elemental diet

An elemental diet is an effective treatment for those with SIBO (a common cause of IBS) who have failed to eliminate the condition with typical treatment approaches like antibiotics or herbal antimicrobials.

Note: This article was originally published on ChrisKresser.com. It has been updated and re-published on this site.

For those with small intestinal bacterial overgrowth (SIBO), the symptoms can sometimes be unbearable. SIBO symptoms include bloating, excessive gas, diarrhea, constipation, abdominal pain…the list goes on. SIBO is also a common cause of IBS.

While simply getting diagnosed in the first place is half the battle, when it is diagnosed, how do we deal with it? If you’ve tried some of the treatment options out there like rifaximin, neomycin or herbal antimicrobials with no luck, what’s left?

What is SIBO?

Before we talk about treatment options, it’s important to know exactly what SIBO is. Small intestinal bacterial overgrowth is exactly what it sounds like – an overgrowth of bacteria in the small intestine.

Normally, the small intestine has very little bacteria compared to the large intestine, which houses most of our gut bacteria. However, bacteria from the large intestine can translocate to the small intestine under some circumstances, leading to the development of SIBO. There are many underlying factors that relate to this translocation, including low stomach acid, pancreatic enzyme insufficiency, and intestinal motility disorders, among others. (1)

SIBO symptoms include bloating, excessive gas, diarrhea, constipation, abdominal pain, reflux, and more.

The usual treatment of SIBO can include diets like the Specific Carbohydrate Diet (SCD) or the GAPS diet (usually in combination with a low-FODMAP approach), antibiotics or herbal antimicrobials. (2) Unfortunately, diet alone is simply not going to get rid of a SIBO infection, as I’ve written about here.

Rifaximin, the antibiotic most commonly used to treat SIBO, is expensive, thus many patients cannot afford treatment. These patients may choose to forgo antibiotics completely and opt for natural antimicrobials such as oregano oil or berberine. These can be very useful in eradicating SIBO.

However, I’ve had more than one client claim that they can’t tolerate the herbal antimicrobials. Or perhaps you’ve tried antibiotics or antimicrobials before to treat your SIBO, but it’s failed. Round after round of antimicrobials and antibiotics, and you’re still stuck with SIBO. This is where the short-term elemental formula can be helpful.

What is an elemental formula?

In the simplest terms, an elemental formula is one that contains pre-digested carbohydrates, proteins, and fats. This means that it is absorbed very quickly from the digestive system. This is key for those with SIBO as we don’t want food sitting in the small intestine, where it would be used as fuel for the unwanted bacteria living there.

Instead, an elemental formula provides a way to nourish you while starving the bacteria. When implementing the elemental diet, you drink the formula instead of your regular meals for two to four weeks, depending on your case.

How effective is an elemental diet?

In a study using the elemental formula Vivonex Plus, patients were instructed to consume only the formula for 14 days. On the 15th day, they were re-tested for the presence of SIBO. Remarkably, 80% tested negative. Those who were still SIBO-positive were instructed to continue the formula for another 7 days, after which the cure rate went up to 85%. (3)

So how does this compare to the other SIBO treatments I discussed above (rifaximin, herbal antimicrobials)? Though figures vary for the efficacy of rifaximin, the majority of studies I’ve seen estimate it to be around 50% effective, but some studies show even lower rates. (4) One study in particular showed the cure rate for rifaximin to be 34%, while herbal antimicrobials were more effective at 46%. (5)

An 85% cure rate for a three-week elemental formula diet is impressive and should certainly be considered as a treatment option for those with SIBO. However, that doesn’t mean that it’s for everyone.

What are the drawbacks of an elemental diet?

There are definitely some downsides to the elemental formula. First, and probably most important in terms of compliance – it’s not the tastiest thing to subsist on for 2-4 weeks. You have to be willing to stick it out for at least two weeks (where we get the 80% cure rate) and potentially up to 3 three weeks to see results. While this doesn’t sound that long, it can be tough to stick to when the drink doesn’t taste so good! This means that anyone about to try this treatment has to be very committed.

The best-tasting elemental formula on the market right now is Integrative Therapeutics Physician’s Elemental Formula. (Click this link to order.)

You can also make your own elemental formula if you choose. If you’re interested to see what goes into a homemade formula, check out this recipe from SIBO researcher, Dr. Allison Siebecker. Both homemade and commercial elemental formulas are expensive (though less expensive for most than a course of rifaximin), which is also a barrier.

Also, for those who are underweight already, embarking on a two to three week elemental diet can cause them to lose even more weight if they’re not careful to consume enough of it. This is potentially dangerous, thus an elemental diet should be very carefully implemented or not implemented at all in those who are underweight. Whether you’re underweight or not, an elemental diet should always be implemented under the supervision of a medical professional who recommends a calorically-appropriate amount of formula for you to drink each day to prevent weight loss.

An elemental diet can also be a short-term fix. SIBO is a condition that recurs frequently, thus during and after any type of treatment for SIBO, it’s imperative that the patient addresses these underlying factors to prevent future SIBO episodes. This means that those looking to an elemental diet to solve their problem forever still have a long road ahead of them after completing the diet. You need to address stress, exercise, motility, and diet after your elemental formula to make sure that you’re giving yourself the best shot of not getting SIBO again.

When to consider an elemental formula

There certainly are benefits to an elemental formula, namely its short duration (2-3 weeks).  Some people need to be on antibiotics or antimicrobials for months to get rid of SIBO, while an elemental diet clears bacterial overgrowth in 80-85% of people in 2-3 weeks.

Not to mention that having an 85% cure rate is pretty incredible compared to the other options as well.

If you’re someone who has trouble tolerating supplements or medications, an elemental diet is a great option. Or, perhaps you don’t want the process to take months to complete. As long as you can tolerate the taste of elemental formula, it’s a great option for many people to cure SIBO.

However, choosing to do an elemental diet to treat SIBO should be a careful decision that one should make with their medical team and not something to take lightly, but its 80-85% cure rate deserves a look.

Hopefully reading this article has made you think about the pros and cons of an elemental diet and allows you to make this decision more easily!

How to Take Elemental Formula

If you’ve decided to do an elemental diet to treat SIBO, there are a few ways that you can consume elemental formula.

You can either consume your elemental formula in a few different “meals” per day, or drink it evenly over the course of the day.

Most of my clients prefer to drink it evenly throughout the day as it helps to mitigate some of the potential side-effects of an elemental diet like headaches, low blood sugar, and energy fluctuations.

Where to Buy Elemental Formula

The best-tasting elemental formula on the market right now is Physicans Elemental Formula. Click the button below to purchase elemental formula easily.

Purchase products through our Fullscript virtual dispensary.

Now I’d like to hear from you. What do you think about elemental diets for SIBO? Do the positives outweigh the negatives or vice versa? Have you tried an elemental diet?

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