The second step in Dr. BG’s 7-Steps Paleo* Gastro IQ SIBO Protocol is:

“Ancient heirloom potatoes, tubers, roots that are low glycemic index (or high if good insulin sensitivity) and ancient heirloom grains, legumes, lentils/dal that are low glycemic index (or high if good insulin sensitivity), prepared the ancient way (soaked, fermented, etc)”

Roasted and cooked culinary delights like spuds, tubers, roots, soaked/cooked grains, legumes, and lentils have been alongside man throughout our evolutionary past. Eating these foods is very important in keeping our gut microflora in top-notch condition.

The Standard Western Diet leads to a Standard Western Microbiome, one that has been starved of healthy, fermentable fibers, flooded with antibiotics, and allowed to proliferate with pathogenic bacteria. This leads to inflammation, metabolic syndrome, and auto-immunity. On the other hand, A paleo diet, with near complete avoidance of refined sugars, flours, gluten, and vegetable oils and plenty of starchy, fibrous plant matter will produce a functional microbiome, replete with beneficial bacteria, flooded with short-chain fatty acids, and ensure immune system homeostasis, glucose regulation, vitamin and mineral uptake, and production of vital hormones and neurotransmitters.

Often times when starting a paleo diet, one restricts carbs. This is an effective strategy for weight loss and may help eliminate unhealthy sugar cravings, but in the long run carb restriction will most certainly lead to a dysfunctional gut microbiome.  Both the Perfect Health Diet or Mark’s Daily Apple Diet outline the optimal amount of starch that one should include in their diet. A daily food intake that is roughly half plant matter, including up to one pound of starchy foods is highly recommended.

[Grace~~ Dispelling fairy tales: I love Paul and Mark. (Particularly Mark’s pectorals and gluteals and how he recognizes a good thing like RESISTANT STARCH for the gut microbiota and insulin metabolism) We have all evolved but I’m not certain if their respective diets entirely have.

What I like about PHD is the 150 grams per day advice for adrenal dysregulation because ketosis/VLC will instigate susceptible adrenals into hypercortisolism, and subsequent low adrenal and low T3 thyroid syndromes. PHD can heal this. However, the reliance on white rice and not the whole grains, whole legumes and RS-rich tubers will lead to gut dysbiosis for those who are vulnerable. Adding these back in are thus imperative. If I consumed 150 grams of high GI (glycemic index) white rice daily, I’d be T2DM within two seconds.  But if I consumed 150-200 grams of low glycemic index carbohydrates that included RS-rich starches, grains, and tubers, ME AND MY MICROBIOTA ARE GOLD *wink wink*.  And the net carbs are 75-100 grams/day.

MDA has two (ancient) popular posts which offend my gut 😉 and the microbiota… (1) The Primal Carb Continuum and (2) All Grains are Unhealthy.  Fiber IS INDEED good for us (and Mark says so HERE).  They feed your microbiota and heal SIBO and promote gut longevity, proper processing requires soaking and fermentation of whole grains, legumes and pulses to make them edible.  So Mat Lalonde has already banished the lectin myths. Please see his AHS ‘Invalid Inferences‘…  How to make our legumes and whole grains work for us? Soak, soak, soak which ferments the starches. Soaking brings alive the microbes that reside on the grain or legume/pulse.  If Gluten Small Grass Grains and unsoaked legumes wiped out the Neanderthals, then it is perhaps food technology that brought Anatomically Modern Humans to the Great Leap Forward 40,000 to 50,000 years ago.]

If ‘carb restriction’ means eliminating gluten, industrially processed flour, and refined sugars, that is perfect! If it means eliminating potatoes, rice, and most other whole, starchy foods that’s a problem.

The purpose of this blog is to teach you how to chose and prepare starchy, fibrous food in a way that will lead to a high Paleo* Gastro IQ.

