Cited by 297Inflammatory Bowel DiseaseNutritional Studies and DietGut microbiota and health

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Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases

Levine, Arie, Rhodes, Jonathan M., Lindsay, James O., Abreu, Maria T., Kamm, Michael A., Gibson, Peter R., Gasche, Christoph, Silverberg, Mark S., Mahadevan, Uma, Boneh, Rotem Sigall, Wine, Eyton, Damas, Oriana M., Syme, Graeme, Trakman, Gina L., Yao, Chu Kion, Stockhamer, Stefanie, Hammami, Muhammad B., Garces, Luis C., Rogler, Gerhard, Koutroubakis, Ioannis E., Ananthakrishnan, Ashwin N., McKeever, Liam, Lewis, James D.·2020·Clinical Gastroenterology and Hepatology

DOI 10.1016/j.cgh.2020.01.046

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Abstract

Recent evidence points to a plausible role of diet and the microbiome in the pathogenesis of both Crohn's disease (CD) and Ulcerative Colitis (UC). Dietary therapies based on exclusion of table foods and replacement with nutritional formulas and/or a combination of nutritional formulas and specific table foods may induce remission in CD. In UC, specific dietary components have also been associated with flare of disease. While evidence of varying quality has identified potential harmful or beneficial dietary components, physicians and patients at the present time do not have guidance as to which foods are safe, may be protective or deleterious for these diseases. The current document has been compiled by the nutrition cluster of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) based on the best current evidence to provide expert opinion regarding specific dietary components, food groups and food additives that may be prudent to increase or decrease in the diet of patients with inflammatory bowel diseases to control and prevent relapse of inflammatory bowel diseases.

