Crohn's Disease Exclusion Diet

[paulk]

Professor Arie Levine from Wolson Medical Center in Israel discussing the diet:



Link to the currently recruiting study:
https://clinicaltrials.gov/ct2/show/NCT02843100
Previously completed trial (12-week prospective trial of children with mild to moderate CD)
https://www.ncbi.nlm.nih.gov/pubmed/31170412

CDED plus PEN was better tolerated than EEN in children with mild to moderate CD. Both diets were effective in inducing remission by week 6. The combination CDED plus PEN induced sustained remission in a significantly higher proportion of patients than EEN, and produced changes in the fecal microbiome associated with remission.

I spent lots of time searching, but it is almost impossible to find any documentation with details about the composition of the diet. Strangely enough a patent was submitted for the diet (currently pending) and information was disclosed:
https://patents.google.com/patent/US20170119037A1/en
The diet consists of two stages. The first one lasting 6 weeks, and the second stage continuing for another 6.

Week 1-6 weeks

Meat /Protein
*Fresh chicken breast or fresh fish (no seafood) - unlimited quantities. Patients should have one or the other at least once daily, but can consume these more than once a day. (Smoked, canned, precooked or processed chicken breast or fish are not allowed).

Fresh Unprocessed beef lean steak (lean meat such as sirloin) -may be consumed up to once a week (up to 200 grams) from week 4. Pre-prepared ground beef is not allowed, but lean steak can be ground by the butcher or at home in to ground beef without additives. Beef is optional, and cannot replace chicken or fish.

*2 Eggs day (all patients should consume 2 eggs/day)

Carbohydrates
White Rice (unlimited quantities)
Rice Noodles without preservatives (one portion per day)
*2 fresh Potatoes (peeled).Frozen potatoes are not allowed. Only one potato can be consumed at any given meal. 8 baby potatoes can be used as an alternative.

Fresh Fruits and Vegetables
2 tomatoes, or 6 cherry tomatoes, 2 cucumbers (peeled), 1 carrot if no stricture is present. If a stricture is present carrot shavings are allowed, fresh spinach (1 cup uncooked leaves), 1 apple (peeled - if no tight stricture), *2 bananas (please consume 2 bananas/day), 1 avocado (the avocado should not be consumed all at once, and may be consumed over two meals ), 5 strawberries, 1 slice melon

Allowed Condiments for cooking:
Olive oil (unlimited), canola oil (unlimited), salt, pepper, paprika, cinnamon stick fresh herb leaves (mint leaves, oregano, coriander, rosemary, sage, basil, thyme, parsley, dill remove stalks if they are going to be eaten, stalks may remain if used just for cooking.), fresh onion, garlic and ginger, fresh carrot shavings for salad, rice or soup, true honey for cooking (do not consume too frequently, we recommend up to 3 tablespoons a day), table sugar (3 teaspoons day for cooking or tea), fresh lemons for juice or zest

Beverages
Water, Soda, herbal teas prepared from fresh leaves (please note that slices of lemon, lime, orange or mint leaves may be added for taste) [195] One glass of freshly squeezed orange juice daily (not from cartons or bottles)

Forbidden foods:
Dairy products of any kind, margarine, wheat, breakfast cereals, breads and baked goods of any kind, yeast for baking, granola, power bars or granola bars, gluten free products not listed above, soy products, potato or corn flour, corn, frozen vegetables, frozen fruits, processed or smoked meats and fish (sausages, luncheon meats, salamis, fish sticks), sauces, salad dressings, syrups and jams of any kind ( mayonnaise, ketchup, mustard, thousand island dressing, chile sauce, tabasco , steak sauce, curry sauce, tomato paste, canned products and dried fruits, packaged snacks (potato chips, pretzels, popcorn, nuts etc), all soft drinks, fruit juices and sweetened beverages, vitamin waters, wines, beers, alcoholic beverages, coffee, frozen drinks, smoothies at restaurants or stores, candies, chocolates, cakes, cookies and chewing gum, artificial sweeteners, vinegars, mixed spices, curry or tomato pastes, nuts.

Weeks 7-12 weeks

Meat /Protein
Like in weeks 1-6 with the addition of one small can of Tuna (packed in oil) twice a week

Carbohydrates
Like in weeks 1-6 with the addition of:
From week 8 one slice whole grain bread
Quinoa

Vegetables
Like in weeks 1-6 with the addition of:l cup Lettuce, 1/2 red bell pepper, 4 fresh mushrooms, 1 zucchini, 2 small pieces of broccoli. From week 8 additional vegetables such as beets, squash, cabbage, cauliflower can be gradually added as substitutes for the new vegetables mentioned above.

Fruit
Like in weeks 1-6 with the addition of exchanges ( 1 pear, nectarine, kiwi, or peach instead of apple, blueberries instead of strawberries), continue to consume 2 bananas per day

Legumes:
(lentils, dry chickpeas), Canned legumes are not allowed.

Nuts:
6 whole Almonds (unsalted unprocessed) or 6 walnut halves (unsalted unprocessed).

Allowed Condiments for cooking:
Like in weeks 1-6 with the addition of fresh carrot shavings for salad, rice or soup

Beverages
Like in weeks 1-6.

