Gut Check - Diet, Technology and AI in the Management of IBS

Feb 25, 2025 1:12pm

63 to 84% of people with IBS report symptoms related to eating specific food items, with a greater number of food triggers identified by individuals with more severe IBS. This article will cover the latest developments in nutritional interventions and technology for the treatment and management of Irritable Bowel Syndrome.

Written by Stephanie Tucker MSc ANutr

Introduction to Irritable Bowel Syndrome (IBS)

IBS affects around 10% of a population, with women affected around 1.5 - 3 fold more than men. It can have a devastating impact on quality of life in terms of pain, discomfort and worry. Research has shown that individuals who suffer from digestive disorders are twice as likely to take time off work, estimates show a loss of around $160bn per year to the economy.

Irritable Bowel Syndrome Onset

Mounting evidence demonstrates the link between our gut health and our mental health. However, research has also found that women with IBS have higher risk of developing depression adding a further burden to the healthcare system. As no two individuals suffer from IBS in the same way, people are always on the lookout for new solutions. Therefore, developing solutions that are good for our gut are good for the economy too.

Common IBS Symptoms

Individuals can suffer from one or multiple IBS symptoms, including:

stomach cramps
bloating
constipation
diarrhoea
acid reflux
excessive gas

Irritable Bowel Syndrome Treatment in Healthcare

There is currently no singular identified cause of IBS so treatments are aimed at managing symptoms, yet well-researched therapies include dietary interventions such as a Low FODMAP diet which is effective in around 70% of cases, as well as Cognitive behavioural therapy (CBT), medications, supplements (eg probiotics) and relaxation techniques such as yoga, hypnotherapy, and meditation. Despite the number of treatment options available, improvements take time to have an effect or require a “test and trial” multi-pronged approach.

NICE guidance:

The NICE guidelines for managing IBS recommend that healthcare professionals take a holistic approach, including dietary and lifestyle modifications, psychological support, and pharmacological treatments tailored to symptom severity. Patients are encouraged to follow a low FODMAP diet, increase physical activity, and consider medications such as antispasmodics, laxatives, or antidepressants if needed. Regular follow-ups and a focus on patient education and self-management are emphasized.

BDA guidance:

The BDA guidelines for managing IBS emphasize individualized dietary advice, starting with general healthy eating and lifestyle changes. If symptoms persist, a structured approach such as the low FODMAP diet, guided by a registered dietitian, is recommended. The guidelines highlight the importance of dietary triggers, adequate fibre and fluid intake, and psychological support where necessary.

Current Challenges in IBS Management

1. Diagnosis: IBS is a functional gastrointestinal disorder with symptoms that overlap with other conditions, making diagnosis challenging. There is no definitive test for IBS, and diagnosis often relies on excluding other conditions.

2. Treatment Efficacy: IBS treatments, including dietary changes, medications, and psychological therapies, can be hit or miss. What works for one patient may not work for another, and managing symptoms often requires a trial-and-error approach.

3. Patient Education: Many patients lack understanding about IBS and how to manage it effectively. Educating patients about the role of diet, stress management, and medication adherence is crucial.

4. Access to Care: Access to specialized care, such as gastroenterologists or dietitians knowledgeable about IBS, can be limited, especially in rural or underserved areas.

5. Stigma: IBS can be stigmatized, with patients often feeling embarrassed about their symptoms, leading to underreporting and reluctance to seek treatment.

Advances in Digital health in the management of IBS

Digital therapeutics (DTx) is defined as products that incorporate advanced technology and best practices relating to design, clinical validation, usability and data security. They are reviewed and cleared or approved by regulatory bodies as required, to support product claims regarding risk, efficacy and intended use as defined by the Digital therapeutic alliance.

Digital therapeutics are particularly relevant to IBS because this condition often does not require hospitalization or acute care. Digital therapeutics therefore provides the opportunity for sufferers to be managed remotely using a toolbox of evidence- based therapeutic approaches.

A digital therapeutic approach has the potential to improve inefficiencies in the healthcare system especially when it comes to providing care at scale for conditions that do not require intensive treatment or monitoring. Digital therapeutics also plays into the self-management approach many healthcare organizations are trying to adopt in order to increase engagement, education, and levels of self-efficacy in individuals.

