Small Intestinal Bacterial Overgrowth syndrome (SIBO) is something that I personally battled with. The process was incredibly frustrating, but it has also been enlightening and educational. After having limited success with traditional antibiotics, I decided to take the treatment to a whole ‘nother level. One important step that I did to treat my severe case of SIBO was do an elemental diet…. not once but TWICE!
This article is part of a series about treating SIBO. If you missed the last parts of the series, catch up here:
- Part 1: What is SIBO?
- Part 2: Symptoms of SIBO
- Part 3: Causes of SIBO
- Part 4: Diagnosing SIBO
- Part 5: Breath Tests for SIBO
- Part 6: Hydrogen vs. Methane SIBO
- Part 7: Antibiotics for SIBO
- Part 8: Herbal Antibiotics for SIBO
What is an Elemental Diet?
An elemental diet, also often called a “bowel reset diet”, isn’t actually a diet in the traditional sense at all. It is a short-term protocol in which you essentially eat nothing. The goal of elemental is to starve off the bacteria in your small intestine. To prevent your body from starving, you take a special liquid formula (formulated for tube feeding patients) which contains predigested nutrients. The nutrients are easily assimilated into the body so bacteria can’t feed off of them and proliferate. Elemental diets are also often used to treat Crohn’s Disease, a condition in which the gastrointestinal tract is severely inflamed. By taking the liquid Elemental Diet instead of eating, the gut is able to start healing.
How Does an Elemental Diet Treat SIBO?
Remember that bacteria are living things. Like all living things, bacteria have to eat something. The bacteria in our small intestines primarily live off of certain carbohydrates that we eat. When you eat these fermentable sugars, you aren’t just feeding yourself but the bacteria too!
This doesn’t mean you shouldn’t ever eat carbs. Remember, it is normal and healthy to have some level of bacteria in our guts. The problem occurs when you’ve got too many of certain carbs in your gut. The bacteria have a smorgasbord and start to proliferate out of control. This leads to SIBO, which in turn can lead to other serious problems like leaky gut. Bear in mind that some carbs are a lot worse than others, and there are a lot of reasons why you might have excess carbs in your small intestine. We talked about this in the first post in the series, What is SIBO.
When you are on an Elemental Diet, you eat nothing solid. Instead, you take a liquid formula which contains predigested nutrients so they are absorbed into your bloodstream quickly and the bacteria can’t use them for food. So, the bacteria have nothing to feed off of and start to die off.
Does it Work?
An elemental diet definitely seems like a hardcore way to deal with SIBO – but it is an effective one. In one study, 93 subjects with IBS and SIBO (diagnosed with a high lactulose breath test) were put on an elemental diet. After 15 days, 80% of them had negative breath tests.1 According to RD Kelsey Marksteiner, elemental diet has a cure rate of 80-85% for SIBO.2 Compare this to the cure rate of antibiotics for SIBO (which is as low as 40%), and the elemental diet is definitely worth considering, especially in severe cases.
Because your gut is able to rest and heal itself while on the elemental diet, it might help cure some of the underlying causes of SIBO and thus reduce recurrence rate. However, there aren’t any studies (that I am aware of at least) which show what the SIBO recurrence rate is for elemental vs. other forms of treatment.
Pros and Cons of the Elemental Diet for SIBO
The main pro of an elemental diet for SIBO is that it is an effective treatment. However, this effectiveness comes with many drawbacks. The main one is that doing an elemental diet is NOT at all a pleasant experience! You can’t have any solid food and those powered elemental formulas aren’t exactly the best tasting thing. Elemental diets usually should last around 2 or 3 weeks to be effective, so you’ve got to be tough to put up with it.
Readymade elemental formulas for SIBO cost between $600- $1000 for 2 weeks or $300-400 for 2 weeks if you choose the homemade version.
Should You Do An Elemental Diet to Treat Your SIBO?
Even though the elemental diet has a higher cure rate than traditional antibiotics, it is understandable that most people wouldn’t want to turn to it as a first-choice treatment option. Doing elemental is not at all a pleasant experience, and you will have to make some serious lifestyle changes while doing it.
I would recommend doing elemental for SIBO under these circumstances:
- Your SIBO case is severe (methane and/or hydrogen numbers over 80 at any point in the 3 hour test.
- You’ve tried traditional or herbal antibiotics for SIBO but haven’t had much success
- You are ready for the extreme measure of going without food (you’ve got to do it 2-3 weeks for it to be effective)
- You have SIBO along with another gut disease where severe inflammation is in place, such as Crohn’s or IBS
Elemental Diet Options
You’ve got three options when it comes to the elemental diet for SIBO: you can buy Vivonex Plus, a readymade formula by Nestle available over the counter directly to consumers, you could use a homemade formula which I’ll detail below, or you can ask your doctor to prescribe the Integrative Therapeutics ready made formula. When I did the elemental diet (twice!) there were only two options available and I did both of these options (Vivonex the first round, and homemade the second). Overall, I liked homemade better. It was easier to mix up than I anticipated and I just did it once a day and portioned out 3 jars in the fridge but I’ve since tasted the third option by Integrative Therapeutics and would certainly consider that option if I had SIBO today.
Here’s the scoop on each of the three options:
Vivonex Plus:
It is not inexpensive at about $1000 for two weeks, but it’s easy. You just add water and take it. This formula has also actually been studied and proven effective for SIBO. You can easily buy Vivonex Plus “over the counter” online here . You will need to buy enough for about 6 packets per day. A drawback with the Vivonex Plus option is that it does contain some not-ideal ingredients (corn) which are actually contraindicated in SIBO (yes, this means it could still feed the bacteria a tiny bit, slowing down the die-off). It is also high carb/low fat as far as macronutrients go, so it won’t be ideal for everyone.4
Another point worth mentioning about Vivonex is that it tastes horrible. It makes sense since it was formulated as a tube feeding formula so they weren’t exactly taking taste into account when they formulated it. I could not get past 2-3 sips of it without gagging. The only way I could get it down was by adding Crystal Light. Yes, I know the ingredients in Crystal Light are terrible (soy, dyes, artificial sweeteners, etc.), but it was the best solution I found and recommended by my doctor, and I had to prioritize starving the bacteria for this short treatment time. A necessary evil. 😉
Homemade Elemental Formula:
The homemade elemental formula allows you to use ingredients that are slightly closer to real food. Expect to pay about $300-$400 for 2 weeks. The ingredients are a lot cleaner since you’re able to choose each one individually. Another plus of going with the homemade route is that you will be able to adjust the amount of carbs and fats a bit to your needs. Bear in mind that you will have to buy each ingredient separately and mix them together each day. The oil doesn’t mix well so I ended up sipping this separately, which isn’t exactly tasty.
Recipes for Homemade Elemental Formula
These recipes come from Dr. Siebecker’s website siboinfo.com (reprinted with her permission). There are two options: high fat/low carb and low fat/high carb. I did the high fat option. Make sure to use quality ingredients because this is what you are going to be living off of for the next 2 weeks.
Ingredients (for 2 weeks)
- 2.2lbs Jo Mar Labs Amino Acids (Original, No-MSM) – buy here
- 10lbs Dextrose – buy here
- Half gallon high-quality oil: I used a combo of organic coconut oil and organic olive oil. You can also use cod liver oil or macadamia oil. Make sure it is great quality!)
- 1 bottle Pure Encapsulations Nutrient 950 Multivitamin – buy here
- Unrefined Celtic Sea Salt- buy here
- Optional flavorings (such as vanilla) in small amounts per dose
Low Carb/High Fat Option:
These instructions are per dose/meal. If you are going to mix everything up at the start/end of the day, then multiply everything by 3 and divide it into 3 cups to put in the fridge.
- 2 tbsp amino acids (24 grams)
- 3.5-5 tbsp dextrose (3.5T = 35g carbs, 5T = 50g carbs)
- 3-3.5 tbsp oil (3T = 41g fat, 3.5T = 49g fat)*
- 2 capsules of the multivitamin, emptied out
- ¼ to ½ tsp salt
*If using higher dextrose amount, use lower oil amount, or use higher oil amount if using lower dextrose amount.
Low Fat/High Carb Option:
These instructions are per dose/meal. If you are going to mix everything up at the start/end of the day, then multiply everything by 3 and divide it into 3 cups to put in the fridge.
- 2 tbsp + 1 tsp amino acids (28 grams)
- 2/3 cup dextrose (106g carbs)
- 1 tsp oil (4.6g fat)
- 2 capsules of the multivitamin, emptied out
- ¼ to ½ tsp salt
Just mix everything together in a blender with water. You can use as much or little water as you want to get a desired thickness. You can add ice too. Never use juice, milk or any other liquid but water to blend the ingredients!
Alternatively, you can take each of the ingredients individually. However, it is probably better to sip it throughout the day, even if it doesn’t taste so fabulous. Using small amounts of vanilla extract as flavorings is allowed but honestly I found it made it taste even worse. I think this is because I found it obnoxiously sweet from the dextrose and the vanilla seemed to accentuate that. It was no where near as terrible tasting as the Vivonex however.
Physicians’ Elemental Diet:
Physicians’ Elemental Diet is the best tasting elemental diet I have tried and contains no artificial flavoring, while being very easy to make. Just add water and the number of scoops you need per meal based on calories. This elemental diet is unique with a strictly hypoallergenic formula that is free from dairy, corn, soy, gluten, and other major allergens, and was formulated with oversight from integrative medicine specialists.
The cost of the product is about $43 a day, which is less expensive than other elemental diets you can buy. For those looking to add a little variety to the product, you can add ice in a blender along with Physicians’ Elemental Diet to reach the coldest temperature possible, or pre-mix a pitcher and refrigerate in advance.
You will need to buy this product through your doctor and can bring this request form with you to help them purchase it.
Elemental Diet Dosage
An elemental diet needs to last 2-3 weeks to be effective. With Vivonex Plus, you use 6 packets per day (you can double them up and take 2 packets, 3 times a day or take the 6 packets separately, as you wish), which comes out to 1800 calories per day. With the homemade elemental, the dosage is 3x per day, which comes out to about 2000 calories.
Keep in mind you don’t have to take the formula 3x or 6x per day. You really have a lot of flexibility with how you take it. For example, while doing the Vivonex elemental formula, there were days when I just laid around in bed and rested. I didn’t need a full 1800 calories during those days, so I took 5 or sometimes even just 4 drinks per day.
For the dosing of the Physician’s Elemental, they recommend you work with your healthcare practitioner to determine your daily caloric need. Once that caloric intake is determined, you can simply thoroughly mix each level scoop needed (36 g) in 4-8 oz. (118 – 236 mL) of chilled or room temperature water. They recommend drinking it within a 15 to 60 minutes window. Once mixed, after 60 minutes refrigerate any leftover formula for a maximum of 24 hours, then shake or stir before drinking.
Consult with your doc to see what is best for you!
Retesting After Elemental Diet
After completing the Elemental Diet, you need to wait at least 4 days before retesting. This gives things time to settle down – but don’t wait more than 2 weeks or you might not get accurate results. The idea is for the test to tell you how effective the treatment was, even if some mild re-feeding happens when you start reintroducing food again.
