Food, Flares and Finding Balance: Eating Well with Crohn’s and Colitis

When food starts to feel complicated

Living with Crohn’s disease or ulcerative colitis often means living with a complicated relationship with food. Many people attend initial appointments already avoiding certain foods, eating cautiously, or feeling unsure about what their gut can tolerate. It is completely understandable. When symptoms are unpredictable, food can feel like one of the few things you can control. But over time, this protective instinct can turn into something that quietly chips away at your health.

How restriction quietly undermines nutrition

What we see repeatedly is that people with IBD are at high risk of undernutrition, not only during flares but also in remission, and not only because of inflammation but because of long‑term restriction. When whole food groups disappear from the diet i.e., dairy, fruit, vegetables, grains, the body eventually feels the consequences. Weight drops, energy dips, muscle mass declines, and recovery becomes harder.

Why Crohn’s carries a higher nutritional burden

Crohn’s disease brings its own unique challenges. Because Crohn’s can affect any part of the gastrointestinal tract, including the small intestine where most nutrients are absorbed, the risk of undernutrition is naturally higher. Add in strictures, fistulas, previous surgeries, and the sheer metabolic cost of chronic inflammation, and it is easy to see why so many people with Crohn’s struggle to maintain weight and strength.

When symptom‑driven avoidance becomes habit

In addition, symptoms like pain, bloating, and diarrhoea can make eating feel unsafe, leading people to avoid foods that seem to trigger discomfort. Over time, this avoidance can become a pattern where raw vegetables disappear, legumes disappear, dairy disappears, and the diet becomes quite restrictive. The intention is to feel better, but the outcome is often the opposite: less resilience, less nourishment, and a gut that becomes even more sensitive because it is not being fed a varied diet.

Crohn’s needs a phase‑specific approach

What makes Crohn’s particularly complex is that the foods that support long‑term gut health are not always the same foods that help during a flare. When Crohn’s is quiet, a balanced, Mediterranean‑style pattern with plenty of plants, moderate dairy and fish, wholegrains, nuts, seeds, and minimal ultra‑processed foods, aligns well with what we know about supporting overall health and reducing long‑term risk. But when Crohn’s is active, the gut sometimes needs a different approach. Certain structured diets used in Crohn’s flares are intentionally low in fibre, lactose, and sometimes gluten, and may rely on nutritionally complete formulas. These diets are not meant to be long‑term lifestyles; they are therapeutic tools used for a specific phase of the disease. The problem arises when people try to replicate these restrictive patterns on their own, without guidance, and stay on them far longer than intended. What was meant to be temporary becomes habitual, and nutritional status suffers.

Ulcerative colitis has a different food pattern

Ulcerative colitis has a different nutritional profile. As ulcerative colitis affects only the colon, nutrient absorption is usually less of a concern than in Crohn’s. But eating can still feel difficult, especially during flares when urgency and diarrhoea make people understandably cautious and overly restrictive with their diet.

The risk of long‑term avoidance in ulcerative colitis

Many people with ulcerative colitis fall into long‑term avoidance of foods they believe might trigger symptoms, most often fibre, fruit, vegetables, legumes, and wholegrains. Over time, this can lead to the same pattern of undernutrition seen in Crohn’s, but for different reasons. In ulcerative colitis, the issue is less about malabsorption and more about chronic under‑eating and fear‑based restriction. Interestingly, the diets being explored for ulcerative colitis management tend to be more plant‑forward, higher in fibre, and lower in meat and dairy which is almost the opposite of Crohn’s flare diets. This highlights how important it is to tailor nutrition advice to the specific condition and the specific phase of the condition. What helps one person may not help another, and what helps during a flare may not be appropriate during remission.

The one message that applies to everyone

Across both Crohn’s and ulcerative colitis, one message consistently stands out and that is long‑term exclusion of whole food groups without guidance is one of the strongest drivers of undernutrition. It is not the occasional day of reduced intake during a flare, and it is not the short periods where appetite naturally dips. It is the chronic, ongoing restriction that slowly depletes nutritional reserves. People often assume that if a food causes symptoms once, it must always be avoided. Tolerance changes with inflammation, stress, sleep, medications, and even the time of day. A food that feels difficult during a flare may be perfectly tolerable in remission. The goal is not to eliminate foods forever but to understand when and how to reintroduce them safely.

Rebuilding confidence with food

The most important thing to remember is that you do not have to figure this out alone. Nutrition in IBD is not about perfection; it is about nourishment, flexibility, and confidence. It is about understanding your diagnosis, your symptoms, and your current disease activity, and matching your diet to where your gut is right now. With the right support, most people can expand their diet, reduce fear, and rebuild a healthier, more resilient relationship with food. Restriction may feel protective in the moment, but nourishment is what supports healing in the long run.

References

Quilliot D, Bonsack O, Mahmutovic M, Peyrin‑Biroulet L, Caron B. Exclusion diet and fasting practices in patients with inflammatory bowel disease: Impact on nutritional status. Clin Nutr ESPEN. 2025;65:375‑381.

Halmos EP, Godny L, Vanderstappen J, Sarbagili‑Shabat C, Svolos V. Role of diet in prevention versus treatment of Crohn's disease and ulcerative colitis. Frontline Gastroenterol. 2024;15(3):247‑257.