
cause a number of problems

WHAT IS SIBO? 1. They damage the microvilli — the absorptive

surface of the small intestine. This can lead to
Small intestine bacterial malabsorption of nutrients. Microvilli are also
responsible for the digestion of small starch molecules
overgrowth is a condition from food. When the microvilli are not working, the
where bacteria which are bacteria use these small starch molecules to cause
fermentation. This bacterial fermentation produces
normally found lower in the methane and hydrogen gas. Not only is this
large intestine have overgrown uncomfortable, but causes further damage to the
in the small intestine instead. 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 inflammation.

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.

Health care disclaimer: This treatment protocol is not intended as Visit www.TheSIBODoctor.com
medical advise and is best used with the guidance of a health care
professional. Please ask your doctor if this protocol is appropriate for more information
for your condition before starting.

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 2

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.

HISTAMINE INTOLERANCE refrigerator, so leftovers can be an issue for some. There are
other foods considered “histamine liberators” (HL) found in
Histamine is a substance that is made inside the body as well certain vegetables, fruits, nuts and eggs.
as found in certain foods. In many cases of SIBO, other foods
besides fermentable carbohydrates can be problematic. The Histamine liberators do not necessarily contain histamine but
most common reactions are to foods containing histamine. can trigger a histamine response. Tolerance to these foods is
Histamine is a substance found in certain foods which can dependent on the individual.
cause symptoms in those with severely disrupted mucosal
A note about seafood: While seafood can easily build
lining of the small intestines. The depletion of the histamine-
histamine as it ages, very fresh/frozen seafood may be well
digesting enzyme, diamine oxidase (DAO), yeast overgrowth,
tolerated. White fish such as halibut, sole and cod, and very
or the prevalence of histamine producing bacteria are
often to blame. As the overgrowth reduces and this lining fresh salmon are typically the best tolerated.
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 HISTAMINE TOLERANCE
as Mast cells. Reducing histamine foods can lower the “total
load” of histamine. Each person is difference in their tolerance and threshold to
histamine foods. Some find that histamine liberating foods
are not at all bothersome to them but high histamine foods
SYMPTOMS OF are. Others must avoid them all to keep their symptoms
HISTAMINE INTOLERANCE controlled. Most, however, will have some tolerance to
histamine foods and simply need to stay under their own
Not everyone with SIBO has histamine intolerance. Beyond personal threshold, or the point at which symptoms begin.
the typical gastrointestinal symptoms, those with HIT often
experience symptoms that resemble allergies including
runny nose, itchy eyes, sneezing, hives, asthma, and chronic HISTAMINE REDUCING FOODS
cough, as well as other symptoms including headaches,
joint pain, anxiety and insomnia. Not everyone with these Try to keep this limited diet as anti-inflammatory as possible
symptoms has HIT but if you do, eliminating histamines by including as many allowed plant-based foods as you
from the diet may provide you some additional relief during can and continue to test HL foods in as you are able. Use
treatment. anti-inflammatory and mast cell-stabilizing herbs and spices
such as black seed oil/spice, turmeric, cilantro, parsley
and watercress, and DAO-stimulating olive oil to flavor
HISTAMINES IN THE DIET foods. Try to eat as organically as you can afford to reduce
pesticides which can add to the histamine load for some.
Histamines in food typically increase with age and Some with severe histamine intolerance find a diet high in
fermentation. Fermented foods (vinegars, 24-hour yogurt, animal protein can trigger their histamine response. We do
wine/beer/cider, sauerkraut, kombucha, kimchi), aged meats not recommend avoiding animal protein as this can limit the
(bacon, sausage, ham, canned meats/fish, smoked salmon, diet even further. Just make sure you are focusing on plant-
bone broths) as well as tomatoes, spinach, eggplant, spicy based fats, herbs, spices, vegetables, and fruits. If you are
foods and chocolate are typically the most problematic for early in treatment and plants are not well tolerated, cooking,
those with HIT. Histamines also increase as food ages in the blending or juicing them may be better tolerated.

