Inflammatory Bowel Disease

What is IBD?

Inflammatory bowel disease (IBD) is a group of conditions that involve chronic and relapsing inflammation of part of the gut. The two main diseases are Crohn’s disease and ulcerative colitis. The ileum (the last section of the small bowel) and the large bowel are common sites of inflammation and deep tissue damage in Crohn’s disease. Ulcerative colitis affects the large bowel. Generally speaking people with IBD experience long periods when they feel well and symptoms are negligible, in combination with shorter periods when the illness flares up. Nonetheless these are serious disorder that can cause a wide range of complications and have a debilitating affect on overall quality of life.

How common is IBD?

It is estimated that 400 people per 100,000 suffer with IBD.

What are the symptoms of IBD?

  • Weight loss
  • Diarrhoea (blood in stool is associated with ulcerative colitis)
  • Abdominal pain
  • Rectal bleeding
  • Tiredness and fatigue
  • Fever
  • Skin disorders (including eruptions, lesions and ulcerations)
  • Pain and redness of the eye
  • Painful joints
  • Delayed growth and development (children)

What causes IBD?

IBD is triggered by an immune response, however what causes this is not entirely understood. Causes may include:
  • Genetics
  • Immune dysfunction and autoimmune disease
  • Environmental factors
  • Allergic reactions
  • Abnormalities in the bacteria and other microorganisms that reside in the gut.

What is the treatment for IBD?

Neither Crohn’s disease or ulcerative colitis is currently considered curable. Medical management is focussed on decreasing the duration and frequency of relapses, reducing complications and managing symptoms. Treatment includes drugs (e.g. anti-inflammatory drugs, steroids, antibiotics and immunosuppressants), medically prescribed diets (e.g. exclusive enteral nutrition, a specially formulated liquid food) and surgical procedures.

What diet and lifestyle strategies can support IBD?

Dietary interventions for IBD may include:
  • Modification or elimination of specific nutrients, e.g. dietary fats, sugars, fibre or artificial sweeteners.
  • Lactose free diet
  • Elimination diet to identify food triggers
  • Specific carbohydrate diet
  • Anti-inflammatory diet
  • Probiotic bacteria and/or pre-biotic supplements and food sources
  • Low FODMAPs protocol
Some people with IBD may poorly absorb nutrients as a result of damage to the gut wall (particularly relevant to Crohn’s disease because the small intestine is where nutrients are absorbed). Dietary strategies should promote a nutritionally balanced diet, to avoid nutritional deficiencies and consider the addition of supplements on an individual basis. Dietary advice also needs to be tailored to individuals in consideration of their IBD history, symptoms and complications, for example fibre would be contraindicated in persons with strictures (a narrowing of the gut which obstructs food matter). General dietary recommendations include:

Eat plenty of fruit and vegetables: eating a wide variety of different coloured fruit and vegetables (if well tolerated and not contraindicated) to provide a source of fibre, antioxidants, vitamins and minerals. Fibre is important for gut health and supporting a diverse population of gut bacteria and other plant chemicals have known antioxidant and anti-inflammatory benefits.

Avoid foods containing sugar and processed foods: these foods may have a negative impact on the gut bacterial populations by encouraging proliferation of less beneficial and potentially disease causing organisms. Processed food can also be a source of artificial sweeteners and emulsifiers, which have been highlighted as potential triggers for IBD.

Dietary or supplemental essential fatty acids: essential fatty acids have anti-inflammatory effects, which may be useful to support the inflammatory response in IBD. Studies have not supported their use, although their safety as a supplement is well researched. Oily fish (sardines, mackerel, anchovy, salmon, herring and tuna) are a good dietary source of essential fatty acids.

Multivitamin and mineral supplement: people with IBD should consider taking a multivitamin and mineral supplement, particularly if their diet is limited. Many people with IBD may have vitamin and mineral deficiencies. Low levels of B vitamins (B6, B12 and folate) and vitamin D have been observed in persons with Crohn’s disease.

Dietary supplement: certain supplements including live bacteria species, curcumin and aloe vera may support clients with IBD alongside their current drug protocols1. Further studies will be required to prove their beneficial effects on reducing inflammation and symptoms.

Glutamine: glutamine, an amino acid, is an important fuel for cells of the gut and has been shown to modulate intestinal inflammation. There is considerable interest in its role in supporting the health of the cells of the gut lining. Studies have shown little benefit to Crohn’s disease, however further studies are required to assess whether this could support ulcerative colitis.

A Nutritional Therapist can help you identify diet and lifestyle factors, which may be contributing to your symptoms.

Moss, A., (2014). Residual inflammation and ulcerative colitis in remission. Gastroenterololgy and Hepatology. 10 (3), 181-183.