How is the Elemental Diet Helpful?

It is one of the more effective therapies in the gut-healing toolkit.

Dr. Michael Ruscio: Hi, everyone. Welcome back to another episode of Dr. Ruscio Radio. Today, we are going to be diving into the elemental diet, what it is, how it can be helpful, and expounding upon the fact that this is one of the more effective therapies that we have available in the gut-healing toolkit.

Remember that things that can heal your gut, because the gut connects to so many other systems of the body, can help with other symptoms and conditions. Namely, we’ll discuss a study later that found equivalent results in quelling the joint pain and inflammation that’s seen in rheumatoid arthritis when using the anti-inflammatory drug, prednisone, or the use of an elemental diet.

Answering all your questions about the Elemental Diet. Diving into the evidence for different conditions, when to take it, how it can be helpful, best tasting options, and more. Click To Tweet

So, we’ll launch here. I’m going to try to strike the balance between some of our audience who are pretty advanced in the realm of gut health and have done a multitude of various interventions for their gut, and those who are a bit newer. So, I’m going to try to toggle back and forth here between detailed and more, I guess, simplified concepts. Hopefully, I’ll strike a balance here that will keep everyone engaged.

[Continue reading below]

In This Episode

What is an Elemental Diet? … 00:02:10
Antibacterial and Antifungal … 00:03:40
Fully vs. Semi Elemental Diet … 00:05:10
Small Intestines and Inflammation … 00:06:49
The Evidence … 00:09:45
IBD, Ulcerative Colitis, and Crohn’s … 00:13:00
Weight and Elemental Diet … 00:15:57
Celiac Disease … 00:17:30
Autoimmunity and the Elemental Diet … 00:18:38
Versions of the Elemental Diet … 00:21:10
How Much Elemental Diet to Use? … 00:24:20
Episode Wrap-Up … 00:46:00

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What is an Elemental Diet?

Key Takeaways

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Elemental diets are…

  • Hypoallergenic
  • Anti-Inflammatory
  • Pre-Digested

Let’s begin. What is an elemental diet? Essentially, it’s a meal replacement that is hypoallergenic and liquid, and can be a pretty powerful gut-healing tool. Elemental diets also function as antibacterial, because they’re devoid of fiber and prebiotics which feed bacteria. They’re also anti-inflammatory, and this is because the food particles are hypoallergenic and predigested. Because of this, they can be reparative for the gut.

So, the contents are fully digested or broken down into elements. This is where the name elemental diet comes from. Proteins are broken down into amino acids or partially hydrolyzed. This aspect, I don’t think is actually as important as the next, which is the carbohydrates being fully digested. And it really does seem to be the fiber and prebiotic content being at about zero that makes these so effective. And also, of course, the lack of antigens, or the lack of any food particles that tend to be inflammatory.


Antibacterial and Antifungal

Key Takeaways

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  • Reduces exposure to irritating foods
  • Gives your gut a chance to rest and regenerate
  • Reduces bacterial (and most likely fungal) overgrowth

I want to also mention really quick here, without going too deep, the antibacterial note and function, I believe, also extends to fungus because (we’ll touch on this a little bit later) the elemental diets are absorbed in the first couple feet of the small intestine. Therefore, none of the carbohydrates impact the majority of the small intestine or any of the colon. So, even though there are some carbohydrates in here, and the thinking is that carbs can feed fungus, but the carbs have to reach the fungus in order to cause an overgrowth.

Remember that the first couple feet of the small intestine, because that’s so close to the highly acidic contents coming out of the stomach, you have a pretty good guard against fungal overgrowths because of that acid. So, you really do risk more of a bacterial or fungal overgrowth the farther down the intestines you go. And this is where none of the elemental diets are going to reach because they’re absorbed in the first few feet.

So, again, the lower fiber content can be helpful for gut inflammation, IBS, and SIBO. This has also been supported by the fact that a low FODMAP diet has been shown to lower inflammation, help with IBS, and ostensibly, help with those who have SIBO. A low FODMAP diet, by design, is a lower prebiotic and somewhat lower fiber diet.


Fully vs. Semi Elemental Diet

Key Takeaways

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  • Evidence shows either version works

Regarding terminology, there are differences between what’s known as a fully elemental and a semi-elemental diet. But as I note here, the research clearly shows equivalent results with either. So, going forward, I will simply use the term “elemental diet” to refer to both, since they both work equally as well.

This is very important because one of the things that we don’t want to do is make getting healthy harder than it has to be. So, if either therapy works equally as well, we don’t want to be saying, “Well, you’ve got to make sure to use the fully elemental,” or, “You’ve got to make sure to do this, and jump through all these hoops.” It’s something I’ve noticed to be very, very important, that when things can be simplified, we act to simplify so that we don’t make someone’s life a living heck because of all the difficult choices they have to make.

