Nutritional Therapy for Clients with Active Inflammatory Bowel Disease

December 30, 2025 •

4 min read

According to the Crohn's & Colitis Foundation, 20-85% of inflammatory bowel disease (IBD) patients are malnourished, underscoring the critical need for effective nutritional therapy for clients with active inflammatory bowel disease. This therapy plays a pivotal role in managing symptoms, correcting nutrient deficiencies, and supporting overall health during disease flares.

Quick Summary

This guide details the components of nutritional therapy for managing active IBD, including symptom-based dietary modifications, specialized enteral and parenteral support, and strategies to address specific nutrient deficiencies and promote healing. It emphasizes a personalized approach with expert guidance.

Key Points

Symptom-Based Diet Adjustments: During active disease, diet focuses on reducing symptoms by modifying fiber and fat intake and potentially temporarily removing lactose.
Nutrient Deficiency Correction: Active IBD and its treatments can cause deficiencies in vital nutrients like iron, Vitamin D, and Vitamin B12, which must be monitored and supplemented.
Specialized Nutritional Support: In severe cases, enteral or parenteral nutrition may be used to provide complete nutrition and promote gut healing while minimizing inflammation.
Low-FODMAP Strategy: A low-FODMAP diet can effectively manage IBS-like symptoms such as bloating and gas that often overlap with IBD.
Professional Guidance is Key: Working with a registered dietitian specializing in IBD is crucial for creating and managing a personalized and safe nutritional plan.
Gradual Reintroduction of Foods: As symptoms improve, dietary restrictions are carefully liberalized to promote a more varied diet and support long-term gut health.
Anti-Inflammatory Eating: In remission, adopting dietary patterns rich in anti-inflammatory foods, such as a Mediterranean-style diet, can help prevent future flares.

Understanding the Goals of Nutritional Therapy in Active IBD

When inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is active, the primary goals of nutritional therapy are to alleviate symptoms, reduce intestinal inflammation, prevent or correct malnutrition, and promote gut healing. Inflammation can lead to malabsorption, decreased appetite, and increased nutritional needs, making a structured approach essential. Since every patient's tolerance is different, personalized care from a registered dietitian is crucial for creating an effective and sustainable plan.

Dietary Modifications During Active Flare-ups

During a flare-up, the digestive system is highly sensitive, and dietary adjustments focus on reducing irritation and minimizing symptoms like diarrhea, pain, and gas. This often involves temporary, restrictive measures to give the gut a chance to rest and heal.

Low-Residue/Low-Fiber Diet: This approach minimizes insoluble fiber, which can bulk up stool and irritate the inflamed intestinal lining. Patients are often advised to consume cooked, peeled fruits and vegetables, refined grains like white rice and sourdough bread, and to avoid tough skins, seeds, and nuts.
Hydration and Electrolyte Replenishment: Chronic diarrhea can lead to significant fluid and electrolyte loss. Proper hydration is critical, and drinks with added electrolytes, like sports drinks or broths, may be recommended.
Fat and Protein Management: High-fat, fried, or greasy foods can worsen diarrhea, especially if a patient experiences fat malabsorption. The focus shifts to lean proteins, which help meet increased protein needs for tissue repair without exacerbating symptoms. Protein intake may need to be increased by 50% during a flare.
Lactose-Free Diet: Inflammation can cause a temporary lactase deficiency, leading to lactose intolerance symptoms like bloating and diarrhea. Avoiding dairy or choosing lactose-free products can provide significant relief.

Specialized Nutrition Support: Enteral and Parenteral Therapy

In more severe cases or when malnutrition is significant, more aggressive nutritional support may be required to bypass the inflamed bowel and provide complete nutrition.

Exclusive Enteral Nutrition (EEN): EEN is a highly effective treatment, particularly for pediatric Crohn's disease, involving a liquid formula administered orally or via a feeding tube for several weeks. It delivers complete, balanced nutrition while avoiding food antigens that may drive inflammation. Evidence for EEN in adults is less robust, but it remains a viable option, especially before surgery to optimize nutritional status.
Partial Enteral Nutrition (PEN): This involves supplementing some of a patient's dietary intake with a liquid formula, typically replacing 35-50% of habitual food intake. The Crohn's Disease Exclusion Diet is one type of PEN that has shown efficacy in some patients.
Parenteral Nutrition (PN): When the gastrointestinal tract cannot be used due to obstruction, fistulas, or severe malabsorption, nutrients are delivered directly into the bloodstream intravenously. This is reserved for the most complex cases where enteral or oral nutrition is not possible.

