Adapted from episode 100 of The Perfect Stool podcast and edited for readability with your host, Lindsey Parsons, EdD, Gut Health Coach, with Roy Steinbock , MD, and Debbie Steinbock, HHC, of Mindful Family Medicine.
Lindsey:
Can you just start by describing to people what an elemental diet is and what it’s used for?
Dr. Roy:
Sure. So elemental diets are basically liquid diets, they’re shakes or formulas that you can buy, or there are some prescriptions. A truly elemental diet has all the nutrients broken down into their simplest form, so it would be amino acids, carbohydrates in the forms of simple sugars, or very mild complex sugars like tapioca, maltodextrin, things like that, as well as fats, and some vitamins and minerals; the things that you need to survive. You can survive on these diets for a couple of weeks. People do them from two to three weeks, typically. But sometimes for more serious conditions like Crohn’s and colitis, people can stay on them for longer periods of time, obviously, with the supervision of a physician or someone who guides people through those kinds of conditions. And the diets are very hypoallergenic. They’re anti-inflammatory, they starve the gut bacteria and give your gut rest, so they can be used in a variety of conditions because of those different reasons.
Debbie:
What I’ll add to what Roy said is that they’re liquid formulas, but they’re usually sold in powdered form that you then mix in with liquid to make a liquid formula. We did a “Q&A” earlier today, and someone was like, “why are they called elemental shakes when they’re really like elemental water?” (because they’re not thick). We think of smoothies when we say shakes. They’re generally much thinner than that.
Dr. Roy:
And it’s certainly not like a milkshake.
Debbie:
Yeah. And then when I spoke about starving the bacteria, it mostly starves the small intestinal gut bacteria. We have such prolific large intestine gut flora, that while that may be impacted on an elemental diet, relative to the bacterial amounts in the small intestine versus the large intestine, we’re having a larger influence on the small intestinal bacteria, as we understand it.
Lindsey:
So what brought you into work on digestive issues and a focus on the elemental diet in particular?
Debbie:
So I have been a nutrition counselor for going on 24 years at this point. I actually learned about elemental diets very early on in my practice, because of my focus in working with clients with inflammatory bowel disease. So I’ve used elemental diets for more than two decades in my practice, but mostly as an adjunct treatment to other things with clients who had inflammatory bowel disease or were going through other treatments. But in the last six or seven years, as elemental diets gained more popularity in the SIBO (small intestinal bacterial overgrowth) community, I started using them more as complete or full elemental diets, doing them with clients for an extended period of weeks. And that led me to other conditions that I use elemental diets with, in addition to SIBO in my practice, and I’m sure we’ll get into those, but we’ve used them for pain conditions, skin conditions, things like that, and autoimmune inflammatory conditions. At that time, about six years ago, when I got really interested in doing more with elemental diets, we did a full elemental diet ourselves together, because we really wanted to have that experience before we took others through it.
Dr. Roy:
We frequently like to experiment with ourselves before we’ll recommend something, so that was a good opportunity. Debbie really wanted to do an elemental diet, and I tagged along for the heck of it.
Lindsey:
That’s very brave of you, because I have sent clients on them. But I can’t say that I ever have done it myself, because I’ve heard that at least the Physicians’ Elemental is not that great tasting, and you can go into a little bit more about that in a minute. But I wanted to ask whether you’re using the elemental diets as a first line therapy for SIBO, or once anti-microbials have failed?
Debbie:
It’s little bit of both. We’re in a very unique position in our practice in the sense that we have people reaching out to us interested in doing elemental diets. So sometimes they just know of the efficacy of them, and it’s something that they want to try first. Other times, like you said, it’s because other treatments have failed.
Dr. Roy:
We have a pretty unique patient population, especially here locally in Boulder, but once you get a reputation for doing something unusual, like elemental diets, people do seek you out. And so a lot of our clients who maybe don’t do well on medications, have fear of taking medications, or have a difficult time with herbs, it’s a great opportunity for them to do something that’s incredibly powerful, effective and super safe. It does take some commitment and determination, but that tends to be our clientele in general. We’re rarely needing to convince people to make changes; we have a relatively intense clientele, I would say.
