Dietetics - Following a 50:50 Diet

What is a 50:50 diet?

After a short-term polymeric diet due to your active Crohn’s Disease and after a period of symptom control, it is usually time to slowly reintroduce solid food. You will be guided by the dietitian or the clinical team when it is a suitable time to start the 50:50 diet.

This diet will consist of introducing small meals or snacks, alongside slowly reducing your intake of nutritional supplements. The aim is to have a mix of food and nutritional supplements.

Remember your ability to digest and absorb the nutrients from your diet may be affected depending on the area of disease in your gut. For this reason, food choices should be made carefully and gradually re-introduced. Often people are confused regarding fibre intakes or have previously been advised to restrict this.

The 50:50 approach allows you to slowly increase the soluble fibre content of your diet, whilst opting for foods which are lower in insoluble fibre.

What is soluble fibre?

Soluble fibre is a softer form of fibre. It dissolves in water to form a gel-like material. This passes more easily through our gut, which is kinder to the gut when healing from inflammation after active flares of Inflammatory Bowel Disease (IBD). In turn, this can help to form stools or soften them, making them easier to pass.

Good sources of soluble fibre are root vegetables which have been cooked soft, without skins or stalks and the soft flesh of fruits. See fruit and vegetable sections for appropriate options to include.

What is insoluble fibre?

Insoluble fibre is a tougher, less digestible for of fibre and does not dissolve in water. This passes through the small bowel without being broken down until it reaches the large bowel.

Whilst having an IBD flare, it is important to avoid insoluble fibre to prevent further irritation to your gut. Insoluble fibre can be found in wholegrain or seeded starchy foods, in the skins and pips of fruit and vegetables and in raw or undercooked vegetables.

Top tips

• It is easier to eat small meals or snacks to begin with, introduce up to three small meals or snacks of your choice initially
• Serve these portions on a side plate to begin with, whilst you gradually build up to a usual portion size
• It is very important that you take your time, chew your food well, and sit up straight whilst eating. This will help ease the digestive process
• It is important that you continue with a regular intake of your prescribed nutritional supplements as you will be starting with smaller portion sizes. This will make sure you are meeting your nutritional requirements
• Continue to avoid fatty and spicy meal choices to limit irritation to the gut
• Foods or drinks with very high added sugar content or high in artificial sweeteners, may make symptoms of loose bowels worse
• Continue to avoid heavily processed foods and choose to cook from fresh when you are able
• Continue to have a good fluid intake between meals, opting for more nourishing, dairy based fluids such as milk, hot chocolates, milkshakes. Lactose free milks can be substituted if this is a tolerance issue for you
• Continue to limit caffeine, fizzy drinks or opt for decaffeinated drinks to minimise irritation

Breads

Include

• White bread, rolls or baguettes
• Tiger bread
• White pitta
• White bagels (without raisins/onions/seeds)
• Chappatis (made with white flour)
• Crackers (made with white flour, without seeds)
• Cripsbreads
• Crumpets
• Croissants
• Melba toast
• Muffins (made with white flour, with no nuts/dried fruit)
• Rice cakes
• White tortilla wraps

Trial small amounts with caution

• 50/50 bread
• 50/50 pitta breads
• Sourdough bread
• Oatmeal bread
• Chappatis (made with gram flour)
• Leavened bread (made with suitable flour)
• Poppadoms/any produce made with chickpea flour

Avoid

• Wholegrain, granary, rye and seeded breads
• Wholegrain or fruit filled bagels
• Crispbreads with seeds/wholegrains
• Wholegrain/seeded crackers
• Wholegrain wraps

Cereals

Include

• Plain cornflakes
• Rice krispies
• Ready brek
• Fine milled porridge oats
• Special K without nuts, seeds or berries

Trial small amounts with caution

• Cheerios
• Coco Pops
• Crunchy nut cornflakes
• Frosties
• Oats - rolled and jumbo
• Oatbix
• Sugar puffs

