SIBO and the Elemental Diet
Great news! We now have clinical trial evidence that a 14-day elemental diet is “highly effective” with an 80 – 84% success at eradicating small intestinal bacterial overgrowth (SIBO) because: “Elemental diets have been shown to reduce enteric flora.”
Dr. Alison Siebecker has a lot of great information about SIBO and appropriate treatments and here is her info page on SIBO and elemental diets.
Interesting to note, the product used in the trial was Nestle’s Vivonex. However, on their product page for Vivonex:
Nestle does not give the full ingredient list – which I find crazy, but anyway, the important specs to note are that the maltodextrin (carb component) of Vivonex is 57 g and the protein is only 13.5 g
Whereas with Absorb Plus, the maltodextrin averages (between flavors) 53 g and the protein is 27 g per serving.
What makes Absorb Plus expensive?
Keep in mind, the most expensive part of an elemental shake is the protein and amino acid component – this is where you’ll find most companies skimp – which is one of the reasons they’re cheaper than Absorb Plus.
Here’s the detailed ingredient list for Vivonex Plus I was finally able to find on Walgreen’s Pharmacy site – this is for the Unflavored version (so only good for tube feeding) BUT you can see from the ingredient list and the forms of some of the vitamins that the flavored versions are probably going to be artificial flavoring (I’ve bolded the worst offenders) – and the maltodextrin, cornstarch and soybean are likely GMO:
The ingredient list for Vivonex Plus
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Absorb Plus Variants
Absorb Plus uses only tapioca maltodextrin and all natural flavors and sweeteners. To avoid all fructose you would use the Unsweetened Versions of Absorb Plus – and then sweeten it to your taste with Stevia, monk fruit, or your choice of sweetener.
We also have Absorb Plus Vegan and Absorb Plus Amino for those of you who are allergic to the whey isolate in Absorb Plus (contains no casein and no lactose). And come in sweetened or unsweetened versions.
If you are using an exclusively elemental diet for SIBO, IBS, Candida, or allergy testing/clearance (and you don’t need to gain weight) then the Absorb Plus Amino formula may work better for a shorter duration diet (1-2 weeks) due to the lowered carb content.
Complete instructions on following my ‘healing-spa version’ of an elemental diet are found in my book, The IBD Remission Diet. Or you can read a quick overview here.
do you have any testimonials of people using your elemental diet to treat SIBO? I’ve been doing a semi-elemental diet with the unsweetened absorb plus, and i feel it’s been helping.
However, with my SIBO, I’ll likely need to do a full elemental diet, and I’m debating whether to use Dr. Siebecker’s formula or use absorb plus.
Would love any feedback or information supporting the use of absorb plus for SIBO.
Thanks,
Jen
Hi Jen,
We’ve received feedback from customers via email, phone, blog comments and chat but no one has specifically left a testimonial at our testimonials page here:
http://www.listentoyourgut.com/testimonials
However, there is currently one review other than yours at the product page from someone with SIBO that was posted in November of last year:
https://shoppe.listentoyourgut.com/absorb-plus-unsweetened/
(click the reviews tab)
If cost is a factor or you prefer the DIY approach, here’s a download link to Jini’s formula for a basic elemental shake as another option:
http://ltygblog.s3.amazonaws.com/how-to-make-elemental-shake.pdf
Regardless of which path you decide to take, we’d love to hear more about your journey and thanks so much for writing in.
Kind regards,
Justin
Customer Care
Hi Jen,
I’m a functional Medicine practitioner who specialises in clinical nutrition.
My speciality is gut related problems. I find a that at least 70 percent of my serious gut patients test positive for SIBO.
I have used absorb plus for my own daughter who I healed from indeterminate Chron’s colitis using Jini’s books whilst studying for a clinical nutrition qualification.
I live in the UK and convinced one of the supplement companies to stock it here. It is now listed under the SIBO section on the website and is always sold out.
I recommend it to a lot of patients and I especially recommend the unsweetened version to SIBO patients. I use Dr. Jacobi’s bi-physic diet along side absorb plus for extra protein and amino acids. I have almost 100 percent success rate with my SIBO patients. I can’t recommend it enough. I do also use it for flare ups and maintenance for patients with IBD too.
I hope that helps to answer your question.
Best
Nishtha Patel
HI
Just read your interesting comment – when you use Absorb Plus, do you use it as full elemental or semi? I’m not well enough to do full elemental (I have severe M.E and am very underweight due to SIBO complications). Could it still be as effective as a semi elemental diet? Also a bit concerned about going from a very low carb diet to drinking shakes high in carbs!
