The Science of Elemental Foods
Ideally we would all be eating a balanced diet of healthy, natural foods to get the range of nutrients we need but sometimes digestive issues can make that difficult.This page provides an overview of what elemental foods are and how their characteristics can be useful before providing a selection of clinical research related to some of their areas of use.
What is digestion?
Digestion is the intricate process through which our bodies break down the foods we eat into nutrients that can be absorbed and utilised for energy, growth, and cellular repair.
The process begins with chewing, where food is ground into smaller particles and mixed with saliva to start the process of breaking down carbohydrates.
Swallowing moves the chewed food down the throat, passing it into the oesophagus. The oesophagus is a muscular tube that carries food and liquids to the stomach and has mechanisms to prevent stomach contents from travelling back up under normal circumstances.
Once in the stomach, the food is mixed with gastric juices, which further break it down into a semi-liquid form which is then slowly released by the body into the small intestine.
In the small instestine, most nutrient absorption occurs. Here, digestive enzymes and bile work together to break nutrients into their most simple forms so they can be absorbed through the walls of the intestines and into the bloodstream, for dispersion throughout the body.
Any remaining indigestible parts of the food pass into the large intestine. In the large intestine, water and remaining minerals are absorbed, and the leftover waste is eventually excreted from the body.
What is different with elemental foods?
Each step of the digestive process can present challenges for individuals with specific health issues. By providing balanced nutrition in a more broken down form than 'normal' food and having no 'hidden' ingredients, elemental foods have features that can can help with digestion:
Where someone has trouble chewing or swallowing, the liquid form of an elemental food can help get nutrients down the throat and oesophagus and into the stomach.
Some people may have enzyme deficiencies or digestive disorders that make it hard to break down certain foods or ingredients. Elemental foods present ingredients in the most simple, pre-broken-down form to aid digestion in these cases.
Some individuals are triggered by specific ingredients found in normal foods, such as lactose, gluten, or other allergens. ElementGold Plus+ has been carefully formulated to avoid common trigger ingredients and all ingredients are clearly listed, including the forms of vitamins and minerals, to help identify and avoid potential 'hidden' triggers.
Those with compromised organs, such as inflammation of the stomach lining or after surgical resection, often find it difficult to digest complex foods. Elemental foods are gentle on the digestive tract, are absorbed quickly and require minimal digestive effort, making them helpful for individuals with such conditions.
How can elemental foods help with specific conditions?
There are general situations where ElementGold Plus+ can help, such as with chewing or swallowing difficulties and when trying to avoid trigger ingredients. Additionally, elemental foods have also been shown to be beneficial in other situations:
Crohn's Disease
Elemental diets are sometimes used as part of the management strategy for Crohn's disease, often involving the exclusive consumption of the elemental food for a period of one or more weeks. This approach helps to rest the gut, reduce inflammation, and minimise exposure to potential dietary triggers and are sometimes referred to as "gut rest diets". ElementGold Plus+ is specifically designed for such use and conforms to the Food for Special Medical Purposes part of the Australia and New Zealand Food Standards Code, including the parts making it suitable as the sole source of nutrition when used under the guidance of a medical professional. Below are several peer-reviewed studies that explore the effects and benefits of elemental diets in the context of Crohn's disease management.
Effects of Exclusive Enteral Nutrition on the Microbiota Profile of Patients with Crohn’s Disease: A Systematic Review
Gatti S, Galeazzi T, Franceschini E, Annibali R, Albano V, Verma AK, De Angelis M, Lionetti ME, Catassi C, Effects of enteral nutrition on the microbiota profile of patients with Crohn’s disease: a systematic review; Nutrients 2017, 9, 832
Despite the high rate of treatment response to enteral nutrition in Crohn's Disease, the exact mechanism of action is poorly understood. This review collates 20 years of study into the subject and concludes that a positive shift in the microbiota is one of the treatment effects. The most frequent reported effects noted were a reduction in microbiota diversity and the induction of bacterial metabolomic changes.
Enteral Nutrition Decreases Hospitalisation Rate in Patients with Crohn's Disease
Watanabe, O.; Ando, T.; Ishiguro, K.; et al Enteral nutrition decreases hospitalisation rates in patients with Crohn’s disease, 2010 Journal of Gastroenterology and Hepatology, Volume 25 Issue s1, s134-s137
The use of an elemental diet was associated with avoiding hospitalisation in Crohn’s disease patients with ileal lesions and may be useful in improving the long-term convalescence of these patients.
