An elemental diet is a restrictive, liquid-only diet designed to provide the body with essential nutrients in an easily digestible form. Healthcare professionals often prescribe it for individuals with certain gastrointestinal conditions, such as small intestinal bacterial overgrowth (SIBO), as the nutrients are more easily digestible. This article explores the elemental diet for SIBO, its advantages and disadvantages, and offers guidance on implementation.
What is an Elemental Diet?
An elemental diet is a liquid-only diet formulated to supply the body with essential nutrients in an easily digestible form. The diet is "elemental" because it provides proteins, fats, and carbohydrates already broken down into their basic building block forms: amino acids, fatty acids, and sugars. Elemental diets also provide vitamins and minerals. These predigested nutrients do not cause additional stress on the digestive tract before the body absorbs them.
Healthcare professionals, such as gastroenterologists and registered dietitians, prescribe them to people with compromised digestive systems, such as those with SIBO. Some elemental diets come as ready-to-drink beverages. Others are powdered formulas a person mixes with water. Whether the healthcare professional recommends a specific commercial brand or a prescription-only version, they will provide instructions on how to follow the diet properly.
How Does an Elemental Diet Work?
The goal of the elemental diet is to provide a person with all the necessary nutrients in an easily digestible form while reducing the amount of food in the small intestine. The elemental diet starves the bacteria, reducing the number of bacteria in the small intestine and improving symptoms.
Usually, the small intestines do not harbor much bacteria. The body has several defense mechanisms to prevent bacteria from entering the small intestines and causing issues. However, when one or more of these mechanisms fail, bacteria can enter the small intestines and begin to multiply. This makes it more difficult to absorb nutrients and causes gastrointestinal symptoms such as bloating, gas, abdominal pain, and diarrhea.
Read also: Understanding Purina Pro Plan Veterinary Diets EL Elemental
Elemental Diet for SIBO
Small intestinal bacterial overgrowth (SIBO) is a digestive condition in which gut bacteria from the large intestine migrate to the small intestine and grow. This results in gastrointestinal symptoms like abdominal pain, bloating, gas, diarrhea, and sometimes constipation. It can also cause inflammation and make it difficult for your body to digest and absorb nutrients.
One of the challenges with treating SIBO is that the food you eat also feeds the bacteria in the small intestine, helping them grow and thrive. The theory behind an elemental diet for SIBO is that the pre-digested nutrients in the formula are easily absorbed in the first part of the small intestine, which then “starves” the bacteria growing further down in the small intestine. An elemental diet can also allow the digestive tract to rest and heal because it doesn’t need to do the work of breaking down nutrients from food.
Benefits of Elemental Diets
While some evidence suggests using an elemental diet may benefit some people with SIBO, larger-scale clinical trials are necessary. In contrast, it appears there is enough empirical evidence in favor of the elemental diet for healthcare professionals to prescribe it for SIBO.
After adhering to an elemental diet for 14 days, participants underwent a follow-up breath test. Of the 93, 80% (74 people) had typical LBT. Those who still had abnormal LBT remained on the diet for an additional 7 days, after which five more participants reached typical LBT, bringing the total to 85%. This study set the elemental diet’s standard time frame of 14-21 days.
Effectiveness in Treating SIBO
Some research shows that an elemental diet can treat SIBO, though large-scale studies still need to be done on this subject. A retrospective study from 2004 examined the effect of an elemental diet on IBS patients who also had SIBO. After two weeks on the diet, 80% of the patients had a normal lactulose breath test (LBT), one of the tests used to diagnose SIBO. After three weeks, 85% of the participants had a normal LBT. Patients in the study also experienced improvements in their digestive symptoms. This is significant because research shows that rifaximin, one of the antibiotics used to treat SIBO, is effective in less than 65% of patients.
Read also: DIY Elemental Diet Guide
Dysbiosis and Gut Health
A common feature across conditions treated with elemental diets is dysbiosis-this is when the gut is inflamed and the microbiome is out of balance. The elemental diet is ideal for calming digestive symptoms when other diet changes haven’t worked or after periods of poor eating. This 1-3 week regimen is used to address issues like SIBO or Candida, where the goal is to starve microbial overgrowths by fully replacing meals.
Risks and Side Effects
Some potential drawbacks or challenges of the elemental diet include:
- Not eating solid food for the duration of the diet.
- Not getting enough nutritional sustenance for a physically active daily routine.
- Experiencing unwanted weight loss.
- Feeling triggered when reintroducing solid foods, especially for people with a history of disordered eating.
- Not having the budget for out-of-pocket costs.
Side effects of an elemental diet may include:
- Hunger
- Fatigue
- Headaches
- Mood swings
- Digestive issues, such as bloating, diarrhea, and constipation
- Nausea
- Fungal overgrowth
Someone following an elemental diet can work with a healthcare professional to monitor side effects and determine when adjustments are necessary.
Palatability and Social Impact
Another major downside of an elemental diet is palatability. Drinking a medical formula for weeks with no solid food can be incredibly challenging. The highly restrictive nature of the diet can also impact social interactions and feel isolating. In addition, high-quality elemental diet formulas can be costly and may not be covered by insurance.
