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The FDA recommendation for the "Guidance of the industry" regarding non-digestible carbohydrates, including Inulin, is so unbelievably ridiculous. The FDA's "scientific evaluation" on the listing and benefits of these fibers, includes "citizen petitions" and "comments that we received". These...

This US study complements the Canadian study showing unfermented b-fructan fibers induces a proinflammatory immune response in certain people with crohn's disease. "Unfermented b-fructan Fibers Fuel Inflammation in Select IBD patients"...

https://news.weill.cornell.edu/news/2024/05/common-type-of-fiber-may-trigger-bowel-inflammation Institute for Research in Inflammatory Bowel Disease, Weill Cornell Medicine, Cornell University Mohammad Arifuzzaman,Tae Hyung Won,Hiroshi Yano,Jazib Uddin, Elizabeth R. Emanuel,Elin Hu,Wen...

Inflammation doesn't wait 1 year. Fistula, strictures and perforations don't wait. They don't wait 1 year (52 weeks) until Vedoluzimab "supposedly" works. I say supposedly because at 52 weeks you no longer have a reliable placebo control arm. EN induces robust clinical remission at 4 weeks...

JAK inhibtors Filgotinib and Tofacitinib were both pulled from the market for crohn's disease because they were both ineffective. And JAK inhibitors have very serious side effects.

Is Vedoluzimab effective at 52+ weeks? Who knows and who cares. Data at 52+ weeks without a placebo arm is completely unreliable. Do people with crohn's disease with active inflammation have the time to wait 1 year before they achieve remission? No. The fact is that Vedoluzimab has failed to...

Vedolizumab is not effective. One of the largest studies to date, 368 patients with crohn's disease. And this was a sponsored study where the maker could pick and choose the type of patients eligible for the study. At 6 weeks, 6.8% of patients were in remission on placebo, only 14% in...

A select few are effective. Many biologics are not efffective for crohn's disease. -Etanercept, an anti-TNF, is not effective in crohn's disease. -JAK inhibitors (while arguably a synthetic and not a biologic) are not effective. -Entyvio (vedolizumab) is not effective for crohn's disease...

Mycotoxins are of interest. Unraveling crohn's disease requires explaining V. Kruiningen his observations. Cases of Crohn's disease tend to cluster within specific geographic locations and even within households. The sheer prevalence of crohn's disease requires an environmental explanation that...

One can speculate regarding significance of the lack of fiber in EN. But supposed microbiota and immune benefits from high intake of fiber are either simply not there if one rigorously looks over in vivo studies, or the role of SCFAs are strictly limited to the colon, which puts into question...

EN significantly reduces fiber intake compared to a regular diet. Of 61 EN used to treat crohn's disease, 82% did not contain any fiber all. In the few that did contain fibre, fibre content was extremely low. Remember that many of these formulations double as IV feeds, they can simply not...

The mechanism of action of EN is unknown. But I do think some pushback against the general recommendation of some dieticians to consume fiber is warranted. We have very credible data EN lacking fiber results in remission. We now have data that shows reintroduction of fiber after EN induced...

It contains very low amounts of fiber actually. Would be pretty difficult to make something with the viscosity of "a smoothie" with fiber. 13 grams of fiber per 1152 grams is around 1%. 71,9 kB

The study added a "daily Freedy multivitamin" to create the "smoothie". It should be noted that even long term use of "professional" EN like Modulen and 028 where every ingredient is carefully balanced, still generally leads to certain deficiencies like choline and potassium. They are just not...

"The macro- and micronutrient composition of common polymeric formulas used for EEN was used to guide the components of the smoothie." A "smoothie" with similar nutrients as EN should produce the same results. This does not seem unreasonable or surprising. The closer CD-Treat mimics EN, the...

The remission rate for ileal crohn's disease and EN is consistently high. How to explain that 10% who don't go into remission. Studies on EN tend to measure mucosal healing at either 4, 8 or 12 weeks. That's a lot of weeks patients are not under direct supervision and there is no way to check...

It is not surprising that the more aggressively a diet starts to mimic EN, the more successful remission become and the more they start to align with EN. The more aggressively a diet removes fiber, mycotoxins, gluten, lactose and FODMAP, the more processed it becomes, but also the more it...

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I found only 2 actual patient studies regarding the Mediterranean diet and crohn's disease. To say the evidence is weak is an understatement. A Turkish study found no difference in CDAI score between crohn's disease patients adhering to a Mediterranean diet and those who did not. A study from...

Thanks for the post. An update to confirm what countless studies easily accessible from the BMJ made evident 40 years ago. The leisurely pace at which evidence from dietary interventions is put into clinical practice has caused a lot of harm. If it wasn't for the work of Anthony Segal and the...