Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a general term for a group of chronic inflammatory disorders of the intestines characterised by recurrent inflammation in specific parts of the intestines. The main diseases are Crohns disease and ulcerative colitis.
Frequent signs and symptoms
- pain in left side of abdomen (the location in the colon) that improves after bowel movements
- attacks of bloody diarrhoea with mucus, alternating with symptom-free periods
- up to 10-20 bowel movements a day
- sweating, nausea
- severe cramps and pain around the rectum
- bloated abdomen
- fever as high as 104°F
- loss of appetite and weight.
Complications of IBD
- Malnutrition – unhealthy weight loss and malnutrition are prevalent in 65-75% of IBD sufferers. Contributing factors include: decreased food intake (most common cause); diarrhoea-induced nutrient loss (especially electrolytes, minerals and trace minerals); malabsorption in people with extensive small intestine involvement resulting in decreased absorptive surface and/or bile salt deficiency; overgrowth of unfriendly bacteria in the small intestine; fat malabsorption, which results in significant loss of calories and fat-soluble vitamins; protein loss due to increased turnover and shedding of intestinal cells (a significant loss of blood proteins across the damaged and inflamed intestinal mucosa occurs that may exceed the ability of the liver to replace, even with a high protein intake). Common drugs the corticosteroids used in the treatment of IBD significantly contribute to malnutrition (corticosteroids stimulate protein breakdown, depress protein synthesis, decrease absorption of calcium and phosphorus, increase urinary excretion of vitamin C, calcium, potassium and zinc, increase levels of blood glucose, tryglycerides and cholesterol, increase the requirement for vitamin B6, vitamin C, folate, and vitamin D, decrease bone formation, and impair wound healing)
- Rheumatoid arthritis occurs in about 25% of IBD sufferers, typically affecting the knees, ankles and wrists. Ankylosing spondylitis is infrequent but symptoms include low back pain and stiffness, with eventual limited movement.
- Skin lesions occur in about 15% of sufferers, can be severe but more typically annoying, like mouth ulcers (which appear in 10% of IBD sufferers)
- Serious liver disease affects 1-7% of people with IBD, can be severe. If liver abnormalities are present, take milk thistle.
Causes No definitive agreement exists as to the causes of IBD. Theories include:
- Genetic predisposition no specific genetic marker has been found but is likely since IBD is two to four times more common in Caucasians and four times more common in people of Jewish descent. Also, in 15-40% of cases, multiple family members have IBD
- Infections agents numerous micro-organisms could potentially cause IBD. Favoured candidates include mycobacteria and viruses such as rotovirus, Epstein-Barr virus, and cytomegalovirus.
- Antibiotic exposure prior to the 1950s, when penicillin and tetracycline became available in oral form, Crohns disease was only found in isolated groups and had a strong genetic component. Since then, the number of cases of Crohns disease has risen rapidly in developed countries, especially in the US (and in countries that had virtually no reported cases).
- Immune system abnormality although immune disturbances are evident in IBD, they are most likely a result rather than a cause of the disease process.
- Dietary factors several lines of evidence strongly support dietary factors as the most important causative factor: Incidence of Crohns disease is increasing in countries where people consume a typical Western diet (high in saturated fats, refined carbohydrates and sugars), where it is almost non-existent where a more ‘primitive’ diet is consumed (high fibre, whole foods). Food is the major factor in determining the intestinal environment. People with ulcerative colitis, however, do not show dietary factors as being a cause compared with controls. In these people, food allergy may be the most important causative factor
- Emotional factors whilst not an initiating cause, psychological factors can significantly affect the course of the disease.
- Minimise consumption of sugars and refined foods
- Eat a health-promoting diet. After identifying and removing any allergenic foods from the diet, choose a balanced diet composed of whole, unprocessed, preferably organic foods, especially plant foods (fruits, vegetables, wholegrains, beans, nuts (especially walnuts), and seeds) and coldwater fish such as salmon.
- Take a high-potency multiple vitamin and mineral supplement providing all the known vitamins and minerals and serving as a foundation upon which to build an individualized health-promoting programme.
- Only use antibiotics when absolutely necessary.
- Take regular exercise tones muscle and improves bowel function.
- Identify and eliminate food allergens
- Eliminate alcohol, caffeine, and sugar all exacerbate inflammation
- Drink at least two litres of clean water daily to prevent dehydration
- Reduce or eliminate consumption of meat and dairy products, whilst increasing consumption of coldwater fish (salmon, mackerel, herring, halibut). Meat and dairy products are the highest source of arachidonic acid (a type of essential fatty acid that the body uses to create inflammatory compounds called leukotrienes, which amplify the inflammatory process and cause intestinal cramping and pain) Coldwater fish are the best source of the anti-inflammatory omega-3 essential fatty acids.
- Avoid all foods containing carrageenan a compound extracted from red seaweeds and widely used by the food industry as a stabilising and suspending agent in milk and milk chocolate products (ice cream, cottage cheese, milk chocolate etc). Carrageenan has been used by researchers to experimentally induce ulcerative colitis in animals, including primates. In healthy people whose intestines are germ-free, carrageenan does not cause ulcerative colitis but a bacteria found in the faecal cultures of people with ulcerative colitis appears to be responsible for facilitating carrageenan-induced damage to the intestines.
- People with IBD typically require as much as, or even more than, 25% more protein than usual.
- Eat a high-complex carbohydrate, high fibre diet, which has been shown to have beneficial effects in IBD. Dietary fibre exerts numerous beneficial effects on the digestive tract, including: provides food for health-promoting intestinal flora; soluble fibre solws transit times in individuals with diarrhea; binds to and removes toxins via faeces. Foods rich in fibre (legumes, fruits, vegetables) and unrefined carbohydrates (starchy vegetables such as brown rice, barley, millet, quinoa, spelt) should be emphasized. Best additional fibre choices are oat bran and flaxseed meal both of which provide soluble fibre. (flaxseed meal also provides omega-3 EFAs).
- Flaxseed oil take 1 tbsp per day, contains omega-3 EFAs which the body converts to anti-inflammatory EPA fatty acid.
- Probiotics friendly bacteria are need to repopulate the intestines, both for their numerous beneficial effects on intestinal health also because they compete with less friendly bacteria that damage the gut wall.
- High-potency vitamin/mineral supplement
- Vitamins C and E primary antioxidants.
- Zinc - deficiency is a well-known complication in IBD, occurring in 45% of sufferers. Zinc deficiency leads to poor healing of fissures and fistulas, skin lesions, retinol dysfunction, lowered immunity and poor appetite.
- Folic acid deficiency results in abnormalities of the intestinal mucosal cells, promoting malabsorption and diarrhoea.
- Vitamin B12 B12 is absorbed in the part of the intestine most commonly affected in IBD.
- Digestive enzymes can reduce inflammation of IBD and help with digestion.