Diet for Chronic Colitis
All patients with chronic colitis should follow a Mediterranean diet rich in fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins while minimizing ultraprocessed foods, added sugar, and salt. 1
Core Dietary Framework
The Mediterranean diet serves as the foundation for colitis management, emphasizing:
- Fresh fruits and vegetables in variety 1
- Monounsaturated fats from olive oil, nuts, and seeds 1
- Complex carbohydrates from whole grains 1
- Lean proteins from fish, poultry, legumes, and low-fat dairy 1
- Minimal red and processed meats - particularly important for ulcerative colitis, where reduction may decrease flare rates 1
This dietary pattern has demonstrated improved quality of life, reduced inflammatory markers, and lower disease activity in both Crohn's disease and ulcerative colitis patients 2.
Foods to Actively Avoid
Sugar-sweetened beverages must be eliminated, as they are linked to both disease development and more severe clinical course 1, 2. Ultraprocessed foods high in added sugar, salt, and artificial additives should be minimized 1, 2.
Critical Modification: Strictures Change Everything
If the patient has symptomatic intestinal strictures, raw fibrous foods become problematic. 1
For patients with strictures, modify the Mediterranean diet by:
- Cooking and steaming all fruits and vegetables to soft consistency 1
- Mashing or blending vegetables (e.g., broccoli becomes acceptable when mashed) 1
- Peeling fruits and vegetables 1
- Emphasizing careful chewing of all foods 1
- Avoiding raw lettuce, unpeeled apples, and other roughage 1
This texture modification allows stricture patients to maintain plant-based nutrition without risking mechanical obstruction 1, 2.
Nutritional Monitoring Requirements
All patients require assessment for nutritional deficiencies, particularly:
- Vitamin D - deficiency occurs in 66-69% of IBD patients 1
- Iron, vitamin B12, and folate - monitor per existing protocols 1
- Calcium - supplement alongside vitamin D 1
- Magnesium and potassium - especially with active disease 1
What NOT to Do: Common Pitfalls
Do not allow patients to adopt overly restrictive elimination diets. 2 Non-evidence-based self-directed exclusion diets lead to limited diet quality and nutrient deficiency 1. There is no consistent evidence supporting gluten avoidance in the absence of celiac disease diagnosis 1, 2.
Despite patient beliefs, regular consumption of fruits and vegetables is associated with 44% lower prevalence of active disease 3, yet many patients unnecessarily avoid these foods even in remission 3.
Adjunctive Dietary Considerations
Low-FODMAP diet may be considered only for patients with concomitant IBS-like symptoms in remission, not as primary therapy 1.
Low-fat, high-fiber approach (10% calories from fat) has shown promise in research, reducing serum amyloid A, increasing beneficial Faecalibacterium prausnitzii, and improving quality of life 4, though the Mediterranean diet remains the guideline-recommended standard 1.
Active Disease Considerations
For patients with active flares requiring therapeutic intervention beyond dietary management, exclusive enteral nutrition or Crohn's disease exclusion diet may be considered, but these are specialized therapeutic approaches requiring gastroenterology guidance 1.