Everyone knows beans and rice, but there is a whole host of other foods that fit the bill for exceptional gut health and getting a variety of these foods is extra-important when healing a broken gut. It would be a very wise move on anyone’s part to seek out some of these ancestrally prepared and cooked starches:
Jobs tears/Adlay/croix
Brown rice
Purple rice
Red rice
Black rice

Legume Fermentation/Soaking Tips
Journal Source: HERE

Basmati white rice
Basmati red rice
Mung beans
Green beans
Red beans
Kidney, black, fava, navy, etc beans
Millet
Sorghum
Buckwheat
Teff
Amaranth
Steel cut oats
Lentils
Chana dal
Garbanzo
Quinoa
Taro
Jicama
Cassava
Yams
Konjac
Okinawan purple potatoes
Andean purple potatoes
Nagaimo (Chinese white mountain yams)
Roasted Potatoes

Plantains
Green Bananas
Mt Uncle’s Ladyfinger-Banana Flour (high resistant starch content when baked/cooked)

 

The list goes on and on, but you get the picture–no need to rely only on beans and rice! Each different variety packs a different punch. Beans and lentils are often frowned upon in paleo circles, but when properly prepared, they are one of the most nutritious foods on the planet.

When it comes to grains and legumes, one of the biggest problems is phytates. An exceptional write-up on phytates and how to remove them can be found here. “…phytic acid does indeed bind with minerals such as calcium, phosphorus, iron and zinc. If you depend on grains and legumes for a high portion of your diet, then those phytates (phytic acid) could lead to mineral deficiences.” Fortunately our ancestors found ways to remove phytates and these methods can be used today to make these evolutionary important foods safe. It would be of great benefit for you to learn the techniques of sprouting and fermenting to increase your range of healthy foods.

A very interesting grain known as Job’s Tears, Chinese Pearl Barley, or Adlay has some remarkable properties including effectively alleviating osteoporosis, leukemia, and rheumatism. Oats are an interesting topic of much debate, and don’t let a Gluten-Free label fool you! Dr. BG said of Gluten- Free foods in 2010:

“Personally I believe gluten-free is not enough for an ultimately optimal lifespan and health. Gluten-free products often still are refined, vastly processed and full of high carbohydrates and problem oils (oxidized, pesticide-laden crops of omega-6 canola, safflower, cottonseed, etc) which spike and increase blood glucoses (BG) and promote silent inflammation. Chronic silent inflammation leads to cancer, obesity, fibromyalgia, mood disorders, arithritis, weight gain, osteoporosis, diabetes, heart attacks and strokes.

Gluten free however alone improves stomach and GI symptoms including bloating, constipation, bloody stools, iron deficiency anemia, chronic fatigue, IBS (irritable bowel syndrome), and gut dysbiosis.”

The best advice we can give you is to include plenty of starchy carbs in your daily menu planning and learn to broaden your horizon. The more variety in your diet, the better profile your gut microbiome will develop.

If you have any questions or concerns about our food list or want to see any added, please comment!

  • Hello Tim,

    I have a question. You say ‘The more variety in your diet, the better profile your gut microbiome will develop’. This makes intuitive sense, but Dr. Ayers of the Cooling Inflammation blog gives the opposite opinion in his latest post stating ‘If the diet is fairly constant, then the diversity of the population (of gut bacteria) gradually increases’.

    I’m sure you’re aware of Dr. Ayers and that he knows his stuff about gut bacteria. How do you reconcile his take with your advice?

    Thanks,
    Aaron

  • Anonymous

    Agree with you entirely, Tim. Dr. Ayers has to evolve and read some current research. I’m sure he was blindsided by studies linking rheumatoid arthritis and T1 diabetes with disbacteriosis of microbiome. Who would have thought: Prevotella copri!

    It’s like putting a predatory snakehead fish into your neighborhood pond.

  • Anonymous

    Tim/Dr. BG,

    1) From what I’ve read here and personal experience, I’m pretty convinced that RS is therapeutic for people with messed up gut biomes, and generally beneficial to all. But can it really be a prereq for good gut health? There must be plenty of people who don’t consume much RS and have in tact guts. How else to explain the near-carnivorous Mr. Pottenger’s bionically badass biome?

    2) Are lacto-fermented foods really such a good idea for people with SIBO? SIBO involves an overgrowth of even normally beneficial organisms, especially D-Lactate producing ones. How does adding more of these help?

