Elimination Diet vs. Elemental Diet

Posted 10.25.11 | Rob McCandlish, RDN

If your little one uses any of the Neocate products, you’ve probably heard the term “elemental diet.”  And if your son or daughter has eosinophilic esophagitis (EoE), you’ve probably also heard of an “elimination diet.”  These two aren’t always the same, so here’s a quick primer on the two.

Elemental Diet

The term “elemental diet” is a historic term that was used to refer to diets where the component nutrients were broken down into their “elements.”  Another term is “semi-elemental.”  In terms of nutrition, a semi-elemental formula, or hydrolysate, is one that has proteins that are partly broken down, or hydrolyzed.  These can be partially or extensively hydrolyzed.  An elemental formula, then, is one that contains only amino acids, the building blocks of protein.  Elemental formulas can also have some fats which are easier for the body to absorb than those found in the standard diet.

Now, technically speaking, elements are atoms, like you would see on the Periodic Table of the Elements.  So, technically, Neocate is not elemental, because it’s made of molecules, not individual atoms.  So in the strictest sense Neocate isn’t elemental: no formula is!  But, many health care professionals still use this term.  The more accurate term for Neocate, which you’ll see on our website, is amino acid-based formula.

Elimination Diet

An elimination diet is one in which one or several foods are eliminated from the diet.  There is no one “elimination diet:” it often varies from patient to patient.  Elimination diets can be based on the results of specific allergy testing (a tailored elimination diet), or more loosely based on common food allergies.  For instance, a six-food elimination diet is often used.  The idea behind an elimination diet, commonly used with EoE, is that you give the body a break from certain offending foods so that inflammation can calm down.  This works best if ALL foods that are causing a response are eliminated, which is why the six-food elimination diet isn’t quite as effective as a tailored elimination diet.

Where the lines get blurry between these two terms is that sometimes an elemental diet is used as a total elimination diet (so ALL food is eliminated!).  Basically a child might go on an elemental diet for a period of weeks, after which they usually start adding foods back to the diet one at a time.  That way there is no mistaking an allergic response to a specific food.  On top of this, an elemental formula like E028 Splash might be added to a six food or tailored elimination diet, to help make sure a child gets all of his/her essential nutrients when foods like dairy are removed.  What’s interesting is that studies have shown that the best response in EoE is to a fully amino acid-based diet.

Do you have any questions about the differences between elemental and elimination diets?

- Rob

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Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.