# Elemental diet

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{{Short description|Liquid diet that is easy to digest}}
An '''elemental diet''' (also termed '''elemental nutrition''') is a [diet](/source/Dieting) of liquid [nutrients](/source/nutrients) which is easy to [digest](/source/Digestion) and provides complete [nutritional requirements](/source/nutritional_requirements). Elemental diet formulas are usually composed of [amino acid](/source/amino_acid)s, [fat](/source/fat)s, [sugar](/source/sugar)s, [vitamin](/source/vitamin)s, and [mineral](/source/mineral)s. The diet does not contain whole or partial [protein](/source/protein)s, [food additive](/source/food_additive)s, or other common [allergen](/source/allergen)s. The diet can be administered orally, via a [gastric feeding tube](/source/gastric_feeding_tube), or via [intravenous](/source/intravenous) feeding.

== Description ==

Elemental diet formulas are variable, but usually consist of a liquid mixture of:    

* Free [amino acid](/source/amino_acid)s:<ref name=":0">{{Cite journal |last1=Nasser |first1=Jason |last2=Mehravar |first2=Sepideh |last3=Pimentel |first3=Mark |last4=Lim |first4=Jane |last5=Mathur |first5=Ruchi |last6=Boustany |first6=Antoine |last7=Rezaie |first7=Ali |date=September 2024 |title=Elemental Diet as a Therapeutic Modality: A Comprehensive Review |journal=Digestive Diseases and Sciences |volume=69 |issue=9 |pages=3344–3360 |doi=10.1007/s10620-024-08543-1 |issn=1573-2568 |pmc=11415405 |pmid=39001958}}</ref> both [essential amino acid](/source/essential_amino_acid)s and [non-essential amino acids](/source/Non-essential_amino_acid).
* [Lipid](/source/Lipid)s: [medium-chain triglyceride](/source/medium-chain_triglyceride)s, sometimes with [long-chain triglyceride](/source/long-chain_triglyceride)s.<ref name=":0" /> 
* [Carbohydrate](/source/Carbohydrate)s: simple sugars ([glucose](/source/glucose) or [maltose](/source/maltose)) or [polysaccharide](/source/polysaccharide)s (e.g., [maltodextrin](/source/maltodextrin)) that are easy to digest.<ref name=":0" />
* [Water-soluble vitamins](/source/Water-soluble_vitamins) and [fat-soluble vitamins](/source/fat-soluble_vitamins).<ref name="pmid806492">{{cite journal |last1=Russel |first1=R I |year=1975 |title=Elemental diets |journal=Gut |volume=16 |issue=1 |pages=68–79 |doi=10.1136/gut.16.1.68 |pmc=1410941 |pmid=806492}}</ref> 
* [Electrolyte](/source/Electrolyte)s.<ref name="pmid806492" /> 

Significant features of the elemental diet are:
* [Hypoallergenic](/source/Hypoallergenic): low potential for allergic reaction since there are no whole proteins, [food additives](/source/Food_additive), or other common [allergens](/source/Allergen).<ref name=":0" /> However, allergic reaction is rarely possible.
* Easy to digest: the liquid diet contains ingredients which require minimal processing by [digestive enzyme](/source/digestive_enzyme)s and may be absorbed efficiently without active digestion. This causes less stimulation of the [pancreas](/source/pancreas) and the [gall bladder](/source/Gallbladder).<ref name=":0" /> 
* [Anti-inflammatory](/source/Anti-inflammatory).<ref name=":0" />
* Generates less [feces](/source/Human_feces)<ref name=":0" /> compared to regular (solid) diets. The liquid is mostly absorbed in the first part of the small intestine.<ref name=":0" />
* Low fat content.<ref name=":0" /> 
* Provides [complete requirements](/source/Dietary_Reference_Intake) for [micronutrient](/source/micronutrient)s and [macronutrients](/source/macronutrients).<ref name=":0" /> 
* Modulates [microbiome](/source/Human_microbiome):<ref name=":0" /> since the elemental diet contains no [complex carbohydrates](/source/Carbohydrate) (such as fiber or resistant starch) which survive digestion in the small intestine, there is no fermentable food source for bacteria in the large intestine.<ref name="pmid20066732">{{cite journal |vauthors=O'Keefe SJ |date=January 2010 |title=Tube feeding, the microbiota, and Clostridium difficile infection |journal=World J. Gastroenterol. |volume=16 |issue=2 |pages=139–42 |doi=10.3748/wjg.v16.i2.139 |pmc=2806551 |pmid=20066732 |doi-access=free}}</ref>
* Promotes healing of the [mucosa](/source/Mucous_membrane) (the lining of the gut) by allowing the gut to rest.<ref name=":0" /> 
When testing for SIBO, the elemental diet may consist only of nutrients that will be absorbed by the proximal small bowel.<ref>{{cite journal |vauthors=Krajicek EJ, Hansel SL |year=2016 |title=Small Intestinal Bacterial Overgrowth: A Primary Care Review |journal=Mayo Clin Proc |type=Review |volume=91 |issue=12 |pages=1828–1833 |doi=10.1016/j.mayocp.2016.07.025 |pmid=27916156 |doi-access=free}}</ref>

