What to eat with Crohn's disease or ulcerative colitis

Remember that Food Guide Pyramid you learned about in elementary school? Researchers recently published a food pyramid specifically for people with Crohn's and colitis. In this post, we'll unpack:

1. How to Read the IBD Food Guide Pyramid
2. What the IBD Food Guide Pyramid Recommends
3. Our Top 5 Tips on How to Personalize for Yourself

How to Read a Food Guide Pyramid

A food pyramid shows the different types of foods and serving sizes of each that a person is recommended to eat on a daily or weekly basis. Foods are placed in the pyramid in a way that implies their relative importance to a healthy, well-rounded diet. Foods placed at the bottom of the pyramid are recommended to be consumed in greater quantities than those higher up.

About the IBD-Specific Guide Food Pyramid

Researchers from Massachusetts General Hospital and Harvard Medical School recently published an IBD-specific food pyramid that outlines the recommended intakes and amounts of dietary food groups based on the combined results of many clinical trials1.

It’s important to note that this food pyramid has not been endorsed by any particular organization and is meant to serve as a guide rather than a prescription.

It’s always important to personalize these recommendations to your unique needs depending on your trigger foods, food preferences, disease activity, surgical status (if applicable), stricturing disease (if applicable), as well as cultural and religious influences.

In the last section of this post we’ll share our tips and best practices you can follow to customize the IBD food pyramid for yourself.

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What Does the IBD-Specific Food Guide Pyramid Recommend?

Let’s start with the bottom of the pyramid which contains the foods that are recommended to consume the most.

Priority 1 - Choose fruits, veggies, and leafy greens

These foods are recommended to be consumed in the greatest quantities relative to other food groups in the pyramid. The guide recommends eating a variety of fruits (e.g. blueberries, raspberries, oranges, apples, bananas), vegetables (e.g. squash, carrots, beets), and leafy greens (e.g. lettuce, spinach, kale) each day.

When choosing fruits and vegetables, it’s good practice to select a variety of colors (sometimes referred to as “eating the rainbow”) to ensure you consume a good mix of nutrients, antioxidants, and dietary fiber.

It can feel challenging to consume enough fruits and vegetables as they may seem to trigger symptoms. Working with a professional registered dietitian that focuses on IBD (like us!) can help you incorporate more fruits/vegetables into your diet in a way you can tolerate and enjoy.

Research suggests patients with Crohn's disease who consumed high fiber foods (including fruits & vegetables) were actually 40% less likely to flare compared to those who avoided fruits and vegetables2.

Priority 2 - Choose certain starches & legumes

The next largest food group recommended to consume are resistant starches (cooled or reheated potatoes, sweet potatoes, yams, or parboiled white rice) and legumes (beans, peas, lentils, chickpeas, edamame beans).

If the recommended serving size is too large or these foods trigger symptoms, consider starting with smaller portions. Instead of consuming 3/4 cup three times a week, you could start with small amounts and work up to 1/3 cup daily. Also, consider preparing the foods differently by mashing or pureeing, or trying legume pasta and bean flours.

Priority 3 - Choose homemade meals

This section of the food pyramid relates to meals consumed inside or outside of the home.

For people with IBD, it’s recommended to eat homemade meals at least 5 days per week and limit consumption of processed foods, baked goods, and foods containing additives.

Be sure to check ingredient labels on packaged foods as these additives often appear in many common foods that may surprise you. If consuming processed foods, choose the ones made from simple ingredients.

Priority 4 - Choose a variety of proteins

This section is all about sources of protein like chicken, fish, nuts, and seeds.

The guide recommends choosing white meat chicken more often than other sources of animal protein if possible.

Five servings of nuts and seeds (use seed or nut butters if better tolerated) are recommended per week as is 2-3 servings (portion size equivalent to about a deck of cards) of fatty fish such as salmon, arctic char, herring, mackerel, sardines, or trout. It’s important to limit fish high in mercury, including: escolar, marline, orange roughy, shark, swordfish, and albacore (white) tuna. Canned light tuna has less mercury than albacore.

Low (less than 2%) or no-fat dairy products may also be included as tolerated. It’s recommended to limit red and processed meats whenever possible.

Priority 5 - Choose certain fats more often

The top section in the pyramid shows foods recommended to be consumed in small quantities. When it comes to fats, it’s recommended to choose extra virgin olive oil whenever possible.

Limit your consumption of saturated fats and eliminate consumption of trans fats like those found in hard margarine, palm oils, shortening, and commercially prepared baked goods.

How to Personalize the Food Guide to Yourself

As we mentioned earlier, this food pyramid is intended to be used only as a guide rather than a prescriptive diet for people with IBD. If you’re looking at these recommendations and seeing some of your trigger foods or the suggested quantities seem unrealistic, we have some tips that you can apply to customize the food pyramid to your unique needs and preferences.

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Top 5 Tips to Personalize the IBD Food Pyramid

1. Start with small incremental changes to your current diet: Large, drastic changes are not sustainable and can lead to increased symptoms and stress. Instead, focus on making small, incremental changes over a longer period of time, usually weeks to months. This will give your body time to adapt to new foods and make the changes more sustainable. For example, consider introducing just a single new food in a small quantity and slowly increasing the portion size week after week. 

2. Swap trigger foods for better tolerated alternatives in the same category: If you’re looking at the IBD food pyramid and notice that some of your trigger foods are included in the list of “what to eat,” try swapping those foods out for better tolerated alternatives in the same category.

3. Reframe your mindset: Sometimes when we hear we should “limit” certain foods, we think we should completely restrict them from our diets. Given the stress and feelings of restriction that can cause, it may be more beneficial to focus instead on adding in more variety. For example, instead of focusing on strictly avoiding red meat, focus on introducing new sources of protein into your diet more often, such as chicken, salmon, ground turkey, tofu, or rice and beans. 

4. Prepare foods differently so they’re more tolerable: If you find that raw fruits and vegetables trigger your symptoms, start by cooking them until fork tender or adding them into a smoothie. These techniques make foods easier to digest and are a way of making them more tolerable for people with IBD. 

5. Consider working with an IBD dietitian: Working towards a healthy, well-balanced diet can be overwhelming to tackle on your own, particularly for people with IBD. Working with a registered dietitian that focuses exclusively on IBD is a safe and effective way to make sure that you are eating the right foods, vitamins, and minerals to support your needs and potentially reduce your risk of flares. 

It’s important to note that what matters most is not whether you consume a single food on the “limit” side of the pyramid, but rather what your diet looks like as a whole over weeks and months.

Too often people feel unnecessary guilt or shame when they consume a food they think they’re “not supposed to eat.”

Instead, we encourage you to work towards consuming a healthy well-balanced diet most of the time and when the occasion arises that you want to eat something from the “limit” side of the pyramid: acknowledge and enjoy it!