Diet & Nutrition
If you have Crohn's disease and have ever searched for dietary advice, you already know the problem: there are at least ten different diets that someone, somewhere, swears by. Low residue, low FODMAP, SCD, Mediterranean, AIP, CDED, elemental, carnivore, vegan, anti-inflammatory. Some have clinical trial data behind them. Most do not. And the advice you get depends entirely on who you ask. This guide compares every major dietary approach for Crohn's disease using a consistent lens: what does the evidence actually say, and who might each diet help?
Why Crohn's Diet Choices Are Harder Than You Think
Crohn's disease can affect any part of the gastrointestinal tract, from the mouth to the anus. That matters for diet because someone with ileal Crohn's (affecting the last section of the small intestine) may have very different food tolerances than someone with colonic Crohn's. Stricturing disease, where the intestinal wall narrows from chronic inflammation, adds another layer of complexity. A high-fiber food that helps one person could cause an obstruction in another. This is why no single diet works for everyone with Crohn's, and why comparison guides that ignore disease location and behavior miss the point entirely.
The Crohn's Disease Exclusion Diet (CDED)
The CDED is the dietary approach with the strongest Crohn's-specific trial data. Developed by Professor Arie Levine at Wolfson Medical Center in Israel, it combines partial enteral nutrition (a liquid formula providing about 50% of calories) with a structured whole-food diet that excludes foods thought to damage the intestinal barrier and alter the microbiome, including processed foods, gluten, dairy, animal fat, emulsifiers, and certain additives.
A 2024 randomized controlled trial in pediatric Crohn's found that 77% of children on the CDED achieved clinical remission by week 8, with 60% maintaining remission through week 24. A 2025 randomized trial in adults showed remission rates reaching 79.2% in the CDED group by 24 weeks, compared to 42.9% in controls. A 2024 systematic review concluded that the CDED with partial enteral nutrition is a viable alternative to exclusive enteral nutrition for inducing remission in both children and adults with active Crohn's disease. The CDED is designed for mild-to-moderate active disease. If you are in remission or have severe disease, this diet may not be the right starting point without guidance from a gastroenterologist.
The Elemental Diet and Exclusive Enteral Nutrition
Exclusive enteral nutrition (EEN) means consuming 100% of your calories from a liquid formula for six to eight weeks. The formula can be elemental (pre-digested amino acids), semi-elemental, or polymeric (whole protein). In pediatric gastroenterology, EEN is already first-line therapy for inducing remission in Crohn's disease, preferred over corticosteroids. A Cochrane review found remission rates around 63-64% regardless of formula type.
For adults, the evidence is equally strong in terms of efficacy, with studies showing remission rates comparable to corticosteroids. The problem is adherence. Drinking nothing but formula for six to eight weeks is monotonous and socially isolating, and adult compliance rates are significantly lower than in children. This is precisely why the CDED was developed as an alternative that combines partial formula with real food. The elemental diet remains most useful for adults who need to induce remission quickly, who want to avoid steroids, or whose disease is too active for a food-based approach.
The Mediterranean Diet
The Mediterranean diet emphasizes fruits, vegetables, whole grains, legumes, olive oil, fish, and moderate dairy. It limits red meat, processed foods, and refined sugars. The DINE-CD trial, the largest randomized dietary trial in Crohn's disease to date, compared the Mediterranean diet to the Specific Carbohydrate Diet in 194 adults with Crohn's. After six weeks, symptomatic remission rates were nearly identical: 43.5% for Mediterranean and 46.5% for SCD. By week 12, the results remained statistically indistinguishable.
Given that the Mediterranean diet is easier to follow, more nutritionally complete, and associated with broader health benefits including reduced cardiovascular risk, the study authors concluded it may be preferred for most Crohn's patients with mild to moderate symptoms. One important caveat: neither diet in the DINE-CD trial normalized C-reactive protein, a marker of inflammation. Symptom improvement did not necessarily mean reduced intestinal inflammation. The 2025 ACG guidelines note that the Mediterranean diet is associated with improved quality of life through its anti-inflammatory and antioxidant effects.
The Specific Carbohydrate Diet (SCD)
The SCD eliminates all grains, most sugars (except honey), most dairy (except homemade 24-hour fermented yogurt and aged cheeses), and all processed foods. The theory is that complex carbohydrates feed harmful gut bacteria, perpetuating inflammation. The SCD has a dedicated following among Crohn's patients, and the DINE-CD trial confirmed it can produce meaningful symptom improvement.