  • Alison

    This is the most informative blog I have found on the whole SIBO/pale/carb debacle. After years of no gluten, sugar/fruit and basically zero carb, I wound up with the most damaged gut and toxic liver a person could have and was wasting away. Couple that with loads of stress, an iatrogenic steroid overdose and everything crashed – gut, immune system, hormones. I’ve been wracked with gut infections, SIBO, parasites and fungal species for the last 4 years. I have been doing ALL the wrong things – a completely carb free a la GAPS, FODMAPS and SCD (but no fruit or honey) has only served to further my decent into Hell and crash my adrenals. As a former athlete, this has been devastating. Everything you have said makes sense, especially when I see almost no butyrate on my stool tests but a lot of other pathogenic critters.Where can I get some more info on the proper way to ferment grains and vegetables? Do you have any instructions available on this blog or elsewhere? Thanks so much for your invaluable and very possibly life saving suggestions.

  • Hey Alison,

    I hear ya. I’ve done many of the things that you’ve done as well (and being BLINDO, I didn’t see the adverse effects on my athletic performance and should’ve stopped immediately).

    Sandar Katz has amazing books for fermenting foods. Have you read him?
    http://drbganimalpharm.blogspot.com/2013/11/how-to-cure-sibo-small-intestinal-bowel_10.html

    Please keep us updated with your progress! I’m so pleased that you are using the integrative medicine stool testing to figure out what is going on. UR SO ADVANCED~!!

  • Webraven

    Dr .BG and Alison,
    Me too!

    Stress ( all types; emotional, surgical, antibiotics..-> disgruntled gut. In my attempts to fix it and it’s attendant sequel are I’ve screwed myself up more every step of the way. Poor T3-T4 conversion was treated with meds instead of gut/stress treatment. I’ve SCD’d (( could never get out of the intro stage, but 3 months of it left me unable to digest any fruits and veggies, basically) and VLC’d and IF’d myself from tried with a bad gut to adrenals exhausted and a very screwed up gut…live and learn, right?

    I suspect that a lot of the VLC and IF advice should at the very least be significantly adjusted for women. Especially stressed women, which is most of us -what with the dual and triple responsibilities women have both biologically and socially.

    Grace, following your story on your fantabulous blog, am I assuming correctly that your fantastic weight loss attained in part with the prolonged cardio regimen you describe came before (lead to?) your adrenal problems? So many people, again women especially, seEm to be walking ( or rather, running :-)) right into this booby traps seduced by success stories ( with no long term follow up, btw) r dramatic body composition improvements from VLC Paleo, IF and the whole nine.

    Thanks for sharing, it is encouraging to feel one isn’t alone in this boat!

  • Hey Webraven,

    I totally concur “I suspect that a lot of the VLC and IF advice should at the very least be significantly adjusted for women. Especially stressed women, which is most of us -what with the dual and triple responsibilities women have both biologically and socially.”

    Actually the great majority of my wt loss was VERY SLOW and by doing long distance running eating croissants, sprouted wheat and peanut butter and jelly all day. It would’ve been faster on rice and glutenfree — but at the time I didn’t know better. Frankly I became too skinny at 110-112 Lbs and found Xfit that raise my muscle mass and I gained wt to 122# which was much more normal.

    VLC was VERY VERY VERY bad for adrenals after I attempted and failed (and subsequently had a horrific biking accident) to ketoadapt for 9 months. You are right on, hawwt grrl. Women perhaps are not genetically built or in modern times our lame, sucky adrenals preclude extremes like VLC or IF’ing.

  • Webraven

    Thanks for commenting drBG-
    Yeah, if it’s true that even HG men eat more protein than the women (easy to see how this would have developed from their different roles in procuring food), and women being gatherers probably are/were nibbles, too, it makes sense even from that perspective that women wouldn’t have developed to need and tolerate VLC and IF the same way men would.

    bTW, I can’t find a way to subscribe to comments here, what am I missing?

  • Mistress Distress

    Hi, is there a list of low glycemic tubers and grains appropriate for the insulin resistant? Also how do you find ancient heirloom versions of these?

