Inflammatory bowel disease (IBD) has been long touted as incurable, leaving people feeling disparate, depressed and hopeless.
As a health professional who has been personally affected by irritable bowel and its manifestations both physically and emotionally, I understand how the very nature of IBD can lead those in the medical community to conclude that managing symptoms is the only treatment available. The reality is that the relief for IBD is in day-to-day diet and lifestyle choices.
I hope this and my next article will help you reframe what it means to develop and live with IBD, and better understand both the possibility and promise of taking back control of your health.
IBD is an umbrella term used to describe disorders of the digestive tract and encompasses both Crohn’s disease and ulcerative colitis. Ulcerative colitis causes inflammatory sores and ulcers in the innermost lining of the colon and rectum, whereas Crohn’s disease is an inflammation of the lining of the digestive tract that often spreads deep into affected tissues. It can impact nutritional status due to its pervasiveness of the small intestine.
I remember my terrible stomach problems that started at a young age, and my dad telling me that IBS (irritable bowel syndrome) runs in the family and I must have inherited the gene. I remember feeling like I had been punched, and the rest of my life would be subject to discomfort squeezed between bouts of anxious anticipation. For me, transitions or new experiences were the most potent antecedents and where I would notice the most discomfort. As I grew in my studies of nutrition and mindfulness, I began an excursion into understanding why this had been the case and strategies I could adopt to help.
Generational IBD can be seen among families. But does family history really translate into destiny? I believe not. Genetics are not to blame. Though we all have pre-dispositions to certain conditions, the science of epigenetics is coming to the fore. Epigenetics is the concept of lifestyle practices dictating the expression, or action, of genes.
In the article published in Frontiers in Immunology in 2015, its authors conclude: “The evidence that genetic factors contribute in small part to disease pathogenesis confirms the important role of microbial and environmental factors. Epigenetic factors can mediate interactions between environment and genome. Epigenetic mechanisms could affect development and progression of IBD. Epigenomics is an emerging field, and future studies could provide new insight into the pathogenesis of IBD.”
Presently, IBD treatment is very symptom-centric. This means that its management is largely reactionary and interventions are determined based on how it presents at a given time. The condition itself is autoimmune in nature, which means the immune system attacks the colon when it perceives bacteria, foods, and other substances as threats. This triggers the inflammation that is the foundational underwriter of the disease.
To understand how to manage IBD, we must understand the nature of an autoimmune condition. At its core, there are three main anchors: the gut, genetic predisposition and the environment. Often it is the confluence of two or more of these anchors that trigger the inflammatory cascade leading to a flare-up.
Targeting triggers and imbalances
Common triggers include:
- Infection (viruses, bacteria, fungi, parasites)
- Nutritional deficiencies or malabsorption
- Antibiotics or birth control
- Food poisoning
- Stress and trauma (physical and emotional)
- Food allergies
- Standard American diet (highly processed and packaged foods with low nutritional value)
The “cure” is really about understanding your unique precursors and triggers, and applying multifactorial strategies and techniques to correct the imbalances that may be causing the flares. This is where prioritizing diet, mind/body health, and daily commitment to healthy habits factor in immensely.
Treatment goals are to control inflammation, correct nutritional deficiencies due to a less than optimal diet — including the loss of protein through the intestine and malabsorption of nutrients — and to relieve symptoms. Other possible complications include arthritis, skin problems, inflammation of the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and bile systems.
So how can we adapt diet and lifestyle to improve our chances of the bowel remaining healthy and calm?
- Eat a diet high in fiber using easy-to-digest cooked vegetables. This includes squashes, warm leafy greens, and berries. During a flare-up, it is best to avoid raw vegetables, fruits, nuts, and seeds because they can create more discomfort and potential complications.
- Avoid caffeine (from coffee, tea, and other stimulants).
- Remove milk, soy, and casein (a milk protein) products from your diet.
- Vegans and vegetarians may be consuming an extract from red seaweed called carrageenan. Based on this 2001 article, this additive is highly inflammatory and should be eliminated.
- Eliminate all processed foods and gluten.
- Eat minimal amounts of pulses, beans, lentils and seeds, as they can be hard to digest.
- Try to prepare 75% of your meals at home. Being diligent about knowing what goes into your food will do wonders. Restaurants and convenience foods rely on extra ingredients that could be activating the disease.
