Nutrition & Wellness Q&A by Dr. Tarique Zaman, MD, MPH

Irritable Bowel Syndrome (IBD)

It seems like so many drugs used to treat IBD have significant side effects; are there any other treatment options that don't involve prescriptions?


You're right; all the commonly used medications to treat Inflammatory Bowel Disease (IBD) are known to have different side effects (such as mesalamine which can cause abdominal pain and headache and sulfasalazine may cause infertility in men). Fortunately, you may be able to improve your condition with minimal use of these medications or even no medication if you are willing to make changes to your diet and lifestyle. Increasing evidence suggests that animal protein may both cause and worsen IBD, and that replacing animal protein with plant protein may help significantly. Also, increasing fiber intake and avoiding hydrogenated oils have been found to have beneficial effects.




I read that long term use of steroids to prevent flares can increase my risk of diabetes among other things. What can I do to minimize or stop steroid use completely?


Steroids may be the best option when IBD gets out of control (also known as flares). Steroid courses may be used for short time--from a few days to a few weeks. However, in some difficult cases, long term use of steroid pills may be necessary. These medications can have serious side effects, so your concern is understandable. The key to minimizing the side effects from steroids is to not to need them in the first place, so I recommend that you focus on prevention of flares through regular exercise and a whole food plant-based diet high in fiber. For more tips, please see the "What You Can Do About IBD" section toward the bottom of this page.




I'm a smoker; I've been told again and again to quit and I've tried before, but now I learned that smoking actually helps with IBD. Should I just continue smoking then?


Research has shown that smoking benefits IBD. However, the harmful effects of cigarette smoking far outweigh the benefit that it may provide. Further research into finding the least harmful way of using tobacco's constituents to treat IBD is underway.




With risks of immune suppressing medication including risk of bacterial or viral illness, should I avoid taking these medications?


I would like to share with you a simple analogy. Imagine a country ravaged by a civil war--unfortunately not so uncommon in many parts of the world. The distressed leader of the country has just appointed a new commander, who is expected to suppress the internal strife. That means he has to turn his army against his own people for the greater good. However, since there are limited resources at his disposal he is forced to leave his international borders weaker and vulnerable to attack for his enemies. It is a similar effect that these immune suppressing medications have on our body's defenses when we take them to stop a flare. We are therefore more vulnerable to external threats like common viruses and bacteria that can cause diseases ranging from a simple flu to serious bacterial or fungal infections in the blood. So the key is to discuss with your doctor whether the benefits of immune suppressive medication outweigh the risks.




I was frightened to learn that for some people their IBD progresses to the point that they need surgery to remove their colon. What can I do avoid becoming one of those people?


Unfortunately, as the disease worsens, and when medical therapy is not sufficient to control the disease (in 25-50% of the patients) surgery to remove the colon becomes the only option. Again the way to minimize the need for surgery would be to make lifestyle changes like exercising regularly and adopting a whole food plant-based diet to prevent the progression of the disease. See the "What I Can Do" section toward the bottom of this page for more non-medical strategies for treating IBD.




I know that stress can make IBD worse, and the worse my IBD is the more stressed I feel; what can I do to stop this downward spiral?


That's right, the more stressed out you are, the more likely you'll suffer a flare which in turn may make you feel even more stressed! The key is to break this vicious cycle as early as possible. While your physician's focus is on medication, your focus needs to be stress prevention and management. Many patients find yoga, meditation and/or psychotherapy sessions to be helpful, especially when things are getting out of hand. Establishing real connections with other patients and sharing your experience can also provide a big boost in morale. For additional resources check out the Crohn's and Colitis Foundation of America website for more information on community support that may be available to you. You should not fight this battle alone! There is power in numbers!