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 3

FERMENTED FOODS HISTAMINE ELIMINATION

AND RE-INTRODUCTION
Fermented foods such as cultured vegetables, sauerkraut,
IN THREE STEPS
kimchi, as well as miso and yogurt are wonderful for the
digestive tract as they contain high amounts of probiotics STEP 1
or beneficial bacteria. But since these foods are high Phase 1 of the Bi-Phasic Diet lasts two–four weeks. You
in histamine, they may not be tolerated and it is best to should avoid all fermentable carbohydrates, histamines and
eliminate them from the diet for now. They can be introduced histamine-liberating foods for at least two weeks before
back in as your symptoms improve and your practitioner considering expanding the histamine liberators (HL) into the
allows. Introduce no more than one tablespoon in any given diet. Follow the food guide as to which foods to choose.
meal and increase only as tolerated.
STEP 2
After two weeks on phase 1, and only once symptoms have
GENERALLY AVOIDING ALCOHOL reduced, you can start testing HL foods if you wish. Use the
Phase 2 “Allowed” list as a guide for foods to introduce. Add
Alcohol is a known gut irritant and disrupter of the normal in one serving of a new HL food for three consecutive days.
microbiome of the intestinal tract. It also reduces the amount If you tolerate, you can keep that food in the diet and layer
of DAO you produce and, if fermented (ie. beer, cider and in another HL food in the same manner. Repeat, as tolerated.
wine), contains high amounts of histamine. It is strongly If you start experiencing symptoms, reduce to previously
recommended to avoid all alcohol while on the Bi-Phasic tolerated histamine load. Know that you may tolerate one
Diet. This is sometimes difficult in social situations. In these HL food over another, so if you do react to one, wait for the
instances, clear spirits like vodka and gin are preferred over symptom to calm and then continue testing with another. If
beer and wine as they do not contain histamine, sulfites or you do not tolerate a particular food, avoid it until you are
yeast. Please limit alcohol consumption even in these cases. 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
HISTAMINE ELIMINATION baseline diet and wait until Phase 2 before testing again.
AND REDUCTION STEP 3
Your practitioner will advise you on when you are ready to
Combining a low fermentable diet with a diet that is low in fully move on to the Phase 2 diet. This will involve adding in
histamine can be challenging as the list of foods is narrow. higher histamine and histamine liberating foods, as you are
While all foods high in histamine and histamine liberators ready. When determining which foods to add in first, always
have been eliminated from the diet in Phase 1, once your consider which foods you miss the most and what will make
symptoms have calmed, you are encouraged to test in the diet more enjoyable. In this phase, you will also be able
histamine liberating foods in an effort to expand the variety to expand more fermentable carbohydrates into the diet, as
and balance of the diet. Histamine containing foods are noted.
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.

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 4

All listed PHASE 1 AVOID FERMENTABLE CARBOHYDRATES, HISTAMINE

quantities AND HISTAMINE LIBERATING FOODS (2–4 WEEKS)
are per
meal
ALLOWED AVOID

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Eggs (HL)
Pork (HL)
Beef (organic, not aged), Lamb, Turkey (organic Seafood (H / HL) see “Histamines in Food” for info.
PROTEIN
if available), Skinless chicken (organic),
must be fresh Seasons/aged meats (ham, bacon, sausage,
Wild/game meats
canned or smoked fish and meats) (H)
FERMENTABLE CARBOHYDRATES
Legumes, Meats seasoned with garlic/onion

