Common Questions about Diets for Inflammatory Bowel Disease (IBD)

Living with an inflammatory bowel disease (IBD) diagnosis can be extremely challenging and disruptive to daily life – especially for a young child. It takes highly experienced and dedicated experts, like The Division of Pediatric Gastroenterology, Hepatology and Nutrition, to determine a nuanced management plan for each patient, and oftentimes dietary interventions are part of that conversation. Below, Gastroenterologist Dr. Joseph Runde and Lurie Children’s Registered Dietitian Sally Schwartz, answers common questions about the role diet might play for a child with IBD.

How is IBD affected by diet?

While the exact cause of IBD is still being explored, we know that it’s the result of an impaired immune system causing harm to the intestine and the disease onset can happen at any point in childhood or adulthood. This abnormal immune system response can be triggered by factors such as a person’s genetic makeup and environmental exposure such as foods, medications like antibiotics, and more. These things help to shape a child’s gut microbiome (the trillions of bacteria and other microbes in your gut which help to digest food and to support immune function, metabolism, and brain development, etc.) from an early stage and are involved in the onset of IBD. That said, diet alone is not response for a person becoming diagnosed with IBD.

However, after a person is diagnosed with IBD, diet continues to be an important factor in restoring them to full health either by using diet to limit inflammation (damage) in specific cases or by using diet to help minimize symptoms, which is always beneficial, no matter the type or location of IBD.

Are there dietary guidelines to follow that will prevent my child from developing IBD?

Currently, no. Parents and caregivers are not responsible for the onset of IBD. The initial triggers that cause IBD inflammation are unique to each person’s environment and lifestyle, and there is not enough evidence at this time to serve as preventative guidance. While research around questions like these is ongoing, at present IBD management focuses on restoring health after diagnosis.

Is dietary therapy recommended for both Crohn’s disease and ulcerative colitis?

Diet considerations will be important with both conditions, but the goals of dietary therapy will differ based on the individual diagnosis and the location of the gut inflammation. Dietary therapy has proven to be especially effective in children (more so than adults) with Crohn’s disease patients, and in some instances can actually be used to promote gut healing in the same way as medical therapy. When it comes to ulcerative colitis, research around whether dietary therapy can actually control inflammation is less clear, but it’s a trusted resource of management in terms of mitigating symptoms.

What are common triggers of IBD? Are there specific types of foods or ingredients to avoid?

IBD triggers will differ from person to person, but foods that might prove more stimulating to the immune system and result in worsening symptoms include:

• Additives like emulsifiers contained in processed foods
• Caffeine
• Foods high in fat content
• Foods high in concentrated sugars such as cakes, candies and cookies
• Gluten
• High-fiber foods
• Spicy foods

Determining what foods to either eat in moderation or eliminate from a child’s diet may depend on where the inflammation is in their GI tract.

What is the process when introducing dietary therapy at Lurie Children’s?

Our care team offers a comprehensive approach to IBD management, and with dietary therapy that means enlisting one of the Lurie Children’s registered dietitians who specialize in IBD conditions and nutrition. Together with the child’s gastroenterologist and pediatrician, the team supports patients through their unique journeys with IBD, which might look like the exclusion or moderation of certain foods or even a temporary adjustment in the way in which a child receives their calories (i.e., formula or oral nutrition supplements). Some of these strategies are thought to help keep the gut microbiome in balance as well as reducing antigens (protein) that are more triggering to our immune systems.

The Gastroenterology, Hepatology & Nutrition team also stays closely connected to determine what other services might benefit a patient from a holistic perspective – whether that’s a clinical psychologist, social worker, or other specialist (such as rheumatology or dermatology).

What are some forms of IBD dietary therapy?

Our care team may recommend trialing a particular diet based on the IBD diagnosis (Crohn’s vs ulcerative colitis), location of inflammation (small intestine, colon, or stomach) and in consideration of the family unit. Two of the more common and effective therapies for Crohn’s disease management include Exclusive Enteral Nutrition (EEN) and Crohn's Disease Exclusion Diet (CDED).

• EEN – An all-formula diet designed to promote better absorption of nutrients, weight gain, increased muscle mass and bone health, aimed at inducing remission in patients. This is a short-term program lasting anywhere from 6-12 weeks.
• CDED – A three-phase whole foods-based diet designed to limit or exclude foods that may negatively affect the gut microbiome, inflammation, and intestine’s ability to absorb nutrients or other functions. CDED is combined with partial enteral nutrition (PEN) using oral nutritional supplements in variable amounts that decrease over phases. CDED is like EEN but designed to be more palatable, and improves health-related quality of life due to increasing whole foods and decreasing intake of oral nutrition supplements.

Other diets that might be recommended to decrease symptoms include the below. Not every diet listed has been shown to reduce IBD inflammation.

• Specific Carbohydrate Diet (SCD) – excludes grains, fiber, and certain sugars, with the idea that undigested starch products may trigger changes in intestinal bacterial growth and inflammation. The SCD eliminates all refined and processed foods (e.g., processed meats, artificial sweeteners), along with high starch vegetables, grains, added sugars, soy, dairy containing lactose, additives, preservatives, and artificial ingredients from the diet.
• Mediterranean diet – A whole foods-based diet rich in fiber and plant-based foods, including olive oil, low-fat dairy, herbs, and spices. There is little to no red meat in this diet, while poultry, eggs, cheese, and yogurt are recommended in moderation. Also, known to be a heart healthy diet.
• Low-FODMAP diet – FODMAP is an acronym for Fermentable, Oligo-, Di-, Monosaccharides and Polyols. This diet that cuts back on a group of fibers and sugars that can be poorly absorbed by your GI tract. This includes foods containing fructose, lactose, sugar polyols (sorbitol and mannitol), fructans (found in garlic, leeks, artichokes, and wheat), and galacto-oligosaccharides (found in lentils, chickpeas, and green peas). The low-FODMAP diet contains three phases: Restriction, Reintroduction and Maintenance. The Restriction phase is meant for short-term trial.
• Anti-inflammatory diet (IBD-AID) – The IBD-AID was developed to restore balance between helpful and harmful gut bacteria while promoting good nutrition. It incorporates features of the SCD by avoiding certain carbohydrates and adding more prebiotic and probiotic to improve the gut microbiome. It is designed to be implemented in phases which involves progressing the texture of food.
• Gluten-free diet – Excludes foods containing gluten: a protein found in wheat, barley, rye, and triticale (a cross between wheat and rye). This diet is most commonly used in people with Celiac disease.

Source: Crohn’s & Colitis Foundation; https://www.crohnscolitisfoundation.org/diet-and-nutrition/special-ibd-diets

Can I trial these diets with my child on our own?

It’s recommended that you consult your gastroenterologist, registered dietitian, and pediatrician before adopting a significantly different or complex diet for your child. Many of these diets are restrictive and/or challenging to manage without guidance. Our experts are here to support your child, ensure they are getting the essential nutrients they need for optimal growth and development, and help mitigate potential complications as they adjust to a new diet structure.

Can dietary therapy be a standalone approach for IBD management or is it recommended alongside other interventions?

This will depend on the type of IBD a child has and your family’s ability to sustain a restrictive diet. With ulcerative colitis, it’s less common that someone can sustain remission with dietary therapy alone. In Crohn’s disease, with certain cases, dietary monotherapy (one type of treatment) can be achieved but it’s important that a patient is meeting all of the targets of remission, such as symptom-free, stable lab work and stool testing and reassuring growth patterns over time. Consult your child’s gastroenterologist for a full scope of condition management recommendations based on their symptoms.

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