Pilot Study: Investigating a Novel Supplement-based Therapy for the Treatment of Small Intestinal Bacterial Overgrowth
Phase: EARLY_PHASE1
Conditions: Small Intestinal Bacterial Overgrowth
Sponsor: Atrium Innovations

 
 
 
 
 
 
 
 
 
 
 
 
 
Pilot Study:  Investigating a Novel 
Supplement-based Therapy for the 
Treatment of Small Intestinal Bacterial 
Overgrowth  
 
 
 
 
 
 
 
 
 
 
 
 
 
Kelly Heim, Ph.D. 
Senior Director, Scientific Affairs at Atrium Innovations 
 
Version #2  
May 3, 2017 
 
 
 

 
 
Study Synopsis 
The aim of this pilot study is to determine the efficacy of a supplement protocol 
combined with a low FODMAP diet for the treatment of small intestinal bacterial 
overgrowth (SIBO). The study is designed as a prospective, open label investigation, 
with an estimated sample size of 10 patients.  
 
Patients diagnosed with SIBO by Dr. Nathan Morris at Good Medicine Clinic (Oxford, 
Ohio) will be offered the opportunity to enroll in this study, if they satisfy the 
inclusion and exclusion criteria upon initial diagnosis. No control group will be 
assigned.  
 
The diagnosis of SIBO will be determined via assessment of clinical symptoms and 
the results of a lactulose breath test. This diagnosis procedure is, currently, the 
standard-of-care.  After administration of the supplement therapy and adherence to 
a low FODMAP diet (8 weeks), the lactulose breath test will be repeated and 
symptoms re-assessed by Dr. Morris.  
 
The post-treatment lactulose breath test and all supplements in the protocol will be 
provide free-of-charge to enrolled patients. In addition, enrolled patients will not be 
billed for the mid-treatment office visit. Patient and/or patient insurance will be 
responsible for all other expenses, including but not limited to the initial breath test, 
all other office visits and travel.   
 
Background 
Small intestinal bacterial overgrowth (SIBO) is a category of gastrointestinal 
infection, characterized by an increased concentration (>100,000 CFU/mL proximal 
jejunal fluid) of bacteria in the small intestine.1  Symptoms of SIBO commonly afflict 
the gastrointestinal tract and include but are not limited to: abdominal pain, 
discomfort, bloating, cramping, flatulence, diarrhea, constipation, eructation, and 
low serum B12.3,4   
 
SIBO is believed to be severely under diagnosed and is associated with numerous 
comorbid conditions including irritable bowel syndrome, diabetes mellitus and 
hypothyroidism.4,5 Small-bowel aspiration (SBA) or breath tests are used to aid in 
the diagnosis of SIBO.  Due to the cost and invasive nature of SBA, glucose or 
lactulose breath tests are more commonly performed. 
 
The treatment of SIBO frequently consists of antibiotic therapy. Rifaxamin is a 
poorly absorbed antibiotic with bacteriocidal activity against enteropathogens and 
is widely prescribed for the treatment of SIBO.3 Nevertheless, both patients and 
practitioners frequently turn to complementary and alternative medicine, due to the 
adverse effects associated with antibiotic use and the recurrent nature of SIBO. In 
2014, a retrospective study (Chedid et al.) found that the efficacy of a particular 
herbal therapy was comparable to Rifaxamin treatment.3 However, both treatment 

options demonstrated a response rate of less than 50%.  This investigation will test 
a more comprehensive, supplement-based therapy in hopes of achieving a greater 
response rate. 
 
Objectives 
This investigation aims to determine the efficacy of a supplement protocol in 
combination with a low FODMAP diet for the treatment of small intestinal bacterial 
overgrowth (SIBO).  
 
Patient Selection 
Patients diagnosed with SIBO at Dr. Morris’ clinic will be offered the opportunity to 
enroll in this study as a theoretical treatment option for SIBO. Other treatment 
options will be discussed with the patient. Enrolled patients must satisfy the 
following inclusion and exclusion criteria: 
 
Inclusion criteria: A positive diagnosis of SIBO, which will be defined by 1) 
presentation of the aforementioned symptoms and 2) positive results of a lactulose 
breast test.  Positive breath test results will be defined as an increase in hydrogen of 
20 ppm or more and/or an increase in methane of 12 ppm or more compared to 
baseline by 90 minutes. 
 