- The gut needs certain proteins to maintain its integrity. Including bone broth from chicken or beef provide these essential amino acids and are extremely healing in nature.
As I mentioned earlier, nutrient deficiencies can be seen with IBD. Here, I recommend a few strategic supplements to include in your routine as an extra shield of immunity:
- Vitamin B-12. Since Crohn’s disease can affect not only the large intestine but also the ileum, which is the lower section of the small intestine, people who have ileitis or who have undergone small bowel surgery may have a vitamin B12 deficiency as this vitamin is absorbed in the lower section of the small intestine. Options for supplementation include diet, oral vitamin supplements, and — if these alone don’t correct the deficiency — the possibility of a monthly intramuscular injection of vitamin B-12 or once weekly nasal spray. The best sources of food-based vitamin B12 include organ meats, animal liver, clams, fish, poultry, and fortified cereals. Fortified nutritional yeast is also an easily accessible supplement.
- Folic acid (another B vitamin) deficiency may occur in IBD patients who take the drug sulfasalazine or methotrexate as medications. They should take a methylfolate tablet, 1 mg daily, as a supplement. The best dietary sources of folic acid include green leafy vegetables like spinach, and citrus fruits.
- Vitamin D. Low serum vitamin D levels are common in people with Crohn’s disease (as reported in this 2015 article from the Journal of Inflammatory Bowel Disease) and can contribute to calcium deficiency — and to potential bone loss and osteoporosis, as vitamin D is an essential cofactor needed to absorb calcium. A least 800 IU’s per day is recommended, and at least 1500 mg per day of calcium should be consumed through diet or via supplementation of 500 mg three times per day. Continuous use of steroids may also slow the bone formation process and interfere with calcium absorption.
- Blood loss due to intestinal injury can lead to iron deficiency, causing anemia. Treatment is indicated via tablets, liquids, or IV infusions.
- Probiotics. “Live” and “friendly” bacteria help keep the ecosystem of the gut in good standing and help to protect against harmful bacteria overgrowth that causes diarrhea or other digestive issues. Probiotics can be consumed through food but are often found in the most potent amounts in dairy, soy and fermented foods — all of which are contraindicated for people with IBD. The best source of probiotics would be from a tablet, powder or capsule that provides at least 20 CFU and 10 strains of bacteria, including Saccharomyces boulardii (as discussed in this 2012 published study).
Another study, published in the journal Gastroenterology in 2006, reports that “S boulardii has a unique action on inflammation by a specific alteration of the migratory behavior of T cells, which accumulate in mesenteric lymph nodes. Therefore, S boulardii treatment limits the infiltration of T-helper 1 cells in the inflamed colon and the amplification of inflammation induced by proinflammatory cytokines production. These results suggest that S boulardii administration may have a beneficial effect in the treatment of IBD.”
- Aloe Vera. This plant has been shown to provide relief for wounds and pain due to its anti-inflammatory and cooling properties. Although not scientifically confirmed, but in my research I have heard some people report mild to moderate relief when drinking aloe vera juice. This plant does have a laxative effect, so individuals who already have overactive immune systems may want to consult with a licensed professional before beginning a regimen that includes aloe in the diet.
Nutrition is only one piece of the puzzle and, as I mentioned earlier, mind/body health is just as important. In the next article, I will share some of my favorite techniques for decreasing stress and creating a lifestyle that supports whole body wellness.
Alana Kessler, MS, RD, CDN, E-RYT, is a registered dietitian, nutritionist, weight management expert, and an accredited member of the CDR (Commission on Dietetic Registration) and the American Dietetic Association. She is also a yoga and meditation teacher, Ayurveda specialist, and the founder of the New York City-based fully integrated mind, body, and spirit urban sanctuary, BE WELL. Alana’s BE WELL ARC System and Method Mapping technique is a holistic multidisciplinary approach to health and wellness that blends Eastern and clinical Western diet and lifestyle support to effect long-lasting behavior change.
A graduate of NYU with a BA and MS in clinical nutrition, Alana is dedicated to helping others learn how to nourish themselves, create balance, and understand their true nature through nutrition, yoga, and inner wellness. She leads Yin Yoga workshops and trainings as well as wellness retreats at international locations. Her health, fitness, and lifestyle expertise has been featured in Aaptiv.com, Droz.com, EatThis.com, RD.com, Redbook, WomensHealthmag.com, and Vogue. For more information, visit her website at bewellbyak.com.