This diet is recommended for IBD according to the ECCO 2025 guidelines

Lange Zeit galt die Ernährung als weniger relevant für die Behandlung von Patient:innen mit der Diagnose Morbus Crohn oder Ulcerative colitis. In einer neuen Veröffentlichung der Europäischen Crohn- und Colitis-Organisation (ECCO) wurde die Meinung zur Ernährung bei Menschen mit CED-Diagnose geändert. In diesem Beitrag beschäftigen wir uns mit den verschiedenen Ernährungsempfehlungen basierend auf den von der ECCO vorgelegten Leitlinien. Weitere Informationen können darin gefunden und nachgelesen werden.

Empfohlen werden von der Europäischen Crohn- und Colitis-Organisation folgende Nahrungsmittel und Ernährungsformen: Sie können Remissionen induzieren oder eine bestehende Remission erhalten. Dabei betrachten wir zunächst die Empfehlungen für Morbus Crohn und im Anschluss jene für Colitis ulcerosa.

With Crohn's disease wird eine Exclusive enteral nutrition (EEN) is recommended for achieving remission. EEN means that the nutrients are either introduced directly into the gastrointestinal tract in a liquid solution or taken orally as a drinkable meal - this involves exclusively consumes these liquid nutrient solutions, not normal food. This form of nutrition is said to be as effective as treatment with corticosteroids in adults.

In addition to EEN, there is also the Partial enteral nutrition (PEN). Only a part of the daily calorie requirement is covered by special drinking or tube feeds, while the remainder consists of selected, normal foods. PEN is therefore more flexible in everyday life, but still provides targeted, balanced nutrients.

The ECCO guidelines suggest that patients with Crohn's disease who have a mild to moderate disease flare should undergo a PEN nutrition with a Exclusion diet in order to achieve remission.

One Exclusion diet means that certain food groups or ingredients that could exacerbate symptoms or promote inflammation in individual patients are deliberately omitted. Which foods these are is determined on an individual basis - usually under medical or nutritional supervision.

Changing your diet to a PEN diet can also help to maintain an existing remission. It is best to ask your doctor whether such nutritional therapy is an option for you.

However, a complete switch to an exclusively PEN-based diet is not recommended for Crohn's disease.

The Mediterranean diet, which is touted in many places as one of the healthiest diets, is only recommended to a limited extent when diagnosed with IBD.

The Mediterranean diet can help patients with ulcerative colitis in particular to maintain an existing remission for longer, but only if it is combined with drug therapy. Mediterranean diets are not recommended for achieving remission.

A diet that includes a lot of raw and red meat is not recommended for patients with ulcerative colitis, as this could impair the maintenance of remission. Avoiding dairy products is also not recommended as an induction therapy for remission in ulcerative colitis, as there are no clear studies on this. 

Chronic inflammatory bowel disease (IBD) often leads to nutrient deficiencies. These can be caused on the one hand by restrictive diets and on the other by episodic diarrhea, during which the body loses important vitamins, minerals and trace elements. For this reason, the ECCO guidelines discuss various supplements - including clear instructions on when and how they can be used.

Turmeric darf bei Patient:innen mit Colitis ulcerosa zusätzlich zur Einnahme von Mesalazin als Supplement verwendet werden. Kurkuma enthält den sekundären Pflanzenstoff Curcumin, der entzündungshemmende Eigenschaften haben kann. Allerdings sollte Kurkuma nach Eintritt einer Remission zeitnah wieder abgesetzt werden. Die hochdosierte, langfristige Einnahme kann in seltenen Fällen die Leber belasten und zu anderen Nebenwirkungen führen. Bei Morbus Crohn wird Kurkuma nicht empfohlen, da die Studienlage keine belastbare Aussage zur Wirksamkeit bei der Remissionsinduktion zulässt.