The Digital Therapeutics Industry

The digital therapeutics market has grown rapidly over the last 5 years and is currently estimated to grow to $9bn by 2025 (Grandview research, 2017), remember that the personalised nutrition market is currently estimated at $6bn.

Innovators in the area of digital therapeutics initially focused on mental health such as mild depression, but now digital therapeutics is making inroads in the area of nutrition starting with irritable bowel syndrome. These approaches can be enhanced as access to using open, sensor, and wearable data becomes easier, making the use of real-time data to develop innovative solutions much simple. However, in order to be approved as a digital therapeutic these need to validated by a clinical trial.

Individuals can be prescribed a digital therapeutic by their doctor and download the app onto their smartphone knowing that the app is considered a treatment. However, these apps are also available in the major app stores without the need for a prescription.

Individuals can track their symptoms, mood, log their food intake, physical activity, stools, and any medication and supplements they are taking, to understand the link between the different data points and their symptoms. Structured online programmes delivered via the app can be accessed at any time, as well as expert healthcare professionals via chat or a private community.

Current Research of Digital Therapeutics in IBS

A recent randomized controlled trial assessed the efficacy of Zemedy, a mobile digital therapeutic app delivering CBT for IBS management. Zemedy offers an 8-module program incorporating psychoeducation, relaxation, exposure therapy, and dietary advice through an interactive chatbot. Results showed significant improvements in IBS symptoms, quality of life, and psychological factors such as anxiety and depression, with benefits maintained at 3 months post-treatment. The findings suggest that Zemedy is an effective tool for enhancing access to CBT, supporting the use of digital therapeutics in IBS care (Hunt et al, 2021).

Another company, MetaMe, founded in 2016, recently received $3.8m seed funding for their Regulora product that provides hypnotherapy via their app through a standardized 12-week programme that brings users into a deep state of relaxation. The start-up is currently conducting a clinical trial for FDA approval.

Challenges of Digital Therapeutics in IBS

DTx products are slowly being recognised as a treatment option, allowing for this approach to become more widely available. However, it is important that new solutions are scientifically validated through inclusive clinical trials.

It is also critical that digital therapeutics are not seen as a replacement for accessing healthcare professionals especially when it comes to following strict dietary therapies such as the Low FODMAP or behaviour change. However, these are a viable option as a first-line therapy or as a stop-gap before seeing a healthcare professional.

The gut-brain connection plays a crucial role in IBS, with psychological factors like stress and anxiety often exacerbating symptoms. Digital therapeutics harness this link by incorporating cognitive behavioural therapy, gut-directed hypnotherapy, and mindfulness techniques to alleviate symptoms. AI-driven tools present exciting opportunities to personalise care, monitor symptoms, and predict flare-ups, offering a more responsive and tailored approach. However, challenges remain in ensuring data privacy, accessibility, and maintaining the human element in patient care, which is essential for long-term management and support.

Personalized Nutrition and IBS

Fiber is recognized as an important but complex tool in managing IBS, the effects of fiber depends on its type. Soluble fiber, found in foods like oats, and some fruits and vegetables, absorb water and form a gel-like consistency. This can help regulate bowel movements and is generally well-tolerated. Insoluble fiber, found in wheat bran, whole grains, and some vegetables, adds bulk to stool. For people with constipation-predominant IBS, soluble fiber can help improve stool consistency and frequency. Those with diarrhea-predominant IBS may find that too much fiber, especially too much insoluble fiber, may worsen urgency and bloating. The general recommendations are to slowly increase fiber intake, prioritising soluable fiber and building up insoluable fiber over time. Some high-fiber foods, particularly those high in FODMAPs, can also trigger bloating and gas. Because IBS symptoms vary from person to person, a personalized approach is key, and working with a dietitian can help ensure fiber intake supports digestive health without making symptoms worse.

The Low FODMAP Diet (LFD) is a dietary approach designed to manage IBS by reducing fermentable short-chain carbohydrates (FODMAPs – Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). These carbohydrates can be poorly absorbed in the small intestine and can cause bloating, gas, diarrhea, and abdominal pain in individuals with IBS.

