I really wanted to write a post on my experience with the Elemental Diet (ED). I get questions on my experience on this topic frequently in the SIBO groups on Facebook (See post: My Recommended SIBO Resources: Books and Online Groups), and it will be much more helpful to be able to explain it in detail here!
I also feel it is important for me to explain my experience for another reason: the ED didn’t go well for me! I really want people to understand the pros and cons and actual risks of doing the ED – something I had little knowledge on (and I feel there is a lack of knowledge out there on), and I wish I had, because it really set me back, health-wise.
Just for some context: When I was first diagnosed with SIBO after performing a breath test, I sought out a naturopath who could help me navigate my health history, as well as a treatment plan for SIBO.
The Naturopath spent an hour and a half with me on our first appointment, going over as much detail on my medical and health history. This helped her piece together possible root causes as well as the SIBO treatment plan. One of the first steps in the plan was to start an elemental diet (ED).
I had heard about this being a recommended protocol for treating SIBO, so I was not surprised to have this recommended by my Naturopath. If anything, I was pleased that she seemed up to date and knowledgeable on treating SIBO.
I was feeling hopeful that I chose the right practitioner to help guide me through this daunting illness, and I would soon feel better. Little did I know at the time that the process to treat SIBO would not only be not a short one, but also would be difficult and challenging in so many ways…
The Basics Of The Elemental Diet
For those of you who don’t know what the elemental diet is, let’s start at the basics before I dive into my own experiences with it. For starters, small intestinal bacterial overgrowth (SIBO) is a condition where excessive gut bacteria are present in the small intestine.
There are different SIBO diets used to help reduce related symptoms and complications, including abdominal bloating, cramping, diarrhea, nutritional deficiencies, weight loss, and more. One of the diets recommended to get rid of SIBO, or at least reduce its numbers of bad bacteria or restore a normal balance of bacteria, is the elemental diet.
An elemental diet is a liquid diet typically used for patients who have compromised digestive systems.The nutrients in an elemental diet are believed to be completely absorbed in the very first part of the small intestine, which reduces the number of food components available to bacteria. Elemental diets have been shown to reduce the number of gut bacteria. Therefore, it is theorized that it may be useful for clearing out bacteria from the small intestine.
How The Elemental Diet Works
The elemental diet involves complete dietary restriction to a specific liquid formulation. The diet gets its name from the fact that nutrients are introduced into the body in as close to their elemental—or primary— form as possible.
The duration of the elemental diet depends on severity of symptoms, how high your numbers are, and your personal capability to not eat solid foods for a long length of time!
The standard duration however is 14 days, maximum is usually 21 days, but some go longer (always with the oversight of a doctor).
The elemental diet is administered as a beverage that you drink, or it may be administered through a feeding tube in more severe cases. The amount of liquid administered is slowly increased over the first few days to reduce unwanted side effects such as diarrhea or abdominal pain.
There are a couple of main elemental diets you can purchase online. The formulation contains nutrients in an easily digestible form. Typical formulations should include:
- Essential and non-essential amino acid
- Glucose (an easily digested carbohydrate)
- Vitamins (fat- and water-soluble
- A small amount of fat (less than 1%)
The most popular or common one is the Physician’s Elemental Diet.
You can even make your own at home! The benefits of that is it can reduce the costs of buying enough formula for 2-3 weeks online. I have heard the taste might not be so great for homemade versions, but I personally did not try it, so I can’t say for sure! Dr. Allison Siebecker has a homemade ED recipe on her website (again, I cannot attest to the taste!).
The Benefits Of The Elemental Diet
There are notable benefits if you decide to do the elemental diet (and there better be! It isn't easy to stick to!)
- The elemental diet allows the gut to rest and repair
- The elemental diet can reduce gas and bloating (A major annoying symptom for most with SIBO!)
- The elemental diet comes in a dextrose-free version for those concerned with candida/yeast/fungal issues
- The elemental diet is easily digestible and can allow you to gain weight, especially if you are experiencing many food intolerances/malabsorption
- The elemental diet is absorbed in the small intestine, reducing food particles for bacteria to feed on, thus starving “bad” bacteria and potentially reducing SIBO numbers
- The elemental diet can be great if you are experiencing a flare-up, as it helps rest the gut
- The elemental diet can help you to absorb nutrients easier
The Cons Of The Elemental Diet
Just as there are benefits of the elemental diet, I think its equally important to consider the potential cons that may arise.
