The Crohn’s Disease Exclusion Diet (CDED)

28 Aug

The Crohn’s disease exclusion diet (CDED) is an established dietary therapy for induction of remission in children and adults. This diet excludes foods that increase inflammation and negatively impact the gut lining. It also includes a set list of mandatory foods foods that can promote gut healing and positively influence the gut microbiome.

The positives of the CDED include:

It has been shown to be as effective as medication treatments (without the side-effects)
It’s associated with mucosal healing
It works quickly
It improves nutritional status
It improves bone health
It supports growth and development
It does not have side-effects like steroid medications

Why not just follow an Exclusive Enteral Nutrition (EEN) plan?

EEN consists of solely consuming nutritionally complete supplement formulas/drinks for 6-8 weeks. It also has great results in active Crohn’s disease.
The CDED is just as effective as EEN in inducing remission in mild-to-moderate active Paediatric Crohn’s disease, however it is a lot better tolerated and easier to follow because you still get to eat foods.

What are the goals of the CDED?

Disease remission, gut healing and improvement in gut symptoms.
Allows for the consumption of healthy foods from different food groups.
It supports growth (Paediatric patients) and lean body mass:

It provides enough macro (carbs, fats, proteins) and micronutrients (vitamins and minderals) to maintain good nutrition.

It’s more enjoyable than just EEN, due to more variety, mouthfeel, tastes and textures.

When is it appropriate to use the CDED?

According to the research, the Crohn’s Disease Exclusion Diet (CDED) has shown its greatest effectiveness in pediatric patients with mild to moderate, uncomplicated Crohn’s disease, particularly those who are relatively new to treatment. This diet is most beneficial for those with active inflammation, usually in cases involving the ileum or ileocolon. Recent research indicates that similar results can be expected in adult patients as well.

When is it not appropriate to use the CDED?

Severe Disease
Extraintestinal manifestations, perianal disease, abscess, fistula
Strictures
Severe malnutrition
ARFID and eating disorders
Other times, case-by-case

The CDED includes 3 Phases

It is important that you work through the different phases with your Dietitian.

Phase 1

This is a 6 week treatment for active Crohn’s inflammation.
It involves a combination of drinking nutrition supplements plus a specific diet.
Nutritionally complete formula/drinks should provide 50% of total calorie intake.
The specific diet includes:

5 Mandatory foods that ensure high quality nutrition as well as support changes in the bacteria of the gut. The mandatory foods include high quality lean proteins, resistant starch and fibre.

Allowed foods: to offer necessary nutrition and promote growth and development
Excluded/avoid foods: to prevent inflammatory processes and negative changes in the gut microbiome.

Phase 2

This follows phase 1, and is for weeks 7-12
It also involves a combination of drinking nutrition supplements + a specific diet, however the diet is expanded.
Nutritionally complete formula/drinks should provide 25% of total calorie intake.
5 Mandatory foods (as above).
Allowed foods - expanded list of foods.

Additional fruits and vegetables allowed for weeks 7-9 and others allowed starting week 10.

Phase 3

This is the maintenance phase.
Nutritionally complete formula/drinks should provide 25% of total calorie intake.
Mandatory foods - are encouraged however there is more flexibility here.
Potentially harmful foods should be limited/avoided
Goals:

Weekdays (or 5 days/week) - maintain phase 2 diet, including additional foods.
Weekends (or 2 days/week) - 2 additional “free meals” are allowed. These ideally should be home made.

Conclusion of the CDED

High quality evidence has shown clear benefits for the use of the CDED to induce remission in children and adults with mild to moderate Crohn's Disease. It is however important to remember that this treatment option is not for everyone. It can be hard to follow, as it is restrictive. It also requires a bit of time for planning and preparing the particular foods.

Research shows that the likelihood of success patients get from this diet depends on them working with a trained Dietitian.

References

Inflammatory Bowel Diseases, 2023, XX, 1–15, https://doi.org/10.1093/ibd/izad255

J. Clin. Med. 2023, 12, 5428. https://doi.org/10.3390/jcm12165428

Journal of Gastroenterology and Hepatology 39 (2024) 446–456