First-Ever Consensus Guidelines on Diet and Nutrition in IBD to Support People Living with IBD

Nutrition matters not only for IBD prevention, but also in its management. We are living in exciting times as more and more studies published in high-impact medical journals recognize the benefits of nutritional therapies at every step of IBD.

The European Crohn’s and Colitis Organisation (ECCO) presented the new international consensus on the dietary management of IBD at the 20th Congress of ECCO (ECCO’25), and it is now published in the Journal of Crohn’s and Colitis. The new guidelines involved a global collaboration of IBD dietitians, adult and pediatric gastroenterologists, and patients.

The new diet and IBD guidelines start highlighting that all people with IBD should have access to a dietitian with experience in IBD, who has a key role in evaluating nutrition status and prescribing the right nutritional therapy to influence disease activity and complications – dietitians’ role goes beyond monitoring dietary intake and assessing nutritional needs.

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💡 All newly diagnosed patients with IBD should have access to a dietitian with IBD expertise.

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Below are summarized key recommendations highlights in five areas:

#1 Diet Recommendations for Induction

The highest quality evidence supporting dietary management of IBD is for all-formula diets (exclusive enteral nutrition, EEN) and oral nutritional supplements accounting for 50% of daily calories (partial enteral nutrition, PEN) in children and adults with mild-to-moderate Crohn’s disease (CD). As different formulations exist and no difference in efficacy has been found, healthcare providers should recommend polymeric formulas, which are nutritionally complete and made up of mostly intact nutrients, for their better taste and palatability.

The Crohn’s disease exclusion diet (CDED), using PEN covering 50% of energy requirements and restricting the food proportion of the diet to 14 foods in the intial phase, is an option for inducing remission in mild-to-moderate CD, especially in patients with biologic-naive, newer-onset CD, or in patients who cannot tolerate EEN. CDED with and without PEN was effective in inducing and maintaining clinical remission in adults with mild-to-moderate CD, and might lead to endoscopic remission.

Data for the use of EEN as induction therapy for ulcerative colitis (UC) are lacking.

While total parenteral nutrition is effective as induction therapy for IBD, it is not recommended as first-line treatment due to the risk of harm.

#2 Diet Recommendations for Maintenance

Providers could consider PEN for the maintenance of remission in CD in children and adults alongside the standard medical treatment. The most benefits have been observed when covering at least 35% of daily calories from liquid formulas while allowing unrestricted food for the remaining intake.

Data for the use of PEN for the maintenance of remission of UC are lacking.

Whole food diets may also have a place for IBD maintenance. The Mediterranean diet could be considered for maintenance of remission in UC as an adjunct to medications. The SCD has not shown a significant difference in the induction of clinical or biochemical remission when compared to the Mediterranean diet in adult CD patients with mild-to-moderate symptoms. Given that the broad general health benefits of the Mediterranean diet extend beyond the digestive tract and greater familiarity among patients, it is reasonable to recommend this as an alternative to SCD.

The consensus also states that unless there is a contraindication (symptomatic strictures), a good general dietary recommendation for patients with IBD is to primarily consume a plant-based diet that emphasizes fruits and vegetables, alongside moderate portions of lean proteins.

Emerging dietary therapies to treat IBD are a semi-vegetarian diet, a food-specific IgG-guided diet, a low microparticle diet, the Crohn’s Disease Treatment-with-EATing diet, the Autoimmune Protocol diet, IBD-Anti-Inflammatory Diet, 4-strategies-to-SUlfide-Reduction diet, UC exclusion diet, and a gluten-free diet. The consensus states that the data are insufficient or controversial to support generalizing their use for all IBD patients.

Regarding the role of particular foods in IBD management, the consensus acknowledges that:

• Reducing the intake of red and processed meat may reduce UC flares.

• Available data do not support reducing dairy consumption. Fermented milks could provide symptom relief in patients with UC in remission.

• While fruits and vegetables could have a protective role in reducing the risk of surgery and hospitalisation, fiber texture should be adapted in the presence of symptomatic strictures.

Nutraceuticals in the treatment of IBD: fact or fiction?

• Curcumin, with or without QingDai, could be used as an adjunct therapy for the induction of remission and maintenance of remission in mild-to-moderate UC. Due to hepatic toxicity and interactions with other medications, medical supervision is advised, especially if used in the long term and at high doses.

• The benefits of fiber supplements for the induction and maintenance of remission of IBD are unclear.

• Prebiotics are not recommended to induce and/or maintain remission of IBD.

• While vitamin D, omega-3, and glutamine may offer health benefits, their impact on IBD disease activity has not been proven.

#3 Dietary Management of IBD Complications

IBS-like symptoms:

IBS symptoms affect up to 40% of IBD patients. The low FODMAP diet has been shown to reduce global IBS symptoms and improve quality of life in patients with CD or UC in remission or with mild-to-moderate disease activity. However, it does not impact IBD disease activity and inflammation markers, so the low FODMAP diet should not be used to reduce inflammation in active IBD.

