Diet may be the ultimate modifiable environmental factor to optimise human health and prevent / treat disease, including inflammatory bowel disease. But it is not the only one • Exercise and stress management also key • Smoking and alcohol too What would you add?

I don't think diet is THE cause of IBD But there is good epidemiological evidence now that the modern western diet is on factor contributing to the global rise in IBD. Some dietary factors may be drivers of inflammation rather than causative. The role of dietary therapy in treating inflammation is established through exclusive enteral nutrition Data for other dietary strategies is weaker. A Mediterranean style diet is recommended if this is available locally and affordable. A Mediterranean diet is typically prepared from fresh whole foods, minimally processed, with fruits, vegetables, leans meats, healthy fats and whole grains. Produce is typically season and local. Meals are enjoyed socially with family and friends. Physical activity and time in nature is also encouraged IBD clearly a global problem arising across many cultures with a multitude of local cuisines. This gives us an opportunity to share knowledge and learn from each other. For many people improving diet quality will have a profound impact on how they feel - including improved mood, sleep quality and energy levels. Important additional considerations: About 25% of IBD patients will also have a degree of IBS Dietary fibre typically needs to be restricted in • stricturing small bowel Crohn's disease necessitates a low fibre diet • during acute flares of colitis