  • Mistress Distress

    Thanks Tim, I’m starting to experiment, and its hard to not want very specific rules and guidelines but I guess that s not very realistic. I’ve been through many diets over the years trying to address IBS-D, leaky gut, and possible SIBO. the more I tried the worse I seemed to feel and I could never go long without cheating with cookies or chips or chocolate, etc. Chips (potato or corn) always seemed to normalize my bowel movements the new next day (it I often diarreah) and I wonder if it’s because of the starch. I’d been scared away from starch from the paleo and primal crowd, and also learned this year I’m prediabetic.. but I’m willing to give this a shot. Unfortunately my soaked stone ground oats cooked this morning did not agree at all. I’ve got soaked lentil and sprouted quinoa waiting for further experimentation. Should I incorporate SBO probiotics right away (I haven’t taken them before) or do each of the 7 SIBO steps require waiting?

  • Anonymous

    Hi,

    I have been reading this blog with much interest and wondered if you could point me in the right direction. I have been on the GAPS diet for the last 10 months due to the extreme bloating, gas and constipation I have been experiencing. This has helped greatly however I am now sensitive to some GAPS foods which are all high FODMAP foods. Would you advise moving straight into the 7 steps to cure SIBO diet (to get Resistant Starch into my diet) or should I do a FODMAP diet first to try and dispel the existing intolerances? After 10 months of very little starch on GAPS I am wondering if I should just dive right in and get some RS into my system.
    Thank you for your wonderful blog!
    Jasmine

  • Hi Dr. BG / Tim,

    I get joint / skin symptoms when I eat fructans or digestible starch – but not when I eat extremely unripe plantains. Do I need to “weed” first? How do I go about “weeding”?

    I’ve yet to try unmodified potato starch because I’m worried about nightshades (I stopped eating them since getting diagnosed with an autoimmune disease).

  • Also, am I not ready to start this 7-step SIBO plan if I can’t tolerate starch?

  • Are any SIBO sufferers finding that legumes make there symptoms worse, even when properly soaked and prepared? I’ve been following the RS steps on this blog and have experienced great results. However, I still can’t have beans or dairy (fermented or not). Both seem to exacerbate the SIBO. While many of my ailments resolve with RS (i.e. dandruff, acne, keratosis pilaris, weak nails, etc.), once I eat certain foods like beans, dairy and cruciferous veggies, the symptoms return. I’m wondering how I can get over the hump and heal my gut for good, so I can enjoy these foods again.

  • Hi

    I saw on your food list ‘Steel cut oats’. Do you think this is a good food to eat? I know it has a good RS content eaten raw but I thought it was unhealthy in other ways?

    I’d appreciate your comment on this and love your blog.

    Regards

    Rohan

  • Jasmine,

    Like all fiber or new foods, the gut requires time to respond and acclimate.

    James L.

    I discuss weeding on this post
    http://drbganimalpharm.blogspot.com/2013/09/my-n1-pre-and-post-microbiome-digestion.html

    Have you done testing? Gut testing reveals what needs to be weeded.

    Rohan,
    Oats are mainly beta glucan and other fiber which are fantastic for the microbiota. Some people do not tolerate if there is gluten cross contamination. The RS content is high when raw but after cooking it goes to almost 1 g or less per serving. Raw oats are problematic for lectins and phytates which bind iron and other vital minerals and cause deficiencies in human trials.

  • Anonymous

    Has anyone tried lotus root as a source of RS? It’s pretty lowcarb and tastes great fried!

  • Anonymous

    Has anyone tried lotus root as a source of RS? It’s pretty lowcarb and tastes great fried!

  • Love lotus roots in Shanghai! Love the crunchiness and versatility blanched in salads or stuffed with meat or sweet glutinous rice as a dessert. Beautiful holes. did you get fresh ones in the USA?

