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Please hack my IBS - anyone tried the elemental diet?

by (15)
Updated about 14 hours ago
Created June 04, 2012 at 12:00 AM

I'm a 28 yo female and have had ibs for 10 years: diarrhea, incomplete bowel movements, extreme bloating & gas, occasional heartburn/indigestion. I can control the gas/bloating a bit through diet (mostly paleo, low carb, but I do eat fermented dairy/coffee/dark chocolate/wine), but no matter what I do the diarrhea and incomplete bowel movements haven't improved at all. I run to the bathroom 5-10 times at least every morning, which is exhausting and embarrassing. My thyroid is supposedly fine. I've had an endoscopy, a colonoscopy, been tested for parasites, gut flora, and food allergies, tried acupuncture, hypnotherapy, psychotherapy, elimination diets (no coffee/dairy/eggs/alcohol), and supplements (probiotics, L-glutamine,enzymes, HCL, etc) but nothing helps. I can't tolerate most sugars & starches, and can't eat many of the "safe" vegetables and fruits on the FODMAPS and SCD diets. My doctor suggested I try the antibiotic Rifaximin to see if it's SIBO; my instinct is to try the elemental diet but the only formula I can find is Vivonex Plus, which lists maltodextrin & cornstarch as its first 2 ingredients (give me gas) and soybean oil as its fourth ingredient (yuck). Has anyone here tried an elemental diet to help with their gut issues? And also, does anybody have any ideas as to what could be causing my problems and what else I could do to try and solve them? I would really appreciate any advice/help you can offer!

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1607 · June 14, 2012 at 8:35 PM

I took the Rezyst probiotic while taking the Rifaximin, and still take it daily to this day.

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8757 · June 05, 2012 at 12:50 PM

thank you, you too! I'm over the rough part now, stuck on stage 6 with dairy, moving slowly but still moving forward. I'm quite happy now, and will give it a full year before trying newer things (beef, so far been intolerant for the last 8 yrs)..finally something that gave me hope!

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734 · June 04, 2012 at 8:19 PM

@Jetski; if you do try it, just make sure to try the low-histamine diet before the Rifaximin (or vice versa), so that you know what relieves your symptoms. If you start Rifaximin and low-histamine at the same time, you won't know whether it's histamine intolerance or SIBO. Good luck!

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15 · June 04, 2012 at 4:21 PM

You're right, somehow I never thought about eliminating all the possible culprits at once. I'd never heard of histamine's possible role in IBS but I think it makes sense, so I'm going to go VLC for a while, just meats, greens, broth and coconut oil and then reintroduce foods back one at a time to see what they do to me.

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15 · June 04, 2012 at 4:18 PM

Thanks NewEra - did you take any probiotics while you were on Rifaximin? I'm concerned about the drug killing off also the good guys..

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4002 · June 04, 2012 at 11:46 AM

Good job with following the GAPS diet! I have been on it for 9 months now and have improved so much! :) I really believe it is the best way to go!

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734 · June 04, 2012 at 10:45 AM

@kelly that's exactly what I was wondering too. Even fermented dairy, chocolate and wine alone have more than enough histamine in them to upset the bowels tremendously. It's about really reducing histamine altogether for a couple of weeks and then evaluating whether there's any difference.

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734 · June 04, 2012 at 10:42 AM

I wouldn't say it's "established" that all IBS is SIBO. Some IBS-patients benefit from Rifaximin treatment, but there are others for whom it doesn't work. As I already mentioned in my own answer, if IBS were caused by one thing only, it wouldn't be a syndrome anymore, but a disease. There's a tendency to want to reduce things so that it looks easier, as if there's a eureka moment (I've found the real cause!), while it's only one possible cause. One last thing: I didnt' find the Rifaximin evidence very convincing... 30% placebo vs 40% Rifaximin felt better in the main clinical trial I know of.

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3850 · June 04, 2012 at 4:06 AM

Have you ever eliminated them all at once, or just one at a time?

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1607 · June 04, 2012 at 2:47 AM

My amazing Paleo advocate gastroenterologist put me on rifaximin for my confusing IBS symptoms, and it really helped. That, coupled with Paleo and Rezyst probiotic have been life changers. I'm not 100%, but I'm so much better now!

