Using the Liquid Elemental Diet to Heal Your Gut, SIBO, IBS and Methylation – Q&A

Okay, so hopefully, that is helpful. Again, if you want to understand that in more detail, I outline that in the book. One of the lessons is don’t think small. Don’t think about mechanism. Think about outcome. This is a key point because I’ve seen so many times people get wrapped up in the mechanism. And then they talk themselves out of things that could help them because they think that mechanism is the most important thing. And then only later do they find out that their thinking was erroneous. And they finally undergo the therapy that was able to help them because they were able to get to the what and not get overly wrapped up in the why.

Listener Question 2

So continuing along this same vein, Robbie asks,

“Curious as to why you used folic acid instead of folate. I have the MTHFR gene, and I’ve been told to stay away from folic acid because it blocks the methylation pathway. Dr. Ben Lynch recommends staying away from it. Any chance, you’ll discontinue folic acid in your elemental drink?”

So again, this is someone who is talking a why. And they’re potentially thwarting their ability to try a successful treatment because they’re not looking at the what. The what outcome is that for people, even with MTHFR presumably, because we have large data sets in various populations showing the elemental diet can be helpful—some of those people likely have MTHFR and still have a positive outcome.

Remember that one of the best ways to optimize methylation—and many methylation experts agree on this—is by fixing your gut. So if the elemental diet helps you fix your gut, that trumps the fact that an elemental diet formula may have folic acid in it, which I believe virtually every elemental formula with the exception of maybe one contains folic acid. So I think it’s a moot point.

But again, to try to get into some of this why even though we shouldn’t—we should be focusing on the outcome. I’ll put up here on the screen for you a study that essentially found a group of patients, a large group of patients in Asia who had MTHFR and were given folic acid—yes, folic acid, which is supposed to be poisonous—actually saw I believe it was a 30% reduction in stroke.

Okay, so I think there are many inferences that are being drawn from gene data that have not been borne out yet. So I would not get overly pulled into that world. Here is one example that illustrates that people with MTHFR actually benefited from folic acid supplementation. Could you criticize some of the finer points of this study? Potentially. But I think it illustrates a very powerful point which is the utility of gene testing is really not there yet clinically. We are still very early in our understanding. And I think there’s much that we don’t yet fully understand.

Now, let me outline that further yet still because I don’t want to come off as a contrarian. I’m open to anything that has been shown to be helpful. But the gene testing doesn’t seem to have been shown to be helpful yet. Rather, there are mechanisms that we can infer if we facilitate a certain mechanism may help someone. But you have to qualify that in an outcome study with humans. You have to qualify that that mechanism, when facilitated or downregulated or upregulated or whatever, actually will produce a health outcome in the people that undergo that intervention.

So we’ve already shown a large study in an Asian population who were administered folic acid and had MTHFR (so they shouldn’t be taking folic acid) actually had a reduction in stroke. But let’s look at other evidence that supports this.

The DIETFITS Study by Christopher Gardner over at Stanford. His study essentially found that genotype was unable to predict who would respond to a diet in any beneficial way. Meaning patients went through these gene tests. The gene tests suggested this diet. And the gene-guided diet had no impact on outcomes for weight.

Further yet still, another study has shown in an ApoE cohort that may be at high risk for cardiovascular involvement that a gene-guided diet had no benefit compared to a normal control diet for improving cardiovascular risk markers.

So I understand that if you don’t feel well and someone tells you about this mechanism of MTHFR slowing down your detoxification and needing folate to help with that, I understand it’s attractive.

But right now, I don’t think that the data is there supporting these approaches. Now, I’ll be very happy to change my mind when we can show some positive outcome. But for right now, for methylation, I think the best thing you can do is optimize the health of your gut.

Dr. Kara Fitzgerald describes this, I think, very eloquently as addressing methylation upstream. So now you get to the upstream source of a toxic burden in your body, the gut. And by alleviating that, you alleviate all these detox pathways that may not be running optimally, perchance that could be MTHFR, by addressing the upstream source of the problem.

So if you have MTHFR, I have zero concern with you using Elemental Heal due to the folic acid content.

Listener Question 3

And then finally, B.L. asks,

“Does the elemental diet work to reduce hydrogen sulfide SIBO?”

Again, there are some potentially faulty presumptions built into this question. How do you know you have hydrogen sulfide SIBO? This is not available outside of the research setting, testing for the hydrogen sulfide SIBO, that is. There is a urine test that may speculatively tell you that you have hydrogen sulfide SIBO. But it is in no way, shape, or form validated. So this is likely a presumed hydrogen sulfide SIBO.

Why is it presumed? It’s probably presumed because this person tested negative for SIBO via the breath test but has symptoms. So what you’re actually asking is, “Can the elemental diet help for digestive symptoms in someone who is negative for SIBO?” And the answer there is, “Absolutely, yes.”

Now, is it guaranteed? No. No treatment is 100% guaranteed. There’s always a subset of people that may not respond well to any therapy. But the elemental diet tends to be very helpful for digestive involvement as a general rule.

So again, I don’t mean to be overly critical or nitpicky. But it’s important to understand when we are getting too granular and mechanistic in our thinking. Natural and alternative medicine claims to be holistic. So you would think the way that we look at these things would be holistic. But instead, there’s a tendency to look at things in these very reductionistic frameworks.

“I can’t use the elemental diet because it contains folic acid, and I have MTHFR.”

“I can’t use the elemental diet because you’ll be sipping that throughout the day and never be fasted. And therefore, you won’t be able to have a migratory motor complex facilitation.”

Those are very reductionistic ways of looking at your healthcare and the human body. So it’s important to zoom out and look at what the outcome data shows. What happens in people in clinical trials undergoing these interventions? And the good news is, a lot of benefit is vectored by the elemental diet.

It doesn’t mean it’s going to work for everyone. It doesn’t mean that for some people there may not be a negative reaction. But I want to try to zoom us out and get people away from thinking in these very reduced, very mechanistic frameworks because I see routinely patients who, again, have talked themselves out of undergoing certain therapies that have been shown to be helpful because they read something about a mechanism that may be associated with that treatment that may not be good. Yet they’re missing the fact that there’s this outcome data showing that, “When a person like you does this treatment, there’s a general tendency to see global improvement in how they’re feeling.”

So don’t overlook the simple outcome data at the expense of the convoluted mechanisms because that can mislead you. And ultimately, it will be a disservice to you. Or if you’re a clinician thinking this way, it will be a disservice to your patient.

And again, regarding all this, I remain open as the body of evidence and literature evolves. But for right now, I want to try to prevent people from getting pulled into speculation, especially with gene testing. I don’t think we’re there yet. And I want to prevent people from thinking that, for whatever reason due to meal frequency, an elemental diet may not be a health-promoting treatment.

If you wanted to learn more about the elemental diet, there’s a whole section about this in my book Healthy Gut, Healthy You that details the different formulas that can be used, how they can be used, the safety data, troubleshooting. And so I’d highly recommend checking out the book.

And the elemental diet formula that we’ve released is called Elemental Heal. And I invite you to try that per the guidelines laid out in Healthy Gut, Healthy You.

Remember, don’t think small. Even though sometimes these mechanisms seem alluring, they can often mislead you. So keep your thinking big picture. And truly this can help you get healthy and get back to your life.

This is Dr. Ruscio. I hope this has helped you. If you have any questions or comments, please let me know. Thank you.

What do you think? I would like to hear your thoughts or experience with this.

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Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.