Picture of many different type of healthy fruits and vegetables

The diet has a crucial role in modulating intestinal inflammation and the risk of inflammatory bowel disease, so the avoidance and/or reduction of proinflammatory foods is considered a good practice for disease prevention.

An illustration of how food might cause Crohn's disease

The CDED is a diet which exclude or limit exposure to foods that may negatively affect the microbiome or alter intestinal barrier function. The CDED is divided into three phases and they all include Partial Enteral Nutrition (PEN) from formula and mandatory foods to ensure high quality nutrition and changes in the bacteria of the gut: high quality lean protein, resistant starch and fibre. The diet includes a list of foods that need to be avoid to prevent inflammatory process.

FOODS TO AVOID/LIMITS

  • High fat
  • Animal fat
  • Red meat
  • Soy
  • Dairy
  • High sugar
  • Low resistant starch
  • Low fibre
  • Gluten
  • Insoluble fibre
  • Artificial sweeteners
  • Emulsifiers
  • Carrageenan
  • Taurine
  • Alcohol
  • Sulfites
  • Titanium dioxide (E171 additive)
  • Maltodextrins
  • Yeast

PHASE 1 AND 2

Phase 1 is weeks 0-6

  • Complete nutrition formula/shake should constitute 50% of total energy intake
  • 5 mandatory foods
  • List of allowed foods

Phase 2 is weeks 7-12

  • Complete nutrition formula/shake should constitute 25% of total energy intake
  • 5 mandatory foods
  • Expanded list of foods
  • Additional fruits and vegetables allowed for weeks 7-9 and others allowed starting week 10

PHASE 3

Maintenance

  • Complete nutrition formula/shake should constitute 25% of total energy intake
  • There are no mandatory foods, however, potentially harmful foods should continue to be limited or avoided
  • Goal is to maintain phase 2 diet with additional foods 5 days per week
  • Allowed 2 homemade “free” meals 2 days per week (some allowance for restaurant meals)
  • There are few foods not allowed at all

Food groups

  Mode of introduction

Protein

  • Fresh chicken breast 5 oz or more (mandatory food) included in all phases of the diet, other chicken parts except wings, skin, and internal organs allowed in stage 3.
  • Eggs 2 per day (mandatory food) included in all phases of the diet.
  • Fresh fish 1 serving once weekly to substitute for serving of chicken included in all phases of the diet.
  • Tuna canned in olive or canola oil twice weekly allowed in phase 2 and 3.
  • Fresh seafood or salmon 1 serving allowed once weekly in phase 3.
  • Lean beef steak (such as sirloin) 6 oz once weekly. Allowed in phase 2 and 3, however, recommended to avoid if possible.
  • Almonds or walnuts, unprocessed, unroasted, unsalted, 6-8 per day allowed in phase 2 and 3.
  • Raw tahini, free from preservatives and sulfites, 2 tablespoons per day allowed in phase 2 and 3.

Dairy

  • Yogurt, natural, unprocessed, full fat, without additives, 1 serving allowed daily in phase 3.

Legumes/beans

  • Lentils, beans, peas, chickpeas, dried, 1⁄2 cup (uncooked), not frozen or canned allowed in phase 2 and 3.

Fats/oils

  • Olive oi, avocado oil and canola oil allowed in all phases.

Fruits

  • Banana, 2 daily (mandatory) allowed in all phase.
  • Apple, 1 peeled (for first 6 weeks) and cooked daily (mandatory) allowed in all phases.
  • Avocado, 1 per day (1/2 per meal) allowed in all phases.
  • Strawberries, 5 per day allowed in all phases.
  • Melon (cantaloupe or honey dew), 1 slice allowed in all phases.
  • Orange juice, freshly squeezed 1 glass per day allowed in all phases.
  • Pear, kiwi, and peach, allowed in phase 2 and 3.
  • Blueberries, 10 as a substitute to strawberries allowed in phase 2 and 3.
  • Mango, pineapple, oranges, 1⁄2 cup cubes allowed after week 10.
  • Other fruits allowed in phase 3 except pomegranate, permission, cactus, and passion fruit.

Vegetables

  • Potatoes, 2 peeled (for the first 6 weeks), cooked, and refrigerated per day (mandatory) allowed in all phases.
  • Tomatoes, 2 allowed daily in all phases.
  • Carrots, 2 peeled allowed in all phases.
  • Spinach, fresh, uncooked 1 cup allowed in all phases.
  • Lettuce, 3 leaves allowed in all phases.
  • Sweet potato or yam, 1⁄2 substitute for potato allowed in phase 2 and 3.
  • Zucchini (1 large or 2 small), 4-6 mushrooms, 2 flowerets of broccoli or cauliflower (not at the same time) are allowed in phase 2 and 3.
  • Other vegetables allowed after week 10 except kale, leeks, asparagus, and artichoke.

Starches/grains

  • Rice, unlimited, including rice flour and rice noodles allowed in all phases.
  • Quinoa, unlimited allowed in phase 2 and 3.
  • Oatmeal, 1⁄2 cup allowed in phase 2 and 3.
  • Bread, homemade made with baking powder instead of yeast, 1 slice per day allowed in phase 2 and 2 slices allowed in phase 3.
  • Pasta, 1 cup cooked as a substitute for bread allowed in phase 3.

Other

  • Pure spices allowed in all phases.
  • Fresh herbs allowed in all phases.
  • Water and sparkling water allowed in all phases.
  • Herbal teas.
  • Honey, 3 tablespoons per day allowed in all phases.
  • Table sugar, 4 teaspoons per day allowed in all phases.
  • Onions, garlic, ginger, and fresh lemon juice allowed in all phases.
  • Baking soda and baking powder allowed in phase 2 and 3.

Bibliography

  1. Arie Levine et al. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology. 2019 Aug;157(2):440-450.e8. doi: 10.1053/j.gastro.2019.04.021. Epub 2019 Jun 4. PMID: 31170412 DOI: 10.1053/j.gastro.2019.04.021
  2. Rotem Sigall Boneh et al. Dietary Therapy With the Crohn’s Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy. J Crohns Colitis. 2017 Oct 1;11(10):1205-1212. doi: 10.1093/ecco-jcc/jjx071. PMID: 28525622 DOI: 10.1093/ecco-jcc/jjx071.
  3. Jennifer Smith, MS, RD, CSP, LD, LMT. Introduction to Crohn’s Disease Exclusion Diet. ANHI Abbot Nutrition Health Institute.
  4. Chun-Han Lo et al. Dietary Inflammatory Potential and Risk of Crohn’s Disease and Ulcerative Colitis. CLINICAL—ALIMENTARY TRACT| VOLUME 159, ISSUE 3, P873-883.E1, SEPTEMBER 01, 2020. Published:May 07,2020DOI:https://doi.org/10.1053/j.gastro.2020.05.011