Elemental Diet for IBD

The elemental diet is primarily known for its effectiveness in managing Small Intestinal Bacterial Overgrowth (SIBO) and Inflammatory Bowel Disease (IBD). However, this specialized liquid nutrition plan has applications far beyond these common conditions. As someone who has researched extensively in this area, I want to share how the elemental diet may benefit people suffering from various other health challenges.

What Is an Elemental Diet?

An elemental diet consists of liquid formulas containing pre-digested nutrients in their simplest forms:

• Amino acids instead of complete proteins
• Simple sugars instead of complex carbohydrates
• Medium-chain triglycerides as fat sources
• Essential vitamins and minerals

These formulations provide complete nutrition while giving your digestive system minimal work to do, essentially allowing it to rest and heal.

Elemental Diet for Lesser-Known Conditions

Diversion Colitis

Diversion colitis occurs when a section of the bowel becomes inflamed after being isolated from the functioning bowel during surgery (like a colostomy). Case studies show:

• Decreased bowel movements
• Resolution of rectal bleeding and mucus discharge
• Significant pain reduction

The theory is that elemental diets remove potential inflammatory antigens from the bowel, reducing autoimmunity and inflammation in the diverted colon.

Eosinophilic Esophagitis (EoE) and Gastroenteritis

Eosinophilic conditions involve immune-mediated inflammation of the digestive tract. Research highlights:

• 90% histologic remission rates in children with EoE
• 88% symptom resolution in adults after four weeks
• Significant decreases in inflammation markers

The hypoallergenic nature of elemental diets helps by eliminating potential food antigen exposures, allowing the inflamed tissues to heal.

Rheumatoid Arthritis (RA)

For those battling inflammatory joint conditions, elemental diets have shown:

• Improved grip strength
• Better Ritchie scores (a measure of joint tenderness)
• Reduced inflammation through “non-antigenic” properties

It’s worth noting that improvements typically aren’t sustained after returning to normal eating, making this approach more suitable as a temporary intervention.

Pancreatitis

Pancreatic inflammation can be extremely painful and difficult to manage. Limited research suggests:

• Clinical improvement in complicated severe acute pancreatitis cases
• Potential pain management benefits in chronic pancreatitis
• Reduced digestive demands on an inflamed pancreas

The low-fat versions of elemental diets may be particularly helpful as they further reduce pancreatic strain.

Celiac Disease and Dermatitis Herpetiformis

For people with refractory celiac disease (who don’t respond to standard gluten-free diets):

• Elemental diets provide completely gluten-free nutrition
• Easily digestible nutrients bypass damaged intestinal areas
• Potential improvement in associated skin conditions like dermatitis herpetiformis

Chemoradiotherapy-Associated Mucositis

Cancer treatment often causes painful mouth sores. Meta-analyses suggest:

• Supplemental elemental diets may help prevent oral mucositis
• Easily absorbed nutrients support healing of damaged tissues
• Complete nutrition during treatment when eating is difficult

How Elemental Diets Work

The benefits across these diverse conditions stem from several mechanisms:

1. Hypoallergenic Properties: Removes potential food allergens and antigens
2. Reduced Digestive Demand: Provides nutrition in pre-digested form
3. Bacterial Modification: May “starve” harmful bacteria while altering intestinal flora
4. Inflammatory Reduction: Limits exposure to irritants
5. Complete Nutrition: Ensures nutritional needs are met despite digestive limitations

Challenges to Consider

Despite their potential benefits, elemental diets come with significant challenges:

• Poor Palatability: Often requires nasogastric tube administration
• Gastrointestinal Side Effects: Potential diarrhea due to hyperosmolality
• Cost: Formulations can be expensive
• Social Restrictions: Difficulty participating in normal eating activities
• Symptom Relapse: Common when returning to regular diet

When to Consider an Elemental Diet

You might consider discussing an elemental diet with your healthcare provider if:

• You’ve been diagnosed with one of the conditions discussed
• Traditional treatments haven’t provided sufficient relief
• You need nutritional support during healing
• You’re willing to commit to the restrictive nature of the diet

Final Thoughts

The elemental diet represents a valuable tool in the treatment arsenal for numerous conditions beyond the commonly associated SIBO and IBD. Its unique ability to provide complete nutrition while minimizing digestive demands makes it worth considering for those dealing with challenging health conditions.

