By Colleen D. Webb, MS, RDN, CLT

For nearly a decade, I’ve counseled people with Crohn’s and ulcerative colitis on what and how to eat for IBD. Every session is unique, but some recommendations apply to almost everybody, no matter their situation. If I had to choose one piece of advice I wish everyone (with and without IBD) would follow, it’s this:

Avoid highly or ultra-processed foods, at least most of the time.

Ultra-processed foods are “formulations of industrial ingredients and other substances derived from foods, plus additives. They mostly contain little if any intact food.” More on this later. Most of us eat many more ultra-processed foods than we think we do.

Research links diets high in ultra-processed foods to obesity and obesity-related chronic diseases, overeating, autoimmune diseases and poor gut health. Recent studies suggest that certain food additives present in ultra-processed foods might contribute to IBD onset and flares. This was a hot topic at this year’s Digestive Disease Week, the world’s leading educational forum for gastroenterologists and other professionals working with GI diseases.

Repeatedly I’ve observed my patients feel better when they strictly limit or eliminate ultra-processed foods from their diets. Many restrictive diets showing clinical promise in improving IBD get rid of highly processed foods and food additives. I’ve always suspected that to be a main reason people feel better on these diets.

In this article, I will show you how to identify ultra-processed foods (these might surprise you!), tell you why avoiding ultra-processed foods is one of the best diet-related things you can do for your Crohn’s or ulcerative colitis, and give you tips for eating more whole and minimally processed foods.

How To Identify Ultra-Processed Foods

Since we don’t eat food directly from the earth, it’s fair to say that most foods are processed to some extent. That’s why it’s important that we differentiate “ultra-processed” foods from “minimally processed” foods.

NOVA, a worldwide recognized and validated tool for nutrition and public health research, classifies foods and drinks as unprocessed or minimally processed, processed culinary ingredients, processed foods, and ultra-processed foods:

Unprocessed or Minimally Processed Foods:
Unprocessed foods: ‘Fresh’ or ‘whole’, come from plants or animals without any industrial processing.

Minimally processed foods: Unprocessed foods altered in ways that do not add or introduce any new substance (such as fats, sugars, or salt) but often involve removal of parts of the food. Minimal processing techniques typically preserve the food and so extend its duration, aid its use, preparation, and cooking, and improve its palatability.

EXAMPLES: Vegetables (fresh, dry, frozen); Fruit (fresh, dry, frozen); Potatoes; Nuts, seeds (whole, butters, flour); Legumes, beans, peanuts; Meat, poultry, fish (fresh or frozen); Eggs.

Processed Culinary Ingredients
Processed culinary ingredients are extracted and refined by industry from food constituents. These substances are not or normally not consumed by themselves. Their main purpose is to be used in the preparation and cooking of foods, so as to make palatable, diverse, nourishing and enjoyable dishes and meals.

EXAMPLES: Sugars; Fats; Oils; Salt.

Processed Foods
Processed foods are made by adding fats, oils, sugars, salt, and other culinary ingredients to minimally processed foods to make them more durable and usually more palatable, and by various methods of preservation.

EXAMPLES: Simple breads; Simple cheeses; Salted, pickled or cured meats, fish and seafood; Hummus; Vegetables, legumes, fruits, and animal foods preserved in oil, brine or syrup.

Ultra-Processed Foods
Ultra-processed foods are not modified foods but formulations of industrial ingredients and other substances derived from foods, plus additives. They mostly contain little if any intact food. For these reasons they are often referred to in the literature as ‘ultra-processed food products’ or simply ‘ultra-processed products’.
The purpose of ultra-processing is to create products that are convenient (durable, ready-to-eat, -drink, or -heat), attractive (hyperpalatable), and profitable (cheap ingredients). Their effect all over the world is to displace all other food groups. They are usually branded assertively, packaged attractively, and marketed intensively.

EXAMPLES: Fast food; Sugary drinks (soda, lemonade, sports drinks, Ensure); Protein bars; Snacks, chips; Candies; Cookies; Sweetened cereals.

Here’s a list of ingredients you can expect to find in ultra-processed foods:

• Artificial sweeteners, such as sucralose and aspartame

• Artificial flavors and food colorings

• Maltodextrin

• Emulsifiers, like polysorbate 80 and carboxymethylcellulose

• Protein isolates

• Xanthan gum

• Carrageenan

• Hydrogenated oils

• High fructose corn syrup

Why Ultra-Processed Foods are Bad for Crohn’s and Ulcerative Colitis

In 2015, scientists from Israel and Germany published a study arguing that modern food additives from ultra-processed foods are responsible for the rise of autoimmune diseases, like Crohn’s disease and ulcerative colitis. Their rationale is that many of these dietary additives disrupt the balance of the gut microbiome and lead to increased gut permeability, resulting in abnormal activation of the immune system. Most non-medical professionals refer to increased gut permeability as “leaky gut.” Leaky gut increases one’s risk of developing autoimmune disease and precedes IBD flare-ups.

These additives include maltodextrin, carrageenan, polysorbate 80 and carboxymethylcellulose.

