Small intestine bacterial overgrowth: the suspected source of IBS in up to 84% of sufferers [R] as well as the inspiration a little game I play with my boyfriend when we’re surrounded by pedestrians called “Pregnant or SIBO?” (That one’s definitely SIBO…)
Antibiotics are likely the most commonly prescribed treatment for SIBO, though herbal treatments have been shown to be just as effective. Or …ineffective, depending on how you look at it. In this study, only 46% of herbal patients cleared the breath test and 34% of antibiotic (Rifaximin) users after a four week course. That’s my first reason for avoiding the antibiotics…
Antibiotics take too damn long and the odds are unimpressive
Four weeks of antibiotics yielded only a 34% success rate? No thank you! I’m impatient. I will take my two weeks of hell-emental, particularly since the success rate has been shown to be 80% for a fifteen day diet [R]. Herbals have been known to take even longer.
Antibiotics probably got me here in the first place
My dermatologist put me on a daily antibiotic in high school for acne, which I was on for six or seven years. By the time I got off it, the evidence of an unhappy gut was strong: I wasn’t absorbing nutrients and debilitating stomach cramps were hitting me in waves. Seven years on the birth control pill followed, during which time I was developing increasing food sensitivities and yeast overgrowth symptoms. Needless to say, my gut was poised and ready for disaster when a violent food poisoning episode hit in spring 2015.
Antibiotics are not selective with the bacteria they destroy – they’re blowing up everything in your gut. When SIBO is caused by an imbalance to begin with, antibiotics are the last thing that is going to restore that balance.
Herbals are powerful and should be used under supervision
I support the use of herbals completely, but they are extremely powerful and I was very cautious about using them on myself without supervision. At the time, I didn’t have a practitioner to work with and even now, my practitioner is a gastro with no herbal training. I realize there are herbal protocols for SIBO all over the Internet, but of course it’s ideal to exercise caution with self treatment.
The elemental diet is the fastest, most effective route
SIBO expert Dr. Allison Siebecker describes the elemental diet as a way to “starve the bacteria, but feed the person, by replacing meals for 2 weeks with an Elemental Formula. Elemental formulas are powdered nutrients in pre-digested, easily absorbed form.” [R]
You can purchase formulas online, but they’re incredibly pricey and contain unhealthy sugars and fats that can be detrimental – particularly to those who also have leaky gut. Dr. Siebecker created a “homemade elemental diet” recipe with more natural ingredients that costs closer to $200. The drawback of the homemade elemental diet is that it hasn’t been studied, but Dr. Siebecker has used it in her practice with great success.
In a study using the Vivonex Plus elemental formula, 80% of subjects had a negative lactulose breath test on day 15 and that number rose to 85% on day 21. [R]
I feel more energized, clear-headed, and sleep better on the elemental diet
You’d THINK not eating anything for two weeks would make you feel like shit, but I actually felt better much of the time. The greatest benefit I experienced was mental clarity and I suspect this is a result of not having food sensitivity induced brain fog! I also had good energy through most of the day – though I would crash in the evenings.
One extra benefit was that my skin cleared up completely. I went from having big honkin’ cystic zits all over my face to completely clear skin by day 9.
Additionally, I didn’t have to cook for two weeks and was much more mobile than I usually am when doing the autoimmune protocol.
But the elemental diet isn’t all sunshine and aminos
Now that I have offered adequate evidence that the elemental diet is great, I have to tell you: it’s tough. It’s really, really tough. It tastes like puke, you can’t eat any food, and you might have die-off symptoms. I had two die-off episodes, which sounds common in the SIBO support group on Facebook (I would highly recommend joining this group if you plan to do the elemental diet – you will receive much-needed support and accounts of others’ experiences). Some people have no die-off symptoms, like SIBO slayer Katie Caldwell.
Additionally, you risk experiencing candida overgrowth. I developed a yeast infection on day 13 and it sounds like Chris Kresser had a similar experience. I cleared this up in a few days with apple cider vinegar and a supplement and it wasn’t a big deal, but know that this is a possibility.
I do have a handful of tips for making the homemade elemental diet more palatable and reducing nausea:
- Separate the ingredients. I put the aminos, multivitamin, and salt in one glass with as little water as needed to dissolve it, and the honey and oil in another with some water.
- Don’t take the multivitamin on an empty stomach. Coat your stomach first with some of the oil and wait 15 minutes.
- Don’t chug the whole thing- I know you just want to get it over with, but drinking it too quickly can cause nausea. I drank half the oil, waited fifteen minutes, drank the multivitamin and salt with some more oil, waited a few minutes, and then finished both solutions.
- My gastro told me that capsules should be okay, and actually I just noticed that Dr. Siebecker’s directions say you can either take the vitamin encapsulated or open the capsule and pour the contents in. I am taking this one step further this time because I just cannot stand the taste of the amino acids and have encapsulated them. This is probably not practical for most people as each meal requires like swallowing like, 20 capsules.
- My gastro also said tea should be fine. I had peppermint tea a lot in the beginning, and was thinking that I would blend the coconut oil into the tea this time using an immersion blender so it’s like a creamer. Coffee made this way is delicious! Again, this is fussy and unnecessary, but another coping technique.
Is the elemental diet right for you?
Many practitioners position the elemental diet as a last resort or don’t mention it at all, but it can certainly be the first line of defense with the right mindset. One common concern is potential weight loss, which varies by individual. The elemental diet took me from 107 down to 100 lbs, but I quickly regained the weight when I began eating again. For those who are severely underweight, this diet may not be the right approach. Work with your healthcare team to determine whether this is the right solution for you.