Each week, I set aside time to review journal articles about IBD and nutrition.
My first read of 2025?
The article Exploring Dietary- and Disease-Related Influences on Flatulence and Fecal Odor Perception in Inflammatory Bowel Disease published in the Journal of Clinical Medicine earlier this year.
To my knowledge, this study is the first to explore the relationship between dietary habits, disease activity, and perceived intestinal (feces and flatulence) malodor in people with IBD compared to healthy controls.
It caught my attention because many IBD patients report smellier gas or stool as an early sign of a flare. It’s one of many patient-reported symptoms that can help assess disease status early on, so it’s super important we ask about any changes in intestinal odor.
This study found that patients with IBD report more malodorous gas and stool than healthy controls, and these changes correlate with higher intake of ultra-processed foods and increased disease activity.
Patients who recognize a change in intestinal odor as an early sign of a flare often ask what they can do to reduce the risk of the flare getting worse.
Assuming there’s no other obvious cause for the new odor, such as dietary changes (e.g., cruciferous vegetables, alcohol, red meat, dried fruit, hard-boiled eggs, and onions are among the most notorious triggers for smelly gas and stool) or antibiotics, here are some strategies that have worked for my patients:
- Notify Their IBD Medical Team. Early intervention is crucial. Encourage patients to report changes to their healthcare providers.
- Focus on Mind-Body Approaches. Stress management techniques, such as meditation or yoga, can help reduce inflammation.
- Eliminate Ultra-Processed Foods. Ultra-processed foods may worsen malodorous gas and stool in both IBD patients and healthy individuals. Also, diets high in these “foods” contribute to chronic inflammation and may increase the risk and duration of IBD flares.
- Prioritize Sleep. Quality sleep is essential for managing inflammation and supporting overall health. Many of my patients feel significantly better after just one week of consistent, good-quality rest.
- Adjust Probiotic Intake. For patients using probiotics like Visbiome (formerly VSL#3) for ulcerative colitis, temporarily increasing the dose may be beneficial. Always advise them to consult their healthcare provider first.
- Adopt a Gentle, Low-Roughage Diet. When disease is active, opting for softer foods can ease symptoms and give the digestive tract a break.
- Avoid Alcohol. Alcohol can worsen inflammation and exacerbate symptoms. It’s also a common trigger for smelly gas and stool, even for those without IBD.
A change in the smell of gas or stool may seem like an odd thing to focus on, but it can provide valuable, non-invasive insight into IBD activity, often prompting small changes that can lead to big improvements.
