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Small Intestine Bacterial Overgrowth syndrome (SIBO) is something that I personally have been battling with. An elemental diet, also often called a bowel reset diet, isn’t actually a diet in the traditional sense at all. An elemental diet definitely seems like a hardcore way to deal with SIBO – but it is an effective one.
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. 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.
You’ve got two options when it comes to the elemental diet for SIBO: you can buy a readymade formula (Vivonex Plus) or do a homemade formula.
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. Without the help that I had during both rounds of element, I guarantee I wouldn’t have made it through it. Your body will be in a for a big shock when you suddenly start eating again, so take it easy on the food front. 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. Sylvie McCracken is a former celebrity assistant in Hollywood turned full time entrepreneur currently living in Abu Dhabi with her husband and 3 kids. Thanks so much for your post which has guided me through my elemental diet this last month to deal with methane-predominant SIBO.
I’m wondering how long it took following your second diet before all your symptoms went away? I’ve been dealing with SIBO for a number of years now with fallout from the little buggers including other areas of my health (hypothyroid, low blood pressure, anemia, amenorrhea) along with the usual GI distress, constipation, food sensitivities, brain fog, fatigue, loss of focus and depression. Finished round three of antibiotics (first time rifaximin + neomycin, second time herbals, third time metronidazole) a couple of weeks ago and for the first time am taking erythromycin post-treatment. Like all living things, bacteria have to eat something.   The bacteria in our small intestines primarily live off of certain carbohydrates that we eat.
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.
In one study, 93 subjects with IBS and SIBO (diagnosed with a high lactulose breath test) were put on an elemental diet.
Doing elemental is not at all a pleasant experience, and you will have to make some serious lifestyle changes while doing it. 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. This gives things time to settle down – but don’t wait more than 2 weeks or you might not get accurate results. 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.
I also took herbal antibiotics and a prokinetic while doing the second round of elemental.  i will talk about the importance of prokinetics for treating SIBO later on in this series. But, for me, it was actually days 8-12 that were the worst, probably because my case was so severe. It might not have been related to SIBO but to the corn and soy ingredients which I don’t react well to. 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. I mean, that’s as low as my breath test results would ever be, I wasn’t eating anything for pete’s sake! 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.

As a mom and business owner, I don’t get too much down time and I have to manage a lot of things. A hot water bottle on your belly (bonus points for castor oil pack) helps reduce nausea and belly pains, as does ginger tea. Get your copy of The SIBO Solution: Your Comprehensive Guide to Eliminating Small Intestinal Bacterial Overgrowth by clicking HERE. 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. I have SIBO again (yuck!) Last time I did a combo of metronidazole and herbal antibiotics, but that didn’t work. I did elemental for 15 days but didn’t notice much for symptoms other than feeling sick on occasion and feeling tired. In the UK, we don’t have Vivonex, so I took something called Elemental Extra 028 for 16 days which is quite similar. I have retested after finishing the diet and my methane levels have reduced down to on average 3 parts per million over the entirity of the breath test when previously they were 22 parts per million.
Would it be a good idea to do 2 weeks of antibiotics and then 2 weeks of elemental diet right after? Have been strict autoimmune paleo and GAPS (minus bone broths and fermented foods because I have issues with histamine) for the past year and have added low FODMAP in the past couple of months. However my symptoms are worst than they were before the antibiotic treatment and my histamine intolerance (which had improved with a year on the GAPS diet) has gone way down.
I love hearing SIBO success stories but find that the real sign of long-term success is not relapsing within 6 months to a year. They help so much in helping those of us dealing with SIBO ourselves find answers and possible solutions to this affliction!
When you eat these fermentable sugars, you aren’t just feeding yourself but the bacteria too! 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. With the homemade elemental, the dosage is 3x per day, which comes out to about 2000 calories. For example, while doing the Vivonex elemental formula, there were days when I just laid around in bed and rested. Scared because I’d heard stories of people not being able to make it past day 4 because they felt so terrible. 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. An interesting thing though is that I found Elemental easier than those weight loss diets I used to do. 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.
Use visceral manipulation (just massage your abdomen, even if you don’t know exactly what you’re doing) to help things get moving along.
So it’s clearly had a massively positive effect, but a week after, I am still experiencing some symptoms. To prevent your body from starving, you take a special liquid formula (formulated for tube feeding patients) which contains predigested nutrients. You can’t have any solid food and those powered elemental formulas aren’t exactly the best tasting thing.
However, even homemade elemental formulas are still going to be a bit pricy because you’ve got to purchase all of the nutrients individually.
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. 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.

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. I think this is because I found it obnoxiously sweet from the dextrose and the vanilla seemed to accentuate that.
I didn’t need a full 1800 calories during those days, so I took 5 or sometimes even just 4 drinks per day.
I relied on detox protocols during this time (especially Epsom salt baths and castor oil packs) to help me through. 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. 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. 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. Things are much, much better but my BMs are a strange shape (still some pellets) and I don’t feel quite right. I have been battling with Gi problems for years yet no doctor ever suggested testing me for SIBO. May be used post-operatively as an enteral alternative to TPN and may also benefit patients with gastrointestinal impairment.
The nutrients are easily assimilated into the body so bacteria can’t feed off of them and proliferate.
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.
Bear in mind that you will have to buy each ingredient separately and mix them together each day. So I didn’t another round of Elemental, this time using the homemade formula and for 13.5 days. 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. Day 14 and 15 were the days I just didn’t feel well off and on throughout the day and then I stopped. Do you think this is likely to improve with time as the gut lining heals, or might it indicate additional work that’s required?
Elemental diets are also often used to treat Crohn’s Disease, a condition in which the gastrointestinal tract is severely inflamed. The bloating was so bad that I looked like was 6-8 months pregnant, depending on the time of day. 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. So after discussing it with my doc, I decided to do a modified elemental diet leading up to getting the rifaximin.
I am going to use bone broth, collagen protein, d-ribose and probably a mix of fats (coconut oil, avocado oil, and maybe one other). Also, do you have any meal suggestions for the first few days aside from the ‘simple food’ advice?

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