From the Guidelines
I strongly recommend a 6-8 week elemental diet plan for patients with inflammatory bowel disease, using commercially available formulas like Elemental 028, Vivonex, Peptamen, or Elecare, as this approach has been shown to induce remission and improve symptoms 1.
Key Considerations
- Start with 1500-2000 calories daily, divided into 6-8 small "meals" consumed throughout the day, to ensure adequate nutrition and minimize digestive workload.
- Begin with half the target volume for 2-3 days to allow the digestive system to adjust, then gradually increase to full volume, as recommended by the British Society of Gastroenterology consensus guidelines 1.
- Mix the formula according to package instructions using clean water, and sip slowly rather than gulping, to reduce the risk of refeeding syndrome and improve tolerance.
- Supplement with essential electrolytes if the formula doesn't contain adequate amounts, as patients with inflammatory bowel disease may be at risk of electrolyte imbalances 1.
Monitoring and Support
- Monitor weight weekly and maintain a symptom journal to track improvements, as this will help identify any potential issues and ensure the patient is responding to the diet.
- Take prescribed medications as directed by a physician, but avoid over-the-counter medications unless approved, to minimize potential interactions and side effects.
- Work with a healthcare provider to gradually reintroduce solid foods after completing the diet, starting with simple, well-cooked items one at a time, to identify any trigger foods and prevent relapse.
Rationale
- The elemental diet works by providing pre-digested nutrients that are easily absorbed in the small intestine, reducing digestive workload and inflammation while allowing the gastrointestinal tract to heal, making it an effective approach for conditions like Crohn's disease, SIBO, or severe IBS 1.
- Exclusive Enteral Nutrition (EEN) has been shown to alter the microbiome and induce remission in mild to moderate Crohn's disease patients, with a minimum duration of 4-6 weeks recommended 1.
From the Research
Elemental Diet Plan
An elemental diet is a precisely formulated, predigested liquid diet capable of providing adequate nutrition for growth, development, and tissue repletion in normal and debilitated patients 2. The diet can be used as the sole means of nutritional support for a variety of gastrointestinal problems.
Key Components of an Elemental Diet
- The diet consists of a liquid formula that is easy to digest
- It provides all the necessary nutrients, including proteins, carbohydrates, fats, vitamins, and minerals
- The formula is often administered through a nasogastric tube or orally
Duration of an Elemental Diet
- The duration of an elemental diet can vary depending on the individual's condition and needs
- Studies have shown that an elemental diet can be effective for 6-8 weeks in inducing remission in patients with Crohn's disease 3
- A 14-day elemental diet has been shown to be highly effective in normalizing the lactulose breath test in patients with irritable bowel syndrome (IBS) 4
Sample Elemental Diet Plan for 6-8 Weeks
- Week 1-2: Exclusive elemental diet, with the formula providing 100% of the daily calorie requirement
- Week 3-4: Gradually introduce small amounts of solid food, while still providing 50-70% of the daily calorie requirement through the elemental diet formula
- Week 5-6: Continue to introduce more solid food, while reducing the amount of elemental diet formula to 30-50% of the daily calorie requirement
- Week 7-8: Further reduce the amount of elemental diet formula, while increasing the amount of solid food
Important Considerations
- The elemental diet should be administered under the auspices of experienced and interested personnel who have a specific interest in surgical nutrition 2
- The diet should be tailored to the individual's specific needs and calorie requirements
- Regular monitoring of the patient's condition and nutritional status is necessary to ensure the effectiveness and safety of the elemental diet 5, 6