1. Is it necessary to be on a full elemental diet, or is a part-time diet an option?
What do you need the Elemental Diet for? Can you perhaps find a middle ground by replacing only one or two meals? Your medical providers will inform you what they think is best in your case: If one were to use the elemental diet for active Crohn’s disease, it certainly would not be a good idea in the early stages, but later, a part-time elemental diet may be a tool to keep you in remission.
For example, one study showed that the longer-term remission rate in Crohn’s disease, when the disease has become quiescent, was significantly higher on a partial elemental diet than a normal diet.
In this partial elemental diet study, half of the required calories were consumed daily through an elemental diet, and the rest of the energy requirement could be met from preferred foods.[1]
For patients with allergic, eosinophilic, or mast cell-related diseases, it is in most cases sufficient after the initial calming phase to replace only one or two meals. The avoidance of individual allergens and triggers allows the intestine or the intestinal mucosa to rest from time to time.[2] Your medical staff in charge can guide you in the transition phase.
2. Do not fall into the habit of thinking you will need to be on an elemental diet forever.
When I first picked up several large packages of my elemental diet at the pharmacy, I vividly reminded myself at the beginning of each meal that this may be the only form of food I eat for a long time. A voice in my head said, “It’s getting worse because otherwise, I wouldn’t be on it…”
These are understandable thoughts, but they do not help. No one knows what tomorrow holds – imagining the rest of your life on an elemental diet is not a good idea!
3. Keep your goal in mind.
Suppose you are on an elemental diet for a stubborn small intestinal bacterial overgrowth (SIBO). In that case, you may not be well in the short term, but in two to three weeks at the latest, you can transition to a much more normal diet. After the elemental diet, which has a good chance of treating your SIBO, you will probably feel better than before!
Write down your goal on an index card and pin it to the fridge: check off every day you have managed to stick to your diet – this helps to get through worse phases.
For patients for whom this diet is a more permanent solution, at least for now, therapists usually cannot put a time frame on the elemental diet course, and that hurts. However, try to imagine what positive effects the elemental diet can have on your health. Maybe you will go into remission or gain weight again?
Before I found a reasonably tolerable elemental diet, periods of severe immune activity or colitis were marked by massive weight loss. I felt terrible and lost weight quickly. The liquid, low-residue diet was and is a great way to get nutrients that the body needs.
4. Taste is king!
- If you have the chance and can tolerate it, experiment – use what tastes best and you tolerate best and stock up on different flavors right away because it helps prevent monotony.Get creative with flavors – mix it!
Maybe mix two flavors and see what that tastes like? Other than that, I have used flavors that you would typically stir into cakes or pastries- these also have no fiber, and some, like vanilla flavor, are relatively easy to tolerate. So, a drop of vanilla or lemon flavoring in the shake has made my day on several occasions!
However, I would keep my hands off mixes such as cocoa or carob, etc. They ensure that the elemental diet can no longer be absorbed entirely in the upper sections of the intestine due to the additional fiber. Adding in those foods possibly nullifies the desired effect.
6. Consume enough salt!
Elemental diets often contain little salt. This is sometimes problematic for a group of patients with relatively low blood pressure or diseases of the autonomic nervous system, which controls blood pressure and pulse. For those with such symptoms or illnesses, switching to a lower salt elemental diet can exacerbate symptoms.
Therefore, it is imperative to continue to provide the body with an adequate salt intake. You may be able to use a pure vegetable broth with no inserts, like those used for fasting, as a “salt carrier” or you may resort to tablets of table salt. The former helps to feel warmer and contains more salt and can help people who often feel cold.
Again, please discuss any changes to your regimen with your health care provider.
7. Keep it cool – everything is better on ice!
The leaflets of most elemental diets say that such diets or drinks taste best cold, and I can only agree with that. It helped me when I threw ice cubes into the shakes – you can chew on them and suck them. That brings other consistencies into play once again because always “eating” the same texture is very monotonous in the long run.
When I was freezing in the winter, and I did not want to drink the elemental diet cold, I warmed the shakes slightly or drank warm water. This can help against feeling cold, which can occur after consuming a cold drink in sensitive people.
