Diet & Nutrition in Crohn’s

Eating patterns can support medical therapy in Crohn’s. No single diet cures the disease, but nutrition can ease symptoms during flares, protect against malnutrition, and help maintain remission. Exclusive enteral nutrition is a proven therapy in children and a selective option in adults. During remission, a Mediterranean-style pattern and adequate fiber, when tolerated, are reasonable long‑term goals. (gastro.org)

Key takeaways

• No diet reliably prevents flares in adults, but a Mediterranean-style pattern is widely recommended. (gastro.org)

• During flares, focus on soft textures and lower insoluble fiber, especially if strictures cause blockage symptoms. Keep strict restriction short term. (pubmed.ncbi.nlm.nih.gov)

• Exclusive enteral nutrition is first‑line induction therapy in pediatric Crohn’s, and a steroid‑sparing option in selected adults. (academic.oup.com)

• Low‑FODMAP helps IBS‑like symptoms in quiescent IBD, but it does not treat gut inflammation. Use short term with dietitian support. (pubmed.ncbi.nlm.nih.gov)

• Monitor and replete iron, vitamin D, and vitamin B12, with added focus after ileal disease or surgery. (pubmed.ncbi.nlm.nih.gov)

The big picture

Diet complements, it does not replace, Crohn’s medications. Large expert guidance advises a Mediterranean-style pattern rich in fruits, vegetables, whole grains, legumes, nuts, fish, and olive oil, and low in ultra‑processed foods. No single adult diet has consistently lowered relapse rates, so choices should match symptoms, disease location, and nutritional needs. (gastro.org)

During flares: practical goals

• Aim for adequate calories, protein, and fluids with small, frequent meals.

• Use gentler textures if the bowel is inflamed or narrowed. Choose well‑cooked vegetables without skins or seeds, soft fruits, oatmeal, white rice, yogurt if tolerated, eggs, tofu, fish, or tender poultry.

• If strictures cause cramps, bloating, or vomiting, emphasize texture modification over blanket “no fiber” rules, and limit tough skins, nuts, and popcorn until swelling settles. Keep any low‑residue approach short, then re‑expand foods. Evidence for strict long‑term low‑residue diets is limited. (pubmed.ncbi.nlm.nih.gov)

When enteral nutrition is used

Exclusive enteral nutrition (EEN) is a complete liquid formula diet taken for about 6 to 8 weeks. It induces remission and promotes healing in children, and many guidelines recommend it as first‑line therapy for active luminal disease. Standard polymeric formulas are usually adequate, taken orally or by a feeding tube when needed. (academic.oup.com)

In adults, EEN can reduce inflammation and may be used as a steroid‑sparing bridge or when medications are contraindicated, although corticosteroids often induce remission faster. Evidence suggests EEN is less effective than steroids in adults, yet remains useful for selected cases. EEN can also help optimize nutrition before elective surgery in malnourished patients. Decisions are best made with a gastroenterologist and dietitian. (pubmed.ncbi.nlm.nih.gov)

Partial enteral nutrition combined with a structured whole‑food plan, such as the Crohn’s Disease Exclusion Diet (CDED), has induced and maintained remission in children and in small adult trials. This option is complex and should be supervised to avoid deficiencies. (pubmed.ncbi.nlm.nih.gov)

In remission: what to eat most of the time

• Mediterranean‑style pattern: emphasize plants, fish, olive oil, and minimally processed foods. This pattern supports overall health and is practical for long‑term use. (gastro.org)

• Fiber: outside of symptomatic strictures, gradually include a variety of fibers. Observational data link higher fiber intake with fewer Crohn’s flares, and recent reviews support fiber inclusion as safe in remission. Reintroduce slowly after flares. (pubmed.ncbi.nlm.nih.gov)

• Protein and energy: meet needs with lean proteins, dairy or alternatives, legumes as tolerated, and healthy fats.

• Alcohol and highly processed foods: minimize if they trigger symptoms.

Targeted diet approaches with evidence

• Mediterranean vs Specific Carbohydrate Diet (SCD): In a head‑to‑head trial of adults with mild‑to‑moderate symptoms, both diets improved symptoms similarly, with no clear anti‑inflammatory advantage. Mediterranean eating is generally easier to follow and supports cardiometabolic health. (pubmed.ncbi.nlm.nih.gov)

• Crohn’s Disease Exclusion Diet (CDED ± partial formula): Early adult data show induction and maintenance of remission, with endoscopic improvement in some. It is promising, but adherence and supervision matter. (pubmed.ncbi.nlm.nih.gov)

• Low‑FODMAP: For people in remission who have persistent gas, bloating, pain, or diarrhea consistent with IBS, low‑FODMAP can reduce symptoms over 2 to 6 weeks, followed by structured reintroduction. It does not treat bowel inflammation and may reduce beneficial bacteria if prolonged without guidance. (pubmed.ncbi.nlm.nih.gov)

Micronutrients and growth or bone health

Regularly screen for and treat iron and vitamin D deficiency, and check vitamin B12 in those with ileal disease or after ileal resection. Consider calcium and vitamin D while on steroids, and evaluate folate, zinc, and magnesium when risk factors are present. Dietitian involvement is recommended for malnutrition, significant weight loss, strictures, short bowel, or complex nutrition plans. (pubmed.ncbi.nlm.nih.gov)

Diet approaches at a glance