Did you know about 7 million people have Inflammatory Bowel Disease (IBD) worldwide? And about 1.6 million of those are Americans. Although it’s not common, an increasing number of people have been diagnosed over the past two decades. And what’s even more shocking is there are estimates of up to 80,000 children in the United States having IBD!
Most of the Americans with IBD are diagnosed before age 35 or after 60. In the USA alone 70,000 new cases of IBD are diagnosed each year. Those are staggering statistics. But what exactly is IBD? How does it differ from IBS (Irritable Bowel Syndrome)? What causes IBD? And what can you do about it? Read on for more.
What is IBD?
IBD stands for Inflammatory Bowel Disease. It is a chronic inflammatory condition of the Gastrointestinal (GI) or digestive system – not to be confused with IBS, Irritable Bowel Syndrome. (You can read more about IBS by clicking here.)
There are two predominant types of IBD – Crohn’s Disease and Ulcerative Colitis. Both are considered autoimmune conditions. An autoimmune condition means your body is attacking itself. It’s an overreaction of your immune system to various things. So in both these conditions there is damage seen in the GI tract.
What is the Difference Between Crohn’s Disease and Ulcerative Colitis?
Crohn’s Disease affects any part of the GI tract , from your mouth to anus. Often it affects a portion of the small intestine called the ileum which is immediately before the large intestine (colon). The damaged areas are in patches, meaning there are some sections affection and some untouched.. Inflammation may reach through multiple layers of the GI tract walls.
Ulcerative Colitis (UC) is actually more common in the population than Crohn’s Disease. It occurs only in the large intestine (colon) and rectum. Damaged areas are continuous, not patchy, in the rectum up into the lower colon but may spread into the entire colon. Inflammation is present only in the innermost layer of the lining of the colon.
Sometimes doctors find it difficult to determine whether a patient has Crohn’s or UC. So in these rare cases, a doctor may say the patient has indeterminate colitis.
What are Symptoms of IBD?
Once the lining of the intestine becomes inflamed and ulcerated, it loses ability to adequately process food and waste or absorb water. This leads to symptoms such as:
- Persistent diarrhea
- Blocked bowels/urgency to move bowels
- Weight loss
- Fatigue
- Fever
- Abdominal pain
- Rectal bleeding
- Bloody stools
Complications from the above symptoms may occur including malabsorption and malnutrition. This means you are not absorbing the nutrients from foods so you may experience deficiencies of vitamins and minerals and amino acids.
And other non-digestive symptoms include eye pain and itchiness, a sore mouth, joint pain, skin issues, osteoporosis, kidney stones, and liver problems.
One unfortunate consequence is how it affects people psychologically. Imagine having a chronic disease with flares that are not only unexpected but also embarrassing. Any type of chronic illness is emotionally burdensome, but with IBD, many patients feel they are alone. and that no one understands or is listening to them. So seeing a counselor, a pastor, a therapist, or someone to help you deal with the emotional and mental burden is a necessity.
Symptoms vary from person to person and may change over time, from mild to severe. When IBD is quiet, it is said to be in remission. But it may flare again which is then called active.
As you can imagine, IBD affects a patient’s quality of life and has a high financial burden due to the many doctors, practitioners, tests, medications, and treatments needed not to mention possible loss of the ability to work during a flare.
What Causes IBD?
The exact cause is unknown, but most doctors and experts believe it is a result of a weakened immune system that overreacts and attacks your body. They believe it could be due to a combination and interaction between these three factors:
*Environmental triggers – virus, bacteria that causes inflammation of the GI tract; we know the gut microbiome (all microorganisms in the GI tract) is key to health; so if there are bacteria and viruses causing havoc in the gut microbiome and you aren’t able to effectively combat them, you’re more likely to develop IBD. Other environmental triggers – smoking, increased risk of antibiotics, increased use of Nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, aspirin), diet – bacteria in food or even just SAD which is inflammatory with high sugary processed foods
*Genetic component – if you have a family history of IBD, you are more at risk of developing it. Now you cannot change your genes, but you do have control over many of the environmental factors noted above.
