What to eat with Crohn’s or colitis: flares, remission and nutrition

There is no single diet for Crohn’s disease or ulcerative colitis. Most people with IBD do best with a varied, nourishing pattern of eating that changes with their symptoms: a broad, Mediterranean-style mix of foods in remission, a gentler, lower-fiber approach during some flares when advised, and regular checks on nutrition. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that no specific food has been shown to cause or worsen Crohn’s disease, and says the same about ulcerative colitis.

That doesn’t mean food doesn’t matter. Many people notice certain foods affect their symptoms, especially during a flare, and steady nourishment supports your body through a condition that can make eating and absorbing nutrients harder. It does mean you don’t need to follow a rigid list, and it’s worth being cautious of anyone selling one plan for all of IBD.

In 2024 the American Gastroenterological Association (AGA) published a clinical practice update on food and nutrition in IBD. As reported by The Hospitalist, the expert panel stated that no diet has consistently been found to decrease the rate of flares in adults with IBD.

What the panel did recommend, unless there’s a reason not to, is a Mediterranean-style eating pattern for adults with IBD, while keeping salt, added sugar and ultra-processed foods low. They also noted that eating less red and processed meat may reduce flares in ulcerative colitis, though it hasn’t been shown to reduce relapse in Crohn’s disease.

Just as important, the panel flagged a downside of older advice. Telling people with IBD to avoid many foods, including fiber, often led them to keep avoiding nourishing foods long after they were in remission. Restriction has costs, so it’s best kept to times and situations where it clearly helps.

Other structured approaches exist. Crohn’s and Colitis Canada lists the low-FODMAP diet, the Mediterranean diet and the Crohn’s disease exclusion diet among options clinicians may use. If low-FODMAP is suggested to you, see our low-FODMAP guide for how it works, and use it only with a dietitian.

Flares are when eating often feels hardest. UCSF Health suggests that during a flare, a low-residue approach may ease abdominal pain and diarrhea, by limiting foods that increase stool output, such as fresh fruit and vegetables, prunes and caffeine. It also notes that cold foods may help with diarrhea.

Low-residue eating is a short-term tool, not a long-term plan, and it isn’t right for everyone. Use it only when your gastroenterologist or dietitian advises it, and ask them when and how to widen your eating again.

• Smaller, more frequent meals are often easier to manage and can help you take in more nourishment across the day.
• Liquid nutrition supplements may help if your appetite is low or solid food is hard to manage. Ask your care team which one suits you.
• Fluids matter. Diarrhea can drain water and electrolytes, so drink regularly and ask about replacing electrolytes.
• For ulcerative colitis, UCSF suggests cutting back on alcohol and concentrated sugars during a flare.
• For Crohn’s disease, UCSF suggests going lactose-free if you’re lactose intolerant, and reducing dietary fat if stools are oily and foul-smelling. Our lactose intolerance guide explains the difference between lactose-free and dairy-free.

When things settle, the goal shifts to variety and enjoyment. UCSF suggests eating a wide variety of foods in remission, including fruits, vegetables, whole grains, lean protein and dairy, and adding fiber back gradually as you tolerate it.

1. Start with gentler sources of fiber, such as well-cooked vegetables, canned fruit and cooked cereals.
2. Reintroduce foods you avoided during the flare one or two at a time, so you can tell what suits you.
3. Keep a short food and symptom diary as you go. NIDDK suggests a food diary can help you spot foods that seem to trigger symptoms.
4. Move toward a Mediterranean-style mix with plenty of produce and a wide range of foods, as tolerated.
5. Review with your dietitian anything you’re still avoiding, to check it’s still needed.

If you notice bloating or IBS-like symptoms even while your IBD is calm, our guides to bloating and food and high-FODMAP foods and swaps may help you have a better conversation with your care team.

Some people with Crohn’s disease develop a stricture, a narrowing of the intestine caused by inflammation, scar tissue or both. Crohn’s & Colitis Australia explains that a modified low-fiber approach may be advised to lower the risk of a blockage. It may be temporary, for example while an inflammatory stricture is treated, or longer-term if the stricture can’t be treated or removed, and it should be followed with an IBD dietitian.

• UCSF suggests people with strictures avoid nuts, seeds, beans and kernels, which can block narrowed sections of bowel.
• The AGA panel suggests softening raw fruits and vegetables by cooking or steaming, or chewing them carefully, if you have symptomatic strictures.
• Once a stricture is treated or removed, a balanced, fiber-containing pattern is usually recommended again.

IBD can make it harder to get enough nourishment. NIDDK explains that symptoms can reduce appetite, inflammation in the small intestine can limit absorption, and some medicines and surgeries can reduce absorption too. In children, this can affect growth and development.

• The AGA panel advises routine checks of iron and vitamin D, and B12 checks for people with extensive disease in the ileum (the last part of the small intestine) or past ileal surgery.
• Your doctor may recommend supplements. NIDDK advises checking with your doctor before taking any vitamins or supplements.
• For people with more complicated IBD, the AGA panel recommends care shared between a gastroenterologist and a registered dietitian who watch for malnutrition.

Some people with Crohn’s disease are offered exclusive enteral nutrition, a period of liquid formula in place of food, to help bring the disease under control. The AGA panel describes it as a reasonable option, possibly more effective in children. This is a medical treatment and is always supervised by your team.

An IBD-experienced registered dietitian can turn general advice into a plan that fits your disease, your medicines and the foods you love. It’s worth asking your gastroenterologist for a referral, especially if:

• You’re cutting out several foods or food groups.
• Your weight is changing without explanation, or your appetite has dropped.
• You have strictures, have had bowel surgery or have a stoma.
• You’re supporting a child with IBD.
• Food has started to feel stressful or frightening.

That last point is common. Living with an unpredictable gut can make every meal feel like a risk. Our guides to food anxiety and digestive conditions and eating out with IBS include practical ideas that apply to IBD too.