Hi Jennifer,
Absorb Plus can be used as either a full elemental diet or semi elemental diet. Jini states in the The IBD Remission Diet, “The remission rates are not as high as a full elemental diet, but they are certainly high enough to be considered a serious treatment option.” If you would like to contact Nishta directly, please follow this blog where you can find her contact info and read her story, https://blog.listentoyourgut.com/mom-heals-daughter-using-jinis-protocols-then-becomes-a-doctor/.
Kind regards,
Isabel
Customer Care
I have SIBO and am doing the Elemental Diet to heal from a terrible Crohn’s flare. If I have SIBO, do I need to avoid the sweetened varieties that contain Fructose? I’m trying desperately to get this right and not waste any time, but am afraid I may be setting myself back with the sweetened varieties. Any feedback you can give me would be VERY helpful! Thank you!
Hi Martha,
To be on the safe side, we recommend the Unsweetened Vanilla flavor for people with SIBO. There isn’t very much fructose in the other flavors (8g in the chocolate, for example) so it’s not terribly likely to cause issues if you purchased those and need to finish up some open containers. If you have concerns or feel like the fructose might be causing issues, you can always just mix 1 scoop of the sweetened with 3 scoops of the unsweetened for a full serving so that the sweetened tubs don’t go to waste.
Kind regards,
Justin
Customer Care
I’m wondering what’s the best way to determine if you’re allergic/intolerant to Absorb Plus (whey)?
I have moderate-severe IBD and IBS and I’ve been taking chocolate Absorb Plus for the past 5 days and I’ve been feeling more ill than before. I haven’t had dairy in 15 years due to apparent lactose intolerance. Within 1-10 minutes of starting a shake I need to run to the bathroom. I believe my stomach pains/nausea/stomach noises have gotten a bit worse and my bowel movements have doubled in frequency from about 10x a day to almost 20x. I started slowly with about 3 shakes a day (half elemental diet). Have not started the oregano or probiotics yet.
Wondering if the sun warrior vegan protein would be better for me even though its not elemental?
Your thoughts are greatly appreciated,
Sara
Hi Sara,
Our first recommendation would be to check out the link below to another blog post where Jini talks about possible signs of allergy and different things you can do to combat the symptoms you’re talking about if allergy doesn’t turn out to be the issue:
https://blog.listentoyourgut.com/bowel-issues-on-an-elemental-diet/
If the whey protein ends up being something that you aren’t able to tolerate then the vegan protein might be a good option for you. If you haven’t seen it already, Jini talks all about how to build a vegan elemental shake here:
https://blog.listentoyourgut.com/how-to-make-a-vegan-elemental-shake/
Kind regards,
Justin
Customer Care
I am doing the elemental diet for SIBO but am sensitive to whey, so I got the vegan shake kit. But now having read the ingredient list more closely, I see it contains xantham gum which is an indigestible polysaccharide. Won’t this still feed the bacterial overgrowth in the small intestine if is not absorbed? I hate to think I wasted a week of just doing the shakes if it’s still feeding the bacteria.
Any help would be appreciated. Thanks, AJ
I think you answered yer own question. It’s ALWAYS good to read ingredients lists and educate yerself on the consequences they can create. EXCELLENT observation!
“Xanthan gum appears to have a high propensity for altering the gut microbiome, and it’s unclear whether that alteration could be problematic in the long run.”
– Chris Kresser
Hello, I am currently battling SIBO for the 4th time and for the 1st time opted to do the Elemetal Diet. Unfortunately, I just discovered this website and wish I had the opportunity to compare the different products before starting on Integrative Therapuetics Elemental formula. I purchased 19 days worth already and started on Monday, Februray 19th 2017. I don’t see a protein content and my sinus feels disturbed. The taste is very tolerable but I am already starting to ecperience headaches and body aches. I would like to know if I can have bone broth from Grass Fed beef bone marrow while on the Elemental Diet or just use the shake?
I have been immine compromised since a child and am now 56 years young. I have been soooo compromised for so many years with autoimmune, candida, thyroid, food poisoning, etc. I firmly believe the root of all stems from my gut and multiple infections…. in particular, Eptein Bar Virus. I have never been able to tolerate probiotics and have tried multiple. Your approach and support of Natren causes me to pause and greatly consider a trial. I will purchase your book today and further research. I desperaely want a LIFE!!! I have been so compromised for so many years. I hope your well researched and humane approach to service others as a result of your health recovery can be of great assistance to me.
