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Crohn's Disease Exclusion Diet

Nutritional Therapy Support for Patients with Crohn's Disease or Ulcerative Colitis


Crohn's Disease Exclusion Diet

Section Introduction and Contents

Learn more about the CDED

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Crohn's Disease Exclusion Diet Introduction

The CDED is a whole foods diet designed to exclude or limit exposure to foods that may adversely affect the microbiome or alter intestinal barrier function (Levine A et al) (Sigall-Boneh et al). The CDED is initiated in three phases and is always combined with Partial Enteral Nutrition (PEN) from formula (Modulen IBD®) in declining amounts, with the last stage maintaining 25% of daily intake from PEN. In patients unwilling to use Exclusive Enteral Nutrition, CDED is an effective alternative for inducing remission (Sigall-Boneh et al), and it may provide a more effective option than standard PEN for maintaining it. The CDED is more recently created for Crohn's disease in 2013 and has been researched in small populations of both children and adults with Crohn's disease with its first publication in pediatric Crohn's disease in 2014. See CDED publications on the NTforIBD website for a listing of the research on CDED.

CDED Food List Overview

The food list provided is a simplistic overview of the basic requirements of the diet, offering a bird's eye view of restricted and allowed foods. It is not an all-inclusive list of the allowed and restricted foods, nor does it define all the rules of the diet. This list should NOT be used as a guide to following the diet.

The CDED is managed a little differently from the other diets. The CDED is divided into three phases. The first two 6-week phases are grouped together as the Induction Phase, which is used for inducing remission. The first six-week phase of the Induction Phase limits insoluble fiber to prevent bowel obstructions. The second 6-week phase adds back in many of those vegetables by week 10. The Induction Phase is the most important phase of the diet and is required for efficacy. The Maintenance Phase is used after remission is achieved and is intended to sustain that remission. However, the principles of the diet are best represented by the Induction Phase, with the Maintenance Phase opened up to include some foods not recommended in order to promote better long-term compliance if necessary. The published studies to date primarily evaluate the Induction Phase, so the scientific evidence is strongest at this time for the Induction Phase and is in progress for the Maintenance Phase. However, a patient may like to know what the diet may look like long term, so it was decided that the most complete picture would be provided by showing data for both the Induction Phase and the Maintenance Phase separately. The Maintenance Phase requires five contiguous days following the diet as written, then allows for a maximum of two contiguous days (generally weekends) that allow two free meals per day (maximum of four free meals per week), excluding only hot dogs, sausages, soft drinks, luncheon meats, bacon, and frozen dough from those free meals. Those free meals are not included in the table.

CDED Food Table

Food Table for Induction Phase

Fish

Weeks 1-6: 1 portion lean fish per week
After week 6: 1 can tuna per week

Red Meat (not processed)

1 portion of lean steak per week after week 6 (not recommended)

Wheat/Gluten

1 slice whole grain bread allowed per day after week 6

Corn

Allowed after week 10

Oats

1/2 cup dry oatmeal per week allowed after week 6 (gluten-free oats preferred but not mandatory)

Rice

Unlimited rice and rice flour or noodles are allowed

Dried Legumes/Beans

1/2 cup dry beans/legumes allowed per day after week 6

Fresh Legumes/Beans

Allowed after week 10

Starchy Vegetables (potatoes, sweet potatoes, yams, turnips, parsnips, etc)

Weeks 1-6: Potatoes only allowed
Weeks 7-9: Potatoes, sweet potatoes, and yams allowed.
Weeks 10-12: Allowed

Nightshades (tomatoes, tomatillos, white potatoes [not sweet potatoes], eggplant, peppers, goji berries, etc)

Weeks 1-6: Tomatoes and Potatoes allowed.
Weeks 7-9: Red Peppers also allowed.
Weeks 10-12: Allowed

Honey

Max 3 TBSP per day

Eggs

Allowed (mandatory: 2 per day)

Formula (PEN; eg, Boost®, Ensure®, Pediasure®, Modulen IBD®)

Allowed (recommended)

Poultry

Fresh chicken breast only (mandatory)

Grains other than wheat, corn, oats, and rice, which are listed separately

Quinoa allowed after week 6

Vegetables other than starchy vegetables and nightshades, which are listed separately

Weeks 1-6: Cucumbers, carrot, spinach, lettuce allowed in limited quantities. Onion, garlic, ginger allowed.
Weeks 7-9: Add zucchini, mushrooms, broccoli, cauliflower
Weeks 10-12: All veggies allowed except kale, leeks, asparagus, and artichoke.

Fruits

Weeks 1-6: Bananas, apples, avocado, strawberries, melon, orange juice in limited quantities, lemon juice (fresh squeezed) as a condiment allowed.
Weeks 7-10: Pears, peaches, kiwis, and blueberries are also allowed.
Weeks 11-12: Mangos, pineapples, and oranges are also allowed.

Nuts

8 almonds or walnuts allowed per day after week 6.

Sweeteners other than honey and artificial sweeteners, which are listed separately

Allows refined sugar (4 tsp per day max)

Fats/Oils

Only olive oil and canola oil allowed

Seafood other than fish, which is listed separately

Excluded

Processed Meat

Exclude

Dairy

Exclude

Seeds

Exclude

Artificial Sweeteners

Exclude

Processed Foods/Preservatives/Artificial Additives

Exclude

Cocoa

Exclude

Coffee

Exclude

Alcohol

Exclude

Emulsifiers

Exclude

Food Table for Maintenance Phase

Fish

One portion of lean fish or other seafood per week, 1 can tuna per week

Seafood other than fish, which is listed separately

1 portion of seafood or lean fish per week, 1 can tuna per week

Red Meat (not processed)

1 portion of lean steak per week only

Wheat/Gluten

2 slices whole grain bread allowed per day (1 cup cooked pasta may be substitued for bread twice per week)

Corn

Allowed

Oats

1/2 cup dry oatmeal allowed per week (gluten-free oats preferred but not mandatory)

Rice

Unlimited rice and rice flour or noodles are allowed

Dried Legumes/Beans

1 1/2 cup dry beans/legumes allowed per day

Fresh Legumes/Beans

Allowed

Starchy Vegetables (potatoes, sweet potatoes, yams, turnips, parsnips, etc)

Allowed

Nightshades (tomatoes, tomatillos, white potatoes [not sweet potatoes], eggplant, peppers, goji berries, etc)

Allowed

Honey

Max 3 TBSP per day (no limit on weekends)

Eggs

Allowed

Cocoa

Allowed

Coffee

Allowed: Black coffee allowed (any coffee allowed on weekends)

Formula (PEN; eg, Boost®, Ensure®, Pediasure®, Modulen IBD®)

Allowed

Poultry

Chicken allowed (no wings or skin)

Grains other than wheat, corn, oats, and rice, which are listed separately

Allows quinoa

Vegetables other than starchy vegetables and nightshades, which are listed separately

No Leeks, Celery, or Large Amounts of Kale

Fruits

No persimmons, pomegranate, cactus fruit, passion fruit

Dairy

1 yogurt allowed per day (other dairy on weekends)

Nuts

8 almonds or walnuts allowed per day

Sweeteners other than honey and artificial sweeteners, which are listed separately

Allows refined sugar (4 tsp per day max; unlimited on weekends)

Fats/Oils

Only olive oil and canola oil allowed

Alcohol

1 cup of wine or beer allowed on weekends

Processed Meat

Exclude

Seeds

Exclude

Artificial Sweeteners

Exclude

Processed Foods/Preservatives/Artificial Additives

Exclude

Emulsifiers

Exclude

EEN
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