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An elemental diet consists of nutritionally complete formulas that contain predigested nutrients.

The diet has been shown to benefit people with a variety of inflammatory diseases and conditions.

This article explains everything you need to know about the elemental diet, including what it is, its uses, benefits, and downsides.

elemental diet

What it is and its uses

The elemental diet is a liquid-only diet that contains nutrients in their predigested form.

This means that the proteins, fats, and carbohydrates are broken down into their simplest form so they can be easily digested and absorbed.

The diet consists of nutritionally complete enteral formulas, which are usually in liquid form but may also be a powder that you reconstitute with water.

Other types of enteral formulas include semi-elemental, which contains nutrients that are partially broken down, and polymeric, which contains whole proteins, carbs, and fats.

These enteral formulas may be provided orally, through a feeding tube, or a combination of the two.

When an elemental diet is followed exclusively, it’s known as an exclusive enteral nutrition diet.

Generally, the diet allows clear liquids such as coffee or tea.

An elemental diet has been shown to induce remission or decrease the signs or symptoms of various inflammatory diseases and conditions, including (1, 2, 3):

The diet is believed to decrease inflammation by positively affecting the gut microbiome, which plays an important role in immune health and maintaining the integrity of the intestinal barrier to prevent leaky gut.

An elemental diet is designed to be followed short-term, usually only a few weeks, but sometimes longer.

Nestle Health Sciences produces two of the most common elemental formulas, Tolerex and Vivonex, both of which come in a premixed or powder option (4).

Another option is the Physicians’ Elemental Diet produced by Integrative Therapeutics, which is available online.

Although these formulas are nutritionally complete, they should only be consumed under the direction of a physician and registered dietitian.

Benefits

By lowering inflammation, the elemental diet has been shown to benefit various inflammatory conditions.

May induce remission in Crohn’s disease

Crohn’s disease is a type of inflammatory bowel disease (IBD) — the other major type is ulcerative colitis.

The condition generally causes flare-ups, during which digestive symptoms temporarily worsen, as well as periods of remission, during which they disappear.

While a variety of diets have been suggested to reduce intestinal inflammation and alleviate symptoms, an elemental diet has been shown to induce remission in 80–85% of children and adolescents with Crohn’s disease (5).

The diet has also been shown to be effective for inducing remission in adults with Crohn’s disease (6).

Semi-elemental and polymeric formulas can be used for inducing remission in people with Crohn’s disease, but they may be poorly tolerated by some people (7).

May decrease IBS and SIBO symptoms

IBS is a disorder that causes recurrent episodes of abdominal pain and uncomfortable digestive symptoms.

It’s estimated that nearly 40% of people and up to 84% of people with IBS have SIBO, a condition in which excess bacteria inhabit the small intestine and cause digestive symptoms (8).

Although a low-FODMAP diet has traditionally been recommended to manage IBS symptoms and remains the most evidence-based treatment for IBS, an elemental diet may alleviate symptoms as well (9).

FODMAP stands for fermentable oligo, di, and monosaccharides and polyols.

A small study demonstrated that 85% of patients who followed an elemental diet for 21 days decreased bacteria in the small intestine, which led to improvements in bowel regularity and other digestive symptoms (3).

May treat eosinophilic esophagitis (EoE)

EoE is a chronic inflammatory disease driven by food allergens that affects the esophagus — the tube that connects your throat and stomach.

Although an elimination diet is generally the first-line treatment for EoE, an elemental diet may be more effective for reducing esophageal inflammation and relieving symptoms.

A review of 33 studies consisting of 1,128 children and 189 adults demonstrated that the elemental diet and 6-food elimination diet induced remission in 90.8% and 72.1% of patients, respectively (10).

Downsides

While the elemental diet has been shown effective for relieving the signs and symptoms of various inflammatory conditions, it has several downsides to consider.

Difficult to follow

Elemental formulas tend to not taste the best since they contain free amino acids, some of which taste sour or bitter.

And although some elemental formulas are flavored to mask the unpleasant flavor, many are not, which can make it difficult to follow the elemental diet long enough to experience its benefits.

Most elemental formulas are unflavored since they are designed to be administered through a feeding tube.

Its benefits may be temporary

The elemental diet is only designed to be followed short-term.

After remission is achieved, solid foods should be reintroduced, at which time, symptoms may return.

Depending on the reason for following an elemental diet, slowly reintroducing foods, with the help of a registered dietitian, may help you remain in remission longer or experience fewer or less severe symptoms.

It can be costly

Following an elemental diet can be expensive since the formulas are highly specialized.

For example, one premixed carton of Vivonex costs slightly under $7.00 on Amazon.com.

To meet 100% of the dietary reference intakes for vitamins and minerals, adults would need to consume six of these cartons, costing around $42 per day.

The Physicians’ Elemental diet is slightly less expensive, costing around $35 for the same number of calories as the Vivonex.

Semi-elemental and polymeric formulas tend to be less expensive and much easier to purchase.

Potential side effects

The elemental diet is safe with a low risk of adverse side effects when followed under medical supervision.

However, some side effects such as vomiting, diarrhea, heartburn, and excessive gas have been reported with the elemental diet (7).

The elemental diet also contains no fiber.

Low-fiber diets can benefit various conditions, such as inflammatory bowel disease, diverticulitis, gastroparesis, and bowel obstructions, but they shouldn’t be followed for longer than needed.

This is because low-fiber diets have been associated with various chronic diseases such as obesity, colon cancer, heart disease, and diabetes, and they also can promote dysfunction in the gut microbiota, known as dysbiosis (11).

The bottom line

The elemental diet consists of nutritionally complete enteral formulas that contain predigested nutrients.

The diet has been shown to benefit various inflammatory conditions, including Crohn’s disease, IBS and SIBO, as well as EoE.

However, the elemental diet can be difficult to follow, its benefits may be temporary, it tends to be more costly compared with other semi-elemental or polymeric diets, and it may cause digestive issues in some people.


Gavin Van De Walle, MS, RD, LN
Gavin Van De Walle, MS, RD, LN

Gavin Van De Walle holds a master's degree in human nutrition and bioenergetics. He is a registered dietitian who aims to arm the public with evidence-based nutrition recommendations so they can make their own educated and informed health decisions.