  • Any SIBO sufferers ever tried Silver Hills’ sprouted ancient grain bread? I’m wondering if this would be safe because the grains are sprouted. I’d really love to get the health benefits of the ancient grains.
    http://www.silverhillsbakery.ca/products/ancient-grains

  • Dan

    Hi
    You guys seem to really know your stuff! I commented on another post here, but then read alot more and now have some more specific questions.
    I have Ankylosing Spondylitis, so I am following a no starch diet. But I do beleive the key to really healing is a healthy gut biome. How do you guys think I should procede, regarding RS? Meaning how can I incorporate it without feeding the Klebsiella or whatever it is that is causing an immune response, and consequently, flares of intense join pain?
    I am also interested in getting a stool test to determine what bugs I do have in my gut. I saw in one post the author asked if anyone wants to get tested – I do.

    Thanks

    Dan

  • Hi Dan

    You sound like you read part 5 of when to avoid RPS? The sooner you can get on potato starch or other roasted tubers if you can seed the gut with good flora and weed out potentil starch eaters and RS eaters in the uppergut that cause sibo. AS like nearly all western civ diseases is sibo

    If you click on my name I’ll let you know how to order testing soon

  • MtnHiker

    Hi Grace,

    The challenge I have with your recommendations above is that I can’t currently tolerate starches. I believe I’m also sensitive to fructans which are in some of the foods listed above. Foods with fructans seem to cause depression for me. Just curious how to make the transition to a point where the foods above are tolerable. I know my gut flora are significantly out of balance. Reseeding lactobacillus and bifido strains seems tough, especially if I’m avoiding prebiotics that can feed them. Any thoughts on how to successfully make it across the chasm?

    Thanks!

    • DrGracePharmD-Gut_Goddess

      MtnHiker

      Thanks for your comment. The bacteria that degrade and breakdown these starchy foods are the same the ride and hitchhike on them… the SBO probiotics and lacto/bifido strains. But as you pointed out they will have difficulty seeding the gut if there are no empty spaces for them or if they starve out. Do you consume fermented foods at this time? Pickled roots, kraut, kvass or kombucha? It’s always a good idea to start low and go slow.

      • MtnHiker

        Hi Grace, At present, I’m only supplementing with probiotics. I’ve tried sauerkraut but end up reacting to it likely for a variety of reasons (fructans, histamine). I’ve got histamine sensitivity which has kept me away from fermented foods generally. Using probiotics, I can more carefully control what strains I’m getting in order to avoid those that produce additional histamine. But as stool tests has showed, I’ve had little luck getting the lacto/bifido strains to stick. I’ve yet to try the SBO probiotic route but was wondering if that wouldn’t work as well without some sort of prebiotic.

        • DrGracePharmD-Gut_Goddess

          One of the best things for crowding out histamine-producers is SBO probiotics and good bifido re-seeding

          • MtnHiker

            In your 7-step plan, you recommend first starting with fermented foods. For histamine sensitive folks, would you then recommend switching the order and jumping to step 3 – starting with SBO probiotics and adding in bifido?

            Appreciate all the feedback!

          • DrGracePharmD-Gut_Goddess

            Yes — actually there is no chronological order fyi and each gut is unique with unique and different blessings and barriers ;( Even with testing, I can’t identify all of the hurdles or obstacles unfortunately so just trying different things and strategies sometimes sheds a lot of light. So you cannot go wrong with trying different strains of probiotics, farmacology (visiting organic farms), gardening, eating different fermented roots/beans/grains/stems/leaves and beverages etc.

          • MtnHiker

            Ah ok, that’s good to know. It’s surely been a long road of experimentation. One that continues. Definitely appreciate the blog posts you’ve put up about all the different steps. SBO sounds like the next experiment for me.

  • Pingback: My Anti-Cholesterol Gameplan - The BJJ Caveman()

  • Dara

    I’m confused by this recommendation (although I love these foods and am thrilled if I can eat them with SIBO!). I agree these are excellent foods for gut health, but every SIBO healing diet I’ve researched says to only eat monosaccharides. Can you help me understand why you recommend eating them for SIBO? Thanks.

  • Amicus

    Hello Dr. Grace,
    There is a general mainstream emphasis on eating several servings of fruits and vegetables a day for good health and especially green vegetables.

