SIBO and the Elemental Diet

Small intestinal bacterial overgrowth, or SIBO, is characterized by an overgrowth of certain bacteria in the small intestine which normally live in the large intestine.  Currently, the most researched and most commonly applied therapy for SIBO is treatment with antibiotics to kill the invading bacteria. The elemental diet offers an alternative approach to treating SIBO, and clinical studies have demonstrated its high efficacy in reducing gastrointestinal symptoms and normalizing lactulose hydrogen breath tests (the most commonly used test for the diagnosis of SIBO), with an 80-84% success rate in eradicating SIBO[1].  The elemental diet seeks to starve the invading bacteria in the small intestine, but still feed the person with the necessary nutrients to sustain a healthy body.  For a period of up to four weeks, meals are replaced with a powdered formula of nutrients in pre-digested, easily absorbed form.  This elemental formula is designed to be used as a person’s sole source of nutrition for a limited period, and no other foods or supplements are consumed during this time.  For patients who are unable or unwilling to tolerate the full elemental diet, a half elemental diet can be done, in which half of the patient’s nutritional needs are met with the elemental diet and the rest are met with well-tolerated foods.

The Elemental Formula

The elemental formula is a powder which can be mixed into water.  It contains proteins in the form of amino acids, carbohydrates in the form of glucose and maltodextrin, fat in the forms of various oils, vitamins, and minerals.  While there are many over-the-counter and prescription brands available, Dr. Treyzon likes Vivonex Plus and the Physicians’ Elemental Diet for his patients.  By doing the elemental diet under your doctor’s care, you will ensure that you have the proper medical monitoring that this treatment requires.

The Advantages

Clinical trial data shows evidence for an 80-84% success rate in eradicating SIBO.  The elemental diet offers proven effectiveness, safety, and tolerability.  It can be ordered and monitored through Dr. Treyzon, or it can be obtained in over-the-counter forms.  The Physicians’ Elemental Diet is a hypoallergenic formula with a well-tolerated flavor.  It can eradicate SIBO and associated gastrointestinal symptoms in one 2-week course, reducing the need for multiple rounds of pricey and potentially harmful antibiotics or herbal therapies.

The Disadvantages

The elemental diet requires no eating for the duration of the treatment, which can be a challenge for some patients.  There can be a high carbohydrate/sugar percentage in elemental formulas, and weight loss can be an unwanted side effect if full caloric needs are not met.  Cost can also be an issue for some patients.

Ask Dr. Treyzon for more information about the elemental diet at your next office visit.


[1] 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. Dig Dis Sci. 2004;49(1):73-77.

Author Natalie Bransky Assistant to Dr. Treyzon

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