Has anyone tried a liquid diet to achieve remission?

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Illini
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   Posted 1/6/2008 9:39 AM (GMT -7)   
I haven't seen or spoken to the doc yet, so I'm not sure what treatment he is going to suggest. Since I've been having liver problems recently I'm hesitant to go on any other drugs. I'm newly diagnosed with Crohn's, I have a ~5 cm stricture at the terminal ileum. No D, my bowel habits are OK and I'm not in that much pain. Worst is I get fevers but I managed to avoid that this month :-)
 
I read that in Japan the 1st line of treatment is a liquid diet (either elemental or something like Ensure), and they also do this with kids in the UK. It's effective in people who have ileal disease, depending on the study, some say as effective as pred.
 
I've dealt with Ensure before, I think maybe I can handle that being my only "food" for a few months.  I want to propose trying this with my doctor when I see him.
 
Has anyone tried a liquid diet to achieve remission?

tinglebell
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Date Joined Apr 2007
Total Posts : 531
   Posted 1/6/2008 11:12 AM (GMT -7)   
No, but wow. Could I give up food??? I had a hard time giving up regular sugar. There was a post about tube feeding/liquid formulas, maybe someone will remember the content. What about infant formula, like enfamil. Hopefully some of the diet guru's on the forum will respond.
DIANNE
Diagnosed at age 19 with CD.
3 small bowel resections, 1 for perforation, 2 for strictures 
 


yogaprof
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Date Joined Apr 2006
Total Posts : 1665
   Posted 1/6/2008 11:24 AM (GMT -7)   
I stopped eating the first few months I was sick except for soup, yogurt, and boost. mostly I did it because food sounded awful and I was paranoid after hearing about pred and weight gain. It really was a mistake for me. I lost a ton of weight and it didn't help my belly at all. I am on a low res diet and that definitely helps. I still have no appetite and just make myself eat a balanced diet to have energy and a clear head. talk to your doc about this, or better yet, go to a nutritionist to do it with some more knowledge.
48 y/o woman.  Diagnosed 4/06 after colonscopy, SBFT, CT-scan all showed crohns. 3 months later, after pred and remicade, all tests showed no crohns. In December had adhesions cut through a laparoscopy. Now just taking Glycolax, Ultra Fiber Plus and vicodin as needed.


pb4
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Date Joined Feb 2004
Total Posts : 20576
   Posted 1/6/2008 11:26 AM (GMT -7)   
Actually it's recommended during severe flares to go on liquid diets for a short period of time, a few days or so, to give the bowels a rest...I know that when one is bad enough GI's will send their pateints to the hospital for tube feeding so they can get bowel rest...if you do a liquid diet at home for a few days or so, then slowly introduce soft, bland foods back into your system while continuing with plenty of liquids.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


potatoqwn
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Date Joined Jan 2006
Total Posts : 355
   Posted 1/6/2008 2:10 PM (GMT -7)   
When I was first diagnosed, I was in pretty bad shape and immediately put on an Ensure and water only diet. I did this for 6 months. It can be done. It's not fun, but not too bad either. I missed chewing, so I chewed gum sometimes. I was also on medications during this time. It helped me. I always keep Ensure in my fridge if I need to let my intestines rest a bit now. It isn't harmful and you can live on the stuff. I would check with your doctor first though for sure.

Illini
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Date Joined Dec 2007
Total Posts : 298
   Posted 1/6/2008 2:23 PM (GMT -7)   
I definitely want to talk to the doc about it, hopefully I can get him to look at the papers and we can discuss it with a nutritionist. I don't want to do anything without talking to the doc first, so I have not changed my eating habits, except for eating more yogurt/soup than before and less insoluble fiber... and trying to chew everything well :). The anxiety level has gone up a bit lately so I'm not as interested in food, but I can't afford to lose any more weight. Because of that I may be supplementing my diet with Ensure regardless.

From what I've read, going on a liquid diet lets the bowels heal, plus it changes your gut flora, maybe removing the "bad" bacteria that cause the small bowel inflammation.

pb4
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Date Joined Feb 2004
Total Posts : 20576
   Posted 1/6/2008 2:48 PM (GMT -7)   
You should take probiotic in pill or powder form daily, in remission or not, yogurt is good but probiotic supplements are much better...one I use is called primadophilus reuteri made by natures way, it has guaranteed intestinal release, also aids with lactose intolerance, high cholesterol and for women, vaginal health. Only one/day is needed, the one downside to it is it must be kept cold at all times, but it's worth it....