Always work with qualified healthcare professionals, including a registered dietitian, before starting an elemental diet. They can help determine if this approach is appropriate for your specific situation, guide you through implementation, and monitor for any adverse effects.

When facing digestive conditions that require an elemental diet, the cost of commercial formulas can be overwhelming. Many people seeking relief from conditions like SIBO (Small Intestinal Bacterial Overgrowth) or Crohn’s disease find themselves struggling with the financial burden of pre-made elemental formulas. This article explores how to create a homemade elemental diet that can be more budget-friendly while still meeting your nutritional needs.

What Is an Elemental Diet?

An elemental diet is a liquid nutrition plan where nutrients are provided in their simplest, most digestible form:

• Amino acids as the protein source
• Simple sugars (glucose or dextrose) for carbohydrates
• Essential fats, often medium-chain triglycerides (MCTs)
• Vitamins and minerals for complete nutrition

The purpose is to provide complete nutrition while allowing the digestive system to rest and heal, as these pre-digested nutrients require minimal digestive effort.

Why Consider a Homemade Formula?

Commercial elemental diet formulas can cost hundreds of dollars per week, making them inaccessible for many people. Creating your own formula can significantly reduce expenses, though it requires careful planning to ensure nutritional completeness.

Essential Components for a Homemade Elemental Diet

1. Protein Source: Amino Acid Powder

• Free-form amino acids provide protein in its most digestible form
• This is typically the most expensive component
• Look for pharmaceutical-grade amino acid powders without additives or fillers

2. Carbohydrate Source

Several options exist for your carbohydrate needs:

• Dextrose (glucose) – less sweet but pure simple sugar
• Honey – more flavorful but must be used carefully if you have SIBO
• Grape syrup – similar profile to honey
• Maltodextrin – another option found in some commercial formulas

3. Fat Source

• MCT oil is highly recommended as it’s easily absorbed even with compromised digestion
• Coconut oil can be a more affordable alternative with similar benefits
• Important note: Introduce MCT oil gradually as it can cause diarrhea if started too quickly

4. Vitamins and Minerals

• Look for synthetic multivitamin/mineral supplements without added fiber or food components
• Recommended options include:
  • Freeda SCD Multi
  • Klaire VitaSpectrum Powder
  • Pure Encapsulations Nutrient 950
• Don’t forget to include salt (sodium) as an essential electrolyte

How to Prepare Your Homemade Formula

1. Measure each component according to your calculated nutritional needs
2. Mix ingredients with water in a blender until desired consistency is reached
3. Important: Never use juice or milk as your mixing liquid
4. Many find it easier to sip the mixture throughout the day rather than consuming large amounts at once

Challenges to Consider

Palatability Issues

Let’s be honest – elemental diets taste unpleasant. The free-form amino acids have a strong, sometimes sulfuric flavor that many compare to sewage water or rotten eggs. Some ways to manage this:

• Use non-caloric flavorings like stevia or crystal light
• Keep the formula cold
• Use a straw placed toward the back of your mouth
• Divide into smaller portions throughout the day

Nutritional Balance

Ensuring proper nutritional balance is critical:

• Calculate your specific caloric and nutrient needs based on weight, height, age, and activity level
• Measure ingredients precisely
• Consider working with a healthcare professional to determine appropriate amounts

Cost Considerations

While homemade formulas are less expensive than commercial options, the components still represent an investment:

• Amino acid powder is the most expensive component
• Shop around for the best prices on all ingredients
• Consider buying in bulk if you’ll be on the diet for more than a week

Important Safety Precautions

Medical supervision is essential when undertaking an elemental diet. This cannot be stressed enough. Before starting:

• Consult with a healthcare provider, preferably one familiar with elemental diets
• Discuss your specific health condition and nutritional needs
• Plan for regular check-ins during the diet
• Have a clear plan for reintroducing foods afterward

Duration Considerations

Most elemental diets for conditions like SIBO last 2-3 weeks. Your healthcare provider should determine the appropriate duration based on your specific condition and response.

Semi-Elemental vs. Fully Elemental Options

If you find a fully elemental diet too challenging:

• Semi-elemental formulas contain partially broken-down proteins (peptides) rather than free amino acids
• These generally taste better and may be easier to tolerate
• However, they haven’t been specifically studied for conditions like SIBO

Final Thoughts

A homemade elemental diet can be a cost-effective alternative to commercial formulas for those needing digestive rest. However, it requires careful planning, precise measurements, and medical supervision to ensure safety and effectiveness.

