👆 Summary
- The elemental diet is a targeted therapy for SIBO, in which only pre-digested nutrient shakes are consumed over a period of 2–3 weeks to reduce bacterial overgrowth in the small intestine.
- The elemental diet offers high efficacy, rapid symptom relief, and can serve as a medication-free alternative to antibiotics.
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The diet requires strict discipline, is costly, and is intended for short-term use only; a subsequent dietary transition and treatment of underlying causes are essential for long-term success.
SIBO Treatment: Elemental Diet
1. What is SIBO?
2. What is elemental diet?
3. The aim of the elemental diet in SIBO
4. Duration and implementation of the elemental diet
5. Advantages of the elemental diet
5.1 High effectiveness
5.2 Drug-free alternative
5.3 Rapid symptom relief
6. Disadvantages and Challenges
6.1 High discipline required
6.2 Cost Factor
6.3 Not intended for long term usage
6.4 Risk of Relapse
7. Who is the elemental diet suitable for?
8. What comes after the diet?
9. Summary
10. FAQs
1. What is SIBO?
SIBO (Small Intestinal Bacterial Overgrowth) 
refers to an abnormal colonization of the small intestine with bacteria that are normally present only in very small numbers there. These bacteria ferment ingested food components such as sugars and fibers in the small intestine, leading to gas production and related symptoms like bloating , abdominal pain , a feeling of fullness, diarrhea , or constipation . SIBO can arise from various factors, such as impaired bowel motility , structural changes in the digestive tract , medications , or infections. The diagnosis is usually made through breath tests , in which hydrogen or methane is measured after drinking certain sugar solutions.
2. What is elemental diet?
The elemental diet is a highly specialized form of nutrition in which the body is provided only with pre-digested nutrients. The nutrients are present in their simplest form: amino acids instead of whole proteins, simple sugars like glucose or maltodextrin instead of complex carbohydrates, and fats in the form of easily absorbable fatty acids. Additionally, vitamins, minerals, and electrolytes are included. This nutrient mixture is usually offered in powder form, which is mixed with water and taken as a drink. Solid food is completely omitted during the duration of the diet.
3. The aim of the elemental diet in SIBO
In SIBO, there is an excessive colonization of bacteria in the small intestine. These bacteria ferment certain components of food, especially complex carbohydrates and fibers. This leads to symptoms such as bloating, abdominal pain, feelings of fullness, diarrhea, or constipation. Since the nutrients in the elemental diet are already broken down, they are quickly absorbed in the upper small intestine. The bacteria thus receive no more food – they ‘starve’. This makes the diet a targeted strategy against bacterial overgrowth.
4. Duration and implementation of the elemental diet
The classical elementary diet is usually carried out over a period of 14 to 21 days. During this time, only the special nutrient solution is consumed. Drinking water is, however, allowed. The procedure should ideally take place under medical supervision, especially in the case of existing underlying conditions or underweight. It is also advisable to have accompanying support from a nutrition therapy trained professional.
5. Advantages of the elemental diet
5.1 High effectiveness
Studies and reports show that the elemental diet leads to significant symptom improvement in many affected individuals (1,2,3). In some cases, over 70 percent of users achieve an improved breath test after the diet (2,4).
A current prospective study (from April 2025) provides evidence for the effectiveness and tolerability of a newly developed, taste-improved elemental diet (PED). In this study, 30 adult individuals with confirmed SIBO and/or IMO participated. After two weeks of exclusive intake of the diet, 83 percent of the participants reported a noticeable relief of their symptoms. Additionally, 73 percent experienced normalization of their breath tests – a clear indication of the reduction of bacterial overgrowth. Changes could also be documented on a microbial level, such as a decrease in methane-producing organisms like Methanobrevibacter smithii , which was accompanied by a significant reduction in measured methane and hydrogen levels. The diet was well tolerated by all participants, and no serious side effects occurred. The results show: A targeted, well-formulated elemental diet can not only alleviate symptoms but also measurably influence the underlying bacterial changes in the gut. (2)
5.2 Drug-free alternative
For people who do not want to take antibiotics or cannot tolerate them, the elemental diet offers a treatment based purely on nutrition. Especially in cases of recurrent SIBO, intolerances to medications, or the desire for a natural approach, it represents a sensible alternative. The elemental diet can also be a gentle solution for sensitive patients who react with side effects to many herbal antimicrobials. Since it specifically targets the cause – the bacterial overgrowth in the small intestine – and does not require systemic agents, it is particularly suitable for individuals seeking an effective treatment method without medications.
5.3 Rapid symptom relief
Many affected individuals report noticeable improvements such as reduced bloating or increased energy within just a few days. This quick relief of symptoms significantly contributes to an improved quality of life during therapy. Additionally, general well-being often increases, as the body is less burdened and digestive issues subside. As a result, many patients feel motivated to consistently adhere to the diet despite the restrictions, thus laying the foundation for a successful treatment.
6. Disadvantages and Challenges
6.1 High discipline required
The diet is socially and mentally demanding, as any solid food is excluded. Eating in everyday life, with friends or family becomes a challenge, as the usual meals can no longer be participated in, and many social situations revolving around food fall away. This can lead to feelings of isolation or of being different and requires a high degree of discipline and mental strength. Additionally, switching to exclusively liquid food is a significant adjustment for many affected individuals, which can be accompanied by hunger, frustration, or mood swings. Therefore, good preparation and, if necessary, psychological support are advisable to carry out the diet successfully and as stress-free as possible.
