Determining the feasibility of the use of the Crohn’s Disease Exclusion Diet (CDED) in adults with Crohn’s disease: A Pilot Study

Crohns Disease Exclusion Diet (CDED). In summary the diet involves the consumption of whole foods but reduces exposure to dietary components that have been shown to induce a flare. The whole foods are also combined with partial enteral nutrition (PEN), or drinks that will supplement the macro & micro nutrients missing from the diet. The main food groups excluded are, gluten, wheat, dairy products, some animal fat, processed meats, emulsifiers, canned foods, soft drinks, alcohol & and coffee. With the inclusion of resistant starch and pectin fibres. The CDED involves 3 phases over 12+ weeks. A dietitian will conduct all education sessions with the participants. They will receive education on all 3 phases of the diet and information pertaining to the PEN. The education will be given to the patient before the commencement of phase 1 - they will be educated on all 3 phases in one sitting. The sessions will take approx. 1hr. Phase 1 (6 weeks) is 50% CDED mandatory & allowed foods+ 50% Partial Enteral Nutrition (PEN). Phase 2 (6 weeks) will be commenced and education provided. Phase 2 is 75% CDED mandatory & allowed foods+ 25% Partial Enteral Nutrition (PEN). The PEN will be provided to the participants free of charge. Nutricia Australia will provide 142 cartons of ‘Fortisip’ (200ml bottles) to the study in four different flavours (vanilla, chocolate, strawberry & banana). The participants will be allowed to taste test each flavour and are able to pick as many flavours as they choose to complete the study. The participants will each be assigned a specific number of ‘Fortisip’ (200ml bottles) that will individually suit their calculated nutrition requirements. The ‘Fortisip’ supplements (200ml bottles) are nutritionally complete, medical grade oral nutrition supplements that can be consumed as a sole source of nutrition if required. As per the Nestle Modulife CDED Program & DECCAN Clinical Practice Toolkit8, Phase 3 (Maintenance Phase) has limited evidence related to maintaining a restrictive diet in the long term. The participants will be advised to gradually re-introduce their usual diet. They will be educated on maintaining a healthy, well-balanced diet in line with the Australian Guide to Healthy Eating. The participants will be advised to continue avoiding processed foods including processed meats, soft drink, ultra-processed foods and excessive caffeine and alcohol. At the end of each review a supplement stocktake will be completed to compare the number of ‘Fortisip’ supplements (200ml bottles) consumed to the volume of supplements the participant should be drinking (i.e. as calculated) to manage reports of over/under reporting. After weeks 1,2,6,8 &12 of the diet a review will be conducted to assess 24hr recall (i.e. dietary intake), gastrointestinal symptoms using the Gastrointestinal Symptom Scale, and compliance to the diet using the Medication Adherence Rating Scale.