Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis)
Dietary and Lifestyle Considerations
Lifestyle changes and nutritional supplementation synergize to promote healthy digestion and absorption while simultaneously reducing the inflammation and damage associated with inflammatory bowel disease (IBD).
Since aspirin increases the risk of Crohn’s disease (but not ulcerative colitis), people with Crohn’s disease should consider avoiding the medication (Chan 2011).
The GI tract of individuals with Crohn’s disease may also be exceptionally sensitive to the negative effects of smoking. Smoking among those diagnosed with Crohn’s disease may increase the risk of flare ups, impede remission, and increase the overall severity of the condition necessitating more invasive treatments (Johnson 2005). The following steps may help patients with Crohn's disease first reduce their symptoms and then begin long-term repair of the damage caused by their disease:
Avoid troublesome foods. Remove all foods that precipitate symptoms. In one study of Crohn’s disease patients, an elemental diet was followed by food reintroduction with one new food daily. If any food reintroductions led to symptoms such as diarrhea or pain, they were excluded. This approach was more effective than glucocorticoids in preventing relapse of Crohn’s disease in this trial (Riordan 1993). A trial diet of just organic meat, spelt, butter, and organic tea was found to be superior to a low-fat, high-carbohydrate, low-fiber diet for people with Crohn’s disease (Bartel 2008). Long-term remission was achieved in 31% of Crohn’s patients in one study solely using an elimination diet (Giaffer 1991). Other evidence suggests Crohn’s disease patients are more reactive to certain foods (Brown 2010; Van Den Bogaerde 2002). Some research suggests a reduced carbohydrate diet (84 g/day) may be associated with better outcomes in Crohn’s disease (Lorenz-Meyer 1996). Also, elevated levels of trans-fats have been found in the adipose (fat) tissue of people with Crohn's disease (Heckers 1988; Lorenz-Meyer 1996). Baker’s yeast should be avoided in those with elevated yeast antibodies, and has been shown to aggravate Crohn’s disease in some research (Barclay 1992).
Following a diet based upon blood IgG antibody testing for food sensitivities has been shown to reduce stool frequency in Crohn’s patients (Bentz 2010). In one trial, Crohn’s disease symptoms were shown to be aggravated by diverse foods differing among study participants. Elimination of the problematic foods was helpful on an individual basis, but the bothersome foods were not the same for all subjects, underscoring the need to identify specific foods that cause symptoms (Triggs 2010). More information about testing for food allergies and sensitivities is available in the Allergies protocol.
Supplement to correct potential nutritional insufficiencies. The diets of most patients who have IBD are deficient in one or more vitamins or minerals (Tighe 2011). Vitamin D and vitamin K deficiencies are frequently found in those with Crohn’s disease, as well as deficiencies in iron, vitamin B6, carotene, vitamin B12, and albumin (protein). (Nakajima 2011; Vagianos 2007; Siffledeen 2003). Patients with Crohn’s disease are usually under increased oxidative stress and have lower levels of antioxidant vitamins. Supplementation with vitamins C and E reduces oxidative stress (Aghdassi 2003).
Balance intestinal microbiota. A normal healthy intestine contains about 100 trillion microorganisms (Tsai 2009). In a diseased intestine, these bacteria are often not present in adequate amounts and/or have been replaced by pathogenic organisms. Balancing microbiota consists of taking mixtures of friendly bacteria (probiotics), which may include Bifidobacteria and Lactobacilli to promote continued repopulation with these beneficial bacteria (Zigra 2007). The probiotic yeast Saccharomyces boulardii may be considered as well. The role of probiotics in inflammatory bowel diseases is expounded upon below.
In children and adolescents who have Crohn’s disease, a semi-elemental diet has been shown to be as effective as glucocorticoids in maintaining remissions (Scholz 2011). In one study of IBD, 44% of the study population went into remission by consuming an elemental diet (Axelsson 1977; Belli 1988). An elemental diet has also been shown to decrease inflammatory parameters in IBD intestinal tissue. The elemental diet also reduces intestinal permeability in those with Crohn’s disease (Meister 2002; Teahon 1991). When coupled with individualized elimination of food triggers, elemental diets reduce the relapse rate of Crohn’s disease (Jones 1987). In another trial involving 268 Crohn’s disease patients, an elemental diet was associated with a reduced hospitalization rate (Watanabe 2010).
Those who use conventional elemental diets are sometimes noted to develop micronutrient deficiencies, such as of selenium (Kuroki 2003). Therefore supplementation with a high quality multivitamin/mineral, among other nutrients discussed below, may be pertinent.
Sulphate-reducing bacteria (SRB) have been implicated in the development of ulcerative colitis through the harmful effects of hydrogen sulphide, a waste product of their respiration (Rowan 2009; Pitcher 1996). Hydrogen sulfide is toxic to the colon lining cells, and is associated with ulcerative colitis. Hydrogen sulfide may, in particular, interfere with butyrate metabolism, a critical nutrient for colon cells produced by beneficial bacteria (Roediger 1997). Also, higher exposure to sulfur dioxide air pollution was associated with higher rates of ulcerative colitis in one study (Kaplan 2010).Ulcerative colitis has also been associated with a higher dietary intake of sulfur containing foods. Removing foods rich in sulfur-containing amino acids (such as milk, eggs, and cheese) is associated with benefits in ulcerative colitis (Jowett 2004; Roediger 1998; Wright 1965).