Enteral Feeding as Primary Therapy for Crohn’s Disease in Australia Children and Adolescents: A Feasible and Effective Approach
Day, A.; Whitten, K.E.; Lemberg, D.A.; Clarkson, C.; Vitug‐Sales, M.; Jackson, R.; Bohane, T.D.; Exclusive enteral feeding as primary therapy for Crohn’s disease in Australian children and adolescents: A feasible and effective approach 2006, J Gastroenterol Hepatol, Volume 21, Issue 10
Exclusive enteral nutrition (EEN) has been shown to be as efficacious as corticosteroids in inducing remission in children with Crohn's Disease with additional nutritional benefits. Twenty-seven children receiving EEN, taken orally, were followed. 80% achieved remission and 4 continued to receive supplementary EEN. All maintained remission after 15.2 months.
Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial
Levine A, Wine E, Assa A, Sigall Boneh R, Shaoul R, Kori M, Cohen S, Peleg S, Shamaly H, On A, Millman P, Abramas L, Ziv-Baran T, Grant S, Abitbol G, Dunn KA, Bielawski JP, Van Limbergen J. Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial, Gastroenterology. 2019 Aug;157(2):440-450
Children were given either exclusive enteral nutrition or the exclusion diet plus partial enteral nutrition. After a period of 6 weeks, both diets were successful in including remission but the exclusion diet plus partial enteral nutrition group achieved a higher rate of sustained remission and changes to the faecal microbiome associated with remission.
Enteral Diets in Combination with Exclusion Diet for Crohn’s Patients Who Have Failed Biological Therapy
Boneh, R.S.; Shabat, C.S.; Yanai, H.; Chermesh, I.;Avraham, S.B.; Boaz, M. and Levine, A. Dietary Therapy with the Crohn’s Disease Exclusion Diet (CDED) is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy, Journal of Crohns and Colitis, 2017, 1205-1212
This group investigated several dietary strategies by combining partial enteral nutrition with the CDED and found that dietary treatment combining partial enteral nutrition with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.
Enteral Nutrition in Combination with Biological Therapy can Enhance Response
Tanaka, T.; Takahama, K.; Kimura, T. et al. Effect of concurrent elemental diet on infliximab treatment for Crohn’s disease. J Gastroenterol Hepatol 2006; 21:1143-9
110 adult patients were followed for 16 weeks after initiating infliximab treatment for Crohn’s disease. These were divided into 2 groups with one group receiving only the biologic and the other group receiving the biologic and an elemental diet concurrently. The patient group receiving the elemental diet had a significantly higher response rate (68.4%) to the biologic than the group receiving the biologic alone (32.4%).
Small Intestinal Bacterial Overgrowth (SIBO)
The use of elemental diets with relation to SIBO was popularised when Pimental et al. demonstrated that a 14 day period where the sole source of nutrition was an elemental food led to a normalised lactulose breath test in 80% of participants. A lactulose test is a diagnosis for SIBO where a solution containing lactulose is consumed and an overgrowth of bacteria will cause elevated levels of hydrogen (and sometimes methane) to be detected in breath samples afterwards.
ElementGold Plus+ is specifically designed for such use and conforms to the Food for Special Medical Purposes part of the Australia and New Zealand Food Standards Code, including the parts making it suitable as the sole source of nutrition when used under the guidance of a medical professional.
Elemental Diets and SIBO
Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 2004 Jan;49(1):73-7.
Patients with IBS and an abnormal lactulose breath test undertook an exclusive elemental diet for 14 days. Of the 93 patients who completed the diet, 80% returned a normal lactulose breath test on day 15. Of these, 66.4% reported improved bowel symptoms one month after they had completed the diet showing not only immediate benefit but lasting benefit after the diet had concluded.
Surgical Recovery
Being easy to digest and absorb, elemental foods like ElementGold Plus+ can promote recovery by assisting in situations where digesting normal foods can be challenging.
Enteral Diet for Recovery from Stomach Surgery
Chen, Y.; Dang, Y.; Yang, J.; Zhang, G.;. Effects of Early Enteral Nutrition on Patients After Gastrectomy, Food Funct. 2016, 7, 1741-1751
Enteral nutrition is effective and feasible for post operative gastric cancer patients. The optimum time for exclusive enteral nutrition is 24 hours post surgery and oral feeding presents the best effect.