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Inflammatory Bowel Disease: Getting the Gist of Things

Suffering from an IBD is not a joke, we take it seriously

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Let’s not get confused here. Before we begin, let’s first define some important terms. Inflammatory bowel disease (IBD) refers to a group of diseases that includes Crohn’s disease and ulcerative colitis. A third less common type of IBD is indeterminate colitis and will not be discussed here. Inflammatory bowel disease is different from irritable bowel syndrome (IBS)*.


*Most health experts don’t classify irritable bowel syndrome as a specific disease. They classify it as a functional disorder meaning a specific anatomic cause could not be identified. While the symptoms of IBS can be similar to IBD, in this article we will focus on the latter.


Inflammatory bowel disease, as the term suggests, is caused by inflammation (swelling) of the intestines. The exact cause of the swelling in inflammatory bowel disease is still unknown as of today, but experts believe it’s a combination of environmental, immunologic, genetic, and other factors. The inflammation can cause diarrhoea, abdominal pain, and other symptoms.


To differentiate between Crohn’s disease and ulcerative colitis, a doctor uses the signs and symptoms of the patient, endoscopy findings, histology, and radiology.

Here are some essential numbers on inflammatory bowel disease:


New ZealandAustralia
PrevalenceAround 15,000 New Zealanders are currently affectedAlmost 75,000 Australians are currently affected
Overall Incidence for IBD
(expressed as incidence rate)
25 people per 100,0029.3 people per 100,000
For Crohn’s disease only17 people per 100,00017 people per 100,000
For Ulcerative colitis8 people per 100,00011 people per 100,000
For Indeterminate colitisNot determined1 person per 100,000
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  • Incidence only includes the number of new IBD cases diagnosed. On the other hand, prevalence is made up of old and new IBD cases.

  • Among developed countries, Australia has one of the highest numbers of cases of IBD. New Zealanders are much better off. An alarming increase in the number of cases seen yearly was reported in Canterbury, New Zealand. More people are afflicted with Crohn’s disease than ulcerative colitis in both countries.

  • Inflammatory bowel disease doesn’t distinguish between the sexes, it can affect both at the same rate. So both women and men can complain of the symptoms of IBD.

  • Sadly, IBD affects the majority of people in the most productive years of their lives (20s to 40s). The mental, physical and economic impacts are huge.



To help you distinguish between Crohn’s disease and ulcerative colitis, let’s compare them in a table:

Crohn’s diseaseUlcerative Colitis
Symptoms
  • Diarrhoea
  • Fever
  • Abdominal pain or tenderness
  • Blood in your stools
  • Weight loss
  • Reduced appetite
  • Abscesses or sometimes sores around your anus
  • At times bowel obstruction can cause nausea and vomiting
  • Diarrhoea
  • Abdominal pain
  • Blood in your stools (more common in ulcerative colitis)
  • Weight loss
  • Reduced appetite
  • Urgency to move the bowels
  • Anaemia – low red blood cell count
  • Fatigue
  • Increased risk of developing colon cancer
How you may look
Thin and malnourished, most of the time.Your weight loss varies.
Parts of your digestive system affected
Can affect any part of your digestive system including your small and large intestine.


Your rectum is usually affected.
Only affects your large intestine (colon).


Your rectum is always affected.
Your endoscopy results (procedure to examine inside your digestive tract)Patchy areas of inflammation (skip lesions) with deep snake-like geographic ulcers.


The walls of your large intestine may have a classic cobblestone look.
The walls of your large intestine are thin with diffuse ulceration.
Your radiology results
(X-ray of your abdomen)

Narrowing (strictures) and fissures are common. Fistulas can also occur.


Inflammation is unevenly distributed (asymmetrical).
Narrowing and fissures are seldom seen. Fistulas are never present.


Inflammation is evenly distributed (symmetrical).
Histology
(microscopic analysis of your intestinal tissue)
Granulomas are present. They’re a group of immune cells doing a “huddle” (like in rugby).


The presence of these huddling immune cells is almost diagnostic (high degree of certainty) of you having Crohn’s disease.
No huddling cells (granulomas) are present.
Other organs affected outside your digestive system

  • Inflammation may affect the eyes, skin and joints
  • Arthritis
  • Painful mouth ulcers
  • Your liver may also be affected
  • Your eyes may be painful and red
  • Painful mouth ulcers
  • Your joints are swollen and painful
  • Skin rashes or sores

Medical Causes

Studies suggest that a misbehaving immune system, environment, and genetics all contribute to the development of Crohn’s disease.


Your diet and stress don’t cause Crohn’s disease; they only worsen your symptoms.


Some experts believe that Crohn’s disease is secondary to your immune system overreacting to a harmful invading microorganism in your intestines.


Genetics may also play a role. 5 – 20% of people with this disease have a child, sibling, or parent with Crohn’s disease.


Your environment also has a hand in it. If you live in urban areas in northern climates, you may be at greater risk of developing Crohn’s disease.
According to recent studies, stress and diet do not cause ulcerative colitis. But they can worsen it.


Multi-factorial. The causes may be a mixture of factors: Immunologic, genetic, and post- infectious processes.


Post-infectious causes means after a virus or bacteria has invaded your large intestine. Ulcerative colitis keeps your immune system in disease-fighting mode even when the offending microorganisms are no longer there.
Smoking
You have a higher risk of developing Crohn’s disease if you’re a smoker.


Smoking also worsens the condition and makes it more aggressive.
Lower risk of this for smokers.
Some research suggests that nicotine may have a positive effect on Ulcerative Colitis.


But we are NOT advising you to start smoking!
Medical Treatment

Diet plays a huge role in management.