DAIRY
Avoid all dairy Avoid all diary
PRODUCTS

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum (spicy/chili) (H)
Eggplant (H)
Alfalfa sprouts, Bamboo shoots, Bok choy, Olives (H)
VEGETABLES Capsicum/bell peppers (not spicy), Carrot, Spinach (H)
unlimited Chard/Silverbeet, Chives, Cucumber, Ginger,
Tomato (red) (H) green or yellow cherry tomato
Kale, Lettuce, Parsnip, Radicchio, Radish,
may be OK
Rocket/arugula, Spring onion (green part only),
Sunflower sprouts, Witlof FERMENTABLE CARBOHYDRATES/STARCH (F)
Cauliflower, Corn, Garlic, Mushroom, Onion,
Sweet Potato, Starch powder: arrowroot, corn,
rice, tapioca

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)
VEGETABLES Celery – ½ stick
one serve per Celery root – ½ cup
meal 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

Blueberries – ½ cup HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Cantaloupe/Rockmelon – ½ cup Avocado (F/HL) – ¼ fruit can test in with HL but
Grapes – 10 ea limited to recommended amount
Lime (to flavour, fresh squeezed) Banana (H)
FRUITS
Lychee – 4 Kiwi (HL) – 1 ea
two serves
Honeydew melon – ½ cup Lemon (HL) (fresh squeezed, likely tolerated)
per day
Kiwi – 1 ea Orange (HL)
Lychee – 5 Raspberries (HL)
Papaya – ½ cup Strawberries (HL)
Passion fruit – 1 ea Tangerine (HL)

ea = each tsp = teaspoon tbsp = tablespoon

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 5

All listed PHASE 1 AVOID FERMENTABLE CARBOHYDRATES, HISTAMINE

quantities AND HISTAMINE LIBERATING FOODS (2–4 WEEKS)
are per
meal
ALLOWED AVOID

FRUITS FERMENTABLE CARBOHYDRATES (F)

Paw paw – ½ cup
(CONT’D) Apple, Apricot, Blackberries, Canned fruit in
Pomegranate – ½ small or ¼ cup of seeds
two serves fruit juice, Custard apple, Fig, Jam, Mango,
Rhubarb – 1 stalk
per day Nashi, Nectarine, Peach, Pear, Persimmon,
Plum, Watermelon

GRAINS, Avoid all, but if practitioner allows, can limit to: Avoid all, but if practitioner allows, can limit to:
STARCHES, Quinoa – ½ cup Quinoa – ½ cup
BREADS AND White rice (basmati, jasmine only) – ½ cup White rice (basmati, jasmine only) – ½ cup
CEREALS cooked cooked

LEGUMES
Avoid Avoid
lentils, beans

Freeze large batches in single servings to

reduce histamine production Bone broth (H/F)
SOUPS
Homemade broths (organic only): chicken, Canned soups and soup bouillon (H/F)
beef, lamb, turkey, 2-hour broths only

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

Tea (herbal) Energy drinks, Fruit juices (H/F), Kombucha,
BEVERAGES
Water (filtered only) Liqueurs and spirits (dark), Seltzer water, Soft
drinks, Tea (black, green), Wine

Artificial sweeteners (avoid completely) (HL),

Yeast overgrowth: limit /avoid all except Stevia
Cane sugar, Chocolate cocoa, Cacao (H/F),
SWEETENERS Dextrose/glucose, Organic honey (clear) — max.
Maple syrup, Sugar alcohols (xylitol, mannitol,
2 tbsp per day, Stevia (100% pure, no inulin)
sorbitol)

Coconut flour/shredded – ¼ cup

All other nuts/seeds (HL) — can introduce upon
Coconut milk (no thickeners) – ¼ cup
NUTS/SEEDS practitioner’s approval to low FODMAP guideline
Coconut cream — 2 tbsp
recommendations
Macadamias – 20 ea

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum/peppers (spicy): chili, cayenne and
their sauces (H)
Allspice, Cardamom, Cinnamon, Cloves,
Nutmeg (HL)
Fermented sauces (such as fish, soy, coconut
All fresh and dried herbs and spices except aminos, oyster, tamari) (H)
those noted in ‘Avoid’ Fermented foods (such as kimchi, sauerkraut,
CONDIMENTS
Green salsa (without onions/garlic) pickles) (H)
– 1-2 tbsp 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,