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15 · June 04, 2012 at 2:01 AM

He suggested it because breath tests are unreliable - if this works then we know for sure it's SIBO. I don't like the idea of taking it either which is why I'm considering the elem. diet. I tried the L299v strain for 2 months, and also Jarro-Dophilus, Primal Defense, PB8, Lactobacillus GG, and some others; I used to take charcoal after meals, and I eat coconut oil every day but haven't noticed an improvement on any of these. Eliminating coffee, wine, and dairy in the past hasn't helped either, but maybe I didn't try long enough (ab. 5 months each) so I'll look into the anti-histamine diet.

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15 · June 04, 2012 at 1:43 AM

Thanks for your answer! My doctor suggested Rifaximin because it's shown promising results in preliminary studies and apparently the breath test is unreliable (false positives/negatives). If the antibiotic works then we know for sure it's SIBO and can address it through diet. I went off caffeine and wine for several months each and didn't notice any improvement. Rice bloats me terribly, and so does most fiber (incl. soluble) but I've never tried acacia so I could give that a shot. I took Lexapro for 3 years for anxiety & depression and that didn't seem to have an effect on my guts either...

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15 · June 04, 2012 at 1:42 AM

It can also be ingested as a powdered formula that contains a mixture of sugar, fat, amino acids, and vitamins, which is what I'm considering. It's one of the (more radical) suggested treatments for SIBO - the idea is to starve off the bad bacteria over the course of a few weeks.

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734 · June 04, 2012 at 1:23 AM

An elemental diet that is composed of liquids containing the most basic food needs, often administered intravenously or by using some kind of gastric feeding tube (in the more severe cases).

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5808 · June 04, 2012 at 1:02 AM

What is the elemental diet? Do you have a link that explains it?

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9 Answers

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11683 · June 04, 2012 at 1:04 AM

Hi Jetsky, I understand where you are coming from - I've had IBS for 15 years and like you have tried every possible treatment under the sun. Two things - I did a hydrogen breath test to test for SIBO (it was negative), instead of just trying a drug to see if it helped. Perhaps those tests aren't conclusive, I'm not sure, just a thought. I don't think people should be trying antibiotics willy-nilly, esp as we know how critical gut flora is in all this.

I can't speak to the elemental diet, but I'm surprised you are still drinking coffee and wine, especially when your stools run towards loose. Caffeine increases gastric motility, and alcohol is a gut irritant. Dark chocolate, too, can have a laxative effect. I know it's hard to give up everything - I still have some wine on occasion - but it seems like those would be particularly unhelpful for you. Also, have you tried increasing your soluble fiber? Acacia fiber I find quite helpful, as well as white rice. I do 1/2 cup of white rice and 1/2 tsp of acacia per day, along with a high-strength probiotic which I also find helps. Finally, a month ago I started Cipralex (Lexapro) which may also be helping a little - at the very least, it's helping my mood so I am not as down about the IBS.

098a2e31e4f8867bcc2a4b22522ded2d
15 · June 04, 2012 at 1:43 AM

Thanks for your answer! My doctor suggested Rifaximin because it's shown promising results in preliminary studies and apparently the breath test is unreliable (false positives/negatives). If the antibiotic works then we know for sure it's SIBO and can address it through diet. I went off caffeine and wine for several months each and didn't notice any improvement. Rice bloats me terribly, and so does most fiber (incl. soluble) but I've never tried acacia so I could give that a shot. I took Lexapro for 3 years for anxiety & depression and that didn't seem to have an effect on my guts either...

best answer

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734 · June 04, 2012 at 1:16 AM

"My doctor suggested I try the antibiotic Rifaximin to see if it's SIBO"... Shouldn't that be the other way round? You should be tested for SIBO first and then start treatment; you shouldn't start a treatment and then see whether you have a condition (at least not when you're talking about antibiotics, which can have an adverse effect on your health).

Secondly, what probiotics did you try? Not all probiotics are created equal. I would suggest trying a probiotics containing a high amount of lactobacillus plantarum 299v strains, since they have been shown in some trials to be very successful in treating IBS. This is the kind of treatment you can try and see if it works. You should be able to feel improvement after about 4 weeks if it works. Personally, I believe probiotics are only useful in combination with a good diet (see below).

Extreme bloating and gas might be relieved by using (activated) charcoal. A cheap supplement with a huge potential, so it's worth trying. Just bear in mind that you should take any medications at least 5 hours earlier or later, since the charcoal diminishes the effects of the medication tremendously.

