Presence of maltodextrin, emulsifiers or lack of fibre do not impact effectivness of EN.

[kiny]

All the studies that scare people regarding emulsifiers, polysorbate 80, maltodextrin, and tell people to eat more fibre, based on their studies in petri dishes, need to start explaining how EN full of emulsifiers, maltodextrin, and complete lacking in fibre are the most effective treatment for inducing remission in crohn's disease.

We went from low-residue diet and elemental diet recommendations for crohn's disease based on clinical evidence in the 90s, to dieticians telling patients to stuff themselves with fibre, prebiotics, probiotics etc, to "feed the good bacteria". Animals with transient microbiomes are doing just fine.

The Elemental formulas that contain most of these emulsifiers and no fibre at all, are ironically some of the most effective in bringing down inflammation.

Fibre has long been advocated as a beneficial nutrient for
Crohn's disease patients despite well-designed RCTs failing to prove
any profound benefit. Despite their clinical effectiveness
and amelioration of gut inflammation, the large majority of the EEN
formulas analysed here (80%) lack any fibre.

Maltodextrin, carrageenan, carboxymethyl cellulose and polysorbate 80 have all been associated with gut inflammation. We have shown here that all EEN formulas, which reported their carbohydrate source, contain excessive amount of modified starches, including maltodextrin, which are disproportionately higher than a healthy
person would potentially consume daily as part of their habitual diet.

We therefore propose that authors making dietary recommendations based on the current epidemiological evidence, animal and in vitro experiments need to have supportive in vivo evidence in human Crohn's disease before such wide ranging dietary
restrictions are introduced to clinical practice.

 

[Andersen007]

Pretty exciting stuff. It's a tricky one to answer, because then you also have diets like CDED, that are proven to work almost as effective as EEN or CDED+PEN just without the EN part... and one of, if not the main feature of CDED vs regular diet is to cut out the above mentioned highly processed ingredients (oh, and milk proteins too). The ingredients that seemingly make no difference in the EEN setting. Kind of baffling, to be honest.

 

[kiny]

Many studies regarding partial Elemental Nutrition either have very few patients, or no control groups. I have posted several large studies that show PEN is not effective.

 

[Andersen007]

Yes, but I am not arguing for PEN+normal diet, thats well proven that is worthless. I am saying CDED specifically is quite effective with or without PEN. Study could be bigger though.
https://pubmed.ncbi.nlm.nih.gov/34739863/
I feel like the authors of this study you linked are going the wrong way. All we know, is there is something overwhelmingly positive in the EEN setting and it almost doesn't even matter what's in it. For all we know the secret might be simply that it's liquid, or some other random thing. To challenge the role of fiber, or any of these ingredients, in the non-EEN setting, I believe is not very well founded, especially that there is some strong indication from animal models, and some weaker, but still fairly obvious indication in the CDED / SCD settings, about the role of those other nutrients.

I do feel personally involved in this one, given EEN made me feel worse and my calpro higher, while wholefood based diets made me feel better and my calpro lower.

There is another possible explanation - the 20-30% of us not reacting to these typical EEN-s might have a different disease altogether, we are just grouped into Crohn's umbrella due to longstanding terminal ileitis. Still that would explain why its not making me feel better, but not why it makes my inflammation worse so rapidly. And there are others out there with the same experience, although not a lot. Apart from me being a well-controlled celiac, and having a fairly mild Crohn's type, I dont think there is anything special about me at all though that would justify this.

This is a pretty interesting one, homemade enteral nutrition seems to be as effective as the "real" one. Unfortunately Dr Dale never published his study apart from this presentation and I just saw he is recruiting again for a second round.


I am giving this a try, as well as retrieving some more exotic EEN-s in the next weeks that are organic, some of them wholefood based, etc. But if indeed I have a sort of different phenotype, I am highly doubtful if it will give any different results. Anyways I will post on this forum if I do figure it out.

 

[kiny]

Look over the study you posted, and you'll see it from the Israeli group lead by Arie Levine. He was arrested for assaulting pediatric patients, raping the mother of a patient, and many other offenses.

I'm still waiting for a reliable study that shows PEN is effective. I have never seen one, but I have posted several that show it is not effective.

 

[kiny]

There is another possible explanation - the 20-30% of us not reacting to these typical EEN-s might have a different disease altogether, we are just grouped into Crohn's umbrella due to longstanding terminal ileitis.

It's certainly possible. Adherence to EN, especially in adults, is also hard to follow.