Food additives aside, eating lots of ultra-processed foods are bad for us for other reasons.

• They take the place of nutritious, disease-fighting foods.
• They throw off our balance of omega-6 to omega-3 fats, which fosters inflammation.
• They’re high in salt and sugar, neither of which are good for us in large quantities.

When we stop eating so many ultra-processed foods, we start eating more disease-fighting fruits, vegetables, and other wholesome foods. Research shows that people who eat more plants have fewer and shorter IBD flares.

In no way do I want anyone to read this article and feel guilty about grabbing a bag of chips or a protein bar now and again. But, save these treats for special occasions. Eat whole foods most of the time.

Favorite Ultra-Processed IBD Food Swaps

Lots of the go-to foods for Crohn’s and ulcerative colitis are ultra-processed. Below is a short list of ultra-processed foods that many of my patients eat regularly before they see me for nutrition counseling. You’ll find the brand, list of ingredients, and suggested swaps:

Ultra-processed IBD Favorite: Martin’s Potato Bread
Ingredients: Unbleached enriched wheat flour (flour, ferrous sulfate, niacin, thiamin, riboflavin, folic acid), nonfat milk, reconstituted potatoes (from potato flour), yeast, sugar, wheat gluten, sunflower oil, contains 2 percent or less of each of the following: salt, butter, dough conditioners (sodium stearoyl lactylate, monoglycerides and diglycerides), monocalcium phosphate, calcium propionate (a preservative), guar gum, ascorbic acid, datem, calcium sulfate, enzymes, turmeric color, annatto color, sesame seeds
Suggested Swap: Bread Alone San Francisco Sourdough
Ingredients: Organic wheat flour, water, and sea salt

Ultra-processed IBD Favorite: Quest Protein Bar (Birthday Cake)
Ingredients: Protein Blend (Milk Protein Isolate, Whey Protein Isolate), Soluble Corn Fiber, Erythritol, Water, Palm Kernel Oil, Almonds, Natural Flavors, Sodium Caseinate. Contains less than 2% of the following: Sea Salt, Gum Arabic, Spirulina Extract (Color), Red Cabbage Extract (Color), Turmeric Extract (Color), Radish Extract (Color), Sucralose, Sunflower Lecithin
Suggested Swap: Freedom Bar (Chocolate Coconut)
Ingredients: Blended organic dates, almonds, cocoa, walnuts, coconut, sea salt

Ultra-processed IBD Favorite: Ensure Plus (Vanilla)
Ingredients: Water, corn maltodextrin, sugar, blend of vegetable oils (canola, corn), milk protein concentrate, soy protein isolate. less than 0.5% of: natural & artificial flavor, nonfat milk, magnesium phosphate, sodium citrate, soy lecithin, potassium citrate, cellulose gel, calcium phosphate, potassium chloride, choline chloride, ascorbic acid, salt, cellulose gum, carrageenan, potassium hydroxide, ferrous sulfate, dl-alpha-tocopheryl acetate, zinc sulfate, niacinamide, manganese sulfate, calcium pantothenate, copper sulfate, vitamin a palmitate, thiamine chloride hydrochloride, pyridoxine hydrochloride, riboflavin, chromium chloride, folic acid, sodium molybdate, biotin, sodium selenate, potassium iodide, phylloquinone, vitamin d3, and vitamin b12.
Suggested Swap: Make Your Own IBD-Friendly Smoothie

Ultra-processed IBD Favorite: Gatorade (Lemon-Lime)
Ingredients: Water, sugar, dextrose, citric acid, salt, sodium citrate, monopotassium phosphate, gum arabic, glycerol ester of rosin, natural flavor, yellow 5
Suggested Swap: Diluted coconut water
Ingredients: Coconut water, water

How To Eat Fewer Ultra-Processed Foods

Keeping away from ultra-processed foods is challenging but not impossible. Check out these five tips from Michael Pollan, author of Food Rules: An Eater’s Manual.

1. Avoid food products containing ingredients that no ordinary human would keep in the pantry.

2. Avoid food products that contain high-fructose corn syrup.

3. Avoid food products that make health claims. Generally, it is the products of modern food science that make the boldest health claims.

4. Eat foods made from ingredients that you can picture in their raw state or growing in nature.

5. Avoid foods pretending to be something they’re not. Margarine is the classic example.

Key Takeaways

All of us could benefit from eating fewer ultra-processed foods. Diets high in these foods are nutritionally inadequate and harmful to our health.

Excluding ultra-processed foods from your regular diet (i.e. most of the time) is a great step towards improving your gut health. Research suggests that ultra-processed foods may contribute to the development and reactivation of Crohn’s and ulcerative colitis.

Don’t worry about the occasional ultra-processed treat, especially in the setting of an overall healthy diet. There is zero evidence that’s a cause for concern, and you’ll drive yourself and everyone around you crazy.

Also, please remember that being healthy isn’t just about what you eat or don’t eat. Other lifestyle factors matter a lot. We need to sleep well, manage stress, engage with others, and exercise. These approaches plus your medical regimen work as a team to help manage your Crohn’s or ulcerative colitis.