Diet & Nutrition in Crohn’s

Nutrition plays a central role in Crohn’s disease. Food does not cause Crohn’s or cure it, but diet choices can affect symptoms, growth and weight, and even inflammation in some situations. This article explains evidence-based approaches during flares and remission, and when enteral nutrition, such as exclusive liquid formulas, is used as a formal treatment strategy.

Key Takeaways

• There is no single “Crohn’s diet.” Dietary plans work best when tailored to disease location, symptoms, and nutrition status with help from an IBD dietitian.

• During flares, many clinicians use temporary lower-fiber, “low-residue” patterns and gentle, soft foods to ease pain and diarrhea, while protecting calories, protein, and hydration. (ucsfhealth.org)

• In remission, guidelines favor a Mediterranean-style pattern rich in plants, healthy fats, and minimal ultra-processed foods rather than highly restrictive specialty diets. (pubmed.ncbi.nlm.nih.gov)

• Exclusive enteral nutrition (EEN) is a first-line induction treatment for children with active Crohn’s and can promote mucosal healing. (academic.oup.com)

• Partial enteral nutrition (PEN), often combined with the Crohn’s Disease Exclusion Diet (CDED), has growing evidence for inducing and maintaining remission, especially in children and young adults. (pubmed.ncbi.nlm.nih.gov)

• Long-term, very restrictive diets can increase the risk of malnutrition and micronutrient deficiency; regular monitoring and professional guidance are essential.

Why Diet & Nutrition Matter in Crohn’s

Crohn’s inflammation can affect any part of the digestive tract, which may reduce appetite, cause pain with eating, and impair absorption of nutrients. Over time, this can lead to weight loss, anemia, vitamin deficiencies, and, in children, poor growth and bone problems.

Medications remain the main tools to control inflammation. Diet works alongside them to keep energy intake adequate, limit symptom triggers, and, in some structured programs, directly reduce gut inflammation.

Common nutrients of concern in Crohn’s include iron, vitamin B12, folate, vitamin D, calcium, and zinc, especially when the small intestine is involved or sections have been removed. Editor note: source required

Core Principles Across Flares and Remission

Regardless of disease activity, several principles tend to hold:

• Individual response first. The same food can be fine for one person and painful for another. Keeping simple food and symptom notes can help identify patterns.

• Avoid unnecessary restriction. Cutting many foods without guidance can worsen fatigue, muscle loss, and bone health.

• Prioritize protein. Lean meats, eggs, fish, dairy or lactose-free alternatives, soy, or other plant proteins help maintain muscle and healing. (ucsfhealth.org)

• Work with professionals. An IBD-focused dietitian can tailor plans for strictures, fistulas, short bowel, or weight concerns, and can coordinate supplements with the gastroenterology team.

Diet During Crohn’s Flares

Goals during a flare

During active inflammation the main nutrition goals are:

• Maintain calories and protein despite poor appetite.

• Reduce mechanical irritation to the gut when it is very inflamed or narrowed.

• Manage diarrhea, urgency, and pain enough to allow adequate intake.

Low-residue, easy-to-digest patterns

Many teams recommend a temporary low-residue or low-fiber approach during flares, especially when there are strictures or frequent diarrhea. (ucsfhealth.org)

Typical features:

• More refined grains such as white bread, white rice, plain pasta.

• Soft, well-cooked vegetables without skins or seeds; peeled, canned, or cooked fruits.

• Limiting nuts, seeds, popcorn, raw salads, bran, and tough peels.

• Lean, tender proteins (eggs, poultry without skin, tofu, fish).

Evidence that low-residue diets change disease activity is limited, so they are viewed mainly as short-term symptom tools, not long-term treatment. (healthline.com)

Other common adjustments in flares

Depending on individual tolerance:

• Lower-fat choices if greasy foods worsen cramps or diarrhea. (ucsfhealth.org)

• Limiting lactose (milk sugar) if milk causes gas and bloating, while using lactose-free milk or fortified alternatives. (ucsfhealth.org)

• Small, frequent meals and oral nutrition supplements if solid food intake is low. (ucsfhealth.org)

If oral intake is very poor, clinicians may recommend liquid formulas as a bridge or as formal exclusive enteral nutrition, described below.

Diet in Remission

When Crohn’s is in remission, nutrition goals shift to:

• Support long-term gut and heart health.

