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Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial (CDED, PEN)

Summary Excerpt: 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. These data support use of CDED plus PEN to induce remission in children with CD.

Gastroenterology. 2019 Aug;157(2):440-450.e8. doi: 10.1053/j.gastro.2019.04.021. Epub 2019 Jun 4
Levine A et al

Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease (AIP)

Summary Excerpt: Dietary elimination can improve symptoms and endoscopic inflammation in patients with IBD. Randomized controlled trials are warranted.

Inflamm Bowel Dis , 23 (11), 2054-2060 Nov 2017
Konijeti GG et al

An Anti-Inflammatory Diet as Treatment for Inflammatory Bowel Disease: a Case Series Report (IBD-AID)

Summary Excerpt: This case series indicates potential for the IBD-AID as an adjunct dietary therapy for the treatment of IBD. A randomized clinical trial is warranted.

Nutr J. 2014 Jan 16;13:5. doi: 10.1186/1475-2891-13-5
Olendzki B et al

Nutritional Therapy in Pediatric Crohn Disease: the Specific Carbohydrate Diet. (SCD)

Summary Excerpt: This chart review suggests that the SCD and other low complex carbohydrate diets may be possible therapeutic options for pediatric Crohn disease. Further prospective studies are required to fully assess the safety and efficacy of the SCD, or any other low complex SCDs in pediatric patients with Crohn disease.

J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):87-91. doi: 10.1097/MPG.0000000000000103.
Suskind DL et al

Exclusive Enteral Nutrition Provides an Effective Bridge to Safer Interval Elective Surgery for Adults With Crohn's Disease (EEN)

Summary Excerpt: Exclusive enteral nutrition frequently down-stages the need for surgery in patients presenting with stricturing or penetrating complications of Crohn's disease; it is associated with a reduction in systemic inflammation, operative times and the incidence of post-operative abscess or anastomotic leak.

Aliment Pharmacol Ther , 45 (5), 660-669 Mar 2017
Heerasing N et al

Dietary Therapy With the Crohn's Disease Exclusion Diet Is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy (CDED)

Summary Excerpt: Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.

J Crohns Colitis , 11 (10), 1205-1212 2017 Oct 1
Sigall-Boneh RS et al

Exclusive Enteral Nutrition Therapy in Paediatric Crohn's Disease Results in Long-term Avoidance of Corticosteroids: Results of a Propensity-score Matched Cohort Analysis (EEN)

Summary Excerpt: These findings suggest that EEN induction therapy is more effective in achieving early remission and is associated with long-term steroid avoidance without increased use of biologics or need for surgery.

J Crohns Colitis , 11 (9), 1063-1070 2017 Sep 1
Connors J et al

Polymeric Diet Alone Versus Corticosteroids in the Treatment of Active Pediatric Crohn's Disease: A Randomized Controlled Open-Label Trial (EEN)

Summary Excerpt: In children with active and recently diagnosed CD, a short course of polymeric diet is more effective than corticosteroids in inducing healing of gut inflammatory lesions.

Clin Gastroenterol Hepatol , 4 (6), 744-53 Jun 2006
Borrelli O et al

The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series (SCD)

Summary Excerpt: Our survey results suggest that SCD can potentially be an effective tool in the management of some patients with IBD and specifically in patients with colonic and ileocolonic CD who made up the majority of our study group. A highly educated group of patients follow the SCD; all but one of the adults in our study had a college or graduate degree. Our results also suggest that in some patients with moderate to severe disease who follow this diet, discontinuation of immunosuppressive agents has been feasible.

J Acad Nutr Diet. 2015 Aug;115(8):1226-32. doi: 10.1016/j.jand.2015.04.016
Kakodkar S et al