Debbie:
I once got asked, “how do you convince people to do such a hard treatment?” I’m like, “I’m not really convincing anyone, they’re calling me!”
Dr. Roy:
I think the other part of why we don’t need to convince people is because a) we did it ourselves, and b) we’ve had so much success doing it. Debbie’s walked hundreds of people through elemental diets successfully. And I think when you really believe in something, when you’ve seen the positive effects that it can have, and you have that under your belt, it’s pretty easy to “sell it”, because you know how effective it is, you know the challenges, and you know how to walk people through the challenges. That’s exactly why we created the program that we have.
Lindsey:
I have to say that for me, it’s been less of a first line treatment, unless, of course, I see someone who says, “okay, I’m sensitive to all these different potential supplements, I can’t do this, and I can’t do that.” And they’re on a bunch of stuff already, so how could I possibly suggest they go on something else? Then, okay, elemental diet, that just simplifies things. It pops into my head in that respect, but because it is sort of hard core, I think, two to three weeks of just eating a powder would be really hard for me, and admittedly, a lot of my clients, too, who are on super restrictive diets anyway. Then I’m thinking, if you’re only eating six things anyway, how much of a big deal is going on this powder for a few weeks? So I’m curious how long you have clients stay on the diet?
Debbie:
Yeah, so I would say two weeks is the average for many people. Occasionally, people will stay on for three weeks. We definitely have had clients who feel so good on the elemental diet, and that starts to kick in into the process. And they’re like, “is it okay if I stay on another week or another five days?” Then with some more severe conditions, people can stay on an elemental diet for more weeks than that, maybe for up to six weeks. However, I generally will transition people to a partial elemental diet at that point, so that they do have food in their system as well. Because as I like to say, there’s only a certain amount of flavor fatigue that people can endure on an elemental diet.
Dr. Roy:
For most people, there is a degree of fatigue of being on that. We tolerated it for two weeks, but I was ready to be done when we got off of it.
Debbie:
Roy also says “it needs to be tolerable but it’s not fine wine.”
Lindsey:
Right. So one thing where I’ve been using them more recently is, in particular, with IMO (intestinal methanogen overgrowth). So I’m curious if you find it to be equally effective for hydrogen SIBO versus IMO or methane SIBO, and I’m also wondering about hydrogen sulfide SIBO.
Dr. Roy:
Exactly. Well, one thing you mentioned, we also don’t use that as a first line treatment for most things. Obviously, we use a more holistic lifestyle approach for all the conditions that we’re treating. It’s usually by the time someone’s gotten to the point of considering an elemental diet, they’ve been through that with us or through that with some someone else. And so with conditions like SIBO, we will try other things first, but elemental diets are so effective and simple that people oftentimes sign up to them.
Debbie:
We’ve used it for all three conditions with really good success. I know that in the research, it’s really only been studied for hydrogen SIBO, but we found it very successful with intestinal methanogen overgrowth, as well as hydrogen sulfide SIBO, either diagnosed or suspected with a flatline breath test.
Lindsey:
Okay. So in my case, I’ve had a couple of clients for whom antimicrobials did nothing; it was not responding to the IMO. Then I got them on the elemental diet, and it broke the bloating a little bit, but it was not like everything was better afterwards, even that was not enough.
Debbie:
Well, you speak to a good point; is eradication of symptoms always correlated with the negative breath test? And as clinicians, we know that while some people feel amazing, there’s oftentimes layers and other things that are going on. Then sometimes, we eradicate SIBO, but somebody’s not feeling great still, and there’s other layers to their health that still need to be addressed.
Lindsey:
Right. So what other things might be causing the bloating if it were not the SIBO or the IMO?
Dr. Roy:
Yeah, well part of it can be things in the large intestine as well. So a lot of times, people have imbalances of gut bacteria in the large intestine, or they just might not be digesting their food well, which could then lead to fermentation. Maybe it’s not overgrowth, but it certainly could lead to fermentation that would cause them to have gas and bloating. Those are a couple of things.