Remember that while saving money is important, your health is paramount. Don’t attempt an elemental diet without proper medical guidance, and be prepared for the challenges involved in creating a nutritionally complete formula that you can tolerate for the necessary duration.

Have you tried an elemental diet? Share your experience in the comments below.

Navigating digestive health challenges can be overwhelming. If you’re researching treatment options for conditions like Crohn’s disease, SIBO, or other digestive disorders, you’ve likely encountered the term “elemental diet.” But what exactly is it, and what are the different types available? This post breaks down everything you need to know about elemental diets in clear, straightforward terms.

What Is an Elemental Diet?

An elemental diet is a specialized nutritional formula designed to provide complete nutrition in a form that requires minimal digestion. These formulas contain nutrients broken down to varying degrees, making them easier for your digestive system to absorb while giving your gut a chance to rest and heal.

Understanding Proteins, Peptides, and Amino Acids

The key distinction between elemental diet types lies in how broken down the protein components are:

• Proteins: These are large, complex molecules made up of hundreds or thousands of amino acids linked together in specific sequences. Proteins require significant digestive effort to break down. Found in partially elemental diets (like those containing whole whey protein), proteins must be broken down by your digestive enzymes before absorption.
• Peptides: These are shorter chains of amino acids (typically 2-50 amino acids linked together). Think of them as partially pre-digested proteins. Your body still needs to break them down further, but the process requires less digestive effort than whole proteins. Semi-elemental diet formulas contain these partially hydrolyzed proteins.
• Amino Acids: These are the most basic building blocks of protein—individual molecules that your body can immediately absorb without further breakdown. Fully elemental diets contain these free-form amino acids, which bypass digestive processes entirely, making them ideal for severely compromised digestive systems.

The progression from proteins to peptides to amino acids represents increasing levels of pre-digestion in the formula and decreasing demands on your digestive system.

The Three Main Types of Elemental Diets

Elemental diets can be categorized into three main types based on how broken down the nutrients are:

1. Fully Elemental Diet

• Protein source: Contains free-form amino acids (the most basic building blocks of protein)
• Carbohydrate source: Simple sugars like glucose, fructose, or dextrose, and sometimes glucose polymers like maltodextrin
• Fat content: Typically very low in fat
• Taste profile: Often described as unpalatable or having a medicinal taste (some users compare it to “sewage water” due to sulfur-containing amino acids)
• Administration: Sometimes given through a feeding tube due to taste issues
• Digestive effort: Requires virtually no digestion, making it ideal for severe digestive conditions

2. Semi-Elemental Diet

• Protein source: Contains partially hydrolyzed proteins (broken down into peptides – short chains of amino acids)
• Carbohydrate source: Mix of simple sugars and some longer-chain carbohydrates
• Fat content: Usually contains easily absorbed fats like medium-chain triglycerides (MCTs)
• Taste profile: Generally better tasting than fully elemental formulas
• Digestive effort: Requires minimal digestion but slightly more than fully elemental formulas
• Usage: Many modern clinical elemental formulas are technically semi-elemental

3. Partially Elemental Diet

• Protein source: May contain whole proteins like whey protein rather than hydrolyzed proteins
• Taste profile: Usually more palatable than the other types
• Cost: Typically less expensive than fully or semi-elemental options
• Application: Sometimes refers to using elemental formulas as partial meal replacements (combining formula intake with some regular food)

Who Might Benefit from an Elemental Diet?

Elemental diets are often recommended for people with:

• Inflammatory bowel diseases (IBD) like Crohn’s disease
• Small intestinal bacterial overgrowth (SIBO)
• Eosinophilic esophagitis
• Severe food allergies or sensitivities
• Malabsorption issues
• During recovery from certain surgeries or treatments

Important Considerations Before Starting

• Medical supervision: Always start an elemental diet under the guidance of a healthcare provider
• Nutritional completeness: Ensure the formula you choose provides complete nutrition
• Duration: Most therapeutic protocols range from 2-4 weeks
• Reintroduction: A careful food reintroduction plan is essential after completing the diet
• Palatability: Consider flavor options and whether you’ll be able to tolerate the taste
• Cost: These specialized formulas can be expensive and may not be covered by insurance

Making Your Choice

When deciding which type of elemental diet might be right for you:

• More severe digestive issues may require a fully elemental formula
• If taste is a significant concern, semi-elemental or partially elemental options might be more tolerable
• Your healthcare provider can help determine which form is most appropriate for your specific condition

Remember that while elemental diets can be effective therapeutic tools, they’re not long-term nutrition solutions for most people. They’re typically used as short-term interventions to allow the digestive system to heal before transitioning back to a more conventional diet.

