Although no singular cause of inflammatory bowel disease (IBD) has been identified, the current evidence on Crohn’s and ulcerative colitis points to an interaction between gut microbiota, environmental factors, and diet.
For many patients with Crohn’s or colitis, making dietary adjustments is the norm, as many patients can control IBD symptoms by tweaking their diet. In fact, 90% of Crohn’s disease and 71% of ulcerative colitis patients follow elimination diets while in remission.
Although difficult to adhere to on a daily basis, many patients are eager to find the best IBD diet, as they look to diet modifications as a way of controlling IBD the natural way.
Regardless of the method, the end goal for all patients is the same: to achieve—and maintain—remission.
But with so many diets out there, how do you know what to put on your grocery list?
Exactly What is “Crohn’s Disease Diet?”
Experts agree that diet is a factor in the management of IBD. Unfortunately, however, there are few studies that have done rigorous examinations of the various IBD diet plans. It’s an evolving field that must examine the effects of diet across individuals with different disease manifestations who take different IBD medications and who’ve undergone different surgical procedures.
For the best IBD diet information, physicians—and patients—have to keep themselves up to date with the latest developments in the field. This article summarizes insight from a scientific review published in a 2017 issue of the journal Nutrients. Below you’ll learn about the latest research on IBD and diet from experts in nutrition, microbiology, physiology, and medicine.
Maintaining IBD Remission with Diet
In their review, the researchers examined results from dozens of studies on IBD remission and diet. Based on these studies, the general dietary guidelines for maintaining remission in IBD are as follows:
Dietary fiber, especially from whole vegetables fruit
Fish and poultry
Soluble fiber: oats, psyllium, pulses
Healthy fats: olive oil, non-hydrogenated nut and seed butters
Eat more (as tolerated)
Insoluble fiber: whole wheat bread, pastas, and brown rice
Nuts and seeds
Red meat (beef, pork. lamb)
Refined carbohydrates, especially sweetened beverages, juices, sweets, and soft drinks
Highly processed foods
N-6 PUFA: Safflower oils, corn oils, margarine, trans-unsaturated fatty acid
Research on Common IBD Diets
There’s a vast amount of information on the web asserting that certain diets will worsen or ameliorate the symptoms of IBD.
In general, the researchers conclude that IBD fad diets should be avoided; there is no single best diet for managing IBD. Even so, there are a number of diets that have been found to yield positive results. Likewise, patients add their stories to forums daily, telling about their success or disappointment with certain foods. Some recommend bananas for Crohn’s. Others swear by cooked spinach. The IBD food list discussion goes on and on.
Diets for controlling IBD symptoms include:
- The low-FODMAP Diet
- Mediterranean Diet
- Low-Residue Diet
- Semi-Vegetarian Diet
- Specific Carbohydrate Diet
- Elemental Diet
- IBD Anti-Inflammatory Diet
- Paleo Diet
Which IBD Diets Work Best?
Of the above diets, the researchers assessed that only two diets had enough supporting evidence to be suggested as dietary measures for IBD patients:
Low-FODMAP Diet for IBD Remission
The Low-FODMAP Diet was considered optional, for use as a short-term solution for dealing with flare symptoms like diarrhea, bloating, gas, and abdominal pain.
Mediterranean Diet for IBD Remission
The Mediterranean Diet, has not been studied extensively in IBD patients, but because it has been shown to reduce inflammation and normalize the microbiota, the researchers believe it may hold promise for maintaining IBD remission through diet.
Supplements for IBD
In their review, the researchers also identified several key dietary supplements for IBD remission maintenance.
Fiber Supplements and IBD
Evidence suggests that fiber supplementation may help maintain disease remission in IBD patients. With IBD fiber supplementation, the type of fiber and the type of IBD seem to be important:
The recommended fiber supplement for Crohn’s disease during remission is wheat bran (½ cup daily).
The recommended fiber supplements for ulcerative colitis during remission include oat bran (20g daily), germinated barley (min 20g daily), and psyllium (min 4g daily).
Vitamin D Supplements and IBD
Several studies support Vitamin D supplements for IBD, with a strongly recommended minimum dose of 1200 IU per day. Vitamin D deficiency is very common among IBD patients, and there is evidence suggesting that a deficiency in Vitamin D can worsen inflammation in IBD. Additionally, adequate Vitamin D levels can promote healthy bones, prevent colorectal cancer, and alleviate depression.
Curcumin Supplements and IBD
Curcumin is the active ingredient in turmeric, a common spice. It has been used for centuries for managing inflammation. A systematic review concluded that curcumin may be an effective supplement for maintaining remission in ulcerative colitis patients, when taken alongside conventional UC medications like sulfasalazine and mesalamine. The recommended dose is approximately 2g per day.
While each patient has a different experience with their IBD, many clinical trials are emerging that address the health and healing of the mucosal lining of the intestine. CROWN is a popular treatment option as it's an easy to consume beverage. Additionally, Ozanimod is another emerging treatment that hopes to heal the integrity of the intestines.
Haskey, N., & Gibson, D. L. (2017). An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. Nutrients, 9(3), 259. http://doi.org/10.3390/nu9030259