Understanding the Elemental Diet: Uses, Benefits, and What to Expect

Understanding the Elemental Diet: A Breakdown

What is an Elemental Diet?

An elemental diet is a diet that is broken down to the most basic of nutrients (into their elemental form) for easy nutrition. It is a liquid diet that consists of amino acids (broken-down protein), short-chain triglycerides (broken-down fat), and short-chain maltodextrins (carbohydrates), along with vitamins, minerals, and electrolytes that are essential for health. Elemental diets have been used for over 50 years for various diseases and acute illnesses to allow for gut rest. An elemental diet can be consumed orally, via enteral nutrition, or tube feeding.

How Does an Elemental Diet Work?

Elemental diets allow for gut rest. Because this diet is broken down into the most basic form of nutrients, it is easily digested and absorbed in the small intestine, bypassing the remainder of the GI tract. While on an elemental diet, it is not recommended to consume other foods unless directed by your physician. Elemental diets are usually used for short periods to allow for gut rest and healing.

When is an Elemental Diet Used?

Inflammatory Bowel Diseases (IBD)

In individuals with inflammatory bowel disease, such as Crohn's disease, elemental diets have been prescribed to allow for the rest of the inflamed portion of the bowel and provide essential nutrients needed for nourishment and prevention of malnutrition. Current research has shown that elemental diets are highly effective in remission of Crohn's disease in both adult and pediatric populations, citing up a 63% remission rate in study subjects. The majority of clinical trials available utilize tube feeding as a means to deliver the elemental diet.

Short Bowel Syndrome

Short bowel syndrome occurs when the small intestine has been shortened or damaged, resulting in malabsorption of nutrients and fluids from food, which can lead to malnutrition, diarrhea, unintended weight loss, dehydration, and fatigue/weakness. The small intestine can be surgically removed or have damage as a result of IBD or from a congenital condition. Initial research from decades ago has confirmed that elemental diets are beneficial in allowing for optimal nutrient absorption when the gut cannot perform, typically allowing for the digestion of intact proteins, fats, and carbohydrates. If oral diet or enteral nutrition is not tolerated, then feeding through the veins or TPN is recommended.

Severe Food Allergies and Intolerances

In cases of individuals diagnosed with eosinophilic esophagitis (EoE) or eosinophilic gastroenteritis (EoGE), which result in severe food allergies to gluten, dairy, wheat, eggs, shellfish, fish, nuts, and peanuts, following an elemental diet has been shown to provide complete histologic remission after 6 weeks of use. It is important to note that an appropriate diagnosis must be confirmed before starting an elemental diet for the management of severe food allergies, such as those with EoE.

The Benefits of an Elemental Diet

Following an elemental diet has multiple potential benefits. However, before starting any diet, it is crucial to consult with a registered dietitian and physician to determine whether this would be an appropriate diet for you. Aside from the benefits, some drawbacks could make following an elemental diet detrimental or difficult.

Resting the Digestive System and Improved Nutrient Absorption

Because an elemental diet contains nutrients at their most basic level—amino acids, short-chain fatty acids, and simple carbohydrates—the body can easily absorb these nutrients with minimal digestion. Enzymes and additional metabolites are not needed to break these nutrients down further, like whole food products need, truly allowing for the rest of the digestive tract. Elemental diets also yield low fecal bulk because not much of the elemental diet is absorbed and utilized by the body.

Reducing Inflammation

In addition to allowing for the rest of the digestive system, elemental diets can reduce inflammation because they are allergen-free, as the protein content is completely broken down. They are also considered low-fat, which is anti-inflammatory. Some research has also suggested that elemental diets can modify the gut microbiome, such as reducing bacterial growth seen with SIBO. Lastly, elemental diets are free from additives, emulsifiers, artificial sweeteners, food colors, and nanoparticles, which can be inflammatory drivers for certain disease pathways, like IBD and IBS.

The Drawbacks of an Elemental Diet

Taste and Texture: A Challenge for Many

Elemental diets are, unfortunately, not the most appealing due to a lack of taste and texture- it’s a liquid diet. Therefore, this poses a potential barrier to total adherence to the diet. Most people, including me, dislike eating the same thing repeatedly. To help overcome this hurdle, if you have to consume this orally, I suggest chilling the liquid before drinking and using a straw that can allow bypass of your tongue. Another method for administration is enteral nutrition (tube feeding). If this is medically appropriate, it would help avoid the taste and texture of the diet. However, enteral nutrition is contraindicated in individuals who can mechanically swallow.

Potential Nutrient Deficiencies

Even though elemental diets are great for supporting gut rest and providing the body with essential nutrients, they may not be the best diet for long-term use, as one may experience nutrient deficiencies. Most commercially prepared elemental diets are prepared in such a way as to allow for meeting vitamin/mineral needs. However, one may need additional supplementation to help meet micronutrient needs. Routine monitoring of labs is pertinent to stay ahead of deficiencies.

Long-Term Use and Psychological Impact

Because eating food is linked to pleasurable experiences like birthday parties, celebrations like weddings and graduations, family get-togethers, and neighborhood barbeques, it can become a psychological burden while following an elemental diet. Sometimes it can be embarrassing to bring your own food/drink and feel like you have to explain to others why you’re following this diet. If this is you, try pouring your elemental formula in a travel mug and sip while at events. Buy a fun cup to use while at home or in the office. Find other enjoyable activities to do while you are on your healing journey.

Transitioning Off an Elemental Diet: A Gradual Process

Introducing Solid Foods Slowly and Returning to Normal Diet

An elemental diet is not meant to be forever. If you’re using this diet to achieve remission with IBD or allow for gut rest, it is typically used for days to weeks. When coming off an elemental diet, it is key to incorporate easy-to-digest foods (often lower in fat, fiber, or modified to avoid specific allergens/intolerant foods), then gradually work your way up to a “normal diet”.  A regular diet for you may vary, given your end goal. Work with a registered dietitian to make your transition easier.

Does anyone in the Foodguides family have experience following an elemental diet? Please feel free to share your journey in the comments below.

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