We recently received this review on the Shoppe listing for Absorb Plus Amino – Coco-Choc flavor:
“Unsweetened Coco-choc is not elemental, it has 3g of fiber/serving. I did 19 days on the elemental diet, taking CH4 and H2 measurements along the way with a Food Marble device. There was a clear spike in gas levels after taking the this shake, in other words, it seemed to cause fermentation, what the elemental diet is supposed to avoid, at least for SIBO sufferers. I’m a bit disappointed and I still have the tub practically full of this stuff! Stick to the Physicians Formula.”
This comment brings up two important points I’d like to address.
Firstly, whether using a hydrogen breath test device after every meal, or frequently, is actually helpful for making health/dietary decisons?
And secondly, I’d like to put this question within the context of carbohydrates and dietary fiber.
Let’s get started…
1. Is using a Food Marble AIRE device beneficial in pursuing holistic health?
This paper shows that 99% of intestinal gas is comprised of hydrogen, carbon dioxide and methane.
And the predominant gas produced is hydrogen:
“H2 is the most predominant gas produced by colonic bacteria and is produced solely through bacterial fermentation of non–digestible substrates in the colon. Accordingly, breath H2 has been used as a primary marker for diagnostic testing of carbohydrate malabsorption or small intestinal bacterial overgrowth.”
As a result of this data, Food Marble’s website states:
“AIRE detects hydrogen, which is produced by your gut bacteria when they come in contact with food that hasn’t been fully digested yet. Any given species of bacteria will only be able to break down certain foods, so the foods that produce large amounts of gas in your gut, will depend on the types of gut bacteria you have. This is one of the main reasons why everyone is completely unique in terms of digestion of food.”
So you’ve got a hydrogen breath test device that you can use at any time of day, after the consumption of any food, to test for the amount of hydrogen being produced by the digestion of that food in your gut.
But, is this a good thing? Do you have a full understanding of what you’re actually testing and the meaning of the data?
Is Hydrogen Bad?
People are acting from the assumption that ‘hydrogen is bad’. And we can probably thank the medical interpretation of data for that perception, again, “breath H2 has been used as a primary marker for diagnostic testing of carbohydrate malabsorption or small intestinal bacterial overgrowth.”
However, if you do a deeper dive into the broader research on this topic, you’ll quickly come across data like in this paper that reveals:
“Although some hydrogen-producing bacteria can be classified as “harmful bacteria” with pathogenic properties, its prevalence is very low in the intestines.
Most species of this bacteria are deemed as “Beneficial Bacteria,” and in this paper, we focus on these hydrogen-producing bacteria that bring extraordinary benefits to human health.”
Wait, what??
You mean the bacteria that ferment the dietary fiber, producing hydrogen gas, are GOOD for the body? Hydrogen is actually a beneficial substance in the gut – and may NOT necessarily be indicative of disease?
“Hydrogen has clinical benefits in many diseases, including neurological diseases, cardiovascular diseases, respiratory diseases, diabetes, liver and metabolic syndrome. More than 1000 papers have been published on the medical applications of hydrogen, including over 90 reports of human clinical trials. These papers confirm that hydrogen is highly effective in the treatment of a variety of diseases and that there are no safety issues. Hydrogen molecules are the only species within the human body that can directly eliminate hydroxyl radicals inside mitochondria. Thus, the effects of hydrogen-producing bacteria outperform other beneficial bacteria, such as lactic acid bacteria and bifidobacteria, that cannot produce hydrogen.”
Hydrogen Breath Test – Understanding the Measure in Detail
Interpreting a hydrogen breath test as a directive to avoid all dietary fiber may be helpful as a short-term measure – but only if accompanied by a rigorous protocol to eliminate harmful microbes from the gut and replace with beneficial bacteria.
Once your gut has a good balance of beneficial bacteria, then small amounts of dietary fiber are helpful to encourage these bacteria to flourish. And as your microbiome improves, you then add increasing amounts of dietary fiber (predominantly soluble fiber, with a lesser amount of insoluble) to assist your body in maintaining a good population of beneficial bacteria.
As this paper outlines:
“Preclinical studies have demonstrated a causal role of fermentable fiber consumption on microbiota diversity, whereby, mice fed diets that are devoid of fermentable fibers develop depleted microbiota diversity over a few generations.”
And then if we look at large data studies on human gut microbiota:
“Cross-sectional studies of human populations across the globe reveal that greater dietary fiber intake is associated with increased gastrointestinal microbial community diversity.”
Again, we’re not just talking about ALL carbohydrates. I go into soluble vs. insoluble fiber in detail in my book on constipation, Listen To Your Colon.
And I have discussed in detail why an elemental diet must contain a carbohydrate component in order to be effective – especially in cases where malnutrition and weight loss are present.
So again, once your microbiome is healthy, you want to consume a certain amount of predominantly soluble fiber to support and maintain that healthy microbiota.
Okay, let’s move onto the next point in the comment I want to address…
2. Fiber and Carbohydrate Content in Elemental Shakes
In the review, she pointed out that the Coco-Choc flavor of Absorb Plus Amino has 3 grams of dietary fiber per serving. She is correct, and this is from the cocoa powder used to naturally flavor the shake, which the FDA requires us to list as ‘dietary fiber’.
However, when the cocoa powder is manufactured from fermented cocoa beans (that are then roasted in the correct manner), they will contain only traces of mono- and disaccharides. So it is safe to use on an elemental diet. If you use an organic or raw cocoa powder, it will probably be fermented properly.
If you prefer, you can also use an Organic Chocolate Extract (alcohol-free) or Organic Chocolate Concentrate to flavor your shakes if you wish to avoid all cocoa powder.
In this case, where you want to stick to Absorb Plus Amino, the Orange-Mango flavor has no fiber at all.
Physician’s Elemental Diet VS Absorb Plus
Or, as the customer pointed out, you could use unflavored Physician’s Elemental instead. Good luck with that. Personally, I would not say that any Amino-only elemental shakes taste ‘good’. But we worked long and hard to make AP Amino tolerable. Whereas Physician’s Elemental is completely disgusting (in my opinion) and undrinkable for any length of time.
Here’s how the 3 products compare in terms of carbohydrate content – and let’s throw in Vivonex (which was used in the clinical trials for SIBO) as well. These are screenshots taken today from each company’s website:
Physician’s Elemental
Absorb Plus Amino – Orange Mango
Vivonex
Of course, Vivonex (by Nestlè) is the product covered by insurance that your MD is likely to recommend!
If they already have maltodextrin listed, then what exactly is the additional ‘modified corn starch’? No further comment.
You May Also Be Interested In:
- Elemental (Bowel Rest) Diet
- Elemental Shake: Which Type is Best for Your Body?
- Challenges & Solutions for Elemental Diet Success
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