Inflammatory Bowel Disease

Did you know that inflammatory bowel diseases affect about 233,000 Canadians, with more than 10,200 new cases being diagnosed annually? In recognition of Crohn’s and Colitis Awareness Month, let’s learn a little more about these difficult conditions.

Crohn’s versus colitis

Inflammatory bowel disease (IBD) includes Crohn’s disease and ulcerative colitis, both of which are autoimmune diseases causing inflammation and damage to the intestine.

Crohn’s disease

Although it most often affects sections of the small and large intestine, Crohn’s can affect any portion of the digestive tract. Symptoms include abdominal pain, weight loss, diarrhea, nausea, and vomiting.

Ulcerative colitis

Affecting only the large intestine, the defining symptom of ulcerative colitis is frequent and bloody diarrhea. Other symptoms include weight loss, abdominal pain, and bowel urgency. Anemia and dehydration are serious risks due to the high volumes of blood and fluid lost in severe diarrhea.

Both conditions can go through periods of remission (mild or no symptoms) and flare-ups. They are also both associated with various complications as time goes on, particularly if not well controlled. These can include inflammation of the eyes, joints, or skin; infections; mouth sores; and nutrient deficiencies. The issue of poor nutrient absorption is an important one, as it can lead to anemia, weakened immunity, osteoporosis, or other concerns.

Who is at risk?

The short answer is: anyone. IBD most often affects Caucasians and occurs between the ages of 15 and 30, but has been known to affect men, women, and children of all ages and ethnic backgrounds. Having a first-degree relative (such as a sibling, parent, or grandparent) with IBD does increase an individual’s risk of developing IBD over time.

Researchers are still trying to determine the role of lifestyle, diet, environment, and other factors in triggering IBD. There is evidence of an increased risk of IBD with more northern latitudes, with Canada having one of the highest rates of IBD in the world.

In terms of nutrition, a 2011 review of the existing studies found some increased risk of IBD associated with high consumption of meat and omega-6 fatty acids, and high total fat intake. Meanwhile, diets high in fruits, vegetables, and fibre were associated with a lower risk of IBD.

The degree to which these and other factors contribute to IBD is still very much under investigation.

IBD treatments

Standard medical treatments for IBD are aimed at one or more of the following.

Controlling inflammation

Ongoing, uncontrolled inflammation causes significant and often permanent damage to the intestine. Medications that suppress inflammation are, therefore, a very common component of IBD management. Steroids are a common medication in this class.

Managing symptoms

Pain, constipation, diarrhea, hemorrhoids, muscle spasms: these are some of the symptoms commonly encountered with IBD. Bulk-forming laxatives, analgesics, muscle relaxants, stool softeners, and similar medications may be prescribed for these concerns.

Suppressing the immune system

Because of the autoimmune nature of IBD, medications that moderate the activity of the immune system have been part of IBD management for many years. The goal of these medications is to reduce what is considered an overactive immune response, which is targeting the body’s own cells. Methotrexate is an example of an immune-modulating medication that has a long history of use in IBD management.

Surgery

In advanced IBD, particularly cases of Crohn’s, surgical removal of sections of the intestine may be required once it becomes too damaged.

Integrative approaches to IBD

To help promote and maintain remission of IBD, an increasing number of people are combining standard treatments with nutritional, herbal, psychological, and stress reduction techniques. In some cases, conventional and complementary treatments have begun to overlap, as the prescription of some supplements and techniques (such as probiotics or stress management) by medical doctors and gastroenterologists becomes more common.

Nutrition and nutrient replacement

Both IBD and its treatment can contribute to nutrient loss. Ulcerative colitis can lead to large volume losses of fluid, electrolytes, and iron. Therefore, fluid replacement and electrolyte beverages are often recommended, as are iron supplements if blood tests show that levels are falling.

Medications commonly used in IBD management can also deplete nutrients, especially with long-term use. Examples include folic acid deficiency with methotrexate and loss of calcium and vitamin D with long-term steroid use.

In addition, IBD sufferers are susceptible to multiple nutrient imbalances due to their compromised intestine. For this reason, a health care practitioner knowledgeable in nutrition is an essential part of the health care team in IBD cases, helping to monitor levels and intakes of iron, calcium, electrolytes, vitamins D and B12, and other nutrients in order to avoid deficiencies.

Vitamin D

Living in northern countries, such as Canada, increases the risk of vitamin D deficiency. IBD rates also seem to be associated with where we live. As a result, researchers are interested in the potential of vitamin D for prevention and/or treatment of IBD.

A 2010 study found that 1,200 IU a day of vitamin D3were able to substantially increase serum vitamin D levels in Crohn’s patients who were in remission. Those who supplemented with vitamin D also had lower rates of symptom relapse than those receiving placebo: 13 percent compared to 29 percent in the placebo group.

Food intolerances and the FODMAP diet

It has a mouthful of a name: the low-fermentable oligo-di-monosaccharides and polyols (FODMAP) diet. FODMAPs are carbohydrates (lactose, fructose, inulin, galactans, and polyols) found in foods such as dairy, fruits, beans, wheat, and artificial sweeteners.

FODMAPs can be difficult for some to digest and can worsen symptoms such as bloating, gassiness, and diarrhea. More commonly recommended for cases of irritable bowel syndrome, this diet can also be helpful in IBD cases, since the damage that IBD causes to the intestine can make these carbohydrates difficult to digest.

Aloe

A popular traditional treatment for digestive complaints, aloe could be helpful for some cases of IBD as well. A small study of patients with ulcerative colitis found that 100 mL of aloe vera gel a day, for four weeks, resulted in more cases of disease remission than placebo, with no reported side effects.

Curcumin

A natural inflammation-reducing component of turmeric, curcumin is also of interest. Studies have so far shown that curcumin, combined with common IBD medications, was associated with fewer symptom relapses in patients with ulcerative colitis in remission. The relapse rate in one study was 25 percent of that in patients receiving the same medications without curcumin.

Stress reduction

IBD can cause a tremendous amount of stress and anxiety for patients, particularly during flare-ups. Stress, in return, can contribute to more unpleasant intestinal symptoms (as anyone who has had “nervous bowels” before an exam will confirm).

For this reason, mind-body approaches that promote relaxation and ease stress and anxiety are a worthwhile addition to IBD care. Both guided imagery exercises and stress management training may provide benefits such as the reduction of pain and anxiety.

Probiotics

High-dose probiotics (in the range of several hundred billion units) have been used with some success in the maintenance of remission of ulcerative colitis. A review of 23 randomized clinical trials found that a particular probiotic product containing eight live bacterial species was especially helpful for maintaining remission.

Probiotics help to promote a healthy gut environment, decreasing inflammation, “crowding out” disease-causing bacteria, and helping in the digestion of carbohydrates.