You say you still eat fermented dairy/dark chocolate/wine, all of which contains high amounts of histamine, which can have huge effects on you. In some people, histamine intolerance manifests itself by migraines, in others in the bowels,... You might want to try a low-histamine (there are many summaries of what you can and cannot eat on the internet) GAPS/SCD/Paleo diet for at least a couple of weeks and see if there's any improvement.

What I also suggest is using coconut oil. It is shown to relieve a lot of symtoms associated with Crohn's, ulcerative colitis, IBS,... Basically all kinds of digestive disorders (and loads of other stuff) and it also works as an antiseptic, so it can also work against any infections.

Please also bear in mind, as you probably know, that IBS is a syndrome disorder rather than a disease, which means that it's nothing more than a list of symptoms that may be caused by a huge range of issues, so the tips described above might work (and have shown to be successful in a number of cases), but it might not work too. There are no guarantees in this.

098a2e31e4f8867bcc2a4b22522ded2d
15 · June 04, 2012 at 2:01 AM

He suggested it because breath tests are unreliable - if this works then we know for sure it's SIBO. I don't like the idea of taking it either which is why I'm considering the elem. diet. I tried the L299v strain for 2 months, and also Jarro-Dophilus, Primal Defense, PB8, Lactobacillus GG, and some others; I used to take charcoal after meals, and I eat coconut oil every day but haven't noticed an improvement on any of these. Eliminating coffee, wine, and dairy in the past hasn't helped either, but maybe I didn't try long enough (ab. 5 months each) so I'll look into the anti-histamine diet.

F0e558010a2ecb31fa37b7c491596b8e
3850 · June 04, 2012 at 4:06 AM

Have you ever eliminated them all at once, or just one at a time?

1e443a3241f80129faa05125ce346e47
734 · June 04, 2012 at 10:45 AM

@kelly that's exactly what I was wondering too. Even fermented dairy, chocolate and wine alone have more than enough histamine in them to upset the bowels tremendously. It's about really reducing histamine altogether for a couple of weeks and then evaluating whether there's any difference.

098a2e31e4f8867bcc2a4b22522ded2d
15 · June 04, 2012 at 4:21 PM

You're right, somehow I never thought about eliminating all the possible culprits at once. I'd never heard of histamine's possible role in IBS but I think it makes sense, so I'm going to go VLC for a while, just meats, greens, broth and coconut oil and then reintroduce foods back one at a time to see what they do to me.

1e443a3241f80129faa05125ce346e47
734 · June 04, 2012 at 8:19 PM

@Jetski; if you do try it, just make sure to try the low-histamine diet before the Rifaximin (or vice versa), so that you know what relieves your symptoms. If you start Rifaximin and low-histamine at the same time, you won't know whether it's histamine intolerance or SIBO. Good luck!

best answer

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25 · June 04, 2012 at 3:16 AM

http://jackkruse.com/emc2-making-factor-x-actionable/#comments

Read comment #88.

Good luck. Hope you find what you need.

best answer

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4002 · June 04, 2012 at 11:45 AM

SIBO is very likely to be the cause if you have trouble tolerating carbs of all types.

I would not recommend the elemental diet, because it contains a lot of artificial ingredients and is high in sugar. I think you can achieve very similar results by following a strict meat and fat diet only for 2-3 weeks (no vegetable matter), as this would deprive the excess of bacteria in your small intestines (if you have SIBO) and hopefully, make them die. Be aware that die-off symptoms are very common!

The Rifaximin treatment can also be very effective but IT NEEDS to be followed by dietary changes to prevent relapse.

Herbal antibiotics can also be another approach that you can discuss with your doctor (most likely with a naturopathic doctor).

The approach you choose is up to you, but you need to adapt your diet to help heal your gut (which is likely to be leaky if you have SIBO), correct nutritional deficiencies caused by SIBO and follow a GAPS-like protocol to slowly increase your food tolerance.

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8757 · June 04, 2012 at 11:02 AM

definitely consider the gaps intro diet,

1) its a diet made to control over growths of bacteria, yeast etc.

2) its a diet that eliminates then introduces and only things to help over growths as above.

3) its a diet meant to help eliminate the dirreaha and fine tune you body

4) its a diet meant to help you repopulate the good stuff in your body and rid of the bad.

Ive had "IBS" for years and I can say its finally under control, not 100%, but in 3 months now on intro I'm finally more stable.

I also can not handle rice, its too taxing on my system and causes horrible bloating. I figure a year on GAPS and I should be able to start 'testing' things. I've seen indicators of my gut sealing and its definitely more tolerable to wine, chocolate when I have the occassional cheat.

look into as well, good luck!!