Symptomatic strictures:

While fiber itself does not cause IBD flares, certain types of fiber can make symptoms worse for some people, particularly during flares. People with stricturing CD and obstructive symptoms may benefit from a low-bulking fiber diet. It is also reasonable to choose soft or easy-to-chew fiber sources in a customized way with a dietitian experienced in IBD.

An all-formula diet could be considered to treat inflammatory strictures in CD.

Nutrition care before surgery:

An all-formula diet or oral nutrition supplement for at least 2 weeks before surgery may reduce hospital length of stay, infections, and inflammation in children and adults with CD undergoing surgery, compared with no nutritional support.

Intestinal resection:

People with a resection of the last part of the small intestine (i.e., terminal ileum) can develop a vitamin B12 deficiency and bile acid diarrhea, which may benefit from vitamin B₁₂ supplementation and a trial of a low-fat diet.

Calcium oxalate stones are more common in people with CD following intestinal resection and could benefit from adequate hydration, increased dietary calcium, supplementary calcium citrate, and a low-oxalate diet.

Stomas:

While boosting fiber intake can increase ileostomy output volume, if dietary fiber intake remains within a reasonable amount, it is likely that stoma bag empting volume will remain within what is considered normal volume.

Constipation is common in people with stomas and a dietitian should help tailor fiber and fluid intake.

Ileal pouch-anal anastomoses:

After proctocolectomy with ileal pouch-anal anastomosis, patients may experience an increase in stool frequency or volume. Incorporating fermentable fibers (e.g., inulin, fructo-oligosaccharides, and resistant starch) may help decrease stool frequency and volume and improve disease activity. In particular, fruits have been shown to help improve pouch function and may protect against pouchitis.

Short-bowel syndrome:

People with CD and short-bowel syndrome have a high risk of dehydration and may benefit from isotonic high-sodium oral rehydration solutions. In those with short-bowel syndrome and a colon, medium-chain triglycerides as a source of dietary fat may improve energy absorption.

#4 Nutritional Assessment and Optimisation for IBD

Dietary restriction is common in patients with IBD and an IBD trained dietitian should detect alarm signs early in disease course that may indicate dietary inadequacies and/or excesses.

All patients with IBD warrant regular screening for malnutrition as it is associated with disease activity and intestinal inflammation. However, relying only in body mass index as an indicator of nutrition status is not a good practice as weight and body mass index do not accurately predict body composition in IBD. Serum proteins are no longer recommended for the identification and diagnosis of malnutrition due to their lack of specificity for nutritional status and high sensitivity to inflammation.

Relevant nutrients in IBD are:

• Iron: it should be monitored at diagnosis and at least every 12 months in patients in remission and at least every 3 months in those with active disease.

• Folic acid and vitamin B₁₂: a deficiency of these vitamins is common in people with small-bowel disease or resection (in particular, patients with CD with extensive ileal disease or prior ileal surgery and those who follow a vegan diet). Both should be monitored at diagnosis and annually.

• Vitamin D: it should be monitored at diagnosis and annually due to high prevalence rates of osteopenia.

• Vitamin C: its deficiency is common in those on restrictive or poor-quality diets.

• Zinc: it should be monitored at diagnosis and annually in people with CD (not during active disease)

• Calcium: inadequate calcium intake is present in one-third of patients with IBD and is a reversible risk factor for osteoporosis.

• Magnesium: it's deficiency is common in people with chronic or severe diarrhea.

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💡 Micronutrient deficiencies are common in active disease and persist even during disease remission. Monitoring serum levels of vitamins and minerals in patients who are in clinical and biochemical remission may help identify which patients may benefit from dietary supplementation.

#5 Diet for IBD Prevention

Healthy eating patterns are encouraged among the general population and those at high risk, including first-degree relatives of patients with IBD.

A diet rich in wholegrains, fruit, vegetables, legumes, nuts, olive oil, moderate in lean proteins has been consistently associated with reduced development of CD and UC. Intake of ultraprocessed foods should also be limited, consistent with healthy eating patterns. For UC, meat intake, particularly red meat, was consistently associated with disease development.

Breastfeeding has health benefits for both the mother and child, although there is currently insufficient evidence supporting that it is a significant protector against IBD development.

Reference:

^{Svolos V, Gordon H, Lomer MCE, et al. ECCO consensus on dietary management of inflammatory bowel disease. J Crohns Colitis. 2025; jjaf122. doi: 10.1093/ecco-jcc/jjaf122.}

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‍Dr. Andreu Prados is a science and medical writer specializing in making reliable evidence of non-prescription therapeutics for gastrointestinal conditions understandable, engaging and ready for use for healthcare professionals and patients.

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