- The elemental diet is expensive
- The elemental diet can be triggering for those who had or have a an eating disorder
- The elemental diet can shock the system if started suddenly
- The elemental diet can be damaging to those with adrenal fatigue, as fasting or consuming low calories with AF is usually not advised\
- The elemental diet can make it difficult for some to consume enough calories (Especially if nausea or diarrhea sets in)
- The elemental diet can make transitioning to solid foods difficult
- The elemental diet can impair the MMC (something I experienced personally)
- The elemental diet has potential for blood sugar dysregulation if you're drinking it really quickly
- The elemental diet can exacerbate a fungal/yeast overgrowth if you have candida, due to the sugar content
- The elemental diet is unlikely to starve all bacteria, as bacteria proliferate very quickly
- The elemental diet is not immune to SIBO relapse rates (it is not addressing root causes!)
- The elemental diet can test your patience and can be an emotional rollercoaster – being hungry, not being allowed to chew solid foods, feeling sick/die-off symptoms – just to name a few potential side effects!
- The elemental diet can cause an intense die-off reaction due to the large amount of bacteria starving in a short amount of time
I was advised to do the ED for 2 weeks by my naturopath, using an easily digestible protein powder (I used Pure Paleo Complete, a Canadian product), and she also advised that I add healthy fat oils (examples: MCT, Coconut) to the shakes for extra calories, and lastly to drink bone broth in between shakes.
I was of course hesitant to go two weeks without any solid foods, but was determined to try it because I wanted to feel better. Within just one day, the hunger hit me and so did the emotions. It surprised me how grumpy and irritable I became, so quickly!
Nevertheless, I carried on. On day two, I was hungry as well as weak, tired and nauseous (die-off symptoms I suspected). By day three, these symptoms continued, as well as new ones such as chills, dizziness and diarrhea. I was warned by members of the SIBO Facebook groups, as well as from my personal reading, that die-off was unpleasant but expected and normal. So I carried on, thinking it was normal and I would be weak or a quitter, if I gave up before the 14 days were up.
However by day 5, I gave in to my hunger and ate small amounts of chicken, and egg yolks. I continued to do a semi-elemental diet, by consuming the ED shakes as well as the chicken and eggs. In my mind, it was either eat a bit of food, or I would stop altogether, as I just couldn’t handle the nausea and hunger. I figured a semi-elemental was better than nothing at all. At the time (this was almost 2 years ago now) I couldn’t find many resources online about the effectiveness of the semi-elemental diet, except one article! Now, there are a few more out there, such as one by Dr. Amy Meyers.
Despite eating, the nausea was so severe, I could barely get any of the shakes down. I was probably consuming only about 800 calories a day at best! It could be that not consuming enough calories contributed to my symptoms, however I just couldn’t bring myself to drink more. It would make me gag and I would feel even more nauseous.
I recall one particularly bad day, when I had to go walk a neighborhood dog (yes, at one point I started a little dog-walking side-gig, as I love dogs but can’t have my own right now!). I could barely stand for over a couple of minutes without feeling such severe nausea and light-headedness. Again, assumed everything was “normal” and it was just a die-off symptom.
Another similar symptom I had during the ED was I would get very dizzy or light-headed upon standing up too quickly. During the night when I would get up to use the washroom, my heart would be racing so quickly, it would take me a few minutes to relax enough to urinate.
I told my naturopath about this but she didn’t seem too concerned. Looking back, this was pretty dangerous. It is recommended to do the ED under the supervision of a doctor, but they don’t always catch things or show enough concern where needed. That is why I will keep repeating: Listen to your body! If it doesn’t feel right, or feels too risky, just stop. It isn’t worth putting your health at further risk to maybe clear SIBO.
Eventually I developed an aversion to even the smell of the shakes (to this day if I smell the protein powder, it brings those same feelings up!). Unfortunately, I lost about 15 lbs over the course of just two weeks, which I really didn’t need to lose (I am 5’5 and weighed a healthy 130 lbs before the ED). Almost one year later, I am only now starting to gain back the weight.
After the 2 weeks on the ED, I transitioned back to solid foods. This was extremely challenging and frustrating, and again very little information out there on how to best do this. I started out with a lot of bone broth, cooked carrots, and chicken. I consumed this for about 4 days. I remember feeling full really quickly, so I didn’t consume too many calories for a few days further.
