Nutrition Interventions for IBD: Crohn’s Disease and Ulcerative Colitis

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic autoimmune condition characterized by inflammation of the gastrointestinal tract. At GI for Kids,  a combination of medications and nutrition intervention is typically used to treat IBD. In recent years, nutrition has been increasingly recognized role in managing symptoms, supporting healing, and improving overall quality of life.

Importantly, nutrition in IBD is not a one-size-fits-all approach. Research continues to evolve, and dietary recommendations have changed significantly over time—often leading to confusion due to conflicting advice. Understanding the current evidence can help guide more personalized and effective nutrition strategies.

How Nutrition Impacts Healing in IBD

Nutrition influences IBD through several key mechanisms:

1. Modulating Inflammation

Certain dietary patterns can either promote or reduce inflammation. Diets high in ultra-processed foods, additives, and saturated fats are associated with increased inflammation, while whole-food-based diets may help reduce it.

2. Supporting the Gut Microbiome

Diet directly affects the composition of gut bacteria. Many therapeutic diets aim to restore balance in the microbiome, which plays a role in immune regulation and intestinal health.

3. Promoting Mucosal Healing

Specific nutrition therapies—such as exclusive enteral nutrition—have been shown to reduce intestinal inflammation and promote healing of the gut lining, particularly in Crohn’s disease.

4. Preventing Malnutrition

Malnutrition is common in IBD due to decreased intake, malabsorption, and increased nutrient needs. Monitoring and correcting deficiencies (e.g., iron, vitamin B12, vitamin D) is a critical part of care.

General Nutrition Guidelines for Reducing Gut Inflammation

While no single diet works for everyone, several broad principles are consistently recommended:

• Emphasize whole, minimally processed foods when available
• Include a variety of fruits and vegetables (as tolerated – during acute flare ups, fruits and vegetables may be tolerated better if they are peeled, cooked or blended)
• Choose lean proteins (fish, poultry, plant-based options)
• Limit or avoid excess sugar. carbonated drinks, caffeine, and spicy foods
• Reduce red and processed meats, particularly in ulcerative colitis

During disease flares, temporary adjustments—such as reducing fiber or choosing softer foods—may help manage symptoms, though these restrictions are typically not needed long term.

Specific Diet Interventions in IBD

A variety of dietary approaches have been studied in IBD. Each has different goals, levels of evidence, and practicality. Some of these diets are specifically recommended to start at the time of diagnosis. If you are interested in more information before you are able to see the Registered Dietitian, please reach out to Madden Wilson, RD at GI for Kids.

It should also be noted that these diets are not required in the treatment for IBD. A less aggressive nutrition intervention may be recommended for patients who are very picky eaters, have many food allergies, or have certain lifestyle considerations.

1. Exclusive Enteral Nutrition (EEN)

• Liquid formula used as the sole source of nutrition, typically for 4-8 weeks
• Evidence shows this diet can help to induce remission, particularly in Crohn’s disease
• Can reduce inflammation and promote mucosal healing
• Can be a difficult diet to follow due to restrictiveness, cost

2. Crohn’s Disease Exclusion Diet (CDED)

• Combines partial enteral nutrition with whole foods
• Eliminates certain dietary components thought to trigger inflammation
• Diet becomes more liberalized over 3 phases

3. Specific Carbohydrate Diet (SCD) & IBD-AID

• Focus on eliminating certain carbohydrates to alter the microbiome
• Some patients report symptom improvement
• Evidence is still limited and mixed
• Diet can be very restrictive

4. Mediterranean Diet

• Rich in fruits, vegetables, whole grains, and healthy fats
• Associated with reduced inflammation and improved overall health
• Commonly recommended for long-term disease management

5. Low-FODMAP Diet

• Reduces fermentable carbohydrates
• Helpful for managing IBS-like symptoms (bloating, gas, discomfort) in IBD
• Not shown to reduce underlying inflammation

Why Diet Recommendations Can Be Confusing

If you’ve researched IBD nutrition, you’ve likely encountered conflicting advice. This can be so confusing! Research using diet interventions to manage IBD is evolving and more research is needed. Previous interventions such as low residue diets are no longer recommended for most patients. However, this may be recommended for a patient with a stricture, fistula, or recent resection.  Also, what works for one person may not work for another so an individualized approach is recommended.

The Role of a Registered Dietitian

Given the complexity of IBD nutrition, working with a registered dietitian—especially one experienced in gastrointestinal conditions—can be highly beneficial.

A dietitian can help:

• Assess nutritional status and identify deficiencies
• Personalize dietary strategies based on symptoms and disease activity
• Prevent overly restrictive eating patterns
• Support sustainable, balanced nutrition

You can schedule an appointment with our Registered Dietitian, Madden Wilson at GI for Kids.

Key Takeaways

• Healthy eating patterns with emphasis on whole foods and avoiding foods that make symptoms worse is generally recommended
• Several therapeutic diets exist, but no single approach works for everyone
• Dietary recommendations have evolved and may continue to change
• Personalized guidance from a registered dietitian can help navigate conflicting information and optimize outcomes