Elemental Diet: Uses, Benefits, and Tips

by Marixie Ann Obsioma, MT, undergrad MD on October 28, 2020
Last updated on May 23, 2021

An elemental diet is composed of easily digestible formulas that come in liquid or powder form and provide all the nutrients your body needs.

Elemental Diet: Uses, Benefits, and Tips

It’s intended for those who have severe digestive issues and usually followed under the supervision of a trained medical team.

Some people may attempt to follow an elemental diet to lose weight, despite the lack of evidence supporting its use for reasons other than treating specific medical conditions.

This article explains what an elemental diet is and reviews its potential benefits, downsides, and effectiveness for weight loss.

What is the Elemental Diet?

The elemental diet is one that uses formulas that contain broken-down macronutrients like carbohydrates, fats and proteins, which are predigested into their most basic elements. These elements include free form amino acids, simple carbohydrates and medium-chain fatty acids. Vitamins and minerals are also incorporated into elemental formulas in order to meet all nutrient needs. These elements are combined to make a powder or liquid beverage that is easily absorbed and beneficial for gut bacteria.

Elemental diets are an alternative to medications and herbal treatments like rifaximin or herbal antimicrobials such as oregano oil that are used to treat digestive problems, including small intestinal bacterial overgrowth (SIBO). Some people eat a limited diet while supplementing with elemental formulas, while others exclusively stick with elemental formulas and abstain from eating all solid food. This usually depends on how severe the person’s symptoms are and is determined by a doctor.

Even though it can be very beneficial, overall the elemental diet is considered by many to be an “aggressive approach” to restoring digestive health. That being said, it’s worth asking yourself if it’s really necessary and you’re really ready for this approach before beginning.

Wondering if elemental diets are safe for infants and children? Yes, and they are used by certain pediatricians with a high degree of success. Infants in particular can adapt to an elemental diet somewhat easily because they are already used to living on an all-liquid diet, from breastmilk or formula. However, a child or infant shouldn’t be started on the elemental diet without being supervised by a doctor.

How Does It Work?

Those who follow an elemental diet typically consume only elemental formulas and no solid food. Water and plain tea are usually the only other permitted liquids.

Elemental formulas come in liquid or powder form and can be administered via a feeding tube or intravenous therapy, or mixed with water and consumed as a drink.

Healthcare providers often recommend drinking elemental formulas at a slow pace to prevent cramping and stomach discomfort.

Several commercially prepared elemental formulas are designed to provide adequate calories and all necessary nutrients. These are available as over-the-counter products or by prescription (1).

An elemental diet is almost always supervised by a registered dietitian and medical doctor who recommends the type and amount of formula based on each person’s calorie and nutrient needs.

In most cases, a person receives all of their nutrition from elemental formulas, but some people may only get a portion of their daily needs from formulas and the rest from solid foods. These instances are referred to as half- or semi-elemental diets (2).

Some people, such as those who have had part of their bowel removed, follow an elemental diet indefinitely, while others only rely on elemental formulas until their symptoms improve.

An elemental diet is not typically recommended for weight loss but could theoretically be used for this purpose.

Benefits of Elemental Diet

The primary benefits of using elemental formulas include:

  • Improving absorption of nutrients
  • Reversing inadequate calorie intake due to disease or anorexia
  • Providing nutrition in the case of severe dietary restrictions
  • Limiting and reversing intestinal losses due to inflammation
  • Providing higher nutritional content during “catabolic states” when demand increases

Improving someone’s nutritional status has many benefits. For example, it’s known to lower the risk for many diseases, especially if eating an anti-inflammatory diet. 

Elemental formulas are also beneficial because they eliminate many types of difficult-to-digest foods, additives and ingredients that promote inflammation and interfere with digestion. For example, “Western diets” that are high in foods like processed meat, added sugar, flour, and refined vegetable oils often increase inflammation of the bowels and contribute to many GI problems, including leaky gut syndrome, IBD and IBS.

Research shows that poor dietary choices can cause changes to the microbiome that have far-reaching health implications. On the other hand, simple or unprocessed healing diets that include many whole plant foods, unrefined fats and fiber are associated with improvements in digestive health and many other health markers. However, sometimes someone has such a compromised or damaged digestive system that he or she is incapable of breaking down whole foods. This is where elemental formulas come into play.

Who Is It For?

