3. Reducing Other Dietary Triggers of Gastrointestinal SymptomsThe TheoryThere are many other potential dietary triggers of gut symptoms. Gluten can induce symptoms in patients with celiac disease (known or undiagnosed), but gluten is not present in any enteral formula. Likewise, dietary chemi- cals, including amines, glutamates, and salicylates, which are implicated in triggering gut symptoms in patients with IBS,35,36 are not likely to be present in for- mulae. However, potential dietary allergens may be pres- ent in any formula that contains whole or partially hydrolyzed proteins.Therapeutic StrategiesA strategy taken in situations where there may be a suspicion of an allergic response to a protein in the feed or an inability to digest dietary protein is to convert the patient to an ele- mental diet. Elemental formulae have been developed in an attempt to improve tolerance and protein absorption. The latter has been demonstrated in randomized trials, although some studies have also indicated that elemental formulae do not provide benefit even to patients with impaired gastroin- testinal function. Elemental formulae have been demon- strated as an effective therapy in human immunodeficiency virus (HIV), however, benefit is sparse and in fact the high osmolality of elemental formulae is often considered a hin drance, particularly in short gut.