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ResultInfluential
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“However, given the importance of diet as an important environmental factor in the pathogenesis of IBD, and taking into account the high interest of patients in the importance of diet, the option to consult a professional clinical dietitian having appropriate qualifications and experience is an important element in the…”
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Perception of the Role of Food and Dietary Modifications in Patients with Inflammatory Bowel Disease: Impact on Lifestyle
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“Recently, the International Organization for the Study of IBD (IOIBD) recommended increasing exposure to fruit and vegetables in Crohn’s disease [18].”
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Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionally affect Hispanics and non-Hispanic Blacks with IBD
Damas, O. M., Kuftinec, G. N., Khakoo, N. S., Morillo, D., Quintero, M. A., Leavitt, J. S., Lopez, J., Kerman, D. H., Abreu, M. T., Deshpande, A. R., et al. (2022) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848221079162 · Cited by 35
Possible role of nutrition in the prevention of inflammatory bowel disease–related colorectal cancer: A focus on human studies
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Polyphenol-protein particles: A nutraceutical breakthrough in nutrition and food science
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Reducing Disease Activity of Inflammatory Bowel Disease by Consumption of Plant-Based Foods and Nutrients
Antoniussen, C. S., Rasmussen, H. H., Holst, M., & Lauridsen, C. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.733433 · Cited by 37
“However, despite these results, the dietary guidance from the IOIBD (41) recommends increased consumption of natural sources of n-3 fatty acids (e.”
BackgroundInfluential
Dietary Management in Pediatric Patients with Crohn’s Disease
Scarallo, L., & Lionetti, P. (2021) · Nutrients · doi:10.3390/nu13051611 · Cited by 35
Intestinal Microbiota in Common Chronic Inflammatory Disorders Affecting Children
Torun, A., Hupalowska, A., Trzonkowski, P., Kierkuś, J., & Pyrzyńska, B. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.642166 · Cited by 40
Association between Fecal Short-Chain Fatty Acid Levels, Diet, and Body Mass Index in Patients with Inflammatory Bowel Disease
Dąbek, A., Kaczmarczyk, O., Woźniakiewicz, M., Paśko, P., Dobrowolska‐Iwanek, J., Woźniakiewicz, A., Piątek-Guziewicz, A., Zagrodzki, P., & Zwolinska-Wcislo, M. M. (2022) · Biology · doi:10.3390/biology11010108 · Cited by 35
“However, there are insufficient scientific data to recommend any specific dietary change or restriction of fruit and vegetables in patients with UC [43].”
Background
What’s new in IBD therapy: An “omics network” approach
Fiocchi, C., & Iliopoulos, D. (2020) · Pharmacological Research · doi:10.1016/j.phrs.2020.104886 · Cited by 34
The dietary practices and beliefs of British South Asian people living with inflammatory bowel disease: a multicenter study from the United Kingdom
Crooks, B. J., Misra, R., Arebi, N., Kok, K. B., Brookes, M., McLaughlin, J. T., & Limdi, J. K. (2021) · Intestinal Research · doi:10.5217/ir.2020.00079 · Cited by 32
“Whilst diet is of great interest to those living with IBD, there remains a paucity of evidence-based dietary recommendations and advice from healthcare professionals is inevitably limited by a relative dearth of credible scientific data.(19,20) This fuels frustration due to perceived clinician indifference, leading th…”
Background
Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (Version 4.1) – living guideline
Sturm, A., Atreya, R. N., Bettenworth, D., Bokemeyer, B., Dignass, A. U., Ehehalt, R., Germer, C.-T., Grunert, P., Helwig, U., Horisberger, K., et al. (2024) · Zeitschrift für Gastroenterologie · doi:10.1055/a-2309-6123 · Cited by 38
Therapeutic Advances in Gut Microbiome Modulation in Patients with Inflammatory Bowel Disease from Pediatrics to Adulthood
Eindor‐Abarbanel, A., Healey, G. R., & Jacobson, K. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222212506 · Cited by 35
Pediatric Management of Crohn’s Disease
Mitchel, E. B., & Rosh, J. R. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2021.12.013 · Cited by 31
Review on the potential application of non-phenolic compounds from native Latin American food byproducts in inflammatory bowel diseases
do Nascimento, R. D. P., Moya, A. M. T. M., Machado, A. P. D. F., Geraldi, M. V., Diez‐Echave, P., Vezza, T., Gálvez, J., Cazarin, C. B. B., & Maróstica, M. R. (2020) · Food Research International · doi:10.1016/j.foodres.2020.109796 · Cited by 32
Vitamin C Deficiency in Inflammatory Bowel Disease: The Forgotten Micronutrient
Dunleavy, K. A., Ungaro, R. C., Manning, L., Gold, S. L., Novak, J. D., & Colombel, J. (2021) · Crohn s & Colitis 360 · doi:10.1093/crocol/otab009 · Cited by 29