The diet consists of three phases:

Elimination – Restricting high-FODMAP foods (e.g., wheat, onions, garlic, dairy, legumes, and certain fruits).
Reintroduction – Systematically reintroducing FODMAP groups to identify individual triggers.
Personalization – Developing a long-term, balanced diet based on tolerated foods.

The LFD has been shown to be effective in reducing IBS symptoms, particularly bloating and diarrhoea, and is recommended under dietitian supervision to prevent nutritional deficiencies and disordered eating. While beneficial for many, it may not be suitable for everyone, and long-term adherence can be challenging.

Despite advances in research around the low FODMAP diet, a recent UK consensus meeting about the management of irritable bowel syndrome showed that traditional dietary advice (TDA), gluten-free diets, and low FODMAP diets have shown comparable short-term efficacy in managing IBS, but TDA appears to be more acceptable. UK guidelines suggest TDA as the first-line approach, though GFD may suit individuals who find gluten a primary trigger, and LFD may be appropriate for stricter FODMAP reduction after dietary consultation (Rej et al, 2022).

Personalized nutrition technologies for IBS you should know

Personalized nutrition solutions that can address symptoms of IBS can be divided into the following:

AI Digestive Health Apps:

There are lots of diet and lifestyle ai apps available for the management of IBS symptoms, however, these have not been validated in a clinical trial and the quality of the information provided in these apps can be highly variable. In order for apps to be recognised and prescribed as a treatment, it must be considered a medical device, and only then, are they considered a digital therapeutic. The following companies offer apps to support digestive health for the relief of IBS symptoms:

Monash Low FODMAP: The most recognised app that helps individuals with IBS symptoms to select foods and suggest recipes is the Monash Low FODMAP app which was developed by Monash University in Australia, where much of the research has been carried out. However, this dietary approach only addresses one aspect of IBS management.

Cara Care - a Berlin start-up set up by two medical doctors, Cara care was launched in 2016 and has over 500,000 downloads in the German and US markets. The free symptom tracking app is designed for individuals suffering from digestive disorders such as IBS, IBD, and GERD (gastroesophageal reflux disease) and allows tracking of food consumption, physical activity, mood, bowel habits, and supplement and medicine intake. A symptom score is computed as an easy way to understand how the different data points correlate and to identify good and bad days. Cara Care was recently acquired by Bayer.

Myhealthygut - a Canadian start-up founded by registered dietitian Desiree Nielsen, was in fact one of the first apps that was launched back in 2016, aimed at individuals with coeliac disease. However since then, the app has been integrated into the Kore digital health solutions platform. The Kore digital health company is looking at providing digital therapeutic solutions for IBD, colon cancer, skin disorders, and managing the gut-brain axis. The app provides advice on dietary supplements, grocery list, recipe and meal planning as well as interactive journals which can be shared via email with a healthcare professional.

Belly Balance - a digital health platform that helps individuals with IBS manage their symptoms and improve their well-being. The platform offers evidence-based solutions and combines technology, nutrition, and stress-release techniques to help users take control of their digestive health and lead healthier lives.

Microbiome Testing:

Microbiome testing can be beneficial in IBS, as those with IBS demonstrate a different microbiome profile than those without IBS. By analyzing the gut microbiota, these tests may provide insights into potential imbalances, dysbiosis, or specific bacterial patterns associated with IBS symptoms. This information can help guide personalized dietary and lifestyle interventions to support gut health. The following companies offer microbiome testing for IBS:

Myota - a health-tech start-up that focuses on improving gut health through data-driven, microbiome-motivated fiber mixes and a digital health platform. They are in the process of launching a gut microbiome test kit, which will help users understand their gut health better. Myota's offerings are designed to improve metabolic, immune, and mental health, as well as alleviate digestive issues like IBS symptoms such as constipation, bloating, and diarrhoea.

Innerbuddies - This Netherlands-based startup offers an at-home microbiome test kit that provides users with insights into their microbiome composition through an online portal. Based on the results, Inner Buddies offers personalized dietary advice, which can be particularly beneficial for individuals with IBS. Their services cater to both consumers and healthcare professionals, and they also provide an API portal for labs, universities, and clinical trials, facilitating broader research and application in the field of gut health.

