Dietary Management

  • Lisa VokesEmail author


All IBD patients should have access to dietitians for nutrition support and, where appropriate, for primary therapy of IBD (Donnellan et al., Ther Adv Gastroenterol 6:231–242, 2013; ibd standards: Dietary management of IBD remains poorly understood (Charlebois et al., Crit Rev Food Sci Nutr 56:1370–1378, 2016); most guidelines do not make recommendations for it (Halmos and Gibson, Nat Rev Gastroenterol Hepatol 12:133–146, 2015) or are insufficiently detailed (Lee et al., J Hum Nutr Diet 27:207–218, 2014).

However, there is much published about dietary management of IBD. Some dietary interventions are now well supported by the evidence, but others require more research and, as such, cannot yet be used as evidence-based practice. The individual with IBD may struggle with the array of information and, together with Internet contradictions and well-meaning help from suboptimally qualified advice givers, is at risk of employing dietary strategies which could be inappropriate to their clinical situation. The IBD MDT, therefore, must help by providing a clear consistent approach about dietary management of IBD.

Dietary management of IBD can be a confusing field due to how different clinical situations such as disease type, patient’s age or stage in the disease, for example, may change what advice is appropriate. This chapter will discuss dietary management strategies, when to apply them but also when not to. It aims to present the available dietary information alongside the current thinking to enable the reader to discern what may or may not be appropriate for their patients. The reader will:
  • Become familiar with dietary management strategies.

  • Become familiar with the current evidence base for different aspects of management.

  • Gain some practical tips and resources.

  • Understand the role and scope of dietetic services for IBD patients.

  • Appreciate that appropriate dietary management will differ from patient to patient.


