Special IBD Diets

Your diet can be helpful in managing your inflammatory bowel disease (IBD) during flares and periods of remission. Your healthcare team, including a registered dietitian specializing in IBD, may recommend a particular diet based on your symptoms.

While several specialized diets may be helpful for some IBD patients, no one plan has been proven to prevent or control IBD with the exception of enteral nutrition, which is delivered in a nutrient-rich formula.

Specialized IBD diets are often debated in the medical community because they don’t work in every case and can be restrictive, which may lead to weight loss or malnutrition. The best diet is one that meets your individual nutritional needs and helps you manage your IBD symptoms.

 

This list is not comprehensive, and there are several studies of various diets that are ongoing. Many of these dietary plans are focused on inducing remission while some include maintaining remission. Long term, most of these approaches involve reintroduction of foods that are rich in vitamins, minerals, and other nutrients. It is important to keep in mind that these diets may require changes based on the individual patient and nutrition-related factors.

The Crohn’s & Colitis Foundation is providing information for educational purposes. Diets are listed in alphabetical order, and are not listed in order of preference. Do not attempt one of these diets until you discuss a plan with your doctor or registered dietitian.

 

Anti-inflammatory diet (IBD-AID)

Research has shown that IBD patients have an imbalance of gut bacteria, which contributes to inflammation.  The IBD-AID was developed to restore balance between helpful and harmful bacteria while promoting good nutrition. It incorporates features of the Specific Carbohydrate Diet by avoiding certain carbohydrates (examples) and adding more prebiotic (promotes growth of beneficial organisms) and probiotic (contains microorganisms) foods to improve the gut microbiome. It is designed to be implemented in phases which involves progressing the texture of food.

References

Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr J. 2014 Jan 16;13:5. doi: 10.1186/1475-2891-13-5.


Autoimmune protocol diet (AIP)

The AIP diet focuses on staged elimination of grains, legumes, nightshade vegetables (tomatoes, eggplants, potatoes, peppers) , sugar (refined sugars), dairy, eggs, nuts, seeds, and processed foods. The diet focuses on nutrient dense foods, lean protein, fruits and vegetables, and is adjusted to as needed.The goal is to reduce dietary factors that contribute to dysbiosis (imbalance of microbiota in the gut), inflammation, and food intolerance. The protocol also emphasizes improving other lifestyle factors, including sleep, stress, physical activity, and social connection.

References

  1. Konijeti GG, Kim N, Lewis JD, Groven S, Chandrasekaran A, Grandhe S, Diamant C, Singh E, Oliveira G, Wang X, Molparia B, Torkamani A. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Nov;23(11):2054-2060. doi: 10.1097/MIB.0000000000001221.
  2.  Chandrasekaran A, Groven S, Lewis JD, Levy SS, Diamant C, Singh E, Konijeti GG. An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct;1(3):otz019. doi: 10.1093/crocol/otz019. Epub 2019 Aug 7.
  3. Chandrasekaran A, Molparia B, Akhtar E, Wang X, Lewis JD, Chang JT, Oliveira G, Torkamani A, Konijeti GG. The Autoimmune Protocol Diet Modifies Intestinal RNA Expression in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct;1(3):otz016. doi: 10.1093/crocol/otz016. Epub 2019 Jul 12.

Crohn's Disease Exclusion Diet (CDED)

The CDED is a whole foods diet designed to limit or exclude foods that may negatively affect the gut microbiome, inflammation, and the intestine’s ability to absorb nutrients or other functions. CDED excludes wheat, dairy, animal fat, additives, processed foods, and red meat. It includes readily available foods such as fruits, vegetables, rice, potatoes, lean meats, and eggs. In order to achieve energy needs and provide an extra supply of protein, calcium, and vitamin D it is recommended, in practice, to combine the diet with a variable amount of a formula as partial enteral nutrition (PEN).

The diet is set in three phases designed to gradually reintroduce diversified foods, provides progressively greater flexibility and improved quality of life. In phase 1, PEN comprises 50% of your calories during the first 6 weeks, decreasing to 25% of your calories over the following 6 weeks. After 12 weeks, there is a maintenance phase, where additional foods are included in the diet, the formula is maintained at 25% or adapted levels recommended by your specialized doctor or dietitian.

CDED has been shown to induce clinical remission and mucosal healing in pediatric and adult Crohn's disease.

Clinical studies using Modulen IBD® as PEN show that CDED + PEN was as effective as the current EEN standard in achieving remission, but the CDED + PEN was better tolerated and superior for sustaining remission.

To learn more about the diet  you may visit the ModulifeTM website. Once you click on the link to this app, you will be leaving the Crohn’s & Colitis Foundation website.

 

Be sure to discuss this diet further with your gastroenterologist, and IBD-specialized dietitian.

