Practitioner Question of the Month – August 2018

Elemental Diet Tips & Troubleshooting

Joe Mather

Way back in your November case series you mention troubleshooting common problems seen on an elemental diet.

Can you expand on the most common problems you see while implementing the ED or SED? What role does oil of oregano play in helping reduce those problems?

I observe that oregano can be caustic/irritating to some patients and always have them take it with food. It seems that these issues would be worse on an ED…

Another good question Joe. Some people will not tolerate the elemental diet no matter what you do, this is important to understand. It doesn’t matter if they use fully elemental or semi-elemental.

Have someone perform a short trial on a few versions and see if there is one that is tolerated. Co-administration of antimicrobials can help with reactions in some, but not in all people – so they are worth a trial also. Some will have short-term turbulence, 3-5 days, and then be OK. Some will see many symptoms improve but have a couple symptoms regress. For example, all their GI CCs improve other than loose stools which become a bit worse. In these cases, it is sometimes a short-term sacrifice for long-term gain, but this is a clinical call to be taken on a case-by-case basis.

Some will feel full/exclusive compliance difficult. If this is the case, it’s OK to allow them to have some food during. 80% elemental is better than 0% elemental, and there are data to support this – expanded upon in “Healthy gut, Healthy you”.

Also, remember the more severe the symptoms and the longer one needed to be on the elemental diet, the more likely they will do best when then transitioning onto the hybrid use of the elemental diet followed by a gradual taper off.

Finally, many feel the elemental diet to be harder than it actually is because of misinformation on the internet. You may have to deprogram some patients first before you get buy-in. “The new formulas taste better than what you read on the internet, they are also filling, thus making the elemental diet not nearly as difficult as portrayed on the internet.”

Most of the above are expanded upon in my book. Hope this helps!

Periodically do something you ask your patients to do

I don’t agree with the statement ‘I never ask my patients to do anything I haven’t done’. I feel this to be well-intentioned but a little naïve. One could not expect a clinician to do everything in their clinical repertoire to themselves. However, this idea comes from a good place and is something we should take into consideration.

Periodically, it is a good idea to do what it is you are asking your patients to do. This helps keep you connected. For example, if you are doling out SIBO breath retesting, you might think twice after you went through a 1-day prep diet combined with the 3-hour serial collection. Or, being hard driving on advising ‘cut out all coffee for a month’ might become a bit softened after you try it thus leading to a revision of ‘cut out all coffee to the best of your ability’ or ‘generally avoid coffee other than special occasions’ or ‘only consume coffee 2 days per week’. The change here is subtle but can be powerful in making your recommendations able to be followed by your patients. Remember, we want to be reasonable in our recommendations so that we can serve more than a small group of supremely motivated people.

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I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next practitioner question of the month.