In this case, thankfully, we have evidence showing either version, fully elemental or semi-elemental, meaning the protein is broken all the way down into amino acids fully, or only partially broken down into whey protein. It doesn’t seem to matter. And, again, how do these diets help? We already touched on this, but they can be incredibly reparative to your gut because of the antibacterial, presumably antifungal, and anti-inflammatory action that they have. And the example I often use here is the runner who sprains an ankle and has to give their ankle a chance to heal. Using a liquid diet can give your gut a break and aid in healing, just like a sprained ankle where you would take some time away from running and activity.


Small Intestines and Inflammation

Key Takeaways

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  • Highly beneficial for small intestinal inflammation and autoimmunity that is seen in Crohn’s disease.
  • Leads to improvements in the bacterial health because it attenuates inflammation, and inflammation is a main driver of the health of the bacteria in your intestines.  

Another reason why the elemental diets work so well is that they have an especially favorable impact on the small intestines. Remember, the small intestine is what houses the majority of your immune system, and it’s the most prone to leaky gut. So, it’s really important.

Often, the small intestine is underappreciated, and there is some published support for my small intestinal theory. Numerous trials have found that the elemental diet is highly beneficial for small intestinal inflammation and autoimmunity that is seen in Crohn’s disease.

Preliminary research also shows that the diet can decrease bacteria known to cause intestinal inflammation and can increase the diversity of healthy bacteria in the small and large intestines. Now, this is preliminary research, so I don’t want to overstate the case. But consider this. If your intestines are inflamed, we know that inflammation is favorable for unhealthy players and it is discouraging the growth of healthy players. So, if there’s inflammation, it’s poisonous to the good guys, and it can feed the bad guys.

So, even though we’re using a diet that doesn’t directly feed the bacteria, being lower in fiber and lower in prebiotics, it can lead to improvements in the bacterial health because it attenuates inflammation, and inflammation is a main driver, a significant driver, of the health of the bacteria in your intestines.

It’s very important to understand this because there’s a somewhat flawed theory that we should just feed your intestinal bacteria, feed your intestinal bacteria lots of fiber, lots prebiotics, which isn’t necessarily a bad thing.

But in those who have preexisting inflammation, this may flare you. Ironically, what can be a helpful intervention in these cases is actually a diet that doesn’t provide a lot of substrates that feed bacteria. So, not a lot of fiber, not a lot of prebiotics, and by doing so, reducing inflammation, thus allowing healthier bacteria to grow, because you now have a less inflammatory environment. 

So, how is it we see increased levels of healthy bacteria? Well, I just kind of went through this whole thing. The ecosystem of these people requires an approach that reduces inflammation, and less inflammation equals healthier bacteria growth.


The Evidence

Key Takeaways

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  • Vivonex Plus has an awful taste – our Elemental Heal formula tastes good!
  • The bulk of research into elemental diets is focused on IBD. 1,2,3,4,5,6,7,8,9,10,11

Elemental diets have been shown to improve IBS, SIBO, celiac disease, and rheumatoid arthritis.

  • After two weeks on the elemental diet, 80% of subjects saw their SIBO breath test normalize, and 65% experienced an improvement in their IBS symptoms. 12
  • An elemental diet has been shown to help repair intestinal damage, reduce intestinal inflammation, and improve symptoms in those with celiac disease who did not respond fully to a gluten-free diet. 13
  • A clinical trial has shown that an elemental diet was as effective as the anti-inflammatory steroid drug prednisone for rheumatoid arthritis. 14

Let’s go to the summary of the evidence. Elemental diets have been shown highly effective for IBD, inflammatory bowel disease, Crohn’s, and ulcerative colitis. Preliminary data show that elemental diets can improve IBS, SIBO, and rheumatoid arthritis, and they may also be helpful for those with celiac. And clinically, I have found elemental diets to be very effective.

Elemental diets for specific conditions, SIBO and IBS. The iconic study here is a 2004 study that examined the effect of an elemental diet. This was Vivonex Plus, the prescription, on 93 patients who had SIBO and also had IBS symptoms. After two weeks on the elemental diet, 80% of subjects saw their SIBO breath tests normalize, and 65% experienced an improvement in their IBS symptoms.

Now, what’s challenging about Vivonex Plus is it tastes awful. It truly does. And I have described this in the past as, if you were to lick an envelope, the glue there that you lick, that is what the Vivonex Plus tastes like.

This leads people to think that all elemental diets taste bad. This is not true. The newer generation of elemental diets, especially the Elemental Heal line that I formulated, tastes pretty darn good.

