Recently, I interviewed Dr. Roy and Debbie Steinbock, who developed the Elemental Diet Success Plan, to discuss how an elemental diet can benefit those with gut issues. In this conversation, Dr. Roy, Debbie, and I discuss how the elemental diet works, the benefits for conditions like SIBO and IBD, their experience with the elemental diet personally and with hundreds of patients, how the diet should be tailored to each patient, who can benefit most from it, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am super excited to talk about the Elemental Diet with Debbie and Dr. Roy Steinbock. This is going to be a great conversation. The Elemental Diet, I might have briefly spoken about it with regard to SIBO. It can help with SIBO and other conditions, which they will talk about. Let’s dive into their bios here.
Starting with Dr. Roy Steinbock: He is a board-certified pediatrician with an integrative and patient-centered approach. He believes that investigating the root cause rather than only addressing symptoms is the best root to achieving and maintaining optimal health and wellbeing.
Dr. Roy combines evidence-based Western medicine with a functional and mindful approach. His areas of expertise include digestive disorders, allergies, eczema, frequent and recurrent illness, anxiety, OCD, ADHD, and other difficult to treat cases.
Debbie Steinbock is a certified holistic health coach and nutrition counselor with a special interest in digestive disorders and autoimmune disease. Her 20+ years in clinical practice includes working with complex conditions that often involve gastrointestinal disease, thyroid imbalances, food allergies and sensitivities, nervous system dysregulation, and more.
Debbie brings a uniquely personal perspective to her work with clients that was gained by navigating her own health challenges. Debbie’s deep, personal understanding combined with a passion for and commitment to continuing education and research makes her a compassionate clinician with an insightful perspective.
Dr. Roy and Debbie are the co-creators of the Elemental Diet Success Plan, a step-by-step road map that teaches participants their proven tips and strategies to complete an Elemental Diet with clarity, direction, and confidence. Thank you so much, Dr. Roy and Debbie.
Dr. Roy Steinbock:
Thanks for having us.
Debbie Steinbock:
Thank you.
Dr. Eric:
Very excited. Let’s just talk a little bit more about how you started focusing on the Elemental Diet. You do a lot more in your practice. But I don’t know any practitioners that have a program dedicated to the Elemental Diet. What led you to create this?
Debbie:
I have been using Elemental Diets in my clinical practice for almost 25 years now. The Elemental Diet gained a lot of popularity back then with inflammatory bowel disease (IBD). I would use it with my clients who had Crohn’s or ulcerative colitis.
Then it was about in 2013 when I met Allison Siebecker and learned that the Elemental Diet was being used for SIBO. Wait, are we talking about the same Elemental Diet I had been using in my practice before? At that point, we really dove into the research of it for SIBO and also learned about all these different conditions that the Elemental Diet was being used for. We expanded in our combined clinical practices what we had been using it for. That was how it was all born.
Dr. Roy:
We decided to try the Elemental Diet ourselves.
Debbie:
Right.
Dr. Roy:
That was huge. Once we went through it, and we saw how it was on one level quite challenging, but on another level, it was actually quite doable.
Debbie, being who she is, the magic of her practice, which is paying so much attention to the details, bringing all the tools together to make her clients become very successful. Prior to doing the Elemental Diet Success Plan, Debbie had a 99% success rate with getting people through the Elemental Diet.
There are always a few people who are maybe overzealous in their desire to do it and decide they can’t do it. Anyone who wants to can really make it through it. We found that first in Debbie’s practice. Then she turned that into our program.
Debbie:
As Roy said, I had known I wanted to try the Elemental Diet myself. I was using it in more extreme cases, somebody who had Crohn’s, colitis. They are very symptomatic but hadn’t dawned on me to use it for something that wasn’t potentially dangerous or life-threatening.
When I decided to try it for myself, Roy always says that when I get into something, I can find the bottom of the internet. Every day, I’d be like, “Look what I learned about it for rheumatoid arthritis. Look what I learned about it for this.”
A few days before we were going to get started, Roy turned to me and said, “I think I want to try it with you.” “Oh my god, are you serious?” It just made it that much more fun that we got to experience it together.
Dr. Roy:
It was. We’re so different that we had really different experiences doing it. It was a really valuable starting point for our knowledge base as well.
Debbie:
Yeah.
Dr. Roy:
One of the reasons that we were only using it for really extreme cases is the initial formulas that were out, the medical shakes that you could get, oftentimes prescription-only, were absolutely disgusting and not palatable. You had to be really miserable to want to drink that for several weeks.