Read also: Comprehensive Elemental Diet Guide
Mental and Emotional Challenges
An elemental diet is very restrictive and can be hard to stick to. People, especially children, often find it very hard to give up food for 6 weeks. The dietary restrictions can also be challenging for parents and families of children on the diet. Because of the change in food intake, an elemental diet can be very emotional. You might notice that you feel:
- Angry
- Frustrated
- Depressed
- Stressed
- Worried
You might miss eating food and be frustrated with your health. Parents might feel guilty and sad about taking food away from their children. The special formulas on an elemental diet may also taste unpleasant. This can be very upsetting, especially for children, and it can also make it hard to get proper nutrition.
Considerations Before Starting
Before starting an elemental diet for SIBO, a person should meet with a healthcare professional to ask questions and clarify the process. People may wish to discuss the following topics:
- Diagnosis: It is important to have an accurate diagnosis and understand the goals of an elemental diet.
- Medications: A specialist may recommend adjusting or temporarily stopping certain medications and supplements for the duration of the diet.
- Readiness: An elemental diet can be both mentally and emotionally challenging. A person’s doctor can help prepare for those challenges and create a plan for dealing with them.
Implementing an Elemental Diet
Following an elemental diet is fairly uncomplicated. A specialist will recommend either a prescription or nonprescription formula and explain how to implement the diet properly. Preparation depends on the specific formula. Some elemental diets come premixed in a ready-to-drink liquid, while others come as a powder to mix with water or another approved liquid.
Someone beginning an elemental diet may consider drinking each serving of the formula slowly until they become familiar with the taste, texture, and how they feel after drinking it.
Duration and Transition
An elemental diet typically lasts 14-21 days. However, the duration may vary depending on factors such as symptom severity and coexisting conditions. Once a person completes an elemental diet, their doctor will advise them to reintroduce solid food gradually. This slow and controlled process allows the body to readjust to solid foods.
Healthcare providers typically recommend following a half-elemental diet or a low-FODMAP diet during the transition. They may also recommend probiotics to re-populate your gut with beneficial flora, and prokinetic agents to stimulate your bowels to begin moving more regularly again. As you return to your more regular diet, pay attention to the way different foods affect your digestive system.
Tips for Success
A person might find it easier to complete an elemental diet by:
- Planning ahead and having enough elemental formula and all other necessary supplies ready.
- Staying hydrated with plenty of water.
- Engaging in light physical activity, such as walking or gentle yoga.
- Recognizing and managing their side effects right away.
- Getting support and encouragement from family, friends, or a support group.
- Keeping a journal to track progress, symptoms, and challenges following the food reintroduction plan.
Anyone experiencing difficulty with the elemental diet can contact a healthcare professional for support, guidance, and additional resources.
Making the Diet More Tolerable
To stick to the diet successfully, healthcare providers recommend that you:
- Keep it cold. Blending the formula with ice, smoothie-style, makes it more palatable.
- Sip it slowly to prevent nausea and drink plenty of water between “meals."
- Make it portable. Have a temperature-controlled thermos to keep your formula in so you don’t get hungry when you’re out and about.
- Stay busy. Distract yourself with fun, non-food-related activities and good company.
Who Should Consider an Elemental Diet?
Because elemental diets are restrictive, costly, and lack large-scale research proving their effectiveness, many healthcare professionals do not recommend them as a first-line treatment for SIBO. An elemental diet may be considered for recurrent cases of SIBO, especially in people who have taken more than two rounds of antibiotics.
Some populations should exercise caution when considering an elemental diet, such as those with:
- Low body weight.
- Eating disorder history.
- Diabetes.
Unintentional weight loss can occur during an elemental diet due to inaccuracies in calorie estimation or the inability to finish the prescribed amount of formula each day. Individuals with an eating disorder history may find the restrictive nature of the diet to be a trigger for disordered thoughts and behaviors to resurface. An elemental diet is high in simple sugars, which may make it challenging for people with diabetes to maintain appropriate blood sugar control during the diet.
When to Avoid an Elemental Diet
Dietitians stress that the elemental diet is not necessarily a cure-all for those with digestive disorders, and it’s certainly not recommended for healthy individuals. There’s no research available on how the elemental diet affects healthy people without serious GI symptoms, because no healthcare provider would recommend this diet to a healthy person. Skipping real food can have big mental, emotional, and social consequences, and could lead to the development of a full-blown eating disorder.
The Scientific Community and Elemental Diets
The scientific community seems divided on whether an elemental diet is the most effective treatment for SIBO. In 2022, researchers with the American College of Gastroenterology (ACG) published an article regarding diet recommendations for small bowel disorders. The researchers note that while diet may modify the microbiome of the small intestine in someone with SIBO, there is greater evidence for using pharmacological treatments such as antibiotics. Similarly, the authors of a 2019 review point to antibiotics as the most effective and well-tolerated treatment option but also note the need for larger, more well-designed randomized clinical trials.
The authors of an older 2016 primary care review noted that SIBO symptoms improved with the elemental diet but also noted the unlikelihood of widespread use due to the diet’s restrictive nature.