== Uses ==
An elemental diet is sometimes used for a range of [gastrointestinal](/source/Gastrointestinal_disease) and [systemic disease](/source/systemic_disease)s, especially those involving [atopy](/source/atopy), [inflammation](/source/inflammation), [indigestion](/source/indigestion), and [malabsorption](/source/malabsorption).<ref name=":0" /> The diet is sometimes used in the following medical situations (with varying degrees of evidence):<ref name=":0" />

* Severe [diarrhea](/source/diarrhea) (e.g., [bile acid diarrhea](/source/Bile_acid_malabsorption))
* High output [ostomy](/source/Stoma_(medicine))
* [Gastrointestinal fistula](/source/Fistula)
* [Eosinophilic esophagitis](/source/Eosinophilic_esophagitis)
* [Eosinophilic gastroenteritis](/source/Eosinophilic_gastroenteritis)
* [Inflammatory bowel disease](/source/Inflammatory_bowel_disease) (e.g., [Crohn's disease](/source/Crohn's_disease), [ulcerative colitis](/source/ulcerative_colitis))
* [Celiac disease](/source/Coeliac_disease)
* [Dermatitis herpetiformis](/source/Dermatitis_herpetiformis)
* [Food intolerance](/source/Food_intolerance)
* [Food allergy](/source/Food_allergy)
* [Pancreatitis](/source/Pancreatitis)
* [Oral mucositis](/source/Mucositis) caused by [chemotherapy](/source/chemotherapy) or [radiotherapy](/source/Radiation_therapy)
* [Short gut syndrome](/source/Short_bowel_syndrome)
* [Small intestinal bacterial overgrowth](/source/Small_intestinal_bacterial_overgrowth) (SIBO) and intestinal [methanogen](/source/methanogen) overgrowth
* [Irritable bowel syndrome](/source/Irritable_bowel_syndrome)
* Severe [asthma](/source/asthma)
* Severe [eczema](/source/eczema)
* [Rheumatoid arthritis](/source/Rheumatoid_arthritis)
* [Intestinal lymphangiectasia](/source/Intestinal_lymphangiectasia) 
* [Cronkhite–Canada syndrome](/source/Cronkhite%E2%80%93Canada_syndrome)
* [Orofacial granulomatosis](/source/Orofacial_granulomatosis)
* [Chylothorax](/source/Chylothorax)
* [Chylous ascites](/source/Ascites)
* To reduce [gastrointestinal bleeding](/source/gastrointestinal_bleeding) in [burn injury](/source/Burn)
* After certain surgical procedures; e.g., [gastrectomy](/source/gastrectomy), [colectomy](/source/colectomy), [pancreatectomy](/source/pancreatectomy), and [duodenectomy](/source/Bowel_resection)

==Adverse effects==
Many people are unable to tolerate the taste, even if the diet is flavored, and choose to receive it through intragastric administration.<ref name="pmid806492" /> In one study, 36% of children could not tolerate the diet.<ref name=":0" /> In another, 41% of adults could not tolerate it.<ref name=":0" /> The elemental diet is also expensive.<ref name=":1" /> Since it prevents people from eating any normal food, it can have psychological effects and be socially limiting.<ref name=":1">{{Cite journal |last1=Arias |first1=Angel |last2=González-Cervera |first2=Jesús |last3=Tenias |first3=José M. |last4=Lucendo |first4=Alfredo J. |date=June 2014 |title=Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis |journal=Gastroenterology |volume=146 |issue=7 |pages=1639–1648 |doi=10.1053/j.gastro.2014.02.006 |issn=1528-0012 |pmid=24534634}}</ref> 

