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HIBD Horizon

Part 3 · Living well with IBD · 11/22

Eating well with IBD

What the guidelines say, what experience teaches, and how to find what works for you.

The experts' message

There is no single diet for IBD. The recommended basis for almost everyone: a Mediterranean-style diet, home-cooked, with little salt, sugar and ultra-processed food.

AGA 2024 and IOIBD guidelines

Eat more of

Vegetablescooked, puréed or raw, depending on how you tolerate them
Fruitpeeled or cooked if needed
Oily fishsardines, mackerel, salmon: omega-3
Olive oilyour everyday fat
Eggsprotein, B12, vitamin D
Meat and poultryunprocessed: iron, zinc, B12
Pulseslentils, chickpeas, puréed at first
Grainsbread, rice, pasta, semolina
Yoghurtsoften well tolerated
Nutswalnuts, almonds, ground if needed

In moderation

Large amounts of red meatespecially with UC: weak signal, depending on your tolerance
Sugar and pastries
Fizzy drinks and sweeteners
Too much saturated fatfried food, palm oil

Avoid

Cured and processed meatsnitrites and additives
Ultra-processed foodbiscuits, ready meals
E…
Emulsifier additivesE466, E433, E407: read the labels
Trans fats“partially hydrogenated” oils

What about milk?

Many patients tolerate milk and cheese well: it really depends on the person.

Lactose intolerance does exist, a little more often when Crohn's affects the small intestine. Aged cheeses and yoghurts contain very little lactose.

If you are on an immunosuppressant or a biologic, avoid raw milk and raw-milk cheeses (especially soft cheeses), because of listeria.

During a flare

Keep things simple while the flare lasts: cooked food, less tough fibre, small meals, and plenty to drink. Then bring foods back in.

If you have a stricture

Fibre is no longer off-limits: vegetables and fruit cooked, peeled, blended and well chewed. Avoid skins, seeds and tough fibre.

Pain without inflammation

A low-FODMAP diet may bring relief, for a short time and with a dietitian.

The food diary

At first, write down what you eat and how you feel. You will spot your problem foods, because everyone reacts differently.

DayI ateHow I feltVerdict
MondayLentilsBloatingTry again
TuesdayFish, riceNothingOK
ThursdayRaw saladPainLater, cooked
SaturdayYoghurtNothingOK
It's not forever

A food you tolerate badly today, during a flare or just after, may suit you very well in 6 months. Try it again in a small amount, later on.

Avoid cutting out too many foods: that opens the door to deficiencies and malnutrition.

When food becomes a treatment

100% liquid nutrition

Nutritional drinks for 6 to 8 weeks can put Crohn's into remission, especially in children. Also useful before surgery.

Crohn's Disease Exclusion Diet

A specific diet combined with a nutritional drink, suggested by the European guidelines for mild to moderate Crohn's flares, including in adults.

Always with your gastro and a dietitian. The “miracle” diets found on the internet have not been proven.

Experiment, observe, adjust

Food remains a very complex subject: everyone has their own genetics (the lactase gene, metabolism genes such as APOE…), their own microbiota, their own digestive enzymes, and a very personal relationship with food. So there is no rule that works for everyone. The pointers on this sheet are a starting point, not a list of forbidden foods. Listen to your body, keep enjoying your food, and let your diary guide you.