A Potential New Dietary Therapy For Crohn’s Disease
Dr. Emma Halmos shares details on the emerging Crohn’s Disease Exclusion Diet and its future potential for managing Crohn’s.
About the Author
Dr. Emma P. Halmos is an Accredited Practising Dietitian and works with the Department of Gastroenterology at both The Alfred Hospital and Monash University in Melbourne
The first known diet therapy to treat active Crohn’s disease was exclusive enteral nutrition (EEN), which induces remission in up to 80% of patients.
Unfortunately, this process of removing all food and replacing it with a liquid nutritional formula for 6-8 weeks is difficult and strict adherence is key for the treatment to be effective. Furthermore, ongoing EEN is unrealistic, so this treatment is not used to maintain remission. Alternative dietary therapies with good evidence for inducing and possibly maintaining remission are needed.
Paediatrician and researcher Dr Arie Levine together with colleagues from Israel have developed a diet called the Crohn’s Disease Exclusion Diet (CDED) and assessed its potential to treat Crohn’s in a controlled trial of children with mild to moderate Crohn’s. The trial showed that CDED combined with partial enteral nutrition (PEN) for six weeks was similar to EEN in gut healing but when CDED and PEN was extended to 12 weeks, remission was maintained whereas many people lost remission if they started eating freely after the usual 6 week EEN program.
This study has indicated that CDED with PEN may be a suitable replacement for EEN and its extended use may maintain remission.
The diet involves eating five foods daily, claiming to provide fibre and starches that are thought good for gut health, while removing certain food components thought bad for the gut.
While more varied than EEN, the CDED is very restrictive and does require the use of PEN to ensure nutritional adequacy. The idea is that the diet may become less restrictive in time under dietitian guidance, but how this impacts on Crohn’s activity is unknown.
Additionally, due to the very strict nature of the diet, we do not know the specific food components involved in Crohn’s activity, or whether it is effective in adults, but we are one step closer to a potential targeted diet for treatment as research continues.
The CDED should be completed in conjunction with a gastroenterologist and dietitian well versed in the diet to ensure that it is applied appropriately and that overall health, including response to medications and nutritional adequacy are not compromised.