SIBO and The Elemental Diet with Dr Lela Altman

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Dr Nirala Jacobi is in conversation with Dr Lela Altman on the
topic of the Elemental Diet.  Dr Altman presented at the
2017 SIBO Symposium, and in 2018 at The Gastroenterology
Association for Naturopathic Physicians, on the topic of the
Elemental Diet.


Dr Altman is a Naturopathic Doctor, she has a private practice
and also lectures at Bastyr University in Seattle.  Dr
Altman is also an Acupuncturist.  Her interests include
gastrointestinal disorders, east asian medicine, diabetes, and
cardiovascular disease.


Topics discussed include


How did Dr Altman get into the field of SIBO with a special
interest in Elemental Diets?

The Elemental Diet is a highly effective standalone
antimicrobial treatment, on par with conventional antibiotics or
herbal antimicrobials.

What are the components of the Elemental Diet? What makes it
different from medical food replacement products such as
Mediclear or powders that aim to heal the gut?

Proteins are in the form of amino acids only, and there
are no other food products in the formula. The nutrients are
predigested - you do not need to break anything down.

Fats in the form of oil, medium chain triglycerides
(MCTs).

Carbohydrate component is either dextrose or
maltodextrin.

Starches may be included.

Essential vitamins and minerals.

No fibre.



Contraindications for the Elemental Diet include

A history of disordered eating

Underweight patients (however patients can gain weight on
the Elemental Diet due to ease of absorption of nutrients)

Caution in diabetes due to higher simple carbohydrate and
sugar content.

Caution for known fungal overgrowth or signs or symptoms.
If using, use in combination with antifungal treatment - Dr
Jacobi always uses an antifungal with the Elemental Diet.



How can people get the Elemental Diet for their patients?

Vivonex - Nestle product (not recommended)

Integrative Therapeutics Physicians’ Elemental Diet

Dr Allison Siebecker’s homemade Elemental Diet



Possible complications encountered with prescription of the
Elemental Diet.

Blood sugar dysregulation

Weight loss

Intolerable flavour

Nausea

Diarrhoea

Die off reactions

Constipation

Abdominal pain



What happens for 2 versus 3 weeks for patients on the
Elemental Diet?

80% effective after 2 weeks

85% effective after 3 weeks

No more effective for 4 weeks



Protocol

Elemental Diet shakes - 6 per day, or daily amount
divided up to have less day every hour.

Drinks allowed - water, (sometimes) dilute black coffee
or black tea.

SIBO testing patient with same day breath test - if still
positive, continue for one more week, if negative, transition
off the Elemental Diet.





 


Transitioning off the Elemental Diet


General


Keep using some of the Elemental Diet shakes for calories as
patient transitions.

Consider using Elemental Diet as the elimination phase of an
Elimination Challenge Diet (eliminate all high allergenic foods
for 2 weeks and then reintroduce one every 3 days, if tolerated
add back in, if not tolerated keep it out)



Day 1


Slow introduction of foods starting with broths (be aware
that some SIBO clients do not do well with cartilage bones due to
the high histamine in glycosaminoglycans. If this is the case,
use only marrow bones or meat broth).

Start patients with Low FODMAP diet for approx 3 days, well
cooked vegetables, avoiding raw foods.

If candida suspected, avoid simple carbohydrates.



Day 2


Continue with well-cooked Low FODMAP vegetables and broth.

Congee addition (if no yeast overgrowth) - rice soup with
chicken / vegetables.

Add cooked meats, fish, eggs, grains.



Day 3


Transition to a simple Low FODMAP diet or Dr Jacobi’s
Bi-Phasic Diet



 


If SIBO breath test is negative start challenging the Low FODMAP
diet as described with Elimination Diet Challenge above.


 


Same day retesting available in Australia with com

Notify the lab before sending the test for fast-tracking

Overnight the test back to com



What are common symptoms that are usually no cause for alarm?

Constipation (due to no fibre intake)

Bowel movements can change largely - client is not
eating enough food to pass on a regular basis.

Great therapeutics include magnesium, herbal
laxatives, suppositories, enemas.



Nausea

Can start within first couple of days and usually
then goes away. Solution is to dilute formula a bit more
if you can.

Can be due to vitamins and supplements taken in
addition to Elemental Diet. Recommendation to discontinue
non-essential supplements.

If using Dr Siebecker’s Formula, switch to the lower
fat higher carb option, as the high fat option can cause
a bit more nausea.



Bowel changes

May notice passing stools of dry grey powder - if
formula used is powder.

Diarrhoea - could be a reaction to something in the
formula (look to corn oil, soy oil). Treat for
dehydration - keep them hydrated and advise sipping
formula slowly throughout the day (which also assists
blood sugar regulation).



What to do to improve flavour of the homemade Elemental
Diet? Options may include:

Stevia

Flavoured magnesium powder (use caution here with
appropriate quantity).

Extract drops, such as almond, peppermint etc.

Blend with ice.

Use a cup with a straw so as to not smell it.

Do not let it sit out for more than the time that it
is being consumed.



The Half Elemental Diet

Not used for SIBO treatment

Can be used for providing bowel rest for anyone in an
inflammatory bowel flare.

Can be used to increase caloric intake for someone
who is requiring hypoallergenic caloric supplementation
(a few days to a week’s duration) - used as a caloric and
nutritional booster for those with extreme food
sensitivities.



Additions

If client is getting hungry on having the Elemental
Diet - add coconut or MCT oil to formula to increase
calories.



Dr Altman’s opinion on using the Elemental Diet in the
daytime and eating meat at night?

The difference between meat protein and elemental diet
protein - the latter is in a free form and are therefore
rapidly absorbed and not much reaches the colon.

Initiate prokinetics immediately at completion of
Elemental Diet to inhibit regrowth of SIBO.

Consider low dose antimicrobial herbs at completion of
Elemental Diet to inhibit regrowth.

Consider that stomach acid is killing most of the
bacteria that we ingest - support this if necessary.

Consider the underlying root cause of client’s initial
SIBO and keep that managed to prevent relapse.

Dr Altman’s clinical pearls re The Elemental Diet.

The cost of a 2-week course of The Elemental Diet

Example at 6 shakes per day of Physicians’ Elemental
Diet it comes to approximately $650 USD.



No need for hunger - patients can have as many shakes as
they want.





 


 


Resources


Dr Lela Altman

Dr Altman’s talk Elemental Diet Webinar with CME
available.

Bastyr University Digestive Wellness Clinic in Seattle,
Washington.

Private Practice in the Bastyr Centre for Natural Health.



Dr Pimentel

Elemental Diet options

Integrative Therapeutics

Physicians’ Elemental Diet



Dr Allison Siebecker’s homemade Elemental Diet

Vivonex - Nestle (not recommended)



Elemental Diet components

Jo Mar Labs Black Label 21 Blend for amino acids



Same day retesting available in Australia with com

Notify the lab before sending the test for fast-tracking

Overnight the test back to com



Dr Jacobi’s Bi-Phasic Diet

Dr Allison Siebecker’s SIBO Specific Diet

Specific Carbohydrate Diet (SCD)