All the article links have to do with the use of parenteral or elemental diets in IBD. I'm familiar with this approach. The benefit is not conferred by it being a NSD/LSD, but is mainly due to the "bowel rest" such a regimen permits. Though this may encourage mucosal healing/induce remission in IBD, most people won't maintain that remission upon reverting to a normal diet. The authors of the 2nd article you referenced below concluded as much: "[L]ong term nutritional supplementation, although beneficial to some patients, is unlikely to suppress inflammation and so prevent disease relapse."

Interesting that all the articles you linked to (but one) are over 20 years old. Here is a nice (free access) summary of the evidence from 2009, which supports the use of enteral nutrition for induction (but not maintenance) of remission - especially in children with growth retardation due to IBD: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691486/

As my daughter was diagnosed in 2004 and had not had growth problems, nutritional approaches were not part of the treatment plan discussion. There is no way I would abandon the Remicade now, as it has worked so well, and since it IS working, I feel no need to mess with her diet. As it happens, she has had a hydrogen breath test and she is not intolerant to lactose.

Originally Posted By: butters
How is a documented and published case report not a form of evidence?


Technically it is a form of evidence, but it is a very low level of evidence. Here are two examples of the types of scales commonly used to grade evidence. The first has many levels but non is "single case study." In the second, case study is the weakest type of evidence listed.

Evidence Grading Scale
M: Meta-analysis
A: Randomized controlled trial: large sample size (n >100)
B: Randomized controlled trial: small sample size (n <100)
C: Prospective trial or large case series
D: Retrospective analysis
O: Other evidence
S: Review article
E: Expert opinion or consensus
F: Basic Laboratory research
L: Legal requirement
Q: Decision analysis
X: No evidence


Levels of Evidence
I Good-quality patient-oriented evidence.
II Limited-quality patient-oriented evidence.
III Other evidence including consensus guidelines, opinion, or case studies.


The difficulty with relying upon case reports and anecdotal evidence is that for every success story there are other stories of failure; but we don't know how many. So an author publishes a case report; but suppose s/he had 99 other patients with the same problem, given the same treatment, who did not respond positively? That would start to look like data/evidence - unless it wasn't published because it didn't support the author's hypothesis/bias.

Case studies should only be relied upon as evidence when there is essentially NOTHING else to inform a decision.


Originally Posted By: butters
Unless you are talking about a child at breast feeding age who cannot breast feed for whatever reason then I don't see how there is any risk to a dairy free diet.


Come on ... don't be so literal. NMT was just using it as an easy example of something people might eliminate, not saying a dairy free diet is, in general, risky. In the USA most people consume a lot of dairy products, which can make up a large portion of a person's dietary fat consumption. Dietary fat is crucial for brain development and absorption of fat-soluble vitamins such as vitamin D. So, if you were to eliminate the primary source of dietary fat from your child's diet you would want to think carefully about replacing it.




Sean, I am already familiar with this information but don't understand why you are connecting it to my drug hypersensitivity reaction?

The new classification of wheat/gluten related health issues is a clarification of what was previously known. It is hardly a sweeping indictment of wheat or an indication that wheat is fundamentally bad - though I'm certain it is a larger problem than is even yet realized. Not at ALL clear what this has to do with SpA, IBD, and the LSD/NSD. I do believe that if people respond to the reduction/elimination of a particular food (or if they have a clear bad reaction to a certain food!) they may want to look into testing for hypersensitivity - or at a minimum, avoid the food.


Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates