Is Precision Nutrition the Future of IBD Management?

This content was created as a collaboration between HealthCentral and the Crohn's & Colitis Foundation. This article was previously published on HealthCentral.

If you’ve been diagnosed with an inflammatory bowel disease (IBD) like Crohn’s disease or ulcerative colitis (UC), one of your first questions is likely to be: “What should I eat?” 

Diet isn’t thought to be a direct cause of Crohn’s or UC, and it’s also not a substitute for medical treatment, according to the Mayo Clinic. But as almost everyone with IBD has experienced firsthand, certain foods can definitely make your symptoms worse. What’s more, mounting evidence shows how your eating patterns can play a major role in making your disease easier—or harder—to manage, notes Alan Moss, M.D., the chief scientific officer for the Crohn’s & Colitis Foundation, based in New York City. 

Enter what’s known as precision nutrition, a therapeutic approach of creating tailored dietary recommendations for individuals with IBD. “For many years, we’ve given generic advice around what to eat and avoid or limit,” says Dr. Moss. “Precision nutrition would give patients unique recommendations based on what may trigger them and what may be beneficial for them, while also factoring in cultural and lifestyle differences.”  

Experts are increasingly convinced that precision nutrition has a role in managing IBD, he adds. That’s because our eating patterns have a direct impact on our gut microbiome, which in turn influences immune system activity and inflammation in the body, research tells us. The problem is, IBD specialists need more data before they can make specific dietary recommendations for any individual, per a 2024 position paper on precision nutrition. 
 
“One person with IBD may benefit from eating lots of fruits and vegetables and for the next person that can be disastrous,” Dr. Moss explains. “Similarly, we don’t yet have the science to understand why one person does fine with lactose when someone else doesn’t, even though they have the same disease.”  

The good news? More data to help shed light on this dietary disconnect is on the way. The Foundation has launched a new five-year research agenda, which includes a focus on precision nutrition. The Foundation is funding pivotal studies in a quest to learn more about how different foods and diets affect different people with IBD, with the goal of being able to create customized eating plans. 

“Our patients continually ask about this, so we decided to go big,” says Dr. Moss. Here’s a look into some of the cutting-edge research on precision nutrition for IBD funded by the Foundation that’s in the works—plus what these findings may one day mean for keeping your Crohn’s or UC as well-controlled as possible.  

Swapping Ultra-Processed for Whole Foods 

Eating mostly whole, minimally processed foods has head-to-toe health perks, reports a review published in the American Journal of Lifestyle Medicine. And for some people with IBD, doing so could be part of the key to achieving IBD symptom remission. Right now, some researchers are working to find out which Crohn’s patients benefit from this approach—and which don’t. 

“Ultra-processed foods have been linked with the development of IBD,” says Berkeley Limketkai, M.D., Ph.D., the director of clinical research at the UCLA Center for Inflammatory Bowel Diseases in Los Angeles, who is part of the study team. “They are also believed to aggravated IBD activity. Intrinsically, the processing of food is not detrimental. However, ultra-processing foods typically require the incorporation of unhealthy additives to improve their appearance, texture, flavor, and shelf life—and it’s thought that these additives could contribute to inflammation in the gut,” he notes.  

The first part of the multi-phase study began by randomly assigning people with mild-to-moderate Crohn’s disease to either a whole foods diet or a continuance of their usual diet. After eight weeks, 71% of those who followed the healthier diet were found to achieve symptomatic remission. The whole foods diet group also showed lower rates of fecal calprotectin, a marker of GI tract inflammation that can be identified in stool samples. 

That’s tremendously encouraging for the 71% of folks who felt better, says Dr. Limketkai. But what about the 29% who didn’t? The UCLA team is hoping to glean answers to that question in the next phase of the study.  

“There is a myriad of factors that could have influenced the outcome, such as underlying genetics, gut microbiome, stress, environmental exposures, quality of food ingredients, concurrent medical therapies, disease severity, and other medical conditions,” says Dr. Limketkai. “We are striving to understand the key clinical and biological features that would provide insight into whether an individual would respond to [this type of dietary intervention].” 

Who Is Helped Most From Anti-Inflammatory Diets?  

Like diets that are low in or free from ultra-processed foods, many people with IBD seem to benefit from an anti-inflammatory diet, which include things like oily fish, certain teas, olive oil, and fruits like grapes and cranberries. On the whole, adopting this way of eating tends to reduce inflammatory activity in the gut, which for some can lead to remission, per a Crohn’s & Colitis 360 review on the role of diet in IBD.  

But again, not every person with IBD responds in the same way. “It’s not just, ‘Does the anti-inflammatory diet help?’ But in those who got a big response, [it’s also]: ‘What is it about those people that got the big response? And in those who didn’t, why didn’t they? Is it related to their microbiome or their genetics?’” asks Dr. Moss. 

Right now, researchers at the University of Calgary in Alberta, Canada are trying to find out. In a randomized controlled clinical trial, scientists there are attempting to identify the clinical and biological patterns that can potentially be used to predict which people can quickly achieve disease remission by following a whole foods anti-inflammatory diet. If researchers can ID the characteristics that cause someone with IBD to respond well to the diet, that would open the door to recommending a similar eating plan to others who share those same characteristics, notes Dr. Moss.  

What Should Relapsing Teens With IBD Eat? 

Partial or all-liquid diets can help some people with severe IBD flares go into remission, according to the Foundation. But symptoms sometimes relapse once the same person tries to return to solid foods.  

At the University of Glasgow in Scotland, researchers are studying adolescents who’ve reached remission with a liquid diet and then relapsed to see whether certain solid foods were responsible for causing their IBD rebound. The study also investigates whether CD-TREAT, a type of diet that manages Crohn’s symptoms by limiting gluten and fiber. This approach can mimic the characteristics of a liquid diet and is better at preventing relapses than falling back to a standard diet. 

The goal: To arm young people who have Crohn’s disease with dietary knowledge that may help keep their symptoms at bay. Teens don’t always like being told what to do by their parents, so “trying to tell them what to eat can sometimes be a fruitless task,” says Dr. Moss. “By identifying the dietary components that cause a relapse, you’re giving them, and their parents, helpful information about what to avoid or increase in their diet.” 

Gathering IBD Dietary Intelligence From AI 

Researchers at the University of California, San Diego, are using artificial intelligence (AI) to create a database of foods that may be helpful or harmful for Crohn’s disease and UC, based on how the body responds to individual menu items. “They’re looking at the composition of subjects’ stool, using AI models to predict whether what a subject ate was pro-inflammatory or anti-inflammatory,” Dr. Moss explains. 

From there, the researchers can see whether a given food correlates with disease severity in different people with IBD. With that knowledge, experts can create specific therapeutic diets comprised of anti-inflammatory foods that are also free of pro-inflammatory ones, notes Dr. Moss.  

Precision Nutrition for Fewer IBD Flares 

Studies like these will lay the groundwork for creating targeted nutrition plans for individuals with Crohn’s disease and UC in the years to come, says Dr. Moss. And that can be a powerful complement to a growing arsenal of medical therapies. “I envision the combination of precision nutrition and medication will get you to a better place,” he adds.  

Eventually, if you have IBD, you may even be able to get real-time feedback about how your recent food choices are affecting your symptoms—with guidance on how to make precise adjustments to help you feel better.  

“We might have the development of blood and stool tests that identify which components of your diet last week were pro- and anti-inflammatory,” says Dr. Moss. “That would empower people with IBD to adjust their diets and identify triggers when their symptoms are starting to act up,” he adds. “They could tailor their diets or identify triggers when they’ve had a bad week.” 

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