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4002 · June 04, 2012 at 11:46 AM

Good job with following the GAPS diet! I have been on it for 9 months now and have improved so much! :) I really believe it is the best way to go!

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8757 · June 05, 2012 at 12:50 PM

thank you, you too! I'm over the rough part now, stuck on stage 6 with dairy, moving slowly but still moving forward. I'm quite happy now, and will give it a full year before trying newer things (beef, so far been intolerant for the last 8 yrs)..finally something that gave me hope!

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20 · July 12, 2012 at 11:31 PM

Hi, As a previous Crohns Disease sufferer of 40 years, I no longer - in my understanding - have the disease :) As much as diet plays a very important role to how a gut behaves, so does ones thinking :) I spent two years after one major attack, bleeding from the bowel pretty much every day, and searching for alternative answers, especially through diets, but also alternative medicines and techniques, pretty much every one that existed! As the two years went on, I got better. The diets may have helped, but I also got happier. Sugar out, alcohol out, fast food out, meat out, etc., etc. Thought I had the solution, but three years later and another stressful situation occurred. The 'Crohns', or rather the name for the symptoms I was having, i.e. inflammation and ulceration of the bowel, resulting in another bleeding attack. More surgery was booked, but before that happened, I had a major fundamental mind shift, and all the bleeding stopped within 7 days. My surgery was cancelled and my specialist was satisfied that the attack had retreated :) That was nearly 13 years ago now :) I definitely agree that diet is important, as certain consumed products have an effect on the gut. Cells change according to their environment, so put something into the body that is an enemy as such, and the cells will REACT accordingly :) But alongside this, look at the drive of this vehicle. How your brain 'thinks' also creates an environment for your body. Any form of 'stress' (ha ha! - the non-acceptance of 'what is') or anger, or frustration, or irritation - anything negative really, can reek havoc on your cellular system. In my understanding, by being the observer of your mind and creating a good and positive environment for your 'Self' there is so important. How you feed your 'physical system' is also very important, in order to create a good environment within the cells of the body, that support the 'Self' :). I think it would be good to keep these two environments healthy :) All the best to you all :) Kit Campbell 'The Irritable Brain Syndrome'

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418 · June 04, 2012 at 2:51 AM

I believe it's established now that IBS is caused by SIBO, even tho the SIBO tests currently aren't very accurate. Take the antibiotic but also start kefir/probiotics to recolonize yourself with good critters. You should ditch the wine & candy for now.

1e443a3241f80129faa05125ce346e47
734 · June 04, 2012 at 10:42 AM

I wouldn't say it's "established" that all IBS is SIBO. Some IBS-patients benefit from Rifaximin treatment, but there are others for whom it doesn't work. As I already mentioned in my own answer, if IBS were caused by one thing only, it wouldn't be a syndrome anymore, but a disease. There's a tendency to want to reduce things so that it looks easier, as if there's a eureka moment (I've found the real cause!), while it's only one possible cause. One last thing: I didnt' find the Rifaximin evidence very convincing... 30% placebo vs 40% Rifaximin felt better in the main clinical trial I know of.

C7ea3d3528fe58cc7c66afee1ba9338d
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0 · October 11, 2014 at 5:57 AM

Not sure if you have had any luck, I am thinking of doing a 7 day water fast or elemental diet to give my digestive system a break. If you are interesting in connecting and going through one together I'd love to have a 'buddy.' 

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0 · July 12, 2012 at 6:45 PM

Hello,

If you are daring enough you can try to make your own version of Vivonex minus the maltodextrin, corn starch and soy oil. You can look here for variations:

http://www.siboinfo.com/uploads/5/4/8/4/5484269/homemade_elemental_diet_options.pdf

You can add mct oil for calories if you are worried about sugars.

Be careful if you try this take it easy. It should be easier than a 2 week fast but still pretty hard. Make sure you don't have yeast parasites they may damage your system.

You also really need to try other remedies especially diet. Eliminate the following for at least 6 months: all sugars and sweetners, dairy, all grains, fruit, just eat less fibrous veggies cooked well like a soup or steam boil until soft and also eat meat and saturated fats.

Look here for ideas here: http://www.slideshare.net/drrinde/sibo-grand-rounds-presentation-2011-best

http://health.groups.yahoo.com/group/sibonation/message/6180

Join sibonation yahoo group if you can't read last URL

Good luck

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