Debbie:
Food allergies or sensitivities too. Or even sometimes just foods that are in their diet that are not necessarily working for them. An example I see really frequently that just came to mind when you said bloating is people that drink a lot of carbonated beverages, and they’re chronically distended, bloated, or have a lot of reflux. Then, when I look at their diet, it’s like, oh, you’re drinking 40 ounces a day of carbonation? Stress can exacerbate all GI conditions as well, so there’s a long list of other things that could be going on.
Lindsey:
So when you recommend that people go on an elemental diet, do you tell them to go off other supplements while they’re on it? Or is it safe to continue them? Or might those other supplements be providing food for the microbes?
Dr. Roy:
Yeah, we often joke that we’re elemental diet purists. When we put up someone on an elemental diet, typically, we’re just recommending being on an elemental diet with the shakes. That being said, we do recommend some supplements; something to maybe quell any potential fungal overgrowth, if that’s an issue. For people with methane SIBO, sometimes we’ll recommend using something like Atrantil, because Debbie had some clients that we used that with and actually found some really great results, both for symptom relief and gas reduction. But in general, what we’ve seen is that people don’t really tolerate a lot of supplements, because there’s no solid food in their digestive tract. Like sometimes we’ll recommend magnesium if someone’s has constipation, but usually they’ll need a smaller dose or be able to tolerate a smaller dose than they could when they were eating solid foods, so your digestion is a little more sensitive when we don’t have food in our belly.
Lindsey:
Yeah, I thought about the Atrantil. I know that those are polyphenols, and polyphenols promote the growth of certain kinds of microbes. So I was thinking, is that cheating?
Debbie:
Yeah, we say it’s always like a cost-benefit analysis of anything you add into the system, while you’re on an elemental diet. Do the benefits of adding it in outweigh the negatives of adding those prebiotic fibers or starches or whatever it is that you’re adding in even in a veggie cap or something like that?
Lindsey:
So I’m familiar with the Physicians’ Elemental diet, which people can find in Fullscript. I know Michael Ruscio has the semi-elemental diet formulas available on his website. Are those both good choices? Or would you say one’s better than the other? Or are there others that you recommend?
Debbie:
So we like to think about which elemental formula to choose based on which condition somebody is coming into the elemental diet with. We, of course, like most practitioners, have ones that are more tried and tested that we’ve used again and again with clients, with really great results. What we’ve also learned in working with so many people is that there’s some that work better for others. For example, there are some formulas that contain tapioca maltodextrin, that are typically lower in sugar than the ones that have glucose, dextrose, fructose. So some people do a lot better for blood sugar regulation and energy with those types of formulas, which a couple of companies have now. And then there’s some people that will do better with the shakes where they have to add their own source of fat to, because some of the fats that are contained in the formulas might not work well for them.
Then there’s the difference between elemental shakes and semi-elemental shakes. There’s some uses for both of them in this field. So we try to personalize it and teach people how to do so in the course that we have, by what condition they’re treating, or what their main concerns are. Or what’s the formula that’s going to best suit their needs? But to speak to your point, we keep saying that year after year, more and more shakes are coming onto the market, and that’s pretty cool, because it just shows us that there really is a need for this type of treatment. And at least in the 20 years that I’ve been tasting these, they have improved so greatly. The ingredients have improved too, to the point that we were willing to finally say, “okay, let’s try this ourselves”. This is not like drinking a hypoallergenic baby formula anymore.”
Dr. Roy:
To directly answer your question, we do use the Physicians’ Elemental a lot. They had a jumpstart on the market in terms of stuff that you could get from a practitioner or online, like Fullscript as you mentioned. We’ve not had a lot of personal experience with the Ruscio formula, but we’ve heard some good things about it. We’ve sampled a lot of different ones, and it’s on our list of ones to sample at some point. And we use Absorb Plus a lot, which is Jenny Patel Thompson’s formula, and that balance is great. She’s got a bunch of flavors and a bunch of different options.
Lindsey:
Is she a functional medicine person?