1. People with SIBO

Currently, one of the most effective ways to help improve gut or microbiota health and increase activity of beneficial bacterial living in the GI tract is through carefully controlling the diet. Certain harmful bacteria that can live in the gut produce byproducts and chemicals that trigger the immune system, causing autoimmune-type symptoms. In order to reduce the presence of these harmful bacteria, their food or energy supply needs to be removed, which is what the elemental diet hopes to accomplish.

Bacteria use undigested food particles found in the intestines to survive and reproduce, so eliminating this supply works to kill off the bacteria. What’s tricky is figuring out a way to keep providing patients with all the calories and nutrients they need without having them eat any problematic foods. Elemental formulas are effective because they are quickly and easily absorbed in the upper intestines; this way residues that feed bad bacteria don’t have a chance to be made.

2. Patients Suffering from Inflammatory Bowel Disease

Diet plays a major role in managing symptoms of digestive disorders, including the most severe types of inflammatory bowel disease; the two most common types being Crohn’s and ulcerative colitis. What you eat has a big impact on your levels of inflammation, gut health and overall well-being. The goal of dietary approaches to control IBD is to eliminate foods that cause further intestinal upset and make symptoms worse.

Many patients with IBD have a hard time breaking down foods such as high-fiber grains, raw fruits including berries, nuts, certain vegetables and refined fats or dealing with caffeine and alcohol. Because so many foods are not tolerated well, it can be hard to get enough calories and prevent malnutrition, so the elemental diet is used to restore nutritional status and promote healing. Certain studies have found that an elemental diet followed by an exclusion diet called LOFFLEX, a diet low in fat and fiber is highly effective in helping patients with IBD reach remission, with up to 60 percent of patients remaining healthy for at least two years (3).

3. People with Food Allergies or Leaky Gut Syndrome

A 2017 study found that following an elemental diet decreased inflammation and improved symptoms in adults with eosinophilic esophagitis, a chronic disease driven by food allergens (4). After four weeks of following the elemental diet, all patients showed significant decreases in symptoms, with 15 patients (88 percent) becoming completely asymptomatic. In addition, 14 patients (82 percent) also experienced significant improvements in terms of inflammation, as measured by blood eosinophil count and serum IgE levels.

4. Arthritic Patients

A pilot trial with 21 people showed a significant improvement in 72% of people, in comparison to 78% for a standard drug (prednisolone). The study concludes that an elemental diet for 2 weeks resulted in a clinical improvement in patients with active rheumatoid arthritis, and was as effective as a course of oral prednisolone 15 mg daily in improving subjective clinical parameters. This study supports the concept that rheumatoid arthritis may be a reaction to a food antigen(s) and that the disease process starts within the intestine (5).

I believe that there would’ve been a bigger improvement had the trial gone on longer and better nutrition was supplied. In addition, supplements would also help.

5. Patients with Autoimmune Disease

A study was done on 800 people with autoimmune conditions who ate a diet that consisted of avoidance of grains, sprouted grains, pseudo-grains, beans and legumes, soy, peanuts, cashews, nightshades, melons and squashes, and non-Southern European cow milk products (Casein A1), and grain and/or bean fed animals.

Most of these people had elevated TNF-alpha. The result after 6 months was a normalization of TNF-alpha in all patients who complied with the diet.

The study concluded that elevated Adiponectin is a marker for lectin and gluten sensitivity, while TNF-alpha can be used as a marker for gluten/lectin exposure in sensitive individuals (6). 

Can It Help You Lose Weight?

Some aspects of an elemental diet may aid weight loss, but there is no scientific research on this specific topic.

Studies in people with conditions that are treated with an elemental diet have shown that it can lead to significant weight loss. However, this is not considered a beneficial or intended outcome of the diet (7).

Since an elemental diet typically consists of nutritionally complete formulas and no other foods, it’s easy to follow and doesn’t require any meal preparation.

Theoretically, you could drink elemental formulas and avoid all solid foods and still meet your nutrient needs.

Single-serve elemental formula packets are available at most drug stores and make it easy to control your calorie intake.

However, following an elemental diet is not recommended without the supervision of a physician or trained healthcare provider.

Overall, elemental formulas are typically designed for those with specific medical conditions. Therefore, they’re not appropriate for weight loss.

How to Follow the Elemental Diet?

While following the elemental diet, a patient may use elemental formulas in place of all regular foods. This means that no other solid or normal foods should be eaten during the elemental diet phase, and only water should be consumed. Some people use “half/semi-elemental diets” to provide about half of their daily calories from elemental formulas, while others follow an “exclusive elemental diet” that provides 100 percent of their calorie and nutrient needs.