In fact, it was interesting to see at the clinic, we were getting some of the taste samples when we were formulating these, and if anyone who’s a patient has spoken with Jazmine, she is wonderful, but also a very picky eater. And even she said, “Mm. Yeah, this is good.” So, when you get buy-in from the pickiest of eaters, that’s a really good sign. It’s great that we have documentation for this formula, Vivonex Plus. Even better now, newer generation formulas exist, namely the Elemental Heal line, that are really quite palatable. 

Now, there’s also a large amount of observational data from clinicians using the elemental diets for SIBO and IBS. There haven’t been a plethora of studies using the elemental diet for SIBO and IBS. There’s only, I believe, one really good study there. It’s not to say that there are studies that disprove it’s helpful, it’s just there haven’t been a lot of studies done. But we do have quite a bit of anecdotal evidence. We have to be careful with anecdotal evidence because people and clinicians are amenable to bias.

However, I think I do a pretty good job in the clinic of setting up experimentation with patients in a pretty nonbiased and also objective way where we can really read variables and see cause and effect. And clearly, this seems to be a very helpful intervention, and probably an area where the clinical science is ahead of what’s been published.


IBD, Ulcerative Colitis, and Crohn’s

Key Takeaways

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  • Studies have shown that any type of elemental diet is as effective as the anti-inflammatory drug prednisone, or Cortef.
  • Can help prevent relapse of the gut inflammation and autoimmunity that is seen in inflammatory bowel disease.

IBD, ulcerative colitis, and Crohn’s with the elemental diet. This is where the majority of the research comes. Numerous trials have found it to be effective. In fact, from what I’ve been told from the European doctor community, this is oftentimes one of the frontline therapies before using anti-inflammatory or steroid drugs. And there are several studies showing that in the treatment of IBD, any type of elemental diet is as effective as the anti-inflammatory drug prednisone, or Cortef.

Again, the study we discussed earlier is pretty compelling and shows evidence of its anti-inflammatory nature. Even for those who may think, “Well, yeah. Natural medicine’s all fine, and good, and great. But aren’t the drugs really powerful? And if I really wanted to get this anti-inflammatory benefit, wouldn’t something like prednisone really be what I needed if I wasn’t responding?”

I understand where that comes from, because prescriptions are behind a prescription wall, and we sometimes think they’re going to be vastly more powerful. Not the case here. Several studies found equivalent results using a steroid or using the elemental diet.

And the nice thing here is that with the elemental diet, we’re likely seeing many secondary benefits, whereas there are obvious side effects to prolonged or repeated use of corticosteroid drugs.

It has also been shown that using an elemental diet can help prevent relapse of the gut inflammation and autoimmunity that is seen in inflammatory bowel disease. By the way, if you’re looking here on the screen, these PMID numbers, you just type that number into pubmed.com, and you can pull up these abstracts.

And what you’re seeing here is very important. I should mention this. These are not, “Hey, we took five rats, and we gave them some elemental diet, and we tracked inflammation,” or, “We took a biopsy of intestinal cells, put those cells in a Petri dish, and then injected inflammatory compounds, and then used elemental diets to see what kind of change there was in the Petri dish,” or some kind of intestinal cell model. These are clinical trials in humans.

So, this data that I’m citing, this is high quality, pinnacle of the evidence-based pyramid, clinical trial level evidence. And as a note here, in my office, I use periodic short courses of elemental diets to help maintain gut health. And can be considered for a pretty wide array of gut conditions like reflux, as an example. Even though I don’t know of any published trials there, it does seem to help.


Weight and Elemental Diet

Key Takeaways

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  • If you’re underweight, you may want to consider using our regular Elemental Heal and not using our Elemental Heal Whey Free, because the whey-free version uses the fully elemental protein of amino acids.

So, weight and the elemental diet. A handful of trials suggest improving gut health can lead to lower cholesterol, lower blood sugar, and may aid in weight loss. Now, what if you’re underweight? Some evidence suggests that elemental diets can aid in weight gain. This is one area where it does appear that using a semi-elemental diet, like a whey protein-based, may be better for gaining weight than a fully elemental diet. Perhaps this is due to taste and compliance, or perhaps there’s something about the less digested semi-elemental form that’s better for weight gain. So, if you’re underweight, you may want to consider using our regular Elemental Heal and not using our Elemental Heal Whey Free, because the whey-free version uses the fully elemental protein of amino acids.

The other thing to consider here is that if you need to gain weight, some patients will actually gain weight when doing an elemental diet because it’s the first time they’ve really been fully able to absorb the nutrition in their diet, because it’s all predigested. And you also want to make sure that you’re consuming adequate calories during a day to help with weight regain.