Debbie:
No, not at all. She actually formulated Absorb Plus for her own personal health. She had Crohn’s disease, used an elemental diet for six weeks to get out of a widespread flare and then created Absorb Plus. Interestingly, semi-elemental formulas were what were considered elemental diets way back then, 25 years ago. The distinction has changed. So now when we say elemental, we mean an amino-based formula. But actually, what she has educated me about over the years, is that most of the studies that you read on elemental diets have actually used semi-elemental formulas that were done all these years ago. So now, when we say semi-elemental, we mean that the formulas have amino acids, simple sugars and fats. Well, you have to add fats if they don’t have them. But they also have small proteins, like dipeptides, or tripeptides, whereas the “true” elemental formulas are the amino-based formulas that don’t have any peptides in them.
Lindsey:
Right. And the reason that they do that is because it tastes better if you put them in that format?
Debbie:
I don’t know if that was the original reason why. I don’t know that it was necessarily for taste; I think it was the populations that they were being used in. If you look back at when elemental shakes were originally used, it was definitely with IBD. They were actually developed for NASA for astronauts to limit the fecal matter while they were in space. For both of those populations, maintaining muscle mass is really important. And there is some thought that the semi-elemental formulas are better at helping to build or maintain muscle mass than just the aminos.
Lindsey:
Okay. So tell me about your use of elemental diets with IBD and how successful that’s been.
Debbie:
So that’s what I’ve been using them for the longest, but like I said, until I had done an elemental diet fully myself, I was really hesitant to get somebody fully off food and onto elemental shake formulas. And so for many years, I just used them occasionally. There was a study, a pretty big one, that talked about how using a half-elemental diet with inflammatory bowel disease was a very effective treatment. So oftentimes, I would have clients use elemental shakes as an adjunct for calories and easily absorbed nutrients, and I still use them that way. But sometimes now, when somebody’s initially starting, like a flare, if they have Crohn’s or colitis, we might have them do elemental shakes as an initial bowel rest treatment; so short term, or a couple of weeks, depending on what’s going on.
Dr. Roy:
In that population and in general for inflammation, these are formulas and shakes that are hypoallergenic, particularly the true elemental shakes with its amino acids. Normally, what we get allergic reactions to or sensitivities is more often due to the protein. And so when it’s broken down into these really simple forms, for most people, though there’s always exceptions, it’s going to be really hypoallergenic, and that can have an effect on everything from arthritis to colitis. They’re also so easily absorbed so high up in the intestine, that it really gives your bowel rest. So intestinal rest is incredibly important. It’s kind of like if you break or sprain your ankle, you want to give it rest. And when we eat three to five times a day, that’s creating a lot of digestive strain for people. So it can really help in terms of that.
Debbie:
Yeah, the reason that it’s used for SIBO and IBD, there’s an antimicrobial element and we know there’s an antibacterial action to them. That probably plays a part in the IBD population as well, whether or not somebody was diagnosed with SIBO or dysbiosis. We assume by nature of the condition that that exists there.
Dr. Roy:
There’s always these new popping-up studies showing that there’s an association between this bacteria and that bacteria, or Crohn’s, colitis and arthritis. Even in the study where they were using it for rheumatoid arthritis where they were able to induce remission for people as effectively as with using steroids, they proposed whether or not rheumatoid arthritis really starts in the gut. Obviously, all holistic practitioners know that or at least have thought that for many years, but it’s interesting to see Western science catch up with that.
Debbie:
Just to finish up answering that question, the other ways that I’ve used it with clients who have inflammatory bowel disease is sometimes, I don’t know if you see this with your clients, but I’ve certainly had the clients who can’t get off of steroids. They’re on steroids, and then every time they wean down to whatever dose it is, they flare up again. So if their doctor is on board with it, I’ve had quite good success helping somebody through using an elemental diet during the weaning off of steroids and had several cases where somebody who had many failed attempts at getting off of steroids was able to use an elemental diet to assist that process.
Lindsey:
But then did you slowly take them off the elemental diet with partial food?
Debbie:
Exactly, and then bringing in really good foods and good supplements to support them after that process.
