Give Your Gut a Break: Put a Stop to your IBS, SIBO, IMO or IBD with the Elemental Diet with Roy Steinbock, MD and Debbie Steinbock, HHC

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and I have to take a moment and say that I'm very excited that this is my 100th episode. I started the podcast in November of 2018, mostly because I wanted to spread the word about fecal transplants and how people were doing it themselves in the US at home because of the FDA restrictions on it. My subject matter as you well know, is now much wider than that, but I still have that passion, and I think I may be the only one out there doing those types of interviews on any kind of a regular basis, at least. But anyway, today I'll be speaking with Dr. Roy and Debbie Steinbach. Dr. Roy is a board-certified and holistic pediatrician and the owner of Mindful Pediatrics. For more than two decades, Dr. Roy has been practicing evidence-based Western medicine with a holistic approach. Debbie Steinbach is a holistic nutrition counselor and the owner of Mindful Nutrition. She specializes in working with individuals with complex digestive concerns and autoimmune conditions. She's one of a small group of practitioners with a high level of experience in guiding clients through elemental diets. But before our conversation, if you haven't yet followed or subscribed to this show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show. Welcome to the podcast, Dr. Roy and Debbie.

Thank you.

Thanks for having us.

My pleasure. So can you just start by describing to people what an elemental diet is and what it's used for?

Sure. So elemental diets are basically liquid diets. They're shakes or formulas that you can buy, or there's some prescriptions. And truly elemental diet has all the nutrients broken down into their simplest form. So it would be amino acids, carbohydrates in the forms of simple sugars or very, very mild complex sugars like tapioca maltodextrin, things like that. And then fats and some vitamins and minerals, things that you need to survive. And you can survive on these diets for a couple weeks. People do them from 2 to 3 weeks typically, but sometimes for more serious conditions like Crohn's and colitis, people can stay on them for longer periods of time, obviously with the supervision of a physician or someone who guided people through those kind of conditions. And the diets are very hypoallergenic, they're anti-inflammatory, they starve the gut bacteria and give you gut rest. And so they can be used in a variety of conditions because of those different reasons.

And what I'll add to what Roy said is that they're liquid formulas, but they're usually sold in powdered form that you then mix in with liquid to make a liquid formula. We did a Q&A earlier today and someone was like, why are they called elemental shakes when they're really like elemental water? Because they're not thick like we think of smoothies when we say shakes. They're generally much thinner than that.

And it's certainly not like a milkshake.

Yeah. And then when Roy spoke about starving the bacteria, it's, it mostly starves the small intestinal gut bacteria. We have such prolific large intestine gut flora that while that may too be impacted on an Elemental Diet, relative to the bacterial amounts in the small intestine versus the large intestine, we're having a larger influence on the small intestinal bacteria as we understand it.

So what brought you into work on digestive issues and a focus on the Elemental Diet in particular?

So I have been a nutrition counselor for going on 23, 24 years at this point. And I actually learned about Elemental Diets very early on in my practice because of my focus in working with clients with inflammatory bowel disease. So I've used Elemental Diets for more than 2 decades in my practice, but mostly as like an adjunct treatment to other things with clients who had inflammatory bowel disease or were going through other treatments. But in the last probably 6 or 7 years, as Elemental Diets gained more popularity in the SIBO, small intestinal bacterial overgrowth, community, I started using them more as complete or full Elemental Diets, doing them with clients for, you know, extended period of weeks. And that kind of led me to other conditions that I use Elemental Diets with in addition to SIBO in my practice. You know, I'm sure we'll get into those, but we've used them for pain conditions or skin conditions, things like that.

And really autoimmune inflammatory conditions.

Yeah.

And really seen their uses. And Rory and I can speak to this, but at that time, about 6 years ago, when I got really interested in doing more with elemental diets, we did a full elemental diet ourselves together because we really wanted to have that experience before we took others through it.

We frequently like to experiment with ourselves before we'll recommend something. And so that was a good opportunity. Debbie really wanted to do an elemental diet. And I kind of tagged along for the heck of it. Yeah.

That's very brave of you cuz I, I've sent clients on them, but I can't say that I ever have done it myself because I've heard that, you know, at least the Physicians' Elemental is not that great tasting, but you can go into a little bit more about that in a minute. But I wanted to ask whether you're using the Elemental Diets as a first-line therapy for SIBO or once antimicrobials have failed or In addition to—

a little bit of both. So, you know, we're in a very unique position in our practice in the sense that we have people reaching out to us interested in doing elemental diets. So, you know, sometimes they just know of the efficacy of them and it's something that they want to try first. Other times, like you said, it's because other treatments have failed.