6.2 Cost Factor
Elemental diet products are expensive (1). A 2- to 3-week course can cost around 800 euros. Statutory health insurance often does not cover these costs. Here in Germany, unlike in the USA, there are currently no products specifically developed for the elemental diet, so it must be looked at individually to determine how the implementation of the elemental diet can be achieved.
6.3 Not intended for long term usage
In the long term, the elemental diet is not suitable because it contains no dietary fibers, which are essential for a healthy gut flora in the large intestine. Dietary fibers serve as food for the beneficial gut bacteria and promote their diversity and activity. Without these nutrients, there can be a shift in gut flora, which can in turn lead to digestive problems and a weakened immune system. Therefore, the elemental diet should always be carried out only for a short period and under medical supervision to avoid possible negative consequences. Because, despite what the name might suggest, the elemental diet is not a diet in itself, but clearly a therapy.
6.4 Risk of Relapse
Without targeted therapy of the underlying cause, there is a significant risk that SIBO will recur. While the elemental diet effectively combats bacterial overgrowth in the small intestine, it does not address the factors that lead to the development of SIBO, such as disturbed gut motility, anatomical changes, chronic stress, or certain medications. If these causes are not addressed, bacteria can quickly regrow and symptoms can return. Therefore, it is important to normalize gut function after the elemental diet and prevent the regrowth of unwanted bacteria. Only through comprehensive follow-up and treatment of the causes can a sustainable therapeutic success be achieved.
7. Who is the elemental diet suitable for?
The elemental diet is particularly suitable for people with confirmed SIBO, for whom classical therapies such as antibiotics or herbal antimicrobials do not show sufficient effectiveness or are undesirable.
The diet is also an option for particularly sensitive patients with severe symptoms who react to many foods.
It is less suitable for individuals with eating disorders, underweight, or certain metabolic disorders. A precise medical assessment should be made beforehand.
8. What comes after the diet?
After completing the diet, it is important to gently reintroduce solid food to the intestines and the gut flora. Many experts recommend a gradual introduction of easily digestible foods. Here, introducing cooked low FODMAP vegetables over 2 days, followed by another 2 days with low FODMAP vegetables, rice, and eggs in addition to the shakes has proven effective. Additionally, the underlying cause of the development of SIBO should be identified and treated – such as impaired intestinal motility, scarring in the abdominal cavity, stress, hormonal imbalances, or other structural causes.
9. Summary
The elemental diet is not an ordinary form of nutrition, but a targeted therapy for SIBO, during which special nutrient shakes are consumed exclusively over a period of two to three weeks. These are formulated to be absorbed particularly quickly in the upper small intestine – even before the mispopulated bacteria can utilize them. In this way, they are deprived of their nutritional basis. The diet is considered one of the most effective and rapid methods for treating SIBO, but it poses psychological and organizational challenges for those affected. Those who adhere to it consistently can expect a noticeable improvement in symptoms. However, a sustainable success is crucially dependent on subsequent dietary changes and the treatment of underlying causes.
10. FAQs
How does the elemental diet work for SIBO?
How long does the elemental diet last and how is it implemented?
Typically, the diet is followed for 14 to 21 days. During this time, only specialized nutrient shakes are consumed, and water is allowed. Implementation should ideally be supervised by a doctor and a nutrition professional.
Who is the elemental diet suitable for?
It is mainly suitable for people with confirmed SIBO for whom antibiotics or herbal treatments are ineffective or not desired. It is not suitable for individuals with eating disorders, underweight, or certain metabolic conditions.
What happens after the elemental diet?
After the diet, the digestive system is gradually reintroduced to solid foods, usually starting with easily digestible low-FODMAP vegetables and rice. Additionally, the underlying cause of SIBO should be addressed to prevent relapse.
References
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- Nasser J, Mehravar S, Pimentel M, Lim J, Mathur R, Boustany A, Rezaie A. Elemental Diet as a Therapeutic Modality: A Comprehensive Review. Dig Dis Sci. 2024 Sep;69(9):3344-3360. doi: 10.1007/s10620-024-08543-1. Epub 2024 Jul 13. PMID: 39001958; PMCID: PMC11415405.
- Rezaie A, Chang BW, de Freitas Germano J, Leite G, Mathur R, Houser K, Hosseini A, Brimberry D, Rashid M, Mehravar S, Villanueva-Millan MJ, Sanchez M, Weitsman S, Fajardo CM, Rivera IG, Joo L, Chan Y, Barlow GM, Pimentel M. Effect, Tolerability, and Safety of Exclusive Palatable Elemental Diet in Patients with Intestinal Microbial Overgrowth. Clin Gastroenterol Hepatol. 2025 Apr 4:S1542-3565(25)00241-1. doi: 10.1016/j.cgh.2025.03.002 . Epub ahead of print. PMID: 40189034.
- Sellge G, Ockenga J. Bakterielle Fehlbesiedlung des Dünndarms (SIBO) – Therapie, Ernährung, Mikrobiom [Small intestinal bacterial overgrowth (SIBO) – Therapy, nutrition, microbiome]. Dtsch Med Wochenschr. 2024 Sep;149(18):1071-1079. German. doi: 10.1055/a-2205-5794. Epub 2024 Aug 29. PMID: 39208859.
- 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 Jan;49(1):73-7. doi: 10.1023/b:ddas.0000011605.43979.e1. PMID: 14992438.
