IBD Diet Recommendations by the IOBD

The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), have long been thought to arise from inappropriate and maladaptive stimulation of the immune system. Emerging evidence demonstrates that environmental factors, including diet, may play an important role in the pathogenesis and inflammation. This highlights the need to provide guidance to physicians and patients regarding which foods may be harmful, beneficial, or safe to consume.

To address this gap in patient care and education, the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) formed a working group to formulate recommendations for physicians, dietitians, and patients based upon best available evidence. These recommendations focus on dietary patterns to control and prevent relapse of IBD.

Fruit & Vegetables

Recommendation

1. In CD it is prudent to recommend moderate to high consumption of fruits and vegetables (evidence level low). In patients with symptomatic or significant fibrostricturing disease, insoluble fiber intake should be restricted (evidence level very low)
2. In UC, there is insufficient evidence to recommend any specific change or restriction in intake of fruit and vegetables. (evidence level very low)

Refined Sugar and Carbohydrates

Recommendation

1. In CD, there is insufficient evidence to recommend any specific change of intake of complex carbohydrates or refined sugars and fructose (evidence level low). It may be prudent to use a low FODMAP diet for patients with persistent symptoms despite resolution of inflammation and absence of strictures (evidence level low).
2. In UC, there is insufficient evidence to recommend any specific change of intake of complex carbohydrates or refined sugars and fructose (evidence level very low). It may be prudent to use a low FODMAP diet for patients with persistent symptoms despite resolution of inflammation (evidence level low).

Wheat and Gluten

Recommendations

1. In CD there is insufficient evidence to recommend restriction of wheat and gluten (evidence level low).
2. In UC there is insufficient evidence to recommend restriction of wheat and gluten (evidence level low).

Red Meat, Processed Meat, Poultry & Eggs

Recommendations

1. In CD, there is evidence that it is unnecessary to restrict moderate consumption of unprocessed red meat, lean chicken meat (breast of chicken) and eggs (evidence level high).
2. In UC, it is prudent to reduce intake of red and processed meat (evidence level low).

Dairy

Recommendations

1. Consensus was not obtained for CD or UC for pasteurized dairy products.
2. Consensus was obtained that unpasteurized dairy products should not be consumed.

Fat

Recommendations

1. In CD, it is prudent to reduce exposure to saturated fats (EL low) and avoid trans fat (evidence level very low).
2. In UC, it is prudent to reduce consumption of myristic acid (palm oil, coconut oil, dairy fats) (evidence level low). It is prudent to increase dietary consumption of omega-3-fatty acids (DHA and EPA) from marine fish (evidence level low), but not from supplements (evidence level high). It is prudent to avoid trans fat (evidence level very low).

Alcohol

Recommendations

1. In CD, there is insufficient evidence to recommend changes in low level alcohol consumption (evidence level low).
2. In UC, there is insufficient evidence to recommend changes in low level alcohol consumption (evidence level low).

Maltodextrin and Artificial Sweeteners

Recommendations

1. In CD, it may be prudent to limit intake of maltodextrin-containing foods and artificial sweeteners (evidence level very low).
2. In UC, it may be prudent to limit intake of maltodextrin-containing foods and artificial sweeteners (evidence level very low).

Emulsifiers and Thickeners

Recommendations

In CD, may be prudent to reduce intake of processed foods that contain carrageenan, carboxymethylcellulouse and polysorbate-80 (evidence level very low).

In UC, may be prudent to reduce intake of processed foods that contain carrageenan, carboxymethylcellulouse and polysorbate-80 (evidence level very low).

Nanoparticles and Sulfites

Recommendations

In CD, it may be prudent to reduce exposure to processed foods containing titanium dioxide and sulfites (evidence level low).

In UC, it may be prudent to reduce exposure to processed foods containing titanium dioxide and sulfites (evidence level very low).

Summary

The dietary guidance consensus document from the IOIBD is based on the best available evidence to date.

For patients with CD, IOBD recommends regular intake of fruits and vegetables (in the absence of symptomatic strictures) and reduced intake of saturated-, trans-, and dairy-fat, additives such as polysorbate 80 and carboxymethylcellulose, processed dairy or foods rich in maltodextrins, artificial sweeteners containing sucralose or saccharine, and processed food containing nanoparticles.

For patients with UC, IOBD recommends increased consumption of natural sources of omega-3 fatty acids (e.g. from wild salmon and other natural sources, not from supplements). The foods that patients with UC should avoid are similar to CD with the possible addition of red and processed meat. There was insufficient evidence to recommend changes in the consumption of fruits, or vegetables for patients with UC.

For patients with either CD or UC, there was insufficient evidence to recommend changes in consumption of wheat or gluten, poultry, alcoholic beverages other than binge drinking (in the absence of other liver disease), and refined sugars. The committee was unable to come to a consensus on pasteurized dairy products.

None of these recommendations are meant to exclude the role of nutritional assessment for malnutrition and correction of deficiencies when needed. The main recommendations are aimed at reducing both symptoms and inflammation.

For patients with persistent symptoms despite resolution of inflammation and absence of strictures, a low FODMAP or lactose-free diet may improve symptoms. Casa de Sante low FODMAP nutritional shakes provide complete gut friendly nutrition safe for IBD and IBS.

Reference

Levine A, Rhodes JM, Lindsay JO, et al. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020;18(6):1381-1392. doi:10.1016/j.cgh.2020.01.046

Medically Reviewed by O Adegbola, MD PhD