Celiac Disease

Key Takeaways

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  • Has been shown to help repair intestinal damage, reduce inflammation, and improve symptoms in those with celiac disease who did not fully respond to a gluten-free diet
    • Perhaps the improvements were due to treating underlying SIBO

What about celiac disease? An elemental diet has been shown to help repair intestinal damage, reduce inflammation, and improve symptoms in those with celiac disease who did not fully respond to a gluten-free diet, according to one exciting trial. Now, perhaps the improvements seen here were because of the anti-inflammatory and intestinal reparative nature of elemental diets. Or, perhaps the improvements were due to treating underlying SIBO.

It has been documented that one of the common reasons celiac patients do not fully respond to a gluten-free diet is because they have SIBO (small intestinal bacterial overgrowth) that’s kind of hanging around from the damage from celiac. Even though one is now going gluten-free, that hadn’t been enough to dislodge the small intestinal bacterial overgrowth. And since we know that elemental diets can clear SIBO, it stands to reason that in those who’ve gone gluten-free and not improved fully, there may be SIBO, and elemental dieting is something that one could consider trying.


Autoimmunity and the Elemental Diet

What about autoimmunity and the elemental diet? Well, rheumatoid arthritis is an autoimmune condition resulting in joint inflammation and pain. We’ve discussed a clinical trial that has shown that elemental diets were as effective as prednisone. But otherwise, elemental diets as a treatment for autoimmunity have not been well-researched. I don’t know of any studies looking at Hashimoto’s, or rheumatoid arthritis, or psoriasis. So there is still more there to learn.

But remember, your gut has a strong influence on your immune system, and thus, anything you do to improve your gut health may help with autoimmunity. Again, we don’t want to oversell that. We don’t want to make a broad sweeping claim that, “Everyone with autoimmunity must do an elemental diet.” That would be, I think, an untenable conclusion to come to. But, certainly, if you wanted to perform a trial in an objective way and see how you feel, it seems justifiable.

What about mood, fatigue, sleep, mental clarity, and the elemental diet? Well, there’s little research looking at these. Fortunately, many of these symptoms will often improve, sometimes dramatically, when you improve the health of your gut.

As an example, we know that IBS and sleep have a direct correlation. We also know that mood and fatigue directly correlate with IBS. So, the more symptomatic someone is from a digestive perspective, the lower their mood, and the lower their energy tends to be.

We do have trials showing that things like probiotics or low FODMAP diets improve mood and improve fatigue. So, we’ve established the precedence that gut-directed therapies can improve sleep, fatigue, and mood, therefore, another gut therapy like the elemental diet stands to reason to aid with those. Mental clarity does tend to correlate with gut health. This is something I personally have noticed, that the healthier my gut is, the more impervious I am to food triggers that used to cause me to feel foggy or irritable, which were the main symptoms that I would see as a byproduct of the gut-brain connection.


Versions of the Elemental Diet

Key Takeaways

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Let’s discuss versions of the elemental diet. If you go to drruscio.com/gutbook, you can see my handout that gives you a more expanded set of guidelines. There is the commercial elemental diet by Integrative Therapeutics, but only available through a doctor. There is a prescription, Vivonex Plus, by Nestle. Then there are our commercial elemental and semi-elemental diets.

These are the various Elemental Heals: Elemental Heal original, Elemental Heal Low Carb, and Elemental Heal Whey Free, which is the fully elemental that does not contain any dairy or whey protein. And these taste really great. I mean, they do. They taste good. I don’t want to be overly self-promotional here, but they really do have a nice flavor profile, and they do not require a doctor’s prescription or note.

There are also a few other formulas that one could consider: EleCare by Abbott, TwoCal HN by Abbott, and Peptamen by Nestle. The challenge with these is they do contain some ingredients that people don’t like: corn, soy, other preservatives. For some patients, these are definitely helpful. I don’t want to be a purist and make the proclamation that you have to have the most pure or clean formula for it to work for you, so these are options.

But thankfully, you have an assortment of different options here. And when I look at all of these formulas, this is why I’m so pleased with what we’ve done with the Elemental Heal line because they have such a good flavor profile.

Kind of like the EleCare, TwoCal, and the Peptamen, they have a pretty good flavor profile. But they’re also clean, and they do not require a doctor’s note or a prescription.

A question occasionally posed is, “What version is best, elemental or semi-elemental?” And we’ve already discussed that there is ample data comparing the two, and there does seem to be equivalent effectiveness. Most namely here, two Cochrane systematic reviews found that semi-elemental diets work just as well as the fully elemental diet.

One of the things that’s noteworthy about the Cochrane reviews is they really do a good job of ensuring there’s no bias in the body of research they’re summarizing in their analyses. So, really compelling evidence they’re showing, don’t sweat it in terms of what version that you use.

Regarding taste, and we’ve covered this, Vivonex tastes bad. There’s also the homemade version, which also tastes bad. And the ones that really taste good are the Elemental Heal line or the EleCare, TwoCal HN, or Peptamen. But many patients kind of hem and haw when they look at the ingredients in those formulas.


