Posted by Alexis Fissinger on October 24, 2024
The Crohn’s Disease Exclusion Diet (CDED) is a dietary therapy that may be utilized to help manage some forms of Crohn’s disease. In this post ICN Registered Dietitians give an overview of the CDED, when and how it may be used as part of IBD care, how the diet is structured, and what CDED users can expect to eat and drink when following the diet.
🍎 When (and when not) to consider using the CDED
The CDED may be used as monotherapy (the only intervention) or as complementary therapy (used with medication) in the treatment and management of Crohn's disease. As with IBD medications, dietary therapies may work for some individuals and not for others. It is important to talk with your IBD team about whether the CDED is appropriate for your child or not.
Currently, the CDED is not appropriate to be used as monotherapy in cases of complicated Crohn's disease, has not been studied in ulcerative colitis, and is not recommended for children diagnosed with or at risk for eating disorders.
🍌 How the CDED is set up
The CDED has three phases. Phases 1 & 2 each last for six weeks. Phase 3 is a long-term maintenance phase. Here is an overview of what to expect in each phase of the CDED:
Phase 1 (weeks 1-6) - During the first phase of the CDED, roughly half of a patient's daily nutrition will come from enteral nutrition shakes and the other half will come from a list of mandatory and allowed CDED foods. Enteral nutrition shakes are commercially available, nutritionally-complete and contain vitamins and minerals. Eating out at restaurants is not allowed in Phase 1.
Phase 2 (weeks 7-12) - During phase two, nutrition shakes can often be reduced to 25% of total daily nutrition, as food variety and volume increases. The current version of the CDED includes a list of mandatory foods, allowed foods, and disallowed foods. Eating out at restaurants is not allowed in Phase 2.
Phase 3 (weeks 13+) - During the third phase of the CDED (also known as the maintenance phase), patients will continue eating a personalized selection of allowable foods that work for them, as well as some nutrition shakes (usually 25% or less of total daily nutrition; the exact ratio will vary by individual). In the maintenance phase there are two “free days” per week. On these days, two “free” meals at home or one meal at a restaurant each day is allowed.
🥔 How the CDED works
It is believed that the key to the CDED is the avoidance of, or reduction in, ingredients which may be higher risk for influencing inflammation and undesirable changes in the microbiome. This is why the foods allowed in this diet are primarily made from single, simple ingredients, and why eating out at restaurants is limited to Phase 3, which even then has certain parameters around it.
🍳 CDED foods - an overview
In the CDED, foods are sorted into three main categories: mandatory, allowed, and disallowed. Your IBD dietitian can provide you with a comprehensive list of mandatory, allowed, and disallowed foods for each phase of the CDED. Here's an overview of each food category:
Mandatory foods - these foods must be eaten during Phases 1 and 2 of the CDED. The purpose of including mandatory foods is to ensure patients get enough essential nutrients and are eating dietary components (soluble fiber and resistant starch) which may be beneficial for the gut microbiome. CDED mandatory foods include: fresh chicken breast, eggs, potatoes (cooked and cooled to optimize impact), apples, and bananas.
Allowed foods - these foods are approved to be eaten during the CDED. Allowed foods are eaten in addition to mandatory foods and the amount and variety will increase as one moves through the phases. In addition to ensuring adequate fiber, vitamins, and minerals are supplied in food form, the purpose of allowed foods is to help maintain variety and enjoyment with eating.
Disallowed foods - these foods are essentially everything else outside of the mandatory and allowed foods. More specifically, once Phase 3 has been reached and food options are more liberalized, disallowed foods are identified as frozen doughs, processed meats (such as hot dogs, sausages, bacon, luncheon meats), ready-made meals, and soft drinks.
Stay tuned for our second post, which will have information on tips and tricks for navigating and troubleshooting the Crohn's Disease Exclusion Diet from ICN Dietitians!