So we have a pretty unique patient population, especially here locally in Boulder. But sure, once you get a reputation for doing something unusual like elemental diets, people do seek you. And so a lot a lot of our clients who maybe don't do well on medications or have fear of taking medications or have difficult time with herbs, you know, it's a great opportunity for them to do something that's incredibly powerful and effective, super safe. It does take some commitment and determination, but that tends to be our clientele in general. We're rarely needing to convince people to make changes. We have a relatively intense clientele, I would say.

Yeah. I once got asked, how do you convince people to do such a hard treatment? I'm like, I'm not really convincing anyone. They're kind of calling me.

I think, I think the other part of why we don't need to convince people is that because A, we did it ourselves, and B, we've had so much success doing it. Debbie's walked hundreds of people through Elemental Diet successfully. And I think when you really believe in something, when you've seen the positive effects that it can have and you have that under your belt, it's pretty easy to sell it, quote unquote, because you know how effective it is, you know the challenges, and you know how to walk people through the challenges. And that's exactly why we created the program that we have.

I have to say that for me, it's been more of a last line treatment because unless of course I see someone who says, okay, I'm sensitive to all these different potential supplements and I can't do this and I can't do that. And they're on a bunch of stuff already. And it's like, how could I possibly suggest they go on something else? Then, okay, Elemental Diet, that just simplifies things. So it pops into my head in that respect, but because it is sort of hardcore, I think 2 to 3 weeks. You know, the way I think about it, of just eating a powder would be really hard for me. And admittedly, a lot of my clients too are on super restrictive diets anyway. And I'm thinking if you're only eating 6 things anyway, how much of a big deal is going on this powder for a few weeks? So I'm curious how long you have clients stay on the diet.

Yeah. So I would say 2 weeks is the average for many people. Occasionally people will stay on. 3 weeks. Uh, you know, we definitely have had clients who feel so good on the Elemental Diet and that starts to kick in into the process. And they're like, "Is it okay if I stay on another week or another 5 days?" And then with some more severe conditions, people can stay on an Elemental Diet for more weeks than that, you know, maybe 4 or 6 weeks. However, I generally will transition people to a Partial Elemental Diet at that point so that they do have foods in their system as well. Because Roy always likes to say there's only a certain amount of flavor fatigue that people can endure on an elemental diet.

For most people, there is a degree of fatigue of being on that. We tolerated it for 2 weeks, but I was ready to be done when we got off of it.

Roy also says it needs to be tolerable, it's not fine wine.

Exactly, exactly. One thing you mentioned, you know, we also don't use it as a first-line treatment for most things. I mean, obviously we use a more holistic lifestyle approach for all the conditions that we're treating. It's usually by the time someone's gotten to the point of considering an elemental diet, they've been through that with us or through that with someone else. And so conditions like SIBO, oftentimes we will try other things first, but elemental diets are so effective and simple that people oftentimes sign up to do them.

Right. So one thing where I've been using them more recently is in particular with EMO, intestinal methanogen overgrowth. So I'm curious if you find it to be equally effective for hydrogen SIBO versus EMO or methane SIBO, and, and I'm also wondering about hydrogen sulfide SIBO.

So we've used it for all three conditions with really, really good success. I know that in the research it's really only been studied for hydrogen SIBO, but we found it very successful with intestinal methanogen overgrowth as well as hydrogen sulfide SIBO, either diagnosed or kind of suspected with a flatline. Breath test.

Okay.

So in my case, I've had a couple of clients who, I mean, antimicrobials, just nothing. It was not, not responding, the emo, and then got them on the Elemental Diet and it broke the bloating a little bit, but it was not like everything was better afterwards. Even that was not enough.

Mm-hmm. Well, you speak to a good point, which is, is eradication of symptoms always correlated with a negative breath test? And as we as clinicians know that while some people feel amazing as it is, there's oftentimes layers and other things that are going on that sometimes we eradicate SIBO, but somebody's not feeling great still and there's other layers to their health that still need to be addressed. Right.

So what other things might be causing the bloating if it were not the SIBO or the emo?

Yeah, well, I mean, part of it can be things in the large intestine as well. So some, a lot of times people have imbalances of gut bacteria in the large intestine or they just might not be digesting their food well, which could then lead to fermentation. Maybe it's not overgrowth, but certainly could lead to fermentation that would, that would cause them to have gas and bloating. Those are a couple of things.

Food allergies or sensitivities. Yeah, right.

Exactly.

