

The elemental diet is a less frequently used but evidence-based option for managing SIBO — and while it’s often thought of as extreme or unapproachable, newer formulations are emerging to make it more palatable than it once was.
Small Intestinal Bacterial Overgrowth (SIBO), occurs when there is an abnormal increase of certain types and amounts of bacteria in the small intestine — an area of the gut that normally has relatively low bacterial populations. This overgrowth can lead to a range of digestive symptoms, including bloating, gas, abdominal discomfort, and changes in bowel habits (both constipation and diarrhea).
For a deeper dive into the causes, diagnosis, and nutrition management of SIBO, check out our complete guide to SIBO and nutrition. While that post covers the foundations, it doesn’t go into much detail about the elemental diet — in this post, we’re going to take a closer look.As a registered dietitian who works closely with patients managing complex gut issues, I often get questions about whether the elemental diet is worth considering — and what the experience is actually like. In this post, I’ll explain how the elemental diet works for SIBO, when it might be used, and how formulations are changing to become more palatable than ever before.
What is the Elemental Diet?
The elemental diet is a nutritionally complete, liquid formula made up of pre-digested nutrients. This means that the carbohydrates, proteins, and fats are broken down into their simplest forms – like amino acids and simple sugars. Because of this, the nutrients are rapidly absorbed in the upper part of the small intestine.
This early absorption leaves little to no fuel behind for bacteria in the lower small bowel, which is why the elemental diet is sometimes used as a treatment strategy for small intestinal bacterial overgrowth (SIBO) — essentially “starving out” the bacteria.
There are several proposed reasons why the elemental diet may support someone with SIBO:
- Rapid nutrient absorption – limiting fuel for bacteria in the small intestine
- Low immune system activation – The lack of common antigens/allergens in these formulas reduces immune system response and food sensitivity reactions
- Decreased inflammation – by lowering pro-inflammatory cytokines
- Improved intestinal permeability (i.e. helping to repair a “leaky gut”)
- Reduced fecal load – Limiting solids gives the gut a bit of a break
- Free from common additives and preservatives – while the connection between additives and digestive symptoms is still being researched and understood, these formulas don’t contain common emulsifiers, gums, and artificial sweeteners.
- Complete nutrition – These formulas are designed to provide essential nutrients while resting the digestive system
While originally developed to support patients with inflammatory bowel disease (IBD), with malabsorptive conditions, in critical care, or those recovering from surgery, the elemental diet is now increasingly used in the treatment of SIBO. However, it’s generally not considered a first-line approach, as it can come with some pretty challenging practical and emotional hurdles.

Elemental Diet vs. Other SIBO Treatments
When it comes to the treatment of SIBO, the mainstay therapy that has gained the most popularity and credibility from the research is antibiotics. One antibiotic in particular, rifaximin, is the most widely researched. However, other broad-spectrum antibiotics like metronidazole, neomycin, and amoxicillin-clavulanate are often used alongside or in place of rifaximin.
So how does the elemental diet compare?
In 2004, a study evaluated the use of an elemental formula over a two-week period in patients with SIBO. In this study, 80% of patients had normalization of their SIBO breath test after the diet, indicating a significant reduction in bacterial overgrowth.1 These results are on par with — and in some cases even better than — what we usually see with antibiotics or herbal antimicrobial treatments.
For instance:
- Antibiotics like rifaximin and/or neomycin often show response rates in the range of 40–70%,2,3 depending on the subtype of SIBO and whether the case involves hydrogen or methane-producing bacteria.
- Herbal antimicrobials – while they have shown some promise in treating SIBO, their benefits are often over-stated. While one study suggests that herbal therapy is as effective as rifaximin, it’s important to note that the antibiotic dose used in that study was lower than the standard treatment dose typically recommended by SIBO specialists. As a result, the comparison may not fully reflect the efficacy of rifaximin when used at optimal dosing. In addition, there were some design flaws in this study, making it difficult to assess efficacy in SIBO.4
- In comparison, a 2–3 week elemental diet protocol has been associated with symptom improvement, normalization of breath tests, and reduction in microbes attributed to causing SIBO, including in some cases where other treatments have not been successful.1,5
While the statistics and results might make the elemental diet seem like an obvious choice, it’s not without its challenges. In particular, many of the product options are notoriously unpleasant — often described as chalky, metallic, or overly sweet. They can also be expensive. Not to mention, mentally and socially challenging, especially when you’re expected to drink these beverages as your sole source of nutrition for multiple weeks.
The Market Expands: Palatable Elemental Diet
As I’ve noted, the biggest barrier to using an elemental diet has been poor taste and tolerability. Add in the challenges of feeling full & satisfied on a liquid-only diet, and it’s easy to see why this option hasn’t always been feasible for patients.
Fortunately, newer elemental formulas are starting to change that.
Several more palatable options have emerged over the past few years — designed with taste and tolerability in mind, without compromising on the core criteria of an elemental diet. These updated formulas still provide protein as individual amino acids, and are very low in fat and fibre for overall gentle digestion.
One option gaining increasing recognition is mBiota, a formula developed by SIBO experts out of Cedars-Sinai. It offers a more neutral taste profile and has been better tolerated by many patients compared to older commercial products.
In fact, 100% of participants in a recent study were able to complete the 2 weeks of this particular elemental diet. Plus, 73% of the participants were able to normalize their SIBO breath tests after the 2 weeks and 83% saw symptom reduction.
Who Might Benefit from a Palatable Elemental Diet?
An elemental diet can be a valuable tool in certain situations — especially when more conventional therapies haven’t worked or aren’t well tolerated.
A more palatable elemental formula may be especially helpful for:
- Individuals with moderate-to-severe SIBO symptoms, particularly those who haven’t responded to antibiotics and/or herbal antimicrobials.
- Patients who prefer to avoid antibiotic use due to personal or medical reasons.
- Those needing symptom relief while awaiting further testing or care, such as breath testing, specialist referral, or additional diagnostic workup.
- Individuals with digestive hypersensitivity or a very limited range of tolerated foods, where even low FODMAP or semi-elemental approaches may cause symptoms.
- Patients with suspected food chemical sensitivities or immune reactivity, who may experience relief from a simplified, low-antigen formula like an elemental diet.
These updated formulas don’t eliminate the challenges entirely, but they may offer a more realistic and manageable option for those who need it most.
Cautions & Considerations
While elemental diets — especially newer, more palatable versions — can be a helpful tool in managing SIBO, they aren’t the right fit for everyone. It’s important to consider both the potential benefits and also the limitations before moving forward.
Elemental diets may not be appropriate for individuals who:
- Have a history of eating disorders or active disordered eating patterns, as the restrictive nature of the diet may be triggering or harmful.
- Are experiencing severe malnutrition, where more comprehensive nutritional support is needed.
- Have very high calorie or energy needs, such as athletes or pregnant individuals, where meeting nutritional requirements may not be feasible with elemental formulas alone.
Medical supervision is essential. This approach should always be done under the guidance of a dietitian who can assess appropriateness, monitor for side effects, and adjust the plan as needed.
It’s also worth noting that even with more tolerable formulas, some individuals may still experience side effects such as struggles with taste and texture, fatigue, die-off symptoms, or occasional bloating during the process.
As with any therapeutic diet, personalization and support are key and what works well for one person may not be the best fit for another.
If you’re interested in learning more about whether a palatable elemental diet could be a good fit for you, consider booking with one of our dietitians. We’d be happy to support you!