Dr. Roy:
One of the things that we’ve seen that is really useful with the elemental diet is it’s virtually an elimination diet as well, because you’re really eliminating all your foods, and so it’s a good opportunity to see what really does affect you in a negative way. You obviously have to take into account that you’ve closed down your digestion for two or three weeks. So we have to fire that up properly, because that could create some digestive symptoms just by starting to eat after not eating for two to three weeks. But once we get that going, it’s a good opportunity to see, like, are strawberries really the thing that’s causing you to get bloated every time you eat them? Or was it more generalized?
Lindsey:
So when people go on an elemental diet, do they typically have stool on a daily basis? Or do they tend to have problems with diarrhea or constipation or any of those things?
Debbie:
It really varies so greatly; there’s such a wide range of what’s normal on an elemental diet. Educating people about that is important, because some people do have liquid breastfed baby poops. And that’s not diarrhea, that’s normal for people who are on an elemental diet, while other people have very little stool volume at all and could go a few days without stool and then when they pass stool, it actually looks quite formed. That’s been fascinating for us to see, even for Roy and I who have the same diet. We have some variation between the foods that we eat, even though we eat all of our meals together, mostly. But on an elemental diet, everything we were doing was exactly the same. And to see, even between the two of us, the difference in how our stools were on an elemental diet was pretty dramatic.
Dr. Roy:
We tend towards different types of bowel movements to start off with. And Debbie always says, and I think this is very true, it’s like people tend to go towards where their challenge is. I tend to have slower bowels, so I had less bowel movements. Though I wouldn’t have called it constipation on the elemental diet, I had normal bowel movements, they were just smaller and less frequent, whereas Debbie tends to have more frequent bowel movements.
Debbie:
And so they were on the elemental diet. Exactly. Sometimes people surprise us where I think I know which way it’s going to go for some of my clients, given their health history, and it surprises me. I’m like, “oh, that’s how their body reacted to the shake.” And it can change over the weeks as well. Remarkably, for some people who are constipated, or have really high methane SIBO, and they’re having a struggle with bowel movements on an elemental diet, they might have one every day. And those are people that are like, “I want to stay on this a little bit longer.”
Lindsey:
So if somebody went on an elemental diet with SIBO, when they’re coming off of it, do you have one of the many SIBO diets that you recommend as a transition?
Debbie:
Yeah, so food reintroduction is really quite individualized for the person. But typically, what we do is we give people a very low residue diet to do for the first five days to really minimize any symptoms that they have. Then, we teach people how to use the different diets that are on the market for SIBO to really customize and learn what works best for them. So the diet that’s best for Debbie is different than Roy, and Lindsey, and that’s really the take home message here. While all these diets are great guides that were created with great intentions, most people don’t need to follow them to a “T”. But as Roy said before, sometimes after an elemental diet or after healing dysbiosis, or SIBO, they have a much wider tolerance of foods. We’ve seen that again and again in our practice. So what we don’t want to do is have somebody transition off an elemental diet and onto another restrictive diet when they’ve actually gained tolerance to foods back. So there’s a way that we teach people how to test that out in a systematic way, where they try the foods that they’re least likely to react to first and then test foods with higher fermentation or things like that down the line.
Dr. Roy:
Or foods that have been challenging for them down the line.
Lindsey:
I was just going to say, it’s challenging sometimes when people have very restrictive diets and then start doing treatments that in theory should get them into a less restrictive diet. It’s tricky getting them to try new foods, and I’m curious how you handle that.
Debbie:
Yeah. I think that speaks to also that there’s a lot of a fear around reintroduction. That’s really important to note because after an elemental diet, especially if somebody feels a lot better after their treatment, they might be very reluctant to try new foods and are very afraid of symptoms coming back as well. I feel like I missed a part of your question.
Lindsey:
Well just how do you handle that?
Dr. Roy:
Well, we give suggestions in our course of how to do that; if you’re going too slowly, what happens if you go too quickly, if you have a relapse, or how to go backwards, we talked about all that. But for the really complicated people who have a lot of psychological and emotional connections to food and challenges with food, that’s probably more based on a one-on-one treatment protocol for them and helping them through that. This goes back to your other question about like, what do you do if someone’s still bloated or not feeling? Well, a lot of times we found, despite people doing all the right things, they’re still not feeling well, and it gets harder and harder to figure out what’s going on with them. At some point, what we realize is that a lot of that is immune-nervous system connection, fight or flight state and really working on that. And there’s some good programs to work on that as well. So you’re really helping people deal with some of their emotional issues around food. Their past history or their trauma around it can be an incredibly important part of their healing.