Avoid

• Granola
• Muesli
• Cereals containing dried fruit, nuts or seeds
• Bran based cereals e.g. All bran/bran flakes/sultana bran
• Weetabix
• Shredded wheat
• Special K with nuts, seeds or berries
• Cereals labelled as 'high fibre'

Flours

Include

• Cornflour
• Rice flour
• Potato flour
• White flour

Trial small amounts with caution

• Chickpea/Gram flour
• Oat flour
• Almond flour

Avoid

• Bran
• Granary flour
• Wholegrain flour

Rice, pasta and other starches

Include

• All types of white rice e.g basmati, jasmine
• All types of white pasta
• All types of white noodles
• Buckwheat
• Couscous - fine/milled
• Sweet potatoes (peeled, cooked soft)
• Pearl barley
• Tapioca
• Sago
• Semolina
• Millet
• All potato products without skins e.g potato waffles, croquettes, chips
• Hash browns or latkes without onion
• Yorkshire puddings
• Waffles
• Pancakes (made with suitable flour)

Trial small amounts with caution

• Giant Couscous
• Matzah/Matzo crackers - ensure not made with whole wheat or labelled “high fibre.” Ensure having plenty of fluids alongside

Avoid

• Barley
• Hash browns containing onions
• White or sweet potato products with skins e.g wedges, jacket potatoes with skin
• Cold potato dishes, e.g potato salad
• All types of non-white rice e.g wild rice, brown rice
• Brown/wholemeal pasta
• Brown/wholemeal noodles
• Spelt
• Any bread or pasta labelled 'high fibre'
• Pancakes made with unsuitable flours or with nuts/unsuitable fruits

Protein

Include

• All types of meat, ensure soft and tender
• All types of fish, without bones
• Eggs
• Smooth pâté
• Matzo/Matzah balls or meatballs or vegetarian meatballs - cut into small pieces

Trial small amounts with caution

• Tough, gristly meats such as sausages, burgers and steak

Avoid

• Fish bones
• Meat/fish products containing onions, peppers, chillies
• Coarse pâté made with onions

Plant based sources of protein

All vegetarian sources of protein will have some fibre content due to being plant based. It is important to ensure you are having a source of suitable protein with each meal or snack. Choose soft protein foods, such as mince alternatives or smooth hummus or smooth peanut butter. Aim for a smaller portion than usual, to ensure tolerated well.

Examples of portion sizes for meat alternatives or pulses could include starting with two tablespoons and building towards the recommended portion of four tablespoons, per main meal.

For nut butters, aim for one tablespoon per portion.

Include

• Tofu
• Quorn/mycoprotein products which are softer e.g mince, meatballs, nuggets, roast chicken/ham style sliced meats
• Smooth nut butters
• Smooth hummus
• Well-cooked, smooth/mashed lentils
• Tahini

Trial small amounts with caution

• Meat free sausages - ensure cooked, soft and the skin is not too gristly
• Soft well-cooked beans and lentils without skins, i.e marrowfat peas, lentils, yellow split peas
• If wishing to trial baked beans, try a very small portion e.g 2 tablespoons and monitor tolerance
• Chickpeas with skins off, cooked soft
• Milled nuts/seeds

Avoid

• Quorn chunks
• Mycoprotein based burgers
• Tempeh
• Crunchy nut butters
• Hummus with whole chickpeas
• Chickpeas with skins
• All whole nuts
• All whole seeds

Dairy

Include

• All milks
• Butter/margarine
• All types of cheese, except those with dried fruits/nuts
• Cream/crème frâiche
• Custard
• Yogurts with fruit from include section
• Ice cream/sorbet without nuts, seeds or fruit from the avoid section

Trial small amounts with caution

• Yogurts with chunks or dried fruit

Avoid

• Dairy products containing any avoid fruits, nuts, seeds, or cereals

Fruits

A typical recommended portion size is 80g, such as a small bowl of fruit. However, try starting off with a much smaller portion, such as a handful of fruit the size of a small tennis ball, chopped into small pieces. Try slowly building up to the recommendation, especially whilst opting for smaller snacks or meals.

