Treating SIBO (Part 9): Elemental Diet - Hollywood Homestead

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:

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 (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).


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.


sibo test 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.

Treating SIBO (Part 10): Elemental Diet - Hollywood Homestead


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.

  Treating SIBO (Part 9): Elemental Diet - Hollywood Homestead

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Sylvie McCracken is a former celebrity assistant in Hollywood turned full time entrepreneur currently living in Ashland, Oregon with her kids. She writes about treating and preventing health conditions with real food and natural remedies, as well as anything else she feels like writing about because she's a rebel like that. ? he also mentors health professionals turned entrepreneurs on her other site,