Yeah. Or even sometimes just foods that are in their diet that are not necessarily working for them. So like an example I see really frequently, you know, just this came to mind when you said bloating is people that drink a lot of like carbonated beverages and they're chronically distended, bloated, or have a lot of reflux. And you know, when I look at their diet and it's like, oh, you're drinking 40 ounces a day of carbonation. So there can be, you know, stress can exacerbate all GI conditions as well. So there's a long list of other things that could be going on.

So when you recommend people are on an Elemental Diet, do you tell them to go off other supplements while they're on it, or is it safe to continue them? Or might those other supplements be providing food for the microbes?

Yeah. So in general, we kind of joke that we're Elemental Diet purists. When we put someone on Elemental Diet, typically we're just recommending being on Elemental Diet with the shakes. That being said, we do recommend some supplements, you know, something to maybe quell any potential fungal overgrowth if that's an issue. And then for people with methane, SIBO, sometimes we'll recommend using something like Atrantil. Because Debbie had some clients that we use that with and actually found some really great results, both the symptom relief and gas reduction. But in general, what we've seen is that people don't really tolerate a lot of supplements because there's no solid food in their digestive tract, whereas someone might be able to tolerate something like— sometimes we'll recommend magnesium if someone has constipation, but usually they'll need a smaller dose or be able to tolerate a smaller dose than they could when they're eating solid foods. So our digestion's a little more sensitive when we don't have food in our belly.

When I have clients dealing with diarrhea or loose stool, I always tell them about tributyrin, which is the best absorbed form of butyrate, which is normally made by bacteria fermenting fiber in your colon. Supplemental tributyrin can help slow your motility down and feed the cells lining your colon, firming up stool and helping create an oxygen-free environment in the colon which helps the butyrate-producing bacteria to survive and multiply. Those bacteria are often wiped out after taking antibiotics, which is why tributyrin is a great accompaniment and follow-up supplement if you have to take antibiotics. My new supplement, Tributyrin Max, has 750 milligrams of tributyrin, which is the highest dose currently available in a capsule. You can find it at tributyrinmax.com— that's T-R-I-B-U-T-Y-R-I-N-M-A-X dot com— and use code INTRO15 for 15% off of your first order.

Yeah, no, I, I thought about the atraenol and I was thinking, but those are polyphenols and polyphenols promote the growth of certain kinds of microbes. So I was thinking, is that cheating?

Yeah, we say it's always like a cost-benefit analysis of anything you add into the system while you're in an elemental diet. Do the benefits of adding it in outweigh the negatives of adding those prebiotic fibers or starches or whatever it is that you're adding in? Even in a veggie cap or something like that.

So I'm familiar with the Physician's Elemental Diet, which people can find in Fullscript. And, um, I know Michael Ruscio has the semi-elemental diet formulas available on his website. Are those both good choices, or would you say one's better than the other, and are, or are there others that you recommend?

So we like to think about, you know, which elemental formula to choose based on which condition somebody's coming into the elemental diet with. We, of course, like most practitioners, we have ones that are more like tried and tested that we've used again and again with clients with really great results. What we've also learned in working with so many people is that there's some that work better for others. For example, there's some formulas that contain tapioca maltodextrin that are typically lower in sugar than the ones that have glucose, dextrose, fructose in them. And so some people, you know, do really a lot better for blood sugar regulation and energy with those types of formulas. Formulas, which a couple companies have now. And then there's some people that will do better with the shakes where they have to add their own source of fat to, because some of the fats that are contained in the formulas might not work well for them. And then there's, you know, the difference between elemental shakes and semi-elemental shakes. And there's some uses for both of them in this field. So we try to personalize it and teach people how to do so in the course that we have by What condition are they treating? What are they— what are their main concerns and what's the formula that's going to best suit their needs then? But to speak to your point, we keep saying there's year after year more and more shakes that come onto the market. And that's pretty cool because it just shows us that there really is a need for this type of treatment. And, you know, at least in the 20 years that I've been tasting these, they have improved so greatly. Over time, and the ingredients have improved too, to the point that we were willing to finally say, okay, let's, let's try this ourselves. This is not drinking a hypoallergenic baby formula anymore.

To directly answer your question, I mean, we do use the Physicians' Elemental a lot. You know, they had a jumpstart on the market in terms of stuff that you could get from a practitioner or online, like Fullscript, like you mentioned. You know, we've not had a lot of personal experience with the Ruscio formula, but we've heard some good things about it. We've sampled a lot of different ones and it's on our list of ones to sample at some point. We use Absorb+ a lot, which is Jenny Patel Thompson's formula, and that, that one's great. And she's got a bunch of flavors and a bunch of different options.

