Crohn’s disease is a chronic inflammatory condition of the bowel that often begins in childhood or adolescence. Diet is believed to play an important part in the development of this disease.

Modern ultra-processed foods contain emulsifiers, maltodextrins, excess animal fats, and other additives that can weaken the intestinal barrier and feed pro-inflammatory bacteria.

Eliminating these dietary triggers is the foundational concept behind the traditional use of exclusive enteral nutrition (EEN) - a liquid-based diet usually followed for 6–8 weeks. While EEN has been shown to be as effective as steroids in inducing remission, it can be very difficult to tolerate, may require nasogastric (NGT) tube feeding, and is typically not feasible beyond the induction phase. 

Medications such as immunosuppressants and biologic agents are very effective, but they can have side effects. Furthermore, in New Zealand, access to biologic agents, although improving, is still somewhat limited.

One dietary approach that has shown promising results is the Crohn’s Disease Exclusion Diet (CDED). Developed in Israel, CDED is a structured, whole-food diet designed to reduce gut inflammation by removing specific foods believed to damage the intestinal lining or support harmful bacteria. Compared to EEN, CDED is often easier to follow, as it allows some real food, making it more acceptable to children and their families.

CDED consists of three phases:

1. Phase 1 (weeks 0–6): A strict exclusion phase combined with a polymeric formula (e.g., Fortisip, Ensure). This phase eliminates processed foods, animal fats, dairy, and gluten. Approved foods include chicken, potatoes, rice, bananas, and apples.

2. Phase 2 (weeks 7–12): Gradual reintroduction of certain foods while continuing partial formula intake.

3. Phase 3 (maintenance): A long-term plan that expands dietary variety while continuing to avoid key trigger foods.

Does It Work?

Yes!CDED is now recommended by both European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and European Crohn’s Colitis Organization (ECCO) in their paediatric nutrition guidelines as an evidence-based alternative to EEN for induction, and a promising option for maintenance.

• 2019 landmark RCT: Children treated with CDED + partial enteral nutrition (PEN) achieved the same week-6 remission rates as those on EEN, with better adherence, improved weight gain, and fewer relapses by week 12.

• 2024 multicentre RCT: After just two weeks of EEN, switching to CDED maintained remission in 75% of children at 24 weeks. This group showed significantly better growth and quality-of-life outcomes than those who continued on formula alone.

• Real-world cohort: A 2024 Italian study found that CDED + PEN was effective in newly diagnosed and biologic-refractory children. Early symptom response predicted remission at week 6.

Adults too: A pilot trial found that CDED, with or without PEN, induced and maintained remission in biologic-naïve adults with mild to moderate Crohn’s disease - suggesting its benefits extend beyond paediatrics.

Is It Right for My Child?

CDED is a medical diet and should only be followed under the supervision of a paediatrician or paediatric gastroenterologist and a specialist dietitian. It is not appropriate for every child, and in some cases, medications may still be required.

However, for many, CDED offers a powerful tool for:

• Induction of remission (as an alternative to EEN, steroids, or biologic agents)

• Maintenance treatment and complementary therapy alongside medication to manage symptoms and improve quality of life.

References

1. Levine A et al. Crohn’s Disease Exclusion Diet plus Partial Enteral Nutrition Induces Sustained Remission in a Randomised Controlled Trial. Gastroenterology. 2019.

2. Sigall-Boneh R et al. Modified CDED Maintains Remission in Paediatric Crohn’s Disease: RCT.Clin Gastroenterol Hepatol. 2024.

3. Scarallo L et al. Real-life Paediatric Experience of CDED at Disease Onset and in Refractory Patients. J Pediatr Gastroenterol Nutr. 2024.

4. Correia I et al. Is There Evidence of CDED in Remission of Active Disease? Nutrients. 2024;16(7):987.

5. Sigall-Boneh R et al. CDED for Induction and Maintenance in Adults: Pilot Randomised Trial. Lancet Gastroenterol Hepatol. 2022.