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08-12-2012, 06:01 AM   #1
DustyKat
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Elemental/Enteral Nutrition

Enteral/Elemental Nutrition (EN)

Elemental is general term used to cover liquid diets. They are considered to be a complete diet and are designed for a person to survive long term without any food intake. These types of diets are used for a number of reasons in Crohn's Disease and include the following:

- Research has shown that these type of diets are as effective as steroids at inducing remission. They are therefore a viable alternative and do not have the associated side effects that steroids do.

- As a treatment to reduce symptoms prior to surgery.

- As bowel rest as they put no stress on the digestive system.

- As part of a continued maintenance program when in remission.

- To assist with weight maintenance or gain.

- They may become an integral part of a persons nutritional intake if extensive surgery has been performed and the ability to digest food has been compromised.

Modes of Delivery:

Elemental - Generally refers to an oral liquid diet but there is crossover between this term and elemental. The types of products used include Boost, Ensure, Carnation Instant Breakfast Drink, Fortisip, Osmolite, Modulen.

Enteral - Refers to the delivery of a liquid diet via a tube - naso-gastric, naso-jejunal, naso-duodenal, tube feeding, gastrostomy feeding or jejunostomy feeding.

Liquid Supplements
*Please note - The following are a sample of what is available. They may not be available in all countries or they may be marketed under different names. Full lists of available products can be found by going to the manufacturers websites in your country of origin. Manufacturers include Abbott, Nestle and Nutricia.

Peptamen or Peptamen Junior for kids — Contains protein that has been partially broken down, making it easier to absorb. This may be useful if portions of the digestive tract are inflamed or have been removed. This formula also contains MCT oils that are absorbed more easily, decreasing the undesirable effects of fat malabsorption (diarrhea, gas and bloating). This formula is not highly concentrated, which also may help decrease diarrhea. An 8 ounce ready-to drink can provides 240 calories, 10 grams protein; made by Nestle. Recommend adding flavor packets to improve palatability.

Peptamen 1.5 — Same composition as Peptamen but offers more calories per can. An 8 ounce ready-to-drink can provides 360 calories, 16 grams protein; made by Nestle.

Modulen IBD — A mild formulation, which may help control diarrhea. It also contains a growth factor which may decrease inflammation. It contains MCT oil for better absorption of fat. An 8 ounce serving made from powder provides 240 calories, 9 grams protein; made by Nestle.

EnLive! — Useful for nutrition before surgery, fat malabsorption, lactose intolerance and gluten sensitivity. This is a clear liquid supplement that is a good source of protein and calories. An 8 ounce. ready-to drink box provides 300 calories, 10 grams protein; made by Ross.

Lipisorb — High in MCT oil, which is an easily absorbed form of fat -- useful for fat malabsorption. An 8 ounce ready-to drink can provides 325 calories, 14 grams protein; made by Mead Johnson.

Subdue — Partially broken down protein plus MCT oil for better absorption of fat. An 8 ounce ready-to drink can provides 240 calories, 12 grams protein; made by Mead Johnson.

Vivonex — May be indicated for severe problems with absorption. This formula is very low in fat and is "elemental" or contains completely broken down protein, so the intestines can absorb nutrients easily. An 8 ounce ready-to drink can provides 240 calories, 11 grams protein; made by Novartis
VivonexPlus: is available in unflavoured 79.5g (2.8 oz) sachets that you add water to. Once mixed it can be left at room temperature for up to eight hours. (Although most formulas taste best well-chilled). It is manufactured by Nestle in the U.S. and available in Canada.

Optimental — This product is also elemental (completely broken down proteins) and contains MCT oils for easier absorption. It is lactose free and contains high levels of antioxidants. An 8 ounce ready-to drink can provides 237 calories, 12 grams protein; made by Ross.[1]


Total Parental Nutrition (TPN)

Total parenteral nutrition is another way of supplying all your nutritional needs. The nutrients are given directly into the bloodstream via a vein. This intravenous feeding generally is reserved for people who are unable to digest food or are severely malnourished. People with severe inflammation not responsive to medications, complications from Crohn's disease such as fistulas, or a very small amount of bowel left that is insufficient to digest and absorb food may also receive TPN. [2]

This can also be used pre surgery to rest the bowel and pre and post surgery to maintain/build weight.

Outcomes

Although, in many cases, EN is as successful as steroids at inducing remission research indicates that it does have high relapse rates once ceased as a treatment. As a result it is recommended to have other interventions in place to increase the chances of maintaining remission over a longer period of time.

Interventions may include one of the following:

- Continuing EN at a reduced rate in combination with a normal diet.

- Introduction of an immunosuppressant type medication.

- Use of the Elimination Diet.


Since I am far from an expert on this anyone please feel free to edit as they see fit. I don't have much knowledge on the products used either.

References
[1] http://www.ucsfhealth.org/education/...ase/index.html
[2] http://www.emedicinehealth.com/diet_...e/page8_em.htm


Books:

Beat Crohn's: Getting into Remission with Enteral Nutrition:
http://www.solutionsbooks.us/ibdbook.html

Dieticians Handbook of Enteral and Parenteral Nutrition:
http://www.jblearning.com/catalog/9780763742904/

Websites:

The Dietary Treatment of Crohn’s Disease:
http://www.crohns.org.uk/Docs/3/The%...20Disease.html

Dietary Interventions in Crohn's Disease:
http://www.crohns.net/Miva/education..._Disease.shtml

Crohn's Disease: The Role of Nutrition Support:
http://www.medscape.com/viewarticle/407945_4

This site gives a good overview of EN, types of formulas, why it is used and the pros and cons of each method:
http://www2.kumc.edu/pharmacy/Nutrit...ion%20(EN).pdf

Nutrition in paediatric Crohn’s disease:
http://www.ajol.info/index.php/sajcn...le/52768/41370

Products:

Abbott brands are listed on the left of the site:
http://abbottnutrition.com/our-products/brands.aspx

Nestle brands:
http://www.nestle.com/Brands/Healthc...Catalogue.aspx

Nestle also has a separate site for Modulen IBD:
http://www.nestlenutrition.co.uk/hea...p=Modulen®+IBD

This lists the Nestle products specific for IBD:
http://www.nestlehealthscience.com.a...Crohns-Disease

Nutricia is another manufacturer.

Oral nutrition supplements:
http://www.nutricia.com.au/clinical/...pplements.aspx

Malabsorption supplements:
http://www.nutricia.com.au/clinical/...bsorption.aspx

Paediatric supplements:
http://www.nutricia.com.au/clinical/...ediatrics.aspx

Please continue to post links to any books, websites or articles that you feel may be of interest.

Dusty.
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Mum of 2 kids with Crohn's.
08-12-2012, 07:02 AM   #2
kiny
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Thanks. I have used 2 products of Nutricia.

-Fortimel, it's a liquid bottle meant to replace 1 full meal, I stopped because it's so heavy and thick, which makes it no easy to digest. You can add water to it though so it's less heavy.

-Protifar. It's nutricia protein powder. It's really nice, no additives at all (unlike many sports brands that tend to use maltodextrin), it's a great protein powder that's really really clean. I still use it. It has no taste whatsover.

I really like this brand because they always tell all their ingredients, they are very well respected in Europe and they always answer questions.

Last edited by kiny; 09-14-2012 at 07:42 AM.
01-09-2014, 03:20 PM   #3
DustyKat
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Although this manual has been written for adults on tube feeds it has information that is generic. Contains very good information about clinical monitoring and troubleshooting…allergies, food avoidances etc.

http://daa.asn.au/wp-content/uploads...l-Oct-2011.pdf

Dusty.
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