The herbal preparation Qingdai – aus der traditionellen chinesischen Medizin – wird in den Leitlinien erwähnt. Es wird aus verschiedenen Indigo-Pflanzen gewonnen und untersucht, weil es entzündungshemmende Effekte haben könnte. Bei Patient:innen mit Colitis ulcerosa kann Qingdai helfen, eine bestehende Remission zu erhalten. Aufgrund der möglichen Nebenwirkungen wie Leberschäden oder Veränderungen im Blutbild sollte es jedoch nur zeitlich begrenzt und unter ärztlicher Begleitung eingesetzt werden.

Prebiotics - i.e. indigestible food components such as inulin or oligofructose, which promote the growth of certain "good" intestinal bacteria - are not recommended by the ECCO for either Crohn's disease or ulcerative colitis when it comes to achieving or maintaining remission. They occur naturally in foods such as chicory, onions and garlic, but are also available in powder or capsule form. According to studies, their effect in the context of IBD is not sufficient to make a recommendation.

If people with IBD experience symptoms such as abdominal pain, diarrhea, constipation, bloating or cramps, a Low FODMAP diet can be helpful. FODMAP stands for "fermentable oligo-, di- and monosaccharides and polyols" - these are certain short-chain carbohydrates and sugar alcohols that ferment easily in the intestine. This fermentation can lead to the symptoms mentioned above. The low FODMAP diet specifically reduces foods with a high FODMAP content, including some types of fruit, wheat products and pulses, in order to relieve the digestive tract.

An artificial bowel outlet is created and inflamed sections of bowel are removed. The ECCO does not currently provide any specific guidelines for nutrition after such an operation. There is only an indication that the output in the stoma bag can be higher with a very high-fiber diet than with a low-fiber diet.

Also Narrowing of the gastrointestinal tract (Stenosen) können bei einer CED auftreten. Patient:innen mit Morbus Crohn, die zu solchen Verengungen neigen, sollten auf eine ballaststoffarme Ernährung achten. Das kann Komplikationen wie Blockaden oder Schmerzen zu vermeiden. Sprich hier am besten mit deinem Arzt oder deiner Ärztin, ob diese Ernährungsform für dich sinnvoll ist.

As recurrent diarrhea during episodes of illness or restrictive diets can lead to insufficient nutrient intake, the Supply of micro and macronutrients bei Personen mit CED-Diagnose regelmäßig überprüft werden. Dabei ist es sinnvoll, neben dem BMI auch die Körperzusammensetzung zu berücksichtigen. Einschätzungen über Individuen sind so zutreffender.

The ECCO guideline recommends checking the following values regularly:

• Hemoglobin
• Vitamin B9 supply (folic acid)
• Vitamin D status
• For patients on a vegan diet, also check the vitamin B12 level

Conclusion

Every IBD is individual - just like the diet that can support you in your everyday life. The tips presented here reflect the current state of scientific knowledge. Pay attention to what is good for you personally and what is not in order to alleviate your symptoms and maintain your remission.
Talk about Major dietary changes immer mit deinem behandelnden Arzt oder deiner behandelnden Ärztin. So kann sichergestellt werden, dass sie zu deiner individuellen Situation passen.
Feel free to share your experiences in the comments - your input can also help others.

Svolos, Vaios and Gordon, Hannah and Lomer, Miranda C E and Aloi, Marina and Bancil, Aaron and Day, Alice S and Day, Andrew S and Fitzpatrick, Jessica A and Gerasimidis, Konstantinos and Gkikas, Konstantinos and Godny, Lihi and Hedin, Charlotte R H and Katsanos, Konstantinos and Narula, Neeraj and Russell, Richard K and Sarbagili-Shabat, Chen and Segal, Jonathan P and Sigall-Boneh, Rotem and Sokol, Harry and Wall, Catherine L and Whelan, Kevin and Wine, Eytan and Yanai, Henit and Hansen, Richard and Halmos, Emma P; ECCO Consensus on Dietary Management of Inflammatory Bowel Disease; Journal of Crohn's and Colitis; 10.1093/ecco-jcc/jjaf122; 2025.