Possible nausea and diarrhea can result from the high sugar content which can also complicate [hyperglycaemia](/source/hyperglycaemia) in people with pre-existing [diabetes](/source/diabetes).<ref name="pmid806492" /> The elemental diet is sometimes gradually started over a period of three days, successively increasing in strength on each day to reduce the likelihood of diarrhea and [abdominal colic](/source/Colic).<ref name="pmid6428577">{{cite journal |last1=O'Morain |first1=C |last2=Segal |first2=A W |last3=Levi |first3=A J |year=1984 |title=Elemental diet as primary treatment of acute Crohn's disease: A controlled trial |journal=BMJ |volume=288 |issue=6434 |pages=1859–62 |doi=10.1136/bmj.288.6434.1859 |jstor=29515542 |pmc=1441790 |pmid=6428577}}</ref><ref name="pmid531031">{{cite journal |last1=O'Morain |first1=C |year=2007 |title=Elemental diets in the treatment of Crohn's disease |journal=Proceedings of the Nutrition Society |volume=38 |issue=3 |pages=403–8 |doi=10.1079/PNS19790064 |pmid=531031 |doi-access=free}}</ref>

The elemental diet reduces [gut motility](/source/Peristalsis) and secretions from the [stomach](/source/stomach), pancreas, and gall bladder.<ref name="pmid20066732" /> These functions normally prevent significant bacterial colonization of the small intestine. Furthermore, long term absence of [fermentable](/source/Fermentation) food source arriving for bacteria in the large intestine may also promote SIBO.<ref name="pmid20066732" />

Experiments have shown that elemental formulas are a perfect [growth medium](/source/growth_medium) for ''[Clostridioides difficile](/source/Clostridioides_difficile)''.<ref name="pmid20066732" /> 

It can be given [orally](/source/Orally_ingested) or through a [nasogastric tube](/source/Gastric_intubation) if the person is not able to tolerate the liquid.{{medical citation needed|date=January 2019}} 

== Effectiveness ==

=== Small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) ===
The elemental diet is an effective treatment for SIBO and intestinal [methanogen](/source/methanogen) overgrowth.<ref name=":0" /> The usefulness of the elemental diet for long term treatment of SIBO and IBS is unknown.<ref name=":0" /> After 14-21 days of elemental diet, people with IBS or SIBO experience a 66% reduction in symptoms.<ref name=":0" /> 85% of people with IBS or SIBO demonstrate normalization of lactulose hydrogen breath testing.<ref name=":0" /> Since the diet is restrictive, costly, and can taste unpleasant, it is most often prescribed to people who cannot tolerate [antibiotic](/source/antibiotic)s or those who have failed to respond to antibiotic treatment.<ref>{{cite journal |vauthors=Rezaie A, Pimentel M, Rao SS |year=2016 |title=How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach. |journal=Curr Gastroenterol Rep |type=Review |volume=18 |issue=2 |article-number=8 |doi=10.1007/s11894-015-0482-9 |pmid=26780631 |s2cid=207329305}}</ref> Antibiotics remain the main treatment for SIBO, even though they are effective in less than 50% of cases.<ref name=":0" />

=== Inflammatory bowel disease ===
An elemental diet is highly effective at inducing a remission period in both adults and children with Crohn's disease.<ref name=":0" /> The usefulness of the diet for maintaining remission in inflammatory bowel disease is unknown.<ref name=":0" />

=== Celiac disease and dermatitis herpetiformis ===
There is limited evidence that an elemental diet may be useful for refractory celiac disease type 1 and dermatitis herpetiformis.<ref name=":0" /> 

=== Eosinophilic esophagitis ===
The elemental diet produces [histologic](/source/Histology) remission of eosinophilic esophagitis in over 90% of cases for both adults and children.<ref name=":1" /> However, despite the fact that the [six food exclusion diet](/source/Eosinophilic_esophagitis) has a lower rate of histologic remission (72%), it is recommended instead of the elemental diet because it avoids the disadvantages of the latter.<ref name=":1" />

=== Eosinophilic Gastritis/Gastroenteritis ===
The elemental diet is highly effective for eosinophilic gastritis/gastroenteritis. A partial elemental diet may be useful to stop recurrence of the condition, along with [elimination diets](/source/Elimination_diet) or [immunosuppressant medications](/source/Immunosuppressive_drug).<ref name=":0" />  

