The Crohn’s Disease Exclusion Diet – a promising new therapy
By Dr Emma P. Halmos
| About the Author Accredited Practising Dietitian, Department of Gastroenterology, The Alfred Hospital & Monash University, Melbourne VIC 3004 |
Historically, diet was always dismissed as a therapy for Crohn’s disease, until the emergence of exclusive enteral nutrition (EEN), a six-week diet comprising only of liquid nutritional supplements. EEN has been proven many times to induce remission in up to 80% of patients with Crohn’s disease and launched a pivotal change to our view of diet. No longer could it be argued that diet had no bearing on disease activity, but replacing food with a synthetic meal replacement gave no clues as to what food components would drive or alleviate intestinal inflammation. Furthermore, living on nothing but supplements for six weeks is an extremely “unfriendly” treatment, so adherence is generally poor, particularly amongst adults.
While our understanding about the specific food components and how they affect IBD is being investigated, one priority is to offer a better dietary treatment than EEN. So, the race was on to find a more attractive alternative to EEN and to prove its benefit in a human trial. The first such diet was developed by a paediatric group in Israel, called the Crohn’s Disease Exclusion Diet (CDED) and the results of their first trial were published last year.
Phases one and two were assessed in a trial of children with mildly active Crohn’s disease in comparison to EEN and showed to be equivalent in treating mild Crohn’s disease on both symptoms and markers of inflammation. This study showed promise for another dietary option to EEN that may be easier to adhere to, albeit still a difficult dietary treatment with rigid rules.
The CDED has not yet been formally investigated in adults, as a stand-alone therapy without PEN or for moderate to severe disease, so caution must be taken in applying it in these circumstances. Furthermore, its impact on nutritional markers are unknown, so EEN may still be more suitable in some situations, such as in those who have planned surgery, where EEN can reduce disease activity as well as improve surgical recovery.
Since publication of the CDED, gastroenterologists and dietitians have been using it with our Crohn’s disease patients and have developed a feel for the practical pros and cons of the diet. Unlike EEN, the CDED is better equipped to satisfy hunger, gives the feeling of being adequately full and does not seem to cause constipation, which is a common side effect of EEN.
Conversely, the limited foods allowed on the CDED can cause difficulties, particularly for families, who may have to cook and eat two different meals. The CDED may also not be an option in someone who already restricts foods that are allowed on the CDED as the use of substitutions have not been assessed. As with any dietary treatment, discussion between patient, gastroenterologist and dietitian of CDED is necessary to ensure careful assessment, application and monitoring of health outcomes.
We know that holistic care can have a huge and positive impact on people living with and managing their Crohn’s disease or ulcerative colitis. However, research shows that access to allied health professionals is low, with fewer than 1 in 3 patients having a dietitian as part of their treatment team*.
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