Types of Diets in IBD

Is there a special diet for IBD?

Specific diets and nutritional therapies can help achieve some of the health goals for people with IBD, which include:

  • Maintaining good nutrition for optimal energy and weight

  • Ensuring children are growing and developing in a healthy way

  • Improving quality of life by managing symptoms, such as nausea and cramps

  • Helping to treat inflammation

There is no one special diet for people with IBD, but there are several diets that people commonly experiment with to find what works for them. 
In children, there are two diet options supported by randomized controlled trials: Exclusive Enteral Nutrition and the Crohn’s Disease Exclusion Diet.

For the other diets, there is anecdotal evidence that patients’ experience improvements in their symptoms, but they are not proven to improve inflammation/ulceration of the gut lining. The common theme between them is to eat whole foods and limit processed foods, with some variations.

What works for one person may not work for another. If you are interested in trying a specific diet, work with a healthcare provider so you do not do it alone. You do not have to stick to a specific diet. Trial and error may help you find the best diet for your body. 


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Low FODMAP diet

The low FODMAP diet is a well-known diet to help improve symptoms of IBD and irritable bowel syndrome (IBS), but is not known to help inflammation. Foods containing FODMAPs can trigger symptoms like gas, bloating, diarrhea, and abdominal pain in some people.

Studies suggest following a low FODMAP diet may be useful to manage symptoms of diarrhea in some cases. Studies do NOT show this diet reduces inflammation in IBD.

FODMAP is an acronym that stands for different carbohydrate and sugar alcohols found in foods that ferment in the body. Some FODMAPs are attractive food to bacteria. If the body is not able to digest these carbohydrates in the small intestine, the bacteria in the gut ferments them when they get to the large intestine and generates gas.

The key to this diet is eating less of the foods that ferment in your gut. The fermenting process results in a build-up of gas, which causes discomfort. 

The following acronym depicts foods high in FODMAPs:

  • Fermentable

  • Oligosaccharides: Onions, garlic, wheat, rye, barley, artichokes, beans, and lentils 

  • Disaccharides (Lactose): Milk

  • Monosaccharides And (Glucose & Fructose): Honey and certain fruits, such as apples, pears, and watermelon

  • Polyols: Artificial sweeteners in chewing gum and mints, and certain fruits and vegetables, like mushrooms and cauliflower 

The low FODMAP diet is challenging to follow because of the large amount of foods containing FODMAPs and foods that contain FODMAPs without our knowledge, and could lead to nutritional deficiencies if unsupervised. Work with a dietician to ensure you are following the diet correctly. 

The way the diet works is to eliminate FODMAPs for 6-12 weeks to see if symptoms improve. If they do not change during this period, this diet may not be working for you. After the elimination period, slowly reintroduce the FODMAPs one by one to help identify the trigger. 

In general, FODMAPs are part of a healthy diet. Only lower your FODMAP intake if recommended by your healthcare provider. 

Include:

  • Most fruits and vegetables

  • Meats

  • Grains

  • Nuts and seeds

Exclude: 

  • Vegetables: Onions, garlic, cabbage, broccoli, cauliflower, snow peas, asparagus, artichokes, leeks, beetroot, celery, sweet corn, brussel sprouts, and mushrooms

  • Fruits (“stone fruits” in particular): Peaches, apricots, nectarines, plums, mangoes, apples, pears, watermelon, cherries, and dried fruits

  • Other: Beans and lentils, wheat and rye, lactose, nuts, and sweeteners


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Mediterranean diet

Following a Mediterranean Diet is said to have anti-inflammatory effects and promote heart health. It was developed based on the traditional foods of the Mediterranean, particularly Italy and Greece. While evidence for this diet in the treatment of IBD is lacking, the Mediterranean diet pattern is widely suggested as an ‘anti-inflammatory’ diet and these properties are believed to be derived from the fat content of the diet.