Exclusion criteria: 1) Use of prescription antibiotics or antifungals within the past 4 
weeks. 2) Younger than 18 or older than 85 years of age 3) Pregnant or breast-
feeding 4) Major drug-supplement interactions between essential medication and 
the proposed supplement therapy. 5) A known allergy to one or more of the 
ingredients in the supplement therapy. 6) Has been diagnosed and treated for SIBO 
within the past 6 months. 7) Has undergone a colonoscopy or barium enema within 
the past 4 weeks. 8) Has an allergy to lactulose. 9) Has diabetes mellitus. 
 
Study Procedures 
The supplement protocol is designed to take 8 weeks. Due to the delay in receiving 
and interpreting test results, the investigation, in its entirety, is estimated to take 12 
weeks. 
 
Visit -1      Dr. Morris will assess patient history and symptoms, at his facility in 
Oxford, Ohio. If suggestive of SIBO, a lactulose breath test will be 
prescribed. Additional testing may be performed, at the discretion of Dr. 
Morris, to aid in the initial diagnosis of the patient.  
 
Visit 0       Dr. Morris will assess the results of the breath test and confirm or deny 
the diagnosis of SIBO. Treatment options for SIBO will be discussed, and 
the patient will be made aware of this investigation as a theoretical 
treatment option.  Patient eligibility will be determined by Dr. Morris who 
will complete the Patient Eligibility Checklist (Appendix A) for each 
patient. All female patients will be asked to complete a urine pregnancy 
test to confirm pregnancy status.  Eligible patients will be asked to review 

and sign the Informed Consent document. Carman Clark (Medical 
Assistant at Good Medicine) will be available to discuss patient consent 
and confidentiality. Enrolled patients will be asked to complete a baseline 
Medical Symptom Questionnaire (Appendix B). Afterwards, Ms. Clark will 
review the supplement therapy (Supplement Overview - Appendix C) and 
low FODMAP diet (Low FODMAP Handout - Appendix D). Patients will 
then be provided with all supplements necessary to complete the 
investigation. Patients will be asked to discontinue all other supplements 
during the study. However, no wash out period is required. Prescription 
medications, over-the-counter medications and/or supplements deemed 
medically necessary by the patient’s primary care physician and/or Dr. 
Morris may be continued, if there are no known contraindications. 
 
Visit 1       Visit 1 will occur approximately 4 weeks after the patient begins the 
supplement protocol. Patients will be asked to report their compliancy 
with the supplement protocol and low FODMAP diet and describe 
adverse effects. Patients will also be asked to complete the Medical 
Symptom Questionnaire. Patients will be provided with the second 
lactulose breath test kit and instructed to perform the test within 2 weeks 
of completing the supplement therapy.  
 
Visit 2  
Visit 2 will occur after the results of the post-treatment breath test are 
available. Dr. Morris will interpret the results of the second breath test, 
and patients will be asked to complete the Medical Symptom 
Questionnaire, report compliancy with the supplement protocol and low 
FODMAP diet, and describe any adverse effects. Further treatment 
options will be discussed if necessary; follow-up treatment will be 
outside the scope of this investigation.  
 
Risk/Safety Information 
This study presents risk in the form of adverse reactions to ingredients in the 
supplement therapy.  Patient risk will be minimized by excluding patients who may 
respond poorly to the supplement therapy or testing procedures from the study, i.e., 
by abiding by the aforementioned patient enrollment exclusion criteria.  
 
Monitoring/Reporting 
Patients may report adverse events to Good Medicine during scheduled office visits 
or by phone during office hours.  If serious or life-threatening side effects arise, 
patients are instructed to call 911.  Possible side effects include but are not limited 
to: diarrhea, constipation, nausea, vomiting, bloating or headache.  When necessary, 
Dr. Morris or Ms. Clark will communicate with patients outside the office by phone 
and record adverse events in the patient’s confidential files.  Medical guidance will 
be provided as necessary.  
 