Lindsey:
Right. So are you using breath tests before and after elemental diets to check on people’s progress?
Debbie:
Yeah, I would say 80 to 90% of people want that for SIBO. We generally recommend it. If they have a before breath test, we generally will do an after breath test, unless there’s financial concerns for somebody. But there’s also clients that are like, “if I don’t have SIBO, I know I still want to try this for just the break and the bowel rest.” So we’ve definitely had people who do that as well. We’ve had clients who have tested for calprotectin or sed rate or CRP before and after elemental diets as well. But for many of the conditions, there’s not much testing you can do before and after.
Dr. Roy:
Right. And usually, by the time we’ve gotten someone to do an elemental diet for something that’s not SIBO, they have gone through a decent amount of testing already to try to figure out what’s going on with them. Sometimes it is a little bit of a “Hail Mary” pass after we’ve tried a lot of things. We know this has helped such a random concoction of different conditions, so people will try it. Oftentimes, we’ve had really good success, even when it’s not SIBO or something obvious.
Lindsey:
So tell me a little bit about some of the unusual conditions that you’ve seen it successful with – like you were mentioning pain and autoimmune and inflammation.
Dr. Roy:
Yeah, some with people who have arthritis, maybe not even specifically rheumatoid arthritis but arthritic conditions, chronic pain–it’s been really helpful for some. We’ve also treated a few people with some serious skin conditions like rosacea, and had pretty dramatic results. Now usually, these are people also having some digestive symptoms as well. It’s not just only for arthritis, though we certainly would do that. I just don’t think we’ve had someone specifically come to us for that.
Debbie:
We’ve done multiple food intolerances like eosinophilic esophagitis and had some really good successes there. And then we use partial elemental diets with all different kinds of conditions, from cancer to HIV.
Dr. Roy:
Those are for clients who just need easy, absorbable nutrition, we’re not necessarily trying to kill anything. And it’s not even necessarily for the anti-inflammatory process, but just to be able to get really easy-to-digest nutrition when they have damaged gut lining. We want it to get absorbed up real high so they can get all the essential nutrients.
Debbie:
Yeah, it’s because the gut affects so many things. Elemental diets clearly have never been studied for mental health conditions, but of course, you have to wonder how useful they would be with a lot of different conditions that they have yet to be studied for.
Dr. Roy:
We’ve seen improved brain fog and difficulty concentrating, or sleep as a positive side effect for people when we’ve treated other conditions. Again, it wasn’t one of the primary issues that we were dealing with, but we’ve seen improvements with that.
Lindsey:
Could you back up a little bit and just explain to people what eosinophilic esophagitis is? Because I don’t think any guest has ever mentioned that before on the show.
Dr. Roy:
Okay, sure. So basically, eosinophils are the type of white blood cells that produce IgE, which is the antibody that creates allergies. It turns out that you can have a higher concentration of eosinophils pretty much in any tissue. Thus, eosinophilic esophagitis is in the esophagus or the connection between your mouth and your stomach. And usually it’s a diagnosis where people are having a difficult time swallowing, consuming foods, or they can be bloated. It can be associated with SIBO, and it’s often times pretty uncomfortable for people. It’s a relatively newer diagnosis, and you can find eosinophils everywhere; there’s eosinophilic gastritis, there’s eosinophilic colitis, so you can find your eosinophils everywhere in the gut. The treatments in terms of Western medicine are pretty limited. It’s mostly steroids. It’s interesting in the Western world, I just find that so many Western doctors are just so terrified to tell a patient that they can’t eat a food, but you know, that can be very effective. And the ultimate elimination diet, like I said, is this elemental diet, and that can be quite effective at decreasing the inflammation. Sometimes that’s permanent, and sometimes that’s temporary. But for a lot of patients with something like this, or something recurring chronic, like maybe rheumatoid arthritis, if you can’t completely halt it, just having another tool, maybe even in addition to using steroids sometimes can be incredibly helpful. This can help decrease the total body burden of steroids and maybe lower the doses.
