Overview
Exclusive enteral nutrition using Modulen IBD
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 about introducing a specialised diet called Modulen® IBD if you have inflammatory bowel disease.
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
Modulen IBD is a vanilla-flavoured powder that can be used to give you exclusive enteral nutrition. It comes in a 400g can with a scoop for measuring. The powder needs to be mixed with water to make a liquid.
The information covers:
- how exclusive enteral nutrition works
- eating other foods while on Modulen IBD
- getting your supply of Modulen IBD
- having fluids
- adding flavour to Modulen IBD
- preparing Modulen IBD
- when to take Modulen IBD
- side effects of Modulen IBD
- how we monitor you while you are on Modulen IBD
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 Modulen IBD takes to work
Most people start to see an improvement within 10 to 12 days. We recommend that you take Modulen IBD for at least 6 weeks to get the most benefit.
Eating other foods while on Modulen IBD
You usually continue to eat food until you can take the fully prescribed amount (dose) of Modulen IBD. 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 Modulen IBD may reduce your appetite. This is normal.
- By day 3, you should get all the nutrients that you need from Modulen IBD only. From this time, you should not eat any other food.
Getting your supply of Modulen IBD
Modulen IBD is available on prescription from your GP. This is the usual process:
- Your dietitian writes to your GP and asks them to prescribe a suitable amount of Modulen IBD 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 Modulen IBD 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 (Modulen IBD can be used as milk)
- 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
Adding flavour to Modulen IBD
Modulen IBD on its own has a slight vanilla flavour. You can add flavour to it if you buy some milkshake flavouring, such as Nesquik®.
The following table gives some flavouring suggestions, based on 210ml of water with 50g (6 scoops) of Modulen IBD. You can add less flavour, depending on the taste:
| Amount to add | Flavouring suggestion |
|---|---|
| 1 heaped teaspoon | Strawberry, banana or chocolate Nesquik |
| Half a heaped teaspoon | Decaffeinated coffee (with the caffeine removed) |
| 4 teaspoons | Monin® gingerbread or cinnamon syrup |
Preparing Modulen IBD
You need to follow these instructions to prepare Modulen IBD:
- Wash your hands and use clean equipment.
- Measure the volume of water needed and pour it into a clean bowl or shaker.
- Using the scoop in the tin, add the number of level scoops needed (make them level with the back of a knife) to the water.
- Stir or shake until the powder is mixed with the water.
- Add the milkshake flavourings, such as Nesquik, and stir or shake until mixed.
Here are some tips when you have prepared the Modulen IBD:
Do
- keep Modulen IBD in the fridge and throw it away if not used within 24 hours
- stir or shake Modulen IBD again when you take it out of the fridge
- serve Modulen IBD chilled
- gently heat Modulen IBD or freeze and serve it as an ice cream if you like (use within 1 month)
Don't
- do not keep Modulen IBD at room temperature for more than 4 hours
- do not boil Modulen IBD
When to take Modulen IBD
There is no specific guide for when you should take Modulen IBD. It is a good idea to:
- spread the amount throughout the day
- take Modulen IBD at your usual eating times
Your dietitian gives you a personalised plan for building up to take the full amount of Modulen IBD over 3 days. However, if you cannot take your Modulen IBD, please talk to your dietitian about this.
Here are some tips for making Modulen IBD easier to prepare and drink:
Do
- drink Modulen IBD chilled
- drink Modulen IBD through a straw
- have Modulen IBD warm but not boiled (for example, as warm hot chocolate or coffee)
- have Modulen IBD frozen (for example, as ice cream)
- use a large shaker and shaker ball whisk
- use a blender
- sip Modulen IBD slowly
Side effects
Modulen IBD can have some side effects, particularly in the early stages of taking it. They are listed here.
Hunger
Sometimes, your nutritional needs are higher than we originally calculated. This might mean that you need to have more Modulen IBD to stop you feeling hungry.
Check first that you are preparing the feed correctly and then talk to your dietitian about this.
Dehydration
People sometimes forget to drink fluids in addition to the Modulen IBD. 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.
Green coloured poo
You may have green coloured poo due to a natural colouring (pigment) present in bile (a yellow-green digestive fluid produced by your liver). This is quite common and not usually a concern.
Bloating or trapped wind
Some people get more bloating or trapped wind in the first few days of taking Modulen IBD. 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 Modulen IBD too quickly. Speak to your dietitian if the symptoms continue.
Pain
You can expect your pain to improve on Modulen IBD.
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 Modulen IBD 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 Modulen IBD
- gradually reduce your caffeine during the week if you have more than 1 drink containing caffeine a day
Resource number: 5435/VER2
Last reviewed: October 2024
Next review due: October 2027
A list of sources is available on request.