 
Study Oversight 

This study will be terminated if one-half or more of enrolled patients withdraw due 
to adverse events.  Dr. Morris and Dr. Kelly Heim (Senior Director, Scientific Affairs 
at Atrium Innovations) will monitor, determine the need for and facilitate the 
termination of the study. Direct access to study related data will be made available 
for monitoring, auditing, IRB review and regulatory inspection.  
 
Data Management 
Lactulose breath test scores and completed Medical Symptom Questionnaire will be 
compared pre- and post-treatment to determine the efficacy of the supplement 
therapy.  The significance of the change in breath test scores will be determined if 
the final sample size permits such analysis.  
 
IRB Review/Ethics/Informed Consent 
This study will be conducted in accordance with the ethical principles that have 
their origin in the Declaration of Helsinki and that are consistent with Good Clinical 
Practice and applicable regulatory requirements.  
 
Any changes to the protocol will be submitted to the IRB for review and approval 
before implementation. However, a protocol change intended to eliminate an 
apparent immediate hazard to patients will be implemented immediately.  The 
reviewing IRB will be notified within 10 working days, if an immediate protocol 
change is necessitated.  
 
The principle investigator (Dr. Nathan Morris) will provide each patient with full 
and adequate verbal and written information using the IRB approved informed 
consent documentation, including the objective and procedures of the study as well 
as the possible risks involved before inclusion in the study. Informed consent will be 
obtained prior to performing any study-related procedures, including screening and 
changes in medications including any washout of medications. A copy of the signed 
informed consent will be given to the study patient. 
 
Confidentiality 
Study-related records identifying the patient will be kept confidential and, to the 
extent permitted by applicable laws and/or regulations, will not be made publicly 
available. The IRB and/or other regulatory authorities will have access to study 
related medical records upon request. Subsequent use of the collected data will 
exclude patient identifying information. 
 
Intended Use of the Data 
The data collected from this investigation will be used to determine the efficacy of 
the proposed supplement therapy. If efficacious, the results will be distributed in 
print and digital advertising.  
 
 
 
References 

1. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth 
syndrome. World J Gastroenterol. 2010;16(24):2978-90.  
2. Ford AC, Spiegel BM, Talley NK, Moayyedi P. Small Intestinal bacterial 
overgrowth in irritable bowel syndrome:  systematic review and meta 
analysis. Clin Gastroenterol Hepatol. 2009;7(12):1279-86 
3. Chedid V, Dhalla S, Clarke J, et al. Herbal Therapy is Equivalent to Rifaximin 
for the Treatment of Small Intestinal Bacterial Overgrowth. Global Advances 
in Health and Medicine Journal. 2014; 3(3): 16-22. 
4. Reynolds K. Small Intestinal Bacterial Overgrowth: A Case-Based Review. 
Journal of Patient-Centered Research and Reviews. 2015; 2(4): 165-171.  
5. Saad R and Chey W. Breath Testing for Small Intestinal Bacterial Overgrowth: 
Maximizing Test Accuracy. Perspectives in Clinical Gastroeneterology and 
Hepatology. 2014; 12:1964-1972. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Appendix A 
 
Patient Eligibility Checklist  
 
This documented is to be complete by Dr. Nathan Morris.  
 
 
YES / NO 
Patient is am between the ages of 18 and 85 years old.  
 
YES / NO  
Patient has used oral, prescription antibiotics and/or antifungals within the 
past 12 weeks. 
 
YES / NO  
Patient is pregnant or breast-feeding or plans to become pregnant/breast-
feeding within the next 4 months. 
 
YES / NO 
Patient is currently taking one or more of the following medications.  
 