Bone broth was also recommended to me, however I could not tolerate this at all. Since then I have learned that it was likely the glutamates in bone broth that I was reacting to. Bone broth also contains histamines, so if you have a bad reaction, this could be why as well.
I was then eventually (after about a week and a half) able to eat more variety and more volume. However, I noticed I had developed two new symptoms: slow motility and constipation. I never had these symptoms prior to the ED, and I suffered with these terrible symptoms for the next 8 months while treating SIBO.
To expand on the above negative consequences of the elemental diet: For me, slow motility meant that whenever I would eat a meal, it felt like the food was sitting in my stomach, undigesting, for hours after eating. I would hear or feel little movement in my stomach. Due to it sitting in there undigested, it would result in belching/burping, and nausea. Oh my god, the nausea was the worst symptom I experienced. It was severe, and almost daily for months! If something could cause you to feel demoralized, this would be it. You can’t function with nausea, and no one enjoys throwing up. It was just an awful sensation and experience I will never forget.
The constipation was not any more enjoyable than the nausea. Feeling backed-up, heavy, bloated and sometimes even in pain. Not to mention the negative consequences to not properly eliminating waste from your system, especially when treating SIBO and not wanting toxins reabsorbed into your system.
Thankfully, I was able to overcome both of these major symptoms! For the nausea and indigestion, I had a surprising savior – Ox bile!
Something I would like to point out – I had NO other obvious symptoms specific to fat malabsorption, such as:
- Floating stools
- Greasy stools that stick to the toilet
- Yellow or pale colored stools
What makes treating SIBO especially difficult, is trying to understand our symptoms and act accordingly. What makes it trickier is we don't always have obvious symptoms!
For the constipation, I tried several things recommended to me by my naturopath, including:
– Cascara Sagrada
– Fat (Coconut oil)
– Vitamin C
The above method did help, but only to a degree unfortunately. Some days I wouldn't have a bowel movement (BM), but most days I would, but it would just feel incomplete, like I couldn't completely evacuate. This would lead me to feel extra bloated and unwell.
What helped the most – and this even surprises me to this day – was acupuncture!
When I told my naturopath one of my biggest issues or symptoms that remained, after months of working with her, was constipation, she said “Look, I've tried all of my methods on you and I am out of ideas. Try acupuncture”.
I was skeptical, but due to desperation, I agreed to try it out. She gave me a recommendation for a highly praised Chinese acupuncturist in my city, named Amy Peng.
I booked an appointment, and I kid you not guys, the difference was immediate! Just after one session, I felt movement, and then had a complete BM. Quite amazing really. I was so grateful for trying it as well as for Amy and her skills.
The acupuncturist recommended I do 3 more sessions (for a total of 4), and as long as I stuck to my paleo diet, I was no longer suffering with constipation. I was going every day with no issue.
I now highly recommend trying acupuncture (how could I not?), with a skilled practitioner trained in Chinese acupuncture. If you are in Montreal, Quebec, Canada, even better – pay Amy a visit, she is the best!
Why I Tried Ox Bile
As mentioned previously, the SIBO facebook groups are so helpful! I did a quick search in the group on nausea, and came across a post by a woman (I sadly can’t remember her name but whoever you are, thank you!), who shared a post on how she fixed her nausea with ox bile.
She really sold it to me and I said “what do I have to lose by trying this? Worst case scenario, when you don’t actually need ox bile, you will experience a bit of stomach upset and/or diarrhea. Both of which are not any worse than what I was already experiencing.
Just a side note to those reading this: Please don’t be so afraid to try a new supplement! I totally understand the anxiety of trying a new product/supplement – what if it makes you feel worse? I completely understand this process. I bought many supplements or products that went completely unused because of this fear. But what if it actually makes you feel better?!
If I hadn’t tried ox bile, despite not having major symptoms of fat malabsorption, and allowed the anxiety and fear to take over, I would have never gotten rid of the nausea. I would still be suffering from something deliberating, all because I didn’t want to take a small chance.
I also understand the process is frustrating and expensive. Of course I am not advocating buying any product on the market that claims to help with bloating, gas etc. But if it resonates with you even slightly, and you have a good feeling about it, I say go for it.
These health issues are complicated and sadly there are answers that doctors won’t be able to give you. That means you will need to take your health into your own hands to a degree, and that means doing independent research and figuring out what might work best for you.