On my first round, I retested after 4 days. On my second round, I did it at 2 weeks after because it also coincided with the retesting schedule of the herbal antibiotics I took simultaneously with elemental. (Retesting after antibiotics requires a 2 week waiting period).
UPDATE:
Good news! There are now SIBO breath tests that you can order directly without a doctor’s order! While I’m a HUGE fan of having a doctor’s guidance, I understand the need to know whether you have SIBO or not before you invest in a practitioner.
You can order the test directly and it will be sent to your home with instructions on how to take it and how to send it back and get your results!
My Personal Experience with the Elemental Diet
Before doing the first round of elemental diet, I was both excited and scared. Excited at the thought that this would be the quickest way to get results (it was). Scared because I’d heard stories of people not being able to make it past day 4 because they felt so terrible.
Because my case was so severe, I did Elemental for 17.5 days the first round. I hoped the extra days would mean I would never have to do this again. Close, but not quite. The results from my next breath test were better, but I still had work to do. So I didn’t another round of Elemental, this time using the homemade formula and for 13.5 days.
Important! I also took herbal antibiotics and a prokinetic while doing the second round of elemental. I talk about the importance of prokinetics for treating SIBO later on in this series as well as in my ebook, The SIBO Solution.
How I Felt While on Elemental Diet
Vivonex Plus (Round 1):
I started on a Monday (isn’t that how diets are supposed to roll? 😉 and I was armed with my drinks made up for the following day, plenty of ice in the freezer to pour them over and, aside from loads of movies to watch, an almost blank to-do list. I also started a diary on Evernote to keep track of how I felt.
I was worried when day 4 rolled around since I had heard that days 4-8 were the worst in regards to bacterial die-off. But, for me, it was actually days 8-12 that were the worst, probably because my case was so severe. During those days, I had diarrhea and terrible bloating and cramping. I relied on detox protocols during this time (especially Epsom salt baths and castor oil packs) to help me through.
Symptoms throughout:
I had headaches which started pretty much on day 1. It might not have been related to SIBO but to the corn and soy ingredients which I don’t react well to. I also often felt itchy and had lots of phlegm. Again, it could have been the ingredients. My breath was terrible and there was some moderate body odor, which is unusual when I’m eating a clean diet. There was some cramping and insane amounts of burping – even in the middle of the night! The bloating was so bad that I looked like was 6-8 months pregnant, depending on the time of day. It was interesting to see this after 10 days of not eating! Clearly, the party in my gut was starting to get disrupted. And one more weird side effect: my teeth started to hurt.
My energy levels were okay for the first few days and then I started to feel lethargic. It could have been the bacterial die-off, but I think inadvertently I wasn’t consuming enough calories because I hated the taste of the drinks so much that I was limiting them to just enough to keep me alive. If I had to do Vivonex Plus again, I’d add some high quality oil like olive oil to sip in addition to the drinks since their profile is pretty low fat.
Here is a post from my diary (Day 11):
The brain fog is unreal. My writing looks dyslexic. And I’m not trying to be funny. Simple math in my head seems impossible. And finding words is very difficult. It’s like my mom when she’s trying to speak English except it happens to me in both languages and at any time of day even after a good night’s sleep. It’s like the synapses just aren’t happening.
How I Felt After Vivonex:
The truth is I was expecting to feel instantly better the minute I got off elemental. I mean, that’s as low as my breath test results would ever be, I wasn’t eating anything for pete’s sake! But, the truth is, although I felt instantly better just having some real food (albeit sticking to very simple, bland things like ground beef and small amounts of cooked vegetables), the SIBO symptoms were not immediately completely gone. Both times my body was a bit shocked and confused to be eating again and digestion seemed slow. I was also a bit scared to eat which may seem silly but I’m just trying to be honest.
Results:
Homemade Elemental (Round 2)
The second round of elemental was much easier. This is most likely because I had made a ton of progress on the first round so there was less die-off and thus fewer symptoms. However, it was still emotionally tough to feel deprived of food. I noticed that, while again I didn’t have life-changing nirvana immediately after finishing, each day that went by after completing elemental I felt better. I was more energized and less bloated. It was like the healing was still happening even though I wasn’t doing anything for it anymore. Sort of like when you step off a treadmill and your heart is still pounding and sweating for quite a bit longer.
Results:
On a Personal Note…
The whole experience was a like a flashback to my “dieting” days. Yes, it made me feel deprived at times. An interesting thing though is that I found Elemental easier than those weight loss diets I used to do. For some reason, it was easier to swear off all food completely than the superhuman willpower it takes to have “just one” bite of cake.
Elemental also had an unexpected benefit for me. As a mom and business owner, I don’t get too much down time and I have to manage a lot of things. It was great to be able to ask my husband and older daughter to pick up some of the slack for a couple of weeks so I could focus on resting. Plus, I hired a housekeeper to help out as well. I didn’t deal with cooking or grocery shopping (which would have been torture while not eating!), so this freed up a lot of time which I could use to focus on relaxing and de-stressing. Again, stress is the biggest cause of SIBO!
My Advice for Elemental Diet:
1. Get Support!
Without the help that I had during both rounds of element, I guarantee I wouldn’t have made it through it. And I don’t just mean help around the house, with the kids, or time off work. I also mean emotional support. The toughest times for me were evenings and weekends, during my family’s meal times. I stayed in my bedroom, turned on my essential oil diffuser so I wouldn’t smell the delicious food or I took an Epsom salt bath. Having my husband to talk me off the ledge when I could have to killed someone for a piece of chicken was incredibly helpful. He offered to bring me tea and took the kids out for dinner a few times so I wouldn’t smell food.
2. Get Time Off Work
Ideally take 2 weeks off and make it your full time job to get well. If you have limited time off, try to schedule it to start after day 4 since that’s when it starts to get difficult, emotionally and also with die-off symptoms
3. Clothing
Do yourself a favor and forget jeans or anything restrictive in the waist. Yoga pants are your friend. I lived in maxi dresses, yoga pants with long shirts and pajamas.
4. Go Easy with Food when Coming Off Elemental
Your body will be in a for a big shock when you suddenly start eating again, so take it easy on the food front. Stick to small portions of well-cooked, simple food for the first few days. Might sound boring but after not eating for a couple of weeks a few bites of ground beef will sound like a holiday feast.
5. Managing Symptoms and Food Cravings
Diffuse peppermint essential oil in the room; it helps with gas (don’t ask me why!) and also helps you not go berserk when you smell the food your family is eating in the other room. A hot water bottle on your belly (bonus points for castor oil pack) helps reduce nausea and belly pains, as does ginger tea. Use visceral manipulation (just massage your abdomen, even if you don’t know exactly what you’re doing) to help things get moving along.
6. The Gross Film on Your Teeth
The elemental diet (especially Vivonex Plus) leaves this weird gross film on your teeth. Brushing with baking soda and a couple drops of Orawellness was the easiest way to handle this. Also, try oil pulling for the teeth pain.
7. Make the time pass
During the first round of elemental, I had a pity party for myself and the 17 1/2 days seemed like an eternity. During the second round, I tried to keep busy by writing, working, and organizing my files and photos (all mostly from my bed) and the time went by a lot quicker.
If you’re in the middle of your elemental diet as you’re reading this, just remember time doesn’t stand still, although it can sometimes feel that way. You’re making progress every single day, getting closer to the end of your treatment, and the end of your SIBO journey. Hang in there.
Ready to eliminate SIBO once and for all? Get your copy of The SIBO Solution: Your Comprehensive Guide to Eliminating Small Intestinal Bacterial Overgrowth by clicking HERE. You’ll also receive a BONUS SIBO Detox Support Guide mini ebook with your purchase.
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Hi Sylvie! 🙂 Thanks so much for providing this info for us, ESPECIALLY the links to purchase the products to make our own, ummm, formula, hehehe. I wrote a lengthy, 2 paragraph, note with a question buried in there too but I guess it didn’t go through. Maybe because I didn’t log in first? So I’ll skip the “about me” part and just go with the question right off the bat here.
So with the die off of our critter/organism friends inside us and all the toxins they no doubt release back into our bloodstream, is there a protocol, or more specifically, a product that we should add to this regimen for our liver? Seems like our little liver buddy may get a bit overwhelmed if we send too much stuff his way, lol.
I should mention I am currently doing 1 coffee enema per day so I am not sure if that is enough support for our liver friend? Unless I missed something I don’t THINK you’re a Doctor, so, I am just looking for an “experience” type of advice for what might be a good plan for this. I have not done a specific liver cleansing of any sort … that I KNOW of.
Thanks,
Lee
Hi Sylvie. Thank you SO much for leaving this blog/info up for us all to utilize. Seems it’s been up here for a few years now so I don’t know if you’re even still around to reply. Anyway, let me tell you a bit about me.
I am a 48-year-old male with a belly full of parasites … AT LEAST! I know I have them because I see them left behind when I do my regular coffee enemas… for the past TWO YEARS!! I have constant bloating. I used to be able to eat an entire large pizza by myself. Like a REAL large pizza from a Sal’s pizza not a chain large pizza like Pizza Hut, hehehe.
Now? I feel like I have a Thanksgiving feast (3 helpings of everything) when I consume something the size of an apple! It’s not frustrating because I WANT to eat a whole pizza by myself anymore, no, at my age, believe me, I appreciate making a $12 pizza last for 2 or 3 meals to save that money, haha! No, it’s the FEELING of being bloated and I can’t seem to “enjoy” the food I eat anymore. *sigh*
So I just purchased all the items needed for the home-made version of the Elemental Diet that I will attempt. I have been juicing for the better part of the last 4 years and have done JUST juice for food consumption for 28 days previously, had no problems ever with that so I don’t anticipate having any with this either. I am looking to likely start this right after Thanksgiving … obvious reasons, lol.
Here’s what I am wondering…
I have your blog with the instructions to make and then take the shakes from the home-made version. This is great. One thing I DON’T see on here is something, ANYTHING about a cleanse for the liver while this is going on. I can only imagine that there must be toxins being released BACK into the bloodstream from the die off of the parasites and bacteria inside us. Is there a protocol for our poor living having to endure all this toxin release we will likely experience? A liver cleanse per se or maybe continuing my daily coffee enemas will be sufficient?
I know you’re not (likely) a Doctor so I am not going to hold YOU accountable for MY choices with which way to go on this. For example if you don’t even respond, as I anticipate, I will simply continue with my daily coffee enemas. I would prefer, however, that if there has been a proven better option for us to go with that may even be MORE effective for the liver cleansing, I’d do that instead. I am just looking for other options that have been tried and proven, even if seemingly, to work better.
Thanks again for all advice,
Lee
My take, I’m also not a doctor, but… if you have parasites… go on an anti-microbial or antibiotic. Coffee enemas or elemental will do nothing for it. They feed of your body, not the food you eat. You can always ask Dr. Ruscio or anyone else who have a good reputation what you should do, but to me it seems clear cut you have to go in hard. Bacterial overgrowth, elemental is a miracle. Parasites, don’t think it’ll do much if anything. Just my 2 cents. Best of luck.