Amiodarone (Cordarone, etc.) 
Anti-diabetes medications 
Artemether  (Artenam, etc) 
Atorvastatin (Lipitor) 
Benzodiazepines 
Buspirone (BuSpar) 
Calcium channel blockers 
Carbamazepine (Tegretol, etc) 
Carvedilol (Coreg) 
Cisapride (Propulsid) 
Clomipramine (Anafranil) 
Cyclosporine (Neoral, etc) 
Dextromethorphan (Robitussin, etc 
etc) 
Estrogen replacement therapy 
Etoposide (Etopophos, etc.) 
Halofantrine 
Intravenous nitroglycerin 
Lovastatin (Mevacor, etc.) 
Lactulose 
Methylprednisolone (Medrol, etc.) 
Pravastatin (Pravachol) 
Praziquantel (Biltricide) 
Quinidine 
Scopolamine 
Sildenafil (Viagra, etc.) 
Simvastatin (Zocor) 
Terfenadine (Seldane) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
YES / NO     
Patient has a known allergy to one or more of the following ingredients. 
 
 
Alpha lipoic acid 
Artichoke 
Berberine 
Broccoli 
Chlorella 
Clove 
Coconut 
Glycine 
Grapefruit 
Kiwi 
L-glutamine 
L-methionine 
Milk thistle 
N-acetyl-l-cysteine 
Olive 
Pineapple 
Safflower 
Sunflower 
Sweet wormwood 
Taurine 
Thistle 
Turmeric
YES / NO  
Patient has a history of one or more of the following conditions.  
  
Bile duct obstruction 
Immunodeficiency 
Kidney stones 
Peptic ulcers  
 
YES / NO   
Patient has have been diagnosed and treated for SIBO within the past 6 
months. 
 
YES / NO  
Patient has undergone a colonoscopy or barium enama within the past 4 
weeks  
 
YES / NO  
Patient has diabetes mellitus. 
 
 
 
 
_______________________________ 
Patient Name (Print) 
 
 
_______________________________ 
Date 
 
 
 
_______________________________ 
Dr. Nathan Morris (Sign) 

Appendix B 
 
The MSQ will be administered online via the Living Matrix platform. The following is a print copy 
of the questionnaire. Instructions to access the Living Matrix will also be provided to patients. 
This document was submitted to Schulman as an additional file.  
 
Living Matrix MSQ 
 
Please answer EVERY QUESTION in this section. Select “Zero” if you do not have this symptom. 
Rate the Symptom  
Headache  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Faintness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Dizziness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Insomnia  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Eyes  
Rate the Symptom  

Rate the Symptom  
Watery or itchy eyes  
• 
   0 - Never or almost never have the 
symptom  
• 
   1 - Occasionally have it, effect is not 
severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Swollen, red or sticky eyelids  
• 
   0 - Never or almost never have the 
symptom  
• 
   1 - Occasionally have it, effect is not 
severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Bags or dark circles under eyes  
• 
   0 - Never or almost never have the 
symptom  
• 
   1 - Occasionally have it, effect is not 
severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Blurred or tunnel vision-does not include near or far-
sightedness  
 
 
 
Ears  
Rate the Symptom  
Itchy ears  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  

 
 
Earaches  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Ear infections  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Drainage from ear  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Ringing in ears  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Hearing loss  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 

Nose  
Rate the Symptom  
 
Stuffy nose  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Sinus problems  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Hay fever  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Sneezing attacks  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Excessive mucus formation  
 
Mouth/Throat  
Rate the Symptom  
Chronic coughing  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  

Rate the Symptom  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Gagging  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Frequent throat clearing  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
Sore throat  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
hoarseness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Loss of voice  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Swollen or discolored tongue, gums or lips  
• 
   0 - Never or almost never have the symptom  

• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Canker sores  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 
Skin  
Rate the Symptom  
Acne  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Hives or Urticaria  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Rashes  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 

 
Dry skin  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Hair loss  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Flushing  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Hot flashes  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Excessive sweating  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 
 
 

Heart  
Rate the Symptom  
Irregular or skipped heartbeat  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Rapid or pounding heartbeat  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Chest pain  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Lungs  
Rate the Symptom  
 
 
Chest congestion  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Asthma  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  

• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Bronchitis  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Shortness of breath  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Difficulty breathing  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Digestive Tract  
Rate the Symptom  
Nausea or Vomiting  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Diarrhea  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Constipation  
• 
   0 - Never or almost never have the symptom  

