Diet in Crohn's Disease

Eating habits matter as much as food lists. Small changes can make eating easier during symptoms.

• Eat smaller, more frequent meals when appetite is poor or pain follows large meals.
• Keep a food and symptom diary for 2 to 4 weeks to find your own triggers; avoid dropping whole food groups without a dietitian.
• Chew well and eat slowly if you have a narrowing.
• Do not smoke: it is one of the strongest modifiable factors that worsens Crohn’s disease.
• Drink enough fluids, especially with diarrhoea; ask about oral rehydration solutions.
• Keep active; weight-bearing exercise protects bones.

Think in three situations: active flare, remission, and narrowed bowel or after surgery. A dietitian experienced in IBD should guide any therapeutic diet. Evidence strength is stated for each point.

• Exclusive enteral nutrition (EEN), strong evidence in children: a nutritionally complete liquid formula is the only nutrition for 6 to 8 weeks, taken by mouth or a feeding tube under dietitian supervision. It heals the gut lining and avoids steroid side effects. In adults the evidence is weaker, and it is mostly used when medicines are unsuitable or before surgery.
• Crohn’s disease exclusion diet (CDED) with partial enteral nutrition, moderate evidence: a structured diet, typically over 12 weeks in phases, that limits foods linked with gut bacterial and barrier changes (for example processed foods, some additives, wheat in the first phases, and red or processed meat) and encourages fresh chicken, eggs, rice, potatoes, fruit and vegetables, together with part of the calories from formula. It suits children and some adults with mild to moderate disease and needs expert supervision because it is restrictive.
• Everyday pattern in remission, reasonable but not proven to prevent flares: a Mediterranean-style diet with vegetables and fruit as tolerated, olive oil, fish, legumes if tolerated, whole grains, and less red and processed meat, sugary drinks, fast food and packaged snacks (ultra-processed foods).
• No single diet is proven best. In a randomised trial the Mediterranean diet and the specific carbohydrate diet performed about the same, so choose the one you can follow and that keeps you well nourished. Very restrictive diets (specific carbohydrate, paleo, gluten-free or dairy-free without a reason) risk weight loss and deficiencies.
• During a flare: choose soft, well-cooked, lower-fibre foods if they help (peeled cooked vegetables, rice, potatoes, eggs, fish, tender chicken, yoghurt if tolerated), and add energy-dense snacks and oral nutritional drinks if you are losing weight. Reintroduce a normal diet as you recover; low fibre is a temporary comfort measure, not a long-term cure.
• If you have a stricture (narrowing) or have had bowel surgery: a low-residue or texture-modified diet may be advised, with well-cooked and peeled vegetables, pulped or blended foods, and avoiding tough skins, seeds, nuts, whole legumes, stringy meat, dried fruit and raw salads. Chew thoroughly. This is guided by your scan and symptoms, not lifelong for everyone.
• Lactose: only avoid milk if it clearly gives you symptoms; many people tolerate yoghurt (laban) or lactose-free milk, and dairy is an important source of calcium.
• Check and replace what you lack: iron, vitamin B12 (especially after ileal disease or resection), folate, vitamin D, calcium, zinc. Take supplements according to blood tests, not by guesswork.
• Alcohol and energy drinks can irritate the gut and interact with medicines; ask your IBD team about safe limits, and avoid alcohol with methotrexate or azathioprine unless advised.

Diet supports, but does not replace, medicines. Your IBD team chooses treatment according to the type, site and severity of disease. See the Crohn’s disease and IBD biologics pages for details.

• Oral nutritional supplement drinks can top up calories and protein when food alone is not enough.
• Iron (oral or intravenous), vitamin B12, vitamin D and calcium are prescribed after deficiency is shown; ask which form suits an inflamed gut.
• Do not stop steroids, biologics or immunomodulators because you are following a diet.
• Tell your team about herbal products and probiotics; their benefit in Crohn’s disease is not proven and some interact with medicines.

Feeding support or surgery is sometimes needed when nutrition cannot be maintained by mouth or the bowel is damaged.

• A feeding tube through the nose (enteral nutrition) may be used for EEN or when oral intake is too low.
• Intravenous (parenteral) nutrition is reserved for bowel failure or when the gut cannot be used.
• Stricture dilation or surgery may be needed for blockage; good nutrition before surgery improves recovery.