Elemental Diet: Hi folks, my gastroenterologist... - IBS Network

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Elemental Diet

Liz1234ty profile image
13 Replies

Hi folks, my gastroenterologist has suggested the elemental diet as a way to allow my gut to rest and reset and potentially to address stubborn SIBO too. This is a purely shake based diet for 2 weeks (no food or alcohol allowed!). Has anyone tried this before and if so what brand did you use and did it work, any side effects?

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Liz1234ty profile image
Liz1234ty
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xjrs profile image
xjrs

Yes. I did. I used Absorb Plus, but it is extremely expensive especially considering the number of tubs that you will need to make up meals for 2 weeks. The problem is it is liquid food in and liquid food out. This means that you will be tied to the house for 2 weeks since you will have unpredictable liquid bowel motions from it. It made me lose weight too (which I couldn't afford to lose). It is a pretty rough experience. I was misdiagnosed with SIBO so this diet did nothing for me. Did your gastroenterologist put you on Rifaximin? That would be the first go to, if they are convinced that you have SIBO - by the way there are no accurate tests for it so a diagnosis is pretty hit and miss.

I was told by a gastroenterologist that true SIBO cases are rare.

I also found out that there is a set list of causes of SIBO. If you do have SIBO and the root cause isn't tackled, it will only keep coming back.

I was presented with this handout which shows these root causes:

clinicaleducation.org/docum...

On the right hand side you will see the box containing the heading "Aetiology" which actually means 'a set of causes'. I went through this list with my gastroenterologist and I have added comments from my own health perspective.

He said that these areas would be covered by the Small Bowel MRI scan that I had:

• Stasis: dysmotility – not apparent

• Surgery (loops, vagotomy, bariatric) – not apparent

• Short Bowel Syndrome - not apparent

• I also added ileocecal valve (which sits between the small and large intestine) to this list, which my therapist kept going on about. She said that my ileocecal valve was stuck open allowing bacteria from my large intestine to wash back into my small bowel and I'd need to visit an osteopath who practices visceral (organ) manipulation to get them to close it for me (or you can do it yourself via a youtube video). I had to go to another city 1.5 hours away to visit such an osteopath who eventually said he didn't manipulate the ileocecal valve (although a phone call indicated he might), but I had a couple of sessions of him manipulating my intestines because they were stiff. My small bowel MRI showed there was nothing at all wrong with my ileocecal valve - it was closed and showed no inflammation or any abnormality that would cause SIBO.

And now for the rest:

• Achlorhydria – no stomach acid – he said this was highly unlikely and also considering I can experience acid reflux

. I also would have thought a fecal elastase test would show if you aren't breaking down proteins correctly (which require stomach acid for digestion) and mine came back OK.

• Hypochlohydria – low stomach acid – same answer as above – the only real test is a PH test directly into your stomach, but he said they didn't do this any more and home testing is inaccurate

• PPIs – my therapist said that I hadn't been on PPIs long enough to make a difference

• Malnutrition – no

• Collagen vascular disease – immune system inflammation e.g. arthritis – not in my case

• Immune deficiency - unlikely

• Advancing Age – no

• Chronic Pancreatitis – this causes constant abdominal pain/fatty stools - no

. It is interesting that another IBS Network member had responded to Rifaxamin but was also diagnosed with a compromised pancreas.

• Chronic ABX use – no

• IgA Deficiency – my tests show this is normal range

• Coeliac Disease – I had blood tests with the GP and these came back fine

• Crohn’s Disease – I had blood tests with the GP and these came back fine

and colonoscopy was OK

• NASH – non alcoholic fatty liver disease –looked at my records for this and this is normal

• Cirrhosis - no

• Fibromyalgia – widespread pain - no

• Rosacea – no

I don't know whether this list helps at all, but might be worth working through with your gastroenterologist from your perspective.Good luck.

Liz1234ty profile image
Liz1234ty in reply to xjrs

Thanks for this comprehensive list. My Gastro is not convinced about the SIBO either (and neither am I). I keep getting positive text results but the degree of positivity does not correlate to the severity of symptoms. I have had 2 rounds of Rifaxmin. At first it worked for about 6 months (not a cure but drastic improvement) but when I tried it again it did not help and since probiotics don't help either and I have tried 3 reputable brands that have undergone clinical trials, and diet does not make a difference, the idea in my case is that the liquid diet is a way or resting and relaxing the gut that may also help kill off lingering/resistent SIBO but that is not the primary reason for taking it. I have tried so many things that have not helped that my gastro is running out of ideas!

I notice that food poisoning is not on your list and that is when I began to feel ill (I think!). Most of what is on your list has been checked for and found negative but I am interested in the small bowel MRI as I have not had that. Do you think it is also worth getting an MRI to check stomach and large bowel too? I will check with my gastro as it would be so good to have a diagnosis or have everything ruled out.

xjrs profile image
xjrs in reply to Liz1234ty

So sorry to hear about all your to'ing and fro'ing. There should really be a service that hard to crack cases are sent to and have multiple disciplines working on it and those cases used for research.

It is interesting that the Rifaximin helped you initially, which suggests there may be something going on in the small bowel department and could be worth getting a small bowel MRI done - for example they may be able to see if your illeocecal valve is working properly. This is what my gastro suggested.

Food poisoning tends to be associated with large intestine infections and IBS symptoms I think, though I haven't researched small bowel infections apart from SIBO (i.e. bacterial overgrowth).