Hi Antoinette,
Thank you for reaching out! Yes, you can alternate Elemental shakes with Bone broths since the gelatin in the broth is very healing for the gut and the savory soup provides needed taste variety. We wish you all the best on your healing journey!
Kind Regards,
Cris B
Customer Care
Thank you Cris. I am interested in trying a Natren probiotic. Should I wait until after the Elemetal Diet? And which one should I try 1st, as I am extremely sensitive?
Thank you
You’re welcome! You can start the Probiotics supplementation while on Elemental diet and Oregano protocol. If you are highly sensitive, then start out with small amounts and very gradually build the dose up. In these cases, it is often best to start with an infant species of bacteria called B. infantis and then gradually work your way up to the adult species like L. acidophilus, B. bifidus and L. bulgaricus. You just have to test a little bit (a pinch, or 1/8 tsp) and see how your gut reacts. If you get too much die-off, or bloating etc. then it’s too soon, or you need to go slower. Everyone’s pace is different, so you need to listen to your own gut.
Kind Regards,
Cris B
Customer Care
Thank you once again Cris. Should I consider taking some form of vitamins while on the Elemental Diet? I don’t know if I should concern myself with making sure I have enough nutrients in my system? I am fasting for 3 weeks and longer if I need to.
Antoinette
Hi Antoinette,
Yes, Jini recommends taking nano sized minerals, Vit D3, Cod liver oil, Pycnogenol, Coenzyme Q10, Ansgtrom Iron if you’re anemic and Vitamin C in mineral Ascorbate for your immune system. Each of these supplements is vital for healing the various symptoms, and they also work synergistically to accelerate healing. Also Jini recommends looking into all aspects in your life in healing, emotional, household products, etc. It can all effect your physical health. However, she does also recommend to listen to your body on what is best for you.
Kind Regards,
Cris B
Customer Care
Hello, I’ve got SIBO and am on Day 12 of my 14-day Absorb-Plus powered elemental diet. I have a few questions.
1. I ordered 2 tubs for a test, but then ran out before my bigger shipment of 7 tubs came in. In the mean time, I made my own shakes for 2-3 days using:
1 scoop Now Sports Whey Protein Isolate
50 grams maltodextrin (derived from corn)
1 TBSP virgin cold-pressed Coconut Oil or Flax Oil
vitamin capsules emptied into mix. (multivitamin, B-complex, E IU400, C-500)
1 cup water
Was the whey protein a good choice?
I am scared that the maltodextrin being corn-based may have messed up the diet. The homemade shakes definitely didn’t satisfy like Absorb Plus does.
2. If I wanted to adjust my macronutrients to fewer carbs and more protein in order to reduce body fat while on this diet, and replaced 1-scoop of Absorb Plus with 1-scoop of Now Sports Whey Protein Isolate, do you see any issue with this? Again, I’m trying to eliminate SIBO, so I wouldn’t want to do anything to reduce my chances of success.
Finally, any suggestions on how to start eating after two weeks? Get back on low Fodmaps? Challenge phase? Just start eating hamburgers and ice cream again like the good old days?
If it worked to eliminate SIBO, should I expect my symptoms to immediately go away when I start eating normal foods again?
Thanks so much.
Hi Sandy,
Thank you for contacting Listen to your Gut. The goal is always remission so the transition back to normal food should start when symptoms have disappeared. We have not tested this type of Protein powder, so we cannot say anything about it. If you want to alternate Absorb Plus with a highly nutritious protein powder that we have tried and beneficial to get rid of SIBO, try this grass-fed whey protein that is minimally pasteurized and from completely grass-fed herds. BUT it also contains less than 1% casein AND less than 10% lactose!
If you prefer a veggie protein, or just want some variety, we found a vegan sprouted brown rice protein that is not only sprouted, but also free of all the usual myriad of greens, seeds, roots and other nutrients that are great for normal digestive systems; but not so good for sensitive systems like SIBO.
Yes, Fodmaps, then see if you can eat more. When starting a new diet Jini recommends to ask your body and gut how long it needs to be on. And then even if you start feeling better before the end of that time keep on the diet until that time as you could feel better without being as healed as you need to be.
Then when you do feel you are well enough to go off the diet we would recommend still just adding in new foods one at a time slowly. Jini recommend just one new food every 3 days to make sure it is not bothering you. Also, best to do a food diary while doing these diets, supplements, and adding in new food to try to pinpoint if anything is bothering you.
We hope that works out for you.
Kind Regards,
Cris B
Customer Care
Hi there, excuse my ignorance on this as I might have missed it. I am thinking of doing an elemental diet for my SIBO.