Because of the work of Dr. Mark Pimentel and Allison Siebecker, bringing it more to the forefront, companies have started using shakes that-
Debbie:
And Jenny Patel Thompson.
Dr. Roy:
And Jenny Patel Thompson. Shakes that are actually not disgusting. I don’t know that I would call them delicious. After a few days, you are relatively happy to drink them. You get used to it. It is totally doable now. Before, they really tasted like vomit.
Dr. Eric:
For those who are not familiar with the Elemental Diet, can you talk more about what it consists of? What’s in the powders? What are you actually drinking?
Debbie:
Elemental shakes are a powdered medical food. The nutrients get combined with water to make a shake. The shakes basically combine all the nutrients that humans require to live off of for an extended period of time. You can go into detail if you want.
Dr. Roy:
Typically, for SIBO, people will do it for two or three weeks. For other conditions, for example, Crohn’s or ulcerative colitis, people can do it for much longer periods of time. Sometimes, for six weeks.
Sometimes, people will even do versions of the Elemental Diet where they are not doing 100% Elemental Diet; they are doing what we call a partial Elemental Diet, where they will drink some of their calories as shakes and eat some of their calories as food.
There is some really good research, particularly with Crohn’s, even Crohn’s in pediatrics, where they showed significant improvement for people who had difficult to treat, resistant cases doing a partial Elemental Diet for up to 12 months.
Debbie:
When you break down what’s in the Elemental shake, everything is broken down in its elemental form, so its most simple form. What that looks like is there is no protein in the shakes. Typically, when we say an elemental shake, it’s just freeform amino acids.
There are some semi-Elemental shakes, and they’re now classified as semi-Elemental. They actually used to be called Elemental. These have short-chain peptides, like dipeptides and tripeptides. Generally, the definition of Elemental means just freeform amino acids.
The carbohydrate form of everything is monosaccharide. Your really simple sugars, which are glucose, fructose, and dextrose. You can also add in glucose polymers, i.e. maltodextrin. Those are the only acceptable carbohydrate sources in Elemental shakes.
Then we have fats. Fats can be any kind of fat. The most common would be MCT oil, flaxseed oil, or fish oil.
Then they add in nutrients and electrolytes.
Dr. Roy:
Vitamins, minerals, electrolytes. It’s basically everything you need to survive for a period of time. It’s not like a health food diet. It’s not a diet I recommend everybody goes on. If you are suffering from inflammatory disorders, digestive disorders, it’s an amazing gut rest and rest from inflammation. It can even turn significant inflammation around.
Debbie:
Yeah, we can talk about some of the benefits if you want.
Dr. Eric:
Let’s go for it. It gives the body a rest, the digestive system a rest. It helps with inflammation if someone has gut inflammation.
Let’s talk more about some of the benefits of an Elemental Diet and why people with some of these conditions—SIBO, IBD, even I’ve heard in some of the interviews you’ve had on other podcasts, like some autoimmune conditions. I’m not sure about Hashimoto’s, but I know you mentioned rheumatoid arthritis. I don’t know if you have seen success with thyroid autoimmunity. I’ll let you take over.
Dr. Roy:
I will talk about the conditions first and then the mechanisms, why it’s so powerful. The different conditions that have been studied. There are some that haven’t been studied, but we have seen in mini clinical studies, like you mentioned, autoimmune arthritis. There are studies in pediatrics and adults with that being very successful.
For Crohn’s and colitis, it is actually the primary, mainstage, first-line treatment in many countries, like Japan. Some countries in Europe. When someone is diagnosed, they don’t get put on a biologic like they do in the United States. They get put on the Elemental Diet. The remission rates are huge.
Also, things like really difficult to treat cases of eczema, food allergies, other food sensitivities, resistant Celiac, chronic pancreatitis. eosinophilic esophagitis.
I was digging in to see if there is specific research with thyroid, and there really isn’t. There obviously is a significant tie between hypothyroidism and SIBO because of the issues with peristalsis that can be caused by hypothyroidism. That can lead to SIBO. It’s very common to see that comorbid condition together. It can help with the treatment of that. But we haven’t seen anything specific for treating autoimmune thyroiditis.
Debbie:
I have been asked that question a lot. I don’t have to tell you, Eric, how common thyroid disease is. Many of my clients have done Elemental Diets who have thyroid disease.
