Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance

Table 1 Summary of best available evidence for diet management of inflammatory bowel disease (remission)

Diet	Recommendation	Ref.
Fiber	There is a lack of evidence that fiber intake should be restricted in patients with IBD. Soluble fiber sources are encouraged[32]. A high fiber diet is likely safe in patients with IBD and may impart a weak benefit[33] Cruciferous vegetables, fruit peels, nuts, seeds should be avoided in patients with known fibrostenotic stricture with obstructive symptoms[29,33]	Hwang et al[29], 2014 Wedlake et al[32], 2014 Kaplan et al[33], 2016
Dairy products	Strict avoidance of dairy products is not justified unless it clearly worsens diarrhea[52]. For patients who are lactose intolerant, it may still be possible to consume small amounts of dairy products with lower amounts of lactose such as fermented dairy products (yogurt and kefir), cottage cheese, butter and aged cheeses[29]	Richman/Rhodes[52], 2013
Low-FODMAP	A low-FODMAP diet may be worth trying in patients with IBD who have FGS such as bloating, abdominal pain or watery diarrhea that have persisted despite appropriate treatments[25,52]	Maagaard et al[25], 2016
Plant-based	Plant-based diets such as a lacto-ovo vegetarian diet or Mediterranean diet pattern may reduce gut inflammation in IBD[19,20]	Chiba et al[19], 2010 Marlow et al[20], 2013
Fat/animal protein	Avoidance of trans fatty acids from processed foods, margarine and fast foods may be warranted[34,52] A diet low in animal fat, particularly from processed meat and red meat (< 2/wk) is encouraged[34,122]	Jowett et al[34], 2004 Owczarek et al[122], 2016
Specific carbohydrate/IBD-AID/gluten-free	The effect of the SCD, IBD-AID and the gluten-free diet on clinical course in IBD remains to be elucidated in future trials

IBD: Inflammatory bowel disease; FODMAP: Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; SCD: Specific carbohydrate diet; AID: Anti-inflammatory diet.