Dr Lela Altman

Dr Nirala Jacobi is in conversation with Dr Lela Altman on the topic of the Elemental Diet.  Dr Altman presented at the 2017 SIBO Symposium, and in 2018 at The Gastroenterology Association for Naturopathic Physicians, both on the topic of the Elemental Diet.

Dr Altman is a Naturopathic Doctor, she has a private practice and also lectures at Bastyr University in Seattle.  Dr Altman is also an Acupuncturist.  Her interests include gastrointestinal disorders, east Asian medicine, diabetes, and cardiovascular disease.


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SIBO and the Elemental Diet

Topics discussed include

  • How did Dr Altman get into the field of SIBO with a special interest in Elemental Diets?
  • The Elemental Diet is a highly effective standalone antimicrobial treatment, on par with conventional antibiotics or herbal antimicrobials.
  • What are the components of the Elemental Diet? What makes it different from medical food replacement products such as Mediclear or powders that aim to heal the gut?
    • Proteins are in the form of amino acids only, and there are no other food products in the formula. The nutrients are predigested – you do not need to break anything down.
    • Fats in the form of oil, medium chain triglycerides (MCTs).
    • Carbohydrate component is either dextrose or maltodextrin.
    • Starches may be included.
    • Essential vitamins and minerals.
    • No fibre.
  • Contraindications for the Elemental Diet include
    • A history of disordered eating
    • Underweight patients (however patients can gain weight on the Elemental Diet due to ease of absorption of nutrients)
    • Caution in diabetes due to higher simple carbohydrate and sugar content.
    • Caution for known fungal overgrowth or signs or symptoms. If using, use in combination with antifungal treatment – Dr Jacobi always uses an antifungal with the Elemental Diet.
  • How can people get the Elemental Diet for their patients?
  • Possible complications encountered with prescription of the Elemental Diet.
    • Blood sugar dysregulation
    • Weight loss
    • Intolerable flavour
    • Nausea
    • Diarrhoea
    • Die off reactions
    • Constipation
    • Abdominal pain
  • What happens for 2 versus 3 weeks for patients on the Elemental Diet?
    • 80% effective after 2 weeks
    • 85% effective after 3 weeks
    • No more effective for 4 weeks
  • Protocol
    • Elemental Diet shakes – 6 per day, or daily amount divided up to have less day every hour.
    • Drinks allowed – water, (sometimes) dilute black coffee or black tea.
    • SIBO testing patient with same day breath test – if still positive, continue for one more week, if negative, transition off the Elemental Diet.


Transitioning off the Elemental Diet


  • Keep using some of the Elemental Diet shakes for calories as patient transitions.
  • Consider using Elemental Diet as the elimination phase of an Elimination Challenge Diet (eliminate all high allergenic foods for 2 weeks and then reintroduce one every 3 days, if tolerated add back in, if not tolerated keep it out)

Day 1

  • Slow introduction of foods starting with broths (be aware that some SIBO clients do not do well with cartilage bones due to the high histamine in glycosaminoglycans. If this is the case, use only marrow bones or meat broth).
  • Start patients with Low FODMAP diet for approx 3 days, well cooked vegetables, avoiding raw foods.
  • If candida suspected, avoid simple carbohydrates.

Day 2

  • Continue with well-cooked Low FODMAP vegetables and broth.
  • Congee addition (if no yeast overgrowth) – rice soup with chicken / vegetables.
  • Add cooked meats, fish, eggs, grains.

Day 3

  • Transition to a simple Low FODMAP diet or Dr Jacobi’s Bi-Phasic Diet

If SIBO breath test is negative start challenging the Low FODMAP diet as described with Elimination Diet Challenge above.

  • Same day retesting available in Australia with SIBOTest.com
    • Notify the lab before sending the test for fast-tracking
    • Overnight the test back to com
  • What are common symptoms that are usually no cause for alarm?
    • Constipation (due to no fibre intake)
      • Bowel movements can change largely – client is not eating enough food to pass on a regular basis.
      • Great therapeutics include magnesium, herbal laxatives, suppositories, enemas.
    • Nausea
      • Can start within first couple of days and usually then goes away. Solution is to dilute formula a bit more if you can.
      • Can be due to vitamins and supplements taken in addition to Elemental Diet. Recommendation to discontinue non-essential supplements.
      • If using Dr Siebecker’s Formula, switch to the lower fat higher carb option, as the high fat option can cause a bit more nausea.
    • Bowel changes
      • May notice passing stools of dry grey powder – if formula used is powder.
      • Diarrhoea – could be a reaction to something in the formula (look to corn oil, soy oil). Treat for dehydration – keep them hydrated and advise sipping formula slowly throughout the day (which also assists blood sugar regulation).
    • What to do to improve flavour of the homemade Elemental Diet? Options may include:
      • Stevia
      • Flavoured magnesium powder (use caution here with appropriate quantity).
      • Extract drops, such as almond, peppermint etc.
      • Blend with ice.
      • Use a cup with a straw so as to not smell it.
      • Do not let it sit out for more than the time that it is being consumed.
    • The Half Elemental Diet
      • Not used for SIBO treatment
      • Can be used for providing bowel rest for anyone in an inflammatory bowel flare.
      • Can be used to increase caloric intake for someone who is requiring hypoallergenic caloric supplementation (a few days to a week’s duration) – used as a caloric and nutritional booster for those with extreme food sensitivities.
    • Additions
      • If client is getting hungry on having the Elemental Diet – add coconut or MCT oil to formula to increase calories.
    • Dr Altman’s opinion on using the Elemental Diet in the daytime and eating meat at night?
    • The difference between meat protein and elemental diet protein – the latter is in a free form and are therefore rapidly absorbed and not much reaches the colon.
    • Initiate prokinetics immediately at completion of Elemental Diet to inhibit regrowth of SIBO.
    • Consider low dose antimicrobial herbs at completion of Elemental Diet to inhibit regrowth.
    • Consider that stomach acid is killing most of the bacteria that we ingest – support this if necessary.
    • Consider the underlying root cause of client’s initial SIBO and keep that managed to prevent relapse.
    • Dr Altman’s clinical pearls re The Elemental Diet.
    • The cost of a 2-week course of The Elemental Diet
    • No need for hunger – patients can have as many shakes as they want.


