Elemental diets are pre-digested, hypoallergenic meal replacements used in the medical setting to treat digestive conditions like small intestinal bacterial overgrowth (SIBO) and inflammatory bowel disease (IBD). This article will provide an overview of the evidence-based clinical applications for an elemental diet, how to implement it into your treatment plan, and the potential side effects of the diet that you should consider before starting.
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What is the Elemental Diet?
The elemental diet (ED) is a formula mixed in water and contains predigested nutrients, including amino acids, vitamins and minerals, fats, and simple carbohydrates. An ED fulfills all caloric and nutritional needs to act as a complete meal replacement.
Additionally, the ED is considered to be hypoallergenic, meaning that it does not contain any of the foods responsible for the vast majority of allergies: milk, eggs, wheat, peanuts, tree nuts, shellfish, and soy.
EDs are most commonly implemented in clinical practice for patients with debilitating digestive symptoms. The ED's antibacterial and anti-inflammatory properties restore microbial balance, remove trigger foods from the diet, and act as a "gut reset" in gut-healing protocols.
What is the Elemental Diet Used For?
The vast majority of research on ED is focused on Crohn's disease, a type of IBD. While individual studies investigating the therapeutic effects of an elemental diet on Crohn's tend to be smaller in population size, the cumulative results favorably support using ED as a first-line therapy in treatment. The elemental diet effectively decreases intestinal inflammation, reduces autoimmunity, maintains remission and prevents relapses, and improves the nutritional status of patients with IBD. (1-4)
This larger retrospective study examined the immediate- and long-term effects of ED in 113 individuals with acute Crohn's disease. The ED profoundly impacted these patients, inducing remission in 85% of participants and reducing the annual relapse rate to 8-10%, comparable to those using steroid treatments.
Many studies have compared ED to steroid treatment, the conventional intervention for acute IBD flares. These studies have consistently concluded that ED is safe and comparable to steroids in reducing intestinal inflammation and disease activity and inducing IBD remission (5-8). This study even found that the ED allowed half the participating patients to avoid steroid therapy altogether.
Conventionally, ED has been used in the inpatient setting for postoperative nutritional therapy in patients undergoing surgery that can result in malnutrition and malabsorption. Introducing the elemental diet as part of the postoperative recovery plan has been shown to reduce weight loss, prevent surgical complications, and improve recovery outcomes and nutritional status in patients following partial surgical removal of the stomach, pancreas, and small intestine. (11, 12)
What Medical Conditions are the Elemental Diet Recommended For?
Medical doctors will prescribe an elemental diet for people with gastrointestinal diseases to reduce inflammation, promote bowel healing, and treat bacterial overgrowth. ED also supports the nutritional needs of those on restricted therapeutic diets or with a malabsorptive disorder causing nutrient deficiencies. (16)
Maldigestion and Malabsorption States
The elemental diet is designed for the dietary and medical management of moderate-to-severely impaired gastrointestinal (GI) function. Evidence supports its use in a wide range of GI disorders, including those characterized by enzyme deficiencies, anatomical variation, and inflammation. ED is often recommended to patients to treat celiac disease, chronic pancreatitis, exocrine pancreatic insufficiency (EPI), IBD, and short bowel syndrome. (13)
Preliminary data appears promising to support the use of ED in treating SIBO and irritable bowel syndrome (IBS). Two weeks of an elemental diet significantly improved digestive symptoms and normalized SIBO breath tests in patients with clinically-diagnosed IBS and SIBO. (9, 10)
Inflammatory Conditions
Studies suggest that leaky gut and immune dysfunction due to intestinal microbiome imbalances underlie the development of rheumatoid arthritis. Your doctor may therefore recommend a trial of ED to help with arthritis symptoms. Although additional studies must be performed to confirm these conclusions, this pilot study concluded that ED could successfully treat joint pain in patients with rheumatoid arthritis.
Inflammation of the digestive mucosa is common during radiation and chemotherapy treatments for cancer. An elemental diet can reduce the burden on the digestive tract as the digestive tract heals from these insults while providing sufficient calories and nutrition required during cancer therapy. (13, 14)
Preliminary research has also documented the benefits of ED in those suffering from eosinophilic esophagitis by removing common dietary allergens implicated in the disease and reducing esophageal inflammation.
Conditions Requiring Supplemental Nutrition
Elemental diets can act as supplemental meal replacements and nutrition for patients unable to meet caloric demands due to increased metabolic states. ED is indicated for patients with anorexia, cancer, and HIV. (13)
What Are the Side Effects of the Elemental Diet?
The most common side effects of an ED are digestive symptoms, which may include changes in bowel habits and abdominal pain (13, 15).
Because ED formulas are high in sugar, blood sugar dysregulation and intestinal yeast overgrowth are also common. Symptoms of high and low blood sugar can include headache, fatigue, lightheadedness, sweating, and changes in heart rate. (15)
Although the benefits (i.e., bowel rest, reduced inflammation, and treatment of bacterial overgrowth) of ED are appealing, the downsides of ED, like unwanted side effects, the restrictive nature of the diet, and bad taste, make compliance with ED difficult. (15, 16)
How to Transition After the Elemental Diet
Digestive symptoms often return quickly when known problem foods are reintroduced into the diet immediately after stopping the ED. It is generally recommended to slowly ease foods into your diet over 3-7 days. The low FODMAP and semi-elemental diets can be recommended to patients as transition diets to allow time for their guts to adjust. A low FODMAP diet eliminates high amounts of certain carbohydrates that trigger digestive symptoms in patients with GI conditions. A semi-elemental diet typically consists of 50% of dietary intake from an elemental formula and the other 50% from well-tolerated foods. (16)
Your doctor will likely also recommend follow-up testing to monitor treatment progress. The labs ordered will vary depending on the underlying condition prompting treatment with an ED but might include inflammatory markers, SIBO breath testing, comprehensive stool testing, and repeat GI imaging.
Summary
The elemental diet is a medical formula designed to treat impaired gastrointestinal function, often caused by inflammatory bowel diseases. Its anti-inflammatory, hypoallergenic, and antibacterial properties can make it a fantastic treatment option for those with severe intestinal inflammation and dysbiosis contributing to malnutrition. Although elemental diets can be used to treat a vast number of medical conditions, they are not for everyone. It is always recommended that you consult a healthcare provider before starting an elemental diet.
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References
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