Article information
Authors: L. Godny, T. Pfeffer-Gik, S. Elial-Fatal, S. Shakhman, I. Dotan
Journal: Current Opinion in Pharmacology
Year: 2026
Volume: 86
Article number: 102587
DOI: https://doi.org/10.1016/j.coph.2025.102587
Study at a glance
- Study type: Narrative review
- Population studied: Patients with inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
- Focus areas: Dietary strategies for inducing remission, maintaining remission, and managing symptoms
- Interventions reviewed: Exclusive enteral nutrition, partial enteral nutrition, Crohn’s disease exclusion diet, CD-TREAT, Tasty&Healthy diet, 4-SURE diet, ulcerative colitis exclusion diet, Mediterranean diet, Specific Carbohydrate Diet, low-FODMAP diet, and others
- Key outcomes: Clinical remission, mucosal healing, symptom control, quality of life, and inflammatory markers
Why was this study done?
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a lifelong condition that usually needs ongoing treatment. Medicines are still the primary treatment, but there is growing evidence that what people eat can affect how active the disease is and how well it stays in remission (the calm, symptom-free periods). Food seems to work through its effect on the gut’s bacteria, the strength of the gut lining, and the way the immune system behaves.
Godny and colleagues gathered the current evidence on the different diets that have been tried in IBD, looking at what each one is made up of and where it might fit in real-world care.
How was the study performed?
The authors reviewed published research on diet in IBD, drawing on clinical trials, longer-term studies that follow groups of patients, and real-world experience. They grouped the diets by what they are used for: settling active Crohn’s disease, settling active ulcerative colitis, keeping people in remission, easing lingering gut symptoms, and supporting people who have had pouch surgery.
What did the researchers find?
Dietary strategies for active Crohn’s disease
The most evidence-based option is a liquid-only approach called exclusive enteral nutrition, where all food is replaced by a complete nutritional formula for six to eight weeks. It is good at calming the disease and healing the gut lining, especially in children. In adults it is used far less, mainly because living on formula alone is hard to keep up.
Because a formula-only diet can be difficult to adhere to, whole-food approaches offer a more manageable alternative. The Crohn’s disease exclusion diet, paired with a partial formula (roughly half the day’s calories), has been shown to deliver outcomes comparable to the liquid-only approach while being easier to follow. The CD-TREAT diet aims for the same nutritional make-up using ordinary foods, leaving out gluten, lactose, and alcohol and cutting back on fibre; early results are encouraging and it is reasonably well tolerated. The Tasty&Healthy diet takes out processed foods, gluten, red meat, and most dairy (plain, unsweetened yogurt is allowed) without needing any formula. In a trial in children and young adults with mild to moderate disease, 56% reached remission, compared with 38% on the liquid-only formula.
Two further trials looked at more targeted changes. The ADDapt trial found that cutting out emulsifiers (additives that may irritate the gut lining) improved symptoms in adults with mild to moderate Crohn’s, with nearly half responding. The DINE-CD trial compared the Specific Carbohydrate Diet (which drops grains, lactose, and most carbohydrates) with the Mediterranean diet and found no real difference in remission, though people found the Mediterranean diet easier to follow.
Dietary strategies for active ulcerative colitis
Here the aim is to shift what the gut bacteria produce: less hydrogen sulfide (a gas that can irritate the bowel) and more short-chain fatty acids (helpful compounds bacteria make from fibre). The ulcerative colitis exclusion diet cuts animal protein, saturated fat, and additives while adding more fermentable fibre, resistant starch, and tryptophan (found in certain protein sources); it brought about a third to a half of children with mild to moderate disease into remission (40%) and healed the gut lining in one in five (20%). The 4-SURE diet limits sulfur-rich and animal-based foods and additives while boosting resistant starch, and early studies showed improved symptoms and less inflammation in adults. In a small study in children, following a Mediterranean diet for 12 weeks improved symptom scores and lowered faecal calprotectin (a stool marker of gut inflammation).
Maintaining remission
There is less evidence here. A partial formula providing about 35 to 50% of daily calories lowered the risk of Crohn’s flare-ups, though relying partly on formula long-term is hard for many people. The Mediterranean diet has drawn interest as something people can genuinely keep up. In a Canadian study of adults whose ulcerative colitis was quiet, those following it kept lower faecal calprotectin than people on a standard healthy diet, and had a healthier balance of gut bacteria. Diets high in ultra-processed foods were linked to more Crohn’s flare-ups, while plant-based, high-fibre eating with few processed foods was linked to better outcomes.
Managing functional symptoms
Some people still get bloating, pain, or changes in their bowel habits even when the disease is quiet. For this overlap with irritable bowel syndrome, a low-FODMAP diet (which limits certain fermentable carbohydrates) helped ease symptoms. Because it also reduced some helpful bacteria, it is best used only for a short time and under a dietitian’s guidance.
What the diets have in common
Most of the whole-food approaches pull in the same direction. They cut back on ultra-processed foods, red and processed meat, and ingredients thought to upset the gut, and they lean on fruit, vegetables, fibre that feeds gut bacteria, eggs, fish, poultry, healthy fats, and fermented foods such as yoghurt
What did the authors conclude?
Diet is becoming a more recognised part of IBD care. For active Crohn’s disease, the focus is on leaving out ingredients that may fuel inflammation; for ulcerative colitis, it is on changing what the gut bacteria produce by eating fewer animal-based foods and more fibre.
For keeping the disease settled over the long run, the evidence for any one diet is still thin, but the authors lean towards flexible, mostly plant-based, minimally processed eating, of which the Mediterranean diet is the clearest example. They stress that bigger, better-designed trials are needed to prove what works, show what happens over time, and set out advice for each type of IBD. Throughout, they see one-to-one support from an IBD-trained dietitian as key, both to help people stick with a diet and to make sure they are still eating well and enjoying their food.
They are candid about the limits of the current research: many studies are small, run for only a short time, and often measure whether a diet is bearable rather than whether it truly works.
Key takeaways
- The liquid-formula approach (exclusive enteral nutrition) is still the best-proven diet for settling active Crohn’s disease, but whole-food alternatives such as the Crohn’s disease exclusion diet, CD-TREAT, and Tasty&Healthy show promise and are easier to live with.
- For ulcerative colitis, the aim is to reduce an irritating gas the gut bacteria make and increase helpful fibre-derived compounds, by eating fewer animal-based foods and more fibre and resistant starch.
- For staying well long-term, flexible, mostly plant-based, minimally processed eating such as the Mediterranean diet looks the most sustainable, while diets heavy in ultra-processed foods are linked to more flare-ups.
- Most of the helpful diets share the same core: fewer ultra-processed foods and processed meats, and more fruit, vegetables, fibre, and healthy fats.
- Personal guidance from an IBD-trained dietitian is essential to turn this evidence into everyday eating, keep people on track, avoid cutting out foods unnecessarily, and protect good nutrition.
This Scientific Publication Summary is an objective summary of the published study for personal and educational use. It does not constitute medical advice, endorsement of the intervention, or a recommendation to alter clinical practice.