Hi,
My naturopathic doc wants me to get on a 3 week Elemental diet regime. My BMI indicates I should consume 2100 calories a day. I want to know is it possible to consume 2100 calories with the physician Elemental diet and maintain my current weight. I lost 20 lbs over 6 months and regained 10. I have had methane dominant SIBO for almost 2 years. While on the journey to get cured had several rounds of pharmaceutical antibiotics and one round of herbals (adp, dysbiocide and berberine)that did bring numbers down. Also, some docs subscribe to taking herbal antibiotics and probiotic while on diet other suggest taking them after finishing the diet. Is there a correct way? What dosages of the herbals you identified in the article? Desperately seeking answers, tired and losing hope
Thank you
Theo
Hi,
I was diagnosed with SIBO almost 2 years ago. My naturopathic doc wants to put me on Elemental diet for 3 weeks. I am want to do but concern about weight loss. I lost 20 pounds but managed to regain 10 pounds. Based on my BMI I should consume 2000 calories per day. As long as I consume 2000 calories worth of the Elemental diet should I be ok? Desperately seeking answers
Thank you
Theo
Thank’s so much for this wealth of information! I’ve been rereading pieces for months now in preparation for the homemade ED. I’m just wondering, did you think the crystal light, tea or anything else to that extent had an effect on the process? Based on the (little) reading I’ve been able to do, I’ve decided to keep coffee on the table, using it to get the oil into my system. I’m also having tea with some honey (an ingredient in Dr. Siebeckers recipe), thanks to a cold that popped up on day one of my ED. Any feedback is great, appreciate all your shared!
Hi Sylvie. I m planning ordering the same herbal antimicrobial regimen that you used. Am i meant to use all three of them(Berberine, Allicin, and Neem) together?
Sylvie- I’ve had SIBO for 3 years, mine never went away with multiple rounds of antibiotics. It actually moved to my vaginal area as well, requiring 6 rounds of antibiotics last year. My Naturopath does not use the breath tests, only a stool study that shows her which bacteria are in abundance. I don’t doubt the diagnosis because of how sick I’ve been but rather what do you recommend for follow up testing? I’m currently on day 9 of the Elemental Diet & hope to complete at least 15 days, it’s been tough not being able to work.
Hi,
I was wondering how much weight you lost during your first and second round. I’m a pretty slim guy as it is so I’m worried about looking too sickly even if I take the full recommended dosage of the diet. Not that this will deter me but it I just want to be prepared.
2000 cal a day is not a low calorie diet for an average human. No running mafathons or bodybuilding and you’ll be ok.
Hi Sylvie,
Just wondered why it is recommended that the amino acids for elemental should be MSM free? I can only find positive benefits online including good for leaky gut.
I ask this as when I checked the ingredients listed on the link for jo mar labs 21 blend (which no longer works by the way) it does contain MSM, unlike the BLACK LABEL 21 blend, as recommended by Dr. Siebecker from siboinfo.com.
It seems to be the only difference in ingredients between the two blends, at a considerable cost increase too I notice……any thoughts any one?
Kind regards
Helen J
Eating 2000 calories a day may be more than you eat now if you are a thin person. 2000 calories isnt a low calorie diet.
My doctor just called and told me my SIBO test is positive, so I’ll be meeting with her next week to come up with a plan of action. Thank you for this great information.
I do have a question. Have you ever heard of a link between SIBO and recurring urinary tract infections? For the past 7 months I’ve been on a roller coaster of having a uti, clearing it up, only to have it return 1-2 weeks later. We’ve tried natural solutions, but eventually I end up on another antibiotic. The hope is that treating my SIBO will help the uti as well. What are your thoughts?
Thanks for all your work. One question I got 🙂
Why is nobody ( Siebecker, etc.) recommending to put the amino acids into gelatin capsules? This way the diet wouldn’t taste so bad. What’s even more confusing. You are recommending to empty out the multi vitamins capsules. Why is that?
Gelatin is made of proteins. The point of the elemental diet is that you are eating proteins which have already been broken down into amino acids. Siebecker actually recommends those vitamins because you *can* dump them out so you don’t get the proteins in the gel caps.
Hi Sylvie,
Can u recommend an alternative to the jomar lab amino acids please, they are no longer available through amazon and I live in the uk.
Many thanks
Hells
Ps you’re website is the best, so clear and concise, you take all the hard work out for us sufferers…thank you!
Hi Sylvie,
Could you recommend an alternative equivalent to the jo mar amino acids as you’re link to Amazon’s is no longer available and I live in the uk…the vast choice of available products is mind boggling and I don’t trust myself to get it right ????
Hi Sylvie,
My question is why is the Nutrient 950 product you suggest without iron? Is getting iron a problem on ED? Or could Nutrient 950 with iron be substituted? My energy levels are massively impacted when I don’t have enough iron, plus SIBO has made me so anemic my white blood cell count is in the tank. Thanks. Appreciate all that I am learning from you.
Also, the amino acid link you use is no longer available. Just FYI. 🙂
I am going to be starting my first elemental diet with the Integrative Therapeutics formula in January. I am curious as to what else I can add, such as teas, oils, etc. (I’m worried about caffeine headaches!). Also, what is the best way to transition to eating again? I plan on doing the SCD from phase 1, but I am wondering if that might still be too hard to digest with the meat.
Hi Sylvie,
First of all, thank you for taking the time to write The SIBO Solution. It has proven to be very helpful and informative. I am currently 1 week into the homemade version of the Elemental Diet and it’s going mostly fine thus far. However, I would just like some clarification as to how I should determine whether the High Carb / Low Fat or Low Carb / High Fat option is better for me.
Thanks,
Joel
Hi Joel,
You’re welcome! As far as whether high(er) carb/ low(er) fat or viceversa, I would try to replicate what has been working for you in terms of your regular diet. Since you’re doing the homemade version you have a bit of wiggle room to tweak one way or the other.
Hope that helps,
Sylvie
Whats your thoughts on fermented/cultured foods. Kefir/kombucher…. Have u considered doing an updated/faq chapter to ur book?
Hi Sylvie,
Great info. I’m currently on the ED, I know you mentioned when you finished your second round of ED you didn’t feel symptoms free right away, how long did it take to be symptoms free after the Ed?
Hi Jay, It’s been a few years so I barely remember but I wrote about it at length in The SIBO Solution (thesiboebook.com). It was more of a gradual subsiding of symptoms than an overnight relief. I felt a little bit better each day and off the top of my head I think it took a few weeks. Hope that helps!
Hi Sylvia… I have ur ebook and so appreciative of it. How long after eere u strict with the diet. Are u able to relax it noe symptom free?
Hi and thank you for the very helpful information provided in this post. I am doing the elemental diet (on day 8 now) and would be very pleased if I could drink at least some herbal teas in addition to water and the ´liquid meals´. Unfortunately, I have not been able to find information on the possibility of drinking herbal teas (ginger for instance) while on the elemental diet. I would really appreciate it if someone could provide this info. Thanks in advance!
Hi Sylvie, thanks for responding to my comment. Seeing as I’ve had SIBO for 2.5 years, I know when it’s gone and it definitely isn’t but I’m now on Day 21 and actually feeling a bit better. It’s mad to think I’ve not eaten for 3 weeks yet my stomach is still bloated. I’m hoping it might go down once I start eating again like it did for you. I am working with a practitioner and seeing him next week so hopefully will get something out of him. I saw another blog that mentioned most people do the elemental diet for 6 weeks or until it dies off. Mad really!
Hi Annie, I highly recommend you retest. Even if it’s not entirely gone knowing how much progress you’ve made is going to help you and your doc make decisions as to how to move forward.
Wishing you all the best!
Hi there, I’m currently on Day 16 of the Physician’s Elemental Diet and I realised around Day 11 that it actually wasn’t working which is heart breaking. My stomach is still swollen, painful and incredibly bloated. I was told to do the diet for 14 days but I think I have a good week’s worth extra so I thinking just to carry it on with the hope that it dies off. I have had symptoms since day 2 such as the shakes, nearly passing out, very bad stomach cramps, diarrhoea etc but I know the SIBO is still there. What would you recommend I do from here? I’m at a loss with how to eat again as I know it will just make it worse 🙁 This SIBO has made me feel like a prisoner in my own body!
Sorry to hear Annie. I know that formula is only available through a practitioner, so I’m guessing you are working with one? What have they suggested? Have you retested? How do you know it “isn’t working”?
Saw many doctor previously they all were clueless about my chronic gas problem it was so awful, Saw alternative medicine doctor he had me do the test had both methane hydrogen. First did the antibiotic nothing happened, I did the diet for one year it helped some, but still problems . Finally did Elemental and it was the cure . No reason to suffer just do it .
Glad to hear it worked for you, Greystone 🙂
It sounds like your just starving yourself! How is this healthy? Im already underweight from this SIBO I cant lose more weight.
If you’re underweight you’ll definitely want to check with your doctor since Elemental might not be right for you. The idea is to starve the bugs while NOT starving yourself 🙂
Hi Sylvie! I wrote you a couple weeks ago about testing and you, so graciously responded, thank you! I tested positive for Sibo and started the elemental diet today. I am feeling week and hungry and am wondering if I should add more calories per day or would this reduce the effectiveness of treatment? Or are these just the symptoms I’m to expect on the first day? Your insight would be much appreciated! Thank you!
Rachel
Hi Rachel,
I’d run it by your doc but my guess is that you’re likely eating less calories on elemental (or perhaps less fat) than you’re used to. Increasing the calories shouldn’t affect effectiveness but never hurts to double check with your doc.
Hang in there, lady! It’s not necessarily fun but if it kicks this thing to the curb for you it’ll be worth it.
Best,
Sylvie
Hi, Sylvie, you mention re-testing after day 4 following ED. I would like to re-test immediately, stay on ED until I find out results and then stay on the ED if I am still positive, and keep going. Dr. Siebecker’s presentation seems to say that people do this. Is there a reason not to take this approach?
Hi David,
I simply followed the guidelines that the lab suggested. I suppose you could do that although I’m guessing you would retest again after completing the elemental? The good news is you can order your own tests now- info here: https://hollywoodhomestead.com/breath-tests/
If you’re an overachiever I say go for it. But if you want to keep the testing to a minimum a before and after should do.
Hope that helps,
Sylvie
Hi Sylvie,
I haven’t been tested but am thinking of doing the elemental diet because I have all of the symptoms and don’t want to waste time/money/recovery time (since anything different that I ingest gives me terrible symptoms lasting around 6weeks – 2 months). I know you have said that testing is a good idea but I would love to skip this step if it means less recovery time. I know the commitment that the elemental diet is and am fully miserable enough and ready;)! So I guess my questions are:
1. Would you still suggest testing?
2. If/when I do the elemental diet, is it possible to substitute a simple carb, like rice powder, instead of dextrose or any sugary substance? Like I alluded to above, I have extreme symptoms when I eat anything besides the same meal that I eat every day and have an especially bad reaction to sweet things.
Thanks so much for all you do!
Rachel
Hi Rachel,
You made me laugh with the “I’m fully miserable enough and ready” comment. Lol.