Once I tried ox bile, the difference was almost immediate. I would take it after eating a meal (usually quite high in fat, as I follow a Paleo diet), and I no longer felt like food was just sitting in my stomach, rotting. I started hearing digestive noises and movements, like we should. The nausea was gone!
It’s been almost a year since I started taking ox bile, and I still take it every day, with both of my main meals. I started just with 125mg at the beginning, and eventually went up to 500mg. I have recently upped my dose from 500mg to 1000mg, with no ill effects. I may even increase further, and see if that helps things get even better.
Unexpected Side Effects Of The ED
As previously mentioned, I lost quite a lot of weight while on the elemental diet – 15lbs to be exact. This may not sound like a lot to some, but on my already-small frame, it was quite dramatic and noticeable. Something many (unfortunately) can relate to is receiving negative comments from family members about their weight. I was not immune to this, as my mother especially seemed to like pointing out how “skinny” I was and how I needed to eat more (thanks, Mom, I hadn’t noticed!). Add that to the already suffering-self-esteem I was experiencing due to my sudden body change, it was not a fun experience to say the least.
I am one of those girls who enjoy lifting weights at the gym, and was actually trying to build some muscle and look strong and healthy. Both SIBO, and the elemental diet in part, took that away from me. I no longer had the physical strength to lift the weights I did prior to, but I also lost a lot of progress I had made in the couple of years leading up to SIBO and doing the elemental diet (goodbye booty 🙁 ). That was not something that was easy to accept nor adapt to. Luckily I have a partner who was always really supportive and would make me feel beautiful every day.
All I can say about this now, to anyone who relates to the above, is that we have to listen to our bodies, take a step back from the things we enjoy, and just remember it won’t be forever! Take some time to let your body rest, heal and repair, and reap the benefits later. A little bit of deprivation and acceptance will go a long way, I promise you.
Less than two years post-ED, my SIBO is gone, I have gained my weight back, I am lifting even more than before at the gym, and I have revamped my lifestyle in so many ways in the hopes to avoid ever getting sick like that again.
Yes, I had to and still have to give up a few things, like staying home instead of going to see friends sometimes, not always getting to eat the foods I used to love and enjoy, and having to rest at times, when I want to do so many things in a day. But the sacrifices are all worth regaining your health, and living the life you deserve to live!
Reflections On My Experience
Sadly, I still to this day am unsure why the ED triggered these symptoms. I have a couple of theories, but that's all they are, just theories. I will never know for sure unless more data comes out or my many hours of research lead me to a resource that can explain it.
The only plus side to doing the elemental diet is that it appeared to have killed some bacteria, as I was much less bloated than before doing it, and it changed my palette for sugar. I was a really big candy and chocolate eater prior to the ED, and afterwards just looking at pictures of desserts would turn me off. Sugar is detrimental to our health as we know, but it is especially important to minimize sugar consumption while treating SIBO and/or candida, so this was a blessing in disguise.
I am aware that the ED can and has helped many with reducing SIBO symptoms, nutrient absorption, and even weight gain. Unfortunately, since the pros did not outweigh the cons for me personally, I cannot recommend the ED. I think there are risks that come with this protocol that people should be aware of before deciding to do it.
In retrospect, there may have been things I could have done to avoid the lasting symptoms I experienced post-ED. For example, I do wish that I had slowly eased into the ED, by replacing one meal or snack with the shakes, and seeing how my body responded, instead of diving straight into it. It might have reduced the extreme die-off symptoms or bad reaction I experienced.
Going from solids to liquids overnight may have shocked my system. Think about starting a Keto diet – it is not advised to just cut down your carb intake dramatically overnight, or you will experience the “keto flu”. The keto flu occurs when we dramatically cut down our carb intake, and the switch over from using carbs to fat as a fuel source causes us to feel ill. I believe the same principle applies to the elemental diet, except when we are already dealing with so much digestive distress and die-off symptoms, we do not need to add any “keto flu” type symptoms to the mix!
Tips On Making The Elemental Diet Experience More Tolerable
Here are some things I learned and would recommend doing if you are considering the elemental diet.
- Ease into the ED slowly! Try replacing just one meal with the ED, and slowly increase until you're off solid foods and strictly on the ED only. Maybe over the span of 3-5 days or so, until you feel good and ready to go full ED. I found switching quickly from eating normally to being on the ED overnight way too difficult both mentally and physically.\
- Listen to your body! If you are nauseous and cannot consume enough calories, I would recommend stopping the ED. Losing weight quickly can be bad for our bodies. Fasting or going low calorie can also be bad for some of us, especially if you have adrenal fatigue or thyroid issues.
