What does the evidence say about diets and supplements for inflammatory bowel disease?

This study review is on this paper - Update on Diet and Nutritional Therapies in Patients with Inflammatory Bowel Disease paper

What did this review do?

This review examined the evidence for diets, nutrition support and dietary supplements in the management of inflammatory bowel disease (IBD).

Below is a summary of the evidence published in the review for each dietary approach and supplement.

Diets

Low fibre/low residue diet

There is no clear evidence that this diet reduces inflammation, although some people may experience an improvement in symptoms. Gastroenterology guidelines (ESPEN and AGA) recommend this approach for people with stricturing Crohn's disease.

Crohn's Disease Exclusion Diet (CDED)

This diet may help reduce inflammation, lower inflammatory markers and support healing of the bowel lining in people with Crohn's disease. Studies also suggest it may help children with Crohn's disease achieve remission.

Specific Carbohydrate Diet (SCD) / Modified SCD

When used alongside medication, this diet may help reduce inflammation, improve symptoms, lower inflammatory markers and promote healing of the bowel lining in children. Studies have shown benefits for both inducing and maintaining remission in paediatric Crohn's disease. Evidence in adults is currently limited. The complexity of the diet may also make it difficult to follow and increase the risk of inadequate nutrient intake.

Mediterranean diet

The Mediterranean diet appears to be helpful for people with IBD, with evidence suggesting improvements in inflammation, symptoms and inflammatory markers. ECCO recommends it as an adjunct to medical therapy for ulcerative colitis.

IBD Anti-Inflammatory Diet (IBD-AID)

The evidence is currently limited. Early studies suggest it may help improve symptoms and reduce medication use, but more research is needed to understand its effects on inflammation and healing of the bowel lining.

Autoimmune Protocol Diet

The evidence is also limited. Early studies suggest potential improvements in symptoms, inflammatory markers and endoscopic findings, but further research is needed.

Low FODMAP diet

A low FODMAP diet may help reduce symptoms in people with IBD who also experience IBS-like symptoms. More research is needed to determine whether it reduces inflammation or helps induce or maintain remission.

Lactose-free diet

Evidence is limited. There is no clear evidence that it reduces inflammation, although some people may notice an improvement in symptoms.

Gluten-free diet

Evidence is limited. There is no clear evidence that it reduces inflammation, although some people may notice an improvement in symptoms.

Exclusive Enteral Nutrition (EEN)

EEN can be used to induce remission by reducing inflammation in children with Crohn's disease. More research is needed in adults and in ulcerative colitis. It may also have a role before and after surgery. AGA and ECCO recommend EEN as first-line induction therapy for children with mild to moderate Crohn's disease.

Partial Enteral Nutrition (PEN)

PEN may also help induce remission in children with Crohn's disease, although EEN appears to be more effective. Evidence in adults is limited. PEN can be combined with other dietary approaches, but further studies are needed.

Parenteral Nutrition (PN)

Parenteral nutrition has specific indications, including chronic obstruction, fistulising Crohn's disease, and nutritional support before and after surgery. Further research is needed.

Supplements

Prebiotics

Prebiotics may help reduce inflammation and maintain remission in ulcerative colitis. Evidence in Crohn's disease is mixed, and further studies using standardised formulations are needed.

Probiotics

Probiotics may help reduce inflammation and maintain remission in ulcerative colitis. The AGA does not currently make a clear recommendation for their routine use in IBD. Evidence in Crohn's disease is limited, and further studies using standardised formulations are needed.

Vitamin D

Vitamin D may help maintain remission by reducing the risk of relapse in adults with IBD. Maintaining adequate vitamin D levels is also important for bone health and calcium absorption.

Omega-3 fatty acids (fish oil)

The evidence is mixed, and it remains unclear whether fish oil is beneficial as an adjunct to medical therapy for reducing inflammation. More clinical trials are needed.

Polyphenols (Curcumin/Resveratrol)

The evidence is mixed, and it is currently unclear whether these supplements reduce inflammation. More clinical trials are needed. ECCO does state that curcumin may be considered as an adjunct to medical therapy in ulcerative colitis.

Aloe vera

No benefit was identified.

Feeling a bit confused?

Many of the people I see in clinic feel exactly the same. There isn't one diet that's right for everyone with IBD, but that doesn't mean we can't find an approach to eating that works well for you.

If you're unsure which dietary approach or supplements are most appropriate for you, I can help you understand the evidence and work out what is most appropriate for your individual situation.