Butter, Coconut, Flax (low lignin) Ghee,

FATS/OILS Grapeseed, Infused (garlic,lemon, onion), Olive, Palm, Soyabean, Pumpkin, Sesame (HL), Walnut
MCT, Sunflower

ea = each tsp = teaspoon tbsp = tablespoon

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 6

PHASE 2 TEST HISTAMINE LIBERATING (HL) FOODS AND CONTINUE

TO AVOID/LIMIT HISTAMINES (H) AND FERMENTABLE
CARBOHYDRATES AS DIRECTED BY YOUR PRACTITIONER

ALLOWED AVOID

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Beef (organic, not aged), Chicken (organic), Seasons/aged meats (ham, bacon, sausage,
PROTEIN Eggs (HL), Lamb, Pork (HL), Seafood (H/HL) see canned or smoked fish and meats) (H)
must be fresh “Histamines in Food” for info, Turkey (organic if
available), Wild/game meats FERMENTABLE CARBOHYDRATES
Legumes, Meats seasoned with garlic/onion

Butter, Ghee
DAIRY Homemade yoghurt (plain, organic) (H) this is
Avoid all other diary not on allowed list
PRODUCTS often well tolerated — reintroduce upon your
practitioner’s advice

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum (spicy/chili) (H)
Alfalfa sprouts, Bamboo shoots, Bok choy, Eggplant (H)
Capsicum/bell peppers (not spicy), Carrot, Olives (H)
VEGETABLES
Chard/Silverbeet, Chives, Cucumber, Ginger, Spinach (H)
unlimited
Kale, Lettuce, Parsnip, Radicchio, Radish, Tomato (H) green/yellow cherry tomato may be OK
Rocket/arugula, Spring onion (green part only),
FERMENTABLE CARBOHYDRATES/STARCH (F)
Sunflower sprouts, Witlof
Canned vegetables, Corn, Garlic, Mushroom,
Onion, Sweet Potato, Starch powder: arrowroot,
corn, rice, tapioca

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)
VEGETABLES Cauliflower – ½ cup
one-two Celery – 1 stick
servings per Celery root – ½ cup
meal 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

Avocado (F/HL) – ¼ cup

Blueberries – ½ cup HISTAMINE (H) HISTAMINE LIBERATORS (HL)
Cantaloupe/Rockmelon – ¼ cup Banana (H)
FRUITS Cherries – 3 ea Orange (H)
two servings Grapes – 10 ea Tangerine (H)
per day Honeydew melon – ¼ cup FERMENTABLE CARBOHYDRATES (F)
Kiwi (HL) – 1 ea Apple, Apricot, Blackberries, Canned fruit in fruit
Lemon (HL) – use to flavour, fresh squeezed juice, Custard apple, Fig, Jam, Mango
Lime (HL) – used to flavour, fresh squeezed

ea = each tsp = teaspoon tbsp = tablespoon

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 7

PHASE 2 TEST HISTAMINE LIBERATING (HL) FOODS AND CONTINUE

TO AVOID/LIMIT HISTAMINES (H) AND FERMENTABLE
CARBOHYDRATES AS DIRECTED BY YOUR PRACTITIONER

ALLOWED AVOID until further notice

Lychee – 5 ea
Passion fruit – 1 ea
FRUITS Paw paw – ¼ cup FERMENTABLE CARBOHYDRATES (F)
two servings Pineapple (HL) – ¼ cup CONT’D
per day Pomegranate – ½ small or ¼ cup seeds Nashi, Nectarine, Peach, Pear,
(CONT’D) Raspberries (HL) –½ cup Persimmon, Plum, Watermelon
Rhubarb – 1 stalk
Strawberries (HL) – ½ cup