Starting an elemental diet can feel overwhelming, but with proper guidance and preparation, you can navigate this therapeutic approach effectively. This guide provides practical steps to help you begin your elemental diet journey safely and successfully.

Preparation Steps: Before You Begin

Medical Consultation

Always consult a healthcare professional before starting an elemental diet. This crucial step ensures:

• Confirmation that an elemental diet is appropriate for your specific condition
• Clear understanding of your treatment goals and timeline
• Review of current medications and supplements that might need adjustment
• Assessment of your readiness for a liquid-only diet
• Identification of any contraindications for your specific health situation

Product Selection

Choosing the right elemental formula is essential for success:

• Formula types: Consider fully elemental (free amino acids), semi-elemental (short peptides), or partially elemental options based on your doctor’s recommendation
• Form: Decide between powder mixes or ready-to-drink liquids
• Taste considerations: Sample flavored and unflavored options if possible
• Dietary restrictions: Look for formulas that accommodate sensitivities (e.g., whey-free for dairy sensitivity)
• Cost and accessibility: Research insurance coverage and ensure you can obtain sufficient supply

Gather Supplies

Prepare all necessary items:

• Sufficient elemental formula for your planned duration
• Shaker bottle or blender for mixing
• Storage containers if pre-mixing batches
• Water bottle for staying hydrated throughout the day

Calculating Your Caloric Needs

Working with your healthcare provider or dietitian to determine your daily caloric requirements is essential:

• Your caloric needs depend on age, sex, weight, height, activity level, and treatment goals
• Calculate the number of servings needed using the formula’s nutritional information
• Ensure you consume at least your basal metabolic rate (BMR) in calories
• Be prepared to adjust intake based on hunger signals and activity levels

Creating a Daily Schedule

Establishing a consistent consumption pattern helps your body adjust:

• Spread formula intake throughout the day rather than consuming large amounts at once
• Sip slowly over 15-30 minutes per serving to improve digestion and comfort
• Listen to your body’s hunger and fullness cues
• Be clear about whether you’re replacing all meals or just some
• Build flexibility into your schedule to accommodate daily activities

Mixing Instructions and Tips

Proper preparation improves palatability and digestibility:

• Follow the specific mixing instructions on your formula’s packaging
• Use the recommended amount of water for proper consistency
• Consider mixing a day’s worth in advance and refrigerating
• Add ice cubes or blend with ice for improved texture and temperature
• Ensure powder is completely dissolved to avoid clumps
• Experiment with temperature – most people prefer their formula cold

Strategies for Success and Compliance

These practical approaches can help you maintain your elemental diet:

• Plan ahead: Keep formula readily available, especially when away from home
• Stay hydrated: Drink plenty of water throughout the day (in addition to your formula)
• Manage taste fatigue: Try different flavors if available or use a straw
• Address hunger: Increase frequency or amount if experiencing excessive hunger
• Maintain light activity: Continue gentle exercise like walking or yoga
• Seek support: Connect with friends, family, or online support groups
• Track your experience: Keep a journal of formula consumption and symptoms
• Manage social situations: Prepare for food-centered events by bringing your formula
• Reduce caffeine beforehand: Gradually wean off caffeine before starting to minimize withdrawal

What to Expect Day-by-Day

Understanding the typical progression can help you persist through challenges:

Days 1-3

• Initial adjustment period with potential taste and texture challenges
• Possible hunger, fatigue, or mild headaches
• Changes in bowel movements
• Clearer urine as hydration increases

Days 3-7

• Body begins adapting to the liquid nutrition
• Hunger typically subsides as caloric needs are met
• Possible reduction in digestive discomfort
• Continuing adjustment of bowel habits

Week 2 onwards

• Increased energy levels for many people
• Greater reduction in target symptoms
• Improved tolerance of formula taste
• Possible mild die-off symptoms as gut microbiome shifts

Final Thoughts

Remember that an elemental diet is a therapeutic tool that requires professional guidance. Stay in communication with your healthcare team throughout the process, especially if you experience concerning side effects or significant discomfort.