Lindsey:
Are you using functional stool tests to diagnose that?
Dr. Roy:
Well, not specifically for eosinophilic esophagitis. We do use stool tests, breath tests, and different functional medicine blood testing for other conditions. Eosinophilic esophagitis is generally diagnosed by esophageal endoscopy, and you have to have a certain number of eosinophils, more than 30 per high-power field, to be considered positive. Now, there’s also the gray zone of like, what if you have 25 and not 30? We see that as well. And that’s beyond the scope of this conversation, but it can be treated beyond just steroids and elemental diets as well. Elemental diets can be a very effective tool, at least squelching that inflammation.
Lindsey:
Right. But in general, that then would be something that was diagnosed by a gastroenterologist?
Dr. Roy:
Correct. That would be a diagnosis made by a gastroenterologist unless someone else is doing endoscopies.
Lindsey:
Right, because I know, like on the GI map, there’s the eosinophil protein X, and I’m wondering if that is indicative of some type of eosinophilic process.
Dr. Roy:
I think it is–it is indicative of some kind of eosinophilic processes. For example, people who have really severe allergies might have very elevated numbers of eosinophils floating in their blood. And that can be a tip off to “oh, these people might have eosinophilic esophagitis.” That being said, I’d say the majority of patients that I’ve seen with eosinophilic esophagitis don’t have elevated eosinophils in their blood or even elevated eosinophil protein X in their stool. Certainly one is not diagnosing the other, but it certainly points in the same direction, which is an issue with eosinophils or immune regulation, kind of like you see in allergies and asthma and eczema. They’re all part of that same immune dysregulation family.
Lindsey:
So I know that (and you mentioned already) that the elemental diet powders need to have fat added to them. I know that at least the semi-elemental, (the Dr. Ruscio ones) do. Does the Physicians’ Elemental diet also have to have fat added?
Debbie:
Those have fat included into the product.
Lindsey:
So when people do have to add fats, I know some of the recommended ones are like Udo’s 3-6-9, or MCT oils. Do you have a preference for a particular type of oil?
Debbie:
Yeah, it depends on the person. It’s really what oil they can tolerate the best. We’ve had clients that have added fish oil. I can’t imagine downing fish oil several times a day in my elemental formula, but for some people, that’s what they tolerate best. But all the ones you mentioned certainly can be added to somebody’s diet depending on their taste tolerance and how well they can tolerate fats and how many calories they can tolerate from fats as well.
Lindsey:
Right? Because I know that MCT oil is known for causing diarrhea.
Dr. Roy:
Right. Drinking oil in general can cause diarrhea.
Lindsey:
We just don’t normally do it.
Dr. Roy:
Exactly, but I also I think it’s less likely to cause that when it’s mixed in with their amino acids or proteins infused in a semi-elemental and carbohydrates as well. We’re designed to absorb food in that way. Obviously, this is a little unnatural, it’s not whole foods. But we’ve not seen a lot of people who have oil diarrhea from it.
Debbie:
Not at all. But there are some people that can’t tolerate MCT oil and some of the oils added into products that do better with less fat or specific kinds of it. We don’t have people add oil into the formulas that contain oil in them. That just feels a bit excessive.
Dr. Roy:
And there’s some conditions where it might make a difference to add more or less oil, for example, things like pancreatitis or gallbladder disease, where that can cause some issues–you might need to use less oil. When it gets to the point where you’re really trying to figure that stuff out, working one-on-one with a practitioner makes more sense.
Lindsey:
So tell me about your Elemental Diet Success Plan* and where people can find it.
Debbie:
So the Elemental Diet Success Plan* course was borne out of all the work we’ve done coaching clients one-on-one through elemental diets. And in that process, we really learned the most commonly confusing questions that people had, where they really needed the most support in the elemental diet process and I personally have been the person seeing the clients in our practice through elemental diets through all of these years. So we put this course together, it’s really like a course for clients or patients, who are interested in getting additional support while going through their elemental diet. So the elemental diet success plan is composed of 14 different video lessons, which take people through planning or preparing for the elemental diet, implementing the elemental diet and then transitioning off the elemental diet successfully. And so we say that all of our lessons are little bite-sized lessons, where they might be as short as five minutes or as long as 25 minutes.