I completely understand the situation. I spend several thousand dollars on my SIBO treatment from start to finish. Some of it, very well spent and some of it a complete waste…
As for testing, yes, I think you should test before you treat (here’s a test you can order directly to your home without a doc: https://hollywoodhomestead.com/sibo-breath-test-3 )
And I think you should test again after. Why?
Your symptoms might be deceiving sometimes. You might feel like “you got zero results” when indeed the lab tests might show you that you went from “severe” to “moderate” or moderate or almost zero.
Without a GPS/ Sat Nav it’s really hard to course correct and figure out what step to take next.
I trust that your symptoms and your intuition are telling you that you’re SIBO positive but that still doesn’t tell you if you’re methane or hydrogen dominant, how bad it is, etc.
As far as the carb replacement for elemental. You can absolutely try a different carb that you think you’ll tolerate better but I wouldn’t skip it entirely. I know it seems counterintuitive since that’s sort of “feeding” the bacteria but the bottom line is we need *some* carbohydrates regardless.
Hope that helps!
We don’t really need any carbs. I was actually kind of shocked that 35 g per meal is considered “low”. Your body will make whatever glucose it absolutely needs for the brain or whatever via gluconeogenesis.
Thanks for your great posts. I am about to start the elemental diet. My methane is 256ppm so very entrenched. I’m assuming three weeks will be required as well as using herbal antibiotics too? I am scared not of the process but the result. I have nowhere else to go if this doesn’t work. I am chronically relapsing so the ED is it for me from here. I look forward to your response.
Hi Sylvie, I’ve been watching many of the videos for the SIBO Summit, including yours, and I found your explanation to be helpful regarding the elemental diet. I want to take the breath test and have a GI doctor appt set up, but I have not been diagnosed. I have a strong suspicion since Ive been going through years of figuring out what I can’t and can tolerate. I definitely have fat malabsorption and likely fructose. For the homemade diet, I would I assume I’d need to do the higher carb in my circumstance? Also, I exercise 3-4 times a week; I lift weights and do some cardio. Is this off limits during an elemental diet or could I just make sure I get enough calories? It makes me uncomfortable to think of stopping my workout routine for this long, as this helps a lot with my mental health just as much as physical. 🙂
Thanks for your help!
Hi Jessica,
Glad you’re liking the vids! Of course, it would be best to run it by your doc and testing to get a few of those hunches you have confirmed would be ideal. As far as exercising while on elemental, it’s not contraindicated per se, so if you can handle it, go for it. I would recommend you tune into your body. My guess would be that as long as your calories and macros support it you’d probably feel fine on the first 4 days or so and then depending on what die off looks like for you, you might want to take it easy for a few days while your body has enough work to do to clean house…
But as with everything it’s highly individual. With the right guidance and tuning into your body you’ll do great.
I’ll be emailing about a joint webinar I’m doing soon with a SIBO doc so make sure you’re on my email list – I think you’ll like it.
Cheers,
Sylvie
Dear Sylvie,
I have methane high SIBO. I just finished my third round of misc antibiotics and started low dose erythromycin, plus I have been on a low FODMAPS/Paleo diet for nearly a year with positively ZERO results. It is time to take more aggressive steps! Your series here has been helpful but I am hoping you can please clarify what you took prior, during and after your elemental diet? And in what doses/when throughout the day etc. Herbal antibiotics, bio film disruptors and motility agents – are these all consumed at the same time as the elemental diet?? Since I am already on erythromycin is it advisable to do the elemental diet now or do I need to start from the beginning with a clean slate? Any insight you have would be greatly appreciated, Thank You.
Hi Sylvie,
Thanks for sharing your experience, and for this highly informative article series.
I have also been suffering from SIBO for the past three years, and my symptoms are fibromyalgia, joint pain, depression, constant loose stools, eye inflammation (epi/scleritis) and the most significant, embarrassing and never-ending smelly hot flatulence (more than 100 times a day!). I had colonoscopy, endoscopy, countless biopsies etc. which showed nothing. I live in Europe, and the gastroenterologists here seem to even not know anything about SIBO, or the seriousness of it at all…
Anyways, I am currently on the 7th day of my elemental diet, and started feeling energetic actually right after the 2nd day. I will be introducing oregano oil and biofilm disruptor (interfase) on the coming days. I am also thinking of doing cleansing using picoprep at the end of the diet, because I felt so good after my colonoscopy due to the intestinal cleansing beforehand, and I was symptom-free for 4 days. Hence, I think it kind of meddles with the bacteria and the biofilm thereof.
I just have one question, and I would be happy if you can give me an idea. I currently have Iberogast at hand, and actually have been thinking of using it during the diet -in order to increase motility, as you would know-. Nevertheless, I am not sure. What do you think?
Thanks!
Dear Sylvie,
How can elemental diet work when its main source of carbs is maltodextrin – it is even worse than sucrose – https://en.wikipedia.org/wiki/Maltodextrin – it is in most elementa diet formulas – they dont have glucose they have maltodextrin
I have a question on the ingredients, I have horrible reactions to corn and soy, I get blisters and burning in my throat along with sinus issues, are there any other alternatives for the elemental diet?
Shawn I would do the homemade version mentioned above and perhaps use honey as an alternative to dextrose for the carbohydrate. There are other elemental diets on the market but they can only be purchased through doctors, not directly. I’m not sure what the ingredients are on those.
sylvie please please answer me …amino acid that used on homemade elemental diet should be diary free or not necessary?
hi sylvie again …Does amino acid we use with elemental diet must be dairy free? I don’t have access to the brand “jo mar labs” you mentioned before that I’m not sure I can have the jo mar labs, so you think I can use amino supplements that have these amino acids ( free from sugar, salt, starch, yeast, wheat, gluten, corn, egg, shellfish or preservatives) but not dairy free? like amino supplement from “now” company? or it must be dairy free too?
please answer my question. this is very important .
hello dear sylvie, I have a question from you, what diet did you had when you start round one of rifaximin? I have’nt found any Information about it, If you had not any diet in round one, why u didn’t elemental diet with rifaximin but you did have ED with herbal antibiotics, Don’t you think If you use antibiotics with elemental diet yo would have get better result? about Dr.pimental presume, I think you are disagree with the sentence ” we should feed bacteria when we using antibiotics.” But it’s clear you have done both path. In round 1 You have give the bacteria food but In round 3 you gave them starving, don’t you think it is a paradox?
tnx
Hi Ali, Great question…
On round one of rifaximin I really had no idea what I was doing and just took the antibiotics and continued on my regular diet which at the time was probably 90% grain free, 100% gluten free but certainly not low fodmap or SCD compliant. I later learned that with my lab tests pre-rifaximin it would have taken FOUR courses to get rid of my SIBO so if I had to re-do it and if I understood the severity of my case, I probably would have gone straight to elemental or elemental + herbals or several rounds of herbals (I had a full time day job at the time so I’m not sure how I would have coped with elemental).
As for Dr Pimentel’s point, I wrote about it in my book published almost 2 years ago but in short, I don’t know. I followed my doctor’s recommendations at the time (Dr Siebecker) to not feed the bacteria while treating. But the truth is that we’re never really entirely starving them either. Because almost all the treatments and diets have at least some ingredient that feeds the bacteria, whether that’s a pre-biotic in a supplement, a certain carbohydrate in the elemental or vegetables in our diet that might be “low” fodmap but are certainly not “no” fodmap, know what I mean?
So, I think that it would be really interesting to see a study done on that some day so we can know which course of action would be better/ faster, BUT in the meantime I think if we’re treating as best we can and RETESTING to see if our treatments are working/ how well they’re working, we’ll get there.
For me, when I got really serious about eliminating my SIBO once and for all and went all in with elemental and herbals as my main weapons I managed to eliminate it despite all the products used not being specifically designed for SIBO nor perfect.
Hope that helps and wishing you a negative test and no symptoms in the near future!
Thank you..so hopeful .Does amino acid we use with elemental diet must be dairy free? I don’t have access to the brand “jo mar labs” you mentioned before that I’m not sure I can have the drug, so you think I can use amino supplements that have these amino acids but not dairy free? like amino supplement from “now” company? or it must be dairy free?
I noticed that you mention taking antibiotics and prokinetics during your diet. I have a hard time with any of the natural prokinetics on the market as I have acid reflux (I’m sure from my SIBO) and the prokinetics all seem to set it off (it’s either the peppermint or the ginger). I’ve tried motilipro, iberogast and ginger. I’m allergic to erythromycin so cannot use that either. I’ve found a specific probiotic that has done wonders for my constipation (it does not contain any acidophilus, but does have the following: Bifidobacterium longum, Bifidobacterium bifidum, Bifidobacterium breve, Bifidobacteria infantis, Lactobacillus salivarius and Saccharomyces boulardii). Although it has helped to alleviate the constipation I still have other SIBO related symptoms still so I’m preparing to embark on the elimination phase. Would you recommend continuing the probiotic I am currently taking during the elimination phase in order to keep the constipation at bay? I will either be doing the elemental diet or the restricted diet/herbal antibiotic combo. Thanks!
I recommend stopping ALL probiotics during treatment. They are absolutely not a replacement for a prokinetic but of course you should check with your doctor as to what is the best solution for your particular case, especially since it seems most prokinetics are not an option for you. 🙁 Hope you feel better soon!
Hi silvie. I just recently started the physicians elemental diet (paleo version) and reading your posts have been very inspiring and assuring that I will get through this. I have a few questions though if you could please give me some of your expertise I would grately appreciate it!
First- I was never advised to take a prokenetic and work with a health coach not a doctor – if you could suggest a prokenetic to for – I am hydrogen dominant with my highest number being 34 at the 180 min mark…. I guess I have some range of constipation but I don’t usually. For the most part my stools range from soft and loose daily and then I can also experience some pebble like stools during those days or on there own days, so I don’t know if you’d call that c or D…I also have a stool test result of a “few” candida overgrowth – so I am wondering if I truly need the prokenetic and not against taking it just wanted to know if there was a natural one I could buy from a health food store or if i need a prescription and if so could please recommend some??
Also what herbal teas did you drink while on the elemental diet I would LOVE one but not sure which one I am allowed to have .. look forward to your response! Thank you!
What do you suggest to take for constipation while on the elemental diet?
Dear Sylvie,
What foods do you recommend eating during the first few days after the elemental diet?
Do you think it’s a good idea to keep drinking shakes while reintroducing foods? If so, which foods should be reintroduced first?
I have methane SIBO and want to go on an elemental diet and antibiotics.
Would it be smarter to go on the diet and then do a round of antibiotics right after?
Or would it make sense to do a round of antibiotics, then do the elemental diet?
Also I know to take a prokinetic but I’m really constipated.
Iberogast and Prucalopride don’t really help much.
I haven’t tried erythromycin and don’t know if it is going to work. I’m going to ask my doctor.
What should I do if I’m still really constipated on the elemental diet? Will it just pass with time?
Should I take ducolax or something to empty my bowels? I think it only empties the large intestine, not the small intestine.
Thank you.
I’m wondering the same as Louise. What was the length in between your first round of the Elemental Diet and second round?
