Small intestinal bacterial overgrowth (SIBO) is an increasingly common gut condition. I get questions about it all the time!

SIBO occurs when the bacteria in your gut get out of balance and overgrow. This can cause a whole range of digestive issues, including food sensitivities and difficulty absorbing nutrients. Recovery requires following a strict diet and avoiding certain foods completely. 

Yet even the SIBO diet I created for my clinical patients was sometimes not enough to get rid of their SIBO in the most extreme cases. That’s where alternative treatments such as supplementing with probiotics and eating protocols can be very helpful in overcoming stubborn SIBO.

One option is the semi-elemental diet. In this article, I’ll explain what this diet is and how it differs from a complete elemental diet. I’ll also tell you why it helps severe cases of SIBO, and the pros and cons of a semi-elemental diet.

I’ll cover key ways you can support your gut health while getting your SIBO under control with supplements including Primal Earth Probiotics. Let’s dive in!

What is SIBO?

As I mentioned earlier, SIBO is a condition in which the bacteria in your gut gets out of balance and overgrows. This can happen in two ways: 

  1. The gut bacteria meant to reside in your large intestine and colon escape into your small intestine.
  2. The small amount of bacteria that occurs naturally in your small intestine grows out of control. 

This overgrowth can be caused by:

  • High-carb diets
  • Nerve and muscle damage from diabetes, scleroderma, or other conditions
  • Physical obstructions such as diverticula, and scarring from surgeries or Crohn’s disease
  • Medications such as antibiotics, acid-blocking drugs, and steroids

Once in your small intestine, even “good” bacteria can cause all sorts of digestive drama as they feed on and ferment undigested food — particularly sugar, carbohydrates, starches, and alcohol. This fermentation process produces hydrogen, methane, or both, as a byproduct. This is why bloating is the No. 1 symptom of SIBO.

Symptoms of SIBO

  1. Gas and bloating
  2. Abdominal pain or cramping
  3. Diarrhea or constipation (less common than diarrhea)
  4. Diagnosis of irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)
  5. Food intolerances, particularly histamine intolerance
  6. Chronic illnesses such as fibromyalgia, chronic fatigue syndrome, diabetes, neuromuscular disorders, and autoimmune diseases
  7. Vitamin and mineral deficiencies, including vitamins A, B12, D, and E
  8. Fat malabsorption (signified by pale, bulky, and malodorous stools)
  9. Rosacea and other skin rashes
  10. Leaky gut
The Semi-Elemental Diet vs. The Elemental Diet – Infographic – Amy Myers MD® The Semi-Elemental Diet vs. The Elemental Diet - Infographic - Amy Myers MD® https://www.amymyersmd.com/article/semi-elemental-diet-sibo/ The Semi-Elemental Diet vs. The Elemental Diet – Infographic – Amy Myers MD®

Semi-Elemental Diet vs. an Elemental Diet

A typical SIBO diet eliminates foods that feed the bacteria in your small intestine, including sugar, alcohol, and carbohydrates (even complex carbs such as whole grains and legumes). 

A SIBO diet minimizes fruit intake and includes plenty of non-starchy vegetables, leafy greens, lean proteins, and healthy fats.

To understand what a semi-elemental diet is, let’s first look at what an elemental diet is.

What is an Elemental Diet?

A full elemental diet is a completely liquid diet made up of nutrient-dense formulas and plenty of water. Sometimes plain, unsweetened herbal teas may be added.

Some elemental formulas contain protein, fat and carbs that have been broken down into amino acids, along with vitamins and minerals. 1

Having these micronutrients already broke down eases the responsibility of your digestive system and allows your GI tract to rest. 

Most elemental formulas are low in fat and high in carbohydrates and protein since fat can be difficult to digest. 

This makes it ideal for patients with severe motility, absorption, or digestion issues. It is typically followed for 14 to 21 days.

SIBO diets are often suggested for people with severe digestive issues such as: 234

  • Crohn’s disease – Inflammatory bowel disease
  • Eosinophilic esophagitis – inflammation that causes damage to the esophagus 
  • And of course SIBO

What is a Semi-Elemental Diet?

A semi-elemental diet also relies on liquid nutrition, however there are some key differences. The main difference between an elemental diet and a semi-elemental diet is in the protein structure. The semi-elemental diet provides protein that is hydrolyzed into peptides (short chains of amino acids), which are thought to be more readily absorbed than individual amino acids or whole proteins. 

