Popular IBD Diets: What are they, and do they work?

Inflammatory bowel disease (which includes Crohn’s disease and ulcerative colitis) are characterized by inflammation in the digestive tract that causes symptoms such as diarrhea, bloating, and abdominal cramping. Many people with inflammatory bowel disease (IBD) try to manage the symptoms of IBD through diet.

The Best IBD Diet?

Drawing firm conclusions about IBD diet and nutrition is a difficult undertaking since symptoms, nutritional needs, lifestyle, and many other factors differ from person to person. Some patients say they have achieved Crohn’s remission without medication through their preferred Crohn’s disease management diet, while other patients have seen better results from IBD medications.

If you are exploring your options for healing Crohn’s disease naturally or managing UC symptoms without medication, you’ll find a plethora of information on common IBD diets, ranging from Low-Residue Diets to Anti-Inflammatory Diets and beyond.

There is no single “best diet for IBD”. However, if you are willing to experiment, you may find that one of these diets help you maintain remission, manage your symptoms, and heal your gut the natural way.

In addition to including or excluding certain foods, IBD researchers are also examining the benefit of nutritional supplements designed to reduce IBD symptoms by healing the mucosal lining. The protein-rich supplement CROWN is currently being offered in clinical trials all over the United States—see if you're eligible to participate in a CROWN treatment near you.

The Low Residue Diet for IBD

What is the Low-Residue Diet?

This diet involves the elimination of fiber, taking whole grains, legumes, all fruits and vegetables (except for bananas and skinless potatoes), dairy and fibrous meats off the grocery list.

Does Low-Residue Diet Work for IBD?

The purpose the low-residue diet is to reduce the frequency and volume of stools, thereby reducing intestinal obstruction. It’s often recommended for managing acute IBD flares in patients with intestinal strictures or narrowing. The Low-Residue diet is considered a short-term measure, but some patients follow it over the long-term, even though studies have shown that following the low-residue diet can result in decrease microbial diversity in the intestine—a condition linked to several chronic diseases. Compounded with the fact that the low-residue diet does not appear to have any anti-inflammatory benefits, researchers caution against following this diet over the long-term.

The low-FODMAP Diet for IBD

What is the low-FODMAP Diet?

The low-FODMAP diet (or low Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol diet) eliminates foods high in fermentable carbohydrates and polyols for approximately 2 months. Eliminated foods include onion, garlic, wheat, a large number of fruits, fruit products, and vegetables, artificial sweeteners, honey, high-fructose sweeteners, dairy products containing lactose, legumes, nuts, seeds, and some grains.

Does low-FODMAP Diet Work for IBD?

Data suggests that this diet can be highly effective for managing IBD symptoms.

One study of 72 IBD patients on the low-FODMAP diet reported that half of the patients experienced a significant improvement in abdominal symptoms, abdominal pain, bloating, gas and diarrhea.

Another review located 88 patients on this diet with similar improvements, reporting a significant reduction in abdominal pain, bloating, flatulence, belching, incomplete evacuation, nausea, and heartburn. They also reported improvements in stool consistency and frequency.

Additional reviews have observed that 24% of IBD patients became asymptomatic, experiencing no symptoms of IBD, while on the low-FODMAP diet.

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The Semi-Vegetarian Diet for IBD

What is the Semi-Vegetarian Diet?

A semi-vegetarian diet is generally considered to be a lacto-ovo vegetarian diet—a vegetarian diet in which eggs and milk are allowed. Sometimes, it also allows for small portions of meat (2 portions per month, for example) and a weekly portion of fish.

Does Semi-Vegetarian Diet Work for IBD?

A study conducted in Japan looked at the impact of this diet for Crohn’s remission. They found that the remission rate achieved with the semi-vegetarian diet was 100% after one year and 92% after two years. Compared to an omnivorous diet (a diet that includes meat), the semi-vegetarian diet resulted in significantly less relapse of the disease.

It appears that this diet may be effective for maintaining remission with Crohn’s disease, but we need more randomized, controlled studies to validate the results from the Japan trial.

The Elemental Diet for IBD

What is the Elemental Diet?

An elemental diet involves providing the patient with nutrients in a liquid solution. The solution is generally called an elemental formula, but you might also come across elemental formulas called monomeric, polymeric, or oligomeric formulas. They contain amino acids, peptides, oligosaccharides, monosaccharides, medium-chain triglycerides, and other nutrients delivered in the form of molecular compounds.

Does Elemental Diet Work for IBD?

