Elemental diet (EEN) and skin

[Charlotte.]

I'm on elemental diet for three weeks now and having really bad acne on my forehead now, moving slowly downwards towards the whole face. It's many small spots, not red or heavily inflamed though, but really nasty.
Did someone else on elemental experience this as a side effect?
I was thinking about the glucose, which is one of the main ingredients, as one of the triggers. Does that makes sense?
I normally don't eat any sugar for more than half a year now.

Would be happy for any comments or experience.

 

[ronroush7]

Just in case you don't get any responses here, there is s thread called Extra Intestinal Manifestations. I hope you get some answers.

 

[my little penguin]

DS has been on een multiple times
Never had issues with acne

 

[Lady Organic]

i tried elemental diet once 3 weeks never had that. UK GI John Hunter who worked long time with elemental diet and lofflex diet doesnt mention it in his book. He used E028 is that what you are on?
you may be right about the sugar...
I think you should contact your Gi for that. it could be allergic reaction, or could it be urticaria ?

 

[GregH65]

In my original symptoms and diagnosis of Crohns I had 'acne like' red bumps appear on my flanks, thighs, knees, and even my palms while in the ER and during my stay. The hospialist who was on my team told me it was a part of the systemic Crohns presentation. The ones on my hands disappeared, my flanks and legs went away but left slowly fading marks. Now I'll have one or two randomly appear, then fade.

 

[Charlotte.]

Thank you so much for your responses, guys!

I'm on elemental 028 by nutricia/SHS.
I should have mentioned that I have been dealing with facial acne in the past, but it disappeared when I stopped eating fruits (fructose intolerant) and dairy (my arthritis reacts to it as well) and also cut out all sorts of sugar.

It does not seem to be a common "side effect", I would not call it that though, it seems to be more a personal problem of not getting along with sugar properly somehow.
I had the exact same effect when I was on Fresubin one year ago; my skin got worse and worse until the point where I no longer could stay on the drinks. I was hoping it's a completely different thing with elemental 028 as there is no dairy in it and pure amino acids, but it's not, unfortunately.

 

[Lady Organic]

do you notice any improvement of digestive issues?

acne is a inflammatory process. If you have a personal sensisitivity to a specific ingredient, my thought is that it may possibly cause inflammation in your guts as well.

 

[Charlotte.]

Thank you, Lady Organic!

My stomach pain/gastritis pain has decreased tremendously, I could taper down the dose of the antacids to a normal level. Some burning pain in my terminal ileum came back, suspected side effect, because the liquid is so concentrated. I also feel nauseous after the drinks (side effect), bloated (side effect) and sometimes have diarrhoea if I don't dilute it enough. So, more or less, the normal side effects that occur quite frequently, I was told. I also feel dizzy regularly, even though I drink the required amount, which can occur as well.

 

[my little penguin]

Are you using a kitchen gram scale to mix it vs the scopes
I know in kids if the concentration is off slightly then that can cause issues.

DS drinks peptamen jr but it is premixed

 

[Charlotte.]

It comes in sachets, 2 sachets per litre, so no scales needed. If I drank it like that, I would have really bad diarrhoea, so I take a few teaspoons per 300ml, that's the only way I can tolerate it.

 

[kiny]

I don't think the EN is the cause.

Glucose in elemental nutrition is normal and necessary. You need it to function. All the carbohydrates you eat from a normal diet consist of glucose, carbs are simply chains of glucose. They all end up in your blood as blood glucose and get converted to energy.

All the elemental diet does is remove the complex carbs from the diet and replace them with a form of glucose which is easier to digest. They're categorized as "dextrose equivalents". Usually in EN they use glocose syrup, which is a > 20 chain of glucose , which is easy to digest.

The amount of glucose in EN is no different from a regular meal, 60-70% carbs, 20-20 fat and protein. 028 is very balanced, how many carbs are in there is on the little pamphlet you get, it's about 60-70%, and a lot will be glucose (dextrose), it's normal, it's no different from a regular diet, just easier to absorb.

There's nothing in EN that is peculiar, the thing that makes EN different, is the bioavailability. The complex carbs, are replaced with glucose syrup, the proteins will often be albumin or hydrolized whey, the fat might be more short chain fatty acids, the goal of EN is imporving absorbency, but there is nothing in EN that isn't present in a normal diet, it's just in a form that is much much easier to digest. It's .. extremely high quality food if you wish.

 

[Charlotte.]

Sounds good, kiny, but the skin reaction is real, and I bet, it will stop when I go back to normal food.
What about the blood sugar, there is a difference whether I eat slow released carbohydrates or pure glucose, right? They also recommend people who have acne to decrease the amount of sweets (which is normally disaccharides, right?), so sugar does play a huge role in acne though.

 

[kiny]

Sounds good, kiny, but the skin reaction is real, and I bet, it will stop when I go back to normal food.
What about the blood sugar, there is a difference whether I eat slow released carbohydrates or pure glucose, right?

Maybe, the insulin response to starch is different from the insulin response from taking a tablet of dextrose or EN.This isn't a problem with EN in people with a normal insulin response, you also aren't eating glucose in isolation, there is protein in EN, the carbs will be used for protein synthesis etc.

When you are underweight in a hospital, they will give people with crohn's disease, glucose IV, it's much much more glucose than is in EN, without any protein or fat. This doesn't cause issues in people.

And you need a large enough uptake of glucose to have enough energy, it gets converted to ATP, glucose gets burned into energy.

If you feel good on the EN, I would be careful of blaming the EN on the acne. But ask a doctor to make sure.

 

[Charlotte.]

Thank you for the explanation! Yes, it's mean comparing elemental with sugar, I see. It definitely makes a huge difference, and I was hoping the acne issues wouldn't come back, but it's the same situation now as it was whilst on Fresubin.
I will aks.