• Reduce relapse risk where possible.

• Rebuild weight, muscle, and micronutrient stores after flares.

Mediterranean-style pattern

An American Gastroenterological Association expert review advises that, when possible, people with IBD follow a Mediterranean-style diet, which is: (pubmed.ncbi.nlm.nih.gov)

• Rich in fruits and vegetables, whole grains, nuts, legumes, and olive oil.

• Includes fish and other lean proteins.

• Lower in red and processed meats, added sugars, and ultra-processed foods.

No adult diet has consistently been proven to prevent Crohn’s flares, but this pattern supports overall health and appears safe and sustainable for many.

A key trial (DINE-CD) compared a Specific Carbohydrate Diet (SCD) with a Mediterranean diet in adults with mild to moderate Crohn’s. Both improved symptoms, but SCD was not superior and was harder to follow, supporting use of the less restrictive Mediterranean approach for many people. (pubmed.ncbi.nlm.nih.gov)

Fiber and plant foods in remission

Once strict inflammation or strictures are controlled:

• Most people in remission are encouraged to gradually increase fiber and plant diversity, cooked and peeled at first if needed. (pubmed.ncbi.nlm.nih.gov)

• Those with fixed strictures often need limits on very fibrous foods but may tolerate soft, well-chewed fruits and vegetables with help from a dietitian. (pubmed.ncbi.nlm.nih.gov)

Enteral Nutrition: When Formulas Become Treatment

Enteral nutrition means using nutritionally complete liquid formulas given by mouth or through a feeding tube. Different strategies are used in Crohn’s.

Exclusive enteral nutrition (EEN)

EEN involves taking only formula (usually for 6 to 8 weeks), with no other foods except water and sometimes small amounts of clear fluids.

Key points:

• Large pediatric guidelines recommend EEN as first-line therapy to induce remission in children with active luminal Crohn’s, often preferred over steroids because it supports growth and bone health and can promote mucosal healing. (academic.oup.com)

• EEN is less commonly used in adults, but may be considered when medications are limited, as preoperative therapy, or when steroids need to be avoided. (mdpi.com)

EEN requires close supervision to ensure adequate calories and adherence, and it can be emotionally and socially challenging.

Partial enteral nutrition (PEN) and CDED

Partial enteral nutrition (PEN) supplies a set percentage of calories from formula, with the rest from whole foods.

Evidence suggests: (pubmed.ncbi.nlm.nih.gov)

• PEN alone with an unrestricted diet is usually not enough to induce remission.

• PEN combined with the Crohn’s Disease Exclusion Diet (CDED), a structured whole-food plan that removes certain wheat products, dairy, animal fat, emulsifiers, and processed foods, can induce and sustain remission in many children and young adults.

• Higher proportions of calories from PEN (over about one third of total energy) may help maintain remission.

These protocols are complex and should be used under an experienced IBD team and dietitian, especially in growing children.

Putting It Together

Diet in Crohn’s is not one-size-fits-all. During flares, gentler, low-residue patterns and, in some cases, enteral nutrition help protect nutrition while easing symptoms. In remission, a varied, Mediterranean-style pattern that limits ultra-processed foods is generally favored over strict, highly exclusionary diets. When structured enteral nutrition plans like EEN or CDED plus PEN are considered, specialist guidance is essential to balance inflammation control with long-term nutritional health.

FAQs

Is there a single “best” diet for Crohn’s?

No single diet has been shown to prevent flares or replace medication for all people with Crohn’s. Mediterranean-style patterns and some structured diets like CDED can help in specific situations, but choices must be individualized.

Can diet replace biologics or other Crohn’s medications?

For most adolescents and adults, diet is adjunctive, not a full replacement for medical therapy. In children, EEN can sometimes replace steroids for initial treatment, but decisions about stopping or avoiding medications must be made with the IBD team.

Are “natural” or very restrictive diets safer?

Not always. Highly restrictive plans can cause weight loss, nutrient deficiencies, and social stress without added benefit over less restrictive options. Monitoring of weight, labs, and bone health is important when following any intensive diet program.

When should someone with Crohn’s see a dietitian?

Dietitian input is particularly important with weight loss, poor appetite, strictures, growth concerns in children or teens, consideration of EEN or CDED, or when multiple food groups are being eliminated.