Because elemental formulas and how they are used vary, reports on elemental nutrition have produced a variety of results. However, elemental formulas that have been delivered to patients by way of enteral nutrition (gastric tube and intravenous feeding) have produced positive results, with one study observing remission from enteral nutrition in 80% of patients. Another study looking at a group who followed a half-elemental diet observed lower relapse rates, recommending the diet as a maintenance therapy for Crohn’s disease.

The efficacy of an elemental diet has been attributed to various mechanisms, including anti-inflammatory effects, epithelial healing, and changes in the intestinal microbiome.

The Anti-Inflammatory Diet (IBD-AID)

What is the Anti-Inflammatory Diet?

The Anti-Inflammatory Diet (also called IBD-AID) restricts certain carbohydrates such as lactose and refined carbohydrates (processed carbs, sugar, etc), saturated fats, and hydrogenated oils. It calls for the addition of pre- and probiotic foods and foods rich in omega-3 fatty acids.

Does Anti-Inflammatory Diet Work for IBD?

Studies on IBD patients on the AID found that 60% reported reduced symptoms, including reduced stool frequency. A small portion of the patients in the study found that they could manage IBD without medication while on the diet.

It makes sense that the anti-inflammatory diet would help reduce symptoms in IBD, a condition characterized by inflammation, and there is anecdotal evidence to suggest that this diet works for IBD symptoms. Researcher point out, however, that we need more more studies that actually measure the biomarkers of inflammation in patients following the diet before making any conclusions about IBD and anti-inflammatory diets.

The Mediterranean Diet for IBD

What is the Mediterranean Diet?

This diet is high in fiber-rich plant-based foods such as cereals, fruits, vegetables, legumes, nuts, seeds and olives. The diet calls for moderate consumption of fish, seafood, eggs, poultry, cheese and yogurt. It allows for wine, low consumption of red meat, and the inclusion of olive oil as the main source of added fat.

Does Mediterranean Diet Work for IBD?

The Mediterranean diet has been associated with significant health improvements as well as decreased inflammation by a growing body of scientific evidence. One reason this diet may work is that is promotes the right ratio of omega-6/omega-3 fatty acids.

One major benefit of this diet is that it is less restrictive than many of the other diets for IBD and may be more realistic to adhere to over the long-term.

One interventional study on Crohn’s disease patients who started the Mediterranean Diet observed reduced inflammation and a return of patient’s microbiota to normal levels.

The Specific Carbohydrate Diet for IBD

What is the Specific Carbohydrate Diet?

This is one of the most prevalent diets in IBD. It is promoted as a diet specifically designed to improve intestinal health and is aimed at people with Crohn’s disease, ulcerative colitis, IBS, and other conditions of the digestive tract. The Specific Carbohydrate Diet is centered around eating from an exclusive group of foods which are grain-free, sugar-free, starch-free, and unprocessed.

Does Specific Carbohydrate Diet Work for IBD?

While there is a lot of talk about this diet, there is a lack of evidence-based published data on the Specific Carbohydrate Diet. Even so, in a survey of 145 patients who had tried the Specific Carbohydrate Diet, the self-reported effectiveness of the diet was rated at a mean of approximately 90% in controlling flare symptoms and 92% at maintaining remission. Reports from some patients say they were able to control their IBD symptoms without medication by following the Specific Carbohydrate Diet.

Because it is similar to the Anti-Inflammatory diet in avoiding processed and refined carbohydrates, it makes sense that patients on the Specific Carbohydrate Diet would experience similar benefits.

The Paleo Diet for IBD

What is the Paleo Diet?

The Paleo Diet avoids processed foods, refined sugars, legumes, dairy, grains and cereals. It encourages the consumption of grass-fed meat, wild fish, fruit, vegetables, nuts, and other healthy fats.

Does Paleo Diet Work for IBD?

Like several other diets used for IBD, the Paleo Diet avoids refined sugar and processed foods, so it makes sense that it leads to improvements in health. The effects of Paleo Diet on IBD haven’t been studied in any clinical trials, however, so for now we have to rely upon anecdotal evidence for any symptomatic relief.

References

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
Sigall-Boneh R, Levine A, Lomer M, Wierdsma N, Allan P, Fiorino G, Gatti S, Jonkers D, Kierkuś J, Katsanos K, Melgar S, Yuksel E, Whelan K, Wine E, Gerasimidis K. (2017) Research Gaps in Diet and Nutrition in Inflammatory Bowel Disease. Journal of Crohn's and Colitis, 11(12), 1407–1419, https://doi.org/10.1093/ecco-jcc/jjx109

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