What I always tell people is I don’t think that two weeks is going to lower someone’s thyroid autoimmunity. We know that the gut is behind all autoimmunity that’s happening. Anything that’s working to rest, heal, seal the gut is going to help with autoimmunity. Again, these two-week Elemental Diets, which is really what most people are doing, I don’t think is long enough to make an impact on thyroid hormones. But make a dent in it? Yes.
Dr. Roy:
I don’t think it would hurt. It’s probably relatively good in general. I think because thyroid, at least in my experience, seems to be more of a smoldering autoimmune condition. It’s crippling in the long run and pervasive in every part of your life. But it doesn’t typically, in my experience, have these huge flares, like a Crohn’s or colitis flare, where you’re really debilitated for a relatively short period of time. Or something like rheumatoid arthritis, where you have these really acute flares. We can have that with thyroid, but it’s less like that. It’s a little harder to see the improvements as well.
The other thing I have seen with thyroid is as you improve, it also happens slowly. You don’t get this one treatment, and all of a sudden, you feel 100% better from thyroid. It takes your body time. Because of the way thyroid works with energy production and energy usage in the body, it takes a while. I usually tell people that people improve after being on the right dose of thyroid for three months. It’s not right away. People don’t generally feel better right away in my experience. It’s harder to tell if this would help.
It works in a bunch of different ways. The most obvious, studied way is the stuff that’s being seen with SIBO. That’s because of the elemental components. The fact that everything is absorbed incredibly high up in the digestive tract. Super high up in the small intestine.
Debbie:
And rapidly.
Dr. Roy:
You don’t need to digest anything, so things are just absorbed. Therefore, you don’t get any substrate or food for the bacteria. After a period of several days, 4-5 days, the bacteria begin to starve, and that is the benefit.
We know that overgrowth of bacteria in the small intestine is inflammatory. Even large intestine bacterial overgrowth can be inflammatory. That alone is well studied and well documented. That is a huge part of it.
They have actually shown that even some of the freeform amino acids themselves decrease pro-inflammatory cytokines and increase anti-inflammatory cytokines. Just the amino acids themselves.
In addition, it’s like a fast. You’re not fasting calorie-wise though. You’re basically giving your digestive tract an opportunity to rest. You’re not putting in solid food. You’re not needing to digest. Therefore, you’re decreasing the amount of energy that your body is using toward inflammation and digestion in the gut. That’s really important for healing as well.
Debbie:
What you’re speaking to is the hypoallergenic nature of the shake. They’re typically either free of allergens. There are some Elemental shakes that do use some corn or soy products, but they are just broken down. I always equate it to hypoallergenic infant formula, where they are broken down into such tiny, predigested pieces.
Dr. Roy:
The large majority of people can tolerate really almost any of the shakes, though because of the nature of the clientele we see and the people who tend to seek Elemental Diets, there are some people who are very sensitive. If they don’t tolerate one, they might try another and be quite successful. We’ve had a few people who don’t tolerate one shake and then tolerate another.
Dr. Eric:
Have your clients tried any homemade ones? I know Dr. Allison Siebecker has her homemade formula. I’m sure there are other ones out there. Is it typically the ones that are premade that they are taking?
Debbie:
It’s a testament to the benefits of Elemental Diet that every year, more and more companies are coming out with Elemental shakes. In this last year, we have two more in our basement for us to invite some friends over and sample with us.
Dr. Roy:
Believe it or not, we actually do that.
Debbie:
More and more companies are coming out with these premade formulas. The taste has gotten so much better over time.
Yes, I have had clients and participants in our program who use Allison Siebecker’s homemade formula. I would say that generally is done for one of two reasons. One is accessibility. They live in a country where Elemental shakes are not as available to them.
Dr. Roy:
Or only by prescription.
Debbie:
The second reason is, as Roy spoke to, that person is really sensitive, and they want to control everything that’s going into the shake, ingredient by ingredient, and pick and choose that way. Otherwise, I think she would agree and say this, too: The premade formula, the flavor profile of them, is so much better than the homemade shake.
Dr. Eric:
Okay. That’s good to know. Do you use it as a starting point with your SIBO patients? Is it something where you maybe put them on an herbal antimicrobial protocol or Rifaximin, and then if they don’t respond, give the Elemental Diet? Does it depend on the person? Maybe you speak about the Elemental Diet as an option. Depending on how they’re reacting, “I’m not sure if I want that,” let’s start with something else and then see how they respond.