How much elemental diet to use?

Key Takeaways

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  • It doesn’t have to be all or nothing – you can use elemental heal by itself or as a meal replacement for one or two meals per day
  • Use exclusively for 2-4 days for a gut reset
  • Can use it exclusively for up to two weeks

Another question I get a lot, “How much do I use?” Regarding this, what I would recommend here is, if you are underweight, paying more attention to how much you eat, and striving for at least 2,000 calories per day as a starting point. If you’re overweight, then you can get away with consuming a little bit less, because this could be a chance for you to go into a little bit of a caloric deficit and help with some of that weight gain.

Some clinicians get pretty prescriptive, and they give you a per body weight goal. I don’t think we need to make it that complicated, other than if you’re underweight, make sure you’re being careful not to under consume these, and aim for 2,000 calories or more. And if you’re overweight, then you can be a bit more liberal in if you use a lot or a little to make sure that you’re satiated and feeling full, but also, if you go into a slight deficit, that wouldn’t be the worst thing in the world

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So, how to use an elemental diet. How much to take per day? We touched on this in our last discussion. There’s no one answer. I like to recommend starting with drinking enough to feel satisfied. Now for some more specific guidelines. Men, 2,500 calories per day, as a general rule. Women, 2,000 calories per day, as a general rule. And if you’re underweight, you can consume more. If you’re overweight, you can consume a little bit less.

So, we don’t have to get overly prescriptive about this. And remember, if you were eating 2,000 calories per day prior, this was causing symptoms, inflammation, flaring your gut, you were presumably mal-absorbing those calories. So, even if you were to consume a bit less on an elemental diet and you had more complete absorption, then you’re still going to be coming out on top. I wouldn’t overly fret here. But if you are underweight, do make sure you are consuming an ample amount so as to not further potentiate the weight loss.

Here’s some of our dosing guidelines. The elementals can be used as a two to four-day reset. Think of this almost as a mini cleanse where you perform two to four days on liquid-only nutrition. You can have a small amount of food. It doesn’t really make a big difference if you have a little bit of food in there.

Some people will notice they can do the whole day on elemental and feel fine. But if they have a small dinner or one small meal in there, it really makes it easier for them, psychologically, and they also may feel a little bit better. So, you can absolutely do that.

Now, if your case is more severe, you may want to do one to three weeks as more formal treatment. This is where you should check in with and be supervised by your doctor. To be fully honest here, there are many cleanse programs out there that have you do this sort of thing all on your own anyway, so that recommendation to check in with your doctor is me being ultra-conservative. But I will leave that out there as a recommendation because different people have different context. And so, it’s never a bad idea to get a healthcare provider’s opinion on this before you do it.

And Elemental Heal can also be used long-term, intermittently. What many people end up falling into, and there is research corroborating this approach, they will, on the front end, do two to four days as a mini reset, or one to three weeks as more formal kind of treatment. And then, from there, they will revert to longer-term intermittent use. There have been a number of studies showing this to be perfectly safe and effective.

Actually, in Crohn’s disease children, the children supplementing about half their calories in a day with an elemental diet, meaning about half their food came from these liquid shakes, they actually had better growth after, I believe it was a two-year follow-up window than kids who were not using these. And, again, that’s presumably because of the improved absorption of their nutrition.

So, what those children did, and what some people will do is, they will skip one meal per day, or most days, or maybe on some days they’ll skip two meals, and they will sip on an elemental shake. Again, nothing here outside of the realm of ordinary. Many people make some kind of protein shake or smoothie in the morning, and that’s their breakfast.

All we’re doing here is going a step further and making sure that that shake or smoothie is a hypoallergenic, fully balanced, and predigested elemental shake that won’t flare your gut, and doesn’t have any questionable ingredients in it that may set back your gut healing.

So, with that last answer, we kind of spoke to the question of how long. But, again, that can be used in one of three general ways: As a short-term reset, as a one to three-week treatment, or they can be used in the long-term, or what’s known as hybrid use. Just kind of going through this quickly here, because we’ve already touched on that.

So, which approach is best for you? As a general rule, the greater the severity of your symptoms or your condition, the longer the duration that you’d want to use these for. In Healthy Gut, Healthy You, I lay out more details. If you have severe IBS, or severe IBD, a two-day reset may not be enough. You may have to go to a full week or two. If you have pretty mild symptoms, a two-day reset may be ample.