  • Enteral feeding for severely malnourished people
  • Elimination diet to find aggravating foods

Drugs like aminosalicylates, corticosteroids, antibiotics, and immunosuppressors.


Half of the patients usually require surgery.

Research on dietary changes for ulcerative colitis is mixed. A normal balanced whole food diet with minimal processed food may be sufficient.


Drugs like aminosalicylates, corticosteroids and immunosuppressants.


Surgery for refractory cases. Yes, they remove the entire colon in extreme cases.
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What else can you do naturally?



Alternative medicine has some natural treatments and lifestyle modifications you might want to try to lessen the severity and occurrence of your symptoms. In general, patients with Crohn’s disease benefit more from a diet change than patients with ulcerative colitis.


Diet. Adjustments in your diet are among the essential things you can do on your own especially if you have Crohn’s disease.

  • Pay special attention to dairy products. Your symptoms may improve if you limit your intake of dairy products. Some people with Crohn’s disease notice that their symptoms like diarrhoea and bloating decrease in severity if they limit their consumption of milk, butter, and cheese. Among New Zealanders with Crohn’s Disease high fat dairy products were reported to worsen symptoms the most frequently.

  • Some people with IBD found it best to cook their vegetables rather than having them raw. If you already have a structural problem in your intestine (stricture or narrowing) which is more common with Crohn’s disease, you better stay away from the members of the cabbage family (cauliflower, broccoli etc) which have been reported to cause problems for some people.

  • Avoid caffeinated beverages, spicy foods, and yes, alcohol. They can all make your symptoms worse.

  • You may benefit from a gluten-free diet. Gluten in foods like bread, pasta, cakes, pastries, and cereals may increase the severity of your IBD symptoms. A recent study observed that people who went on a gluten-free diet complained less about their IBD symptoms. It’s worth a try.

  • One study found that high fat foods may be more problematic for some people. Though as we are all different, each person may respond differently to certain dietary components. So we recommend using a food diary to identify any foods that you notice make your symptoms worse or trigger a flare-up. For general health a diet low in processed meats, processed carbohydrates, damaged fats and sugars is recommended.


Alternative therapies consist of the following:


  1. Probiotics. The presence of more live beneficial bacteria in your intestines may offer better chances of alleviating your symptoms and maintaining remission of the disease. Also, recent studies have indicated that beneficial bacteria can influence how well your immune system works and helps your body deal with inflammation in a positive way.


  2. Prebiotics. Preliminary studies have repeatedly shown that prebiotics like oligosaccharides and inulin can increase the numbers of beneficial bacteria. As a consequence, this may help to reduce damage (inflammation) to the mucosal lining of your intestines.

  3. Dealing with dysbiosis. People with IBD may have an imbalance between good and bad microorganisms in their intestines called dysbiosis. Harmful fungi and bacteria may have flourished and increased in numbers. This will most certainly upset those with IBD. Of course, we want the good guys to win. Eliminate harmful microorganisms with oregano oil, a powerful and natural antibiotic.


    Also to be considered in the fight against dysbiosis is a versatile and powerful probiotic yeast called Saccharomyces boulardii. It can stabilise the chaotic population of microorganisms in your digestive tract and also helps by reducing fungi numbers.

  4. Turmeric. Turmeric contains the active ingredient curcumin. It can block most of the major inflammatory mechanisms in patients with IBD. Oh, let’s not forget its incontestable safety profile. Impressive.

  5. Aloe vera in gel form. This famous skin herb also has benefits when taken orally for symptoms of IBD. It has natural anti-inflammatory and antioxidant actions that may help to improve severity of symptoms in IBD. In one study, 9 of the study participants even had clinical remission of their ulcerative colitis.

  6. Fish oil. The exact mechanism by which omega-3 fatty acids help people with IBD is still unknown. But it is likely to be linked to the anti-inflammatory effects of the omega-3 fatty acids. Research found that supplementation with fish oil reduced the severity of symptoms in IBD.

  7. Acupuncture. May be beneficial for those with ulcerative colitis. A few studies have demonstrated that some patients may benefit more from acupuncture than conventional drugs used in the treatment of ulcerative colitis.

  8. Slippery elm. This herb is rich in mucilage, a substance that coats and soothes the inflamed digestive tract of people with IBD. It increases mucus production and also aids healing of the digestive tract lining.

  9. L-glutamine. It’s not only bodybuilders who can benefit from this amino acid. L-glutamine helps to rebuild the damaged walls of your intestine, decreasing the damage caused by your IBD.

  10. Multivitamin and mineral complex. Having IBD takes a huge toll on your nutrition and well-being. You have to increase your vitamin and mineral intake because of malabsorption (your intestines have a hard time absorbing nutrients from your food). Research also showed that vitamin D supplementation benefited Crohn’s disease, likely because of its role in healthy immune function.



Stop smoking. It makes your inflammatory bowel disease worse, not to mention your state of health. This is especially true for Crohn’s disease.


Stress management. Chronic stress can have a huge impact on your digestive system, usually resulting in more rush visits to the loo. You must learn to relax.


The Bottom Line



Inflammatory bowel disease can cause redness and swelling of the different parts of your digestive system and even outside it. The symptoms can be mild to incapacitating in some cases. Schedule an appointment with your healthcare practitioner if you suspect you may have IBD.


Setting aside the economic impact of IBD, the individual suffering brought about by these diseases is immeasurable. Your personal freedom, how you value yourself, choice of career, and your quality of life are all affected. The pain and suffering caused by IBD is real and serious. But, with today’s improvements in medical treatment, patients can live a normal life. Additionally, natural and alternative forms of treatment are widely available and can benefit each person with IBD differently. Ultimately, it all depends on the person’s will to adapt and survive this debilitating group of diseases.


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