Executive summary

What we know

Across paediatric and adult populations with mild-to-moderate Crohn’s disease, the Crohn’s Disease Exclusion Diet (CDED) — often paired with partial enteral nutrition (PEN) — consistently induces clinical remission and can maintain it in a significant proportion of patients. Compared with exclusive enteral nutrition (EEN), CDED-based strategies are generally better tolerated, with higher adherence and comparable or superior sustained remission, while supporting favourable body composition and growth in children.

Why it matters for KLK

CDED provides an evidence-based, whole‑food framework that aligns with our personalised, practical, sustainable ethos. We will apply a CDED‑informed approach for induction and maintenance phases, tailored to symptoms, preferences, and macros, and supported by behaviour‑change coaching.

Evidence timeline

2019

Randomised controlled trial in children comparing CDED + PEN versus EEN for 12 weeks. Tolerance markedly higher with CDED + PEN (97.5% vs 73.6%). Week‑12 corticosteroid‑free remission 75.6% with CDED + PEN vs 45.1% with EEN→PEN. Associated with reductions in CRP, faecal calprotectin and Proteobacteria. Gastroenterology 2019;157:440–450.e8. PMID 31170412.

2021–2022

Open‑label, pilot RCT in adults (CDED‑AD) shows feasibility and efficacy signals for CDED in induction and maintenance in mild‑to‑moderate disease. Lancet Gastroenterol Hepatol 2022;7:49–59. PMID 34739863.

2023

Systematic review of 7 studies (2014–2022) concludes CDED appears effective for induction and maintenance in children and adults with mild‑to‑moderate disease, while calling for larger, well‑designed RCTs. Therap Adv Gastroenterol 2023;16:17562848231184056. PMID 37655057.

2024

Systematic review focused on CDED + PEN vs EEN finds promising remission outcomes with better tolerance and adherence for CDED + PEN across age groups. Nutrients 2024;16(7):987. PMID 38613020.

Comprehensive multidisciplinary review positions CDED as a validated dietary therapy and practical alternative to EEN for many mild‑to‑moderate cases; emphasises dietitian involvement, candidate selection, and long‑term considerations. Inflamm Bowel Dis 2024;30(10):1888–1902. PMID 37978895 (PMCID PMC11446999).

Paediatric RCT of a modified CDED schedule up to week 24 shows high remission rates (70% at week 14; 60% at week 24, ns vs EEN due to underpowering) and significant BMI z‑score improvement in CDED arm. Clin Gastroenterol Hepatol 2024 Dec 26. PMID 39732356.

2025

Adult open‑label RCT comparing CDED with Mediterranean diet reports higher remission rates with CDED at week 12 (70.8% vs 38.1%) and week 24 (79.2% vs 42.9%); fibrinogen lower; fat mass decreased with preservation of fat‑free mass. Eur J Clin Invest 2025;55(6):e14389. PMID 39853756.

What CDED is

CDED is a staged, whole‑food protocol that limits dietary components implicated in dysbiosis and barrier dysfunction (e.g., emulsifiers, maltodextrin, certain additives, ultra‑processed foods) while promoting minimally processed, nutrient‑dense foods. Many protocols pair CDED with PEN (commonly 50% energy for early induction, then 25% for consolidation/maintenance in paediatrics; adult protocols vary), improving nutritional adequacy and adherence.

Induction phase

Goal

Reduce symptoms and inflammatory activity while protecting energy availability and muscle.

Default duration

6–12 weeks, staged (e.g., classic Phase 1 → Phase 2); adults commonly 12 weeks; adapt to response and tolerance.

Nutrition strategy

• Whole‑food meals curated to exclude additives/emulsifiers and ultra‑processed foods.

• Simple cooking methods with ghee for heat and extra virgin olive oil added after cooking.

• Adequate protein distribution across meals to support healing and satiety.

• PEN support where appropriate (e.g., Huel Complete Protein as tolerated) to raise protein/energy, especially in low appetite, high symptom burden, or paediatrics.

• Hydration and electrolytes prioritised; warm herbal infusions preferred over lemon water.

Food architecture

• Lean meats, fish, eggs; well‑cooked, lower‑fibre choices as needed during flares.

• Root veg and peeled/cooked produce; gentle grains and starches as tolerated.

• Exclude/emphasise according to symptom tracking and phenotype (e.g., stricturing).

Behavioural supports

• If–then planning for meal timing, hydration, and pre‑meal breathwork.

• CNS down‑regulation before eating (2–4 mins).

• Simple adherence trackers (daily check‑ins), growth mindset cues, and self‑compassion prompts.

Monitoring

• Symptoms and stool form daily; weight weekly.

• Consider HBI/CDAI where appropriate.

• Labs at baseline and ~8–12 weeks: CRP, albumin, iron panel, B12, folate, Vit D; faecal calprotectin to corroborate response.

Maintenance phase

Goal

Sustain remission, diversify diet, and build resilience while preserving the CDED backbone.

Default duration

12–24+ weeks, stepping down restrictions; structured reintroductions with symptom and marker feedback.