And then, when you go to the hybrid use in the longer term where you’re replacing one or two meals per day, if you’re a severe case, you may want to go from exclusive liquid nutrition for two weeks, and then go to replacing two meals per day for a couple of weeks. So, you’re only having one meal per day, so you’re slowly bringing back in whole foods. And then after a number of weeks, you make that two whole foods meals per day, and one shake. You slowly wean down to maybe only one meal replacement shake per day after you’ve done the more complete one to three weeks as a full-on treatment.

It’s not that complicated, so I don’t want to give too many specific examples and make people think they have to follow one of those specific examples. The general rule that should guide you, and you should listen to your body along the way, the more severe your symptoms, the more exclusive you’ll probably have to use this to get yourself to a place where your symptoms have quelled, and then the slower and more gradual you should be in converting from exclusive elemental dieting to bringing your normal whole foods back into your diet.

Again, how should you use the Elemental Diet? The more severe the symptoms, the longer you may need it. The longer you do use it, the more important it is to transition to the hybrid approach. Meaning, if you had to use the elemental diet for two weeks to feel like you were getting to the point of being normal again, then you probably shouldn’t go right from that, fully off of it, back to whole foods. So, the longer you use it, the more important that you do a transitional wean from fully elemental dieting on your way to trying to be totally whole foods based. So, the longer you use it, the more important it is to have that transitionary period off.

I should also mention that when people start going on food again, they usually notice a little bit of a regression. So, the way this plays out, let’s say 0, you feel terrible, and 100, you feel amazing. So, let’s say someone started off at 30%. They went on the elemental diet, and after a week, they hit 90%. Great. They’re feeling so much better.

Then, they start to bring foods back in, and they regress to 70%. Now, what most people will do is they’ll get frustrated that they’ve regressed, but they’ll overlook the fact that they are still 40% better than their baseline. That’s really important to keep in mind, because this is not abnormal.

It’s important that you don’t stress out or defeat yourself, even though you’re actually on a somewhat normal trajectory. And this is where with the hybrid use, over time, that 70 should creep back up to 90, especially if you’re leveraging other supports like probiotics.

Also, remember, that this can be used as a periodic reset. So, let’s say you had to travel to Dominican Republic for a wedding. You’re traveling, your sleep is off, you’re drinking some alcohol, you’re having some non-planned food. Great. You’re doing all these things that I want you to do, right? That you should do. You shouldn’t be afraid of these things.

But depending on where you are on your gut-healing journey, that may be enough negative stimuli to set you back. And when you return, if you notice, “Oh, boy. My gut’s not feeling good,” or if your gut symptoms manifest more so in your joints, or your skin, or your sleep, or your mood, those symptoms have now regressed, you can go back on for a one, two, three, or four-day reset to allow your gut that rest and that chance to heal.

So how do you make these? It’s very straightforward. One cup of water — I actually like to dilute these with more than one cup of water. So, I might use two cups, 18 ounces or so, just so I can be drinking more and have them diluted so I can sip on it for a longer period. Four scoops of your Elemental Heal, and then depending on the version that you’re using, just check your label, the Low Carb and the Whey Free do not call for the addition of external fats. But you can add flax oil, or Udo’s oil, or MTC oil, and that can be added into the regular versions of our Elemental Heal.

And then you can either put it in a shaker bottle or in the blender. And I actually like putting ice in with the blender to make it a little bit frothy. And, there you go. It’s essentially like making a protein shake, which most people know how to do. So, it’s not anything too complicated there.

Now, what does the science say about safety? The bulk of the research has been done for those with inflammation and autoimmunity of the small intestine, as seen in Crohn’s disease. And a Cochrane systematic review examined long-term use of elemental diets and found them to improve the patients with Crohn’s.

And, as we talked about before, the patients examined used the elemental diet interchangeably with foods and obtained anywhere from 30 to 50% of their calories per day from an elemental diet over a period as long as three years. And it clearly helped patients and appeared very safe. This is important. This tells you that you can use the Elemental Heal as a meal replacement, daily, for a long period of time without any potential risk of nutrient deficiencies or other ill health effects.

Now, another randomized control trial looked at this, what’s called hybrid approach, where you get some of your food from elemental, some of your food from regular foodstuffs, and found that mixing food with Elemental Heal, or looked at mixing food with Elemental Heal in the long-term, and this is the study we touched on earlier. These patients who had Crohn’s disease were divided into two groups. And over a three-year period, the group that followed the hybrid use and got half of their calories from elemental diet and half from normal foods, those on the elemental diet hybrid cut their risk for digestive flares in half.

So, this is a really important point. When we look at a group of children with Crohn’s disease over a three-year period, those who were routinely using elemental diet had half the risk of having a digestive flare as compared to the other cohort who were just eating normal foodstuffs. So, this is why I think so many fall into a pattern of using the elemental diet.

