What is the recommended diet for patients with Crohn's disease?

Dietary Management for Crohn's Disease

The Mediterranean diet modified for Crohn's disease, with careful food processing and texture modification, is recommended as the primary dietary approach for patients with Crohn's disease, while the Crohn's Disease Exclusion Diet with partial enteral nutrition (CDED+PEN) is the most effective specialized dietary therapy for inducing remission in active disease. 1

General Dietary Recommendations

Mediterranean Diet Approach

• Base diet on fresh fruits and vegetables (cooked and peeled to reduce fibrous content)
• Include monounsaturated fats (olive oil)
• Emphasize complex carbohydrates and lean proteins
• Limit ultraprocessed foods, added sugar, and salt 1

Important Modifications

• Cook and process fruits and vegetables to a soft consistency
• Peel fruits and vegetables to reduce fibrous content
• Avoid roughage like raw lettuce, unpeeled apples, and raw broccoli
• Practice careful chewing 1

Specialized Dietary Therapies for Active Disease

Exclusive Enteral Nutrition (EEN)

• Most effective for inducing clinical remission and endoscopic response
• Consists of prescribed liquid diet excluding all food and drink except still water
• Duration: Minimum 4-6 weeks (10 days for symptomatic relief, up to 8 weeks for mucosal healing)
• Equally effective whether using whole protein, peptide, or elemental formulations (whole protein more palatable) 2, 1

Crohn's Disease Exclusion Diet (CDED) + Partial Enteral Nutrition (PEN)

• Alternative to EEN with better tolerance and adherence rates (97.5%)
• Effective for induction of clinical remission in mild-to-moderate Crohn's disease
• Nutritionally adequate for adults, meeting >80% of recommended daily micronutrient intake
• Should be prescribed by a specialist IBD dietitian 1, 3, 4

Recent evidence shows CDED with or without PEN is effective for both induction and maintenance of remission in adults with mild-to-moderate biologic-naive Crohn's disease and may lead to endoscopic remission 4. In a pilot randomized trial, 68% of patients on CDED+PEN and 57% on CDED alone achieved clinical remission at 6 weeks 4.

Other Dietary Approaches

Low-FODMAP Diet

• Beneficial for patients with concomitant IBS-like symptoms
• Use elimination and rechallenge approach (up to 8 weeks) 1

Food Reintroduction After EEN

• Can be done more quickly than traditionally thought
• A 3-day rapid food reintroduction has shown similar relapse rates to a 5-week plan 2

Special Considerations

For Stricturing Disease

• Modify food textures appropriately
• Avoid high-fiber foods that may cause obstruction 1

For Malnutrition

• Regular screening for malnutrition is essential
• Monitor for specific deficiencies, particularly vitamin D, iron, and vitamin B12 (especially in patients with ileal disease) 1

For Surgery

• EEN recommended for malnourished patients before elective surgery to optimize nutritional status 1

Common Pitfalls to Avoid

1. Unnecessarily restricting healthy foods during remission
2. Attempting EEN without proper support and monitoring
3. Failing to modify food textures for patients with strictures
4. Overlooking the importance of gradual food reintroduction after EEN
5. Not considering individual food intolerances 1

Implementation Guidance

• Consultation with a registered dietitian is essential, especially for:

  • Newly diagnosed patients
  • Patients with complicated disease
  • Implementation of specialized diets like EEN or CDED 1

• Regular follow-up with gastroenterology is recommended

• Co-management with dietitian and medical team provides best outcomes 1

The evidence strongly supports dietary therapy as an important component of Crohn's disease management, with the Mediterranean diet as a foundation for general health and specialized approaches like CDED+PEN for active disease management.