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EEN makes things worse - any advice?

Some of you know my journey and struggles already, but I thought I make a clear post about it, in the hopes of someone being able to offer guidance, or professional I could turn to.

28 year old male, diagnosed with ileal Crohn's 2022 December, at that point colonoscopy findings as well as symptoms were mild, seemingly only in the terminal ileum, at least based on ileocolonoscopy + MRE + symptoms. I also have celiac disease since 16 years, that is well controlled and the blood tests and biopsy confirmed everything good in duodenum. Calpro was 450. Everything in blood work was fine including markers of inflammation and malnutrition.

My symptoms on diagnosis were 4-5 stools per day, always liquid, and odd pains few times per week, but nothing really bad. I have immediately started to look into diet and lifestyle changes, and had the following:
-tried Pediasure and Ensure formulas as PEN next to CDED - symptoms improved somewhat but Calpro increased up to 800 and I still had liquidish diarrhea from time to time.
-tried Modulen as PEN, then EEN - the point I went EEN on it, after a few days I was very visibly sick, had liquid diarrhea 4-5 times again, and calpro was 1200
-went on SCD diet, excluded further foods so made it almost keto, and basically was eating a very monotonous diet - calpro went down to 130, and I had stools once per day typically quite solid, Bristol 4-5, recovered a lot of weight, so clearly I was reacting very positively to nutritional changes
-I cheated on the diet on my wedding, Calpro skyrocketed again to 1600
-trying to address the inflammation, again I thought I will try EEN - I tried Fortisip, got somewhat worse, so instead I switched to Elemental 028 which doesn't have any intact proteins that could cause allergies, again I have gone into a much worse flare, my eyes went bloody 2-3 days after starting consistent with episcleritis, had liquid diarrhea 4-5 times per day, I didn't feel great and according to people around me looked really sick
-going back to SCD keto-like brought calpro back down to 260 but couldn't bring it below, stools went back to 1-2x per day, not liquid but looser than a healthy person
-I thought I probably just have issues with maltodextrin, so I got some Kate Farms ordered from the US, I took 1 yesterday, 2 today, and again its the same story - I am having liquid diarrhea, already 3 times, concerned to get into a flare again if I continue

So basically, I tried pretty much all formulas under the sun, there is not even an overlap in ingredients, Kate Farms is organic, plant based, E028 doesnt even have intact proteins, Modulen uses corn syrup, etc etc carbohydrate sources are different etc. My concern is not that these things dont improve my condition. My concern is that they make it explicitly worse, every time, and I cannot make sense of why. I haven't read anything like this in any studies. And clearly nutrition plays a critical role in my disease as I respond to what I eat very intensely both positively and negatively. I cannot make any sense of this, and I am even concerned I might have a different disease altogether. And my staple diet on EEN included a lot of meat, eggs, and almonds, so quite a lot of fat. Even though I do have issue with eating too many almonds at once, it also didn't feel like the fat would be the problem, given I ate 12 eggs per day and was very happy on them.

I tried to ask my IBD specialist, but he said he is not knowledgeable about nutrition, and basically pushing me to go on biologics. I will have an MRE and compare with 1 year ago, to see if there is damage there that would justify this. But I am even more sceptical because of how differently I seem to react to this.

Anyone has any idea whatsoever about what might be behind this, what I could do, and if there is a professional anywhere in the world specialising on Crohn's who could advise? At this point I am even contemplating just trying it ingredient by ingredient, make a shake, and see my reaction. My impression is any carbohydrates and any fiber is making things worse. So most likely I will try carnivore.

Hi. Honestly, I know of no current professionals who will advise on nutrition, but the link between diet as a treatment and CD is well established.

And my staple diet on EEN included a lot of meat, eggs, and almonds, so quite a lot of fat.
I've read your post, but note you've stated the above - were you not doing the elemental shakes on their own? i.e did you continue to eat whilst doing the shakes?