I would use the unsweetened powder. But, what else would I need to add? Is there a guide to go off of? I did watch one of Jinis YouTube’s and what ingredients she adds but I thought I’d ask
Thank you,
Amanda
Amanda
Hi Amanda,
Thanks for contacting us here. No, we don’t have a guide specifically for SIBO. However, as Jini writes in The IBD Remission Diet book, it’s a very good idea and she encourages you to add organic, unrefined, cold-pressed, flax seed oil to increase Omega-3 and ‘good fat’ (Essential Fatty Acid) levels in your body, if you wish. Jini didn’t include any flax oil in Absorb Plus because she wanted the product to work for people who have a complete fat intolerance, plus any cold-pressed oil needs to be kept refrigerated and in a dark container at all times or the fat denatures and becomes rancid so this would pose serious problems in shipping the product to you. Lastly, different people can tolerate different levels of fat (dependent on type and location of illness and degree of inflammation), so Jini felt it best to allow you to add the level of fat that’s right for you.
Once you’re ready to to come off the elemental diet (as per Jini’s book, The IBD Remission Diet), we have some well-tolerated protein shake recipes here which are better tolerated than normal food. People use these shakes when they’re ready to transition off an elemental diet, before they start eating regular food. So these shakes may be all you need. Check link below:
https://blog.listentoyourgut.com/easy-ways-to-transition-off-an-elemental-diet/
Please let me know if you have any additional questions,
Cris B
Customer Care
Hi,
I have a quick question. Since the sugar content is so high, is there any sort of recommended fungal overgrowth preventative measure to take to prevent any sort of fungal overgrowth since it’s so hard to test for that before you start an ED? Seems like a high percentage of sibo sufferers also have coinciding fungal overgrowth too.
Hi Eric,
Thank you for reaching out! Absorb Plus uses Tapioca Maltodextrin because without it a bowel rest diet using only whey protein (no carbohydrate component) will quickly surpass your maximum daily protein limit whilst still feeling really hungry and tired. But more importantly, you will likely not gain any weight, so will remain very thin and weak, with low energy and lots of fatigue.
In The IBD Remission Diet, SIBO (that can be exacerbated by the maltodextrin) is addressed by using Jini’s Wild Oregano Oil Protocol (a broad-spectrum anti-pathogen) in combination with high dose Natren probiotics and in many cases, people use Jini’s Probiotic Retention Enema as well. SIBO is also addressed strongly after the Diet, with high dose oral probiotic supplementation for at least 6 months. Many people (especially if they are infected with mycobacteria) also continue on Jini’s Wild Oregano Oil Protocol for 2 – 3 more years (cycling on and off every few months).
Please check Jini’s IBD Remission Diet Chapter Three: Probiotics Supplementation – Page 72 and Chapter 6 pages 128-131 for Oregano Protocol.
Kind Regards,
Cris B
Customer Care
Hi, i have just been diagnosed with Sibo from which I have been suffering for years. I would like to start absorbplus unsweetened vanilla but I am concerned of my weight. I am a female, 178 centimetres tall (5’10) and 60 kilograms (9,45 stone). That means that one 1 kilogram of absorbplus is barely or just enough for two days to maintain my weight? I don’t want to lose my weight.Or is there any way to make it last longer by adding things to it but keeping fully elemental?
Also I think I have problems with my motility ( I have these symptoms since Sibo started) . Sorry I don’t want to be descriptive but I can’t go to the toilet ( sorry) for 2-3 weeks, as if my digestion stopped. But if I drink coffee which now I do on a daily basis, it makes me go 10 minutes after drinking it.is there any pro kinetic I could use and safe? Thank you very much for your help.
Kind regards, Kat
Hi Kat. We recommend adding oil to your Absorb Plus shakes for added fat, since AP itself has no fat. You can learn more about this here: https://blog.listentoyourgut.com/should-i-add-oil-to-my-absorb-plus-shakes/
You can also alternate with broths – read about benefits here, and there are 4 homemade broth recipes throughout this post: https://blog.listentoyourgut.com/the-health-benefits-of-broths/
Here are several more posts I feel will benefit you:
https://blog.listentoyourgut.com/when-you-cannot-afford-to-do-an-elemental-diet/
https://blog.listentoyourgut.com/use-common-foods-to-heal-inflammatory-bowel-disease/
https://blog.listentoyourgut.com/help-for-ongoing-sibo-ibs-gut-issues/
https://blog.listentoyourgut.com/how-to-use-an-elemental-diet-to-treat-sibo-ibs/
https://blog.listentoyourgut.com/next-level-elemental-diet-for-crohns-colitis-diverticulitis-sibo-and-ibs/
I hope this helps!