By following these guidelines and working closely with your healthcare provider, you can maximize the potential benefits of an elemental diet while minimizing challenges and discomfort.

Starting an elemental diet can be a significant step in your health journey, particularly if you’re dealing with conditions like SIBO, Crohn’s disease, or other digestive disorders. While this specialized liquid nutrition approach offers benefits for many, it’s equally important to understand the potential challenges you might face. This article provides transparent information about the risks and side effects to help you prepare adequately.

Common Side Effects

When beginning an elemental diet, your body needs time to adjust to this new form of nutrition. You may experience:

• Gastrointestinal symptoms – Initially, many people notice gas, bloating, diarrhea, and abdominal pain
• Bowel changes – Output can vary widely from very low (constipation) to frequent loose stools
• Hunger and fatigue – These are normal responses as your body adapts to liquid nutrition
• Headaches and mood swings – Often temporary but can be challenging during the adjustment period
• Nausea – Possibly related to the high sugar content in some formulas
• Oral symptoms – The lack of chewing can lead to mouth discomfort
• Die-off symptoms – As gut bacteria populations change, you might experience headache, flu-like symptoms, muscle aches, fatigue, and brain fog

Managing Hunger and Psychological Aspects

The psychological challenge of not eating solid food shouldn’t be underestimated. Successful strategies include:

• Drink formula slowly throughout the day rather than in large amounts at once
• Sip over 15-30 minutes instead of quickly consuming
• Use a favorite cup or mug to make the experience more pleasant
• Follow a predictable schedule to create a routine
• Keep a journal to track progress, symptoms, and challenges
• Seek support from family, friends, or online communities
• Prepare mentally for the restrictive nature of the diet before starting

When to Contact a Doctor

Medical supervision is crucial during an elemental diet. Contact your healthcare provider:

• Before starting, changing, or stopping the diet
• If you experience severe or persistent side effects
• When following the diet for longer than 3 weeks
• To discuss how the diet interacts with your current medications and supplements
• To clarify the specific goals of the diet for your condition

Contraindications

An elemental diet may not be suitable for everyone. Exercise caution if you have:

• A restrictive food intake disorder or food aversions
• Blood sugar control issues, including type 2 diabetes
• Other medical conditions that might be complicated by a liquid-only diet

Strategies for Minimizing Discomfort

These practical tips can help make the experience more manageable:

• Refrigerate the formula and drink it cold or with ice to improve taste
• Discuss different formula brands or permitted flavorings with your dietitian
• Drink the formula slowly to prevent cramping and stomach discomfort
• Stay hydrated by drinking plenty of water throughout the day
• Engage in light physical activity like walking or gentle yoga if you feel up to it

Real-World Expectations During the Diet

Understanding what to realistically expect can help you prepare:

• Taste challenges – Up to 40% of people struggle with the taste and smell
• Restrictive nature – This is exclusively a liquid formula diet in most cases
• Weight changes – Weight loss may occur but isn’t the primary goal
• Duration – Typically short-term (2-6 weeks depending on condition)
• Social impact – Dining out and social gatherings become more challenging
• Reintroduction phase – Returning to solid foods requires a careful, gradual approach
• Cost considerations – Elemental formulas can be expensive without insurance coverage

Final Thoughts

An elemental diet can be a valuable therapeutic tool for specific health conditions, but it comes with challenges. By understanding and preparing for the potential side effects and difficulties, you can approach this treatment with realistic expectations.

Remember that this diet should only be undertaken with proper medical supervision. Your healthcare team can help you navigate the challenges, monitor your progress, and adjust your approach as needed to maximize benefits while minimizing discomfort.

Have you tried an elemental diet? What strategies helped you manage the side effects most effectively? Share your experience in the comments to help others on their healing journey.

If you’re struggling with uncomfortable digestive symptoms related to Small Intestinal Bacterial Overgrowth (SIBO), you may have heard about the elemental diet as a potential treatment option. This liquid-only diet has shown impressive success rates in clinical studies and offers an alternative approach for those who haven’t found relief through antibiotics or other treatments.