Is she a functional medicine person?

No, not at all. So she actually formulated Absorb+ for her own personal health. She has Crohn's disease and used an elemental diet for 6 weeks to get out of like a widespread flare and then created Absorb+ which interestingly semi-elemental formulas were what were considered elemental diets way back then, 25 years ago. The distinction has changed. So now when we say elemental, we mean an amino-based formula. But actually what she has educated me about over the years is that most of the studies that you read on elemental diets are— have actually used semi-elemental formulas that were done all these years ago. So now, you know, when we say semi-elemental, we mean that the formulas have amino acids and simple sugars and fats. Well, you have to add fats if they don't have them, but they also have small proteins like dipeptides or tripeptides, whereas the true quote unquote elemental formulas are the amino-based formulas that don't have any peptides in them.

Right.

And the reason that they do that is because it tastes better if you put them in that format?

I don't know that that was the original reason why. I don't know that it was necessarily for taste. I think it was the populations that they were being used in. So if you look back and when like Elemental Shakes were originally used, definitely with IBD, they were actually developed for NASA, for astronauts to limit the fecal matter. While they were in space. And so for both of those populations, maintaining muscle mass is really important. And there's some thoughts that the semi-elemental formulas are better at helping to build or maintain muscle mass than just the aminos.

Ah, okay. So tell me about your use of elemental diets with IBD and how successful that's been.

Yeah. So that's what I've been using them for the longest. But like I said, I was always, until I had done it, an Elemental Diet fully myself, really hesitant to get somebody fully off food and onto Elemental Shake formulas. And so for many years I just used them. There was a couple of studies or one study, I don't know, but a pretty big one that talked about that using a half Elemental Diet with inflammatory bowel disease was a very effective treatment. And so oftentimes I would have clients use Elemental Shakes as like an adjunct for calories and easily absorbed nutrients and still use them that way. But sometimes now when somebody's initially starting like a flare, if they have Crohn's or colitis, we might have them do Elemental Shakes as an initial bowel rest treatment. So short-term or a couple weeks, depending on what's going on.

In that population, and in general for inflammation, you know, these are formulas and shakes that are hypoallergenic, particularly the True Elemental shakes. It's amino acids. And normally what we get allergic reactions to or sensitivities is more the protein. And so when it's broken down into these really simple forms, for most people, there's always exceptions, of course, but for most people, it's going to be really hypoallergenic. And, and that can have an effect in everything from arthritis to to colitis. And so that's one part. They're also so easily absorbed and absorbed so high up in the intestine that it really gives your bowel a rest. So intestinal rest is incredibly important. It's kind of like if you break or sprain your ankle, you're gonna wanna give it rest. And when we eat 3 to 5 times a day, that's creating a lot of digestive strain for people, intestinal strain. So it can really help in terms of that. Yeah.

Like the reason that it's used for SIBO, also imagine an IBD, there's an antimicrobial.

Exactly.

And we know there's antibacterial action to them. Sure. And that probably plays a part for— in the IBD population as well, whether or not somebody was diagnosed with SIBO or dysbiosis, we kind of assume by nature of the condition that that exists there.

Yeah, there's always these new popping up studies showing that there's an association between this bacteria and that bacteria and Crohn's and colitis and arthritis. Even in the study that there was using it for rheumatoid arthritis where they were able to induce remission for people's as effectively as with using steroids. They proposed whether arthritis or rheumatoid arthritis really starts in the gut. And obviously all holistic practitioners know that, but, or at least have thought that for many years. But it is, uh, it's interesting to see Western science kind of catch up with that.

Yeah, just to finish up answering that question, the other ways that I've used it with clients who have inflammatory bowel disease is sometimes, I don't know if you see this with your clients, but I've certainly had the clients that they can't get off of steroids. They're on steroids and then every time they wean down to whatever dose it is, they flare up again. And so if their doctor is on board with it, I've had quite good success helping somebody through using an Elemental Diet during the wean down of steroids and had had several cases where somebody who had had many failed attempts at getting off of steroids was able to use an Elemental Diet to assist that process.

And then did you slowly take them off the Elemental Diet, like, you know, partial food for a bit?

Exactly. And then bringing in really good foods and good supplements to support them after that process.

