IBD: Crohn’s Disease & Ulcerative Colitis
Chronic inflammation in the digestive tract, also known as Inflammatory Bowel Disease. Inflammatory Bowel Disease (IBD) consists of Ulcerative Colitis and Crohn’s disease. Don’t mistake IBD for Inflammatory Bowel Syndrome (IBS), while the names might be similar. They are as different as day and night. Read on to learn more about IBD: Crohn’s disease and Ulcerative Colitis and how to manage it.
The information on Positive Gut is for informational purposes only. The information is not meant to be a substitute for professional medical advice, diagnosis or treatment. If you have any concerns about your health, always seek the advice of your doctor.
What is IBD
At the end of 2019 the British Society of Gastroenterology published a consensus guideline on the management of IBD in adults. A great overview of all that is known on IBD at the moment. In my article below I strive to give an overview of what is known at the moment of writing.
As mentioned above, IBD is the abbreviation of Irritable Bowel Disease. It’s a chronic inflammation that can flare up in the digestive tract that consists of Ulcerative Colitis and Crohn’s Disease. In the case of Crohn’s the inflammation can be present anywhere from the mouth to the anus. In the case of Ulcerative Colitis it will be present in the last part of the colon.
IBD is the inflammation of the mucosa that is lining your digestive tract. This inflammation can have periods of remission (when it’s calm) and flare-ups. You can manage and lengthen your periods of remission and prevent flare-ups as much as possible if you’re doing all the right things. But sometimes, the inflammation will still be there, even if you’ve done everything right.
In Ulcerative Colitis, over 90% of the people will experience one or more relapses after their initial attack. A fast relapse after the first attack (within 2 years) is associated with a worse disease course overall.
Symptoms of IBD
The symptoms that show in both Crohn’s Disease and Ulcerative Colitis are very similar. That is why symptoms are not a reliable way to diagnose the disease.
Common symptoms are increased stool frequency, diarrhea, rectal bleeding, and mucus with the stools.
Diagnosis of IBD
Distinguishing between Crohn’s and Colitis is not always easy since both can show similar symptoms in the same parts of the digestive tract. However, there is a consensus on how to diagnose both Crohn’s and Colitis.
When IBD is diagnosed at a young age (child) the disease is often more extensive than when the first show is in the adult age.
Ulcerative colitis is often diagnosed by a sigmoidoscopy, where they can look into the last 20 cm of your colon with a tiny camera. Or an ileocolonoscopy, where they check your full colon and the last part of your small intestine.
If the inflammation is higher up than the colon, the disease will most likely be Crohn’s.
For Crohn’s disease, there is not a single definition that captures it. And often a combination of tests is needed to identify it. Those tests can consist of a clinical history and examination, ileocolonoscopy, small bowel imaging, blood test and histology (where they check the health of the cells lining the digestive tract after taking a biopsy). The combination of the results of these tests can provide the doctor with enough information to determine whether it’s Crohn’s or not.
Treatment: Nutrition and Lifestyle
Often Crohn’s Disease and Ulcerative Colitis are treated with a combination of medication, nutrition, and lifestyle. Since I’m not a doctor, I will focus on the nutrition and lifestyle part for the people that are in remission (no flare-ups at this moment). For any questions about the medication that fits Crohn’s or Colitis, or what to do during a flare-up please consult your GP.
When people are having a severe flare-up of their symptoms and are admitted to a hospital enteral nutrition (a.k.a. tube feeding) can be used to improve nutritional status. Since that is mostly used in hospitals or at home and provided by hospital dietitians. I won’t go into that any further either.
Nutrition and IBD
Malnutrition is relatively common in IBD. When eating hurts or the digestive tract hurts, it is far less appealing to eat a lot. Apart from that, inflammation requires a lot of energy and thus elevates the energy needs of the body. The inflammation can diminish the ability of the body to absorb nutrients and there can be losses of energy with for example diarrhea.
