Diet and Nutrition

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. 

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

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!

The Specific Carbohydrate diet is based on the theory that complex carbohydrates (which are essentially long chains of sugar) are not digested properly in the body and poorly absorbed, leading to an increase in harmful bacteria and yeast which may damage the intestine. Therefore, to eliminate the growth of harmful bacteria in the gut, this diet excludes most carbs and processed foods, only allowing those that require minimal digestion. Studies do NOT conclusively show this diet reduces inflammation in IBD. Following this diet long-term is challenging as it limits dairy, fruits and vegetables which can increase your risk of calcium, vitamin A, B, C and D deficiencies. Please consult your healthcare provider before taking on this diet.

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

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

The IBD-AID diet is derived from the specific carbohydrate diet. This diet is unique diet because it doesn’t just list foods into allowed and not allowed categories, but talks about groupings of food as well.

It involves 5 main pillars;

1. Consuming probiotic rich foods regularly: fermented foods that contain probiotics (beneficial bacteria) include yogurt, kafir, kimchi, miso, sauerkraut and honey

2. Increasing intake of prebiotics: these are types of fiber that feed the beneficial bacteria in our gut and include foods like bananas, blueberries, oats, chia and ground flax seeds

3. Avoiding pro-inflammatory carbohydrates: these foods are poorly absorbed in the intestine and can worsen the symptoms of IBD and include foods such as lactose, wheat, refined sugars and corn

4. Maintaining good nutrition: this diet emphasized the importance of soluble fibers and encourages the consumption of lean proteins and healthy fats to maintain a balanced diet

5. Implementing texture modification: this involves having blended or pureed foods when your symptoms are acting up during a flare to build up tolerance to the regular texture of foods as you progress towards remission

The effectiveness of this diet and the way in which it helps those with IBD still remains unknown, which makes recommending it difficult for healthcare providers.

Include: 

• Fresh meat, poultry, eggs, fish

• Fresh fruits and vegetables

• Fats & oils

• Aged cheeses and lactose free yogurt

• Honey

• Lentils, split peas and nuts

• Weak tea or coffee

Exclude: 

• Processed meats (e.g. deli, hotdogs, wings)

• Corn

• Lactose

• Refined sugar

• Wheat

The Gluten-free diet is commonly known to be used as a treatment for those with celiac disease. Individuals diagnosed with celiac disease cannot eat gluten (a type of protein found in wheat, barely and rye) as it triggers their immune response and causes symptoms similar to IBD (abdominal pain and diarrhea). A study published by the reputable Journal ‘Gastroenterology’ confirmed that there is an increased chance of having celiac disease in patients with IBD, therefore, individuals with IBD who are in remission could still be experiencing symptoms caused by their celiac disease.

The gluten-free diet can also be beneficial for individuals with non-celiac gluten sensitivity (NCGS) who show symptoms when they eat gluten even though they are not diagnosed with celiac disease.

This diet does involve low FODMAP consumption and so it is unclear whether the reduction in IBD symptoms is directly related to the avoidance of gluten specifically or if it is the low FODMAP resulting in symptom improvement. Following this diet may put you at risk of inadequate fiber intake, which can potentially worsen colon health, especially since some fibers tend to have an anti-inflammatory benefit.

Include

• Grains and starches free from gluten

• Meat, fish and eggs

• Dairy

• Fruits

• Vegetables

Exclude

• Wheat

• Barley

• Rye

• Derivatives of the above

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.