Rate the Symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 
 
Bloated feeling  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Belching  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Passing gas  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Heartburn  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Intestinal or stomach pain  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  

• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
Joints/Muscle  
Rate the Symptom  
Pain or aches in joints  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Arthritis  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Stiffness or limitation of movement  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Pain or aches in muscles  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Feeling of weakness or tiredness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 

Weight 
Craving certain foods  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Excessive weight  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Compulsive eating  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Water retention  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Underweight  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 

Energy/Activity  
Rate the Symptom  
Fatigue  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Sluggishness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Apathy  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Lethargy  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Hyperactivity  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Restlessness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  

• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
Mind  
Rate the Symptom  
Poor memory  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Confusion  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Poor comprehension  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Poor concentration  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
Poor physical coordination  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  

• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Difficulty in making decisions  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Stuttering or stammering  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Slurred speech  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Learning disabilities  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
Emotions  
Rate the Symptom  
Mood swings  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  

Rate the Symptom  
• 
   4- Frequently have it, effect is severe  
Anxiety  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Fear  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
 
Nervousness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Anger  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Irritability  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  

Aggressiveness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Depression  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 
Rate the Symptom  
Frequent illness  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Frequent or urgent urination  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
Genital itch or discharge  
• 
   0 - Never or almost never have the symptom  
• 
   1 - Occasionally have it, effect is not severe  
• 
   2 - Occasionally have it, effect is severe  
• 
   3 - Frequently have it, effect is not severe  
• 
   4- Frequently have it, effect is severe  
 

 
 
Appendix C 
 
 
Small Intestinal Bacterial Overgrowth (SIBO) Protocol 
 
Dietary Recommendations 
Follow the low FODMAP diet at the guidance of a healthcare professional. See included Stanford University 
Medical Center FODMAP handout for a brief introduction to this diet.  
 
Duration 
This protocol is designed to take 8 weeks.  
 
Product Overview 
 
*The number of capsules purchased may exceed the amount required by this protocol, due to limited bottle sizes.  
**Digestive Enzymes Ultra with Betaine HCl may be replaced with Digestive Enzymes Ultra, if patient responds poorly to Betaine HCl.   
Category 
Products 
Servings per Bottle 
Capsules per Day 
Duration 
Number of Bottles* 
Detox Support 
Liver-G.I. Detox 
60 capsules 
2 per day 
30 days 
One bottle 
GI Support  
L-Glutamine Powder 
73 scoops 
2 scoops per day 
35 days 
One bottle 
Microbial Balance 
MicroDefense 
90 capsules 
1 per day 
49 days 
One bottle 
Microbial Balance 
A.C. Formula II 
120 capsules 
4 per day 
49 days 
Two bottles 
Probiotic 
Probiotic-5 
60 capsules 
1 per day 
49 days 
One Bottle 
Digestive Enzymes 
Digestive Enzymes Ultra 
with Betaine HCl** 
180 capsules 
As needed 
(up to 6) 
Long term 
One bottle 

Protocol 
 
 
Product 
Breakfast 
Lunch 
Dinner 
Week 1 
Liver-G.I. Detox 
1 capsule 
 
1 capsule 
Digestive Enzymes Ultra with Betaine 
1-2 capsules or as 
needed before meal 
1-2 capsules or as needed 
before meal 
1-2 capsules or as needed 
before meal 
Weeks 
2 – 5 
Liver-G.I. Detox (finish 2 days into week 5) 
1 capsule 
 
1 capsule 
Digestive Enzymes Ultra with Betaine 
1-2 capsules or as 
needed before meal 
1-2 capsules or as needed 
before meal 
1-2 capsules or as needed 
before meal 
L-Glutamine 
1 serving 
1 serving 
 
A.C. Formula II 
2 capsules before meal 
2 capsules before meal 
 
MicroDefense 
 
1 capsule before meal 
 
Probiotic-5 
 
 
1 capsule 
Week 6 
Digestive Enzymes Ultra with Betaine 
1-2 capsules or as 
needed before meal 
1-2 capsules or as needed 
before meal 
1-2 capsules or as needed 
before meal 
L-Glutamine 
1 serving 
1 serving 
 
