IBD – Symptoms, Causes & Treatment

Inflammatory bowel disease is a chronic, autoimmune, inflammatory disease of the bowel. The disease can occur at any age but generally affects young adults 15 to 35.

There are two main types of IBD:

• Crohn’s disease: a type of IBD which usually affects the intestines, but may occur anywhere from the mouth to the anus. Inflammation generally extends the entire thickness of the intestinal wall. Prognosis is generally more favourable than UC and malignancies are unlikely.
• Ulcerative colitis: a type of IBD which affects the lining of the large intestine and rectum. Inflammation usually affects the lining of the intestinal wall only. There is an increased risk of carcinoma after 7-10 years.

Symptoms can vary in intensity and depend on the part of the GIT affected. The disease is often characterised by period flare-ups.

Most common symptoms of IBD

• Abdominal pain and cramping, especially in the lower right quadrant of the stomach area
• Recurrent diarrhoea, with blood and mucous in stools
• Abdominal sounds
• Fever, malaise
• Fatigue
• Loss of appetite
• Tenesmus (rectal pain)
• Weight loss
• Fistulas: occur in 10% of Crohn’s disease

Causes of Irritable Bowel Disease (IBD)

The cause of IBD is unknown, but it is linked to an auto-immune response by the body against the tissues of the digestive tract. Evidence suggests that genetic, immunological and environmental factors initiate the autoimmune process.  As with all autoimmune disease, intestinal permeability and a compromised gut precede onset of the majority of conditions

Risk factors

• Family history of IBD
• Chronic infection, intestinal permeability (leaky gut) and/or bowel dysbiosis
• Smoking: doubles the risk
• Poor diet: high sugar, refined foods, chemically altered fats
• Stress, anxiety and depression: all associated with immune dysregulation

Investigations into IBD

• Advanced stool analysis (including Clostridium difficile assay)
• Internal examination: colonoscopy, endoscopy
• Barium enema
• C-reactive protein
• Antibody testing
• Celiac disease screening and food reactivity screening
• SIBO breath test
• Intestinal permeability

TREATMENT STRATEGY FOR IRRITABLE BOWEL DISEASE (IBD)

• Decrease intestinal inflammation and oxidative stress
• Module immune response
• Repair intestinal mucosa
• Restore bowel microflora
• Improve digestive function
• Address incorrect dietary habits and food allergy
• Correct nutritional deficiency
• Support nervous system

Diet plan guidelines for Irritable Bowel Disease

• During acute-flare ups or attacks, elemental formulas containing amino acids, glucose, essential fats, minerals and vitamins are indicated. These formulas are more easily absorbed and support initial healing of the mucosa.  Whole foods can further irritate an inflamed intestinal lining
• Following an acute flare-up, an Autoimmune paleo diet is recommended (AIP diet)
• Wheat and dairy are the most common offenders and should be completely avoided as in the AIP diet.
• Gluten should be eliminated in inflammatory bowel disease as it promotes an inflammatory response in the intestine
• Minimise pro-inflammatory foods: sugar, refined carbohydrates, trans fats, omega-6 fatty acids, caffeine and alcohol
• Avoid carageenan, sulphur preservatives (220-227) and MSG: may exacerbate symptoms of IBD
• Fibre intake: while a high-fibre diet is generally recommended, people with IBD may need to be on a relatively low fibre diet, especially during acute flare-ups

Supplements that support IBD

• Omega-3 EFA’s – to reduce inflammation
• Curcumin – daily between meals: anti-inflammatory and improves colonic morphology and survival.
• Slippery elm – protection if intestinal lining
• Glutamine – to promote mucosal repair
• Zinc – to promote mucosal repair and support immune function
• Vitamins A and E – to promote mucosal repair
• Selenium – immune system modulation
• Magnesium – supports nervous system and reduces spasm
• Vitamin D – depending on status, important for regulating immune response
• Probiotics: especially L.plantarum GG (anti-inflammatory), Bifidobacter spp. (found to be deficient in IBD) and S.boulardii.  In addition bacillus and soil based probiotic organisms are well tolerated.
• Nutrient replacement where necessary: specific deficiencies may include vitamins A, D, E, K, B12, folic acid, calcium, iron, magnesium, zinc and protein

Herbal medicine treatment to support IBD

• Demulcents: slippery elm, marshmallow, licorice
• Mucosal repair: calendula, goldenseal, aloe vera
• Astringent: bayberry, shepherd’s purse
• Carminative: chamomile, peppermint, cinnamon, fennel, ginger
• Anti-inflammatory: turmeric, boswellia, turmeric, ginger, licorice
• Anti-spasmodic: cramp bark, wild yam, chamomile, peppermint, lemon balm
• Immune support: echinacea, cat’s claw
• Digestive stimulant: ginger, gentian, angelica, centaury, goldenseal
• Antimicrobial: echinacea, baptisia, chamomile, cat’s claw
• Adaptogenic (chronic inflammation): Siberian ginseng

Lifestyle / Physical measures that improve IBD

• Stress management techniques
• Regular moderate exercise very important for prevention of flare-ups
• Avoid cigarette smoking – increases disease activity

FUNCTIONAL MEDICINE TREATMENT OF IRRITABLE BOWEL DISEASE

The above nutritional and dietary considerations may assist with the support of Irritable Bowel Disease (IBD).  IBD is a complex disease that requires thorough investigation into underlying pathology and regulation of the immune system.

Identifying immune system triggers, viral and bacterial loads, nutrient imbalances, food intolerances and impaired mucous membranes are all areas that commonly require investigation.

We have experience with IBD at our Perth clinic of Advanced Functional Medicine

If you or a family member are suffering from IBD or another digestive disorder we would love to hear from you, what are your main triggers?  What treatments have worked best for you?  Please write a comment below.

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