Now, thankfully, after hearing this, if you had any concerns, those have been allayed. The food-only group had a 64% chance of relapse compared to a 34% chance of relapse in the hybrid group. So, a pretty notable difference there. Also, there were no adverse events reported, which illustrates the safety of this approach. And there is the reference for the study there.

Now, similar studies have reinforced the finding that this hybrid approach is helpful and safe. One study showed those doing the half-and-half approach, so half of your food per day, roughly, from elemental meal replacement shakes, had an improved quality of life. And even more evidence, other studies have even shown that those with Crohn’s who consumed more of the elemental liquid diet solution did better than those who consumed less when being tracked over a two-year period.

I want to be careful not to potentially misrepresent this. I don’t think that the elemental diets are contributing to healing actively. But what they’re doing is they are reducing your exposure to things that irritate your gut. And there does seem to be this important aim with gut health. It’s not about, “Well, we need to take all these gut-healing nutrients, glutamine, and collagen.” And oftentimes, these people will end up going on a very high-histamine, high-fiber diet.

Ironically, that flares them because it’s not just about putting nutrients into the gut that heal it. If nutrients like glutamine that heal the gut, or potentially probiotics, as in some fermented foods, come in a package with other things that flare your gut, then you are at a net loss. So, here, what the elemental diet I believe to be doing, coming back to the sprained ankle analogy, it’s giving your gut a chance to rest.

If you give the gut a chance to rest, it can heal. And it wants to heal, like any other tissue of your body. It has regenerative capabilities, and that program wants to run as long as there’s not an interfering factor present.

This is why I feel that those who consume more elemental diet actually had better outcomes, not because the elemental diet is this incredible healing tool. I’d love for that to be the case, but it’s probably a bit more simple than that, and more credit should go to your body, where all we’re doing is getting rid of the interfering factors that are thwarting your gut from healing, which it wants to do by default anyway.

Again, even though these are very safe, it’s always a good idea to speak with your doctor before starting any dietary changes. If you’re going to do this, never a bad idea to check in with your doctor. That said, there is really ample safety evidence.

I share this because some people seem to have, and I’ve made this remark before, it’s often that you’ll see, when intermittent fasting first came on the scene, there seemed to be all these media outlet interviews of some credentialed nutritionist saying, “Well, we’re concerned about people not getting enough nutrients,” and they missed a bigger point of the utility of intermittent fasting.

I think this is a similar sort of issue where I could see on some morning talk show someone’s brought in to say that we shouldn’t be using meal replacements. Which, I generally agree with. We should not be relying on meal replacements to get our nutrition. We should be relying on healthy, whole foods. However, if replacing one-ish meal per day heals your gut, then that should lead to healthier outcomes. And that’s exactly what all of this evidence here is showing.

So, a few different variables here, to be balanced. Because the elemental diets seem to allow those with gut inflammation and damage to heal, even though an elemental shake probably isn’t as nutritious as an organic, biodynamically raised meal of healthy vegetables, fruits, meats, and fats, you may actually end up being a healthier person by doing that because it reduces the inflammation in the intestines that thwarts absorption and does not allow your intestinal tissue to heal.


Episode Wrap-Up

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So, concept summary. An elemental diet can work very well to improve gut health for those who have not responded to other interventions. Liquid elemental diets have been shown to have impressive results for IBS, SIBO, and IBD. They are very safe but should be used under a doctor’s supervision if you’re going to be doing this exclusively for anywhere from one to three weeks.

You can learn more here at healthyguthealthyyoubook.com. These are our elemental diet formulas. These two are original. Now, we actually have the two additional low-carb and whey-free versions.

A few final questions here, to follow up. Is the Elemental Heal diet different from the liquid elemental diet, or are they the same thing? Yes, they are exactly the same thing. Elemental Heal is just our product, which is a liquid elemental diet. So, one is a product name, the other is the therapy name.

What supplements do I take after I’m done with the Elemental Heal diet? Well, remember, one approach is using it as a daily, or on most days, meal replacement. Additionally, no specific supplements are required. But two helpful, supportive strategies. One, as I just mentioned, Elemental Heal as a daily meal replacement. And then, two, and this is my daily gut health protocol, I take all three of our probiotics, our Lacto-Bifido Blend, our Saccharomyces Boulardii, and our Soil-Based Probiotic, and our Gut Rebuild Nutrients which helps with the repair of the intestinal lining. So, if you wanted to add something to Elemental Heal, this would definitely be a great adjunct.

And now, what you’re doing is you’re giving your gut a chance to rest and to heal with the Elemental Heal, plus you’re supporting balance, your microbiota, and a healthy anti-inflammatory immune balancing effect with the probiotics, plus providing some nutrients to help with healing and repair of the lining of your gut.

This together can be quite powerful, and this can be the difference between someone who’s feeling like their gut’s always getting a flare, and someone who feels like they can pretty much do whatever they want, within reason, and not having symptoms.