Nutrition strategy

• Gradual widening of tolerated whole foods, with continued avoidance of key additives/ultra‑processed items.

• Consider PEN at ~25% energy in select cases (paediatrics, low BMI, high training load, or relapse risk).

• Emphasise fibre progression to support microbiome diversity when stable.

• Match macros to client goals (e.g., strength, weight restoration, pregnancy prep) within tolerance.

Monitoring

• Quarterly labs or as clinically indicated; periodic faecal calprotectin.

• Review weight, body composition, performance and energy.

• Relapse plan with rapid return to an earlier tolerated phase if needed.

Who it’s for

• Best evidence in mild‑to‑moderate Crohn’s disease (adults and paediatrics).

• Consider in patients preferring dietary therapy, those intolerant to EEN, or as an adjunct to medical therapy.

• Use case‑by‑case in severe, complicated or extraintestinal disease with gastroenterology oversight.

Red flags and cautions

• Rapid weight loss, poor growth, low BMI, eating disorder risk, pregnancy, stricturing disease, significant micronutrient deficiencies, or complex comorbidities warrant modified protocols and medical input.

• Closely supervise paediatric cases; prioritise growth and micronutrient sufficiency.

• Consider interactions with biologics and concurrent therapies; coordinate with the medical team.

Adherence and behaviour change

What improves success

• Collaborative goal setting and mental contrasting with if–then plans.

• Autonomy‑supportive coaching to increase self‑efficacy.

• Normalising lapses; re‑framing setbacks as data.

• Practical food skills, batch‑cooking routines, shopping lists, and travel strategies.

What we measure

• Adherence to phase‑specific rules; meal completion; hydration; symptom curves; energy and mood; readiness markers.

PEN implementation at KLK

• Product choice tailored to tolerance; Huel Complete Protein is our default when a protein powder is used.

• Typical targets: 25–50% of daily energy during induction where indicated, stepping down to ~25% in maintenance for select cases (especially paediatrics or low energy availability).

• Always alongside whole‑food meals and digestive pacing.

How KLK customises CDED

• Phase personalisation

Align restriction level to symptom severity, phenotype, and psychology (e.g., lower‑fibre, low‑histamine variants for active inflammation; reflux‑safe variants).

• Cultural and family fit

Adapt food lists to local cuisines and household patterns; provide swaps and shopping guides.

• Macros and performance

Set protein (often ≥1.6–2.2 g/kg where appropriate), carbohydrate periodisation for training, and sufficient fat for hormones; ensure micronutrient coverage.

• Nervous system care

Embed breathwork, pre‑meal rituals, and stress‑reduction to support the gut‑brain axis.

Limitations and transparency

• Several leading authors have industry links (e.g., Nestlé Health Science); we interpret outcomes with awareness of potential bias.

• Some adult data remain open‑label or pilot; heterogeneity and underpowered samples occur.

• Nonetheless, the converging evidence across RCTs, systematic reviews, and pragmatic studies supports CDED as a credible, evidence‑based option for many.

Client‑facing explainer

The KLK approach to healing Crohn’s with food

We use a CDED‑informed framework that removes common dietary triggers for the gut lining and microbiome, while keeping meals simple, tasty and nourishing. For some clients, we temporarily add a measured portion of a nutrition shake to make sure energy and protein are high enough while symptoms calm down. As you improve, we gradually widen your foods again. This approach is evidence‑based, personalised, and sustainable.

What success looks like

Fewer symptoms, better energy and mood, improved labs (like CRP and faecal calprotectin), and in children, healthy growth.

Slide‑ready bullets

• CDED = whole‑food, additive‑light, microbiome‑supportive

• Strong paediatric RCT data; growing adult RCT data

• Better tolerance and adherence than EEN

• Induction 6–12 weeks, then stepwise maintenance

• PEN 25–50% early, ~25% maintenance in select cases

• Monitor symptoms, CRP, faecal calprotectin, body composition/growth

• Personalise by phenotype, culture, psychology

• Pair with behaviour‑change and CNS regulation

References

• Levine A, et al. CDED + PEN induces sustained remission vs EEN in paediatric CD. Gastroenterology 2019;157:440–450.e8. PMID 31170412.

• Yanai H, et al. CDED‑AD adult pilot RCT. Lancet Gastroenterol Hepatol 2022;7:49–59. PMID 34739863.

• Zhu Z, et al. Systematic review of CDED. Therap Adv Gastroenterol 2023;16:17562848231184056. PMID 37655057.

• Correia I, et al. Systematic review of CDED + PEN. Nutrients 2024;16(7):987. PMID 38613020.

• Sigall Boneh R, et al. Comprehensive review and guidance. Inflamm Bowel Dis 2024;30(10):1888–1902. PMID 37978895 (PMCID PMC11446999).

• Sigall Boneh R, et al. Modified CDED RCT to week 24 (paediatrics). Clin Gastroenterol Hepatol 2024 Dec 26. PMID 39732356.

• Pasta A, et al. Adult open‑label RCT CDED vs Mediterranean diet. Eur J Clin Invest 2025;55(6):e14389. PMID 39853756.

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