Dietary patterns, food groups and nutrients in Crohn’s disease: associations with gut and systemic inflammation
Naqvi, S. A., Taylor, L., Panaccione, R., Ghosh, S. K., Barkema, H. W., Hotte, N., Shommu, N. S., Kaur, S., Reimer, R. A., Madsen, K. L., et al. (2021) · Scientific Reports · doi:10.1038/s41598-020-80924-8 · Cited by 34
Abdominal Pain in Inflammatory Bowel Disease: An Evidence-Based, Multidisciplinary Review
Coates, M. D., Clarke, K., Williams, E. D., Jeganathan, N., Yadav, S., Giampetro, D., Gordin, V., Smith, S. E., Vrana, K. E., Bobb, A. D., et al. (2023) · Crohn's & Colitis 360 · doi:10.1093/crocol/otad055 · Cited by 28
Dietary Interventions in Ulcerative Colitis: A Systematic Review of the Evidence with Meta-Analysis
Herrador‐López, M., Martín‐Masot, R., & Navas‐López, V. M. (2023) · Nutrients · doi:10.3390/nu15194194 · Cited by 29
“However, while the connection between diet and gut health is becoming clearer, the precise role of diet in managing UC remains a matter of ongoing investigation [1].”
BackgroundInfluential
Meat Consumption and All-Cause Mortality in 5 763 Inflammatory Bowel Disease Patients: A Prospective Cohort Study
Chen, H., Fu, T., Dan, L., Chen, X., Sun, Y., Chen, J., Wang, X., & Hesketh, T. M. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101406 · Cited by 31
Nutraceuticals for the Treatment of IBD: Current Progress and Future Directions
Ban, Q.-Y., Liu, M., Ding, N., Chen, Y., Lin, Q., Zha, J., & He, W. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.794169 · Cited by 26
“For patients with IBD, it is suggested to reduce the intake of saturated fat, trans-fat, animal protein, and food additives (146).”
Background
Current recommendations on the role of diet in the aetiology and management of IBD
Gerasimidis, K., Godny, L., Boneh, R. S., Svolos, V., Wall, C. L., & Halmos, E. P. (2021) · Frontline Gastroenterology · doi:10.1136/flgastro-2020-101429 · Cited by 26
Comparison and recommendation of dietary patterns based on nutrients for Eastern and Western patients with inflammatory bowel disease
Hou, Y., Wang, S.-F., Zhou, K., & Dai, S. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1066252 · Cited by 24
“In contrast, lean chicken breast is a low animal fat and low taurine protein source that can be appropriately used in CD-exclusion diets, but there are also studies showing no association between red meat intake and IBD (12).”
Background
Dietary salt exacerbates intestinal fibrosis in chronic TNBS colitis via fibroblasts activation
Amamou, A., Rouland, M., Yaker, L., Goichon, A., Guérin, C., Aziz, M., Savoye, G., & Marion‐Letellier, R. (2021) · Scientific Reports · doi:10.1038/s41598-021-94280-8 · Cited by 26
Dysbiosis in a canine model of human fistulizing Crohn’s disease
Maldonado‐Contreras, A., Ferrer, L., Cawley, C., Crain, S. K., Bhattarai, S. K., Toscano, J., Ward, D. V., & Hoffman, A. M. (2020) · Gut Microbes · doi:10.1080/19490976.2020.1785246 · Cited by 25
“A dietary guidance for patients with IBD has been recently published highlighting the lack of strong evidence for foods to include or avoid for patients with IBD.(22) Most IBD-friendly whole food diets involved exclusion of carbohydrates, inclusion of lean protein, fruits, and vegetables.”
BackgroundInfluential
Biological Treatments in Inflammatory Bowel Disease: A Complex Mix of Mechanisms and Actions
Moreno, L. O., Fernández‐Tomé, S., & Abalo, R. (2021) · Biologics · doi:10.3390/biologics1020012 · Cited by 23
Clinical Trial: The Effects of Emulsifiers in the Food Supply on Disease Activity in Crohn's Disease: An Exploratory Double‐Blinded Randomised Feeding Trial
Fitzpatrick, J. A., Gibson, P. R., Taylor, K. M., Anderson, E. J., Friedman, A. B., Ardalan, Z. S., Smith, R. L., & Halmos, E. P. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70041 · Cited by 25
“…is gathering momentum, with The European Society of Parenteral and Enteral Nutrition [11] and the International Organisation for the Study of Inflammatory Bowel Disease [12] recommending restriction or exclusion of UPF and specifically dietary emulsifiers in patients with Crohn's disease.”
Dietary beliefs and recommendations in inflammatory bowel disease: a national survey of healthcare professionals in the UK
Crooks, B. J., McLaughlin, J. T., & Limdi, J. K. (2020) · Frontline Gastroenterology · doi:10.1136/flgastro-2020-101723 · Cited by 22
Diets for inflammatory bowel disease: What do we know so far?
Serrano‐Moreno, C., Torrecilla, N. B., Arhip, L., Romero, I., Morales, Á., Carrascal, M. L., Cuerda, C., Motilla, M., Camblor, M., Velasco, C., et al. (2022) · European Journal of Clinical Nutrition · doi:10.1038/s41430-021-01051-9 · Cited by 24
Food avoidance and fasting in patients with inflammatory bowel disease: Experience from the Nancy IBD nutrition clinic
Bonsack, O., Caron, B., Baumann, C., Heba, A.-C., Vieujean, S., Arnone, D., Netter, P., Danese, S., Quilliot, D., & Peyrin‐Biroulet, L. (2023) · United European Gastroenterology Journal · doi:10.1002/ueg2.12385 · Cited by 22