However, the same trial showed it performed no better than the less restrictive Mediterranean diet. The SCD also carries nutritional risks: it can lead to deficiencies in B vitamins, calcium, vitamin D, and vitamin E, and may cause unintended weight loss. For patients who have already tried and responded to the SCD, there is no reason to stop. But for someone choosing a first dietary approach, the Mediterranean diet achieves similar results with fewer restrictions and better nutritional balance.
The Low-FODMAP Diet
FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are short-chain carbohydrates that are poorly absorbed and rapidly fermented by gut bacteria, causing gas, bloating, and diarrhea. Roughly 40% of people with Crohn's disease experience IBS-like symptoms even when their disease is in remission, and the low-FODMAP diet targets these functional symptoms effectively.
A randomized trial published in Gastroenterology found that a four-week low-FODMAP diet reduced functional GI symptoms and improved quality of life in patients with quiescent inflammatory bowel disease (IBD). The critical distinction: the low-FODMAP diet did not reduce inflammation markers like fecal calprotectin. It manages symptoms, not disease activity. This diet is best suited for Crohn's patients in remission who still have persistent bloating, gas, or abdominal pain. It should be used short-term (four to six weeks) with structured reintroduction, ideally guided by a dietitian, because long-term FODMAP restriction can negatively affect the gut microbiome.
The Low-Residue Diet
Low-residue diets limit fiber, seeds, nuts, raw fruits, and raw vegetables to reduce the volume of undigested material passing through the intestines. Gastroenterologists commonly recommend this approach during active flares or for patients with intestinal strictures where bulky food could cause a blockage.
The evidence supporting low-residue diets as a long-term strategy is weak. A prospective controlled study found that lifting dietary restrictions did not worsen symptoms or precipitate bowel obstruction in Crohn's patients. And a 2016 study found that adults with Crohn's who did not avoid high-fiber foods were roughly 40% less likely to experience a flare over six months compared to those who did. The low-residue diet has a clear role during acute flares and in managing symptomatic strictures, but it should be temporary. Staying on it long-term may actually deprive you of the fiber your gut microbiome needs.
The Autoimmune Protocol (AIP) Diet
The AIP diet starts with an aggressive elimination phase that removes grains, dairy, eggs, nuts, seeds, nightshade vegetables, legumes, alcohol, coffee, refined sugar, and food additives. After several weeks, foods are reintroduced one at a time to identify personal triggers. A 2017 pilot study of 15 IBD patients (including those with Crohn's) found that 73% achieved clinical remission by week 6, with improvements in the Harvey-Bradshaw Index for Crohn's patients specifically. Fecal calprotectin levels also trended downward, suggesting reduced intestinal inflammation.
These results are encouraging but come from a very small, uncontrolled study. No randomized controlled trial has tested the AIP diet specifically in Crohn's disease. The elimination phase is also extremely restrictive, making it difficult to sustain and nutritionally challenging without careful planning. The AIP's strength is its systematic reintroduction framework, which helps patients identify their personal trigger foods rather than permanently eliminating entire food groups.
The Carnivore Diet
The carnivore diet, which consists exclusively of animal products, has gained a vocal following online among people with IBD. A 2024 case series of 10 IBD patients on a carnivore-ketogenic diet reported clinical improvements across the board. But case series without controls represent the lowest level of clinical evidence, and no randomized trial has tested this approach.
Meanwhile, a large prospective cohort study found that carnivorous dietary patterns were associated with greater likelihood of developing IBD in the first place. The diet eliminates all plant fiber, which decades of microbiome research suggest is critical for gut health. While some individuals may feel better in the short term, possibly because they have simultaneously eliminated personal trigger foods, the long-term nutritional and microbiome consequences remain unknown. IBD dietitians generally consider this the dietary approach with the most potential for harm in people with inflammatory bowel disease.
How to Choose the Right Approach
Your disease status matters more than any diet's marketing. During an active flare, the CDED or exclusive enteral nutrition have the strongest evidence for inducing remission. If your Crohn's is mild to moderate and you want a sustainable dietary framework, the Mediterranean diet offers the best combination of evidence, nutritional completeness, and ease of adherence. If you are in remission but still dealing with bloating, gas, or unpredictable bowel habits, a short-term low-FODMAP elimination may help you identify which fermentable carbohydrates are triggering your symptoms. And if you have stricturing disease, a temporary low-residue approach during symptomatic episodes can reduce obstruction risk while you work with your gastroenterologist on longer-term management.
Whichever diet approach you try, track your meals and symptoms with Aidy to see what actually works for your gut, not just what worked for someone on social media.