The digestive system is vital for our health and wellbeing because it brings nutrients to the body. Problems with digestion are common and complex to manage without various dietary modifications. Various eating patterns and programs are available today for persons with digestive problems and an elemental diet is one of them. What is elemental diet and what effects to expect? Find the answer to that question and many others in this post.
What is An Elemental Diet?
An elemental diet is a form of liquid diet whose primary objective is to help people with certain digestive problems. This meal replacement formula is anti-inflammatory, anti-bacterial, and hypoallergenic.
The elemental diet focuses on nutritionally complete formulas in a pre-digested form and comes as drinks or powders that people mix with water and then consume. These formulas contain macronutrients protein, fat, and carbs that have been broken down into their building blocks. For example, proteins are broken down into amino acids. Besides macronutrients, elemental diet formulas also contain micronutrients such as various vitamins and minerals.
Since these nutrients are introduced into the body in their elemental forms, hence the name of this diet. The main premise of the elemental diet is to supply the body with much-needed nutrients, without overburdening the digestive system.
Who Is This Diet For?
An elemental diet is primarily intended for patients with severe digestive problems, such as:
- Crohn’s disease: A type of inflammatory bowel disease (IBD). The condition can be painful and may lead to life-threatening situations. Crohn’s disease can affect any part of the small or large intestine. In some people, the disease predominantly occupies the colon. Symptoms of Crohn’s disease can range from mild to severe and although they tend to develop gradually, they may appear suddenly and without a warning too. Active Crohn’s disease manifests itself through symptoms such as diarrhea, fever, fatigue, abdominal pain and cramping, mouth sores, blood in stool, weight loss, and reduced appetite, among others. The exact cause of this form of IBD is unknown, but it could be down to heredity and impaired immune system (1).
- Eosinophilic esophagitis (EoE): A chronic immune system disease wherein eosinophil (a type of white blood cells) accumulates in the esophagus. The buildup of these cells is a reaction to food, acid reflux, and allergens. In adults, the most common symptoms of EoE include difficulty swallowing, chest pain that doesn’t respond to antacids, food getting stuck in the esophagus after swallowing, and backflow of undigested food. The condition can inflame or injure esophageal tissues (2).
- Small intestinal bacterial overgrowth (SIBO): The presence of excessive bacteria in the small intestine. It is frequently implicated as the cause of malabsorption and chronic diarrhea. Persons with SIBO may experience unintentional weight loss, osteoporosis, and nutritional deficiencies (3). The condition may occur due to complications of abdominal surgery including a gastric bypass for obesity and gastrectomy to treat stomach cancer and peptic ulcers. Additionally, causes of SIBO may also include structural problems in and around the small intestine, and certain health conditions such as Crohn’s disease, celiac disease, diabetes, among others (4).
As you can see, an elemental diet is an eating pattern that is primarily intended for persons with digestive diseases. A patient follows the diet under medical supervision.
Healthcare providers may prescribe this diet to patients who have undergone surgeries on the intestines and digestive tract. An elemental diet is also prescribed to persons who struggle to meet their nutrient needs such as people with anorexia nervosa and cancer patients.
How Does the Elemental Diet Work?
Essentially, the elemental diet revolves around meal replacements. Solid foods are replaced with a liquid formula. Or you can combine powder formula with water and drink it. Besides drinking, elemental diet formulas can also be administered through a feeding tube or intravenous therapy (5).
The only permitted fluids in the elemental diet are water and plain tea. In other words, just because it’s a liquid diet it doesn’t mean a person can consume just about any beverage out there. As mentioned above, an elemental diet requires medical supervision. The healthcare provider provides instructions and recommendations to follow to keep a patient’s time on the diet safe and healthy. For example, you may need to drink formula at a slow pace to prevent stomach discomfort and cramps.
The elemental diet starves bacteria of fuel and gives a patient’s digestive system a much-needed break from allergies, food sensitivities, irritation, enzyme deficiencies, and other factors that overburden the GI tract.