I read an article recently that they have found that the body still as a 'memory' for foods causing trouble releasing histamine even after an infection has been resolved.

Just a thought do you leave at least 4 hours or so between meals and as long as possible between dinner and breakfast? Fasting between meals allows the MMC (migratory motor complex) to run which sweeps out your small intestine into the large intestine. Constant snacking can stop the MMC running so that food hangs around in the small intestine attracting bugs to feed on it and multiply.

What are your symptoms at the moment?

Liz1234ty profile image
Liz1234ty in reply to xjrs

Funnily enough you are taking more of an interest than the GPs and gastros that I have seen! Once the standard tests come back negative I have found that the medical community lose interest.

My symptoms have not really changed over the past 3 years and comprise burping (irregularly but often for many hours at a time), excessive wind, urgent feeling to evacuate bowels due to strong noises and sensations akin to a reaction such as food poisoning but D is rare for me other than a tendency towards multiple stools. It is really the noises and sensations of a gut that is roiling away that drive me insane as they go on and on for hours and days with then an arbitrary break before starting again. I have never eaten breakfasts and since experimenting with this it makes things worse so instead I have a light brunch followed by a evening meal. In essence I fast (in terms of food not drink) for many hours each day and this can help a little. My sensations of hunger and toilet needs have been lost or heavily affected by the general discomfort, bubbling, sounds like water moving through pipes etc (no pain) and this helps with the fasting as hunger sensations are unreliable. I also have bloating tendencies. I have also tried prokinetics to help the MMC but if it is slow then they did not help.

I experimented with both prokinetics and anti-diarrhea / spasmodics as a means to test whether my guts are overactive or underactive with fermentation but neither help so I still don't know what is really happening. In terms of a diagnosis it falls under "functional bloating".

Interesting about what you say about the "memory" of a problem as one of the things I am doing is gut-directed hypnotherapy as my gastro wondered if my body is still reacting to a problem that has been resolved but has affected the gut brain axis thus still causing physical symptoms. Early days yet but I've not seen any improvement following my first 3 sessions.

xjrs profile image
xjrs in reply to Liz1234ty

Hmmmm. Your symptoms don't sound like typical IBS, though it may be a less typical version of IBS or even SIBO. Things I note are normal bowels (i.e. not loose or constipated), just greater frequency and also without pain.

The gut directed hypnotherapy sounds like a great idea. Maybe stick with it a bit. Interested to hear about how it goes. Good luck.

Liz1234ty profile image
Liz1234ty in reply to xjrs

Thanks - I will defo update on the gut directed hypnotherapy if it works. If not I may not update as I don't want to discourage others as the success rate in relieving symptoms is impressive but it simply does not work for everyone.

Technically I don't have IBS but a functional gut disorder (of which I understand IBS is the most well known of the functional gut disorders). But that is just the working hypothesis given the lack of anything showing up in test results.

xjrs profile image
xjrs in reply to Liz1234ty

Yes. We're all a mystery! One day they will be able to pigeon hole us into a variety of different syndromes. In the mean time we're left doing our own research to find out what works best for us. The big thing for most of us is not being able to eat what we want. I can only hope that one day they will land on something 🙏.

Narwhal10 profile image
Narwhal10 in reply to xjrs

THANK YOU SOOOO MUCH

tiredmum profile image
tiredmum

My son had this for about a month. Can’t remember the name but he said it was the best thing he ever did even though it was extremely tough. He found he was still hungry so had to increase the quantity and he had the one where you could mix nesquick into the shake so it was flavoursome. He still had diarrhoea but nowhere near as bad. He says he would do it again if things got as bad as they were.

Liz1234ty profile image
Liz1234ty in reply to tiredmum

Thanks for this - really good to know that he was helped by it. It does sound like a rough experience but then so is suffering from bowel problems so hopefully it will be worth it.

JNM1234 profile image
JNM1234

Hi, I followed the Physicians Elemental Diet (very expensive) for three weeks three different times over the course of 5 months. Each time I took herbal antimicrobials and one time followed it by 14 days of Rifaximin. I was never improved at all. In fact, after each time, my symptoms got worse. I was tested by Stanford University with a breath test for SIBO, which was negative. I was completely normal and had perfect once daily complete bowel movements until a year ago when I got sick one night (vomiting, diahrrea). I was tested and found to have a parasite, Blastocystis hominis. I took multiple antibiotics to kill it (maybe overdosed), but I was so determined to kill it, as I had researched that bug and found out that it is often very resistant to eradication, especially with Flagyl. I tried Nitazoxanide first, but my symptoms did not improve. I should have retested, but I didn't. So I attacked it with heavy drugs which test showed eradicated it. But the initial infection plus all the antibiotics have left me with "Post-infectous IBS". I have tried everything: probiotics, prebiotics, Low-Fodmap, numerous supplements to heal the gut, a prokinetic (Zelnorm, although I have loose stools, not constipation). Nothing has helped me have a solid stool, less bloating and gas. Next I will try bile acid sequestrants, motility testing. One of my doctor says my only hope is a fecal transplant.

Narwhal10 profile image
Narwhal10 in reply to JNM1234

Poor you 😞

Liz1234ty profile image
Liz1234ty

Hi, thanks for sharing your experience. That sounds really unpleasant. The main reservation I have is cost and i am a little worried about effects of then reintroducing foods.

I have heard worrisome things about fecal transplants. Have you looked into gut brain connection? Just wondering if gut directed hypnotherapy might help your body to reset.

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