A.C. Formula II 
2 capsules before meal 
2 capsules before meal 
 
MicroDefense 
 
1 capsule before meal 
 
Probiotic-5 
 
 
1 capsule 
Weeks 
7 & 8 
Digestive Enzymes Ultra with Betaine 
1-2 capsules or as 
needed before meal 
1-2 capsules or as needed 
before meal 
1-2 capsules or as needed 
before meal 
A.C. Formula II 
2 capsules before meal 
2 capsules before meal 
 
MicroDefense 
 
1 capsule before meal 
 
Probiotic-5 
 
 
1 capsule 

Low-FODMAP Food Plan
FATS & OILS  
 
 
      Fats
Servings/day_________
Minimally refined, cold pressed, organic,  
non-GMO preferred
 Avocado–2 T or  
⅛ whole
 Butter/ghee (clarified 
butter, grass-fed)–1 t
 Coconut milk, regular 
(canned)–1 ½ T
 Coconut milk, light 
(canned)–3 T
 Mayonnaise 
(unsweetened)–1 t 
 Oils, cooking: Avocado, 
coconut, ghee, olive 
(extra virgin), rice bran, 
sesame–1 t
 Oils, salad: Almond, 
avocado, flaxseed oil, 
hempseed, olive (extra 
virgin), safflower 
(high-oleic), sesame, 
sunflower (high-oleic), 
walnut–1 t 
 Olives: Black, green, 
Kalamata–8 
 Pesto (olive oil)–1 t 
1 serving = 45 calories, 5 g fat
Eliminate
Chocolate, soybean oil, and any salad dressings or sauces made with 
sweeteners or other high-FODMAP additives. 
PROTEINS   
 
 
Proteins
Servings/day_________
Lean, free-range, grass-fed, organically grown animal 
protein; non-GMO, organic plant protein; and wild-
caught, low-mercury fish preferred. Canned meats are 
allowed if cans are BPA-free and if the meat is free of 
high-FODMAP fillers.
Animal Protein:
 Cheese (hard): cheddar, 
colby, feta, havarti, 
manchego, Pecorino, 
Swiss–½ oz 
 Cheese (soft): 
brie, Camambert, 
chevre, goat cheese, 
mozzarella–1 oz
 Cottage cheese  
(dry curd)–¼ c
 Cream cheese–2 T
 Parmesan cheese–2 T 
 Ricotta cheese–2 T
 Egg–1, or 2 egg whites
 Fish/shellfish: 
Anchovies, clams, 
cod, flounder, halibut, 
salmon, sardines, trout, 
tuna, etc.–1 oz 
 Meat: beef, buffalo, elk, 
lamb, pork, venison, 
other wild game–1 oz 
 Poultry (skinless): 
Chicken, Cornish hen, 
duck, pheasant, turkey, 
etc.–1 oz
Plant Protein:
 Spirulina–2 T
 Tempeh–1 oz
 Tofu (firm/extra 
firm)–1½-2 oz
Protein Powder:
 Check label for  
# grams/scoop 
(1 protein serving=7 g) 
Bovine collagen, egg, 
hemp, whey protein 
isolate
1 serving as listed = 35–75 calories, 5–7 g protein, 3–5 g fat, 
0–4 g carbs
Average protein serving is 3–4 oz (size of palm of hand).
DAIRY & ALTERNATIVES   Proteins/Carbs
Servings/day_________
Unsweetened, organic preferred
Dairy:
 Milk (plain): Lactose-
free cow, goat–8 oz
 Yogurt (plain): Lactose-
free cow, goat–4-6 oz
Dairy Alternatives:
 Milk: Almond, hemp– 
8 oz 
 Milk: Coconut–4 oz 
 Milk: Rice–6 oz 
 Yogurt (plain): 
coconut–4-6 oz
1 dairy serving = 90–150 calories, 7–8 g protein, 12 g carbs
1 dairy alternative serving = 25–90 calories, 1–9 g protein,  
1–4 g carbs (nutritional values vary)
Eliminate
Buttermilk, evaporated milk, goat milk, heavy cream, kefir, oat milk, sour 
cream, soy milk, sweetened condensed milk, yogurt (except those listed), 
and any other lactose-containing dairy products. Check milk substitutes for 
high-FODMAP sweeteners and additives. Unsweetened homemade dairy 
alternatives are preferred.
NUTS & SEEDS  
           Proteins/Fats
Servings/day_________
Unsweetened, unsalted, organic preferred
 Almonds–6 
 Brazil nuts–2 
 Chia seeds–1 T
 Chestnuts–5
 Coconut (fresh)–⅓ c 
 Coconut (dried, 
shredded)–3 T
 Flax seeds–½ T
 Hazelnuts–5
 Macadamias–2-3 
 Nut and seed butters: 
Almond, tahini 
(sesame seed)–½ T
 Nut flour/meal: 
Almond–¼ c 
 Peanuts–10 
 Pecan halves–4 
 Pine nuts–1 T
 Pumpkin seeds–1 T
 Sesame seeds–1 T
 Sunflower seeds–½ T
 Walnut halves–4 
LEGUMES               
Proteins/Carbs
Servings/day_________
Organic, non-GMO preferred
 Black beans  
(canned only)–¼ c
 Green peas 
(cooked)–⅛ c
 Chickpeas  
(canned only)–¼ c
 Hummus–1 T
 Mung beans 
(cooked)–¼ c
1 serving = 90–110 calories, 3–7 g protein, 0 fat, 15 g carbs
Version 1
Items in orange indicate moderate- and high-
FODMAP foods that may be tolerated in reduced 
serving sizes, as specified. Limit orange foods to a 
maximum 1 serving from each food category daily.
© 2016 The Institute for Functional Medicine
Notes: Nutritional amounts are based on average values for the 
variety of foods within each food category.
 