What we want is for people to be able to take an overview of the course. But then as they’re in each phase, they can go back and re-listen to that lesson again when they’re in it and they really need that additional support. Then what we also have as part of the program is some different guide books that take them through the process as well, so like a program timeline that helps them keep track of their progress through the program, a workbook that we say is kind of like the virtual handholding from us through the whole process that helps them through their calorie calculations, making their shake schedule, figuring out what foods they’re going to go back to after the elemental diet, troubleshooting symptoms, whether that’s psychological or physical symptoms of the elemental diet.
Dr. Roy:
It also helps with figuring out their inspiration for why they’re doing an elemental diet, how to stay on an elemental diet and how to persevere through an elemental diet.
Debbie:
Or the mindset part of the elemental diet. Then we give them a detox support guide to support them through more challenging days to make symptoms more bearable, as well as transition diet recipes to help them through those first five days especially, and really the first two weeks of food reintroduction. So that’s the overview. Did I miss anything?
Dr. Roy:
No–what I would say is that, like many doctors, I’m not walking people through elemental diets. It’s really Debbie’s experience of walking hundreds of people through elemental diets. We always joke in our family that for Debbie, if she was a superhero, her superpower would be organization and the overview of everything. She really just knows how to put things together for people and how to really guide people from beginning to end. Her amazing observational skills over these years have put together a program, initially one-on-one for her clients, but then turned it into a self-led program that really helps people be successful. That’s why we named it the elemental diet success plan, because we were thinking about what’s the purpose of it? It was that Debbie has guided hundreds of people successfully through an elemental diet with virtually a 0% attrition rate. I mean, there’s people who give up before they start, but anyone who has started and gone through the work with Debbie has made it through an elemental diet and many people already through the Elemental Diet Success Plan, self-guided.
Debbie:
We always say we can’t guarantee someone’s success with the results they’ll get from anything, but we can guarantee that we can successfully guide them through all the things they would need to have the greatest likelihood of a successful elemental diet experience, and therefore, a successful experience with their health as a result.
Dr. Roy:
And a pleasant experience, because despite there being some challenges during an elemental diet, for the most part, it’s really doable for the majority of people who want to do it.
Debbie:
And we don’t stop people white knuckling it.
Lindsey:
During this process, do they have access to some type of community or some online source such that they’re not totally alone?
Debbie:
Yeah, the videos take them along this– we’ve built out and continue to do so, like with our participant FAQ inside the course. At this point, there’s not an interactive forum, but we actually did a Q&A this morning for our current program participants right now, which was so wildly successful that we’re considering the idea of doing little pop up Q&As along the way so we can catch people at different phases of their process. But with that said, what I’ve also done is quite a few hybrids, where a lot of the people that worked with me one-on-one, now that we have the Elemental Diet Success Plan*, they might buy the course and then say, “Hey, I just have a few things that I want to check in with you and make sure I got this right, I’m doing this right for my health, and you don’t have anything else you’d add to the mix given your experience.” And that’s worked so beautifully for people to have a little one-on-one but also have the course materials to take them through.
Dr. Roy:
Yeah, it really makes that part more affordable, so you can learn the basics from the course and then get one-on-one with Debbie. Our support staff will answer some very basic clarifying questions, but we can’t do one-on-one consultations in that way through email with people whose health information we aren’t privy to.
Lindsey:
Yeah, every time I get a client question, I’m just like, “Okay, now let me go back to my database, reread all the notes I have about your conditions, look at the supplements you’re taking, and okay, now I can answer it.” So I can totally understand that. Any final thoughts before we head off?
Debbie:
No, that’s it. It’s a pleasure to meet you, and it’s nice to get to sit down and talk to you. Thank you so much for having us!
If you’re struggling with bloating, constipation, diarrhea, soft stool, acid reflux, IBS, IBD or any type of chronic disease, etc. and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
