By Dr Pranab Gyawali, Consultant Gastroenterologist (UK-trained) in Dubai
If you want to understand the earlier Oxygen Trap concept behind this discussion, please see this related VLOG first: The Oxygen Trap and the gut microbiome in IBD.
If you have Crohn’s disease or ulcerative colitis and are on biologics, you may well have wondered whether diet affects how your treatment works. Many patients feel strongly that it does. What has been less clear is the biological reason why.
A recent paper in Gastroenterology, one of the leading journals in our field, strengthens the idea that the gut environment in inflammatory bowel disease is already altered very early on. This may be one reason why patients can respond differently to the same treatment.
What did the recent microbiome research show
The paper identified a pattern of fewer protective gut bacteria and more oxygen tolerant and oral type bacteria in inflammatory bowel disease. The protective genera highlighted included Alistipes, Agathobacter, Bacteroides and Roseburia. The enriched genera included Pseudomonas, Haemophilus, Fusobacterium and Granulicatella.
This is important because it suggests the gut environment is not neutral. It is already shifted toward a pattern that may support more inflammation.
Why does this matter for biologics
Biologics act on the immune system within the gut lining. The immune system in the gut is continuously interacting with the microbiome. So when I think about why one patient responds well to biologics and another does not, I do not think only about the drug. I also think about the environment in which that drug is working.
We do not yet have definitive proof that diet directly changes biologic success. But the theory is difficult to ignore. If the microbiome helps shape the immune environment, then it is reasonable to think that the environment could influence treatment response.
What practical role might diet have
This is why I focus a lot on diet in inflammatory bowel disease. Not as a replacement for treatment, but as a way of supporting the environment where biologics and other medicines are working.
Patterns such as a Mediterranean style or plant forward diet are increasingly discussed because they may help support a healthier microbiome balance. The practical aim is consistency, not extremes. It is about helping the gut environment rather than chasing quick fixes.
What should patients take from this
If you are on biologics and you feel diet matters, I think that is a very reasonable instinct. We still need more direct research on how diet affects biologic response, but this is exactly the kind of area I believe will become more important over time.
I will be watching closely for future work exploring how diet, microbiome patterns and biologic response interact.
FAQ
Does diet affect how biologics work in Crohn’s disease or ulcerative colitis
We do not yet have definitive proof that diet directly changes biologic response, but diet affects the gut microbiome and the microbiome interacts closely with the immune system in the gut.
Why do biologics work for some patients and not others
There are several reasons, including disease biology and inflammatory pathways. One possible contributor is the gut environment, including the microbiome.
Should diet replace biologic treatment
No. Diet should be seen as supportive, not as a substitute for properly indicated medical therapy.
What bacteria were highlighted in this paper
The paper highlighted fewer protective genera such as Alistipes, Agathobacter, Bacteroides and Roseburia, and more oxygen tolerant or oral associated genera such as Pseudomonas, Haemophilus, Fusobacterium and Granulicatella.
If you wish to discuss this further or would like to make an appointment, please use the booking form on this page.
Recommended Guides
- Learn about Biologicals used in UC and Crohn’s in Dubai – Overview of biologic treatment options and how these are used in practice.
- Crohn’s Disease Treatment in Dubai – Main Crohn’s hero page with treatment, monitoring and practical patient guidance.
- Ulcerative Colitis Treatment in Dubai – Main ulcerative colitis hero page with symptoms, treatment and follow up guidance.
- Gut Microbiome and Gut Health in Dubai – Main microbiome hero page that explains the broader microbiome framework.
- The Oxygen Trap and the Gut Microbiome in IBD – Earlier VLOG introducing the oxygen related microbiome shift concept.
Related IBD Topics
- IBD Treatment Update 2026 – Overview of what is changing in Crohn’s disease and colitis treatment.
- Crohn’s VLOG Hub – Additional Crohn’s disease VLOG content in one place.
- Gut Health VLOG Archive – Broader VLOG archive with relevant microbiome, diet and gut health topics.
Related Gastroenterology Topics
- Gastroenterology Services in Dubai – Main specialty page covering consultations, conditions and procedures.
- Inflammatory Bowel Disease in Dubai – Broader overview page for IBD assessment and management.
- Small Intestinal Bacterial Overgrowth in Dubai – Related microbiome and symptom overlap topic.
- Bloating Treatment in Dubai – Useful for patients with persistent symptoms despite treatment.
Investigations and Procedures
- Colonoscopy in Dubai – Endoscopic assessment remains central to IBD evaluation and follow up.
- Capsule Endoscopy in Dubai – Relevant in selected Crohn’s disease assessment pathways.
- Hydrogen and Methane Breath Test for SIBO – Useful where microbiome related symptoms overlap with IBD management.
- Gut Microbiome Testing in Dubai – Main testing page for patients exploring microbiome related assessment.
If you wish to discuss this further or would like to make an appointment, please use the booking form on this page. A member of our team will contact you within 12 business hours.