What You Can Do About IBD:


New research indicates that diet and lifestyle change can be effective in helping patients manage their Inflammatory Bowel Disease (IBD). These changes alone may be sufficient to manage IBD or they can also work in conjunction with medication.
- Substitute animal protein with plant protein--the more the better: there is increasing evidence that animal protein has both causative and provocative effect on Inflammatory Bowel Disease (IBD) - Replace milk from cows, goats, etc. and other dairy products with soy or almond milk - Stay away from fast foods options rich in hydrogenated oils and instead choose wholesome low fat plant based foods - Increase your fiber intake by consuming an abundance of vegetables and fruits - Avoid oral iron supplements but plant based foods rich in iron are fine - Exercise! Physical activity has been shown to reduce the risk of flares Here are a few other things to keep in mind: - When switching to an exclusively plant-based diet you may need vitamin supplementation to avoid deficiencies of vitamins B6 and B12
- Increase green leafy veggies to 3 servings per day to prevent deficiency of vitamin K from IBD medication
- Take care of your emotional health! Connect with other IBD patients to learn what worked for them, find strength in their victories and learn from their mistakes





Benefits of Whole Food Plant-Based Nutrition

Are chronic diseases like diabetes and hypertension reversible?


Yes, in a majority of cases, if diagnosed in time, chronic diseases like type 2 diabetes, hypertension (high blood pressure),and hyperlipidemia (high cholesterol levels) are reversible. And fortunately the steps you take to reverse one, also have a reversing effect on the other chronic diseases that you may suffer from...or better yet, prevent them from coming on in the first place.

These steps are usually painted in one broad stroke as "lifestyle changes." I hope that was not a surprise to you. Unfortunately, in this age of 10-15 minutes face-to-face appointments with your primary doctor or specialist you are only given general advice like "limit carbs," "control your portion size," "stop eating junk food," or "cut out the salt." Unfortunately this kind of advice doesn't cut it, and sets patients up for failure. When it comes to reversing chronic disease a more holistic approach is required--one that includes a diet of delicious nutrient-dense low fat whole plant foods, as well as an active, healthy lifestyle.





Diabetes

Do you suggest the keto diet to treat diabetics?


Great question. No, we don't. Keto can give you quick weight loss and even lower your A1C BUT it's lowering your A1C because you're starving your body of glucose, NOT because you're reducing your insulin resistance (the cause of T2D). And in fact a low-carb high-fat diet has been found in numerous studies published in peer reviewed medical journals to INDUCE insulin resistance. So you can suppress your symptoms with keto, but it's still fueling the progression of your disease.




Aren't I supposed to be following a low-carb diet if I have diabetes?


I do not recommend a low-carb diet to my diabetic patients and I'll tell you why. Limiting carbs avoids triggering your symptoms but actually worsens insulin resistance (see https://bit.ly/2Gr6tOp “a low carbohydrate, high fat diet was associated with a reduced ability of insulin to reduce plasmic glucose; conversely, a low fat, high carbohydrate diet was associated with an improvement in insulin's ability to stimulate glucose disposal.”)

I advise my diabetic patients to really restrict their saturated fat intake to make progress on their blood glucose quickly. Stick to unrefined carbs, but realize that in the beginning your blood glucose levels WILL spike, but over time as you follow this way of eating your body's response to carbs will change as your insulin sensitivity increases. Test often to guard against hypoglycemia as your need for meds decreases, and keep in close communication with your doctor for advice on how to safely phase of meds.





Acid Reflux/GERD

What would you suggest to treat acid reflux?


The most powerful intervention is usually a dietary one. High fat foods relax the oesophageal sphincter (the ring of muscle at the top of the stomach), allowing acid to rise into your oesophagus [see https://www.ncbi.nlm.nih.gov/pubmed/15591498]. Not only does this cause acid reflux and make you miserable, it’s also correlated with a higher incidence of oesophageal cancer (linked specifically to eating red meat) and stomach cancers (linked specifically to eating poultry) [see https://www.ncbi.nlm.nih.gov/pubmed/18537156].

On the other hand, diets high in fiber have been found to be protective against acid reflux [see https://www.ncbi.nlm.nih.gov/pubmed/23477993].

So here are my top tips for getting rid of acid reflux:

1.) Minimize fat intake (strive for just 10% of your calories coming from fat)
2.) Load up on fiber (aim for 30+ grams per day)
3.) Take your time; chew your food well and eat slowly to avoid accidentally overeating
4.) After you’ve eaten give yourself plenty of time to digest your food before lying down

If you follow these faithfully, there’s a good chance you’ll experience significant improvement in a matter of weeks.