As previously discussed, diet can play a major role in the management of Crohn's disease and ulcerative colitis. With so much information currently accessible to us, it can be difficult to filter through diet trends that you might hear or read about. The following summarizes the most popular diets out there that have claimed to help others with Crohn's and colitis, and highlights which ones may be more worthwhile to try under the guidance of a registered dietitian or physician.
1. The Specific Carbohydrate Diet (SCD / Breaking the Vicious Cycle)
This diet was first developed by Dr. Sidney Haas as a way to treat celiac disease. It was made more popular for the treatment of Crohn's disease and ulcerative colitis by biochemist Elaine Gottchall through her book Breaking the Vicious Cycle.
Diet Summary & Claims:
The Specific Carbohydrate Diet limits most carbohydrates from the diet except for monosaccharides (glucose, fructose, and galactose), with the rationale being the single molecule structure of monosaccharides allows them to be easily absorbed into the intestine wall. The diet proposes that complex carbohydrates are not easily digested and therefore feed harmful bacteria in our digestive tract causing them to overgrow producing by products and inflaming intestine wall. The goal of the diet is to “starve out” harmful bacteria and restore the balance of bacteria in our gut (Gottschall, 2012).
While limited research currently exists for the Specific Carbohydrate Diet and its use in the management of Crohn's disease and ulcerative colitis, preliminary evidence suggests SCD may help control symptoms and inflammation in a pediatric population with Crohn's disease and ulcerative colitis when adopted in conjunction with medical therapy (Chinonyelum, 2015).
Due to promising results from preliminary research with the Specific Carbohydrate Diet in children with Crohn's or colitis, this diet may be worth trying when other dietary options have been exhausted. It is recommended to follow the guidance of a registered dietitian for support as this diet can put individuals at a higher risk for nutrient deficiencies.
2. The Low FODMAP Diet
This diet was developed by gastroenterologist Dr. Peter Gibson and registered dietitian Dr. Sue Shepherd. It was intended to decrease functional gut symptoms such as gas, bloating, distention and diarrhea and/or constipation commonly seen in people with irritable bowel syndrome.
Diet Summary & Claims:
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols – which are all different types of short chain carbohydrates that are poorly digested in the small intestine and increase small intestinal water content or are rapidly fermented by gut bacteria that naturally reside in the large intestine, resulting in symptoms such as gas, bloating, diarrhea and/or constipation. The low FODMAP diet eliminates foods that are high in short chain carbohydrates in order to decrease symptoms.
There is substantial scientific evidence to show the low FODMAP diet improves symptoms in 75% of patients with irritable bowel syndrome (Gibson, 2010). A pilot study revealed an improvement in functional gut symptoms when patients with stable Crohn's or colitis adhered to the low FODMAP diet (Gearry, 2009). A subsequent study also demonstrated an increase in the relief of functional gut symptoms and reduction in symptom severity among IBD patients who followed the low FODMAP diet as delivered by a team of registered dietitians (Prince, 2009).
The low FODMAP diet is strongly recommended for patients with Crohn's disease or ulcerative colitis who also experience gas, bloating, distention and diarrhea. However, it will not treat inflammation that comes with the disease, and therefore is not recommended to replace medical treatments but instead used in conjunction with medical treatments prescribed by your physician.
3. The Paleo Diet
This diet was introduced by a gastroenterologist, Dr. Walter L. Voeglin. It has been made more popular by Dr. Loren Cordain and was initially designed to optimize health, minimize risk for chronic disease, and achieve weight loss.
Diet Summary & Claims:
The theory behind the Paleo diet is that the digestive tract is not able to handle foods in our diet that resulted from modern agricultural methods, and that these foods result in modern diseases. This diet emphasizes intake of lean meats and plant-based foods, and to avoid consumption of grains and legumes (Eaton, 1985). A large portion of energy intake is supposed to come from protein and fat instead of carbohydrates as a major energy source. The Paleo diet is based on assumptions of our evolution, and therefore, has no specific claims about the effect of this diet on Crohn's or colitis.
There have been no scientific studies done on the benefits of the Paleo diet for the management of Crohn's disease and ulcerative colitis.
The Paleo diet is not recommended as there is no scientific evidence supporting its use for managing Crohn's and colitis as there are major restrictions placed on dietary intake that may result in nutrient deficiencies, low energy intake, and further weight loss. Due to the emphasis on animal protein and fat in this diet, it also puts individuals with Crohn's or colitis at risk of developing further health conditions in the long term such as high cholesterol, high blood pressure, and cardiovascular disease or stroke.
1. Gottschall, E. Breaking the vicious cycle: intestinal health through diet. Kirkton, Baltimore. 2012.
2. Obih, Chinonyelum, et al. "Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center." Nutrition 32.4 (2016): 418-425.
*3. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J of Gastroenterol and Hepatology. 25 (2): 252-258, 2010.
4. Gearry RB, Irving PM, Barett JS, Nathan DM, Shepherd SJ, Gibson PR. Reduction of poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study. J Crohns Colitis. 3 (1): 8-14, 2009.
4. Prince, Alexis C., et al. "Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease." Inflammatory bowel diseases 22.5 (2016): 1129-1136.
*5. Eaton SB, Konner M. Paleothilic nutrition. A consideration of its nature and current implications. N Engl J Med. 31: 283-289, 1985.