I love it.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


bluemoon7
Regular Member


Date Joined Sep 2007
Total Posts : 62
   Posted 1/6/2008 4:41 PM (GMT -7)   
I take a probiotic pill everyday. Do you have to keep pills cold??  Never heard that.

Illini
Regular Member


Date Joined Dec 2007
Total Posts : 298
   Posted 1/6/2008 6:51 PM (GMT -7)   
Where do you buy that probiotic, pb4? At a health food store?

pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20576
   Posted 1/6/2008 7:37 PM (GMT -7)   
Yes, I buy this one at the healthfood store...not all brands have to be kept cold, but I've often heard the ones that do need to be kept refidgerated are better, something to do with them having stronger strains of good bacteria cultures.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


Writer
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Date Joined Aug 2006
Total Posts : 443
   Posted 1/6/2008 8:21 PM (GMT -7)   

Hello, Confused in IL,

 

I think you have a great idea there, but I admit I'm biased. I'm writing a patient-oriented book about enteral nutrition (the fancy name for liquid diets) in Crohn's disease because it is so rarely offered in the US, and I think people deserve to know about it as a treatment option. As you have already discovered, it's the gold standard treatment in Japan, and is pretty widely used in Canada and the UK, especially for children. It doesn't work for everyone, but you have two excellent points in your favor: new-onset disease, and ileal disease (small intestinal Crohn's responds best to this treatment). Generally if it is going to work, you'll notice a least some improvement within the first 10 days, but totally getting rid of the stricture is likely to take longer. Long-standing fibrous strictures are unlikely to respond to enteral nutrition, but inflammatory strictures (what you probably have, since you haven't had symptoms for very long) can disappear very nicely. Enteral nutrition works best to induce remission if you don't eat any food except your liquid formula (and stick with the same formula). But once in remission, some people use enteral nutrition supplements (say, 500-1000 calories per day) to maintain remission longer, drinking them instead of eating solid food for one meal per day, for instance.

 

Pretty much all of the enteral nutrition formulas work equally well, although occasionally someone is intolerant of a particular formula. That can't be predicted in advance, but if you start getting bad diarrhea after starting the formula, then just switch to a formula with a different composition. But most people don't have problems.

 

Some doctors will discourage you from starting enteral nutrition, mainly because they think it is too hard to give up regular food (the largest studies in adults have had big dropout rates). But if you persist, they will generally concede that it is a valid treatment and let you give it a try. The big benefit, as you point out, is that you avoid the risk of drug-induced side effects. Whether it will help your liver or not, I don't know. In responders, enteral nutrition does have systemic anti-inflammatory effects (reduces ESR, reduces production of TNF-alpha, etc.). I've seen a case report of a Crohn's patient with renal amyloidosis (kidney disease associated with Crohn's) who achieved excellent control of both the amyloidosis and the intestinal Crohn's symptoms with enteral nutrition, but to the best of my knowledge, there are no reports on the use of enteral nutrition in someone with Crohn's related liver disease.

 

Anyway, if you do decide to try this, I hope it works really well for you.


Illini
Regular Member


Date Joined Dec 2007
Total Posts : 298
   Posted 1/6/2008 9:15 PM (GMT -7)   
Writer--I hope you do write that book! Are there any textbooks or articles on the subject you recommend? The only way I found out about enteral nutrition is by searching medical journals. I have access since I'm a grad student. I really, really hope the doc agrees I can try it and lets me talk to a nutritionist. I'm no food connoisseur so I think I can handle enteral nutrition for a while. Honestly the only thing I'm hesitant to give up is cranberry juice (for avoiding UTI's). I've always been thin and when I was a teenager I was on food + Ensure for a while because the docs said I was malnourished. I don't remember it being too bad and it's probably improved since then.
 
My hope is to try enteral nutrition for 8-12 weeks and then transition back to 2 meals a day "real" food. That's based on what I've read. I'll discuss it with the doc when I see him on the 17th, I'm going to print out some papers and bring them with me in case he's not familiar with it. In the meantime I'm not making any drastic changes to my diet, although I do wish I could start sooner. It's hard for me to say how long this has been going on. I've had various forms of GI discomfort since March, but the fevers happened in May and June. I was asymptomatic and my ESR, liver function, etc. was improving until November/December when the fevers came back and my ESR went up again. But the stricture is narrow enough already that the GI doc could not get the scope through.
 