Semi-elemental diets also contain fats in the form of medium-chain triglycerides (MCTs). MCTs are found in coconut oil and are processed differently than long-chain fatty acids. These MCTs are more easily digestible than other types of fats because of their shorter length.5

Unlike other fats, MCTs go straight from the gut to the liver, where they are converted into energy or turned into ketones. 

Another difference between a semi-elemental diet and a complete elemental diet is that people on a semi-elemental diet only get a portion of their dietary needs from liquids and formula and the rest from solid foods.

How Can the Semi-Elemental Diet Help Reverse Damage from SIBO

When amino acids “piggyback” on di- or tripeptides, they may help patients gain or maintain a healthy weight and improve nutrition status.6

Protein is the building block of every cell in your body and is essential for repairing your gut and strengthening your immune system — two key steps in overcoming and treating SIBO.

Studies show that a semi-elemental diet offers health benefits for the entire digestive process in patients with Crohn’s, pancreatitis, and autoimmune disorders. It can help speed up metabolism, reduce gastrointestinal symptoms, aid nutrient absorption, and improve overall clinical outcomes.789

Is the Semi-Elemental Diet Radical?

You might be wondering whether it is radical to follow a semi-elemental diet. I’d actually argue that a semi-elemental diet is much less extreme than fad cleanses. 

The semi-elemental diet is strictly for those with SIBO and other digestive issues which prevent full recovery on a solid diet. Additionally, a patient is typically on the semi-elemental diet for only 2-3 weeks, while they repair their gut. A semi-elemental diet is a temporary solution, not a lifestyle.

The Basics of the Semi-Elemental Diet

If you’re wondering if this diet is right for you, I want to equip you with all the tools you need to safely follow a semi-elemental diet and restore your gut health naturally.

What to Drink and Eat on a Semi-Elemental Diet

Depending on how you define a semi-elemental diet, your food and drink choices might vary slightly. The following options each have their own pros and cons:

  • Premade Formulas: You can buy specially made semi-elemental diet formulas online. The benefit of choosing premade elemental formulas is that they take the guesswork out of knowing what to drink or eat. There are specifically designed semi-elemental diet formulas for people with diabetes, autoimmune disease, liver or kidney disorders, and other special cases.

However, these formulas can be expensive, with some costing upwards of $400. They are also commonly made with whey protein, and dairy products that are highly inflammatory.10

  • The Myers Way® Protein Powder: My Paleo protein powders are made with hydrolyzed beef protein sourced from non-GMO, hormone- and antibiotic-free, grass-fed beef. The Myers Way® Paleo Protein comes in four delicious flavors and is 100% soy-, gluten-, dairy-, and egg-free, making it one of the least allergenic protein powders on the market. It is also a good source of MCTs, which can support a healthy microbiome by fighting bacterial overgrowth and repairing a leaky gut.1112
  • Solid Foods: If you can tolerate solid foods, incorporate small amounts in your diet only if you’re not on a full SIBO diet. They will keep you feeling satisfied and well-nourished. Focus on steamed non-starchy veggies, soups, and bone broth, and, of course–smoothies!

How Long Should You Follow a Semi-Elemental Diet?

I recommend following a semi-elemental diet for 2 to 3 weeks, and seeing how you feel.13 You can stop when you no longer experience symptoms of SIBO. A good sign that you’ve overcome SIBO is that you don’t experience extreme bloating after eating a meal. You can also track your improvements using my symptoms quiz, and compare your new results to your old.

Potential Side Effects

While potential side effects are few, there are some important ones to consider:

  • Nutrient deficiencies: If you do not emphasize nutrient-dense liquids, you could risk nutrient deficiency and weight loss. Make sure you’re taking in plenty of vitamins and minerals in their most bioavailable form. I recommend everyone take a multivitamin. This is especially important during a semi-elemental diet, or while recovering from an illness. 
  • GI issues: Switching to an elemental or semi-elemental diet may cause some initial gut distress including diarrhea or abdominal pain.14 To avoid this, go slow. Increase the liquids in your diet gradually over a few days.
  • Falling off track: Depending on the diet formula, it might not be palatable or financially sustainable. If you are not able to strictly adhere to your diet, your recovery could be delayed.