But perhaps such a cool drink also has positive sides: Exposure to cold is a way of stimulating the parasympathetic nervous system and thus exerting a relaxing effect on the autonomic nervous system, which can be expressed, for example, in increased heart rate variability.
In a study cooling down the stomach through a 6-degree Celsius cold liquid compared to a 37-degree Celsius body-warm liquid triggered a shift of the nervous system towards increased parasympathetic activity, at least in healthy individuals. The cold fluid caused a slowing of the heartbeat and increased heart rate variability.[3]
8. Change the texture.
Sometimes it can help to dilute the elemental diet. On the one hand, this helps against a “too artificial” taste and thus, for some, the associated nausea. On the other hand, diluting can be helpful, especially in the trial phase for allergy and mast cell patients who react very quickly.
The advantage is that the potentially intolerable substances are present in lower concentrations in the diluted solution, and thus possible reactions are less severe. In the case of intolerance, it is also easier to stay below the reaction threshold.
However, you should make sure that you consume enough calories and nutrients and discuss it with trained professionals.
9. Consume enough calories.
See point 8: Sufficient calorie intake. I fully sympathize with you if you are on elemental diet and do not like to eat this special form of diet. But it doesn’t help anyone if you lose weight and become even weaker, does it? Therefore, eat enough Elemental Diet and weigh yourself regularly. If you lose weight unintentionally, please discuss it with medical professionals!
10. Watch your blood sugar to prevent side effects.
To ensure that the elemental diet can be absorbed in the upper parts of the intestine and requires little or no digestive work, the carbohydrates in the elemental diet are in the form of simple sugar compounds that are quickly absorbed into the blood. So-called simple sugars, called monosaccharides in technical jargon, are glucose, fructose, galactose, etc.
These compounds provide energy quickly and therefore also lead to a more substantial rise in blood sugar. There is a reason why the intake of carbohydrates in a complex form with fiber is usually recommended so that blood sugar rises more slowly. Complex compounds must first be broken down and are therefore not immediately absorbed in their entirety.
The intake of many simple sugars and carbohydrates in the form of the elemental diet can lead to a blood sugar roller coaster, especially at the beginning. Due to this, one can feel fatigued. Unfortunately, this is one of the side effects of this type of diet.
What can help against this, in my experience, are fixed mealtimes, slow drinking, and light exercise (walks, etc., whatever the condition allows).
Otherwise, you get into the awkward state of being ravenous because you have been postponing that “yummy” meal further and further and then drink the shake too fast.
The end of the story is that you feel sick afterward or find yourself in the ultimate carbohydrate coma. What you also want to avoid is realizing in the evening that you have not yet reached your minimum number of calories, and then you have to drink two shakes at once, which also may lead to higher blood sugar.
11. Bonus tip from a fellow sufferer: Try different products!
After someone who was also affected pointed out to me that I had forgotten one of the rather obvious points, I would like to add this good tip here: “If one [elemental diet] does not work or does not taste good, try out several different ones. Therefore, don’t throw in the towel right away if you may not have had a good experience with your first elemental diet.” I can only agree with that – thanks for the tip!
These are my personal tips from years of experience with various elemental diets. What else has helped you? Feel free to write it in the comments and share it with other sufferers.
References
[1] Takagi S, Utsunomiya K, Kuriyama S, et al. Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Alimentary Pharmacology & Therapeutics. 2006;24(9):1333-1340. doi:10.1111/j.1365-2036.2006.03120.x
[2] Hetterich U, Raithel M, Taumann W. VAEM – Ernährungumstellung, hypoallergene Formulardiäten. http://vaem.eu/1395/4-hypoallergene-formulardiaeten/ [abgerufen am: 11.07.2020]
[3] Jungmann M, Vencatachellum S, Van Ryckeghem D, Vögele C. Effects of Cold Stimulation on Cardiac-Vagal Activation in Healthy Participants: Randomized Controlled Trial. JMIR Form Res. 2018;2(2):e10257. Published 2018 Oct 9. doi:10.2196/10257
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Thanks, I have SIBO and I’m trying to do an elemental diet completely on my own because I’m on Medicaid in the USA and I have virtually no healthcare for this available to me. Your article here made me feel so much more positive and hopeful about my situation and I wish you all the best 😻
Thank you so much Thea!
I wish you all the best, too!