- Die-off symptoms are normal. Remembering that feeling some herx symptoms are normal may help calm you down when you’re wondering why you feel so badly while on the ED. However, remember that it shouldn’t be so bad that you can’t consume enough calories or can’t function (see previous point).
- Transitioning back to solid foods is tricky, have a plan in place! I still cannot recommend the best way to do this, as it's very individual and we all seem to handle this stage differently. However I think for the majority of people, transitioning back to regular foods is easiest when the food is mashed, pureed, in the form of soups and smoothies, and cooked very well. Proteins like fish and chicken are easier to digest than beef or lamb.
Here’s a handy little chart:
Note: Eggs are one of the most common allergenic foods, so I am not saying digestion of eggs is necessarily “easy” for everyone.
Although I have also seen sources that show that rare cooked beef is easier to digest than chicken, especially with the skin still on. Personally, I find this to be true. But again, this is very individual, so it's always best to go based on how you feel! Choose foods you think are safe for you, or were safe before the ED. Hopefully they are still safe post-ED completion
- Drink the ED slowly! Some find it best to consume over the course of an hour or two. This can help avoid diarrhea or nausea.
- Add an easily digestible oil like MCT oil to the ED shakes to add more calories, if consuming enough is an issue for you
- Add ice to the ED shakes. Some find the taste more tolerable when its chilled
- If you live with other people, try to avoid being around when they are eating meals. The smells of the food might be too difficult to tolerate when you aren’t allowed to have any!
- Try to find support during this time. There are some elemental diet Facebook groups where members will start at the same time, so they can support each other (yay for being nice to our fellow humans!). Also if you have a partner, prepare them as well as yourself for this potentially difficult time. Warn them that you may be irritable, hungry, feel unwell, and that their support would also be greatly appreciated. My partner really helped me during this time by getting me things I needed, rubbing my back when I felt nauseous, and using encouraging words not to give up early!
- When transitioning back to solid foods, I would recommend still consuming the shakes and slowly weaning off of them. Just like it can be a shock to the system to suddenly start the ED, it can be just as shocking to the body, if not more, to suddenly start eating solids again. The ED when taking long term (more than a couple of days), essentially turns off the full digestive process. It may need time and slow adjusting to turn it back “on” again. Trying to rush this process will likely result in pain, indigestion, nausea, and a lot of frustration and worry.
- Support detox pathways to avoid intense die-off reactions. The main point in using the ED for SIBO is the intention of killing “bad” bacteria in the small intestine. The large amount of killed bacteria in a short amount of time can result in a lot of toxins being released into the body, thus giving us die-off symptoms.
- Start herbals or antibiotics AFTER the ED. I (or my naturopath) made the mistake of prescribing herbals to take with the ED. This was way too much for my system to handle and likely led my die-off symptoms to be very severe. There is also evidence that shows the bacteria need to be fed (specifically with prebiotic guar gum) while taking antibiotics or herbals, and this is not possible if you are on the ED, due to the quick absorption of the formula.
Die-off symptoms are not exactly normal. I know many of us look for those symptoms are an indicator or proof that the treatment is “working”, however all it really means is, your body is unable to properly handle or process the toxins effectively.
For example, when taking herbals, if the die-off is too severe, your Doc or Naturopath may suggest taking a day or two off, and allow your body to “catch up” (or for your liver to catch up processing the toxin overload). The same applies for the ED, however stopping the ED half way through, is not ideal.
If you are experiencing die-off, supporting your detox pathways can help. Here are some ways you can do that:
- Dry brushing
- Oil pulling
- Epsom salt baths (my personal favorite)
- Liver support: milk thistle, dandelion root tea
- Glutathione (not to be taken if you are mercury toxic however)
- Use a binder, so toxins are not reabsorbed, such as activated charcoal (if you use activated charcoal, take away from food or other medications, as it will absorb those as well, and note it can cause constipation) or G.I Detox.
Looking back, I wish I had known a bit more about the ED, and what I was getting myself into. I also wish I had stopped sooner and listened to my body. Unfortunately for me, the cons outweigh the pros that resulted from the ED. Please know that I am not trying to deter anyone from doing the ED, because it does help people! I just want people to be aware of the risks, and have tips on making the process smoothe and side-effect free 🙂