Pros and Cons of the Semi-Elemental Diet for SIBO

The following pros and cons can help you decide whether you might thrive on a semi-elemental diet:

Pros

  • Formulas take the guesswork out of meal planning
  • Easy to digest; lets your gut rest and recover
  • Nutrients are more easily absorbed than in an elemental diet
  • Helps maintain a healthy weight

Cons

  • Many premade formulas are allergenic or inflammatory
  • Poorly planned diets can lead to malnutrition and GI issues
  • Strict nature of diet may be difficult to follow
  • Can be expensive

Gut-Repairing Supplements to Consider

There are a number of supplements I recommend to support a semi-elemental diet without the use of pricey formulations. This will help you get optimal nutrition while repairing your gut.

Paleo Protein

The Myers Way® Paleo Protein will be your go-to meal replacement on a semi-elemental diet. It provides the most highly absorbable form of protein and amino acids and gut-friendly MCTs.

Whether or not you try a semi-elemental diet, I highly recommend Paleo Protein smoothies because of their gut-repairing benefits. I drink one every morning. It’s the perfect, quick, breakfast that provides sustained energy.

Collagen

My Collagen Protein is made from easily-absorbed bovine collagen peptides. It is an ideal complement to Paleo Protein for providing extra protein and amino acids while following a semi-elemental diet. Furthermore, collagen helps support a healthy gut barrier and mixes easily into any smoothie or other beverage, hot or cold.

Leaky Gut Revive®

This is my most comprehensive tool for repairing and maintaining a healthy gut lining. Repairing your gut is the first step in overcoming SIBO and other chronic illnesses, and Leaky Gut Revive® can fast-track your progress. 

It contains a potent blend of gut-repairing herbs and nutrients, including L-glutamine. L-glutamine assists in cell turnover to help repair your mucosal lining and support overall intestinal health. It also curbs sugar cravings to help you beat SIBO.

Soil-Based Probiotics

While you have SIBO, I recommend you only take a soil-based probiotic to avoid feeding bad bacteria with the good. My soil-based Primal Earth Probiotic contains three well-studied strains of spore-forming bacteria specifically chosen to mimic the most important natural flora found in traditional and paleolithic diets. These bacteria are able to bypass your small intestine without feeding the overgrowth.

Primal Earth Probiotics promote a normal bowl pattern and survives stomach acid and the digestive process. Standard lactic acid based probiotics can actually cause more complications than they solve. SIBO is one of those situations. This is a situation where a soil-based probiotic can really shine. They don’t populate in the small intestine and lend themselves to bacterial overgrowth there, instead heading to the large intestine and colon where they can support vibrant health.

Now that you understand how a semi-elemental diet can help combat SIBO, you may be wondering if I recommend it. It depends on whether you follow it in a way that supports optimal health. Follow any diet poorly, and it may not work optimally. 

Therefore, I recommend enlisting the help of a functional medicine physician to ensure you are meeting all of your nutritional needs. Drink plenty of nutrient-dense smoothies such as this Semi-Elemental Diet Vanilla Shake and this Semi-Elemental Diet Chocolate Shake

If you do choose to eat small amounts of food, there are some better options. These include soft-cooked, organic foods such as leafy greens and non-starchy vegetables, grass-fed beef, and wild-caught fish. When done safely and optimally, a semi-elemental diet can offer many health benefits for those struggling with SIBO.

Bottle of Primal Earth Probiotic

Article Sources

  1. What Is an Elemental Diet, and Can You Use It for Weight Loss?. . Healthline. .
  2. Erythrocyte lipids in triose-phosphate isomerase deficiency.. NCBI. .
  3. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. PubMed. .
  4. How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach. PubMed. .
  5. Elemental and Semi-Elemental Formulas: Are They Superior to Polymeric Formulas?. . University of Virginia. .
  6. Protein digestion and amino acid and peptide absorption. Cambridge University. .
  7. 2004 MacLean–Mueller Prize Enteral or parenteral nutrition for severe pancreatitis: a randomized controlled trial and health technology assessment. . NCBI. .
  8. Enteral nutrition in the early postoperative period: a new semi-elemental formula versus total parenteral nutrition. PubMed. .
  9. Improved growth and disease activity after intermittent administration of a defined formula diet in children with Crohn's disease. PubMed. .
  10. Enternal Nutrition Overview. . Global Nutrition Services LLC. .
  11. Antimicrobial effects of virgin coconut oil and its medium-chain fatty acids on Clostridium difficile. . PubMed. .
  12. Gut Microbiota and Metabolic Health: The Potential Beneficial Effects of a Medium Chain Triglyceride Diet in Obese Individuals. . NCBI. .
  13. The Elemental Diet for SIBO and Other Gut Conditions. . Natural Medicine Journal. .
  14. How the Elemental Diet Works. . Verywell Health. .