The only other thing that comes to mind is the change in osmotic pressure (i.e. solid foods to liquid), and that your guts are taking time to adjust to the change - maybe continue for longer, or try a semi-elemental formula?

my little penguin

Staff member
So all your formulas were semi elemental or polymeric except e028 .
Just like steriods een takes time
You wouldn’t expect steriods to work over night een is the same
Weeks before it gets better and you get diarrhea
Liquid in equals liquid out
Additionally een is no solid foods only formula and water
E028 is made for little kids and is not complete nutrition for adults
Organic or not does not mean much for healing the gut .

to determine if een is working
No other food or drink just formula
For 6-8 weeks
Vionex is elemental for adults
Elemental means less waste so constipation can be an issue
Nutrica are the big three for formula including elemental
All have stores online
My kiddo did een 2-3 times


Staff member
My daughter did EEN for 4 months and she used Vivonex. It was very hard on her. She did have semi-formed or liquid stools for that time - her GI said it really varies based on the person. When you're doing EEN, you typically do 100% formula and no food at all. That is what my daughter did. Some studies with kids have shown that 90% formula and 10% food works nearly as well or as well to induce remission. That makes it easier for kids to do. But most GIs tell their patients what to eat in those cases. It's usually very plain, bland food - chicken or fish, no red meat, rice, potatoes etc.

Also, not every person responds to EEN. Some people require steroids. Some require steroids AND EEN. I would encourage you to do this WITH your GI, not just by yourself. Most GI departments have a dietician or nutritionist. And EEN is generally only used to induce remission - at the same time, a maintenance medication is started to help keep the IBD in remission. The current thinking is to start patients on meds to prevent damage from occurring, rather than starting meds once damage has already occurred. Once there is scar tissue and a stricture forms, for example, meds won't help as much as they would when there's inflammation but no scar tissue.
Thanks everyone for your responses. I did a typo above - I wanted to say that my staple diet when NOT on EEN included a lot of fat (the one that worked).

For those of you who mentioned your kid did EEN and had liquid stools most of the time, how long did it last? One thing is liquid stools but I feel like way more liquid comes out than it should and it went up to 4-5 times per day instead of my normal 1-2, and I feel quite shit too, after 2-3 days, even though I actually love the taste. I am simply too scared to carry on longer because I feel like it might be putting me into a flare, because normally I am in clinical remission with some level of residual inflammation as per calpro.

In reality I only tried Modulen and E028 as exclusive nutrition, the rest I added to my diet gradually to see my tolerance and when a very low threshold was reached I just started to have liquid stools all over. My calpro seemed to have gone up in both of those EEN cases, although I got scared and stopped at around day 4. It took a long time to normalize after with my usual SCD diet. So maybe I didnt wait long enough and I should soldiet through 2 weeks and only measure after, and this increased stool frequency and them being totally liquid is kind of normal? I also had some pain / cramping that I dont normally have, and urgency, which is also very rare for me.

Unfortunately our GI dept does not believe in EEN for adults and there is no alternative as I live on an island. He also said there is 9 months waiting list to a dietatitian. But maybe you can advise me - my suspicion is related to what one of you said, I think I have issues with liquids, period. I seem to for example do much better on simple grilled meat vs chicken broth. Did any of you try to cook something more solid from EEN, and do you think it could make sense? E.g. With gelatin, or maybe fry it with some eggs. I know adding extra ingredients is not great, but maybe my real issue is with the liquid itself and an extra ingredient that I know I can tolerate could help.
EEN for adults is a totally valid approach - I've done it more than once as sole treatment.

2-3 weeks is the length of time I'd spent on it, and I used E028 - no solid food as it takes away from the purpose of EEN.
EEN won't put you into a flare - unless you are reacting to any of the ingredients in the shakes.
The change in osmotic presssure is rough (pain, cramps etc.) - trust the process!

I didn't test calpro during it, but essentially you should see a downward trend following EEN - it won't go 'normal' striaght away, it'll take weeks/months. Any 'spikes' will be in reactions to foods you're eating when reintroducing solid food after EEN -


Staff member
My daughter did supplemental EN to gain weight first and because she was malnourished (it was like 60% formula, 40% food). So the first time she did it, she did feeds overnight with an NG tube (she inserted the tube every night, did the feeds while sleeping and pulled the tube out in the morning so she didn't have to go to school with it). She was told that it would take her body several weeks to adjust to the formula and it was normal to have diarrhea in the beginning (despite the fact that she was also eating during the day). In her case, after a month she still had diarrhea, so her GI switched her formula to from a semi-elemental formula (Peptamen) to an elemental formula (Neocate). That worked - her stool became soft or semi-formed (if I'm remembering correctly).

When she was later on 100% elemental formula several years later (Vivonex) she had loose stools, but not totally liquid diarrhea (usually - sometimes she did). She was allowed to drink broth and water, of course, so she was just getting a lot of liquid. When we added food back, they became more formed.

For kids/teens/young adults EEN is recommended for 6-8 weeks to induce remission. If you do it for 4 days, it's really not going to do anything and your body has no chance to get used to the formula.

We were told that you are not supposed to cook/heat or freeze EEN - that makes it lose nutrients.