Groundbreaking research presented at ECCO'25 reveals how daily environmental exposures and dietary choices interact with genetics to influence IBD risk and progression.
For the millions worldwide living with inflammatory bowel diseases (IBD) like Crohn's disease and ulcerative colitis, treatment has long centered on powerful medications. Yet, a record number of research abstracts presented at the 2025 European Crohn's and Colitis Organisation (ECCO) Congress reveals a dramatic shift. Scientists are now uncovering how our daily environmental exposures and dietary choices interact with genetics to influence disease risk and progression. This article explores the groundbreaking studies presented at ECCO'25 that are moving diet and lifestyle from the periphery to the core of sustainable IBD management.
Accepted abstracts at ECCO'25
Worldwide affected by IBD
Portion dedicated to nutrition & environment
The congress, held under the theme "Sustainability in IBD and Beyond," featured over 1,500 accepted abstracts, with a significant portion dedicated to nutritional and environmental science 2 . This surge in research highlights a growing recognition that managing IBD requires a holistic approach. As we will see, the latest evidence suggests that the food on our plates and the air we breathe may be just as critical to managing IBD as the medications in our cabinets.
Western lifestyles are a major driver of the rising global incidence of IBD 7 . But what exactly makes these lifestyles so risky? Research presented by Dr. Rupa Banerjee pinpointed several key environmental triggers, including short breastfeeding periods, early-life antibiotic exposure, urbanization, and the "Westernized diet" 7 . This diet, high in red meat, processed foods, and refined sugars while low in fiber, is now being examined through its profound impact on the gut microbiome. The theory is that these environmental factors alter the microbiome, which can then trigger IBD in genetically susceptible individuals 7 .
Perhaps one of the most compelling insights comes from the UK Biobank cohort. Research showed that a diet rich in methyl donors—nutrients like methionine, folate, choline, and betaine found abundantly in fruits, green leafy vegetables, and legumes—can actually reduce the risk of developing ulcerative colitis and Crohn's disease 7 . Crucially, this protective effect was strongest in individuals exposed to high air pollution or those with a significant smoking history. This suggests that while we cannot always avoid environmental pollution, a nutrient-dense diet may help counteract some of its damaging effects and lower IBD risk 7 .
For years, observational studies have linked the consumption of ultra-processed foods (UPFs) to an increased risk of Crohn's disease 7 . Food additive emulsifiers, used to improve texture and shelf-life in many UPFs, have been a prime suspect. Until ECCO'25, however, no clinical trial had tested whether restricting them could actually improve the disease.
Dr. Aaron Bancil presented the first multi-centre, randomised, double-blind, placebo-controlled trial to assess this question 7 . Patients with mild-to-moderately active Crohn's disease were divided into two groups. Both received detailed dietary advice from a dietitian, but the intervention group also received supermarket deliveries of emulsifier-free packaged foods and snacks for eight weeks 7 . This rigorous design ensured that the only systematic difference between the groups was the presence of emulsifiers in their diet, allowing researchers to isolate the effect of this specific ingredient.
The findings were striking. Patients following the emulsifier-free diet were three times more likely to see an improvement in their symptoms and twice as likely to achieve clinical remission based on the Crohn's Disease Activity Index 7 . Objectively, the group restricting emulsifiers saw their fecal calprotectin levels—a key marker of gut inflammation—cut in half 7 . This provides strong evidence that dietary emulsifiers are not just correlated with disease but can actively contribute to disease activity in Crohn's.
| Outcome Measure | Emulsifier-Free Diet Group | Control Group | Significance |
|---|---|---|---|
| Clinical Symptom Improvement | 3x more likely | Baseline | Statistically significant |
| Clinical Remission (CDAI) | 2x more likely | Baseline | Statistically significant |
| Change in Fecal Calprotectin | Reduced by half | Marked reduction in inflammation |
The research on emulsifiers is just one piece of the dietary puzzle. The role of fiber in IBD has long been debated, but new data is bringing clarity. Findings from the GEM Project showed that a higher intake of fermentable fibers like inulin and beta-glucan was associated with a reduced risk of developing Crohn's disease 7 . For those already living with IBD, the advice is shifting away from blanket fiber restriction. Studies indicate that psyllium fiber supplementation (7-20 g/day) can reduce relapse rates in ulcerative colitis 7 .
Key Components: Refined grains, sugary drinks, processed foods
Higher IBD Risk
Higher Surgery Risk
Key Components: Whole fruits, vegetables, legumes, whole grains
Lower IBD Risk
Lower Surgery Risk
Research presented by Dr. Jie Chen, analyzing over 529,000 participants, drew a critical distinction between unhealthy and healthy plant-based diets and their impact on IBD risk and outcomes 7 .
Another innovative study presented by Luba Plotkin, RD, tested an "Exclusive Whole-Food Diet" against the standard liquid-only exclusive enteral nutrition (EEN) for inducing remission in Crohn's disease 7 . The whole-food diet, which excluded processed foods, gluten, and animal fats but was otherwise flexible, was found to be comparable to EEN in inducing clinical and biological remission 7 . Notably, it also produced a more diverse and healthier fecal microbiome, enriched with anti-inflammatory bacteria, which may explain its therapeutic effect 7 .
To understand how these dietary studies are conducted, it helps to know the tools researchers use.
A non-invasive biomarker measured from stool samples to assess the level of inflammation in the gut.
A standardized scoring system that uses symptoms and lab values to quantify disease activity for clinical trials.
A genetic technique used to identify and profile the diverse bacterial communities that make up the gut microbiome.
Detailed surveys that allow researchers to estimate a participant's habitual dietary intake over time.
Ensures scientific rigor by providing comparison groups with identical-looking and -tasting foods.
The evidence presented at ECCO'25 makes it clear that the future of IBD care is multifaceted. It is not about choosing drugs over diet, but about intelligently combining both. The research underscores that psychosocial factors like anxiety, depression, and poor sleep are also significantly associated with clinical flares 7 . This supports the need for a holistic treatment model that integrates advanced medications with personalized nutritional guidance and mental health support.
Targeted biologic therapies remain essential for controlling inflammation.
Dietary interventions tailored to individual needs and responses.
Addressing anxiety, depression, and stress as part of comprehensive care.
As the upcoming ECCO consensus on diet and nutrition in IBD is finalized, its recommendations will likely provide a more structured framework for clinicians and patients 7 . The journey toward sustainable remission in IBD is expanding from a narrow focus on the biologic to a broader, more empowering view that includes the food we eat, the environment we live in, and the daily choices we make for our overall well-being.