One of the things that we've seen is really useful with the Elemental Diet is it's virtually an elimination diet as well. So because you're really eliminating all your foods. And so it's a good opportunity to see what really does affect you in a negative way. You obviously have to take into account that you've closed down your digestion for 2, 3 weeks, so we have to find a— fire that up properly because that could create some digestive symptoms just by starting to eat after not eating for 2 to 3 weeks. But once we get that going, it's a good opportunity to see, like, are strawberries really the thing that's causing you to get bloated every time you eat them? Or Was it more sort of generalized?

So when people go on an elemental diet, do they typically have stool on a daily basis, or do they tend to have problems with diarrhea or constipation or any of those things?

It really varies so greatly. There's such a wide range of what's normal on an elemental diet, and really educating people about that is important because some people do have liquid breastfed baby poops, and that's not diarrhea. That's kind of normal. That's normal for people, some people who are on an elemental diet, while other people have very, very little stool volume at all and could go a few days without stool. And then when they pass stool, it actually looks quite formed. And that's been fascinating for us to see that people that are drinking, even Roy and I, who have the diet, we have some variation between the foods that we eat, even though we eat all of our meals together mostly. But on an elemental diet, everything we were doing was exactly the same. And to see even between the two of us, the difference in how our stools were on an elemental diet was pretty dramatic.

We, we tend towards different types of bowel movements to start off with. And Debbie always says, and I think this is very true, it's like people tend to go towards where their challenges are.

The extreme of whatever their body wants to gravitate towards. Stored.

I tend to have slower bowels, and so I had less bowel movements, though I wouldn't have called it constipation on the Elemental Diet. I had normal bowel movements, but they were just smaller and less frequent, whereas Debbie tends to have more frequent bowel movements.

And so that's what they were on the Elemental Diet.

Exactly.

Yeah. And sometimes people surprise us where, you know, I think I know which way it's going to go for some of my clients given their health history, and it surprises me. I'm like, oh, that's how their body reacted. To the shake, and it can change over the weeks as well. And remarkably, for some people who are constipated or have really high methane SIBO and they're having a struggle with bowel movements on an Elemental Diet, they might have one every day. And those are people that are like, ooh, I wanna stay on this a little bit longer.

So if somebody went on an Elemental Diet with SIBO, when they're coming off of it, do you have one of the many SIBO diets that you recommend as a transition?

Yeah. So food reintroduction is really quite individualized for the person, but typically what we do is we give people very low-residue diet to do for the first 5 days to really minimize any symptoms that they have. And then we teach people how to use the different diets that are on the market for SIBO to really customize and learn what works best for them. So the diet that's best for Debbie is different than Roy and Lindsey Parsons. And that's really the take-home message here. So like where all these diets are great guides that were created with great intentions, most people don't need to follow them to a T. But to really discover what foods, you know, as Roy said before, sometimes after an elemental diet or after healing dysbiosis or SIBO, they have a much wider tolerance of foods. We've seen that again and again in our practice. So what we don't want to do is have somebody transition off an elemental diet and onto another restrictive diet when they've actually really gained tolerance to foods back. And so there's a way that we teach people how to test that out in like a systematic way where they try the foods that they're least likely to react to first and then test foods with higher fermentation or things like that down the line.

Or foods that have been challenging for them down the line.

Mm-hmm.

Oh, I was just gonna say it's challenging sometimes when people have very restrictive diets and then start doing treatments that in theory should get them into a less restrictive diet. It's tricky getting them to try new foods. And I'm curious how you handle that.

Yeah, well, I think that speaks to also that there's a lot of fear around food reintroduction. And that's really important to note because after an Elemental Diet, especially if somebody feels a lot better after their treatment, they might be very reluctant to try new foods and are, are very afraid of symptoms coming back. Back as well. I feel like I missed a part of your question.

Well, just how do you handle that?

Well, we give suggestions in our course of how to do that. And if you're going too slowly, what happens if you go too quickly? If you have a relapse, where— how to go backwards, we talk about that. But for the really complicated people who have a lot of psychological and emotional connections to food and challenges with food, that's probably more based on a one-on-one treatment protocol for them, helping them through that. And this kind of goes back to your other question about like, what do you do if someone's still bloated or not feeling well? A lot of times what we found, despite people doing all the right things, they're still not feeling well and it just gets harder and harder to figure out what's going on with them. And at some point what we realized is that a lot of that is nervous system, immune nervous system connection, fight or flight state, and really working on that. And there's some good programs to work on that as well. So, you know, really helping people deal with some of their emotional issues around food, their past history, their trauma around it can be incredibly important part of their healing.