I don't know that a liquid diet will help the liver but I don't think it should hurt. At this point my Crohn's symptoms are relatively mild (no fever this month!  yeah ) so I have a hard time putting my liver at any further risk... I know Pentasa can rarely cause hepatitis and after my experience with BCPs I'd just assume avoid all steriods. 
 
Thank you everyone for your replies! We'll see what happens. I have an appointment with my primary tomorrow so I'll talk to her about it too.

Aimee =)
Veteran Member


Date Joined Jun 2004
Total Posts : 1020
   Posted 1/6/2008 11:26 PM (GMT -7)   
I practically did that and it didn't help me. I was forced into a liquid diet when in a major flare last year - anything slightly solid got stuck (ouch!). I went 3 months without a drop of solid food, was hospitalized twice, and lost 60 pounds. Still didn't get into remission.

It took Humira to do that.

Writer
Regular Member


Date Joined Aug 2006
Total Posts : 443
   Posted 1/7/2008 4:23 PM (GMT -7)   
Really the best source for information about enteral nutrition is articles from medical journals, as you've already discovered (I have most of a file drawer full of medical articles in five languages). You'll probably get the most hits if you structure your Medline search as a Boolean search as follows: enteral AND Crohn's. There isn't a really solid totally inclusive book to recommend, or one article that really includes everything. However, Fred Saibil, M.D.’s patient education book, Crohn's Disease and Ulcerative Colitis: Everything You Need to Know (second edition, 2003) has a nice introduction to the use of liquid diets for the general reader. But I wanted all the details and not just an overview available in one place, which is why I'm writing my book. It's actually nearly finished, but I'm still trying to round up some personal experiences from adults who had used enteral nutrition. I have some great reports from parents of kids who've used enteral nutrition, but so few adults use it in the US that it's been hard to find people to share their stories. But having just the facts and not the stories, too, makes for a less appealing book.

Anyway, to go back to your own experiment. Four to six weeks of treatment is often enough for a good remission, but strictures can be pokey, so you may need the eight to 12 weeks you suggest. One thing you can do, if you want to know if it's having an effect, is to check your ESR before you start and then 10 days to two weeks later. You should see it going down some by then if the diet is having an effect. Effects on a stricture are tougher to judge. As long as you are having liquids only, the stricture probably won't bother you. That means you won't know if it's disappearing until you go back to solid food or your doctor does a procedure or x-ray or whatever to see if it's still there. One thing I recommend is to brush your tongue whenever you brush your teeth while you're using enteral nutrition. Without the friction of chewing solid food to clean the tongue, the formula tends to build up on it.

I hope your visit with your primary was encouraging!

Illini
Regular Member


Date Joined Dec 2007
Total Posts : 298
   Posted 1/7/2008 9:24 PM (GMT -7)   
Seeing my primary today wasn't very informative, but that's about what I expected. I gave her all the reports from my recent CT, colonoscopy, etc. Based on some right kidney weirdness in the CT she let me submit a urinalysis/culture. I wanted to check my ESR and LFTs again but decided to wait in case the GI doc orders it next week. My primary doesn't know anything about Crohn's so there wasn't much point in trying to discuss treatment with her, she just said to have the gastro send her a report on whatever treatment he decides.

Aimee that sounds awful, I hope you are feeling better!

Thankfully I'm not that bad off. Over the past few days I've been feeling worse, probably stress and worrying about my liver. I'm eager to start treatment for the Crohn's... But I've also got my heart set on trying enteral nutrition first, before meds, so I hope the GI doc is open-minded. I figure it works well for kids and teens, I'm about the size of your average 12 year old so I've got high hopes :) . I'm going to gather up more journal articles to bring with me to the appointment, and I'll try to pick up that book as well.