A person who follows the elemental diet uses commercially prepared elemental formulas specifically designed to provide necessary nutrients and an adequate amount of calories. The formulas are available with prescription and over-the-counter (6). Most formulas deliver more protein and carbohydrates than fat. Why? Fat can be more difficult to digest and the goal here is to avoid putting too much stress on your digestive tract.
What’s in the Formula?
Elemental diets revolve around specific formulas, as seen above. In most cases the formulations include the following:
- Essential and non-essential amino acids (building blocks of protein)
- Vitamins (both fat- and water-soluble)
- Glucose (an easily digestible form of carbs)
- Electrolytes
- Minerals
- Fat (less than 1%)
How Long to Follow An Elemental Diet?
A healthcare provider determines the most suitable protocol based on a patient’s condition and severity of symptoms. For example, some people may need to stick to the elemental diet indefinitely. These include patients who have had a part of their bowel removed. Other patients may need to adhere to the elemental diet only until their symptoms improve.
Again, persons with digestive diseases follow this diet under medical supervision and with help from dietitians and nutritionists. Never underestimate the importance of professional help and guidance. That’s the best way to get results (improved symptoms) in a safe manner.
What Are the Benefits of An Elemental Diet?
An elemental diet is considered beneficial for the treatment of inflammatory bowel diseases. It works because nutrients are broken down into their elementary forms and the body digests them easily.
Remission of Crohn’s Disease
Studies show elemental diet produces excellent results in the management of Crohn’s disease. In fact, 80% to 100% of compliant patients get into remission within two to three weeks (7).
Elemental diet has the potential to improve nutritional balance in patients with Crohn’s disease and may even encourage weight gain. This is particularly important if we bear in mind that many patients with this disease experience unintentional weight loss. The exact mechanism through which elemental diet aids the management of Crohn’s disease is unclear. A combination of different factors could play a role including (8):
- Altering the course of the disease by modifying the nutritional state of the patient
- Inducing critical and beneficial change in the intestinal microflora
- Hypoallergenic properties
- Acting as a medical bypass from the affected area
It’s also important to mention elemental diet appears to be a simple and safe method of inducing remission of Crohn’s disease resulting in alleviation of symptoms, improved nutritional status, and healthier weight (9).
Treatment of Eosinophilic Esophagitis (EoE)
Symptoms of EoE can easily affect a patient’s quality of life. An elemental diet can help treat and even put EoE in remission. One review of evidence on this subject found elemental diet was effective in 90.8% of cases. Scientists concluded dietary interventions like this one have the potential to produce histologic remission in patients with EoE (10).
A study in 21 subjects with EoE found that 88% of participants didn’t experience symptoms of this condition after four weeks on an elemental diet. The elemental diet also produced anti-inflammatory effects (11).
Treatment of SIBO
Men and women with SIBO may experience improvement in their symptoms with an elimination diet.
A study from the journal Digestive Diseases and Sciences found 14 days of elemental diet normalized subjects’ lactulose breath tests. In fact, of 93 participants 85% experienced this improvement (12). Over half of those with normal lactulose breath tests also experienced improvements in their symptoms. For your reference, the abnormal lactulose breath test is a marker of SIBO.
The elemental diet helps people with SIBO because nutrients are quickly absorbed and are not available long enough to feed intestinal bacteria. As a result, bacteria starve thus preventing overgrowth.
Other benefits of an elemental diet require further research. Studies also show it can improve the recovery of patients after gastrectomy (13).
Management of Chronic Pancreatitis
Chronic pancreatitis is long-term inflammation of the pancreas. The main function of the pancreas is to produce enzymes to aid digestion and hormones such as insulin to regulate the way our body processes glucose. Main symptoms of chronic pancreatitis include pain in the upper abdomen, unintentional weight loss, and steatorrhea (oily and smelly stool) (14).
An elemental diet may be helpful for men and women with chronic pancreatitis. A study from the Pancreas journal followed 596 patients in Japan and found elemental diet decreased pain and improved nutritional indices. Scientists concluded an oral low-fat elemental diet composed of purified amino acids may improve the quality of life among patients with chronic pancreatitis (15).