Addressing Micronutrient Deficiencies

Active inflammation, malabsorption, and restrictive diets can lead to deficiencies in essential vitamins and minerals. A dietitian will assess and recommend supplements as needed, including:

Iron: Blood loss and inflammation can lead to anemia, requiring iron supplementation.
Vitamin D and Calcium: Steroid use, a common treatment for active IBD, increases the risk of bone disease. Supplementation with calcium and vitamin D is essential, and sources low in lactose may be necessary.
B Vitamins: Inflammation, particularly in the ileum for Crohn's patients, can impair absorption of B12. Sulfasalazine, a common medication, also interferes with folate absorption.
Zinc and Magnesium: Chronic diarrhea can lead to losses of these minerals, requiring careful monitoring and supplementation.

Comparison of Common Dietary Approaches During Flares


Dietary Approach	Primary Goal	Recommended During Flare?	Typical Duration	Examples of Allowed Foods	Examples of Foods to Avoid
Low-Residue Diet	Reduce stool volume and bowel irritation	Yes	Short-term (1-2 weeks)	Cooked, peeled fruit and veg; refined grains; lean protein	Raw fruit/veg; whole grains; nuts; seeds
Low-FODMAP Diet	Reduce gas, bloating, and diarrhea	May be beneficial, especially with IBS-like symptoms	6-8 weeks restriction, then reintroduction	Cooked carrots; bananas; gluten-free oats	High-FODMAP foods like onions, garlic, wheat
Exclusive Enteral Nutrition (EEN)	Induce remission and provide total nutrition	Yes, first-line for pediatric CD	6-8 weeks	Liquid medical formula only	All solid food

The Importance of Professional Guidance

Navigating nutritional therapy for active IBD is complex and requires the expertise of a specialized registered dietitian. A dietitian works within a multidisciplinary team to:

Conduct a comprehensive nutritional assessment to identify and address deficiencies.
Develop an individualized eating plan tailored to the patient's symptoms and tolerances.
Provide guidance on supplementation and specialized nutrition support.
Educate patients on reading food labels, modifying recipes, and reintroducing foods gradually as symptoms improve.

The Path Forward: Transitioning to Remission

As active inflammation subsides, the nutritional focus shifts from symptom management to restoring a varied, balanced diet to promote long-term gut health. Gradually reintroducing foods and focusing on anti-inflammatory patterns, like the Mediterranean diet, can support a sustained remission. Patients are encouraged to work closely with their healthcare team to manage this transition carefully and avoid triggers.

Conclusion

Nutritional therapy is an integral part of managing active IBD, offering a powerful tool to manage symptoms and correct the significant nutritional deficits that often accompany disease flares. From temporary, symptom-focused dietary changes and specialized feeding methods like EEN to long-term strategies for promoting gut health during remission, a personalized plan is essential. For effective management and improved quality of life, clients with active inflammatory bowel disease should receive tailored nutrition therapy under the guidance of a qualified dietitian.

Visit the Crohn's & Colitis Foundation for additional resources

Frequently Asked Questions

The best diet during a flare is highly individual, but it generally involves a temporary, low-residue or low-fiber diet to reduce irritation and minimize symptoms. This often includes easy-to-digest foods and avoids high-fiber, greasy, or spicy items.

EEN is a medical therapy where all nutritional needs are met through a liquid formula for a specific period, typically 6-8 weeks. It is a first-line treatment for pediatric Crohn's disease to induce remission and is also used in adults and for pre-operative optimization.

Active inflammation increases the body's protein needs for tissue repair. However, appetite and food intake are often reduced during flares. Therefore, consuming lean, easily digestible protein sources or supplements helps meet this increased demand and prevent muscle wasting.

Inflammation can cause a temporary lactase deficiency. If you experience bloating, gas, cramping, or diarrhea after consuming dairy products like milk or ice cream, it may be beneficial to temporarily switch to lactose-free alternatives.

A low-FODMAP diet can be helpful for managing IBS-like symptoms such as bloating and gas that may overlap with active IBD. It is a short-term, phased approach that should be implemented with dietitian guidance to avoid nutrient deficiencies and ensure proper reintroduction.

After a flare, foods should be reintroduced slowly and systematically. Start with well-tolerated foods like tender cooked vegetables, canned fruits, and lean proteins before adding more fiber, nuts, and seeds as tolerated.

An IBD dietitian provides personalized medical nutrition therapy, conducts detailed nutritional assessments, corrects deficiencies, and provides education and support for dietary changes during both active disease and remission. They are a critical part of the multidisciplinary care team.