Hey, this is Lindsey here, just letting you know that if you're tired of dealing with digestive issues like bloating, indigestion, soft stool, diarrhea, constipation, reflux, IBS, IBD, or the numerous health conditions that come about when your gut is off, like brain fog, weight gain, UTIs, fatigue, mental health issues, or complex conditions like fibromyalgia and ME/CFS, that's my specialty. With my 3 or 5 session gut health coaching packages. We'll discuss different stool and functional medicine tests to find out the root cause of your symptoms. I'll interpret the results and provide clear explanations, empowering you to make informed choices for your gut and overall health. And together we'll develop a customized action plan based on your test results so you can find relief and regain your health and vitality. I come from a functional medicine perspective, trying to incorporate the latest peer-reviewed research and educating you on protocols used by functional medicine practitioners but devoting lots of time and support to my clients the way a doctor simply can't. If you're interested in a 3 or 5 session coaching package, you can sign up for complimentary 30-minute breakthrough session. Or if you can only afford one appointment at a time, you can book an initial 60-minute consultation. Links for those are in the show notes. Now back to the show.

So are you using breath tests before and after Elemental Diets to check on people's progress?

Yeah, I would say most of them, 80, 90% of people want that for SIBO. There's—

and we generally recommend it.

Yeah. If they have a before breath test, we generally will do an after breath test unless there's financial concerns for somebody. But there's also clients that are like, if I don't have SIBO, I know I still wanna try this for just the break and the bowel rest. And so we've definitely had people who do that as well. I mean, we've, uh, had clients who have tested like Calprotectin or what have we seen, sed rate, CRP.

Less SIBO.

Yep. Before and after elemental diets as well. But many of the conditions, there's not much testing you can do before and after.

Right. I mean, usually by the time we've gotten someone to do an elemental diet for something that's not SIBO, they've gone through a decent amount of testing already to try to figure out what's going on with them. And sometimes it is a little bit of a Hail Mary pass of we've tried a lot of things. We know this has just helped such a random concoction of different conditions and people will try it and oftentimes we've had really good success on even when it's not SIBO or not something obvious.

So tell me a little bit about some of the unusual conditions that you've seen it successful with, like you were mentioning pain and autoimmune and inflammation.

Yeah. I mean, some with people who have kind of arthritis, maybe not even specifically rheumatoid arthritis. But arthritic conditions, chronic pain, it's been really helpful for some. We've also treated a few people with some serious skin conditions like rosacea and had pretty dramatic results. Now, usually these are people also having some digestive symptoms as well. It's not just only for arthritis, though we certainly would do that. I just don't think we've had someone specifically come to us for that.

Right, exactly. We've done, um, multiple food intolerances, eosinophilic gastroenteritis. And had some really good successes there. And then partial elemental diets with all different kinds of conditions, cancer, and I've used it with HIV in the past.

Those are for clients who just need easy absorbable nutrition. We're not necessarily trying to kill anything, and it's not even necessarily for the anti-inflammatory process, but just to be able to get really, really easy to digest nutrition when they have sort of damaged gut lining. We want to just get absorbed up real high so they can get all the essential nutrients Yeah, it's because the gut affects so many things.

I mean, elemental diets clearly have never been studied for mental health conditions, you know, but of course you have to wonder how useful they would be with a lot of different conditions that they have yet to be studied for.

We've seen it improve brain fog and difficulty concentrating, sleep, sleep, as like as a positive side effect for people when we've treated other conditions. Again, those weren't the primary issues that we were dealing with, but we've seen improvements with that.

Could you back up a little bit and just explain to people what eosinophilic esophagitis is? Because I don't think any guest has ever mentioned that before on the show.

Okay, sure. So basically, eosinophils are the type of white blood cells that produce IgE, which is the antibody that creates allergies. And it turns out that you can have a higher concentration of eosinophils pretty much in any tissue. That's Eosinophilic esophagitis is in the esophagus, sort of the connection between your mouth and your stomach. And, you know, usually it's a diagnosis where people are having a difficult time swallowing, difficult time consuming foods. They can be bloated. It can be associated with SIBO. It's oftentimes pretty uncomfortable for people. It's a relatively newer diagnosis, and you can find eosinophils everywhere. There's eosinophilic gastritis, eosinophilic colitis. So you can kind of find eosinophils everywhere in the gut. And the treatments in terms of Western medicine are pretty limited. It's kind of steroids. So food elimination, which oftentimes doctors have a hard time recommending. It's interesting in the Western world, I just find that so many Western doctors are just so terrified to tell a patient they can't eat a food. But you know, that can be very effective. And the ultimate elimination diet, like I said, is this elemental diet. And that can be quite effective at decreasing the inflammation. Sometimes that's sometimes that's permanent and sometimes that's temporary. But for a lot of patients with something like this or with something recurring chronic, like maybe rheumatoid arthritis, if you can't completely halt it, just having another tool, maybe even in addition to using steroids, sometimes can be incredibly helpful and just decrease the total body burden of steroids and maybe lowering the doses, things like that.

