Therapeutic Diets

Therapeutic diets are whole-food based, nutritionally balanced dietary plans that improve symptoms, reduce inflammation, and aid in mucosal healing. Items that have been shown to be harmful (processed foods and additives) are eliminated and items with potential deleterious effects in IBD (gluten, sugar, and dairy) are either eliminated or limited, while the quantity and variety of beneficial fruits and vegetables are increased.

Specific Carbohydrate Diet (SCD)

The SCD was originally developed by Sydney V. Haas, MD, for the treatment of celiac disease and was popularized and refined by Elaine Gottschall for the treatment of IBD in her book, Breaking the Vicious Cycle. It eliminates high starch vegetables, grains, processed/added sugars (honey is allowed), dairy containing lactose, processed foods, additives, preservatives, and artificial ingredients from the diet. It focuses on a diversity of healthy fruits and vegetables, nuts/nut flours/nut butters, fish, poultry, meat, homemade yogurt, and aged cheeses.

Modified Specific Carbohydrate Diet (mSCD)

Modified SCD is a diet that is derived from SCD but attempts to add back in a few select healthy whole foods to offer patients expanding options and to potentially feed a more diverse microbiome. Note that the definition of modified SCD is evolving. The specifics as to how the diet is modified could be as vague as the diet was not followed strictly (early uses of the term), to a very defined list of added foods allowed in specified amounts if tolerated.

Anti-Inflammatory Diet for IBD (IBD-AID)

The IBD-AID was derived from the Specific Carbohydrate Diet and modified to include more prebiotic and probiotic foods in order to restore a healthy microbiome balance. More specifically, it includes specific sources of carbohydrates, fruits and vegetables, and nut and legume flours. It includes omega-3 eggs, fish, poultry, and lean meats; limited aged cheeses made with cultures and enzymes; probiotic food sources like yogurt, kefir, and miso; and honey. Prebiotic food sources such as bananas, oats, blended chicory root, and flax meal are suggested. The diet is divided into 3 phases that correlate with symptoms and which are based on food textures (Olendzki BC et al).

Autoimmune Protocol Diet (AIP)

The AIP is also known as Paleo Autoimmune Protocol because it is derived from the Paleolithic diet (which is based on meat, fish, vegetables, nuts, and seeds) (Medical News Today), although it is a stricter version, eliminating foods that may be antigenic, stimulate the immune system, or create dysbiosis. There are three phases: the initial elimination phase removes grains, legumes, nightshade vegetables, sugar, dairy, eggs, nuts, seeds, alcohol and coffee, processed foods, and industrial seed oils; the reintroduction phase, where items are individually reintroduced while monitoring for symptoms or progression of disease; and the maintenance phase, in which patients sustain their personalized restrictions and reintroductions as long as they are symptom free.

Crohn's Disease Exclusion Diet (CDED)

The CDED is a whole foods diet designed to exclude or limit exposure to foods that may adversely affect the microbiome or alter intestinal barrier function (Levine A et al) (Sigall-Boneh et al). The CDED is initiated in three phases and is always combined with Partial Enteral Nutrition (PEN) from formula (Modulen IBD®) in declining amounts, with the last stage maintaining 25% of daily intake from PEN. In patients unwilling to use Exclusive Enteral Nutrition, CDED is an effective alternative for inducing remission (Sigall-Boneh et al), and it may provide a more effective option than standard PEN for maintaining it.

Overview of the Therapeutic Diets

For a side-by-side look at all of the therapeutic diets and their included and restricted foods, please visit our Therapeutic Diets Overview page.

Other Dietary Options

Managing Symptoms

A low-FODMAP diet is often recommended to control symptoms in IBD. The low-FODMAP diet is not categorized as a therapeutic diet because it has not been shown to reduce markers of inflammation or impact disease activity. It may be helpful when used short term (4 weeks) for symptom relief, but is not recommended longer term because it may adversely affect the microbiome (Cox SR et al).

Overall Healthy Diet

The Mediterranean Diet (MD) is a good recommendation for patients not interested in a therapeutic diet as part of their treatment plan. Data support its health benefits in other disease states such as cardiovascular disease, cancer, and diabetes, with much of its benefit attributed to reductions in inflammation from higher consumption of vegetables, fruits, nuts, and healthful fats from avocados, fish, and olive oil (Martina D) (Tosti V et al). As it has not been evaluated in IBD for its effects on inflammation or disease activity, it is not currently listed above as a therapeutic diet for potential treatment of IBD. The DINE-CD trial is currently investigating its use in this context and may soon clarify whether or not it can be successfully implemented for therapeutic purposes. For IBD patients who choose not to adopt a therapeutic diet, the MD is a good choice for potentially improving overall health, favorably affecting the microbiome (Reddavide R et al) (Tomasello G et al) (Godny L et al) (Ghosh TS et al), and possibly preventing later-onset of CD (Khalili H et al).

The Mediterranean Foods Alliance has created an informative guide that can be a helpful resource for patients wishing to adopt the MD.

Investigational

Therapeutic diets are continuously evolving as new dietary research is released. As above, the MD is currently under evaluation to determine its potential as a therapeutic option for Crohn’s disease. CD-TREAT (Svolos V et al), a whole-foods-based alternative to EEN, and the Semi-Vegetarian Diet (Chiba M et al) (Chiba M et al) (Chiba M et al) are two additional potential therapeutic diets under investigation.