Also, even though you went from an 80, to 38 after the first round. Did your symptoms improve as a result or not really? (after the1st round).
Would love to hear your response:) thank you.
Hi Sylvie! I was wondering how long you waited between the first round of elemental diet and the second round of elemental? I’m done with one round now but it has’nt helped as much, and I was wondering when I should start the next round. I hope you will answer. Thank you!
Thank you so much for sharing your story and very helpful knowledge. I was wondering if you have any information on the stuff my nutritionist put me on. It is an elemental diet from Integrative Therapeutics called Physicians’ Elemental Diet. It is less expensive, hypoallergenic and tastes like butterscotch.
Hi Julene,
I have no personal experience with it but have heard good things. Would love to hear back from you after you’ve retested to see how it worked for you.
🙂
Sylvie McCracken, What type of prokinetic did you take? I have MotilPro at home but have not noticed any difference, and it burns my stomach. I also can’t get a script from my doctor.
Hi Sylvie,
Today is my last day of the elemental diet (I was told to do 14 days). I have another days’ worth of Vivonex left, so I could continue which is where my question comes in. I haven’t had that many terrible symptoms during the diet, no cramps, just a lot of “rumbling” in my stomach after taking it and diarrhea but not too bad. Yesterday and today I have had more gas than I’ve had during the whole experience, though, so now I’m wondering if I should continue for another week as I’ve heard some people do… How should I be feeling on day 14 if everything went well? I’m sooooo ready to stop the diet, but don’t want to “mess it up” if staying on it longer would be better.
Let me know your thoughts, it’s very much appreciated! Thank you, Jalda
Hi Silvie. I have SIBO again (yuck!) Last time I did a combo of metronidazole and herbal antibiotics, but that didn’t work. I ended up curing it with an elemental diet. It was SOOOOOO gross! I hated it and choked it down every time. I made my own with amino acids and honey. So, this time I am going to use rifaximin. I have to order it through the Canadian pharmacy and it will take 2-3 weeks to get here. So after discussing it with my doc, I decided to do a modified elemental diet leading up to getting the rifaximin. I am going to use bone broth, collagen protein, d-ribose and probably a mix of fats (coconut oil, avocado oil, and maybe one other). Just curious what your thoughts are about it? Any reason you can think of that any of that stuff would not be a good idea? I do not have an issue with histamine. Thanks!
Sylvie
Thank you for all your time and information. I did elemental for 15 days but didn’t notice much for symptoms other than feeling sick on occasion and feeling tired. I was also taking Candibactin AR/BR along with herbs you mentioned. I noticed the nausea coincided with taking the Candibactin AR. Day 14 and 15 were the days I just didn’t feel well off and on throughout the day and then I stopped. Now that I am eating SIBO friendly/low FODMAP/ and avoiding foods from my ALCAT test I have noticed all the bloating is back after I eat. However, the day to day weight gain and continual bloat hasn’t been a problem (flat stomach in the morning now). But not eating starchy veggies or anything processed either. Should I have kept going and stopped to early just as it may have started die off, should I do another round? Your thoughts would be appreciated.
Hi Sylvie,
Thanks so much for your post which has guided me through my elemental diet this last month to deal with methane-predominant SIBO. In the UK, we don’t have Vivonex, so I took something called Elemental Extra 028 for 16 days which is quite similar.
I’m wondering how long it took following your second diet before all your symptoms went away? I have retested after finishing the diet and my methane levels have reduced down to on average 3 parts per million over the entirity of the breath test when previously they were 22 parts per million. So it’s clearly had a massively positive effect, but a week after, I am still experiencing some symptoms. Things are much, much better but my BMs are a strange shape (still some pellets) and I don’t feel quite right. Do you think this is likely to improve with time as the gut lining heals, or might it indicate additional work that’s required?
Many thanks
Peter.
Is it okay to have herbal tea while on the Elemental Diet? Thanks so much!
Hi Courtney,
Yes, as long as it doesn’t include any of the ingredients on the “no” list (here https://hollywoodhomestead.com/sibo-diet/ ) it shouldn’t be a problem.
I liked peppermint and ginger teas while on elemental. Kept me (relatively) sane. 😉
Hope that helps!
Sylvie
Hello,
Just diagnosed with SIBO and about to start antibiotics . Would it be a good idea to do 2 weeks of antibiotics and then 2 weeks of elemental diet right after? Or should I retest in the middle . I have been battling with Gi problems for years yet no doctor ever suggested testing me for SIBO. I was just going to do both . Has anyone ever tried that? Would I have better results?
Hi Sylvie,
I’ve been dealing with SIBO for a number of years now with fallout from the little buggers including other areas of my health (hypothyroid, low blood pressure, anemia, amenorrhea) along with the usual GI distress, constipation, food sensitivities, brain fog, fatigue, loss of focus and depression. Have been strict autoimmune paleo and GAPS (minus bone broths and fermented foods because I have issues with histamine) for the past year and have added low FODMAP in the past couple of months.
Finished round three of antibiotics (first time rifaximin + neomycin, second time herbals, third time metronidazole) a couple of weeks ago and for the first time am taking erythromycin post-treatment. However my symptoms are worst than they were before the antibiotic treatment and my histamine intolerance (which had improved with a year on the GAPS diet) has gone way down.
I’ve also recently taken up gargling and activating my gag reflex to try to improve my MMC and vagus nerve tone (see: Dr. Kharazzian’s recent work on this). Weird stuff, but I’m willing to try anything 🙂
All this background just to ask: how are you doing now? I love hearing SIBO success stories but find that the real sign of long-term success is not relapsing within 6 months to a year. And, of course, not having to rely on prokinetics long-term.
Also, thank you for sharing your journey, methods and results! They help so much in helping those of us dealing with SIBO ourselves find answers and possible solutions to this affliction! Cheers.
Hi Alex,
Yes I am still SIBO free. 🙂
You’re welcome! I’m glad you like the site.
Cheers,
Sylvie
Is it okay to put the amino acid powder in capsules? It tastes so bad I’d rather take it that way if possible.
I can’t see why not Robin! Although that would be quite a few capsules. I agree – it tastes absolutely awful. :/
Hello! Thank you for sharing your experiences, along with so much helpful information! I’m looking into the Vivonex Plus elemental diet for SIBO, and I’m wondering if you can help me to identify which food-related products are okay to mix with it, to enhance the flavor, if needed. I’ve read different things in different places. These are some of the things that I’ve read are approved to use, and I wanted to get your opinion on whether this is accurate: Crystal Light (I’ve never purchased it – Are there certain flavors that are approved for the SIBO elemental diet, vs. others that are not?); vanilla extract; stevia; also, possibly honey? Are these acceptable? Am I missing any? Are any drinks permitted outside of water? I think I read that it’s okay to have tea? (decaf or regular?).
If I’m not able to handle the plain Vivonex, I may try, at separate times, adding in each of the above (if they’re permitted), with the hopes of finding one that works for me.
Thank you so much for your advice!
Hi Mary,
Any crystal light, and small amounts of vanilla. I would stick to that. Technically, you should just do elemental and water but I did black coffee and various herbal teas without a problem.
Hope that helps!
Sylvie
Thank you, Sylvie! 🙂 I’ll have to see how it goes. I just bought your e-book last night, and I look forward to reading that as another resource. Did I read somewhere on your site that you have a coupon code for Vivonex purchases? I can’t seem to recall where that was…
Awesome Mary! No, the coupon is for Allimed. You can find that here: https://hollywoodhomestead.com/sibo-ebook-resources/
Hello Sylvie,
Thank you for documenting your experience! The only symptom I’ve had of SIBO was unbelievable distension that hasn’t gone away for 7 months. H breath test reached 70 by the 60 min mark, so they stopped it there. (Haven’t had the Methane.) I’ve done 2 courses of Rifaximin, and am on Day 15 of the homemade elemental- herbal antibiotics taken all the way through both protocols. I’m still not seeing much difference in the bloating, so will go through to Day 21. My question is- will my tongue go back to its normal state after this? It’s like it’s wearing a white/yellow sweater. Is this detox? What was your experience? Also, do you have any meal suggestions for the first few days aside from the ‘simple food’ advice? Can I have a giant bowl of SCD vegetables?
Thank you again for being an inspiring example.
Hi Autumn,
Sorry to hear about your discomfort. Have you been tested for candida? Did your tongue have this same coating before you started the protocol or only during?
As for recipes I have a whole cookbook section in my ebook, The SIBO Solution here: https://hollywoodhomestead.com/sibo-solution/
For the first few days I just did ground beef with a few well cooked vegetables. As boring as it sounds it felt like a feast after being on the elemental diet.
Hope you feel better soon,
Sylvie
Does everybody lose weight on the elemental diet? I am trying to get an idea of how much weight I might lose so I can decide if it is my best route. Also…I can’t take time away. I am a SAHM and my husband works around 60-70 hours a week. Will I be functional? I can’t tell by all the comments. Thank you so much. I have a doctor but truly need some outside input. Thank you so so much
So I did the Elemental Diet for 4 days (Dr. Siebecker’s homemade) just to see ‘test’ and see if it would be tolerable or do any damage. Well it has!! 🙁 I haven’t been able to have a bowel movement without laxatives since I did it 3 weeks ago. I’m concerned that I killed off ‘too much’ good bacteria while doing this! Does anyone know if this can happen?? I do have methane levels that spiked even in my stomach. Afraid that’s now taken over big-time. I also have yeast overgrowth in my GI and I took Nystatin while doing the elemental but the yeast seemed to get far worse afterwards despite that! I also went very very light on the honey. Anyone have any suggestions? I’m at a loss.
Hi Amy,
I would recommend you consult a specialist. I don’t think it’s as simple as “killing too much good bacteria”. If I had to guess, and I’m not a doc, you stopped right in the middle of die off.
It does usually get worse before it gets better (during elemental).
That said, and since you’re dealing with the SIBO/yeast combo, maybe it was good to discontinue.
I think it’s really time for 1:1 help with a doc.
Hope you feel better soon!
Sylvie
Hi Sylvie
I am just starting my first day of homemade elemental today after trying two courses of Rifaximin and low fodmap diet. I’m excited to start this process! I made my first batch this morning and noticed that the ingredients didn’t mix so well… some powder chunks separate from water even though I blended it forever- is that how it’s supposed to be? Just want to make sure I’m doing it right. And my other main concern is coffee– I think I might have some major withdrawals heading my way, so is even a cup of black coffee a no no? I also wanted to know your thoughts about using baby food as a reintroduction food? I’m traveling and working a lot so I’m trying to figure out the best way to make my introductory foods portable. Thank you for this website! I’m really excited to beat this thing!
Thanks!
Farah
Hi Farah,
Congrats on getting started with your healing! Yes, it’s normal for it to separate. I just mixed as I was drinking (quick mix – drink – quick mix – drink and so forth) and then added a bit of water to get the last bit that’s left at the bottom each time since that stuff isn’t cheap!
Black coffee should be fine. I did 1 cup a day of that and several cups of herbal tea.
I think baby food would be fine if you find ones that are on the yes list at the bottom of this post: https://hollywoodhomestead.com/sibo-diet/
That might be hard though but see what you can do. If you’re traveling something like canned salmon might be helpful.