And are you using like functional stool tests to diagnose that?

Well, not specifically for eosinophilic esophagitis. So we do use stool tests and breath tests and different functional medicine blood testing, things like that for other conditions. Eosinophilic esophagitis is generally, or really exclusively, diagnosed by an esophageal endoscopy. And you have to have a certain number of eosinophils, more than 30 per high-power field, to be considered positive. Now there's also the gray zone of like, what if you have 25 and not 30? We see that as well. But yeah, so high concentration of eosinophils, and that's beyond the scope of this conversation, but it can be treated beyond just steroids and elemental diets as well. But elemental diets can be a very effective tool, at least quenching that inflammation.

Right. But in general, that then would be something that was diagnosed by a gastroenterologist, correct?

Yes, that is a diagnosis made by a gastroenterologist, unless someone else is doing endoscopies.

Right. Because I know like on the GI map, there's the eosinophil protein.

Exactly. Protein X. Mm-hmm.

Right. And I'm wondering if that is indicative of some type of eosinophilic process.

Right. I think it is, it is indicative of some kind of eosinophilic process. So for example, people who have really severe allergies might have very elevated numbers of eosinophils floating in their blood. And that can be a tip off to, oh, these people might have eosinophilic esophagitis. That being said, I'd say the majority of patients that I've seen with eosinophilic esophagitis don't have elevated eosinophils in their blood or even elevated eosinophil protein X in their stool. Certainly, that one is not diagnosing the other, but it certainly points in the same direction, which is an issue with the eosinophils or immune regulation, kind of like you see in allergies and asthma and eczema. They're all kind of part of that same immune dysregulation family.

So I know that, and you mentioned already that the Elemental Diet powders need to have fat added to them. I know that, well, at least the semi-elemental, the Garucha ones do.

Does the Physicians also have to have fat added?

Those have fat included into the shake product. Yeah.

So when people do have to add fats, I know some of the recommended ones are like the Udo's 369 or MCT oils. Do you have a preference for a particular type of oil?

Yeah, it depends on the person. Like, it's really what oil they can tolerate the best.

Best.

So, I mean, we've had clients that have added fish oil. I can't imagine downing fish oil several times a day in my Elemental Formula, but for some people that's what they tolerate best. But all the ones you mentioned certainly can be added to somebody's taste tolerance and how well they can tolerate fats and how many calories they can tolerate from fats as well.

Right, because I know the MCT oil is known for causing diarrhea, right?

Exactly.

I mean, drinking oil in general can cause diarrhea, so We just don't normally do it.

Exactly.

But I also, I think it's less likely to cause that mixed in with the amino acids or protein if using a semi-elemental and carbohydrates as well. I mean, we're, we're designed to absorb food in that way. Obviously this is a little unnatural. It's not whole foods, but we've not seen a lot of people have like oil diarrhea from it.

Not at all. Yeah. But there are some people that can't tolerate MCT oils and some of the oils added into products that do better with less fat or specific kinds of it. You know, we don't have people oil into the formulas that contain oil in them. That just feels a bit excessive.

And there's some conditions where it might make a difference to add more or less oil. For example, things like pancreatitis or gallbladder disease where that can cause some issues. You might need to use less oil. When it gets to the point where you're really trying to figure that stuff out, sometimes working one-on-one with a practitioner makes more sense.

So tell me about your Elemental Diet Success Plan and where people can find it.

So the Elemental Diet Success Plan course was born out of all the work we've done coaching clients one-on-one through elemental diets. And in that process, we really learned the most commonly confusing questions that people had, where they really needed the most support in the elemental diet process. And I personally have been the person seeing the clients in our practice through elemental diets through all of these years. So we put this course together. It's really like a course for clients or patients who are interested in getting additional support while going through their Elemental Diet. And so the Elemental Diet Success Plan, it's composed of 14 different video lessons which take people through planning or preparing for the Elemental Diet, implementing the Elemental Diet, and then transitioning off the Elemental Diet successfully.

Successfully.