Several dietary components have been associated with an increase in the risk of relapse in IBD. Which include sugar, fat, cereals and even dietary fibre, fruit, vegetables and protein. But no strong evidence exists for any of these factors yet. The increased intake of processed and fast food in the Western diet has shown to elevate the risk of developing IBD.
In IBD, a varied diet that meets the body’s nutrient needs is advised. No type of elimination diet has yet proven effective against relapse in IBD (not even gluten-free or lactose-free diets). Except if you have proven intolerances, there is no need to follow an elimination diet.
The current nutritional recommendation for IBD is as follows:
|An abundance of:|
|Nuts and seeds|
|Healthy unsaturated fats and omega-3 fats/fish oil|
|High-fat foods, particularly animal fat|
|Red and processed/salted/smoked meat|
|Saturated fats and omega-6 fats|
Fiber should pose no problems when you have IBD. It can only become a problem if the inflammation ‘blocks’ the passage in the digestive tract. During a flare-up it is recommended to reduce the total fiber intake and transfer to a low fiber diet, to give your intestines a ‘break’. After the flare-up it is important to get the fiber back in your diet, since a low fiber diet can promote microbiota dysbiosis.
Cannabis (CBD) has been reported to improve IBD symptoms. It has shown to reduce nausea, gastric acid secretion and has anti-inflammatory effects and can reduce the intestinal motility. If you want to try CBD, be aware that this is not the same as the THC that is getting you high. Get yourself a medical grade and properly tested supplement.
There are several vitamins and minerals that are at risk for a deficiency in IBD.
|Vitamin D deficiency is common in people with IBD especially with the use corticosteroïd based medication. If you want to read more about vitamin D (supplementation) and IBD, click this link. Apart from vitamin D, calcium is also often deficient. Vitamin D and calcium are often combined in a supplement, so you can catch two birds with one stone.|
|Magnesium. It is thought that Magnesium gets lost with excessive stools. Symptoms of a Magnesium deficiency include abdominal cramps and tiredness. Supplementation can be useful, but oral supplementation can worsen diarrhea symptoms.|
|Iron. Inflammation inhibits the absorption of Iron. During the remission periods, a supplement with a maximum dosage of 100 mg elemental Iron can be taken.|
If you have any worries about your vitamin D, Magnesium, Calcium, and Iron levels, please contact your specialist or GP to get them tested and get the proper treatment.
Diets like the FODMAP diet can sometimes be effective if the IBD is present in combination with functional bowel symptoms (IBS). If you want to try a FODMAP diet, always seek the guidance from a dietitian!
Probiotic supplements have not proven effective yet in the treatment of IBD.
Do you want to optimize your diet for IBD or do you want to follow the FODMAP diet? Schedule an online consultation at my online dietitian practice Darm diëtist, and I will help you with all your questions!
Lifestyle and IBD
If you have Crohn’s and you smoke, try to stop. People who have never smoked and have stopped smoking have an overall better disease course than smokers. No difference is found in light-smoking (less than 10 a day) and passive smoking in comparison to heavy smoking.
If you have Ulcerative Colitis and you smoke. Try to stop. The overall risk of flare does get a little higher after quitting. But the overall health benefits of quitting outweigh this.
Stress is also linked to flare-ups of IBD. Try and identify stressors in your daily life and try to find solutions to minimize them. Psychological help like psychotherapy en relaxation techniques can aid in this. Other options are physical activity like yoga, walking or sports and having a relaxing hobby.
Do you have IBD? What are you currently doing to prevent flare-ups? How does it work for you? Let me know!
Hi there, I’m Manon.
In my daily life I work as a registered dietitian in the Netherlands with a special interest in gut health.
During my workday I get loads of questions about healthy food, recipes and lifestyle to make it a little easier to get healthy. On Positive Gut I collect my best recommendations, tips and recipes to make your healthy lifestyle a little easier!