Dietary prescription is subject to the discretion of the 
health practitioner.
1 serving = 45 calories, 5 g fat
Eliminate
Cashews and pistachios.
Appendix D

VEGETABLES Non-starchy      
   Carbs
Servings/day_________
 Artichoke hearts 
(canned)–⅛ c
 Arugula
 Asparagus–1 spear
 Bamboo shoots
 Beets (cubed)–¼ c
 Bok choy
 Broccoli–¼ c 
 Cabbage: Green, 
purple, Savoy
 Carrots
 Celeriac root
 Celery–¼ med stalk
 Chard/Swiss chard
 Chervil
 Chives
 Cilantro
 Cucumbers
 Daikon radishes
 Eggplant
 Endive
 Escarole
 Fennel
 Fermented vegetables: 
Kimchi, sauerkraut–1 T
 Green beans
 Greens: Beet, collard, 
kale, mustard, turnip, etc. 
 Ginger root–1 t
 Horseradish 
 Kohlrabi
 Lettuce, all
 Microgreens
 Parsley
 Parsnips
 Peppers, all
 Pumpkin  
(canned only)–¼ c
 Radicchio
 Radishes
 Scallions (green part 
only)–2 T
 Sea vegetables 
 Snow peas–5 pods
 Spinach
 Sprouts: Alfalfa, bean
 Squash: Delicata, 
chayote, spaghetti, 
yellow, zucchini
 Tomato
 Tomato juice–¾ c 
 Tomato paste, sauce 
(unsweetened)
 Turnips
 Vegetable juice–¾ c 
 Water chestnuts
 Watercress
1 serving = ½ c, 1 c raw greens = 25 calories, 5 g carbs
Eliminate
Bittermelon, Brussels sprouts, cauliflower, dandelion greens, garlic, jicama, 
leeks, mushrooms, okra, onion, shallots, sugar snap peas, sunchokes  
(Jersulaem artichokes), and sweet corn. 
VEGETABLES Starchy  
     
   Carbs
Servings/day_________
 Acorn squash 
(cubed)–1 c
 Butternut squash 
(cubed)–¼ c 
 Plantain–⅓ c or ½ whole 
 Potato: Purple, red, 
sweet, yellow–½ med
 Potatoes (mashed)–½ c 
 Root vegetables: Parsnip, 
rutabaga, taro, turnip–½ c 
 Yam–½ med 
1 serving = 80 calories, 15 g carbs
FRUITS 
 