Tinned fruit, in natural juice can be an easy first choice as it is pre-prepared and a softer texture.

Include

• Apples (not skins) - either fresh, stewed, tinned
• Melon
• Nectarines/peach (peeled)
• Papaya
• Pears (peeled)
• Ripe/soft plums (peeled)
• Watermelon (no seeds/pips)
• Ripe mango
• Fruit juice (no bits/smooth)
• Puréed, stewed, or cooked fruit (without skins, pips, or stones)
• Puréed fruit, fruit sauces and coulis with pips removed e.g. sieved raspberry coulis, apple sauce
• Tinned fuit (in juice)

Trial small amounts with caution

• Bananas - ensure more softer/riper
• Smoothies - ensure made with fruits from include column
• Apricots (peeled)
• Soft strawberries
• Soft raspberries
• Soft blackberries
• Fruit juice with bits
• Coconut

Avoid

Any fruit which has skin/pith which cannot be removed fully:

• Blackcurrants
• Blueberries
• All Citrus fruit
• Cherries
• Cranberries (fresh and dried)
• Dates
• Dried apricots
• Figs
• Gooseberries
• Grapes
• Kiwi
• Passion fruit
• Pineapple
• Pomegranate
• Prunes
• Raisins
• Redcurrants
• Rhubarb
• Sultanas
• All dried fruit

Vegetables

A typical recommended portion size is 80g, such as three heaped tablespoons. However, try starting off with a much smaller portion, such as one or two tablespoons, with a meal. Focus on slowly building up to the recommendation, especially whilst opting for smaller meal portions.

A simple rule to help guide your choices, is to opt for vegetables which can be mashed by a fork, to a soft or smooth texture, on your plate.

Vegetables that mash down to leave piths, seeds, or stringy parts, are best avoided.

Include

• Soft, well-cooked/mashed root veg, with no skins; carrots, swede, parsnips, turnips, butternut squash
• Aubergine (peeled)
• Tinned, deseeded tomatoes
• Tomato puree or passata
• Vegetable juice without pulp
• Broccoli and cauliflower, cooked soft with no stalks
• Peeled and deseeded cucumbers and courgettes
• Avocado
• Peeled/mashed yams
• Smooth vegetable soups

Trial small amounts with caution

• Well cooked, finely diced, or pureed onion
• Pureed garlic
• Pureed chilli
• Peppers
• Herbs (opt for small amounts of dried herbs instead of fresh herbs)
• Split peas/garden peas
• Well-cooked cabbage
• Cooked spinach

Avoid

• Asparagus
• Baby corn
• Bean sprouts
• Brussel sprouts
• Green beans
• Celery
• Chilli (fresh)
• Edamame
• Garlic (whole, raw, undercooked)
•  Artichokes
• Leeks
• Lettuce
• Kale
• Mushrooms
• Mangetout
• Okra
• Onions (whole, raw, largely sliced)
• Pak Choi
• Pickled onions
• Shallots
• Raw spinach
• Sugar snap peas
• Sweetcorn
• Tomatoes (whole, with skins and seeds)
• Avoid all pips, skins, seeds and stalks
• Raw/crunchy vegetables
• Soups with vegetable chunks, expecially those listed above

Sweet snacks/puddings

Include

• Biscuits without fruit or nuts, e.g rich tea, lotus, nice, bourbons, short ginger, ginger nut, custard cream, marie
• Biscotti/Madel bread
• Chocolate without dried fruit, nuts or seeds
• Jelly without fruit
• Marshmellows
• Toffee, fudge
• Boiled/jelly sweets
• Halva
• Plain scones
• Hot cross buns without dried fruit
• Almond macarons
• Mochi
• Egg tart
• Marzipan
• Cakes made with white flour without dried fruit or nuts e.g. Victoria sponge, Madeira
• Ensure any baked products eg brownies/cookies/cupcakes/ pastries are made with suitable flour and do not add nuts, seeds and only have fruit from allowed section
• Nutella/hazlenut spread (ensure smooth)
• Seedless jam