Debbie:
Good question. I say it’s really self-selecting. People seek me out to do an Elemental Diet with me. I get a lot of clients who are really interested in Elemental Diets. That may be because they have failed other treatments before. That might be that they do a SIBO test, and their numbers come back so high that when they’re faced with the option, it’s 2-3 weeks of an Elemental Diet or potentially three courses of antibiotics, 12-16 weeks of herbs. Okay, I think I can muster it up to do this for 2-3 weeks.
For us, a lot depends on the person and what the person wants. You don’t want to twist anyone’s arm into doing an Elemental Diet. If it’s something that they’re willing to do, we want to give them the tools to do it appropriately and easily.
Dr. Roy:
Because we both have personally done them, and we’ve had so much success—Debbie has gotten so many people successfully through the Elemental Diet—we have more testimonials than we could put up of people’s incredible success.
Oftentimes, there is these amazing success side effects. They didn’t do it for the fact that they had back pain and neck and shoulder pain and aches and pains, but they get dramatically better from that even though that’s not why we did it.
Because we sell it very enthusiastically, and we have seen so many people do it successfully, and we guide people through it very successfully, we probably use it a lot more than other people.
In pediatrics, generally, I start with medications. Mostly because of compliance. Sometimes, you have to take multiple medications, depending on if they have hydrogen and methane SIBO or just methane SIBO. The compliance on the herbs can be very challenging. A lot of kids don’t swallow pills, so we have to crush up tablets. I tend to start with that. If we get success-
It’s also harder to get kids to do this, and to get most of my kids’ parents in my practice to think about an Elemental Diet. We have done it with some teenagers really successfully. And a few younger than teenagers. But much more in adults.
Dr. Eric:
Makes sense. 2-3 weeks in the case of SIBO, is that usually enough to eradicate it? I’m sure it depends on the person. If someone follows Elemental Diet for three weeks, let’s say, I don’t know if you do a follow-up breath test or just go by symptoms. If it’s a lot better, but maybe they still are not quite where they need to be. What approach do you take then? Can they go an extra week or two?
Debbie:
It depends on the person. We have jokingly said this many times, so you may have heard us say this. There are some people who finish their last shake and say, “I will never touch this again.” There are other people who finish their last shake, and they incorporate shakes ongoing into their healing toolkit.
A client specifically with SIBO, we will do a follow-up breath test. I have been saying for years that I think it’s 80-85% effective for both hydrogen methane and hydrogen sulfide SIBO. The research had only been from 2004 on hydrogen SIBO. I heard Mark Pimentel speak recently. He did a study on methane SIBO and found that same success rate. I have seen that for years.
Generally, we see an improvement even if it’s not 100% eradication. For those people who still have some SIBO, they might choose to go back on the Elemental Diet, or they might choose to follow things up with an herbal protocol or sometimes one course of antibiotics. It’s really individual.
I say often that what I’m trying to flesh out with my clients is the stress that continuing on the Elemental Diet is causing versus the healing benefits that it’s providing. Any time someone gets into the situation where they are simply white knuckling it and don’t want to do this anymore, I believe that is a stress on their body. Then it’s not really the same healing tool.
Dr. Roy:
Some people have the opposite reaction, where they are feeling so good on the Elemental Diet that if you tell them to do another week, they’d do it happily. That’s the minority though.
Debbie:
Some people are slow to go back on food because they feel such a relief from symptoms that they’re afraid that food is going to cause their symptoms to come right back.
Dr. Eric:
Do you take a similar approach with IBD? Ulcerative colitis, Crohn’s, where you give them the option? Talk to them about the Elemental Diet. I think Dr. Roy, you mentioned in the case of IBD, they could actually be on it longer, maybe 4-6 weeks.
Dr. Roy:
People do Elemental Diets for around six weeks, 100% Elemental Diets. Then we use it in our practice a few different ways. That answers your question. If people need to be on it longer, they can be. Even past three weeks.
Our program for example is self-led, so you can do it by yourself. Doing 2-3 weeks, as long as we have contraindications of when you shouldn’t do it, as long as you fit the model, which is 99% of people, who can do it very safely by themselves at home, that’s fine.
If you are going to go past three weeks, you probably should be under the supervision of at least a very well experienced nutritionist, dietician, medical physician. At that point, you’re also shutting down your digestive functions in your body. You need to know how to turn that back on. After a couple weeks, you do. But even longer for sure. That’s something I would experiment with at home by myself.
