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PEN (partial elemental nutrition) scepticism.


Well-known member
A handful of studies claim Partial Elemental Nutrion (PEN) is just as successful as exclusive (total) elemental nutrition (EEN/TEN) in inducing remission, and they are wildly shared online.

The CDED study from Israel is very popular. If you believe this study, you only need to consume 50% EN with a 50% exclusion diet, to have the same effect as EEN.

A team in Japan has made similar claims. It should be noted that NOD2 mutations specific to Westerners with crohn's disease are absent in Japanese patients, which might influence study results. https://linkinghub.elsevier.com/retrieve/pii/S0016508502000665

Among the subjects in our 3 study groups, including patients with CD, patients with ulcerative colitis, and healthy controls, none had common NOD2 variants that have been associated with CD in white patients.
It is a very attractive suggestion. You don't need to adhere to EN, you can just kind of wing it and combine it with a "non-western" diet.

These PEN studies focus heavily on the Western diet to explain crohn's disease. Societies where crohn's disease was uncommon and became prevalent in the last few decades. They focus heavily on excluding the "western diet".

But the studies that show PEN is not effective, are not wildly shared. They live in a corner of the internet because the story they tell about PEN is not positive.

The CDED study from Israel which showed PEN was effective, was cited 142 times in other studies. The UK and US studies that showed PEN was not effective were rarely cited, even though they were more rigorous studies that had a higher number of patients enrolled in the study.

These studies should also be shared, because they raise a lot of scepticism about the recent PEN studies.

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