Hi,
I have sibo Hydrogen/methane combined and I am doing a semielemental diet using hydrolyzed whey isolate in the formula made by dr allison seibecker mentioned on your website. My question is about the probiotics. I have gastroparesis and very low motility due to hypothyroidism.
Is it ok to use probiotics when you have low motility which seems like they will just allow them to settle in the small intestine creating more SIBO?
Also, before starting the semi-elemental diet i was taking something for motility which i have stopped since starting the diet. Should I keep taking the product for the motility even during the diet until my thyroid is optimized and the motility comes back on its own?
thanks!
Melannie
Hi Melannie, if it were me, I would take Magnesium Citrate (up to 1,000 mg per day) and Vitamin C in ascorbic acid form (up to 10,000 mg per day) to encourage bowel motility. Both these are allowed on an elemental diet.
Once you have the motility issue sorted, you can then proceed as you wish with probiotic supplementation – test it and see how your body responds. And one more thing: Natren’s Digesta-Lac is often very helpful with constipation, so I would take that species first.
I can’t thank you enough for responding! I am sorry iasked the same question twice. My brain is not really in top form right at the moment. I responded back to you on the other question with a follow up question. I will definitly check out the natren digesta-lac once i get my motility and mmc working again.
thanks again: can’t tell you what it means to me!
Melannie
I would like your observation as to my unexpected result.. I did a 28 day full elemental diet in 2018 with Integrative Therapuetics and had a completely negative reaction. I became extremely bloated, SIBO increased and my test results were off the charts! I became so despondent as a result and hopeless. I can’t figure out why my body responded this way. Any thoughts
Thank you
Antoinette
That’s really interesting. I’ve never heard of that before. Did you use the dextrose-free version?
Hi Antoinette, I can’t know for sure, but here are my thoughts:
– I’m surprised you did 28 days, most people with SIBO do 14 days, so perhaps that’s a factor
– the Integrative Therapeutics formula only contains 5g of free-form amino acids per serving. So that’s a very small amount and a very low protein intake. The balance of the formula is carbs (dextrose and maltodextrin). So if you also have a Candida albicans overgrowth, then the carbs will be feeding the Candida and making it much worse.
– If you were simultaneously taking a broad-spectrum anti-pathogen (like wild oregano or olive leaf) that would help to control the yeast/fungus and also any bad bacteria that are benefiting from the carbs.
Personally, I think everyone with SIBO would have better results from following my Wild Oregano Oil Protocol and high dose oral Natren probiotics, along with a low carb, low residue diet. If I had SIBO, that’s what I’d do! Details are here: https://listentoyourgut.com/jinis-healing-guide-natural-treatments-for-gut-infection-ebook/
Hope that helps!
Also, for what it’s worth, my methane was around 45 and hydrogen around 10 and 15 days of the dextrose-free physician elemental diet normalized the numbers. If you were doing the one with sugar, it can be a lot of sugar per serving. If I remember correctly like 11g per serving? I would do 2 scoops 6x a day. You could potentially be looking at 130-150g of sugar a day. I would agree with Jini, use oregano or other antifungal/antimicrobial along with the dextrose free version. Her protocol sounds solid and give that a try. If you’re looking to try the elemental again, try the dextrose-free version. Just my two cents.
I thank you so much for your response. I would like to take you up on your recommedation. Does Absorb Plus have a dextrose free version? I am a little confused. I want to attempt again and include all your recommendations. I am so tired of dealing with this and the repeated rounds of Rifaxin. It has my hormones, muscles, hair and overall skin flacid, dry, wasting and just blah!! I must have malabsorption. And, I do believe I am in need of more amino acids. Which Absorb Plus do you recommend. And I just found out I do have some Candida.
Thank you,
Antoinette
Hi Antoinette. This blog post should answer any questions you may have: https://blog.listentoyourgut.com/which-version-of-absorb-plus-elemental-shake-should-i-use/
Hi thank you all for your good work to save people from suffering! How long do you recommend for SIBO mixed hydrogen/methane? I am thinking at least 3 weeks, but I would like a more knowledgable opinion because I am determined that this time, I am going to overcome!
thanks! Melannie
Eric’s advice looks good to me!
From what I’ve read the typical protocol is 14 days with the elemental, re-test on day 15 and if it isn’t gone, go another 7 days. Re-test with the breath test because you can’t really go off of symptoms. You may not need 21 days. The stats are 80% effective after 14 days 85% after 21. From what I’ve read.