Quinoa – ½ cup per serving

GRAINS,
Rice cakes (plain) – 2
STARCHES, Avoid all other grains, breads,
Rice noodles – ½ cup cooked
BREADS AND cereals, cakes and biscuits
White rice (basmati or jasmine only) – ½ cup
CEREALS
cooked per serving

Lentils (brown, chana, urad) – ½ cup

LEGUMES
Lentils (green, red) – ¼ cup All other legumes and beans
lentils, beans
Lima beans – ¼ cup

Freeze large batches in single servings to

SOUPS reduce histamine production Bone broth (H/F)
organic Homemade broths (organic only): chicken, beef, Canned soups and soup bouillon (H/F)
lamb, turkey, 2-hour broths only

(All H) Beer, Cider, Coffee (caffeinated),

BEVERAGES Alcohol (clear spirits) – no more than 30ml
Energy drinks, Fruit juices (H/F),
every other day, Decaf Coffee (black),
Kombucha, Liqueurs and spirits (dark),
Seltzer water, Tea (herbal), Water (filtered only)
Soft drinks, Tea (black, green), Wine

Dextrose/glucose Agave nectar, Artificial sweeteners (avoid

SWEETENERS Organic honey (clear) – no more than completely (HL), Cane sugar, Chocolate,
2 tbsp per day cocoa, cacao (H/F), Maple syrup, Sugar
Stevia (100% pure, no inulin) alcohols (xylitol,mannitol, sorbitol)

Almonds (HL) – 10 ea OR
Almond flour/meal – 2 tbsp OR
Almond milk (unsweetened, without added
thickners) – 1 cup
Coconut (flour/shredded) – ¼ cup OR
Coconut milk (without thickeners or gums) –
¼ cup OR
NUTS AND Coconut cream — 2-3 tbsp
SEEDS Chia seeds, Flaxseed, Peanuts
Hazelnuts (HL) – 20 ea
Macadamias – 20 ea
Pecans (HL) – 40 ea
Pine nuts (HL) – 1 tbsp
Pumpkin seeds (HL) – 2 tbsp
Sesame seeds (HL) – 1 tbsp
Sunflower seeds (HL) – 2 tbsp
Walnuts (HL) – 10 ea

ea = each tsp = teaspoon tbsp = tablespoon

© 2018 THE SIBO DOCTOR

 THE SIBO/HISTAMINE BI-PHASIC DIET � 8

PHASE 2 TEST HISTAMINE LIBERATING (HL) FOODS AND CONTINUE

TO AVOID/LIMIT HISTAMINES (H) AND FERMENTABLE
CARBOHYDRATES AS DIRECTED BY YOUR PRACTITIONER

ALLOWED AVOID until further notice

HISTAMINE (H) HISTAMINE LIBERATORS (HL)

Capsicum/peppers (spicy ie. chili, cayenne and
their sauces) (H)
Allspice, Cinnamon, Cloves, Nutmeg – small
amount OK
Fermented sauces (such as coconut aminos, fish,
All fresh and dried herbs and spices except oyster, soy, tamari) (H)
those noted in ‘Avoid’ Fermented foods (such as kimchi, pickles,
CONDIMENTS
Mayonnaise (sugarless) (H) –1 tbsp sauerkraut) (H)
Vinegar (apple cider, rice) –1 tsp Mustard (H)
Vinegars (H), All other

FERMENTABLE CARBOHYDRATES/STARCHES (F)

READ LABELS! No Asafetida, Chicory
root, Garlic, Gums/carageenan/thickners,
Maltodextrin, Onions, Starches, Sugar

Butter, Coconut, Infused (garlic), Flax (low

lignin), Ghee, Grapeseed, MCT, Olive,
FATS/OILS Palm, Soyabean
Polyunsaturated vegetable, Pumpkin seed,
Sesame, Sunflower, Walnut (HL)

ea = each tsp = teaspoon tbsp = tablespoon

© 2018 THE SIBO DOCTOR