But we do use it in other ways in the practice as well. Do you want to talk about the other ways that we do it, like the rests and the resets?
Debbie:
With IBD, we have markers that we can be monitoring. We might be monitoring someone’s fecal calprotectin or ESR. You will generally see those coming down. We won’t necessarily keep someone on an Elemental Diet until those have completely normalized.
In those cases specifically, we will often transition someone onto a half Elemental or partial Elemental diet, which is what we call it because it’s not really half. They might continue to consume shakes for a portion of a day, like breakfast or breakfast and lunch, and then do a well-tolerated whole foods dinner. A lot of people can do that ongoing for an extended period of time.
Jus as an example, my sister, who has a plethora of different autoimmune conditions, did an Elemental Diet last summer through our program. Still to this day, her afternoon snack is an Elemental shake. She likes it. It gives her that period of bowel rest in the day. There are ways to extend it like that.
As Roy just said, we also teach people about how to use them ongoing, where they might do an Elemental Diet reset. We have some clients where very quickly, they will feel the anti-inflammatory benefits. They might go back to an Elemental Diet after they go on vacation, and they indulge, and things flare back up for them. A short period of bowel rest doing an Elemental Diet can be very helpful for them not to continue a downward spiral but go back on the ups.
Dr. Eric:
How about SIFO (small intestinal fungal overgrowth)? We spoke about SIBO. Is the Elemental Diet helpful with that?
Dr. Roy:
Nobody knows.
Debbie:
We don’t know.
Dr. Roy:
It hasn’t been studied. In theory, because the carbohydrates are being absorbed so high up, and fungus love carbohydrates, so they can grow things as well. You would think it would have a similar effect.
Early on, there were concerns that you could actually exacerbate fungal overgrowth because the early shakes, and some still do, have really high amounts of carbohydrates and sugar. There were concerns. We have at times put people on either antifungals, pharmaceuticals, or moreso herbal, just to prevent that.
It doesn’t seem like that’s really the case. We haven’t seen that be an issue, even in groups. Debbie did a group with a larger number of people who treat a lot of SIBO. It doesn’t seem an additional fungal overgrowth, if you didn’t have SIFO to start with, or mild SIFO gets worse. It doesn’t seem like it gets worse. No one has specifically studied that, so we don’t really know.
Debbie:
There are some practitioners who hypothesize that it also treats SIFO. Like Roy said, we really don’t know.
When we did an Elemental Diet ourselves, this was really when that next generation of shakes were coming in that used the glucose polymers and were lower in carbohydrate content. That was a question that I had for us: Do I put us on a prophylactic antifungal treatment? That was what we were doing previously with these older versions of shakes.
Generally, if people can tolerate it, we do that because they’re tolerating it. We may be helping treat a comorbid case of SIFO at the same time.
Dr. Roy:
Most people do tolerate it. Pharmaceutical antifungals, like nystatin, are not systemically absorbed. They are relatively tolerable for most people. Some people feel great after taking a course of nystatin in general. Same with using more botanicals. We have good tolerance, except with more sensitive cases.
Debbie:
What we don’t recommend people do is throw in a whole slew of supplements or medications, not that people throw in a slew of medications, but more supplements, while they are on an Elemental Diet. With an Elemental Diet, we are restricting those complex carbohydrates. Even cellulose capsules, things that people with a lot of these conditions often want to take, would not be considered Elemental. We don’t want to put in all this effort to do an Elemental Diet and then be taking handfuls of pills that are counter to an Elemental Diet.
Dr. Roy:
Also, depending on what pills you’re taking, some of these pills are very difficult to tolerate on an empty stomach.
Dr. Eric:
Makes sense. That was one of the questions I was going to ask you. Would you recommend typically not taking any supplements or just minimal supplements? If someone was taking magnesium and Vitamin D for example and a fish oil, would you say just take a break from those while following an Elemental Diet?
Debbie:
Generally, yes. The shakes have all that stuff in them.
There are times where we might add in a select number of supplements, just to address a condition that somebody has more than- They don’t need Vitamin D. That’s in the shake. They don’t need fish oil. There are fatty acids or oils in most of the shakes. Maybe we need to add some magnesium citrate because their bowels got really sluggish and backed up on an Elemental Diet.
Dr. Roy:
We don’t prophylactically start with that. We do it on a case-by-case basis. We actually in the course go over how to decide whether you need that or not. Just with a handful of supplements. We keep it really simple.
