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How to Transition from an Elemental Diet to Low Fermentation Eating (LFE)
Successfully completing an elemental diet is a huge accomplishment. Congratulations!
We know how much hard work and discipline it takes to complete a course of elemental diet, and how scary it can feel returning back to solid food. We understand that you don’t want to sabotage all the hard work you just did to finally feel better.
Good LFE is a resource center for people with varying chronic conditions who want to manage their digestive health through science-backed dietary strategies. We offer recipes, meal plans, and expert advice on how to adopt Low Fermentation Eating (LFE) into your daily routine to achieve digestive balance and prevent flare-ups.
To make your transition back to solid foods as easy and convenient as possible, we’ve created a set of general guidelines along with a detailed meal plan with recipes for your first seven days. It was developed in partnership with Robin Berlin RDN, a co-author of The Good LFE Cookbook, and a practicing GI dietician working with clients in Los Angeles and virtually.
Since the microbiome is unique to each person, we strongly recommend working with a health care provider or a registered dietician to develop a personalized plan. In the meantime, we hope this general guidance will help you frame how to think about this better.
General Tips
Check in with your doctor:
Depending on your condition, they may advise for follow-up tests, such as a breath test, to check your GI function. Depending on the results, some patients may require more time on the elemental diet after the initial two-week course.
Stay hydrated:
Adequate hydration is essential for digestive health. Drink plenty of water to support your body’s digestive processes.
Portion control:
During a liquid diet, your stomach may shrink in size. Start with small portions and gradually increase them as you observe how your body responds.
Skip the blender:
You do not need to start with just broth, or puree any of your first meals. It’s best to reintroduce solid foods right away to “wake up” the gut after it’s rest and recovery, and help it regain its normal function.
Meal spacing:
Space meals at least four hours apart to give your digestive system enough time to finish processing the meal. Every few hours, the GI tract experiences contractions, known as “cleansing waves,” in order to clear out undigested food and bacteria. Snacking interferes with this natural cleaning cycle and should be avoided. Ask your doctor if you should take digestive enzymes, bitters, or hydrochloric acid before eating a meal to help with the digestive process. You can also take a prokinetic before or after a meal to help support the cleansing waves.
Chew food slowly:
Chewing stimulates your body’s digestive enzymes and secretions, and the more you chew, the more you tell your brain to switch the gut on and process your food.
Partial elemental transition:
Smaller portions, combined with spacing meals hours apart, can leave people feeling hungry. You may want to consider using mBIOTA Elemental™ shakes as supplemental nutrition to keep your calorie count and energy level up during this time.
Keep a food journal:
Track what you eat and how you feel afterward to help you identify foods that should be avoided, or introduced more gradually.
Trigger foods:
Wait at least four weeks to reintroduce any foods that would previously trigger your symptoms. Introduce these gradually and one at a time, monitoring for any side effects. If you have a known food allergy, do not reintroduce that food without consulting a doctor.
Everyone is different:
The gut microbiome can be as personal as a fingerprint, and experiences returning to solid foods will vary. Some people might notice larger and softer stools during the transition, while others don’t. Some people will feel full quickly during meals, while others will not. It’s also common to experience some temporary bloating. It can take up to two weeks for a GI system to fully adjust to eating food again, so be patient with your body during this time.
However, if you experience any ongoing discomfort or worsening symptoms, seek advice from a health care professional to rule out underlying issues or consider dietary modifications.
Kickstart your Digestive System with a “Soup and Sandwich” Approach
During the elemental diet, the gut essentially shuts down to rest and repair itself. You need to wake up with normal, solid foods, a process which will take about two weeks to complete.
We recommend starting with a small group of low-fat, low-fiber foods in their simplest forms. Consider light, easy-to-digest food such as eggs, sourdough and French baguette bread, lean poultry, fish, rice (white, jasmine, or sushi), potatoes, pasta, and noodles. If you have a known food allergy, keep that food eliminated from your diet.
We call this the “soup and sandwich” approach, because most of these starter foods are often found in one or the other (or both).