Flore - A Spanish company that provides microbiome tests and precision probiotics through a three-step process. Users collect a faecal sample at home, receive a report with recommendations, and can purchase precision probiotics tailored to their needs. This approach is designed to help individuals with IBS by offering personalized insights and interventions based on their unique gut microbiome composition.

Metabolites:

Metabolite tracking and assessment can be a useful approach for individuals with IBS as metabolic changes in the body can reflect alterations in gut function, inflammation, and microbial activity. People with IBS may exhibit distinct metabolite profiles compared to those without the condition, which can provide valuable insights into potential triggers, nutrient absorption, and overall gut health. Individuals with IBS are also more likely to have nutrient deficiencies caused by their sensitivity and therefore avoidance of certain foods, for example research by Hujoel et al 2020 showed that zinc is a common deficiency in individuals with IBS. By measuring key metabolites, tools can help inform personalized dietary and lifestyle strategies to better manage IBS symptoms. Several companies offer metabolite tracking and assessment tools for individuals with IBS, including:

Insidetracker - InsideTracker is a U.S.-based company that offers a personalized nutrition system by analyzing blood, DNA, and lifestyle data to optimize health. For individuals with IBS, who often suffer from nutritional deficiencies, InsideTracker can be particularly beneficial. By providing insights into blood biomarkers, InsideTracker helps identify specific nutrient deficiencies and offers personalized dietary recommendations to address these gaps. This approach can help IBS sufferers manage their symptoms more effectively by ensuring they receive the necessary nutrients to support overall health and well-being.

Ombre (previously Thyrve): focuses on gut health by offering microbiome testing and personalized probiotic recommendations. For IBS sufferers, Ombre's microbiome analysis can provide insights into the gut bacteria composition, which is often imbalanced in IBS. By understanding these imbalances, Ombre can recommend specific probiotics and dietary changes to help restore gut health, potentially alleviating IBS symptoms and addressing related nutritional deficiencies. Their approach emphasizes the importance of a balanced microbiome in maintaining overall digestive health and nutrient absorption.

Breathables and Personalised Nutrition Devices:

Individuals with IBS tend to have higher levels of methane and hydrogen in their breath. These gases are produced by gut microbes during the fermentation of undigested carbohydrates and can be associated with symptoms such as bloating, gas, and altered bowel habits. Measuring these gases can be beneficial for identifying the cause of the IBS. FoodMarble Aire offer a testing device:

FoodMarble Aire - The AIRE device is a portable breath analysis device designed to measure the levels of hydrogen and methane in the breath. These gases are produced by the gut microbiome during the digestion of certain foods, particularly those high in fermentable carbohydrates, known as FODMAPs. Individuals with IBS often have higher levels of these gases, which can contribute to symptoms such as bloating, pain, and altered bowel habits.

Personalized Foods and Supplements:

Personalized supplements can be a beneficial approach for individuals with IBS, as they are designed to address specific gut health concerns based on individual needs. Rather than a one-size-fits-all approach, these supplements are tailored to target issues such as dysbiosis, inflammation, or digestive discomfort, helping to support a balanced microbiome and improve symptom management. Personalized formulations may include specific strains of probiotics, prebiotics, or other nutrients to enhance gut function and overall well-being.

The Collagen (GutMe!) study aimed to evaluate the feasibility of a Registered Dietitian Nutritionist-led Food as Medicine (FAM) program using the Nutrition Care Process framework. Participants received personalized nutrition care over six months, either in person or via telehealth. The intervention included customized nutrition guidance supported by software-generated meal plans and shopping lists for online grocery purchases. The study reported improvement rates for prevalent nutritional issues: 81% for excessive energy intake, 88% for excessive carbohydrate intake, and 100% for obesity. Additionally, the FAM intervention led to enhancements in dietary quality, quality of life, body weight, waist circumference, and systolic blood pressure.