We have probably said a million times we are Elemental Diet purists. It’s so powerful that you don’t need a whole lot when you’re doing it. Especially if you’re doing it for SIBO, just do the Elemental Diet.
Dr. Eric:
How about coffee, tea, herbal tea?
Debbie:
Technically. Let me say it this way. I was answering for SIBO. For SIBO, technically, you can do some weak coffee and some weak teas on an Elemental Diet. We do not recommend that both in our program and with our clients. We want this to be bowel rest. To have a bowel rest diet that involves caffeine is generally not the direction that we want to go in.
I have used this example a couple times I have spoken. I had a client that was drinking a pot of coffee a day. She is a nurse and would work the night shift. She would drink coffee to get herself through her night shift.
When she contacted me to do an Elemental Diet, we really worked to wean her off of caffeine before she started. A few times during her shift, she would have half a cup of coffee while she was on the Elemental Diet. That was such a huge improvement from where she was at.
She had amazing results from the Elemental Diet. Completely got off her prescription laxatives that she had been on for years. She was having normal bowel movements afterwards.
Dr. Roy:
And stayed off of caffeine for the most part.
Debbie:
If people can get off of caffeinated teas and coffee, that’s best. Herbal teas, you can definitely drink. I’m a little bit more specific about which ones when somebody has SIBO. If they’re doing it for another condition like IBD or rheumatoid arthritis, really any teas are going to be careful. I do think about the roots and carbohydrate content of certain teas, if we’re specifically dealing with SIBO.
Dr. Roy:
One thing I feel is really special about the program and was in Debbie’s approach prior is there is a whole preparation phase. The program is not buy the shakes, drink it. Anyone can do that. With preparing your body for optimal success, and not just success through eradicating SIBO, but just to have general good foundational health.
I know in the holistic world, some people are very pro-coffee. There are maybe some benefits to it. I had been a coffee drinker during my residency and many years of college. But I can tell you that removing those things generally makes you feel healthier. It really does for most people. It’s not mandatory to get off caffeine, but we do find that people feel better when they do.
Dr. Eric:
Okay. Ideally, avoid coffee, avoid black tea, probably green tea, too, since it has some caffeine, not a lot, but still avoid pretty much anything with caffeine. Herbal tea, it really depends.
Dr. Roy:
You have to prepare yourself for that. The last thing you want to do is if you are a pot a day a drinker, to stop and just start your Elemental Diet. You will feel terrible.
Debbie:
You will feel horrible.
Dr. Eric:
I agree. I can’t say I put a lot of people on the Elemental Diet. But if I am putting someone on an elimination diet, usually I will recommend for them to take a break from coffee and other things with caffeine. If they are drinking 3-4 cups a day, it’s not a bad idea to gradually decrease. I am sure you have come across people who say they can just stop, and they actually do stop, and it seems like they’re okay. More times than not, that’s not the case.
Debbie:
Totally. There are people who feel the caffeine hit from white tea and can’t drink it because we are so sensitive to caffeine.
Dr. Roy:
One thing I want to jump back to for a second, I know it’s a little far back in our conversation, but I think it’s important to mention. We mention that Elemental Diets are used for the first line for Crohn’s and colitis. That’s not what our first line is generally.
If someone comes in who is really inflamed and in bad shape, that might be our first line for them. but generally, we start with more holistic, health-promoting approaches, looking at things like removing coffee from their diet, looking at their diet, a more foundational, functional, holistic, whatever you want to call it approach.
We have a ton of success with that. It’s still relatively a minority of patients we see who end up on the Elemental Diet. This is more for people who have done the foundational, health promoting, holistic approaches and are still suffering. Or if they come in in really bad shape initially.
Debbie:
One thing I will add is people who have IBD a lot of the time live with that fear of what if the bad flare-up happens. “I have been pretty okay now, but I have read XYZ, and it can get worse.”
I always tell people that it makes people feel so good psychologically to know that this tool exists that they can have in their back pocket. A lot of my clients in particular don’t want to go on some of these heavy-hitting drugs. They are maintaining on some of the less heavy-hitting drugs, but they think if things turn for the worse, that’s where they have to go, and they don’t want to go that way. Knowing that the Elemental Diet is an option for them brings a lot of relief for them psychologically.
