Liquid stools / diarrhea on EEN - normal?

[Andersen007]

Hi! I have been trying different polymeric enteral nutrition formulas in the past, and unfortunately all of them have given me cramps, pain, and (often explosive) diarrhea as well as increased my calpro. These were typically milk protein based formulas. Afterwards I was able to find a restricted SCD diet that but me on remission for a couple of months with calpro normalised, but then I strayed off from it on my bachelor's party and wedding, and things haven't been the same since even sticking to the diet. To induce remission as my latest calpro was again 1600, right now I am trying 100% Elemental 028, an elemental formula with broken down proteins thats supposed to be hypoallergenic. I started yesterday morning, and although this time I don't have pains or cramps, but I have very mushy, close to liquid stools, 2-3 times per day. I guess my question is, is this normal / expected on EEN, or does this indicate I am intolerant to something in this as well? Should I expect this to normalise, and if so how long should I wait before thinking this is not working? My challenge is even in a flare, I barely have symptoms, basically I just had 1-2 quite loose stools per day before starting this, my main motivation to do it was my very elevated calprotectin, and to reset my gut.

 

[my little penguin]

My kiddo has done een a few times .
He used semi elemental peptamen jr
Which resulted in pure liquid
We were told all liquid in sometimes equals all liquid out
He later used neocate jr (elemental formula -amino acid based)
Give your body time to get used to the E028 splash .
Amino acid formulas have very little waste since normally your body breaks down proteins into amino acids to use them
With elemental formula you only need a few inches of healthy intestine to absorb it .

my kiddo did een for 9 weeks the first time
And maybe 8 weeks the second
First and second week are the hardest since your body needs to adjust and psychologically it’s hard not to eat solid food

good luck

 

[Andersen007]

My kiddo has done een a few times .
He used semi elemental peptamen jr
Which resulted in pure liquid
We were told all liquid in sometimes equals all liquid out
He later used neocate jr (elemental formula -amino acid based)
Give your body time to get used to the E028 splash .
Amino acid formulas have very little waste since normally your body breaks down proteins into amino acids to use them
With elemental formula you only need a few inches of healthy intestine to absorb it .

my kiddo did een for 9 weeks the first time
And maybe 8 weeks the second
First and second week are the hardest since your body needs to adjust and psychologically it’s hard not to eat solid food

good luck

Thanks for sharing your experience. I switched to chicken broth for now, because I was quite concerned about the formula making things worse - I got circles around my eyes and in the white part of it many blood vessels started to show, which made my wife scared too. And by the end of the second day it was as you said, totally liquid out. Its hard to say if it was helping or now bc my only symptom normally is diarrhea. The quantity of the stool was a bit more than I thought is normal if I digested everything, around 2 dl-s or so, 2-3x per day. I am thinking maybe its the maltodextrin, so will get the E028 powder next time (this one was the premade liquid), that one has glucose syrup instead. Its so weird coz, most of my intestine is healthy, I am not malnourished according to all of my labs either, and it still feels like any EEN I try is actually making things worse.

 

[Andersen007]

I dont know, I failed similarly with Modulen in the past, there I stopped after 4 days and my calpro after was actually way higher than a couple of days before I started. I thought its the milk proteins in it, hence tried the E028. I got liquid stools then too, but there I had cramps and pain too so it was more obvious. Also I did have this blood vessel thing in my eye too before E028 but it definetly got worse in the 2 days I was on it. I wish my doctor would have an idea about EEN, he is an IBD specialist and thinks I should just take steroids and not waste my time. I find it very difficult to try to guess these things, in reality I didnt even find studies about EEN actually worsening things.

 

[Andersen007]

One thing that does stand out though - now that I have switched to broth and chicken breast in it for around 24 hours, my eyes seem much less inflamed / way less blood vessels are clearly visible. So based on that I am kind of guessing EEN did in fact do something that wasn't great.

 

[my little penguin]

Eyes can flare if your inflamed -epi scleritis
See an ophthalmologist (md )
Chicken and broth is not enough nutrients
E028 is all amino acid so even kids who are allergic to every thing can use it
No intact protein
Depending on where your inflammation is at depends on if een works and how much
And how many times you used een before
Colon inflammation does not respond as well
If your eyes are inflamed then it’s more systemic see a doc
Vionex is for adults
E028 is for little kids under 13 so not enough nutrition for adults
There are other adult formulas
Powder is fine but watch osmolality
Use kitchen gram scale not the scoop to weigh the powder

 

[Andersen007]

Eyes can flare if your inflamed -epi scleritis
See an ophthalmologist (md )
Chicken and broth is not enough nutrients
E028 is all amino acid so even kids who are allergic to every thing can use it
No intact protein
Depending on where your inflammation is at depends on if een works and how much
And how many times you used een before
Colon inflammation does not respond as well
If your eyes are inflamed then it’s more systemic see a doc
Vionex is for adults
E028 is for little kids under 13 so not enough nutrition for adults
There are other adult formulas
Powder is fine but watch osmolality
Use kitchen gram scale not the scoop to weigh the powder

cool thanks! actually my eyes turned almost fine since I went off from Elemental 028 - gonna give it a few more days to really draw conclusion if it was somehow driven by EEN, but with what mechanism, I have no idea - maybe it somehow flared up my Crohn's but that would be almost unheard of (?)

yea agree, unfortunate truth about broth is, its great but can only be used for a few days and malnutrition and weight loss are real risks, so have to transition away from it in the next days..

regarding location thats what weirds me out the most - my colon is totally healthy, all my previous MRE-s and biopsies showed inflammation only in terminal ileum, and that seems to be the type which normally responds most positively to nutritional changes - and before E028 journey in the last days, I had 1-2 stools per day, and no pain in the colon even when palpated

more than that, my Crohn's is very responsive to nutrition - after I started SCD in spring I had normal calpro and no symptoms within a few weeks, which was after the Modulen flare

I guess I will have to see if the powder makes any difference, but if that causes the same problems, even without maltodextrin, I will be at a complete loss of whats going on - I have celiac disease too for 15 years, but all biopsies including one done couple of months ago show complete healing of the vili and these formulas are all gluten free so that cant be behind this either - maybe I just tolerate all liquids poorly

 

[patulsius]

"Maltodextrin and gut bacteria. Maltodextrin may affect the balance of bacteria in the gut. Research in its early stages suggests that maltodextrin may reduce the number of good bacteria and increase the harmful bacteria. This can cause damage to the intestine and increase the risk of inflammatory bowel disease. The powder may also enhance the survival of salmonella bacteria. It causes gastroenteritis and other inflammatory conditions.
May cause allergic reactions. If you consume maltodextrin in large amounts, this may cause gastrointestinal symptoms. These include gas, gurgling sounds, and diarrhea. Studies show that it can cause allergic reactions like cramping and skin irritations. The process of making the powder removes all protein, including gluten, but traces may still be found. This can be dangerous for you if you have gluten intolerance or celiac disease."
https://www.webmd.com/diet/what-is-...dextrin in,like cramping and skin irritations.