11 thoughts on “SIBO and The Elemental Diet with Dr Lela Altman”

  1. I hope somebody answers, because in germany I’ve been to 5 doctors. And they did not even know that SIBO patients can exhale methane. So,… they are not a good source for information. My question is:

    Why is nobody ( Siebecker, etc.) recommending to put the amino acids into gelatin capsules? This way the diet wouldn’t taste so bad. What’s even more confusing. The author of “The SIBO solution” Sylvie McCracken recommends to empty out the multi vitamins capsules. Why is that?

    1. To the patient in Germany, I don’t know if you’ll see this, but if a supplement (e.g. multivitamin) is in a cellulose capsule, that might provide some fermentable carbohydrate. So, gelatin capsules or emptying a non-gelatin capsule is recommended (I got this from Dr. Siebecker’s Elemental Diet video on her website).

      I live in Canada, and my family doctor and an internist I saw do not know about SIBO either. The internist only thought it happened in people with a severe, acute infection that would obviously need antibiotics (i.e. patient would appear sick). I told him I had a breath test though a naturopath, and he told me to just deal with the naturopath then. He never even wrote it in his report, so it seems he did not think it was legitimate.

      I don’t know if any local gastroenterologists here treat it because I would need to be referred by my family doctor, and he just tells me to meditate, drink some prune juice if I’m constipated, and take a PPI if I have reflux. I am seeing a naturopath, but I’m not really impressed with the treatment options either. As a former pharmacist, I just can’t get behind the herbals because there do not appear to be published, in vitro human studies on them. I might have fungal overgrowth as well, so am a little hesitant about the elemental diet.

  2. Hello, yes that can be done and is recommended by some practitioners. If you can’t purchase empty gelatin capsules, you could employ that method you mentioned. Many Doctors are not aware of SIBO, even in the USA. Most primary care doctors still think SIBO/IBS is a psychologically associated condition, despite all the evidence to the contrary! Lots of work to do, which is why we started this podcast.

    1. There can be a problem with the gelatin in relation to SIBO.
      Also some gelatin capsules are made from a vegetable source and are not true gelatin. I think they may be cellulose or akin to cellulose, which is contraindicated. Also, keep in mind that gelatin is made from cartilage.
      I strongly suspect Dr. Siebecker had reasons for not recommending gelatin and these may be the reasons. Beware!

  3. Pingback: Elemental Diet For SIBO- The Ultimate Guide [80-84% Success Rate]

  4. I did well on just amino acids and oils-no sugars!! Blood sugar normal. No yeast coming up after ED. But on day 4 of ED I got sulfur stinky diarrhea which I only have after food poisoning. Felt VERY sick, burning, aching all over body, migraines, nausea. What happened? Die-off? Biofilm buster effect? Freeing of bad bugs previously hiding? was on ED 3x before and this never happened.

  5. I did well on just amino acids and oils-no sugars!! Blood sugar normal. No yeast coming up after ED. But on day 4 of ED I got sulfur stinky diarrhea which I only have after food poisoning. Felt VERY sick, burning, aching all over body, migraines, nausea. What happened? Die-off? Biofilm buster effect? Freeing of bad bugs previously hiding? was on ED 3x before and this never happened.

  6. Hi there.

    I have a Hydrogen positive SIBO. What is the difference between the dextrose or maltodextrin? Which should I use and why?

    My dietician doesn’t seem interested in using this option and I want to cure this! Willing to do it on my own and order my own breath test retest if I can. After 6 years, I’m done dealing with people who don’t wish to help me.

  7. Are there any concerns for individuals with aortic stenosis (I have a bovine aortic valve implanted 7 years ago) to be on the Elemental Diet? I’ve been told to try just 3 days of it to see if it would restart my gut. I have SIBO w/methane.

  8. I completed a 3 week elemental diet almost 3 weeks ago to eliminate SIBO and now am following an fodmap and AIP diet. Because of high levels of yeast my doctor suspects SIFO. I am not sure if its the sifo or something else but I haven’t been able to have a solid bowel movement since I completed the elemental diet and its been 3 weeks! Is this normal- how can I correct this?

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