And so we say that all of our lessons are little bite-sized lessons where they might be as short as 5 minutes, as long as 25 minutes. But what we want is for people to be able to take an overview of the course, but then as they're in each phase, go back and re-listen to that lesson again when they're in it and they really need that additional support. And then what we also have as part of the program is some different guidebooks that take them through the process as well. So like a program timeline that helps them keep track of their progress through the program, a workbook that we say is kind of like the virtual handholding from us through the whole process that helps them through their calorie calculations, making their shake schedule, figuring out what foods they're going to go back to after the Elemental Diet, troubleshooting symptoms, whether that's psychological or physical symptoms of the Elemental Diet.—

even figuring out their inspiration for why they're doing the Elemental Diet, how to stay on an Elemental Diet, how to persevere through an Elemental Diet.

Through the mindset part of the Elemental Diet. And then we give them a detox support guide to support them through more challenging days to make symptoms more bearable, as well as transition diet recipes to help them through those first 5 days especially, and really the first 2 weeks of food reintroduction. So that's the overview. Did I miss anything?

No. I mean, what I would say is that like many doctors, I'm not walking people through elemental diets. It's really Debbie's— her experience of walking hundreds of people through elemental diets. We always joke in our family, like, Debbie, if she was a superhero, her superpower would be organization and the overview of everything. And she really just knows how to put things together for people, how to really guide people from beginning to end. And, you know, just her amazing observational skills over these years has put together a program initially one-on-one for her clients, but then turned it into a self-led program that really helps people be successful. I mean, that's why we named it the Elemental Diet Success Plan, because when we were thinking about what's the purpose of it, it was that, I mean, Debbie has guided hundreds of people successfully through an elemental diet with virtually a 0% attrition rate. I mean, there's people who give up before they start, but anyone who started and gone through the work with Debbie has made it through an elemental diet.. And many people already through the Elemental Diet Success Plan, self-guided.

And while we always say we can't guarantee someone's success with the results they'll get from anything, we can guarantee that we can successfully guide them through all the things they would need to really have the most likelihood of a successful Elemental Diet experience and therefore a successful experience with their health as a result.

And a pleasant experience because despite there being some challenges during Elemental Diet, for the most part, it's really doable for the majority of people who want to do it.

And we don't want people white-knuckling it.

And during this process, do they have access to some type of community or, or some online source such that they're not totally alone? Or—

yeah, so the videos take them along this whole— we've built out and continue to do so, like our participant FAQ with inside the course. At this point, there's not an interactive forum, but we actually did a Q&A this morning for our current program participants right now that is so wildly successful that we're considering the idea of doing little pop-up Q&As along the way so we can catch people at different phases of their process. But with that said, what I've also done is quite a few hybrids where a lot of the people that worked with me one-on-one only, now that we have the Elemental Diet Success Plan, they might buy the course and then say, hey, I just I have a few things that I want to check in with you and make sure I got this right and I'm doing this right for my health. And you don't have anything else you'd add to the mix given your experience. And that's just worked so beautifully for people to have a little one-on-one, but also have the course materials to take them through.

Yeah, it really makes that part more affordable. So you can kind of learn the basics from the course and then get one-on-one with Debbie. Our support staff will answer some very basic clarifying questions, but we can't do one-on-one consultations, obviously, in that way, through email with people who we don't have our privy to their health relationship with.

Yeah, yeah, yeah. Every time I get a client question, I'm just like, okay, now let me go back to my database, reread all the notes I have about your conditions, look at the supplements you're taking. Oh, okay, now I can answer it.

Like, and that's for someone that you know, right?

Right. So I completely understand that. Um, okay, so, and I will include a link in the show notes. I signed up for an affiliate account, so you're supporting the podcast if you go through my link. So I appreciate people doing that. And any final thoughts before we head off?

No, that's it. I mean, it's a pleasure to meet you, and it's nice to get to sit down and talk to you.

So much for having us.

You too.

Well, I heard about you by the SIBO Summit, so I thought, great, I'll get them on. And I'm so glad we were able to set it up so quickly.

Yeah, that's great. They've been so supportive of our work. We're really just so, so grateful.

Yeah, great. Well, thank you so much.

You're so welcome, Lindsey. Thank you.

Don't go, because I have a coupon code to share with you, which is HDH50 for High Desert Health 50, which will get you $50 off the Elemental Diet Success Plan program, which you'll find a link to in the show notes. But it's only going to be valid for 2 weeks from the date that I publish this podcast, so jump on it if you are interested in the Elemental Diet Success Plan. On another note, I was really glad to have them on because we've not talked much about elemental diets in the show, so I think that was very useful.. And also, if you're a longtime listener or you're getting lots of useful information from the podcast, please consider becoming a regular supporter on Patreon. And if you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as Twitter, Instagram, TikTok, and Pinterest. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.