*Poor or weak immune system – if you already have a weakened immune system, then your body is more at risk to be unable to fight off pathogens or handle all the environmental factors that we experience in our modern world.
How is IBD Diagnosed?
Medical practitioners will usually use one or more of the following diagnostic tests or procedures:
- Upper Endoscopy
- Colonoscopy
- Imaging studies such as x-rays, MRI, CT scan
- Stool sample analysis
- Blood testing
In the upper endoscopy and colonoscopy if there are polyps or cysts seen, doctors may do a biopsy and have a lab analyze it to see if there are any pathological reasons that caused them. If so, that would provide a certain path to treatment type.
How is IBD Different than IBS?
As noted in my previous post on IBS (click here to check that out), IBS is a group of symptoms and is a disorder of the GI tract and the way the GI system is functioning. But on testing, no damage or disease is seen if you have IBS. But in IBD there is inflammation and visible damage seen during scoping such as sores or narrowing of the intestines. It is autoimmune in nature, meaning the body is attacking and damaging itself – the intestines in this case.
There are some similar symptoms which makes it hard to differentiate. However, with IBS usually there is not weight loss, fever, or anemia. That is more common in IBD. That’s why you need to see a doctor who can do the specialized tests to give you an accurate diagnosis.
How is IBD Treated?
After diagnosis, conventional doctors usually treat with one or more of these five types of medications:
- Immunosuppressants to help dampen the immune system attacking the intestine. One example is Methotrexate.
- Steroids which are anti-inflammatory medicines to decrease inflammation and relieve symptoms. One example is Prednisone. However, steroids are only short-term for flares, not for long-term use due to the side effects.
- Antibiotics are sometimes used in Crohn’s Disease for infections or abscesses. They are also used after surgery if you have to have it.
- 5-Aminosalicylic acids which are also anti-inflammatory at the intestinal wall and primarily used for Ulcerative Colitis.
- Biologics block inflammation in the immune system and are used for moderate to severe cases.
Surgery may be recommended to remove damaged portions of the GI tract. Of course, this is usually a last-case recommendation. Some are permanent and others may be reversed after healing has occurred.
In addition, there is a medication that has recently been used to help patients with IBD. It is LDN, Low Dose Naltrexone. This medicine has been used traditionally in higher doses primarily for patients who have been addicted to opioids. However, some studies have shown success in using lower doses of naltrexone to help IBD patients. Because this is prescription only and lower doses are compounded, you’d need to discuss with your doctor and find a compounding pharmacy.
What are Things You Can Do to Help Yourself?
First, breathe. Yes, once you get a diagnosis of any kind it can be traumatic to think about. You may be concerned about your future, relationships with family and friends, can you have a social life, can you work, what about the cost of treatment, and more. But remember, you do not have to understand or do everything at once. You simply learn what you can, talk to your practitioner, do some research yourself, ask questions, think and pray about it, and take one step at a time.
In addition, there are some practical ways to help yourself including the following.
- Keep a food diary
- Diet
- Probiotics
- Supplementation
- Herbs
- Exercise/movement
- Improving sleep quality
- Stress Management
- Counseling
Diet – No one says eating a certain way “cures” IBD, but for some patients you can decrease symptoms so it’s certainly worth trying, right? And keeping a food diary or journal to help figure out your own food triggers and symptoms is key to help you understand your patterns which will hopefully help your treatment. Plus, when you see a practitioner, you can take this with you which will be very helpful.
Incorporating an anti-inflammatory diet and eating whole real foods is better than the Standard American Diet of processed, fried, and sugary foods. Some anti-inflammatory diets you may want to research and try include the Mediterranean diet, low FODMAP, Paleo, SCD (Specific Carbohydrate Diet) and GAPS (Gut and Psychology Syndrome) diet. But in a flare you may have to make some modifications.
