All the article links have to do with the use of parenteral or elemental diets in IBD. I'm familiar with this approach.

None of the articles were about parenteral nutrition, they were about enteral, elemental and polymeric nutrition.
The benefit is not conferred by it being a NSD/LSD, but is mainly due to the "bowel rest" such a regimen permits.

I am not an advocate/supporter of starch-restrictive diets or claiming that these studies are evidence of their efficacy, the point of linking to the studies was to show that gut inflammation can be affected by variations in the type of food entering the intestines. The 2nd article addresses the idea of "bowel rest" -

"In the past, the effect of “bowel rest” on active Crohn's disease was studied in adult patients. Patients were randomised to TEN, total parenteral nutrition, or a combination of parenteral nutrition and normal food, and remission rates in each group were not significantly different (approximately 65%). Although the study was underpowered, it was concluded that “bowel rest” was not an important factor in nutritional therapy for active Crohn's disease."
Though this may encourage mucosal healing/induce remission in IBD, most people won't maintain that remission upon reverting to a normal diet.

Yes that's right, indicating that the changes in diet can have a dramatic effect on disease activity.
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."

What they were referring to was a diet that was 50% enteral nutrition and 50% unrestricted diet. The effects of a 50% unrestricted diet negated most of the benefits of the 50% enteral diet. Using intermittent periods of a 100% enteral diet seems to be much more effective.
Interesting that all the articles you linked to (but one) are over 20 years old.

Actually 3 of them were from the 2000's. Some of the old research from the 70's and 80's is awesome. My favourite is the crazy Canadian researchers that deliberately inoculated themselves with ureaplasma to test the effect of antibiotics on reactive arthritis - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1049094/
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/

Thanks. Why do you say "but not for maintenance" when the study seems to be pro EN for maintenance - "the available evidence suggests that supplementary EN may be effective for maintenance of remission in CD."
Technically it is a form of evidence, but it is a very low level of evidence.


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.

Agreed, the success/failure rate for any particular dietary regime is unknown and will naturally be biased toward over reporting success and under reporting failures. This can also be true of pharmaceutical treatments as drug companies aren't obliged to publish trials which have negative outcomes -

"Sometimes, drug companies conduct lots of trials, and when they see that the results are unflattering, they simply fail to publish them... And this data is withheld from everyone in medicine, from top to bottom. NICE, for example, is the National Institute for Health and Clinical Excellence, created by the British government to conduct careful, unbiased summaries of all the evidence on new treatments. It is unable either to identify or to access data on a drug's effectiveness that's been withheld by researchers or companies: Nice has no more legal right to that data than you or I do, even though it is making decisions about effectiveness, and cost-effectiveness, on behalf of the NHS, for millions of people.

In any sensible world, when researchers are conducting trials on a new tablet for a drug company, for example, we'd expect universal contracts, making it clear that all researchers are obliged to publish their results, and that industry sponsors – which have a huge interest in positive results – must have no control over the data. But, despite everything we know about industry-funded research being systematically biased, this does not happen. In fact, the opposite is true: it is entirely normal for researchers and academics conducting industry-funded trials to sign contracts subjecting them to gagging clauses that forbid them to publish, discuss or analyse data from their trials without the permission of the funder." - Ben Goldacre

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.

Sorry, I must have interpreted it wrong. I guess I have a bee in my bonnet about the idea that dairy products are an essential food group, which seems to be quite wide spread.