EMom
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Date Joined Aug 2007
Total Posts : 990
   Posted 1/8/2008 7:19 AM (GMT -7)   
Hi Confused in IL! My son opted to do a liquid diet in early October when he had a flare. Ironically, he had a regularly scheduled GI appointment at the exact time of the flare. When we told the docs what he was doing, the young Fellow (CD specialist in training) did not discourage him, while the veteran GI Crohn's specialist nearly did. The veteran GI made comments like, "This is really, really tough to do" and "You know, you'll have to drink at least 10 of those a day to get enough nutrition" and "It will take at least 4 to 6 weeks, that's why it's soooo difficult to do." He was NOT encouraging. They both concurred, though, that it is an effective approach--as effective as prednisone, like you said.

Our docs are at the local children's hospital. They also added that they've never had anyone attempt a liquid diet--until my son, that is. Seems sad if it's really that effective.

We proceeded with the liquid diet and thankfully it only took about 9 days. Who knows, maybe it could have been less, but my son was being ultra cautious.

Hope this helps! Good luck to you!
EMom
Mother to 15 year old boy diagnosed in June, 2007.
Currently taking Asacol, omega 3s, digestive enzymes, probiotics, iron, vit. C, calcium w/D3 and a good multivitamin.
Started The Maker's Diet in early September.


FitzyK23
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Date Joined May 2005
Total Posts : 4219
   Posted 1/8/2008 8:50 AM (GMT -7)   
I do during a flare.  I usually just do it for a couple days and then slowly re-introduce "safe" foods.  I don't buy anything too fancy.  I just make smoothies w/ protein powder, ice, soy milk, and yogurt, and a bananna.  I drink pedialyte and gatorade. Ill eat apple sauce.  Ill "eat" all different kind of broths.  Sometimes Ill eat the noodles in rameen noodles and reintroduce bananna's and rice and pieces of bread first.  Then broiled chicken or plain tuna.  I am certain I have avoided going back on entocort several times by giving my bowels a rest for a couple days.  I highly doubt it would take weeks as the doctors claim.
26 Year old married female.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  Currently on Pentasa 4 pills/4x day, hysociamine prn, nexium, and ortho evra.  Good times!!!
 
 


Illini
Regular Member


Date Joined Dec 2007
Total Posts : 298
   Posted 1/9/2008 6:58 AM (GMT -7)   
EMom, did your son use Ensure, or one of the elemental/semi-elemental diets?
 
Good news is that my urinalysis came back within normal limits (though I don't trust the health center 100%) so hopefully my kidney is OK. But I still don't see the GI doc for a week and a half.

EMom
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Date Joined Aug 2007
Total Posts : 990
   Posted 1/9/2008 8:54 AM (GMT -7)   
Confused in IL said...
EMom, did your son use Ensure, or one of the elemental/semi-elemental diets?


Well, Writer, as you may have gathered, it the expert here on liquid diets. She told me that what my son used was technically a semi-elemental formula. It is called Crohn's Complete Elemental Shake and I purchased it from evitamins.com. My son started out on Ensure, but after about 3 days he switched over completely to the CC Shake because he said it made his gut "feel better". If anyone else knows of a good product for this, please share!

Hope this helps! I'm happy to hear of your positive urinalysis! That's good news! BTW, I live downstate from you.
EMom
Mother to 15 year old boy diagnosed in June, 2007.
Currently taking Asacol, omega 3s, digestive enzymes, probiotics, iron, vit. C, calcium w/D3 and a good multivitamin.
Started The Maker's Diet in early September.


Marie-Claire
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Date Joined Mar 2007
Total Posts : 900
   Posted 1/9/2008 11:36 PM (GMT -7)   
I always start with a liquid diet at the first sign of a flare. I opted for this during my last flare....was on sulfasalazine QID and ensure. ...this went on for about 3 months...it was terribly difficult. I was extremely fatigued etc...but was determined not to go to the bigger guns ie. pred. as I always have so many side effects to any kind of medication. Even the sulfasalazine gave me horrible headaches....but the flare finally ended . I have been flare free(major flares anyway...I get minor ones from time to time and stop eating immediately). I have managed to avoid a major flare this way. This was my doctors first suggestion. He told I knew my body the best and knew when things were about to start , so he suggested just going to liquids right from the get go...then introduce broths, shakes, yogurt.mushed bananas etc. Just as Fitzyk23 . It works for me.
50 yr.old retired RN,Crohn's D for last35 yrs..severe esophagitis, migraines,strictures,urethral stricture,depression,probable MS.
 
 

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