While evidence confirms the effectiveness of elemental diet in the management of chronic pancreatitis, scientists call for further research on this subject (16).
Is An Elemental Diet Recommended for Weight Loss?
In order to lose weight, many people strive to adhere to different diet regimens. The concept of elemental diet may be appealing for weight loss purposes too. However, you need to keep in mind elemental diet is not intended for weight loss. Although it could theoretically help a person slim down a few pounds, an elemental diet is primarily designed to help patients with digestive diseases.
Some aspects of elemental diet could support weight loss, such as:
- Controlled calorie intake
- No overeating
- Supplying the body with nutrients it truly needs
- Quick absorption of nutrients
- No trans fats, sugar, and other unhealthy compounds
However, at this point, there is no specific research focusing on elemental diet for weight-loss purposes only. Following this diet is not recommended without medical supervision because the diet itself is not intended nor considered appropriate for weight loss.
If you want to slim down, you may benefit the most from a well-balanced diet combined with regular physical activity.
Are There Any Risks and Drawbacks of An Elemental Diet?
A major problem with elemental diet is patient compliance. In most studies, about 25% of subjects are not willing to restrict their nutritional intake to a liquid feed for two to three weeks. At the same time, about 5% of participants find the taste of these formulas unpalatable. Patient adherence to the diet is vital for its success in improving symptoms and quality of life.
Despite the beneficial effects of elemental diet and its potential to aid management of IBD, some mechanisms of action are not favorable. Studies show the elemental diet can reduce the diversity of the gut microbiome (17). For this reason, it’s crucial to follow this diet under medical supervision.
In patients with chronic pancreatitis, the elemental diet may impair glycemic control. Particular attention is necessary when administering this diet protocol to chronic pancreatitis patients with diabetes.
Since it excludes solid foods, an elemental diet can be difficult to follow for a long time, which correlates with the above-mentioned lack of compliance. Some people may experience irritability and fatigue at the very beginning of this diet. These side effects are usually a result of a lack of food choices and the need to avoid solid foods, despite cravings you may have.
You may experience nausea if you ingest too much too quickly.
Yet another potential drawback of the elemental diet is the financial aspect. Considering the fact a single packet of elemental diet formula costs about $10, this diet may not be budget-friendly for everyday use to most people. This is particularly the case if you don’t have a prescription or the health insurance doesn’t cover it.
For instance, you may need four single-serving packets of 300 calories a day. This costs at least $40. That means you need to spend at least $280 on these packets per week or $1240 minimum per month. Many people with Crohn’s disease and other problems do not have that budget.
Should You Try An Elemental Diet?
If you have a disease of the digestive tract, an elemental diet could help improve symptoms and quality of life. You may want to consult a doctor and dietitian or nutritionist regarding this subject. In case you go ahead with the diet, you should do so under their supervision.
Another useful thing to mention is that you should make sure your healthcare insurance can cover these packets. That way, when you get a prescription it’s easier to follow the diet.
However, if you only want to try an elemental diet to slim down, it’s better to focus on other weight-loss methods. There is no scientific research on this specific subject. Plus, this diet isn’t intended for that specific purpose in the first place.
Conclusion
An elemental diet is intended for persons with digestive diseases. Studies show this diet can put Crohn’s disease into remission, for example. The benefits of the elemental diet are down to the elementary form of nutrients our body digests and absorbs easily.
References:
(1) https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304
(2) https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197
(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/
(4) https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/symptoms-causes/syc-20370168
(5) https://www.wjgnet.com/1007-9327/full/v22/i7/2179.htm
(6) https://clinicalnutritionespen.com/article/S1751-4991(09)00035-3/fulltext
(7) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285926/
(8) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1714497/
(9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1628143/?page=4
(10) https://pubmed.ncbi.nlm.nih.gov/24534634/
(11) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324627/
(12) https://pubmed.ncbi.nlm.nih.gov/14992438/
(13) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070231/
(14) https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes/syc-20360227
(15) https://pubmed.ncbi.nlm.nih.gov/24622078/
(16) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590936/
(17) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769412/
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