    1. Would properly prepared tubers, grains, legumes, and roots be more healthy than the popular vegetables of the leaves and stems variety (salad, kale, broccoli, etc) because they are better food for the good bacteria? It seems in traditional societies leaves and stems were more condiments, especially when fermented, and the base of the food pyramid would have been the tubers, grains, legumes, and roots. Put another way, if the good gut bacteria are being well fed by tubers, grains, legumes, and roots are leaves and stems even that necessary–except perhaps as a fermented condiment?

    2. Some nutritionists recommend getting mega-nutrients by juicing your greens–absorbing several cups of spinach or kale at once without any of the fiber. Have you seen any studies or do you have any theories about how juicing, even say a no fruit green juice, effects the microbiota?

    3. I’ve sent a couple of messages on the contact page about testing and consultation. I’m not convinced they sent or perhaps there is a waiting list. Do you know if they sent?

    Thanks for your insight and the great work you’ve done. The 7-steps are reversing 10 years of misery. I used to be terrified of fiber and grains. After fermenting all grains before eating they have become the easiest to digest–much more than just soaking. Now I hardly don’t want to eat anything that hasn’t reached some level of fermentation.

    • Clay Spootles

      Amicus, would you mind sharing the methods you’re using to ferment your grains?? Thank you!

      I’ve also tried to contact Dr. Grace regarding a consultation several times to no avail. My guess is that there is indeed a waiting list.

      • Amicus

        Clay, So far I just put the grains (I’ve tried brown rice, buckwheat and teff) in a mason jar, add spring water and screw down a coffee filter in place of the flat lid. The buckwheat likes to float to the top after a couple of days and the teff really expands with water so putting the mason jar in a bowl keeps the counter clean. After about three days you start to see some bubbles and smell the souring mixture–and that’s it. Some methods go on for 4-5 days. You can add whey or kefir or starter to speed up the process. I add water from a previous batch to the next. They taste sour and have a strong smell but it’s an interesting taste and seems to go well with soy sauce or nama shoyu. I usually cook them in extra water so that it’s a gelatinous porridge. Here’s a site from some homesteaders describing their process and ideas: http://www.nourishingdays.com/2012/07/why-soaking-grains-isnt-necessarily-the-best-way-to-prepare-them/

        • Clay Spootles

          Amicus, so cool! And, uh, awesomely easy. How do you make more than one serving at a time? Can it get stored somehow? Dehydrated or something so larger portions will keep? We’ve tried standard vegetable lacto-fermentation before, but never grains, so this is all new for me. Thanks!

          • Amicus

            This is a new process for me too and I’m still experimenting. I don’t see why when the grains have reached fermentation after 3-5 days they can’t just be kept in the same water in the refrigerator for some weeks like the standard vegetable lacto-fermentation. But I’ve never tried it. They would continue to sour of course but at a much slower rate. Those same homesteaders mentioned above keep a continuous pot of grains going by leaving a cup in from the previous batch while adding 2 more to make a new one. This cuts down the fermentation time: http://www.nourishingdays.com/2012/01/fermented-grains-the-perpetual-soured-porridge-pot/
            Here’s a video of a guy demonstrating the fermentation of the (gluten free) Ethiopian grain teff and how to make the flatbread, injera. It’s similar to the South Indian dosa which is made with fermented rice and lentils.
            https://www.youtube.com/watch?v=VjFbisPeYMA

        • Clay Spootles

          Amicus, so cool! And, uh, awesomely easy. How do you make more than one serving at a time? Can it get stored somehow? Dehydrated or something so larger portions will keep? We’ve tried standard vegetable lacto-fermentation before, but never grains, so this is all new for me. Thanks!

  • Josh Finlay

    Hello Grace,

    What worries me here is that the recommendation to eat resistant starch (RS2) rich food is now acknowledged to be wrong. What’s to say that your advice to eat more starch, which at the time of writing you seemed to be equally convinced about, is not equally as wrong?.. Genuine question.

  • Josh Finlay

    Hello Grace,

    What worries me here is that the recommendation to eat resistant starch (RS2) rich food is now acknowledged to be wrong. What’s to say that your advice to eat more starch, which at the time of writing you seemed to be equally convinced about, is not equally as wrong?.. Genuine question.