=== Pouchitis ===
There is no good evidence that elemental diets are effective in treating chronic [pouchitis](/source/pouchitis).<ref name="pmid28008631">{{cite journal|vauthors=Segal JP, Ding NS, Worley G, Mclaughlin S, Preston S, Faiz OD, etal| title=Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm. | journal=Aliment Pharmacol Ther | year= 2017 | volume= 45 | issue= 5 | pages= 581–592 | pmid=28008631 | doi=10.1111/apt.13905 | hdl=10044/1/43858 | s2cid=3305011 | hdl-access=free }}</ref>

=== Pancreatitis ===
As treatment for [acute pancreatitis](/source/acute_pancreatitis), there is no clear difference between elemental formulas and other enteral feeding formulas.<ref name=":0" /> In chronic pancreatitis, supplementation of the individual's diet with elemental formula may improve pain symptoms.<ref name=":0" />  

=== Mucositis and other side effects during chemotheraphy ===
Dietary measures such as an elemental diet may prevent chemotherapy-induced mucositis.<ref>{{Cite journal |last1=Bullard |first1=Brooke M. |last2=McDonald |first2=Sierra J. |last3=Cardaci |first3=Thomas D. |last4=VanderVeen |first4=Brandon N. |last5=Murphy |first5=E. Angela |date=2022-09-01 |title=Nonpharmacological approaches for improving gut resilience to chemotherapy |journal=Current Opinion in Supportive and Palliative Care |volume=16 |issue=3 |pages=151–160 |doi=10.1097/SPC.0000000000000599 |issn=1751-4266 |pmid=35862879}}</ref><ref name=":2">{{Cite journal |last1=Tanaka |first1=Yoshihiro |last2=Shimokawa |first2=Toshio |last3=Harada |first3=Koji |last4=Yoshida |first4=Kazuhiro |date=June 2022 |title=Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis |journal=Clinical Nutrition ESPEN |volume=49 |pages=172–180 |doi=10.1016/j.clnesp.2022.03.005 |issn=2405-4577 |pmid=35623809|doi-access=free }}</ref> This preventative effect may be more significant in gastroenterological cancer and esophageal cancer.<ref name=":2" /> However, another study reported that an elemental diet does not prevent oral mucositis or diarrhea in people with esophageal cancer.<ref name=":3">{{Cite journal |last1=Lan |first1=Hao-Ning |last2=Huang |first2=Xu-Ying |last3=Ge |first3=Yang |last4=An |first4=Guang-Yu |last5=Yao |first5=Jian-Nan |last6=Zhang |first6=Hui-Yun |date=2024-06-27 |title=Elemental diet preventative effects for adverse events during chemotherapy in patients with esophageal cancer - A systematic review and meta-analysis |journal=Nutricion Hospitalaria |volume=41 |issue=3 |pages=666–676 |doi=10.20960/nh.04787 |issn=1699-5198 |pmid=38726608|doi-access=free }}</ref> The elemental diet may prevent [neutropenia](/source/neutropenia) and [leucopenia](/source/Leukopenia) in such people.<ref name=":3" />

=== Bile acid diarrhea ===
Supplementation with elemental formula may have beneficial effects in secondary bile acid diarrhea (very low‐certainty evidence).<ref>{{Cite journal |last1=McKenzie |first1=Yvonne A. |last2=Sremanakova |first2=Jana |last3=Todd |first3=Chris |last4=Burden |first4=Sorrel |date=December 2022 |title=Effectiveness of diet, psychological, and exercise therapies for the management of bile acid diarrhoea in adults: A systematic review |journal=Journal of Human Nutrition and Dietetics |volume=35 |issue=6 |pages=1087–1104 |doi=10.1111/jhn.13005 |issn=1365-277X |pmc=9790321 |pmid=35274385}}</ref>

== See also ==
* [Infant formula](/source/Infant_formula)
* [List of diets](/source/List_of_diets)
* [Meal replacement](/source/Meal_replacement)
* [Medical food](/source/Medical_food)
* [Low residue diet](/source/Low-fiber%2Flow-residue_diet) (low fiber diet)

==References==
{{reflist}}

Category:Diets

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Adapted from the Wikipedia article [Elemental diet](https://en.wikipedia.org/wiki/Elemental_diet) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Elemental_diet?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.