Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder, characterized by uncontrolled intestinal immune response, that affects many people world-wide. It first cropped up in developed countries in the mid-twentieth century. Since then, there has been a steady rise of cases. In North America it first appeared in northern areas in the 1940s and then in southern areas in the 1960s. IBD results in a huge quality of life reduction; these conditions may lead to frequent hospital visits, surgery, complications, and even death. Do you or someone you know suffer from IBD, Crohn's, or colitis? This article will give you some good information about these diseases as well as ways to effectively manage them.
IBD is characterized by short term inflammation, frequent remission, and deregulation of intestinal microbiota. Ulcerative colitis (UC) and Crohn's disease (CD) are two major IBD disorders. UC is characterized by inflammation and deregulated tight junctions in the intestine. On the other hand, CD is characterized by damaged areas of the gut wall, primarily in the ilium and colon. Malnutrition is a particular problem in people with IBD and protein, caloric, vitamin, and mineral deficiencies are common. Symptoms of IBD include weight loss, diarrhea, blood loss, abdominal pain, and fatigue.
While there are obvious genetic predispositions for IBD, including defects of the intestinal epithelial barrier and immune system, the increase in IBD over the past few decades indicates that genetics alone doesn't regulate IBD. Diet and lifestyle are clearly important contributors. So what has changed in our diets and lifestyles that has resulted in the rise in IBD? What are factors that put you at a higher risk?
Aside from diet, factors that increase risks include smoking, stress, oral contraceptives, lack of or shortened breastfeeding duration, and development in an overly sterile environment. Antibiotic use (including tetracycline, commonly used to treat acne) has also been demonstrated to increase risks for IBD. Furthermore, antibiotic use during pregnancy increases risks for the development of IBD in the child. Antibiotic use is associated with a reduction of beneficial gut bacteria, which are often replaced by harmful bacteria. Common modern practices seem to be making us more prone to many chronic diseases, including IBD.
Our diets also play a large role in the regulation of our gut microbiota. Westernized diets, which are characterized by low-fiber, high sugar, and high meat consumption, often result in deregulated gut microbiota and an increased risk for IBD. Meat consumption increases risks for IBD a number of ways, including its heme and omega-6 content as well as the heterocyclic amines, polycyclic aromatic hydrocarbons (PAH), and N-nitroso compounds (which arise through cooking and result in an increased risk for cancer) that are present. Case-control studies show that sugar, refined carbohydrates, low fruit and vegetable consumption, and high omega-6 intake also increase risks for IBD (as well as most chronic inflammatory diseases).
So what are your options outside of medical treatment, and how can you reduce your risks?
1) Early studies have shown that olive oil (via the oleic acid) and coconut oil (via its medium-chain triglycerides) can have anti-inflammatory properties and help with immune modulation and improve bowel damage.
2) Polyunsaturated fatty acids are also important in interventions. Higher omega-6 to omega-3 ratios are associated with a higher IBD risk; fish oil supplementation has been found to reduce inflammation and symptoms associated with IBD by lowering omega-6 to omega-3 ratios.
3) Cleaner diets, with more fruits and vegetables and fewer animal products, sugar, and refined carbohydrates, may help with the treatment of IBD and be a risk reduction as well.
4) Probiotics (live microbria) have had success in IBD patients by improving immune function and regulating gut bacteria. They are associated with reduced symptoms, reduced inflammation, increased mucosal integrity, and improved overall immune function. Probiotics have minimal to no adverse effects.
5) Aloe and fresh pineapple juice (not boiled) has been associated with a short term improvement in IBD symptoms and a reduction in the associated inflammation.
6) Finally, glutamine supplementation has been shown to reduce intestinal damage, improve nitrogen balance, and improve IBD symptoms.
So to wrap things up: supplementing with a DHA omega-3, glutamine, and probiotics may be a good option for managing IBD. Cleaner diets are also important, with less refined foods, sugar, and meat, and more fruits, vegetables, nuts, and seeds. Stress relief is another important consideration; exercise is great for that, as well as for the reduction of inflammation. Find something you love so that you'll stick to it; exercise can include anything from yoga to water fitness. Finally, if you’re on an oral contraceptive, consider going off it for a while to see if your symptoms improve without them.
IBD is a troublesome condition that affects many people. Hopefully this article will steer you or someone you know in the right direction in terms of treatment and risk reductions.
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Guangnozzi D, Gonzalez-castillo S, Olveira A, Lucendo A. (2012) Nutritional treatment in inflammatory bowel disease. An update. Rev Esp Enferm Dig.104(9):479-488.
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Neuman M, Nanau R. (2012) Inflammatory bowel disease: role of diet, microbiota, life style. doi:10.1016/j.trsl.2011.09.001.
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