Dr. Roy:
Especially because they feel better, but we can also measure markers of inflammation, the calprotectin, the ESR, the CRP. That is really useful. It’s a nice tool to have because it does mirror how they’re feeling most of the time. If their markers are great, then they can decide for themselves whether they want to be on medications or not. If their markers are still not great, we need to look a little deeper. Maybe medications are appropriate at that point.
Dr. Eric:
What about side effects? You mentioned constipation potentially. Then the magnesium citrate if someone is experiencing constipation is maybe an option to consider. Anything else people should look for if they are going through your program? Anything common or uncommon but might be concerning?
Debbie:
You used a good word. We have two lessons in our course that go through this. There are the psychological challenges that people go through of not having food. Then there are the physical challenges of being on an Elemental Diet.
We’ll speak to the physical ones because those are the ones most people are curious about. As far as bowel stuff, literally all over the board. Roy and I were opposite ends of the Elemental Diet spectrum.
Dr. Roy:
We’re on opposite ends of the physical spectrum. I say this on every podcast. It’s hard to tell because Debbie is sitting on a cushion, but I’m a foot taller than her.
Debbie:
Naturally, our bowels go in different directions. On an Elemental Diet, many people go to the extreme of what their bowels generally gravitate toward. Some clients that have slower transit time and motility will end up with constipation. We always point out that an Elemental Diet was used by NASA to send astronauts up into space because it produces little fecal matter.
Dr. Roy:
Very low residue; therefore, some people don’t produce a lot of poop.
Debbie:
Some people get really low fecal output. It’s not actually constipation.
Dr. Roy:
They don’t feel constipated. They don’t get abdominal pain. They feel great.
Debbie:
It’s just low fecal output, whereas other people are like a breast-fed baby. Everything comes out and looks like it did in your baby’s breast-fed or bottle-fed diaper. That is also completely normal.
A lot of what we’re doing is preparing people for what we call par for the course normal. When it happens for them, they don’t freak out about it.
The things we have people looking out for are changes in their bowels, changes in their energy level, brain function, blood sugar regulation.
There are oral symptoms that can come with an Elemental Diet that are by nature of not eating and chewing. Things change in your mouth as a result of that.
People have to think about their relationship with exercise when they’re on an Elemental Diet. That falls into energy and blood sugar sometimes.
They can get any side effects of die-off, microbial shifts. That’s what we’re going for here. Those bacteria sometimes are not going to go down without a fight. As the lipopolysaccharides get into people’s bloodstreams, they might feel the side effects of die-off, and that can feel like headaches, flu-like, muscle aches, fatigue, brain fog.
The other thing we teach people is we have a detox support guide in our program. How do you do the things? We can’t go to binders. That’s not Elemental. We teach people what are the things you can do on an Elemental Diet that will help you move those toxins through your system?
Dr. Roy:
While most people do feel some symptoms typically, they won’t feel all of them. They are probably not going to feel bad the entire time. I felt great on the Elemental Diet. Debbie did not. She didn’t feel bad the entire time. We have not really seen people who feel terrible the entire time.
We’ve had a couple people who psychologically struggled the entire time. It depends on where they are. They are taking it at a time where they need to do it for their health, but they are not prepared for it. They white-knuckle through it. That’s a tiny minority of the people we have guided.
Debbie:
I’m glad you pointed that out. What we often say is in the beginning, we didn’t know how people would react to this. We can speak now with this confidence of working with hundreds of people one-on-one and hundreds of people through our program. We have not seen those people that just feel absolutely awful the whole time. It really does come in pockets for people.
Dr. Eric:
The last thing I wanted to ask you. We spoke about specific conditions, like SIBO and Crohn’s and ulcerative colitis. For someone who has been undiagnosed, maybe they went to a gastroenterologist, and everything looked okay according to the endoscopy and whatever other testing they did. Maybe that same person got a comprehensive stool test, and for the most part, usually we will find some dysbiosis, but nothing screaming out.
Dr. Roy:
We call it the garden variety dysbiosis.
Debbie:
Yep, that’s our term for it.
Dr. Eric:
Overall, the composition of the stool test looks okay. The SIBO breath test comes back negative. We know no test is perfect, but that’s the point. It looks like everything’s okay, and they have done elimination diets and followed all these diets and protocols, yet they are still having gut issues, digestive symptoms. It sounds like there is no harm for a person in this situation to give the Elemental Diet a try for two or three weeks.