Best to you,
Sylvie
Hi Sylvie. I have just started the elemental diet and following your advice and adding some herbal antibiotics. I have also downloaded your book for help. Could you please say some words about food reintroduction after coming off the elemental diet. What diet you followed after coming off the elemental diet? (Low fodmap SIBO) and how long? How quickly you introduced probiotics and what probiotics you used. Thanks. Peachy
Hi Peachy,
Congrats on getting started on your treatment!
I used the diet described in the ebook. It’s a combo of Low Fodmap + SCD + Paleo and I didn’t do it perfectly but as much as possible for the first few months. My reintroduction wasn’t super methodical. It was mostly based on “life” (i.e. if I happened to be at a restaurant and had onions or garlic in a dish). I would advise reintroducing slowly and try to do 1 at a time if you can just so you can pay attention and see what foods you’re ok with and which are still tricky for you. I waited months before reintroducing probiotics and I’ve only tried prescript assist brand on that front. So far so good. 🙂
Hope that helps!
Sylvie
I spoke with Dr. Sandberg-Lewis and wanted to tell everyone what he told me! He said I could use pea protein or whey if I wanted but there is no proof showing that these will result in lowering methane/hydrogen. This made sense – as I felt SUPER bloated and awful on the pea protein powder! Who knows if the SIBO was feeding off of it. I feel great after discontinuing it. Sandberg did say he has seen a couple of patients who have eatin’ either a 6 ounce steak or chicken every 4th day. Their levels still dropped after the full 3 weeks. I’m going to give this a shot!
That’s awesome, Amy! Thanks so much for sharing that advice. I’m sure it will be helpful for others who are struggling to not lose weight while on elemental. Would love to hear how the process works out for you! -Sylvie
I’ve had SIBO (IBS-C) for about 20 months now. I”m experimenting with a homemade elemental diet this weekend for 4-5 days. I’ve just come off my 2nd round of Neomycin/Rifaximin and I’m hoping a full elemental diet (2weeks+) will not be necessary. I will be getting retested soon (prolly a week after the elemental).
A few random notes I didn’t see discussed. My Methane numbers were only in the 20s – but after working with Dr. Melanie Keller and NCNM the numbers don’t always coincide with the symptoms. Even though my numbers were not high, my colon motility was nil. Why? for me, is that I have low stomach acid and a hiatal hernia. Dr. Keller said hiatal hernias are common with SIBO patients since the hydrogen/methane gas expands the small intestine (and colon) and pushes the stomach up. Getting a Heidelburg test is a good idea if your feel food is not digested that well. After taking HCL capsules my symptoms and motility did improve. Not normal by any stretch but good enough to get through my work day in only mild misery.
Other things.. I am taking low dose eythromycin at night… and I also have Iberogast that I take before and after meals. As Sylvie has stressed… MOTILITY IS KEY. Chewing food and not eating too much is helpful too. I usually space out my meals 5-6 hours with zero calories or snacking in between. Low FODMAP/SCD diet of course. It’s still about MOTILITY.. one GI Doc that I spoke with said that he neutralizes stomach acid in a ton of patients yet they rarely get SIBO. If you have solid motility (google: migrating motor complex) in your small intestine – bacteria have trouble setting up a permanent residence.
So, no matter what you do to rid the SIBO.. a prokinetic is absolutely positively necessary. I know i’m basically repeating myself, but it’s that important.
Back to the homemade elemental experiment….
I have JoMar Labs pure form 21 in 2 different forms.. capsules and powder.
Clover honey (not cloudy)
Olive Oil (get a good quality california olive oil) <-don't need to worry if it's tainted then
Coconut oil ( best is tropical traditions gold label)
KlaireLabs Vitaspectrum powder
Cod Liver oil ( lemon flavored nordic naturals)
salt – cinnamon – and alcohol free vanilla extract – lemons –
L Glutamine capsules and powder ( 5 grams at night, 5 in the morning)
Vital nutrients Betaine HCL , pepsin, Gentian root
apple cider vinegar
example 1 –
1 HCL capsule
40 JoMar labs capsules – 81 calories
cinnamon- 2 TBSP coconut oil- little bit of honey mixed together – 260 calories
eat a pinch of sea salt
1 TBSP of honey – 60 calories
Trick is I "eat" all of them separately. Drink water capsules first… mix the coconut oil-cinnamon-honey and consume.. then finish with the honey.
CALORIES: 401
wait 3 hours..
REPEAT with a little different setup
2 TBSP Amino acid powder and a little lemon juice or apple cider vinegar- drink fast in 8-10ounces water – 104 calories
2 TBSP Olive oil – i just pour a TBSP in a large spoon and take ( flavor is not bad at all) – 240calories
1 TBSP Cod Liver oil – 45 calories
eat a pinch of sea salt
1 TBSP honey – 60 calories
CALORIES: 449
Amino acids in powder form leave a mild unpleasant flavor even if you finish with honey. After an hour, I'll make some peppermint or ginger tea ..
wait 3 hours… I can do this 5-6 times a day… calories can range 2000-2500.
I think 3 hours is a good time for spacing out your liquid meals… your elemental formula should digest in the first hour and will give you small intestine's migrating motor complex time to do some housecleaning…
I am on day 4 and so far so good. I had a little bit of a headache an hour ago, but it resolved. I even had enough energy to work out a little bit this morning. I am coming off herbal ABs for a while, then Neo/Rifax combo so I should have very light die off symptoms (if any). I'm really doing this to give my digestive system a break… and test out the elemental diet just in case I have to do a 2 week stint. I started at dinner on Wed night after a successful hydrocolonic.
I have made some meat broth and I'll probably drink some tomorrow. Dr. Keller said to stay away from bone broth because it is too nutritious and has some properties that can feed the bacteria.
That's what I'm trying .. hope it helps someone 🙂
Thanks so much for sharing that Scott!
I don’t think we can stress prokinetics enough: it’s definitely one of the biggest mistakes I made with my first treatment- not taking them right away so thanks for adding that as well.
Best to you!
Sylvie
Thanks so much for your help and wealth of info! Did you also have candida issues? I have both (SIBO and candida). So hopeful elemtary diet will help make my system stronger!
Anytime! Not that I know of (I never tested for candida but didn’t have symptoms). I did start a candida protocol just in case and noticed no die off after 3 weeks on it so that was my very unscientific way of ruling it out 😉 Testing while living in the middle east has not been easy or cheap so that was my reasoning there. The SIBO and candida combo is quite common among my readers if you check out the comments on these 10 posts in the series (not to mention the emails from my SIBO ebook customers), so I may tackle writing about that later this year if there’s enough interest.
I don’t know that elemental diet will help make your system stronger per se but if it eliminates SIBO for you, THAT will definitely give your body a welcome sigh of relief. Hope it works for you!
Do vitamins have to be iron free? Thx!
Hi Nikki,
No they don’t HAVE to be and if you’re low in iron I would certainly recommend you do the ones that have iron with the blessing of your doc. I always struggle with excess iron having to to donate blood to deal with that so any chance I have to not increase the burden, I take it 🙂
Good question – thanks for asking!
Sylvie
Just realized honey was mentioned as a dextrose replacement in comments—sorry! Would manuka honey work?
glad you saw that- That’s kind of why I left honey out- because I feel like it gets complicated for people with all the different types of honey. At the end of this post https://hollywoodhomestead.com/sibo-diet/ I have a yes/no list for foods that are allowed on the SIBO diet (what you would eat once you’re done with Elemental) but it can also be referenced as far as lists of teas you can have during elemental and I suppose as a guide for the honey to use in elemental to a degree.
According to Dr Siebecker for elemental diet if using honey: “Clear honey should be used as it is easier to absorb-cloudy honey may have complex pollen proteins.”…
The only one I can tell you I’ve tried personally is clover honey.
Sorry that’s not exactly a yes or no answer. 🙂
Thanks so much for sharing! Great info! A couple of questions—did you also have candida issues? Why is dextrose in elemental diet? I know we need sugars, but is there a natural substitue?
I am on day 4 of the diet and started it with a cold. I was expecting to have no energy but actually have tons. However, I am suffering from cough attacks and wanted to know if I can use sugar free cough drops? Also, are you allowed to drink seltzer water with lemon or lime? Thanks for all your advice, Elizabeth
Hi Elizabeth,
Hmmm I wonder if the cold is part of the die off or just a coincidence. I guess it depends what the sweetener is in the cough drops but if you really need them, take them even if it slows your progress a bit. As for the seltzer with lemon and lime, technically no. Can you do a cup of herbal tea instead?
Hope that helps, Sylvie
Sylvie, I’m on day 4. Doing the low fat version of the home made elemental diet. Today I’m very light headed and sleepy. Is this normal? Should I plan on not working at all during the diet? Also – BMs are liquid – and orange, looks just like what I’m drinking.
Absolutely normal. Sounds like die off to me! If you can take the time off I think that would be best but I’ve had readers do it while working- one while working at a supermarket dealing with food all day! Diarrhea is a common die off symptom. Of course, you should check with your doc if you’re worried. If you have my ebook make sure to read the section on my experience as well as the Detox Support mini ebook that came with it. Hope that helps!
Thanks so much for the information–especially your comparison to the two different elemental diets–extremely helpful. I’m curious if during the second round when you took herbal antibiotics whether you emptied out the capsules, like the multivitamin, or swallowed the capsules whole. I wonder if that bit of digestion matters. Also, did you take probiotics while on the elemental diet, or immediately after? Thanks heaps.
You’re welcome, Sky! I didn’t empty the capsules- just swallowed them. I didn’t take probiotics during nor immediately after. I started them a few months after testing negative (#paranoia lol) What I did take immediately after is prokinetics and would highly recommend doing so.
Hope that helps!
Sylvie
firts day on my homemade elemental diet im using PURE ENCAPSULATIONS amino repler,BCAA,l-ARGANIN,L-GLUTAMIN, NUTRIENT 950, COCONUTOIL,HIMALAYANSALT, AND PURE NATURAL UNFILTERED BLACKBERRY HONEY.
Do you think this is all good ingridents?
and my question is i had an ide how to take the coconut oil and hone with the meal if pure cacao is allowed then i would make choklat and take that becousae just putting those ingrients toghter makes a great choklat, so is pure cacao powder allowed or the bacterias would have a feast?
thanks catrin
Hi Catrin,
Sounds like the only thing you changed was the amino acid. I’m not sure how that one compares to the Jomar labs but I do like that brand.
As for the cacao I would skip it for now and wait till you’re done with the diet to see how you do with that. You can mix your coconut oil into your tea.
Hope that helps,
Sylvie
Sylvie – thank you for all the great information! My question is about calories in the elemental diet. I am gearing up to start the Low Fat/High Carb Option — but my calculations are different than what you state in the article above. I come up with ~293 calories per meal. I used the nutritional information on the label of Jo Mar Labs Amino Acids. It states 6 calories per 1500mg. It also states 4.4 grams per tsp – or 4400mg per tsp. I come up with 123 calories in the amino acids, 128 calories in the honey, and ~42 calories in the fat. If this is correct – 3 meals would only be 879 calories. Can you tell me how you came up with 2000 calories per day with the homemade version? I’m hoping to lose some weight while killing out the SIBO — but I want to do it safely.