Some general practices that may be helpful include:
- Eating small portions of food more frequently
- Eating a gluten-free and dairy-free diet
- Cooking vegetables and fruits rather than eating them raw
- Removing skins from fruits
- Avoiding fried foods
- Eating more Omega-3 fatty acid foods like salmon or sardines
- Some do better with low fat for a period of time
- Limiting/avoiding caffeinated beverage and foods
- Not eating or drinking foods with sugar such as sodas, juices, candy
- Limiting/avoiding alcohol and spicy foods
- Limiting/avoiding sugar alcohols (end in -ol) such erythritol or xylitol – cause more bloating and may worsen diarrhea
- If you have strictures, avoid nuts, seeds, beans, and kernels
- Drinking enough water during the day but not drinking a lot during meals which may dilute digestive enzymes and acid
Some people may do better with liquids so you can make smoothies with blended vegetables and fruits to boost nutrients. Because your blender has pureed the food, this means your body doesn’t have to digest it so much which makes it easier for you to tolerate and absorb. Just don’t drink large portions of it or you’ll feel bloated. Small portions are best. In addition, when in a flare another helpful liquid is bone broth which will supply some nutrients while being easy on your digestive symptoms.
Although fiber is healthy for those without IBD, when you have IBD, fiber or undigestible matter from fruits, vegetables, and whole grains can become stuck and cause severe symptoms. So a low fiber diet may be helpful especially when in a flare.
Taking multivitamins and minerals may be necessary to address malnutrition caused not only by the IBD but also due to side effects of the medications and/or surgery.
Some patients who are in a flare and unable to eat or drink much need to restore electrolytes. I would not recommend Gatorade or Powerade because those have chemicals and unhealthy ingredients in them. Some healthier options are LMNT, Dr. Berg’s, and Seeking Health. And some people tolerate coconut water which has electrolytes, but you need to listen to your body as always.
Probiotics – According to one article in the National Library of Medicine probiotics may be helpful for IBD. Interestingly, Lactobacillus strains were found theoretically to decrease colitis but clinically proved ineffective. Another type of probiotic called Saccharomyces Boulardii (yeast-based) has been shown to maintain remission of inactive Crohn’s Disease. And Bifidobacterium may be effective for Ulcerative Colitis.
Taking supplements to decrease inflammation and support gut lining may be helpful including the following:
- Ginger
- Turmeric
- Boswellia
- Bromelain
- Ginseng
- Psyllium husk
- Glutamine
- Peppermint – do not use if you have acid reflux or GERD
- Wormwood
As always, please discuss any supplements and herbs with your own medical practitioner prior to using.
What are Lifestyle Strategies?
There are some lifestyle strategies you do have control over as well. These include:
- Exercise or movement – this can improve bowel motility plus relieve stress and improve mood
- Improving sleep quality can help you by not only getting the rest you need, but your body heals itself during sleep so you want to get adequate, good sleep
- Stress Management is key for patients with IBD. Although stress does not cause IBD, too much and the inability to handle it can make IBD worse. So find ways to make time for joy in life, pursue hobbies, read, get outside in nature, get involved in church, journal, find things you are grateful for
- Support from others – see a counselor, join a Facebook support group, or find an in-person support group locally
Although there is technically no “cure” for IBD, there are many things you can do. Using a combination of medications, lifestyle and diet changes, natural remedies, sleep and stress improvements, staying active, maintaining spiritual health and mental health, finding things that bring you joy, plus counseling may help you stay in remission. There is always hope.
I am a National Board Certified Health and Wellness Coach and help women over 40 who have digestive issues (like bloating, constipation, diarrhea, acid reflux), fatigue, brain fog, weight issues, and thyroid and autoimmune conditions. As a team, you and I work together as we focus on nutrition and lifestyle factors to help you decrease your symptoms, have more energy, think clearer, and fit into those favorite jeans again. You can do this! You just might need some help from someone who’s been there herself and worked with clients – helping guide, support, and encourage you each step of the way. Contact me here to set up a free strategy session to see how we can work together. — Leah Cheshire, NBC-HWC
Disclaimer: This information is for educational purposes only and is not meant to be used as medical advice. Please check with your own practitioner before making any nutritional or lifestyle modifications.
