Elemental Diets

Elemental diets have been in use since the 1940’s in hospital settings; however, recent research has resurfaced the benefits of using it as a dietary intervention for the dietary management of patients with compromised digestive systems. The elemental diet is a medically supervised, sole nutrition dietary management given to individuals with moderate to severe impaired gastrointestinal function for 14-21 days. Some elemental diets are also considered medical foods.

Clinical evidence supports the use of elemental diets in the dietary management of gastrointestinal/digestive impairments including SIBO, Irritable Bowel, and Crohn’s disease.1-12 The diet consists of macronutrients broken down into their elemental form requiring little to no digestive functionality allowing time for the gut to rest. Elemental formulations are believed to be entirely absorbed within the first few feet of small intestine.17

Products designed for the Elemental Diet contain anywhere from 14-18% of calories from protein in the form of amino acids, 42-76% calories from carbohydrate in the form of monosaccharaides, and 6-43% of calories from fat in the form of fatty acids. The micronutrient composition of an elemental diet is complex because it must be sufficient for up to 3 weeks, but not exceed safe levels of ingestion even for impaired individuals.

Elemental diets require minimal digestive functionality for assimilation and meet the distinctive nutritional requirements of individuals with impaired gastrointestinal function.  Elemental diets offer complete nutrition in an easily digestible and absorbent liquid form.

elemental diets compared to meal replacements, targeted proteins and semi-elemental diets

Elemental diets are often confused between a variety of other diet plans and products.

Semi-elemental diets are a perfect example. Semi-elemental diets are diets that make up a subset of an elemental diet as they use hydrolyzed protein in their formula.13 These diets are used for management of less severe cases of gastrointestinal/digestive impairment including SIBO and Crohn’s disease.14

Meal replacement products are also commonly compared to elemental diets. While both an elemental diet and meal replacement product can be used as sole nutrition, meal replacements are designed primarily for weight loss15 or weight gain.16 Meal replacements also contain whole proteins which are not suitable for comprised systems.

Targeted protein products also contain whole proteins. These products are not designed to be a sole source of nutrition for an individual and are not indicated for severely impaired GI dysfunction.

 

References:

  1. Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., Vorisek, V. and Kopacova, M. 2010. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 16:2978-2990.
  2. Devlin, J., David, T.J. and Stanton, R.H. 1991. Elemental diet for refractory atopic eczema. Arch Dis Child. 66:93-99
  3. Eidon 2003. Nutritional considerations in inflammatory bowel disease. Pract. Gastroenterol. Nutrition Issues in Gastroenterology, Series #5. May 2003, pp. 12., http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-supportteam/nutrition-articles/may03eidenarticle.pdf
  4. Fisher, R.L. 1999. Wasting in Chronic Gastrointestinal Diseases. J. Nutr. 129:252S–255S.
  5. Gorard, D.A., Hunt, J.B., Payne-James, J.J., Palmer, K.R., Rees, R.G., Clark, M.L., Farthing, M.J., Misiewicz, J.J. and Silk, D.B. 1993. Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone. Gut. 34:1198-1202.
  6. O'Morain, C., Segal, A.W. and Levi, A.J. 1984. Elemental diet as primary treatment of acute Crohn's disease: a controlled trial. Br Med J (Clin Res Ed). 288:1859-1862.
  7. Pimentel, M., Constantino, T., Kong, Y., Bajwa, M., Rezaei, A. and Park, S. 2004. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 49:73-77.
  8. Ueno, F., Matsui, T., Matsumoto, T., Matsuoka, K., Watanabe, M., Hibi. T., and On Behalf of the Guidelines Project Group of the Research Group of Intractable Inflammatory Bowel Disease. 2013. Evidence-based clinical practice guidelines for Crohn’s disease, integrated with formal consensus of experts in Japan. J Gastroenterol. 48:31–72.
  9. Van Citters, G.W. and Lin, H.C. 2005. Management of small intestinal bacterial overgrowth. Curr Gastroenterol Rep. 7:317- 320.
  10. Verma, S., Kirkwood, B., Brown, S. and Giaffer, M.H. 2000. Oral nutritional supplementation is effective in the maintenance of remission in Crohn's disease. Dig Liver Dis. 32:769-774.
  11. Yamamoto, T., Nakahigashi, M., Umegae, S., Kitagawa, T. and Matsumoto, K. 2005. Impact of elemental diet on mucosal inflammation in patients with active Crohn's disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis. 11:580-588.
  12. Zoli, G., Carè, M., Parazza, M., Spanò, C., Biagi, P.L., Bernardi, M. and Gasbarrini, G. 1997. A randomized controlled study comparing elemental diet and steroid treatment in Crohn's disease. Aliment Pharmacol Ther. 11:735-740.
  13. Vandenplas Y, Plaskie K. Safety and adequacy of an optimized formula for pediatric patients with cow's milk-sensitive enteropathy. Minerva Pediatr. 2010 Aug;62(4):339-45.
  14. Eichenberger JR, Hadorn B, Schmidt BJ. A semi-elemental diet with low osmolarity and high content of hydrolyzed lactalbumin in the treatment of acute diarrhea in malnourished children. Arq Gastroenterol. 1984 Jul-Sep;21(3):130-5.
  15. Fuller NR, Fong M, Gerofi J, et al. A randomized controlled trial to determine the efficacy of a high carbohydrate and high protein ready-to-eat food product for weight loss. Clin Obes. 2016 Apr;6(2):108-16.
  16. Katsanos CS, Chinkes DL, Paddon-Jones D, et al. Whey protein ingestion in elderly persons results in greater muscle protein accrual than ingestion of its constituent essential amino acid content. Nutr Res. 2008 Oct;28(10):651-8.
  17. Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Digestive Diseases And Sciences. 2004;49(1):73-7.