The Crohn’s Disease Exclusion Diet (CDED): A Comprehensive Review

[kiny]

I think the positive data for CDED has been weak so far. While CDED is more restrictive, previous studies where a 50% EN and 50% free diet was tried failed.

Still, the idea of only having to consume 50% EN combined with a less restrictive diet is appealing to increase compliance with patients. EN studies are cheap and there are plenty patients willing to try a diet to relieve symptoms, many more studies are being done. This is a good overview so far.

 

[kiny]

 

[Pam.estella]

CDED did NOT work for us. Calpro went from 500-2200 in 3 months - but interestingly it did completely clear a small patch of psoriasis that has never returned.

 

[kiny]

There was a new study in the UAE that showed very low compliance with CDED / EN.

Only 40% of patients could maintain the diet for more than 3 months.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515460/pdf/cureus-0015-00000043970.pdf

Out of the total, 84% of the cohort utilized the CDED, while 16% used EEN.

(3%) could only follow the diet plan for a few days
(19%) were able to follow the plan for one and two months
(40%) were able to follow the diet plan for more than three months
(19%) of patients were able to continue the diet plan for more than one year

The biggest factor for failing the diet was intolerance and difficulty to follow. Other factors were high cost and difficulty to prepare the meals.




It's not that surprising when I think about it. I have been using EN for longer than I can count. If I was allowed to eat 50% of my calories through solid foods, I would surely not maintain my compliance with EN, because cravings for solid foods would return.

The big selling point of CDED is compliance, if it can not increase compliance it is pointless.

The remission data on CDED is still far too weak (I noticed the other day that one study on CDED+EN had abnormally low remission rates for exclusive EN. EN remission rates are generally 80%-90% after 8 weeks, higher in ileal patients. This study had too low remission rates on EEN, which makes me question the compliance of the study subjects and the positive CDED conclusions.).

 

[hh11]

Sharing some personal experience with CDED + PEN.

• I started CDED + PEN back in 2020 when I was first diagnosed. At the time of diagnosis, I had 1700 FCP and 10+ CRP.
• The first 2 week of the diet was quite brutal, I had consistent stomach pains and diarrhea.
• Some time around week 4, it stopped and I felt better.
• I had a FCP test done 6 weeks later, FCP dropped to about 600 levels. CRP normalized.
• I persisted with the diet for about a year, FCP hovered between 300-600. Symptom-wise, I didn't really have much aside from urgency and occassional diarrhea once or twice a day every few weeks or so.
• Started entyvio a year later (early 2022-ish) to see if there are any improvements.
• 6 months later (mid 2022) with entyvio, didn't feel anything, FCP stayed the same.
• Decided to tweak the diet a bit. The CDED diet allows for unlimited amount of white rice, but I read some research on buckwheat and I swapped that out soba noodles. Within a week, the urgency stopped.
• Did a FCP test in July, FCP dropped to 120s.
• Had a colonoscopy in Sep of 2022, attained full mucusal healing. FCP normalized to 80s
• Stopped entyvio around early 2023.
• June 2023, FCP was < 50.
• I decided to travel and live somewhere else for a change. I started eating out with friends almost weekly.
• I noticed some occassional diarrhea (once or twice a month).
• Feb 2024, FCP shot back up to 240.
• No more eating out for some time, back to a more restrictive diet.

I hope my experience helps someone!