Trial small amounts with caution

• Flapjacks
• Plain/chocolate digestives
• Hobnobs
• Coconut macarons

Avoid

• Wholegrain/oatbased biscuits
• Biscuits with dried fruit
• Biscuits containing nuts
• Muesli/cereal bars
• Chocolate with dried fruit/nuts/seeds
• Jelly with fruit pieces
• Fruit scones
• Hot cross buns with dried fruit
• Cakes containing dried fruits or nuts or made with flour from avoid section
• Any sweet nut-based snacks

Savoury snacks

Include

• Crisps
• Tortilla chips
• Plain breadsticks
• Cheese biscuits
• Smooth dips (smooth guacamole, smooth cheese dip, ranch)
• Plain pretzels
• Prawn crackers

Trial small amounts with caution

Avoid

• Bombay mix
• All types of nuts
• All types of seeds
• Trail mix
• Popcorn
• Coleslaw
• Dips with whole tomatoes/cucumbers/onions
• Seeded biscuits
• Seeded breadsticks
• Wholegrain crisps
• Pretzels with seeds/nuts

Fats and oils

There are no evidence-based guidelines for types of fats or oils which are best for use in IBD.

However, for general health and wellbeing, unsaturated fats are a good source of calories and healthy fats.

High intakes of any fats or fatty foods may exacerbate loose bowel symptoms and be poorly tolerated, therefore should be included with caution.

Include

• Butter/margarine
• Any type of plant-based cooking oils such as olive oil, vegetable oil, sunflower oil, canola oil, avocado oil
• Garlic infused oil and onion oil

Trial small amounts with caution

• Duck fat
• Goose fat
• Coconut oil

Avoid

• Spray based oils such as Frylight or low calorie spray oils
• Chilli oil or chilli infused oil

Snack ideas

• Greek yogurt or suitable yogurt with suitable fruit
• Mashed avocado (ensure ripe) or scrambled egg on white toast
• Nutella/hazelnut/peanut butter on toast with small, sliced banana
• Smoked salmon on suitable crackers or crispbreads
• Custard, mousse, or rice pudding pots
• Cheese and white crackers
• Plain breadsticks or plain pretzels with suitable dip
• Plain scones with plain jam and cream
• Crumpets with butter or cheese

Meal ideas

Breakfast

• Suitable cereal or ready brek with milk of choice
• Pancakes or waffles made with suitable flour, served with small amounts of suitabls fruit and yogurt of choice
• Toast, made with suitable bread, served with protein of choice - egg, smooth peanut butter, cheese or small amount of bacon
• Croissants/pastries/crumpets
• Hashbrowns or latkes without onions

Lunch

• Sandwiches made with white bread with butter, sliced meat or sliced meat style quorn
• Smooth vegetable soup, with added cream, serve with white warm toast/toastie/bread roll with added butter
• Jacket potato with no skins with suitable filling such as cheese or tuna. Servce with a small serving of suitable vegetables
• Omelette with ham/vegetarian ham and grated cheese of choice
• Matzo ball soup - ensure matzo balls are soft and cut into smaller pieces. Enure only suitable vegetables in soup along with suitable meat portion. Avoid adding onions

Evening Meal

• Roast dinner with suitable vegetables only, Yorkshire puddings, gravy without onions and mash potatoes. Ensure the meat is soft and tender
• Any pasta dish made with the white pasta e.g macaroni cheese/lasagne/ravioli/cannoli/kugel. Ensure using tomato passatta or puree
• Chappatis made with white flour or soft white rice, served with mild curry made with suitable vegetables or smooth, mashed lentils.

Further Reading

Crohn’s and Colitis UK website on diet

https://crohnsandcolitis.org.uk/info-support/information-about-  crohns-and-colitis/all-information-about-crohns-and-colitis/living- with-crohns-or-colitis/food
 

 

Guts UK info on Crohn’s Disease

https://gutscharity.org.uk/advice-and-information/conditions/ crohns-disease/
 

If you have any questions or concerns regarding your diet and managing your symptoms, please contact us on gastrodietitians@nca.nhs.uk