References
  1. Levine et al., Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial Gastroenterology, 2019;157:440-450.
  2. Szczubelek et al, Effectiveness of Crohn’s disease exclusion diet for induction of remission in Crohn’s Disease Adult Patients, Nutrients. 2021;12:4112.
  3. Yanai et al., 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, randomized trial, The Lancet. 2022;7:48-59.
  4. Matuszczyk  et al., Effect of the Crohn’s Disease Exclusion Diet (CDED) on the Fecal Calprotectin Level in Children with Active Crohn’s Disease, J. Clin. Med. 2022, 11, 4146
  5. Agrawal et al., Approach to the management of recently diagnosed inflammatory bowel disease patients: A user’s guide for adult and pediatric gastroenterologists, Gastroenterology. 2021;161:47-65

CD-TREAT diet 

The CD-TREAT diet is an anti-inflammatory whole foods-based diet designed to recreate the effects of exclusive enteral nutrition (EEN) by using whole foods (foods that are not prescribed formulas). This diet involves eliminating certain complex carbohydrates (gluten, lactose, alcohol) while increasing specific fruits, vegetables, and proteins.

References

Svolos V, Hansen R, Nichols B, Quince C, Ijaz UZ, Papadopoulou RT, Edwards CA, Watson D, Alghamdi A, Brejnrod A, Ansalone C, Duncan H, Gervais L, Tayler R, Salmond J, Bolognini D, Klopfleisch R, Gaya DR, Milling S, Russell RK, Gerasimidis K. Treatment of Active Crohn's Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology. 2019 Apr;156(5):1354-1367.e6. doi: 10.1053/j.gastro.2018.12.002. Epub 2018 Dec 11.

 

Exclusive Enteral Nutrition (EEN) 

Exclusive enteral nutrition, or EEN, means you receive all of your calories through a special nutrition formula and you do not eat regular food.  “Enteral” means passing through the intestines and these liquids contain all the proteins, carbohydrates, fats, minerals and vitamins necessary to sustain you. EEN has been proven to induce remission in children with Crohn’s disease, and is a popular pediatric therapy in Western Europe. EEN may also help to improve response rates for IBD patients already on biologic therapy. More recently it was compared to the CDED + PEN, as described above. 

Another important role for enteral nutrition is in the perioperative setting, to help improve surgical outcomes for patients with IBD. In these studies, a diet of EEN prior to surgery can be associated with improved nutritional status, reduced length of surgery, and lower rate of complications such as infection.

For patients interested in pursuing a formula-based diet, it is especially important to partner with a registered dietitian to help ensure adequate nutrient intake and monitor tolerance. For more information on enteral nutrition visit: www.crohnscolitisfoundation.org//diet-and-nutrition/nutritional-support-therapy

References

  1. Hirai F, Takeda T, Takada Y, et al. Efficacy of enteral nutrition in patients with Crohn's disease on maintenance anti-TNF-alpha antibody therapy: a meta-analysis. J Gastroenterol 2020:55(2):133-41. Doi:10.1007/s00535-019-01634-1. 
  2. Abdalla S, Benoist S, Maggiori L, et al. Impact of preoperative enteral nutritional support on postoperative outcome in patients with Crohn’s disease complicated by malnutrition. Colorectal Dis 2021:23:1451-62. Doi:10.1111/codi.15600.
  3. Meade S, Patel KV, Luber RP, et al. A retrospective cohort study: Pre-operative oral enteral nutritional optimisation for Crohn's disease in a UK tertiary IBD Centre. Aliment Pharmacol Ther 2022:56:646-63. Doi:10.1111/apt.17055.
  4. Heerasing N, Thompson B, Hendy P, et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease. Aliment Pharmacol Ther 2017:45:660-69. Doi:10.1111/apt.13934.

 

Low-FODMAP diet 

FODMAP is an acronym for Fermentable, Oligo-, Di-, Monosaccharides and Polyols. The language may sound complicated, but it is a diet that cuts back on a group of fibers and sugars that can be poorly absorbed by your GI tract. This includes foods containing fructose, lactose, sugar polyols (sorbitol and mannitol), fructans (found in garlic, leeks, artichokes, and wheat), and galacto-oligosaccharides (found in lentils, chickpeas, and green peas).

A low-FODMAP diet is meant only for short-term use and it may be recommended to help reduce your IBD symptoms. Research hasn’t yet shown it to reduce IBD inflammation.

References

  1. Cox SR, Lindsay JO, Fromentin S, Stagg AJ, McCarthy NE, Galleron N, Ibraim SB, Roume H, Levenez F, Pons N, Maziers N, Lomer MC, Ehrlich SD, Irving PM, Whelan K. Effects of Low FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized Trial. Gastroenterology. 2020 Jan;158(1):176-188.e7. doi: 10.1053/j.gastro.2019.09.024. Epub 2019 Oct 2.
  2.  Bodini G, Zanella C, Crespi M, Lo Pumo S, Demarzo MG, Savarino E, Savarino V, Giannini EG.
  3. A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease. Nutrition. 2019 Nov-Dec;67-68:110542. doi: 10.1016/j.nut.2019.06.023. Epub 2019 Jul 1.

 

Mediterranean diet

This diet is rich in fiber and plant-based foods, including olive oil, low-fat dairy, herbs, and spices. There is little to no red meat in this diet, while poultry, eggs, cheese, and yogurt are recommended in moderation. 