I understand that this is taking a bunch of stuff. And for me, personally, it’s worth taking some stuff in the long term and not have to worry about, “Well, I had some of that, and it flared my gut. And now, I’m feeling foggy. I guess I’ve got to be more careful with where I eat, what I eat, when I eat, how I eat.” If we can get one to a point where they don’t have to be so discriminatory with all their food and lifestyle choices, then that’s a really big lifestyle win.

Another question. What if I’m lactose and casein intolerant? Can I use the product? Yes. Elemental Heal is lactose and casein-free. We get so many questions about Elemental Heal, “I’m lactose intolerant.” On the label, it says “lactose-free”. So, I don’t know how much more clear we could make that. But, yes, all the Elemental Heals are lactose and casein-free. This is what causes the vast majority of dairy intolerance problems.

Is Elemental Heal okay for people with dairy allergies and intolerances? Yes, for most, because it’s lactose and casein-free.

What if you’re allergic to whey, though? What if you notice a problem with whey protein? Well, two things. Be cautious. Elemental Heal, the regular one, uses whey protein. However, not all whey proteins are lactose-free like ours is, and many use fillers and excipients that irritate the gut. So, you may do okay with Elemental Heal, and it’s worth a cautious trial. Or, you can try our alternative version. It’s actually out now, which is Elemental Heal Whey Free.

Do you recommend Elemental Heal if you have an allergy to milk proteins and not just lactose intolerance? Potentially, again, worth a cautious trial. Or, try our available Elemental Heal Whey Free.

Can Elemental Heal help with weight loss? Potentially, if used as a meal replacement and toward the aim of reducing total daily caloric intake. Or, it also may help via reduced inflammation as your gut heals.

Will the carbs in Elemental Heal feed fungus or candida? We talked on this earlier, but there’s no research to officially answer this question. In my opinion, no. Why? Because it is absorbed in the first few feet of the small intestine. So, it should have the ability to starve the fungus, just like it starves bacteria. This is a crucially important point to understand.

The first couple feet of the intestine is right where the food’s coming out of the stomach, and then into the intestine. This is still fairly acidic, so this area of the small intestine is not prone to bacterial and fungal overgrowth because of that acid. This is where Elemental Heal and the carbs in it are being absorbed, so you have almost no risk. And then the rest of the intestinal tract is not going to be touched by the carbs because they’re already absorbed. So, I think it’s a real misnomer to think that people will get fungal overgrowths because Elemental Heal contains carbohydrates.

Some people will get a little bit of oral thrush, or whiteness on their tongue. That’s likely more so due to just direct contact with the mouth and using a mouth rinse or mouthwash can guard against that. Or, when people get off of exclusive use, that oftentimes goes right away, while they’re also experiencing, in most cases, pretty marked improvements in digestive health.

Is Elemental Heal safe for children? Yes. We covered this earlier. Robust research showing benefit for children with inflammatory bowel disease: reduced symptoms, less relapse, improved growth.

Can Elemental Heal be used by highly active people? Yes. Why? It is a highly absorbable form of calories. Many patients have noted they feel improved energy and vigor during a workout. This is my clinical observation, not published. Make sure you are getting enough calories, though. Again, this makes complete sense.

If you are eating a normal diet but you were barely absorbing those calories, you start using Elemental Heal, now you’re absorbing all those calories, yes, you would have better energy in the gym. But ultimately, here, listen to your body. 

Can Elemental Heal be used all day? I prefer to blend up all of my Elemental Heal shakes at the beginning of the day, but on the bottle, it says to consume within four hours. Why is that? What happens after four hours? This is just a precautionary note to make sure that it does not spoil. If you’re keeping it cool, then you are fine to use it all day.

Proteins, once they’re mixed with water and oils, after left out at room temperature, they might get a little bit rancid. They may not smell great. As long as you’re keeping it out of heat, out of direct sunlight, keeping it somewhat cool, you should be absolutely fine.

So, those are the questions. Great questions. Very important, very relevant. Again, for a more expanded narrative, you can see Healthy Gut, Healthy You in terms of where does Elemental Heal fit into the larger health picture. And if you go to our website drrusciodc.com/elemental-heal, you can learn more.

And I hope that if you haven’t tried Elemental Heal yet, you will. It’s definitely a great adjunct to your plan. And hopefully, you’re understanding that gut health oftentimes requires a few various types of support to really encourage the healthiest balance in that ecosystem, that complex ecosystem that is your gut. So, this is one approach that is very helpful, and as the research shows, it can be used quite effectively to reduce inflammation, to starve overgrowths, and to really allow your gut to have periods of rest so that it can heal.

So, I hope this has been helpful. And if you have any other questions, please let me know.

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