I found mistake – I was using 2 TB Honey when I should have been using 5.5 TB. This still only calculates to 1554 calories – but that is satisfactory. I plan on doing a lower calorie per day version – so will probably only do 2 drinks per day. 🙂
Glad you figured that out Tomi. Let us know how it works out!
I see you figured it out in the other comment 🙂
Hi, thanks for all the information. I have SIBO-C, numbers aren’t too high but driving me insane. I did one round of antibiotic but not a combo. It helped, but even without retesting I know I still have problems. I thought about doing the elemental diet, but I’m allergic to corn. Do you know anyone who has had success with the honey version of the elemental diet?
Hi JB,
Yes you can definitely do the honey version of the diet and yes I’ve heard from people that have had success with it. Best of luck to you. Would love to hear an update from you after your protocol!
Sylvie
Hi Brooke!
So glad it’s been helpful. Thanks so much for your comment. I would have him start the broth right after elemental. During elemental if would be good if his gut gets a little break between the drinks, taking prokinetics between “meals” and just sipping water or herbal tea (something that doesn’t need digesting) to give his MMC a chance to do it’s thing. For broth he might find he does better with the beef broth as discussed in the ebook.
Sending you and your husband my best!
Sylvie
Hi Sylvia, Thank you so much for posting all of this wonderful information. I bought your Sibo Solution book and I am just so thankful for all of the information that you have complied and shared. Your site has been by far one of the most educational that I have found to date on the subject of SIBO and Leaky Gut. My husband has had SIBO for quite a while but was just diagnosed in March, after doing some herbal antibiotcs his Hydrogen level went way down but his Methanye levels went way up. He also has Leaky gut syndrome, and has started to have symptoms of some auto immune diseases. We are starting the homemade elemental diet today, my question to you is, In your post about Leaky gut you mentioned Gellatin as a good healing agent, I was wondering do you think it would it be beneficial or permittable to have him also sip on Bone broth while he is on the elemental diet to help speed the healing of his gut?
Hi Brooke!
So glad it’s been helpful. Thanks so much for your comment. I would have him start the broth right after elemental. During elemental if would be good if his gut gets a little break between the drinks, taking prokinetics between “meals” and just sipping water or herbal tea (something that doesn’t need digesting) to give his MMC a chance to do it’s thing. For broth he might find he does better with the beef broth as discussed in the ebook.
Sending you and your husband my best!
Sylvie
Meg Davidson Sorry to hear that! 🙁 Did you retest and if so what were the results if you’d like to share? Specifically, I’m curious if you made progress but perhaps didn’t eradicate SIBO in your first round which was my experience since my levels were also sky high.
I think retesting is KEY.
Hope you feel better soon.
Sylvie
I hate to tell you this, but my experience since coming off the elemental diet has not been good and I would urge anyone considering it to do their homework carefully before they attempt it.
Despite having SIBO and various food sensitivities, before trying the elemental diet I felt pretty good on a diet that excluded the things I knew I was sensitive to. But that was nothing to how fantastic and energetic I felt two weeks into the elemental diet. I was over the moon. Not only did I remember what full health felt like but it was confirmation that a faulty digestive system was the reason I’d been ill.
But I’ve paid a high price for that brief respite. I was given little advice about how to reintroduce real food after three weeks on the elemental diet. I figured I would be okay with food that was ‘safe’ before. Not so. It seems I am more sensitive to amines than I was before. The flatulence that was the most troubling symptom of my SIBO (and then only when I ate FODMAPs) now occurs when I eat stuff that I could safely eat before. I’ve had it every day since reintroducing food. This morning I have stomach cramps and diarrhea, and I have no idea what set it off. Everything I ate yesterday and this morning was on my previous ‘safe’ list.
In despair a few days ago I emailed my dietician, saying I wanted to go back to the elemental diet. She advised against it, saying that there was evidence that the longer you stayed on it, the more likely it was that food sensitivities could worsen. How I wish she had warned me of that before.
There might yet be a good outcome. I certainly hope so. But right now I’m feeling pretty depressed about the whole business.
Hi Sylvie! What would you recommend after the elemental and for how long? Broth, fruit and veggie in low FOD? Also I did the elemental for 2 weeks and symptoms came back quick because maybe I didn’t ease into eating slowly again. Would you recommend elemental for one week again? Seems like you are more knowledgeable than my doctor about this! 🙂
Hi Melissa, the next post in this series is all about diet and you’ll find a Yes/No food list at the bottom: https://hollywoodhomestead.com/sibo-diet/
I have tons of recipes in The SIBO Solution that are SIBO compliant: https://hollywoodhomestead.com/sibo-solution/
But I think you’re spot on and you should do 1 more week as a quick reset before it gets too out of hand (as long as you’re not underweight). I would definitely retest after this next elemental though to see where you’re at!
Hope that helps!!
Wow! This is a lot of information to consume! I was recently diagnosed with SIBO and prior to this only scanned over information on health pod casts and websites about SIBO because it didn’t apply to me. My test results read totally hydrogen dominant, but my symptoms might say methane because of the constipation. It appears since I have adapted a more Fodmap/SCD diet over the last couple of weeks, the constipation has increased. I went to see a gastroenterologist today and he wants me to do Rifaximin/Neomycin and later Resolor, over Erythromyacin. I am a huge Chris Kresser fan and scheduled to see him but my finances are so limited I might have to cancel or reschedule. He appears to be so well informed and comprehensive in his approach to functional medicine and can handle the most difficult of cases (that would be me). I am contemplating doing the antibiotics regimen first, and then the herbals if it doesn’t resolve itself. I am so at a such a cross road bc I was saddled with an autoimmune illness that had me on and off life support for years, and now to have to encounter this is really disheartening. Question: I am experiencing muscle loss, hair loss, and pain in my buttocks, have you ever heard of this from anyone else diagnosed with SIBO?
Thank you,
Hi Antoinette,
Sorry to hear you’re dealing with SIBO. You could give the antibiotics a shot as per your doc (make sure to read my post on antibiotics in this series). Resolor over Erythromicin might be fine for you as well but I would stress that you definitely take a prokinetic (Resolor, Erythro… etc) immediately after treating and also that you retest 2 weeks later. If finances are limited I would suggest you see a SIBO specialist. I LOVE Chris Kresser and respect his work immensely but you can see a SIBO specialist via Skype from the SIBO center in Oregon for half the price. Book soon though because they get booked out for a while.
As for muscle loss and hair loss I would imagine you have some hormonal stuff going on in addition- have you had your thyroid checked? As for the pain in your buttocks that has me stumped.
I hope you find relief soon.
Sylvie
Wow, just read through all your articles. Could SIBO also contribute to group B strep urinary problems? I’ve been fighting them for 5 years. Antibiotics only help temporarily. I am also breastfeeding. Any tips to help and any research on group b strep in urine as relates to SIBO?
That’s a really interesting question Erica and the first time I’ve heard it! Unfortunately I truly don’t know. My instinct would be that they’re not related but I would recommend checking with a SIBO specialist if you suspect it. Trust your gut and get it checked out. If you’re breastfeeding that will be an important thing to note to your doc as it will likely affect what treatment they recommend. Sorry I can’t be more helpful. :/
Why do you need to add dextrose to the homemade elemental diet? It has carbs in it, wouldn’t that feed the bacteria?
Hi Timmy,
We need *some* carbs and that’s one of the ones that is safe for SIBO. You could also use certain types of honey like clover. Even the Vivonex formula which has carbs that are technically NOT safe for SIBO like corn products works. It is possible that it does feed the bacteria a bit which would slow down the die off but it’s still mostly starving it. Does that make sense? My guess would be that if we compared the vivonex and the homemade that the die off would be faster with the homemade.
Hope that helps!
Sylvie
Thanks Sylvie! What prokinetic did you use?
Here you go Melissa- check last couple paragraphs of this post: https://hollywoodhomestead.com/herbal-antibiotics-sibo/
Sylvie,
Are you now able to eat high FODMAP foods without symptoms? Or are you following a low fermentable diet? Thanks.
Tamara
Hi Tamara,
I’ve experimented with a few low fodmap foods but at home tend to stick to low fodmap/ SCD/ Paleo combo (detailed here https://hollywoodhomestead.com/sibo-diet/) and when I’m out I relax a bit more. This summer I’ll play around with different foods so I can really figure out which I’m truly ok with and which I might need to avoid while I continue to heal. So far I haven’t been super methodical about it. Will definitely blog about it as I sort it out! Hope that helps.
Sylvie
Amazing that NZ government funds that- that’s awesome! Thanks so much for sharing your journey. I’m sure you’ll knock this out and get back to feeling great 🙂 Keep us posted if you feel so inclined.
Yes it does, thank you very much…..I feel I would need to up the amount of shakes though, I need the calories if I’m in full workout mode so I don’t mind mixing them with a fair carbohydrate level. Dextrose is a bodybuilding supplement I always have on hand, looks like it’s the recommended carb source for this diet, and I’m pretty OK with that. I don’t really care to stop lifting while I do this, or at the very least lift just enough to maintain so I don’t reverse any more of my hard work than I need to. And one good thing I can derive from all this is that coconut oil as a fat source may save my backside since it appears to be beneficial to SIBO, actually absorbs (as opposed to other fats if I’m not metabolizing them correctly), and is very good for bodybuilding. I tend to use it a lot already. Pea protein is an isolate that absorbs quickly too, I can just use that, it tastes a lot like cardboard but is very effective, but the daily dose of real meat would be welcomed! Thanks again.
Yeah I think you should do ok lifting especially in the first few days. You might see a decrease in energy a few days in so might want to scale it back a bit then and do a de-load week or sorts during that die off period. I wonder if it would help to play around with eating meat for dinner on the days you lift and only elemental on the days you don’t… or perhaps the consistency would be better. It’s about trial and error I think. Good luck!
Great that you have documented your journey with the elemental diet. I’ve got severe SIBO (sky-high hydrogen levels.) An exclusion diet uncovered a number of food sensitivities and I react badly to most FODMAPs. After an unsuccessful course of Rifaximin I wasn’t game (or rich enough) to try a second round, so I started on the specific carbohydrate diet (excluding also amines and glutamates, which I react to) and felt very well on it – although was dismayed to learn that it takes YEARS to kill the bacteria this way. My dietician was also concerned that I wasn’t getting enough VitB1 – there were just too many things I had to exclude in addition to the bacteria-feeding ones. She suggested an elemental diet.
I am now 7 days into a course of Nutricia Elemental 028 and it’s not nearly as hard as I expected. The drink is really very palatable. I particularly like the grapefruit flavour. Its slight bitterness mask the unfood-like taste very effectively, and I don’t find it at all cloying if I drink it chilled and diluted.