Companies that produce personalized supplements and food for IBS management:

39yTu - A Spanish company that use stool sample testing to create personalized probiotics for relief of IBS symptoms. The company analyzes the sample to understand the individual's gut microbiome composition, which is crucial for identifying imbalances that may contribute to IBS symptoms.

Field Doctor - A UK company that produce personalized ready meals for the management of health conditions, users can fill out a form with dietary information and symptoms for a personalized menu, including low FODMAP meals for the management of IBS.

Opportunities in IBS

1. Develop Personalized Nutrition: Advances in personalized nutrition offer opportunities to tailor dietary interventions to individual needs, potentially improving IBS management.

2. Partner with Digital Health players to provide complimentary services: Telehealth and mobile health apps can increase access to care and provide patients with tools to track symptoms, dietary intake, and response to treatment.

3. Conduct Research: There is ongoing research into the gut-brain axis, microbiome, and dietary interventions, which may lead to new insights and treatments for IBS.

4. Signpost individuals living with IBS: Increasing public awareness about IBS can reduce stigma and encourage more people to seek help. Campaigns and education programs can also inform patients about effective management strategies.

5. Collaborative Care: Integrating care between primary physicians, gastroenterologists, dietitians, and mental health professionals can provide comprehensive support for IBS patients.

6. Adopt a Food as medicine approach: In the context of Foodsmart's vision to make 'Food as Medicine' a nationwide standard by 2030, the challenges include capturing meaningful data to demonstrate the efficacy of nutritional interventions, educating healthcare providers about the importance of diet in managing conditions like IBS, and securing continued funding for such initiatives. The opportunities lie in the potential for reduced healthcare costs, improved patient outcomes, and the growing recognition of the role of diet in health, which may drive the expansion of programs like Foodscripts.

The Qina Take

Digestive health is a big opportunity and the rapid advances in technology and cloud computing offer an accessible therapeutic tool that can be used as first-line therapy for individuals who are looking for a non-drug approach. It means that despite a lack of clear or strong clinical evidence, digital therapeutics is rapidly being adopted as part of both a lifestyle and an IBS management tool. The easy integration of crucial real-world evidence such as sensor, activity, sentiment, and location data, provides rich contextual information that can be used to connect the dots and provide insight into potential triggers to common symptoms. This real-time approach and continuous feedback can aid in consumer engagement and increases adherence to treatment plans and is poised to drive further growth in the industry.

For more insights into the personalized nutrition industry sign up to the Qina platform here.

References

1. Kerbage A, Kassab J, El Dahdah J, Burke CA, Achkar JP, Rouphael C. Accuracy of ChatGPT in Common Gastrointestinal Diseases: Impact for Patients and Providers. Clin Gastroenterol Hepatol. 2023 Nov 19:S1542-3565(23)00946-1. doi: 10.1016/j.cgh.2023.11.008. Epub ahead of print. PMID: 37984563.

2. Rej, A., Avery, A., Aziz, I. et al. Diet and irritable bowel syndrome: an update from a UK consensus meeting. BMC Med 20, 287 (2022). https://doi.org/10.1186/s12916-022-02496-wv https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02496-w#citeas

3. Vasant DH, Paine PA, Black CJ, et al. Gut Epub ahead of print: doi:10.1136/ gutjnl-2021-324598

4. NICE Guidelines for IBS: Introduction | Irritable bowel syndrome in adults: diagnosis and management | Guidance | NICE

5. BDA Guidelines for IBS: National practice guidelines - British Dietetic Association (BDA)

6. Hunt et al, 2021. Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial - PMC

7. Hujoel et al 2020. Nutritional status in irritable bowel syndrome: A North American population‐based study - PMC

8. CaraCare. Cara Care App: Your Digital Platform to Better Gut Health - CARA CARE

9. MyHealthyGut. Home - myHealthyGut

10. Belly Balance. Belly Balance | Irritable Bowel Syndrome Solution

11. Monash. Low FODMAP Diet | IBS Research at Monash University - Monash Fodmap

12. Myota. myota - transform your health through your microbiome – Myota Health

13. Innerbuddies. Microbiome Test & Gut Health Test | InnerBuddies Personalised Insights

14. Flore. The Best Custom Probiotics For Improving Your Gut Health – Floré by Sun Genomics