What Is SIBO?

SIBO occurs when excessive bacteria build up in your small intestine – an area that should have relatively few bacteria compared to your large intestine. This overgrowth can lead to:

• Bloating and excessive gas
• Abdominal pain and discomfort
• Diarrhea or constipation
• Nutrient absorption issues
• Fatigue and other systemic symptoms

What Is an Elemental Diet?

An elemental diet consists of liquid formulas containing nutrients in their most basic, pre-digested forms:

• Proteins broken down into individual amino acids
• Carbohydrates in simple sugar form
• Fats as essential fatty acids
• Essential vitamins and minerals

These formulas provide complete nutrition while being absorbed in the upper part of your small intestine, leaving little for bacteria further down to feed on.

How Elemental Diets Help Treat SIBO

The primary mechanism is surprisingly simple but effective:

1. Bacterial starvation: Since nutrients are absorbed high in the digestive tract, bacteria in the small intestine have less food available.
2. Reduced fermentation: Less fermentable material means reduced gas production and bloating.
3. Digestive rest: The easily digestible formula allows your digestive system to recover.
4. Anti-inflammatory effects: Some components may possess properties that help heal the gut lining.

The Protocol: What to Expect

A typical elemental diet protocol for SIBO involves:

• Duration: 2-3 weeks (14-21 days) of exclusive elemental formula consumption
• Formula intake: Consuming enough formula to meet your daily caloric needs
• No solid food: Replacing all meals with the liquid formula
• Medical supervision: Regular check-ins with your healthcare provider
• Gradual reintroduction: Slowly reintroducing solid foods after completion

Success Rates: What the Research Shows

Clinical studies have demonstrated impressive results:

• A 2004 study found that 80% of participants normalized their lactulose breath test after 14 days, with an additional 5% improving after 21 days.
• A more recent clinical trial showed 100% normalization of breath tests in SIBO patients using a palatable elemental formula.
• Overall success rates appear to be significantly higher than antibiotic approaches, which typically show around 50% effectiveness.

Elemental Diet vs. Antibiotics for SIBO

When comparing treatment options:

Aspect	Elemental Diet	Antibiotics
Effectiveness	80-100% in studies	Around 50% or less
Mechanism	Starves bacteria	Kills bacteria
Side effects	Hunger, fatigue, headaches	Digestive upset, potential resistance
Ease of use	Challenging (liquid-only)	Relatively simple (pills)
Cost	Often expensive	May be covered by insurance
Duration	2-3 weeks	1-2 weeks typically

Important Considerations Before Starting

Before embarking on an elemental diet, consider these factors:

• Taste challenges: Many formulas have an unpleasant taste that can make adherence difficult
• Cost implications: Commercial formulas can be expensive and may not be covered by insurance
• Social limitations: A liquid-only diet can impact your social life and daily routines
• Potential side effects: Hunger, headaches, fatigue, and digestive adjustments are common
• Medical supervision: Always undertake this approach under healthcare supervision
• Personal circumstances: Consider your work schedule, living situation, and support system

Who Should Consider an Elemental Diet?

This approach may be particularly beneficial if:

• You’ve tried antibiotics without success
• You have recurrent SIBO that keeps returning
• You prefer a non-pharmaceutical approach
• Your symptoms are severe and significantly impacting quality of life
• You have other gut conditions that might benefit from digestive rest

Product Options

While specific product recommendations should come from your healthcare provider, some formulas used in studies include:

• Vivonex Plus (used in the landmark 2004 study)
• Mbiota Elemental (designed for improved palatability)
• Semi-elemental options with hydrolyzed proteins (may be easier to tolerate)

Your doctor or dietitian can help you select the most appropriate formula based on your specific needs, allergies, and sensitivities.

The Bottom Line

The elemental diet represents a powerful tool for addressing SIBO, with success rates that often exceed traditional antibiotic approaches. However, it requires commitment, preparation, and medical supervision to implement safely and effectively.

If you’re considering this approach, discuss it thoroughly with your healthcare provider to determine if it’s appropriate for your specific situation. While challenging to follow, many patients find the temporary restrictions worthwhile when they experience significant relief from troublesome SIBO symptoms.

Have you tried an elemental diet for SIBO? What was your experience like? Share your thoughts in the comments below.