I have no trouble drinking the required amount, haven’t lost any weight, didn’t feel hungry at all after the first day and feel more energetic than I have in a long time. There are other unexpected benefits: I’m saving a lot of money! In New Zealand the government funds elemental diets, unlike drugs like Rifaximin, so I’m getting three weeks’ total nutrition for $10. Also, I have so much time on my hands I don’t know what to do with myself. I hadn’t fully realised what a large part of our day is taken up preparing food, eating food and cleaning up afterwards. It was particularly time-consuming on the exclusion diet and SCD.
I note that other people have suffered bad die-off symptoms. I’ve had nothing like this, possibly because I had already eliminated most of the bacteria on my previous diets. I had stomach cramps and diarrhoea for the first few days but this has stopped now. The one unpleasant side-effect is the film the drink leaves in my mouth, but pfft! I just brush my teeth more.
I haven’t been seriously tempted to eat real food. I’m missing it but the thought that if I get through another two weeks of this I might be able to eat a whole lot of things I couldn’t before is a great incentive to stay honest. If I am not in the 80-85% of people I have read are cured of SIBO with this diet,or I relapse, I will not find it difficult to do it again.
Amazing that NZ government funds that- that’s awesome! Thanks so much for sharing your journey. I’m sure you’ll knock this out and get back to feeling great 🙂 Keep us posted if you feel so inclined.
I hate to tell you this, but my experience since coming off the elemental diet has not been good and I would urge anyone considering it to do their homework carefully before they attempt it.
Despite having SIBO and various food sensitivities, before trying the elemental diet I felt pretty good on a diet that excluded the things I knew I was sensitive to. But that was nothing to how fantastic and energetic I felt two weeks into the elemental diet. I was over the moon. Not only did I remember what full health felt like but it was confirmation that a faulty digestive system was the reason I’d been ill.
But I’ve paid a high price for that brief respite. I was given little advice about how to reintroduce real food after three weeks on the elemental diet. I figured I would be okay with food that was ‘safe’ before. Not so. It seems I am more sensitive to amines than I was before. The flatulence that was the most troubling symptom of my SIBO (and then only when I ate FODMAPs) now occurs when I eat stuff that I could safely eat before. I’ve had it every day since reintroducing food. This morning I have stomach cramps and diarrhea, and I have no idea what set it off. Everything I ate yesterday and this morning was on my previous ‘safe’ list.
In despair a few days ago I emailed my dietician, saying I wanted to go back to the elemental diet. She advised against it, saying that there was evidence that the longer you stayed on it, the more likely it was that food sensitivities could worsen. How I wish she had warned me of that before.
There might yet be a good outcome. I certainly hope so. But right now I’m feeling pretty depressed about the whole business.
Meg Davidson Sorry to hear that! 🙁 Did you retest and if so what were the results if you’d like to share? Specifically, I’m curious if you made progress but perhaps didn’t eradicate SIBO in your first round which was my experience since my levels were also sky high.
I think retesting is KEY.
Hope you feel better soon.
Sylvie
Question on this…..if I were to try this elemental diet approach, is there a way to increase the amount of protein?? I’m a bodybuilder and this has been devastating to me. I would like to up the level of protein so I don’t lose any more muscle mass than absolutely necessary. The liquid “no food” aspect of this wouldn’t be a problem at all. Can you answer this and if it’s possible to add protein, what would it need to be?
Hi Shasta,
I would go for the homemade version in your case instead of the vivonex (which is high carb) and increase the amino acids (with help from a dietician perhaps). You could also do a modified elemental which would probably not yield results quite as quickly but would still work. So, adding meat only (no veg) once a day. For example, you’d do the shake for breakfast, another for lunch and at dinner some ground beef in addition to a shake. The good news is that meat/protein isn’t a problem for SIBO. It’s the rest of the foods that get a little tricky as to which and how much as discussed in this post: https://hollywoodhomestead.com/sibo-diet/
Hope that helps!
Sylvie
Wow Sylvie that’s really interesting – pemmican is lard and jerky, way more palatable than Vivonex, available from US Wellness Meats, do you suppose it could form the basis of an elemental diet?
Hi Jonathan, It would no doubt be more palatable. It wouldn’t quite be the same because you’d be missing the carbohydrate although perhaps you could do the pemmican plus a bit of dextrose or an acceptable honey. It also wouldn’t give your digestion as much of a break as a liquid diet.
So, it might not be perfect but you would make progress most likely.
Hope that helps!
Sylvie
Yes!! If my H test is +ve I’ll try it, I’ll keep you posted, thanks!
Hi Sylvie, thanks so much for this wonderful info as I heal myself. Would you recommend doing the herbal treatment and elemental diet at the same time, or one first to see how it goes? Thank you!!
Hi Melissa,
If I had to do it again I’d go straight to herbals + homemade elemental but my numbers were quite high and I suspect they were even higher by the time I started elemental since my test results were several months old at that point and my symptoms were worse. If yours are less severe I would say just elemental and if they’re not severe at all I’d go for herbals which is a much easier treatment (in that you pop pills and go on with your life) 😉
All of that with the blessing of your doc of course. Hope that helps!
Sylvie
Hi Sylvie,
Thanks so much for sharing! Would you let us know where you are at with your SIBO now? Any recurrence?
Hi Ari,
So far so good! No recurrence. I will probably retest in a few months just to be sure. Since I’m out of the country testing is costly and tricky but luckily so far my symptoms don’t indicate any recurrence. I’m still actively working on figuring out what might have caused this in the first place since knowing that will be a huge help in preventing recurrence. Hope that helps!
Sylvie
Do you have a recommendation about using honey instead of dextrose? Is there any reason not too use honey? How much would you recommend?
Hi Madeline, I didn’t use it. If you do, I’d make sure you use an acceptable type for SIBO like clover honey. As for the amount, you can do 2-3Tbsp for each dose depending on whether you want more or less carbs. If you’re doing the higher fat recipe I would use 2Tbsp and if you’re doing the higher carb I would do 3. Hope that helps!
Thanks so much, Mary!
Great post! This series is so great and helpful for all the clients I coach through kicking SIBO.
Thanks so much, Mary!
Sylvie,
I wish I had the same result as yours. I I did elemental diet 3 times, twice 14 days and third time 21 days but no luck. I didn’t take herbal abx, interfase and prokinetic though like you did. I did multiple round of neomycin/xifaxan and herbs but I haveno relief. What was your methane and hydrogen initially? Mine was 222 methane and now it is 29. I am really impressed with your results. Thank you for sharing. I might try it again with herbs too next time.
Wow Elizabeth! 222 for methane is quite high but getting it down to 29 is amazing! That’s not no luck! My highest recorded number was 83 (for methane) but I suspect it was quite a bit higher months later when I first did elemental since my symptoms were much worse. I posted my lab tests in this post: https://hollywoodhomestead.com/elemental-diet/ I recommend you read the whole series if you can. And see if your doc agrees to do 1 more elemental plus herbal. I think you’re so close to beating this thing- look how far you’ve come!
Thanks for describing your experience! I’m on day two of homemade elemental diet, and the mix is so nauseating I’m barely able to eat any. You mentioned ginger tea –are we allowed to have teas on the diet? I’d love that!!! Also, I do better with ghee than with coconut oil, do you know if that’s allowed?
Thanks so much!
Hi Robin,
Hang in there! I know, it’s really awful. Ginger tea is fine but ghee is not. The only oils that would be ok are coconut, olive and cod liver. I found it easiest to sip (and I mean tiny sips) the olive oil out of a shot glass. Sometimes I only managed to have a little bit and just kept it around to have some later if/when I got hungry. Hope that helps!
I am interested in reading more posts on this. I have been battling SIBO-C for over a year. After a very short course of Rifaximin (only 3 days) and following the Low FODMAP diet (I also took Iberogast to stay regular, but it started losing effectiveness), I felt better for 6 months, but then my symptoms came back with a vengeance. I decided to treat myself with an herbal antibiotic regimen (same as the one you mentioned in a previous post, but for 4 weeks). On the 4th week, my acid reflux came back and I still had constipation. I don’t know why the herbal treatment seemed to do nothing. I refuse to ever take PPIs again, so I went back to my Integrative Medicine Dr. She agreed to prescribe the treatment of Rifaximin and Neomycin that Dr. Siebecker recommends for methane (after my urging) along with an antifungal for candida of which a small amount showed up on my stool test. I also started a combo SCD/Low FODMAP diet. My insurance will not cover the Rifaximin and it is about $400 (although I may look into ordering it from Canada as you suggested). I am just hesitant to go this route if it is not going to work for the long-term, which seems to happen in many cases. It would be very difficult for me to follow the elemental diet because of work and grad school (I am also a competitive runner, which makes restrictive diets especially difficult!), but I will do it if there is a good chance it will work. I can’t decide what step to take next. I guess I need to try things until I find something that works. Any advice you have is appreciated.
The ironic thing is that stress is a factor with SIBO, yet I find that going on a very restrictive diet is extremely stressful, so this just makes the whole situation worse! I have started meditating and doing yoga as a way to handle the stress, which I hope helps also. I find it very interesting that more woman have SIBO than men and it makes me wonder what the connection is. I wish I could fast forward 10-20 years (without aging, of course) to see where the research is on this because I just don’t think we know enough about it yet.
I really hope the elemental diet works for you, and I appreciate you sharing your experience and knowledge!
I completely understand your frustration, Lisa. Did you retest after any of these protocols? If possible I would urge you to retest since sometimes what you think has been ineffective has actually gotten you quite a bit closer to the goal and perhaps another round will do the trick (of herbals for example if you want to avoid Elemental so you can continue running). Also, I’ll be posting about The SIBO diet soon which in my experience is better than just low FODMAP. Stay tuned!
Thanks! I have a breath test scheduled so I can see exactly where I am in regards to SIBO. My symptoms have definitely been worse lately, so I need to figure out what is going on. Going to read your next post now!
Hi sylvie,
I’ve just tested positive for sibo with high hydrogen levels and will start treatment soon. I was thinking about homemade elemental with herbal antibiotics plus the biofilm disruptor and motility agent followed by rifaximin. I’m already on gaps and low fodmap. I’ll be getting fmt treatment for my large intestine soon so I’m very keen on eradicating sibo before that. My question is whether you have not relapsed after following this treatment? I read a lot about people relapsing. Also I’m a bit scared of going on elemental as I used to be very malnourished and have only just gained weight on gaps, any comments to that? Did you lose any weight? Thanks, Layla
Hi Layla,
It’s been about 3 weeks since my negative SIBO test so I’m very much on the prevention bandwagon and recurrence is definitely something I’m keeping an eye on. I will likely retest in a few months regardless of symptoms just to stay on top of it. The best thing you can do to prevent recurrence is to continue the prokinetics, keep your diet sibo friendly as much as possible without driving yourself nuts, and try to continue to discover what caused this in the first place if you don’t already know.
I did lose a bit of weight on elemental and that is definitely a concern for people like you. I wonder if your doc might suggest tweaking the diet a bit or simply asking you to add more calories in the way of more shakes and more oil.
The rifaximin after all of that does sound like a bit much. I would run that one by a doc although I totally understand your eagerness to knock this out once and for all.
Hope that helps!
Sylvie
This is very interesting. I’m looking forward to next part.
Thank you Patrik! It will be posted later this week!