The Microbiome Connection by Dr. Mark Pimentel

Author:Dr. Mark Pimentel
Language: eng
Format: epub
Publisher: Agate Publishing

Figure 6.3 How we handle patients.

PI=post-infectious w/u=workup +ve=positive -ve=negative Rx=prescription

*Could substitute metronidazole

The Elemental Diet

Another more extreme method of treating SIBO is the elemental diet, which consists of a mixture of essential amino acids with non-essential amino acids, fat, and sugars. Often, water-soluble vitamins, fat-soluble vitamins, and electrolytes are also added. When choosing an elemental diet, it is important to choose one in which the daily allowance of vitamins and nutrients is 100 percent RDA-recommended. Our first published use of this technique used Vivonex® Plus; since then, other less formally studied alternatives have emerged.

The principle of the elemental diet is related to the ability to digest and absorb food. The faster you break down and assimilate or absorb food, the fewer calories or nutrients are available for the microbiomes in the small intestine and colon. The three main components of the food you eat are fat, carbohydrates, and protein. During digestion, enzymes break these components into smaller pieces, yielding fatty acids, triglycerides, monosaccharides, and amino acids. An elemental diet contains the broken- down components packed together; you don’t need enzymes to digest or absorb them. The components of the elemental diet are absorbed in the first few feet of the small intestine. The rest of the small intestine is not exposed to nutrients, so bacteria are depleted of food sources and in essence, starve to death.

There is some evidence that an elemental diet may be useful in inducing remission in some SIBO patients. We most often prescribe an elemental diet if you can’t tolerate antibiotics or have failed to respond to antibiotic treatment because the diet is very restrictive and can be costly. We’ve found that the elemental diet is an effective way of attacking SIBO. In our study published 15 years ago, a 14-day elemental diet was more than 80 percent effective in treating hydrogen-type SIBO. This study predates the use of and availability of drugs like rifaximin. Fifteen years ago, if you were on an elemental diet for 14 days you would have been more likely to get SIBO relief than if you took the antibiotics available at that time.

There are many challenges with the elemental diet. Many patients are unable to tolerate the taste of the elemental diet, even if the diet is flavored. If the diet is flavored, it’s important to use flavoring that’s not sweetened by sucralose or alcohol sugars. These are non-absorbed sugars that would feed the bacteria, thus defeating the purpose of your extraordinary effort.Possible side effects of the diet include nausea and diarrhea. Also, because you have no source of food for bacteria—including healthy bacteria— prolonged use of the elemental diet can theoretically affect the stool microbiome, although the short-term consequence of this is unknown.

As with antibiotic therapy, if you have an adhesion your SIBO will return right after finishing your elemental diet. After the great effort to eat this liquid diet for two weeks, the return of SIBO would be very disappointing. As such, it’s important to rule out modifiable secondary causes of SIBO before beginning an elemental diet.

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