Therapeutic diets are not new to medicine. Records from St Bartholomew's Hospital in London show hospital "milk diets" and "broth diets" being prescribed centuries before dietetics existed as a formal profession [1]. Yet diet therapy for Inflammatory Bowel Disease (IBD) has been slow to follow. 1946 marked the first reported attempt to treat Ulcerative Colitis through diet (raw pork enemas), but it was not until the 1970s that exclusive enteral nutrition (EEN) emerged as an effective induction therapy for Crohn's Disease. For much of the twentieth century, the dietitian's role in IBD care was largely supportive, feeding patients rather than treating them [1]. It wasn't until 2015, with the formation of the Dietitians of ECCO (D-ECCO) Committee, that IBD dietetics gained formal international representation as a distinct area of practice.
This trajectory has accelerated sharply in the last decade. The evidence base linking diet to IBD pathogenesis, through the microbiome, metabolite production and gut barrier integrity, has matured to the point where dietary therapy now sits alongside pharmacotherapy. EEN is embedded in international paediatric guidelines [2], the Crohn's Disease Exclusion Diet has demonstrated efficacy in children and adults [3] and interest in whole food, plant-based therapeutic diets for Ulcerative Colitis (e.g. the Mediterranean diet) is growing [4]. This shift was formalised in the 2025 ECCO Consensus on Dietary Management of IBD, which names four pillars [RM1.1] where dietitians with IBD expertise should be involved: induction and maintenance of remission, comorbidity management, nutritional assessment and optimisation, and disease prevention [5]. Critically, the Consensus states plainly that every patient with IBD should have access to a dietitian with experience in the condition [5]. This is a marker of how far the role has moved from the periphery of IBD care to being a central standard of care. Yet access and expertise remain inconsistent: surveys suggest that many dietitians spend less than 10% of their clinical time on IBD and many IBD services are still without a dietitian dedicated to the service with experience in IBD nutritional care, exposing a real gap between guideline ambition and clinical capacity [1].
Closing that gap is the next frontier. D-ECCO has proposed a six-step roadmap: defining the scope of the IBD dietitian role, developing an accredited postgraduate qualification, embedding dietitians formally into multidisciplinary teams, building routine clinical auditing and outcomes data, integrating IBD nutrition into tertiary curricula and research training, and advocating at government level for funding and equitable access [1]. The parallel is deliberate. This mirrors the pathway N-ECCO has already built for IBD nursing and signals an ambition for the same international standardisation and recognition. Realising it will require dietitians to move further into research leadership, workforce advocacy and formal credentialing, not just delivering evidence-based care but shaping the systems that make that care consistently available. The kitchen-to-IBD clinic journey isn't finished; the next chapter is about making specialist IBD dietetic care a guaranteed part of every patient's pathway, not a matter of geographic or institutional luck. We look forward to the publication of ECCO’s upcoming Consensus on the Role of Dietitians in Caring for Patients with IBD in 2027 as another significant milestone.
This article draws on Alice S. Day, Julie Vanderstappen, Alicia Sandall, Vaios Svolos and Chen S. Shabat. 2026. From kitchen to inflammatory bowel disease (IBD) clinic: Transforming the role of dietitians in IBD care. A narrative review by dietitians with expertise in IBD. JCC Plus: e70007. https://doi.org/10.1002/jcc5.70007.
