Diet Plays a Key Role in the Management of Chronic Inflammatory Bowel Diseases

Chronic inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, are complex disorders where diet plays a central role. Although their exact causes remain poorly understood, it is now established that certain diets and nutrients can influence their progression, treatment, and even prevention.

Dietary habits have a direct impact on intestinal inflammation. A diet high in refined sugars, saturated fats, and low in fruits and vegetables—typical of Western diets—is associated with an increased risk of developing these diseases. In contrast, the Mediterranean diet, based on high consumption of fruits, vegetables, fish, olive oil, and whole grains, appears to reduce this risk. This difference is also observed between regions: in northern France, where dietary habits are more Western, Crohn’s disease is more common than in the south, where the Mediterranean diet predominates.

Certain specific diets have demonstrated their effectiveness in alleviating symptoms and promoting remission. The Crohn’s disease exclusion diet, for example, gradually eliminates foods suspected of worsening intestinal inflammation, such as gluten, dairy products, processed foods, and additives. It is often combined with partial enteral nutrition, where some calories come from specialized liquid formulas. Studies show that this diet can induce remission in a large proportion of patients, including those who no longer respond to biological treatments. It is particularly effective in children and young adults, with remission rates reaching 70% after a few weeks.

The specific carbohydrate diet, which excludes complex sugars such as disaccharides and polysaccharides, has also shown promising results. It is based on the idea that these poorly digested carbohydrates feed pathogenic gut bacteria, thereby worsening inflammation. In children with Crohn’s disease, this diet has led to clinical improvement and a reduction in inflammatory markers. However, its complexity can make long-term adherence difficult, with a risk of nutritional deficiencies if strict dietary monitoring is not ensured.

The Mediterranean diet, easier to adopt, has proven as effective as the specific carbohydrate diet in reducing symptoms and inflammatory markers in adults with Crohn’s disease. One study even showed that children following this diet had lower levels of fecal calprotectin, a marker of intestinal inflammation. Additionally, combining this diet with regular physical activity significantly reduces relapses and the need for corticosteroids.

Other approaches, such as the anti-inflammatory diet for inflammatory bowel diseases, aim to rebalance the gut microbiota by limiting refined sugars and promoting foods rich in prebiotics and probiotics. This diet includes lean proteins, healthy fats like omega-3s, fruits, and vegetables, while avoiding processed foods. Early results suggest an improvement in symptoms and a reduction in medication use in some patients.

Low-FODMAP diets, which temporarily eliminate fermentable carbohydrates, have also proven useful in relieving digestive symptoms in patients in remission or with mild to moderate disease. These carbohydrates, which are poorly absorbed, ferment in the colon, causing bloating, gas, and pain. One study showed that 78% of patients on this diet experienced significant symptom relief after six weeks.

Exclusive enteral nutrition, where the patient consumes only specialized liquid formulas for several weeks, is particularly effective in inducing remission in children with Crohn’s disease. It allows for improvement in the intestinal mucosa and a reduction in inflammation, with success rates comparable to those of corticosteroids. In adults, although less commonly used due to poor acceptance, it remains a valid option, especially in the perioperative period to improve surgical outcomes.

Dietary supplements also play a role. Prebiotics, such as inulin or fructo-oligosaccharides, stimulate the growth of beneficial bacteria in the gut, thereby reducing inflammation. Probiotics, particularly certain strains like Escherichia coli Nissle 1917 or the VSL#3 mixture, have shown effectiveness in maintaining remission in ulcerative colitis. Vitamin D, often deficient in patients, also appears to play a role in modulating the immune response. Adequate supplementation reduces relapses and improves quality of life.

Omega-3 fatty acids, found in fish oil, may reduce inflammation, although study results remain mixed. Turmeric, a polyphenol with anti-inflammatory properties, has demonstrated effectiveness in maintaining remission in ulcerative colitis, with a significant reduction in relapses compared to a placebo. Resveratrol, another polyphenol, has also shown promising effects in reducing inflammatory markers.

However, adopting these diets and supplements is not without challenges. Many patients avoid certain foods out of fear of symptoms, which can lead to deficiencies or disordered eating behaviors. Food insecurity—limited access to sufficient and nutritious food—also affects some patients, limiting their ability to follow these recommendations. Cultural practices, such as culinary traditions or religious restrictions, can also complicate adherence to these diets.

Finally, personalized and multidisciplinary management is essential. Each patient responds differently to dietary approaches, and follow-up by a specialized team, including a gastroenterologist and a dietitian, helps optimize results while avoiding deficiencies. Diets must be tailored to individual needs, taking into account preferences, tolerances, and lifestyle.

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DOI: https://doi.org/10.1007/s10620-026-10049-x

Title: Update on Diet and Nutritional Therapies in Patients with Inflammatory Bowel Disease

Journal: Digestive Diseases and Sciences

Publisher: Springer Science and Business Media LLC

Authors: Mark R. Baniqued; Neha D. Shah; Jessica Dominguez; Alyssa M. Parian