Fasting & Elemental Diets
Most patients with SIBO feel significantly better when they skip meals, and many have settled in on a pattern where they only eat once or twice a day because their meals so frequently cause bloating and misery.
The reason for this is simple: as soon as food enters your small intestine, it feeds any microbes that are present. Normally, with a healthy GI tract and a small number of healthy bacteria then we don’t have any problems. However, in SIBO all of these extra bacteria go to work fermenting sugars and producing gas and other inflammatory products. They especially love when you feed them their favorites - highly processed foods, lots of sugar or foods with a lot of FODMAPs.
This is where fasting can come in. Purposely skipping meals can help both to starve off the extra bacteria as well as reset the digestive process.
If you are ready to starve off some extra bacteria then you’ve got two main options:
1. Traditional Fasting
A fast is when you don’t eat food for 24 hours or more. This is different than intermittent fasting (also called time restricted eating), where you eat a regular amount of calories, but in a compressed amount of time. Most patients who follow this pattern eat 1-2 larger meals over 4-6 hours, rather than 3 meals over 12-14 hours. Compressing the amount of time that we are eating can allow for more recovery in the gut, and can increase the GI motility.
However, I typically ask my SIBO patients to start with a traditional 24 hour fast - because it’s more effective in reducing GI symptoms than intermittent fasting, and a lot easier than patients think!
2. Elemental Diets
In those patients with SIBO who aren’t good candidates for fasting, or who simply feel poorly when they fast but want some of the benefits, then there’s another option: the elemental diet. Elemental diets are a complete nutritional powders that are absorbed very quickly in the GI tract, which starves overgrown bacteria farther down the tract of nutrition. These treatments have the advantage of being incredibly powerful at reducing bacterial counts while allowing the patient to keep nutrition coming in to their system.
Fasting for SIBO
For patients with SIBO, fasting can be a lifesaver. It is simple to add into any treatment plan, and has a lot of other benefits than reducing GI symptoms from SIBO. To this end, I included some of my favorite studies in a carousel to the right because I wanted to highlight some of the best studies in the medical literature on the topic.
Benefits of Fasting
It quickly reduces SIBO symptoms
It is is completely free!
It is simple. (Literally do nothing and you feel better!)
Fasting makes you live longer.
Fasting improves cognition and reduces your chance of Alzheimer’s Dementia.
Fasting Tips From Dr Joe
I ask my patients to plan to fast for 24 hours once as a trial, and if their GI symptoms decrease they are allowed to extend their fast for as long as they feel well. At any point, if they begin to feel poorly they are to simply stop their fast.
Plan to fast from dinner one day through dinner the following day. This means you get to sleep through at least 8 hours of your fast. Then if helpful my patients repeat the once fast weekly. (If you have an elevated fasting morning glucose, then try going from breakfast to breakfast as going to bed with an empty stomach can be helpful in stabilizing overnight blood glucose levels.)
Drink plenty of fluids while fasting. My patients are allowed to drink coffee, tea, sparking water or bone broth.
Fasting doesn’t have to be 100% to be effective. It is perfectly acceptable to have a small snack of protein (2 hardboiled eggs, piece of chiken, protein powder) in the middle of the fast if it helps you prolong or get through the fast. This is especially true if you are newer to fasting.
Fasting works best when paired with other treatments such as a the right diet for SIBO, with probiotics, or with herbal or prescription antibiotics.
What is an Elemental Diet?
An elemental diet is a nutritional powder that contains all of the required nutrients to meet your standard needs. You can think of it like a powdered multivitamin with added protein, carbs and fats. What makes an elemental diet special is that it is formulated so that all of the nutrients are very quickly absorbed in the very first part of the small intestine. It effectively starves our bacterial overgrowth, while letting a patient to continue to meet their nutritional needs. It really shines in cases where patients are losing weight due to their chronic GI symptoms.
Are Elemental Diets Effective for SIBO?
Absolutely! Out of all of the treatments that I’ve used for SIBO, the elemental diet has been the treatment that has given the most dramatic results. It’s not just my patients.
Dr. Mark Pimentel proved that an elemental diet is a safe and effective way to treat SIBO. In this study 124 patients used an elemental diet as their only source of calories for two weeks. At the end of the study it was found that 80% of the patients normalized their breath test, and many felt significantly better.
In my practice, it is extremely rare that I use an elemental diet for more than five days simply because if you have done the proper preparation with diet and probiotics, this more intense and pricey treatment is rarely needed.
Can you combine food with an elemental diet?
I hear from a lot of patients who are shocked to learn that I let them add low FODMAP meals to their elemental diet treatment. Over the years, I’ve found that you don’t have be “perfect” to get results, and in fact, the easier you make it on patients, the better they do. This is sometimes called a “hybrid elemental diet” and it may look something like this on a patient who is on a low FODMAP diet and probiotics but still feeling poorly. The idea is to use the treatment for just as long as needed then wean off.
Stage 1: One low FODMAP meal + elemental diet formula throughout the day to meet caloric needs until symptoms are controlled.
Stage 2: Two low FODMAP meals + elemental diet formula throughout the day to meet caloric needs
Stage 3: Three low FODMAP meals + elemental diet formula periodically in place of a meal as needed to control occasional symptoms.
Are Elemental Diets Safe?
Elemental diets have been studied for a large variety of GI conditions in lots of different types of patients. There are several studies that have shown elemental diets to be safe and effective when given to malnourished children with cystic fibrosis. As an example, this study followed children for 1 year and the elemental diet supplementation resulted in weight gain, improved growth and fewer pulmonary infections.
To get a different perspective, let’s look at my favorite elemental diet study.
In this study researchers followed a group of 51 patients who were being sent home after being admitted to the hospital for a flare of Crohn’s disease. Some were sent home with their usual diet and medications, while some were given instructions to continue their standard diet and medications, but also to replace half their calories with an elemental diet. They were using a “hybrid elemental” approach that we discussed above.
These patients were followed for 1.5 years - and there were no adverse effects in the hybrid elemental group. Even more impressive was that the relapse rate of the group was significantly lower which you can see on the graph. The study was meant to go on longer but it was stopped early because it was determined that the control group should also be offered a chance to go on an elemental diet.