Debbie:
I would agree with that. You said the key words I was thinking. They have tried the other things. They have done a whole foods diet, some sort of elimination diet of allergens. As long as they have done all those things- I used my sister as an example. The only thing she has been diagnosed with is Hashimoto’s, but she has other autoimmune issues.
Dr. Roy:
Mystery autoimmune thing.
Debbie:
Nobody has put their fingers on it.
Dr. Roy:
There is not an exact diagnosis, but it is clearly inflammatory autoimmune.
Debbie:
Exactly. I am even running a client through right now who is in that same boat. The picture of this person is just screaming inflammation, but there is not really the diagnosis to support it. Oftentimes, an Elemental Diet is incredibly successful for those people.
Dr. Roy:
Let’s say it’s an extreme elimination diet because you are literally eliminating all proteins, which tend to be the bigger issue. Fats and carbohydrates can cause problems as well. You can really introduce things very slowly. We don’t recommend people finish an elemental Diet and go-
Debbie:
Eat a pizza.
Dr. Roy:
You have this unique opportunity. If you are feeling great, start introducing things really slowly. See which foods you’re reacting to. It’s a clean plate.
Dr. Eric:
Makes sense. This has been great. This is definitely the most in-depth anybody on the podcast has gone into with regards to the Elemental Diet, and will in the future, unless we have you back for an update in the future. Is there anything that I should have asked you that I didn’t ask you? Anything else you wanted to talk about before we wrap up?
Debbie:
The only thing that comes to mind for me, and I’m curious what you say, Roy, is we touched upon this a little. We often say that sometimes when people hear about Elemental Diets or hear us speak about them, they get really excited, and they want to try it.
But what we always tell people is that it is something that you should absolutely plan for. Understand what you’re getting into. Understand the side effects that you might experience. The term we always say is those people who plan are really planning for their success.
I think the more someone goes into it, educated, thoughtful, understanding what to experience, understanding how to transition off of it, what testing they might want to do before and after, they generally will have better results than the person who at 2am listens to this podcast, feels desperate, orders it, and starts the next day.
Dr. Roy:
Which there seems to be a decent number of people who do that.
In addition to what Debbie said, also having the time to order the shakes. Knowing which shake to order. There is a variety, and different ones can be used for different conditions. We go over that in our program.
The one thing we didn’t talk about that I think would be important, particularly for people who are really suffering with chronic illness, is weight loss. We get a lot of people, particularly with IBD or SIBO for long periods of time, who are really struggling with keeping on weight. They get worried they are going to lose weight when on the Elemental Diet.
Although you generally lose a little bit of weight, like water or poop weight, because you actually have a decent amount of poop in your body. You are not putting in any solid mass in your body, so you are not going to gain the daily weight. People with significant digestive and absorption issues can gain weight better than they could on regular diets because it’s still highly absorbable. You can build some muscle mass, especially when using semi-Elemental Diets. There are a lot of details. We do cover most of that in our program.
Debbie:
I spoke on a recent podcast. We had a client that has Crohn’s. She got her period back a few days into the Elemental Diet. She hadn’t had it for years after having four children and because of IBD. While that sucked for her, it was such a great sign that her body was actually getting nutrients that it had not been getting. She was able to get her period again.
Little bit of a tangent. There are a lot of details to think about as Roy was saying in terms of how people’s bodies are going to respond.
Dr. Eric:
All right. This has been amazing. Let’s go ahead and tell people where they can find you. Throughout this presentation, you spoke about the Elemental Diet Success Plan. Is there anything else you want to briefly talk about with that? You also have your five free diet tips. Where can people find out more about you?
Debbie:
They can find us at MindfulFamilyMedicine.com. You will learn about both me and Roy there.
Dr. Roy:
That’s our shared website.
Debbie:
Under our Programs tab, you’ll find the Elemental Diet Success Plan.
Dr. Roy:
And some other programs.
Debbie:
We have a couple other programs. What I have added in recently after launching the Elemental Diet Success Plan, what we learned is there are some people who, even with all that information, just want that one-on-one support through the Elemental Diet.
There is a separate program that I call One-on-One Elemental Diet Guidance, which combines the Elemental Diet Success Plan with check-in sessions with me along the way, so they can make sure they have their plan clear before they get started and along the way. I’m available for questions they have as well.
Dr. Eric:
Wonderful. Thank you so much, Dr. Roy and Debbie. It was great chatting with you. I’m sure the listeners learned a lot about the Elemental Diet. I learned some things as well.
Dr. Roy & Debbie:
Thanks for having us!
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