“In 2020, the International Organization for the Study of Inflammatory Bowel Diseases published a dietary guidance consensus.(6) It refers to several dietary patterns that are commonly recommended to patients with IBD (e.”
Background
The complexities of approaching nutrition in inflammatory bowel disease: current recommendations and future directions
Russell, L. A., Balart, M. T., Serrano, P. E., Armstrong, D., & Pinto-Sánchez, M. I. (2021) · Nutrition Reviews · doi:10.1093/nutrit/nuab015 · Cited by 21
“Macronutrients, specifically carbohydrates, fats, and proteins, are essential components of proper nutrition within a healthy diet.9 Patients with IBD are particularly at risk for fat malabsorption and protein-losing enteropathy, especially those with small-bowel involvement or surgical resection of terminal ileum.9 C…”
BackgroundInfluential
Review article: Evidence‐based dietary management of inflammatory bowel disease
Gibson, P. R., Yao, C. K., & Halmos, E. P. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18214 · Cited by 24
“This has not inhibited ESPEN 35 or the IOIBD 131 to advise that UPF and dietary emulsifiers be excluded from or reduced in the diet in patients with IBD.”
Major yolk protein from sea cucumber (Stichopus japonicus) attenuates acute colitis via regulation of microbial dysbiosis and inflammatory responses
Feng, J., Zhang, L., Xue Ming, T. A. N. G., Wei, H., & Zhou, P. (2021) · Food Research International · doi:10.1016/j.foodres.2021.110841 · Cited by 20
Brazilian guide to nutrition in bariatric and metabolic surgery
Pereira, S., Rossoni, C., Cambi, M. P. C., Faria, S. L., Magno, F. C. C. M., Campos, T. B. F. D., Petry, T. B. Z., da Silva, S. A., Pereira, A. Z., Umeda, L. M., et al. (2023) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-023-02868-7 · Cited by 30
“of animal origin, a source of saturated fat (milk fat; meats, lard (pig fat) and charcuterie), as well as coconut oil (vegetable fat), should be avoided or consumed in restricted amounts (< 10% of the total amount of recommended fat intake) [123].”
Mechanistic investigation and the optimal dose based on baicalin in the treatment of ulcerative colitis–A preclinical systematic review and meta-analysis
Chong, J., Chen, Z., Ma, J., He, L., Zhu, Y., Lu, Z., Qiu, Z., Chen, C., Chen, Y., & Jiang, F. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-03629-0 · Cited by 19
Gut microbiome in IBD: past, present and the future
Zhang, J., Mak, J. W. Y., & Ng, S. C. (2025) · Gut · doi:10.1136/gutjnl-2025-335626 · Cited by 22
“92 In 2024, the American Gastroenterological Association highlights that all patients with IBD should be advised to follow a Mediterranean diet 93 ; this diet has been found to be associated with lower rates of active disease, inflammatory marker elevation and improved quality of life in CD and UC.”
Dietary practices, beliefs and behaviours of adults with inflammatory bowel disease: a cross-sectional study
Murtagh, A., Cooney, L., Higginbotham, C. L., & Heavey, P. (2022) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-022-03097-5 · Cited by 19
D -Psicose intake exacerbates dextran sulfate sodium-induced colitis in mice through alteration in the gut microbiota and dysfunction of mucosal barrier
Zhang, X., Li, A., Wang, Y., Wang, J., Zhang, B., Zhang, Y., Liu, J., & Wang, S. (2023) · Food Science and Human Wellness · doi:10.26599/fshw.2022.9250046 · Cited by 19
Evidence and hypotheses on adverse effects of the food additives carrageenan (E 407)/processed Eucheuma seaweed (E 407a) and carboxymethylcellulose (E 466) on the intestines: a scoping review
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Practical application of the Crohn's disease exclusion diet as therapy in an adult Australian population
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What Should I Eat? Dietary Recommendations for Patients with Inflammatory Bowel Disease
Saha, S., & Patel, N. (2023) · Nutrients · doi:10.3390/nu15040896 · Cited by 19
“Based on the current evidence, a guidance statement was released, in which the authors thought it prudent to increase the dietary intake of fruits and vegetables in CD (with the exception of stricturing disease) [16].”
Background
Inflammatory Potential of the Diet and Risk of Crohn's Disease and Ulcerative Colitis
Meyer, A., Chan, S. S. M., Touvier, M., Julia, C., Tjønneland, A. M., Kyrø, C., Dahm, C. C., Katzke, V. A., Schulze, M. B., Tumino, R., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18497 · Cited by 17
“Further studies should focus on the effect of various types of dietary fibre upon the risk of developing IBD [37].”
Crohn’s Disease: Is the Cold Chain Hypothesis Still Hot?
Hugot, J., Dumay, A., Barreau, F., & Meinzer, U. (2020) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjaa192 · Cited by 18
Telenutrition for the management of inflammatory bowel disease: Benefits, limits, and future perspectives
Guney-Coskun, M., Kolay, E., & Başaranoğlu, M. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i2.308 · Cited by 19

