Overview
Exclusive enteral nutrition using a liquid nutritional supplement
Important
This information is produced for adults under the care of Guy’s and St Thomas’ hospitals.
We usually give you the information after an assessment or appointment. Your dietitian or other health professional may give you different guidance, depending on your specific medical needs.
It is important to check with a health professional before making any changes to your diet. Please contact your dietitian if you have any questions or concerns.
If you are not a patient at Guy’s and St Thomas’ hospitals, please contact a GP or specialist health professional.
This information is relevant if you have inflammatory bowel disease and need a liquid diet called exclusive enteral nutrition.
Exclusive enteral nutrition is a prescribed liquid diet that we recommend for some people with inflammatory bowel disease. This diet:
- can improve inflammation in the gut if used as your only source of nutrition for about 6 weeks
- gives you all the nutrients that you need during this time
The information covers:
- how exclusive enteral nutrition works
- eating other foods while on the liquid diet
- getting your supply of the liquid supplements
- having fluids
- when to take your liquid supplements
- side effects of the liquid supplements
- how we monitor you while you are on exclusive enteral nutrition
If you need any more advice or have any questions, please speak to your gastroenterology dietitian.
How exclusive enteral nutrition works
The reasons why a liquid diet helps to treat inflammatory bowel disease are not clear.
We do know that liquid diets improve nutritional status (a person's health condition as influenced by their diet) and allow the gut to heal in 65 out of 100 adults with Crohn's disease.
How long the liquid diet takes to work
Most people start to see an improvement within 10 to 12 days. We recommend that you follow the liquid diet for at least 6 weeks to get the most benefit.
Eating other foods while on the liquid diet
You usually continue to eat food until you can take the fully prescribed amount (dose) of the liquid nutritional supplement that you prefer. This is unless your gastroenterology team gives you different advice.
The aim is for you to have the full amount by day 3, although for some people this can take longer:
- On days 1 and 2, you continue to eat food but the liquid supplements may reduce your appetite. This is normal.
- By day 3, you should get all the nutrients that you need from the liquid supplements only. From this time, you should not eat any other food.
Getting your supply of the liquid supplements
Your GP prescribes the liquid supplements. This is the usual process:
- Your dietitian writes to your GP and asks them to prescribe a suitable amount of the liquid supplements for you.
- After your dietitian has sent the prescription request, please liaise with your GP. They send the prescription to a named pharmacy.
- You can then collect your liquid supplements from the pharmacy. Some pharmacies can deliver the prescription to your address.
Having fluids
It is important to stay hydrated. You may need to have extra fluids, particularly during hot weather.
Most people can drink:
- water
- cordial (a sweet fruit-flavoured drink) or squash
- diluted fruit juice
- 1 black tea or coffee containing caffeine a day
- herbal tea without milk
You can also have:
- chewing gum
- Bovril or a stock cube in water
- clear consommé soup (a type of clear soup made from richly flavoured stock or broth that has been clarified)
- clear jelly
- hard boiled sweets, such as glacier mints
When to take your liquid supplements
There is no specified timetable for taking the liquid supplements. It is a good idea to:
- spread the amount throughout the day
- take the liquid supplements at your usual eating times
Your dietitian gives you a personalised plan for building up to take the full amount of the liquid supplements over 3 days. However, if you cannot take your supplement, please talk to your dietitian about this.
Here are some tips for making the liquid supplement easier to prepare and drink:
Do
- drink the liquid supplement chilled
- drink the liquid supplement through a straw
- have the liquid supplement warm but not boiled (for example, as warm hot chocolate or coffee)
- have the liquid supplement frozen (for example, as ice cream)
- sip the liquid supplement slowly
Side effects
The liquid supplements can have some side effects, particularly in the early stages of taking them. They are listed here.
Hunger
Sometimes, your nutritional needs are higher than we originally calculated. This might mean that you need to have more supplement drinks to stop you feeling hungry. Please tell your dietitian.
Dehydration
People sometimes forget to drink fluids in addition to the liquid supplements. This can lead to dehydration (when your body does not have as much water as it needs).
If you feel dizzy, get headaches or have dark pee (urine), you need to drink extra fluids. Your pee should be straw-coloured.
Bloating or trapped wind
Some people get more bloating or trapped wind in the first few days of taking the liquid supplements. This usually settles within 7 to 10 days. If the symptoms continue, please speak to your dietitian.
Looser poo or urgent feeling to have a poo
A liquid diet may:
- make your poo looser than usual
- give you an increased urgency to go to the toilet for a poo
These symptoms might be caused by drinking your liquid supplements too quickly. Speak to your dietitian if the symptoms continue.
Pain
You can expect your pain to improve on the liquid diet.
Contact your dietitian or gastroenterology team if:
- you find that your pain is getting worse
- the pain prevents you from taking the full amount (volume) of liquid supplement that we have recommended
Headaches and feeling irritable
Headaches and feeling irritable can be a result of caffeine withdrawal.
Here are some tips that may help to avoid caffeine withdrawal headaches and irritability:
Do
- try to reduce how much caffeine you drink during the first week of taking your liquid supplements
- gradually reduce your caffeine during the week if you have more than 1 drink containing caffeine a day
Resource number: 5434/VER2
Last reviewed: October 2024
Next review due: October 2027
A list of sources is available on request.