*For Crohn’s disease patients with mild-to-moderate symptoms, a Mediterranean style diet and the Specific Carbohydrate Diet™ (see below for more detailed description of this diet) appeared to similarly improve symptoms, inflammation, and quality of life over the course of 12 weeks, according to a study published in Gastroenterology and funded by the Crohn’s & Colitis Foundation and the Patient-Centered Outcomes Research Institute (PCORI). A more recent study of patients with Crohn’s disease and ulcerative colitis found the Mediterranean diet improved nutritional status, IBD activity, inflammatory markers and quality of life over six months. At this time, based on the best available data, the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) recommends a Mediterranean-style diet for patients with IBD. 

References 

  1. Lewis JD, Sandler RS, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson JS, Suskind DL, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen BL, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn's Disease. Gastroenterology. 2021 Sep;161(3):837-852.e9. doi: 10.1053/j.gastro.2021.05.047. Epub 2021 May 27.
  2. Levine A, Rhodes JM, Lindsay JO, et al. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology: the Official Clinical Practice Journal of the American Gastroenterological Association 2020:18(6):1381-92. Doi:10.1016/j.cgh.2020.01.046. 
  3. Chicco F, Magrì S, Cingolani A, et al. Multidimensional Impact of Mediterranean Diet on IBD Patients. Inflamm Bowel Dis 2020:27(1):1-9. Doi:10.1093/ibd/izaa097.

 

Specific Carbohydrate Diet (SCD) 

The SCD limits or totally excludes grains, fiber, and certain sugars, with the idea that undigested starch products may trigger changes in intestinal bacterial growth and inflammation. The SCD eliminates all refined and processed foods (e.g. processed meats, artificial sweeteners), along with soy, lactose, sucrose, and grains. Certain vegetables are also taken out of the diet, including potatoes, okra, and corn. This diet can cause your body to run low on B vitamins, calcium, vitamin D, and vitamin E, and may lead to weight loss, so stay in close contact with your healthcare team to make sure you remain nutritionally healthy. As mentioned above, the SCD appears to be as effective as the Mediterranean diet for symptoms and inflammation in IBD, but the SCD is more restrictive.

References

  1. Lewis JD, Sandler RS, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson JS, Suskind DL, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen BL, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn's Disease. Gastroenterology. 2021 Sep;161(3):837-852.e9. doi: 10.1053/j.gastro.2021.05.047. Epub 2021 May 27.
  2.  Suskind DL, Lee D, Kim YM, Wahbeh G, Singh N, Braly K, Nuding M, Nicora CD, Purvine SO, Lipton MS, Jansson JK, Nelson WC. The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn's Disease: A Randomized Diet Controlled Trial. Nutrients. 2020 Dec 6;12(12):3749. doi: 10.3390/nu12123749.
  3.  Suskind DL, Cohen SA, Brittnacher MJ, Wahbeh G, Lee D, Shaffer ML, Braly K, Hayden HS, Klein J, Gold B, Giefer M, Stallworth A, Miller SI. Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease. J Clin Gastroenterol. 2018 Feb;52(2):155-163. doi: 10.1097/MCG.0000000000000772.

Semi-vegetarian diet

The Semi-Vegetarian diet includes eggs, yogurt, fruit, vegetables, legumes, brown rice, miso, and pickled vegetables, along with the occasional glass of milk and green tea. This diet calls for limited animal proteins—fish once a week and meat just once every two weeks. 

References

Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010;16(20):2484-2495. doi:10.3748/wjg.v16.i20.2484

 

Ulcerative colitis exclusion diet (UCED) with or without fecal microbiota transplantation

The UCED is a two-stage diet that limits animal fats and sulfated amino acids, and has been suggested to improve symptoms in patients with mild-to-moderate UC. Interestingly, a recent trial called CRAFT UC compared UCED with or without fecal microbiota transplantation (FMT) in adults with UC. They found that UCED alone achieved higher remission and mucosal healing rates compared to FMT with or without dietary modification. At this time FMT is allowed by the FDA only for patients with C. difficile infection not responsive to standard therapies.

References:

  1. Sarbagili-Shabat C, Albenberg L, Van Limbergen J, et al. A novel UC exclusion diet and antibiotics for treatment of mild to moderate pediatric ulcerative colitis: a prospective open-label pilot study. Nutrients 2021:13:3736. Doi:10.3390/nu13113736.
  2. Levine A, Scaldaferri F, Sarbagili Shabat C, et al. OP01 Comparison of fecal transplantation, fecal transplantation with the novel UC diet or the UC diet alone for Refractory Mild to Moderate Active Ulcerative Colitis: The CRAFT UC randomized controlled trial. Journal of Crohn's and Colitis 2021:15(Supplement 1):S001. doi:10.1093/ecco-jcc/jjab165. 
  3. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-regarding-investigational-new-drug-requirements-use-fecal-microbiota-0

 

Talk to your healthcare professional or a registered dietitian if you don’t believe your relationship with food is in a healthy place. Implementing one of these diets could be more harmful than helpful when not done with the guidance of your healthcare team. It’s important to work with your healthcare team to determine the diet which is best for you. 

Related Resources