Elemental Diet for SIBO: Benefits, What to Expect, & More

An elemental diet is an oral formula consisting of broken-down nutrients, sometimes used to treat small intestinal bacterial overgrowth (SIBO). It usually lasts two to three weeks and works by starving the bacteria that is causing damage in the small intestine. 

Keep reading to learn more about what the research says about elemental diets for treating SIBO. 

Connect with a registered dietitian through Nourish for individualized guidance on diet and lifestyle interventions to manage SIBO. 

What is an Elemental Diet? 

An elemental diet is a type of liquid diet sometimes recommended by medical professionals for managing certain digestive conditions like SIBO (small intestinal bacterial overgrowth). It contains easy-to-digest nutrients your body needs to function. 

When you eat whole foods, most of the nutrients are broken down in your digestive tract and are absorbed and used by your body.

For example, proteins must be broken down into amino acids, starches into sugars, and fats into fatty acids. 

Elemental diet formulas contain macronutrients in their most basic form, which decreases demand on the digestive system and allows it to heal and reduce inflammation. 

Elemental diet formulas can be purchased over the counter or as a prescription.

These products are typically in a powder form that is mixed with water to prepare.

While elemental diet formulas can be made at home, this is not typically recommended due to a lack of research and low palatability. 

Benefits of 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. 

SIBO is typically treated with antibiotic therapy.

However, antibiotics are not always effective at eradicating the bacteria in the small intestine, which can lead to recurrent SIBO. As a result, some people try supplements, natural treatments, and elemental diets to manage SIBO. 

How Can An Elemental Diet Help SIBO?

Your doctor may recommend an elemental diet if your SIBO is not improving after two rounds of antibiotic therapy.

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. 

How Does the Elemental Diet Work for SIBO? 

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. 

Things To Consider Before Starting

Before starting an elemental diet for SIBO, it’s important to talk with your gastroenterologist about the pros and cons of pursuing this treatment option. Elemental diets should always be done under medical supervision.

Because all of your nutrition will come from an elemental formula during this diet, a registered dietitian can help calculate your calorie needs and the formula needed each day. They can also guide you in transitioning back to solid foods once you’ve completed the elimination diet. 

What Should You Expect During and After An Elemental Diet? 

You can expect an elemental diet to consist of approximately three “meals” per day of liquid elemental formula, which will replace all solid food.

Sipping on the formula throughout the day is not recommended because it’s important to let your digestive tract rest between meals when you have SIBO. 

Flavor options for elemental formulas vary based on the brand, with some being unflavored and others having a mild vanilla or chocolate taste. 

How Long Does The Elemental Diet Last? 

An elemental diet for SIBO is not meant to be a long-term nutrition plan. Most elemental diets last two to three weeks. The diet may be repeated in the future if the SIBO returns. 

Following the elemental diet, you’ll be instructed to slowly transition back to solid food as your primary source of nutrition. Sometimes, a low FODMAP diet is advised during this time. 

Risks and Side Effects

While an elemental diet may be useful to address bacteria growth and digestive symptoms in the short term, long-term solutions should focus on treating the underlying cause of the SIBO.

The root cause can vary from person to person, ranging from irritable bowel disease (IBD) to diabetes. 

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. 

Who Should Use an Elemental Diet for SIBO? 

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. 

Tips For Successfully Completing the Elemental Diet for SIBO Symptoms

Following an elemental diet for SIBO while eliminating solid food can be very challenging.

Set yourself up for success by gathering a team of healthcare professionals to supervise your progress and address your questions and concerns while following the plan. This should include a gastroenterologist and a registered dietitian. 

Next, choose a time to commit to the diet. It’s best to identify a few weeks when you won’t be traveling and have few social obligations. Starting an elemental diet right before a big trip or around a holiday would not be ideal. 

Talk to your family and friends about your plans in advance, and ask for their support. This may include not eating around you or inviting you to eat out. 

Takeaway

An elemental diet allows the digestive tract to rest and easily absorb nutrients while “starving” unwanted bacteria in the small intestine.

Though large-scale research is lacking, smaller studies have shown that an elemental diet can be used to treat SIBO. 

It’s important to talk with your doctor before starting an elemental diet to ensure it’s the best fit for you. 

Managing SIBO with an RD 

Navigating an elemental diet and transitioning back to solid foods can feel overwhelming.

A SIBO nutritionist can help estimate your calorie needs and the amount of elemental formula you need daily. After the diet, your dietitian can guide you in safely reintroducing solid foods. 

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