Great first-meal options include:
- chicken soup with toast
- eggs with toast
- roast chicken with potatoes or rice
- baked potato
- toast with nut butter
- sushi and sashimi
- turkey or tuna sandwiches
At this time you can also welcome all coffee and tea back into your diet immediately, although you may find that you need less of it after completing the elemental diet. Sweetening with table sugar is fine but avoid artificial sweeteners.
After two days:
Small portions of avocados, papaya, and berries are good to reintroduce (for an avocado, stick to ¼ of a large one, or ½ of a small one).
For the first three days, limit the amount of vegetables to a small amount and avoid dairy (even lactose-free products). After that, if dairy was not a trigger for you, reintroduce non-dairy milk, lactose-free cheese, and hard aged cheeses, like Gruyere, cheddar, parmesan, and manchego.
After three days:
You can now add cooked vegetables back into the rotation (wait at least a week for raw vegetables, including salads). Adding a little arugula or spinach to a sandwich after a few days should be fine.
After four days:
The allowed fruits on the Low Fermentation Eating (LFE) plan are now okay to try – just keep it to one serving of fruit at a time. Avoid hot spices for at least five days, and skip red meat and alcohol for at least one week.
Your Journey to Better Wellness is Just Beginning
It is very important to understand that when it comes to functional nutrition, one size does not fit all. Reintroducing foods is a process of trial and error, and can sometimes feel like one step back and two steps forward.
Please rest assured that if you eat something that does not sit well with you, that you have not just sabotaged all the progress you worked so hard to achieve. The gut doesn't work that way. In the past 14 days, your digestive tract has undergone deep healing that cannot be undone in a single meal, or even two or three.
This is the perfect time to begin a process of discovery to identify what foods make you react. We encourage you to view the ups and downs of this process as part of your journey toward getting to know your body better.
If you don’t feel good after eating one of the suggested foods, stop that food for a week and try to reintroduce it again after a week. If you don’t feel good after the second try, you may need to avoid that food, or investigate the response further with an allergist or a GI doctor.
Sustain Long-Term Recovery and Maintenance with the LFE diet
After your body has adjusted to eating solid foods again, we recommend sticking with a Low Fermentation Eating (LFE) diet for the best chance at sustained remission.
The LFE diet is a nutritionally balanced long-term eating plan designed for anyone struggling with a sensitive gut. It was created by Drs. Mark Pimentel and Ali Rezaie, who are both at the forefront of gut microbiome research at Cedars-Sinai Hospital in Los Angeles.
Anyone can follow a LFE diet, but it is especially valuable after finishing a course of treatment like antibiotics or the elemental diet. While other low-ferm frameworks like low FODMAP can be used safely for up to six months, the LFE diet can be followed safely for life. It also allows patients to return to eating that feels normal and not overly restrictive.
What is Low Fermentation Eating?
The purpose of the LFE diet is to minimize the foods that are tough to digest and likely to stick around and ferment in the digestive tract. Notably, this is different from avoiding foods that have undergone fermentation before they are consumed.
The fermentation we are concerned with here takes place when bacteria in the gut try to break down high-FODMAP carbohydrates found in certain foods. This can cause symptoms like gas, bloating, altered bowel movements, cramping, nutrient malabsorption, and inflammation.
By minimizing fermentation, the LFE diet reduces the severity of these symptoms, leading to a better quality of life and overall digestive health. It also reduces the likelihood of developing a small intestinal bacterial overgrowth (known as SIBO).
To help you get started on this journey, download our seven-day meal plan specifically designed for the transition from an elemental diet to Low Fermentation Eating, with some bonus recipes from The Good LFE Cookbook.
More Low Fermentation Eating Resources
LFE Books
Learn about SIBO, IBS and your microbiome in The Microbiome Connection and then treat your GI system with delicious food from our cookbook.
Low Fermentation Recipes
Pulled from our cookbook and Krystyna's kitchen, these delicious and SIBO friendly recipes use Low Fermentation Eating to balance your microbiome.
The Science Behind SIBO & IBS
We help you gain a better understanding of the science behind SIBO, IBS and other GI issues so you can gain greater control of your health.