Forbidden foods and Ingredients
Like in weeks 1-6.

 

[asadmom]

You know what I don't like is the amount of white rice this diet consumes. Maybe it's totally fine but it's just the polar opposite of SCD.

Rice is bad, rice is excellent... what?

I seriously cannot believe two proposed diets for Crohn's run opposite of each other.

Did you end up trying it? How are you doing?

 

[Pangolin]

Rice has been a particularly safe food in our experience.

 

[Scipio]

I seriously cannot believe two proposed diets for Crohn's run opposite of each other.

I can believe it, because results of dietary choices in Crohn's is such a variable and individual thing. Reading this board will show you over and over that dietary items that soothe (or inflame) the gut in one Crohn's person often work just the opposite in someone else. You gotta find what works for you.

 

[asadmom]

I can believe it, because results of dietary choices in Crohn's is such a variable and individual thing. Reading this board will show you over and over that dietary items that soothe (or inflame) the gut in one Crohn's person often work just the opposite in someone else. You gotta find what works for you.

We can't really know for sure if certain foods are causing problems internally unless we do some type of testing. This is all very complex with like 1000 variables.

In addion, een using drinks that combine all the illegal foods in a 8oz bottle actually help a good number of people according to the research. We probably still have the diet thing wrong.

 

[asadmom]

https://clinicaltrials.gov/ct2/show/NCT04225689

 

[asadmom]

https://bmcgastroenterol.biomedcent...rganic&utm_campaign=twitter_2021_bmcseries is

 

[jadegreen]

No, I don't think we have the diet thing wrong, exactly. I think that there are different mechanisms that cause EEN and special diets to work--many of the drugs on the market work for many people, and they also operate through different pathways.

What I think we are missing here, in my opinion, is that Crohn's disease may not really be one disease. It could be several diseases that just look the same on a scope. My diagnosis is stricturing Crohn's, but I have never had diarrhea problems that most people with Crohn's talk about. I tend to lean the opposite direction.

So do I have the same disease, really, as someone who struggles with diarrhea? My diagnosis says that I do, but I have to eat loads and loads of fiber every day to keep things moving. I also seem to need lots of milk kefir to keep it all moving, maybe I have a problem with lack of good bacteria in my gut? It's hard to say.

 

[jadegreen]

I have looked at the Crohn's disease elimination diet pretty closely, because the nutritionist I worked with suggested it. Honestly, when I compare SCD to CDED, I see a lot of overlap, not a lot of differences. They don't really have you eating all that much rice or oats, it seems to me that the CDED approaches a few grains as pre-biotics, which lines up with my own experience from the last several months: eat some prebiotic foods (I try to eat two cups of blueberries every morning) and mix it or chase it with kefir and things go well for me.

Disclaimer: I haven't had a colonoscopy since my diagnosis almost a year ago due to my current pregnancy, but my BMs are generally good and I feel generally good. So that's some progress on those fronts, if nothing else.

The advantage of the SCD in particular is that is is MORE limited, so you can get a start controlling more of the variables in the beginning, and drinking lots of bone broth ought to stop diarrhea in the first few days for most people. You can add things back to your diet later (I think people tend to wait 6 mos to a year), one at a time, and see how things go.

 

[asadmom]

I have looked at the Crohn's disease elimination diet pretty closely, because the nutritionist I worked with suggested it. Honestly, when I compare SCD to CDED, I see a lot of overlap, not a lot of differences. They don't really have you eating all that much rice or oats, it seems to me that the CDED approaches a few grains as pre-biotics, which lines up with my own experience from the last several months: eat some prebiotic foods (I try to eat two cups of blueberries every morning) and mix it or chase it with kefir and things go well for me.

Disclaimer: I haven't had a colonoscopy since my diagnosis almost a year ago due to my current pregnancy, but my BMs are generally good and I feel generally good. So that's some progress on those fronts, if nothing else.

The advantage of the SCD in particular is that is is MORE limited, so you can get a start controlling more of the variables in the beginning, and drinking lots of bone broth ought to stop diarrhea in the first few days for most people. You can add things back to your diet later (I think people tend to wait 6 mos to a year), one at a time, and see how things go.

Our doc told me last week that just because the blood test report comes out fine it doesn't mean the internal is fine, which, is so depressing. I stared at him for a bit trying to process, another, new piece of information. The conclusion is if the blood test is not fine then something is wrong, guaranteed. If you feel fine, something might still be wrong or growing internally. If the blood test report is fine, same conclusion.

Let me tell ya...

 

[jadegreen]

Yeah I know, it's a lot of info to take in. I figure if I'm having good BMs every day and I'm not in pain, then I'm at least doing okay, and will have a colonoscopy again when I can. I mean, I lived not knowing I had Crohn's for decades (there were signs I didn't recognize), so I'm not gonna worry about it for now. And even tho blood lab tests aren't as good as imaging, they aren't completely useless. They do tell you some of what is going on.

I realize, though, that things feel different when you are thinking about your child, tho. My oldest has EOE (which is chronic inflammation of the esophagus) and, where he is now, I'm not worried, but there have been periods of worry that I've had to work through.

 

[jadegreen]

Oh, and calprotectin too, that's a pretty good indicator, even if it's still not as great as imaging.