Authors: Levine, A., Rhodes, J. M., Lindsay, J. O., Abreu, M. T., Kamm, M. A., Gibson, P. R., Gasche, C., Silverberg, M. S., Mahadevan, U., Boneh, R. S., Wine, E., Damas, O. M., Syme, G., Trakman, G. L., Yao, C. K., Stockhamer, S., Hammami, M. B., Garces, L. C., Rogler, G., Koutroubakis, I. E., Ananthakrishnan, A. N., McKeever, L., & Lewis, J. D.
Affiliations: Tel Aviv University (IL)
University of Liverpool (GB)
Queen Mary University of London (GB)
University of Miami (US)
The University of Melbourne (AU)
Alfred Health (AU)
Mount Sinai Hospital (CA)
University of California, San Francisco (US)
Barts Health NHS Trust (GB)
University Hospital Zurich (CH)
Massachusetts General Hospital (US)
University of Pennsylvania (US)
Corresponding author: Lewis, James D.
ORCID: Levine, Arie
Rhodes, Jonathan M.
Lindsay, James O.
Abreu, Maria T.
Kamm, Michael A.
Silverberg, Mark S.
Mahadevan, Uma
Boneh, Rotem Sigall
Damas, Oriana M.
Trakman, Gina L.
Yao, Chu Kion
Hammami, Muhammad B.
Rogler, Gerhard
Ananthakrishnan, Ashwin N.
McKeever, Liam
Lewis, James D.
Venue: Clinical Gastroenterology and Hepatology
Publisher: Elsevier BV
Published: 2020-05
Volume: 18
Issue: 6
Pages: 1381-1392
ISSN: 1542-3565 (ISSN-L)
DOI: 10.1016/j.cgh.2020.01.046
OpenAlex: W3005828812
Cited by: 297
References: 105
Citations by year: 2026: 36 · 2025: 48 · 2024: 53 · 2023: 54 · 2022: 37 · 2021: 44 · 2020: 24
FWCI: 5.68
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Gastroenterology and Hepatology (publishedVersion)
PubMed (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis, dietary recommendations, gut microbiota, dietary therapy, nutritional formula, food additives, disease flares, remission, relapse prevention, food safety
MeSH terms: Colitis, Ulcerative, Crohn Disease, Diet, Humans, Inflammatory Bowel Diseases, Microbiota

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Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases

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