Diet in IBD Nutrition screening Enteral nutrition Micronutrients 


  1. Barbalhoa SM, de Alvares Goulartb R, Quesadac K, Becharad MD, de Carvalhoe A d CA (2016) Inflammatory bowel disease: can omega-3 fatty acids really help? Ann Gastroenterol 29:37–43Google Scholar
  2. Borrelli O, Cordischi L, Cirulli M, Paganelli M, Labalestra V, Uccini S, Russo PM, Cucchiara S (2006) Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 4:744–753CrossRefGoogle Scholar
  3. Burch J (2013) Care of patients with a stoma. Nurs Stand 27(32):49–56. Date of submission: November 5 2012; date of acceptance: February 1 2013CrossRefGoogle Scholar
  4. Charlebois A, Rosenfeld G, Bressler B (2016) The impact of dietary interventions on the symptoms of inflammatory bowel disease: a systematic review. Crit Rev Food Sci Nutr 56(8):1370–1378. CrossRefPubMedGoogle Scholar
  5. Cronin E (2012) Dietary advice for patients with a stoma. Br J Nurs 21(16):S32–S34 (Stoma Care Supplement)CrossRefGoogle Scholar
  6. Day AS, Lopez RN (2015) Exclusive enteral nutrition in children with Crohn’s disease. World J Gastroenterol 21(22):6809–6816CrossRefGoogle Scholar
  7. Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel J-F, Allez M, D’Haens G, D’Hoore A, Mantzaris G, Novacek G et al (2012) Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis 6(10):991–1030. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Donnellan CF, Yann LH, Lal S (2013) Nutritional management of Crohn’s disease. Ther Adv Gastroenterol 6(3):231–242. CrossRefGoogle Scholar
  9. Durchschein F, Petritsch W, Hammer HF (2016) Diet therapy for inflammatory bowel diseases: the established and the new. World J Gastroenterol 22(7):2179–2194CrossRefGoogle Scholar
  10. El-Matary W, Otley A, Critch J, Abou-Setta AM (2017) Enteral feeding therapy for maintaining remission in Crohn’s disease a systematic review. JPEN J Parenter Enteral Nutr 41(4):550–561. First Published July 11, 2016CrossRefPubMedGoogle Scholar
  11. Fernández-Bañares F, Hinojosa J, Sánchez-Lombraña JL, Navarro E, Martínez-Salmerón JF, García-Pugés A, González-Huix F, Riera J, González-Lara V, Domínguez-Abascal F, Giné JJ, Moles J, Gomollón F, Gassull MA (1999) Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn’s Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol 94:427–433CrossRefGoogle Scholar
  12. Gibson PR (2017) Use of the low-FODMAP diet in inflammatory bowel disease. J Gastroenterol Hepatol 32(Suppl. 1):40–42CrossRefGoogle Scholar
  13. Hallert C, Kaldma M, Petersson BG (1991) Ispaghula husk may relieve gastrointestinal symptoms in ulcerative colitis in remission. Scand J Gastroenterol 26:747–750CrossRefGoogle Scholar
  14. Halmos EP, Gibson PR (2015).; published online 3 February 2015) Dietary management of IBD—insights and advice. Nat Rev Gastroenterol Hepatol 12:133–146. CrossRefPubMedGoogle Scholar
  15. Kim S, Koh H (2015) Nutritional aspect of pediatric inflammatory bowel disease: its clinical importance. Korean J Pediatr 58(10):363–368CrossRefGoogle Scholar
  16. Kornbluth A, Sachar DB, The Practice Parameters Committee of the American College of Gastroenterology (2010) Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 105:501–523.; published online 12 January 2010CrossRefPubMedGoogle Scholar
  17. Lee J, Allen R, Ashley S, Becker S, Cummins P, Gbadamosi A, Gooding O, Huston J, Le Couteur J, O’Sullivan D, Wilson S, Lomer MCE, on behalf of Gastroenterology Specialist Group of the British Dietetic Association (2014) British Dietetic Association evidence-based guidelines for the dietary management of Crohn’s disease in adults. J Hum Nutr Diet 27:207–218. CrossRefPubMedGoogle Scholar
  18. Mowat C, Cole A, Windsor A et al (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60(5):571–607. CrossRefGoogle Scholar
  19. Nakahigashi M, Yamamoto T, Sacco R, Hanai H, Kobayashi F (2016) Enteral nutrition for maintaining remission in patients with quiescent Crohn’s disease: current status and future perspectives. Int J Color Dis 31:1–7. CrossRefGoogle Scholar
  20. Nguyen DL, Palmer LB, Nguyen ET, McClave SA, Martindale RG, Bechtold ML (2015) Specialized enteral nutrition therapy in Crohn’s disease patients on maintenance infliximab therapy: a meta-analysis. Ther Adv Gastroenterol 8(4):168–175. CrossRefGoogle Scholar
  21. Owczarek D, Rodacki T, Domagała-Rodacka R, Cibor D, Mach T (2016) Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol 22(3):895–905CrossRefGoogle Scholar
  22. Penagini F, Dilillo D, Borsani B, Cococcioni L, Galli E, Bedogni G, Zuin G, Zuccotti GV (2016) Nutrition in pediatric inflammatory bowel disease: from etiology to treatment. A systematic review. Nutrients 8:334. CrossRefPubMedCentralGoogle Scholar
  23. Pituch-Zdanowska A, Banaszkiewicz A, Albrecht P (2015) The role of dietary fibre in inflammatory bowel disease. Prz Gastroenterol 10(3):135–141PubMedPubMedCentralGoogle Scholar
  24. Raghu Subramanian C, Triadafilopoulos G (2016) Care of inflammatory bowel disease patients in remission. Gastroenterol Rep 4(4):261–271Google Scholar
  25. Sadeghian M, Saneei P, Siassi F, Esmaillzadeh A (2016) Vitamin D status in relation to Crohn’s disease: Meta-analysis of observational studies. Nutrition 32(5):505–514. Epub 2015 Dec 22CrossRefPubMedGoogle Scholar
  26. Schwartz E (2016) Perioperative parenteral nutrition in adults with inflammatory bowel disease: a review of the literature. Nutr Clin Pract 31(2):159–170CrossRefGoogle Scholar
  27. Shah ND, Parian AM, Mullin GE, Limketkai BN (2015) Oral diets and nutrition support for inflammatory bowel disease: what is the evidence?. Nutr Clin Pract 30(4):462–473 © 2015 American Society for Parenteral and Enteral Nutrition. hosted at online.sagepub.comCrossRefGoogle Scholar
  28. Staudacher HM et al (2014).; published online 21 January 2014) Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol 11:256–266. CrossRefPubMedGoogle Scholar
  29. Tsertsvadze A, Gurung T, Court R, Clarke A, Sutcliffe P (2015) Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis. Health Technol Assess 19(26):1–138CrossRefGoogle Scholar
  30. Verma S, Holdsworth C, Giaffer M (2001) Does adjuvant nutritional support diminish steroid dependency in Crohn disease? Scand J Gastroenterol 36:383–388CrossRefGoogle Scholar
  31. Wedlake L, Slack N, Andreyev HJ, Whelan K (2014) Fiber in the treatment and maintenance of inflammatory bowel disease: a systematic review of randomized controlled trials. Inflamm Bowel Dis 20:576–586CrossRefGoogle Scholar
  32. Wędrychowicz A, Zając A, Tomasik P (2016) Advances in nutritional therapy in inflammatory bowel diseases: review 2016 inflammatory bowel disease: global view. World J Gastroenterol 22(3):1045–1066CrossRefGoogle Scholar
  33. Weisshof R, Chermesh I (2015) Micronutrient deficiencies in IBD. Curr Opin Clin Nutr Metab Care 18:576–581CrossRefGoogle Scholar
  34. Wong C, Harris PJ, Ferguson LR (2016) Potential benefits of dietary fibre intervention in inflammatory bowel disease. Int J Mol Sci 17:919. CrossRefPubMedCentralGoogle Scholar
  35. Yamamoto T et al (2017) Dietary and enteral interventions for Crohn’s disease. Curr Opin Biotechnol 44:69–73CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Oxford University Hospitals NHS TrustOxfordUK

Personalised recommendations