Include:

  • Fruits and vegetables

  • Nuts, seeds

  • Legumes, potatoes and whole gains

  • Fish, seafood, and healthy fats.

  • Eat poultry, eggs, cheese, and yogurt in moderation.

  • Moderate amounts of red wine, coffee, and tea are acceptable. 

Exclude:

  • The focus is on moderation rather than elimination

  • Eat red meat rarely.

  • Do not consume added sugars

  • Processed foods including meat, and refined grains.

​Crohn’s and Colitis Canada funds research that is examining the effect of dietary fats and the Mediterranean diet on managing IBD, please click here to read more about this research.

To learn more about the mediterranean diet and get your questions answered by the experts, click here register for our upcoming virtual gutsy learning series event!


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Specific carbohydrate diet

The Specific Carbohydrate diet is based on the theory that carbs are not digested properly in the body. It excludes most carbs and processed foods, only allowing those that require minimal digestion. The idea is there will not be undigested carbs, therefore eliminating the growth of harmful bacteria in the gut. Following this diet long-term is challenging. Studies do NOT conclusively show this diet reduces inflammation in IBD.

Include:

  • Fresh fruit and most vegetables

  • Fresh meat and fish (without additives)

  • Homemade yogurt and certain cheeses

  • Certain legumes (including dried beans and lentils)

  • Most nuts (including all natural peanut butter) and honey

  • Most oils and white vinegar

  • Teas, coffee, and natural juices

Exclude:

  • All grains and starches

  • Sugars

  • Processed meats

  • Canned vegetables and starchy vegetables (potatoes, yams, parsnips)

  • Some legumes (chickpeas, fava beans, bean sprouts)

  • Dairy products

  • Candy and chocolate

  • Commercial condiments like mayo, ketchup, margarine, and balsamic vinegar


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Paleo diet

The Paleo Diet is inspired by whole foods that would have been eaten during the Paleolithic era when hunting and gathering was the way to find food. Studies do NOT show this diet is effective in IBD.

Include: 

  • Lean meats (especially grass-fed animals or wild game)

  • Fish and seafood

  • Fruits and vegetables

  • Nuts and seeds

  • Healthy fats and oils

Exclude:

  • Grains

  • Legumes

  • Dairy

  • Refined sugar, salt, and processed foods


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Crohn’s Disease Exclusion Diet (CDED)

What is CDED?

The Crohn’s Disease Exclusion Diet is based on excluding elements of the Western diet that are associated with causing inflammation and changing the environment of the gut. It combines whole foods with partial enteral nutrition in two stages the first more restrictive than the second in order to induce remission. The idea is dietary therapy paired with an exclusion diet can play a larger role in disease control.

A recent randomized controlled trial, with support from the IMAGINE Network and Crohn’s and Colitis Canada, has shown the Crohn’s Disease Exclusion diet with partial enteral nutrition is effective to induce remission in children with mild-to-moderate Crohn’s disease and helps maintain remission up to 12 weeks (Van Limbergan, 2019). Studies in adults with Crohn’s disease show promising results, and clinical trials are ongoing. 

Include:

  • Whole foods consisting of fruits, vegetables and meats
  • Complex and simple carbohydrates

Exclude:

  • Animal fats and processed meats
  • Dairy
  • Wheat
  • Sauces, salad dressings, syrups, jams and canned products
  • Dried fruits
  • Packaged snacks (chips, nuts, etc.)
  • All soft drinks, fruit juices, coffee, alcohol
  • Candies, gum, chocolates and other desserts,
  • Certain “gluten-free” products

Watch the video below to learn more from an expert gastroentereologist about the Crohn's Disease Exclusion diet for the management of IBD:

Speaker: 

Dr. Johan Van Limbergen (MD, FRCPCH, PhD), is a clinician-scientist at the Amsterdam University Medical Centres in the Netherlands and previously the Department of Pediatric Gastroenterology & Nutrition, IWK Health Centre at Dalhousie University, Halifax, Nova Scotia.


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