How long should you follow the elemental diet? This phase will usually last for about two to three weeks. Your doctor might choose to customize the elemental diet to fit your needs, so this might mean sticking with the diet for a shorter or longer period of time. When it comes to the recommended amount of elemental formulas you should use, speak with your doctor to be safe. You may need to be monitored, and you should never stop medications without being advised to do so.

Nutrient deficiencies that are most common among people with moderate to severe digestive problems include vitamin A, vitamin C, vitamin B12, niacin, iron, folate and calcium deficiency. If the variation of the elemental diet that you’re following includes some whole foods, then it’s a good idea to try and include sources of these nutrients.

During a true elemental diet (not semi/half) you’ll want to eat very simple foods, avoiding all fiber, complex proteins or complex carbohydrates. The exact diet you should follow will be determined by your doctor.

If you’re following a half/semi-elemental diet, then food and nutrients to consume on the elemental diet include:

  • Cooked Vegetables: Try to make about 40 percent of your plate cooked vegetables, along with about 30 percent “clean” sources of protein, 20 percent healthy fats, and the remaining percent whole-food carbohydrates and fruit. Most of your plate should be taken up by vegetables that are ideally organic, removing pesticides that may be triggers. Vegetables that are especially good choices for a healing diet include all leafy greens, artichokes, fennel, celery, cucumbers, squash, mushrooms, snow peas, radishes, sprouts, sea vegetables and fresh herbs. Some people can tolerate cruciferous vegetables like broccoli, cauliflower and Brussels sprouts, but some cannot.
  • Small Amounts of Fruits: Berries may be hard to digest, so try melon, bananas or cooked apples/pears first.
  • Proteins: About 30 percent of your plate should come from high-quality proteins. Aim to include plenty of “clean” protein foods, such as organic, grass-fed meat and poultry, wild-caught fish, cage-free eggs (unless you suspect an egg allergy), bone broth or collagen protein powder, and possibly small amounts of sprouted beans.
  • Healthy Fats: Healthy sources of fats include coconut products such as coconut oil, olive oil, coconut milk/butter, grass-fed butter, avocado, and possibly small amounts of nuts or seeds, if tolerated.

Foods to avoid while on the elemental diet include:

  • Common allergens like grains, especially those containing gluten, tree nuts including peanuts, shellfish, citrus fruits, cow’s milk, eggs, soy and corn.
  • Avoid foods made with flour, hydrogenated fats, added sugar, synthetic ingredients and dyes, and artificial sweeteners, as well as caffeine and alcohol.

Are There Possible Side Effects? 

While elemental diets can be very helpful, they might not be necessary if you only have a mild digestive problem. Some people also find them difficult to follow, even if the diet only lasts several weeks.

It’s best to work with a medical professional while attempting to treat any digestive disorder. This way, you’ll have guidance and accountability. Rarely will someone jump right in to the elemental diet without trying other treatment methods first, so consider if a simpler approach might be a better starting point for you.

Overall, following the elemental diet, exclusion diet or elimination diet takes patience and consistency. It can be hard to identify which specific foods a person with digestive distress will need to avoid. Everyone is a bit different in terms of what can and cannot be tolerated, so some trial and error is usually part of the recovery process. Many patients will have more than one problematic, triggering food, so in some cases they may need to avoid up to a dozen or more different foods such as gluten, dairy, peanuts, certain fruits, and veggies in order to control their symptoms.

Tips for Patient Adherence

If patients become bored with repeated flavor or are looking to deviate from their diet, it is important for them to speak with you as their healthcare professional before altering their plan of action. Encourage patients to maintain an active and healthy social life while exploring activities that don’t involve food (think mini-golf, pottery, and more). Inviting them to lean on friends and family for support and to remain positive are key to adherence.

Try these quick tips which vary the consistency and sweetness of the elemental diet:

  • Add ice in a blender along with the formula for a smoothie-like experience.
  • Make up a pitcher of the medical food and store in the fridge for a cool and convenient drink.
  • Consider consuming it with additional water to adjust to taste.
  • For those on-the-go, mix the powder in a Mason jar or favorite beverage carrier to make the product more portable.

The Bottom Line 

An elemental diet consists of easily digestible liquid formulas that provide all the nutrients your body needs.

It’s typically used under medical supervision to treat severe digestive issues.

While you could theoretically follow an elemental diet to try to lose weight, this is not recommended.

Eating a balanced diet based on whole-foods is a better way to lose weight and reach your goals.

References

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