 
 
    Carbs
Servings/day_________ 
Unsweetened, no sugar added
 Banana–½ med
 Blueberries–¾ c
 Cranberries–¾ c 
 Dried fruit: 
Cranberries, currants, 
Gogi berries, papaya, 
pineapple, raisins–1 T 
 Grapefruit–½ med 
 Grapes–15 
 Guava–1 med 
 Kiwi–1 med
 Melon, all–1 c
 Orange–1 sm
 Papaya–1 c 
 Passionfruit–1 med
 Pineapple–¾ c
 Pomegranate 
seeds–¼ c 
 Raspberries–1 c
 Rhubarb–1 c
 Starfruit–1 med
 Strawberries–1¼ c
 Tangerines–2 sm
1 serving = 60 calories, 15 g carbs
Eliminate
Apples, applesauce, apricots, blackberries, boysenberries, cherries, dates, 
figs, lychee, mango, nectarines, peaches, pears, persimmon, plums, prunes, 
watermelon, and all canned fruit. 
Organic, non–GMO fruits, vegetables, herbs and spices preferred
BEVERAGES, SPICES & CONDIMENTS
Unsweetened, no sugar added
 Filtered water
 Sparkling/mineral 
water
 Coconut water–4 oz
 Coffee
 Fruit juice: Orange, 
cranberry–4 oz
 Tea: Black, chai green, 
peppermint, white
 Tea (diluted): 
Chamomile, herbal, 
oolong
 Cacao powder
 Cocoa powder
 Herbs: basil, cilantro, 
curry leaves, kafir 
lime, lemongrass, 
mint, parsley, rosemary, 
sage, tarragon, thyme, 
watercress
 Spices, all
 Condiments: Fish 
sauce, ketchup 
(unsweetened), lemon/
lime juice, miso paste, 
mustard, vinegar (apple 
cider, balsamic, rice 
wine), Worchestershire 
sauce–use sparingly, 
suggest 1 T or less per 
serving
Approved sweeteners: Maple syrup, molasses, Stevia— 
use sparingly, suggest 1 t. 
Eliminate
Artificial sweeteners, dandelion tea, fruit juice (except those listed),  
garlic salt, honey, and onion salt.
WHOLE GRAINS (100%)          
   Carbs
Servings/day_________
Unsweetened, organic preferred
Gluten Free:
 Amaranth–¼ c
 Buckwheat–½ c 
 Cereal: Corn, 
quinoa–½ c
 Cous cous: Corn, 
rice–¼ c
 Flours: Buckwheat, 
corn, cornstarch, millet, 
quinoa, rice, teff, 
potato, tapioca
 Grits: corn (polenta)–½ c
 Millet–½ c
 Oats: quick 
(rolled)–¼ c 
 Oats: steel-cut–½ c
 Quinoa–½ c 
 Popcorn–1 c 
 Rice: Basmati, black, 
brown, purple, red, 
white, wild–⅓ c 
 Sorghum–⅛ c
 Teff–¾ c
Gluten Containing:
 Bulgur–¼ c 
 Spelt–¼ c 
Individual portions:
 Bread–1 slice
 Pasta–⅓ c
 Tortilla–1, 6 in
All grain servings are for 
cooked amounts.
1 serving = 75–110 calories, 15 g carbs
Eliminate
Eliminate any breads, cereals, crackers, pastas, etc., made from wheat, rye, 
and barley. This includes cous cous (wheat), flour tortillas, freekeh, granola 
mixes, naan, Roti, sprouted bread. 
Items in orange indicate moderate- and high-
FODMAP foods that may be tolerated in reduced 
serving sizes, as specified. Limit orange foods to a 
maximum 1 serving from each food category daily.
© 2016 The Institute for Functional Medicine
Notes: Nutritional amounts are based on average values for the 
variety of foods within each food category.
 
Dietary prescription is subject to the discretion of the 
health practitioner.