Exciting News in Nutrition Therapy for Crohn’s Disease
Emerging evidence supports the use of a new diet therapy plan, the Crohn’s Disease Exclusion Diet (CDED), as a primary treatment of mild to moderate Crohn’s disease. In the last twenty years, research in diet and Crohn’s disease has increasingly implicated the Westernized diet or Standard American Diet (SAD) as a factor in the development of Crohn’s Disease (CD). Research on the role diet therapy has after diagnosis has been underwhelming.
Diet is acknowledged as an adjunct therapy in the management of CD in adults and has mainly focused on eliminating foods to minimize symptoms during active disease flares. The reduction of insoluble fiber, concentrated sweets, high fat, caffeine/alcohol and sugar alcohols are frequently recommended. However, there is a need for a complete management strategy to tackle the complexity of CD, particularly in adults.
Exclusive enteral nutrition (EEN) is a treatment with one hundred percent of nutritional needs being provided by liquid formula with intake of no solid food for eight to twelve weeks. EEN is a well-established therapy that induces remission in up to 75-80% of children with newly diagnosed CD. The role of EEN in the management of adult patients with active CD is evolving. Although high-quality studies are limited, EEN may be as effective as corticosteroid therapy for induction of remission in adults with CD. EEN improves nutrition status, promotes bowel wall healing and favorably changes the gut microbiota in people with CD. In the US, EEN is used as a short-term treatment of CD and there is no strategy to maintain remission after successful EEN therapy. Compliance to an eight to twelve-week course of EEN can be challenging and has contributed to poorer results in adult studies. Research shows that a diet combination of partial calories from formula (PEN) and continued intake of the SAD does not induce remission in CD. Additionally, research shows return to SAD diet after remission using EEN quickly results in return of increased pro-inflammatory markers associated with active disease.
The Crohn’s Disease Exclusion Diet (CDED), which combines a specific PEN formula with a defined whole food diet is a new therapy proven not only to induce disease remission but also for long term management of CD. The design of the CDED is to exclude components of the Western diet that negatively impact intestinal wall health and microbiome. Mandatory foods with soluble fiber and resistant starch are included to restore intestinal health and meet nutritional needs. The diet includes three phases with increasing food choices at each of the phases. The third phase allows 2 days with unrestricted intake of more liberal food choices thus making it appealing as a more sustainable diet treatment option.
Emerging evidence supports the use of the CDED as a primary treatment strategy. One recent study showed that the CDED was better tolerated than EEN in children and adolescents with mild to moderate CD. Both diets were effective in inducing remission by the sixth week. The CDED induced sustained remission in a significantly higher proportion of patients than EEN, and produced positive changes in the gut’s microbiome that are associated with remission. Another smaller study demonstrated that diet therapy based on the CDED may restore remission in adults and children who fail common medications know as biological therapies. These authors concluded that the use of dietary therapy, such as the CDED should be considered in this population.
The diet should be undertaken only with the guidance of a Registered Dietitian – Nutritionist who is a certified trained CDED expert. This expert will guide you through the three phases, while ensuring adequate nutrient consumption to promote desired outcomes such as disease remission, growth, weight gain, increase in lean body mass, and nutrient repletion. Your CDED expert will continue to provide updated information to the IBD community as research continues on the use of this exciting new treatment option.
Gina Barbetta MS, RD, CD-N is a Registered Dietitian – Nutritionist with over 25-years of experience. She is the owner of Nourish by Gina, LLC. Gina is a certified trained CDED expert. She uses an integrative, personalized approach to manage adult and pediatric nutrition issues. For further information call 203.206.3873. Telehealth Available. Most insurances accepted. Katherine Vance RD, CNSC is a Registered Dietitian – Nutritionist with extensive experience in pediatric nutrition care. She is employed at Connecticut Children’s Medical Center in the Department of Pediatric Gastroenterology.