Date Title Diets Authors Summary Excerpt Citation
Aug 2014 Partial Enteral Nutrition With a Crohn's Disease Exclusion Diet Is Effective for Induction of Remission in Children and Young Adults With Crohn's Disease CDED, PEN Sigall-Boneh R et al Dietary therapy involving PEN with an exclusion diet seems to lead to high remission rates in early mild-to-moderate luminal Crohn's disease in children and young adults. Inflamm Bowel Dis , 20 (8), 1353-60 Aug 2014
Oct 2017 Dietary Therapy With the Crohn's Disease Exclusion Diet Is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy CDED Sigall-Boneh RS et al Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation. J Crohns Colitis , 11 (10), 1205-1212 2017 Oct 1
Oct 2020 Effectiveness of Mediterranean Diet's Adherence in children with Inflammatory Bowel Diseases MED Strisciuglio C et al Children with IBD in remission have a sub-optimal food intake compared to HCs. MD seems to correlate to decreased intestinal inflammation. Nutrients . 2020 Oct 20;12(10):3206. doi: 10.3390/nu12103206.
Nov 2016 Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease SCD Suskind DL et al Individuals perceived clinical improvement on the SCD. Four percent reported clinical remission prior to the SCD, while 33 % reported remission at 2 months after initiation of the SCD, and 42 % at both 6 and 12 months. For those reporting clinical remission, 13 % reported time to achieve remission of less than 2 weeks, 17 % reported 2 weeks to a month, 36 % reported 1-3 months, and 34 % reported greater than 3 months. For individuals who reported reaching remission, 47 % of individuals reported associated improvement in abnormal laboratory values. Dig Dis Sci. 2016 Nov;61(11):3255-3260. Epub 2016 Sep 16
Feb 2018 Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease SCD Suskind DL et al SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD. J Clin Gastroenterol. 2018 Feb;52(2):155-163. doi: 10.1097/MCG.0000000000000772.
Jan 2014 Nutritional Therapy in Pediatric Crohn Disease: the Specific Carbohydrate Diet. SCD Suskind DL et al This chart review suggests that the SCD and other low complex carbohydrate diets may be possible therapeutic options for pediatric Crohn disease. Further prospective studies are required to fully assess the safety and efficacy of the SCD, or any other low complex SCDs in pediatric patients with Crohn disease. J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):87-91. doi: 10.1097/MPG.0000000000000103.
Dec 2020 The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn's Disease: A Randomized Diet Controlled Trial SCD, mSCD Suskind DL et al This study emphasizes the impact of diet in CD. Each diet had a positive effect on symptoms and inflammatory burden; the more exclusionary diets were associated with a better resolution of inflammation. Nutrients . 2020 Dec 6;12(12):E3749. doi: 10.3390/nu12123749
Apr 2019 Treatment of Active Crohn's Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition CD-TREAT Svolos V et al CD-TREAT replicates EEN changes in the microbiome, decreases gut inflammation, is well tolerated, and is potentially effective in patients with active CD. Gastroenterology . 2019 Apr;156(5):1354-1367.e6. doi: 10.1053/j.gastro.2018.12.002. Epub 2018 Dec 11.
Mar 2020 Partial Enteral Nutrition Induces Clinical and Endoscopic Remission in Active Pediatric Crohn's Disease: Results of a Prospective Cohort Study PEN Urlep D et al The results of our prospective pilot study suggest that PEN, allowing one meal from AID, could be as effective as EEN in inducing clinical and endoscopic remission in children with active CD. However, larger randomized controlled studies are warranted to confirm our findings. Eur J Pediatr . 2020 Mar;179(3):431-438. doi: 10.1007/s00431-019-03520-7. Epub 2019 Nov 28.
Sep 2017 Lack of Mucosal Healing From Modified Specific Carbohydrate Diet in Pediatric Patients With Crohn Disease mSCD Wahbeh GT et al All subjects reported no active symptoms before repeat endoscopic evaluation on mSCD, the majority had consistently normal C-reactive protein, albumin and hematocrit assessments, and mildly elevated fecal calprotectin (>50 μg/g, median 201, range 65-312) at any point within 3 months before the repeat endoscopy. One patient showed complete ileocolonic healing but persistent upper gastrointestinal tract ulceration. Complete macroscopic mucosal healing of both the ileocolon and upper gastrointestinal tract was not seen in any patient. J Pediatr Gastroenterol Nutr. 2017 Sep;65(3):289-292. doi: 10.1097/MPG.0000000000001619.
Jun 2014 Analysis of Gut Microbiome and Diet Modification in Patients with Crohn's Disease SCD Walters SS et al Changes in the composition and complexity of the gut microbiome were identified in response to specialized carbohydrate diet. The SCD was associated with restructuring of the gut microbial communities. SOJ Microbiol Infect Dis. 2014;2(3):1-13. doi: 10.15226/sojmid/2/3/00122. Epub 2014 Jun 27.
Nov 2021 The Crohn's disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn's disease (CDED-AD): an open-label, pilot, randomised trial CDED Yanai, H. et al. CDED with or without partial enteral nutrition was effective for induction and maintenance of remission in adults with mild-to-moderate biologic naive Crohn's disease and might lead to endoscopic remission. Lancet Gastroenterol Hepatol. 2021;S2468-1253(21)00299-5. doi:10.1016/S2468-1253(21)00299-5

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