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Taking Control of IBD


Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease is just what it sounds like--inflammation in the gut. Ulcerative Colitis (UC) and Crohn's Disease are both types of IBD. UC only involves swelling in the large intestine, while Crohn's can affect any part of the gut. Unfortunately, there is no cure for IBD, but with lifestyle change and medication (if needed) it is possible for most people with IBD to live normal lives.

NOTE: If you're just interested in non-medical strategies for treatment of IBD, please see the "What I Can Do" section at the bottom of this page.

Questions from Patients with IBD:

1. 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?

2. 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?

3. 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?

4. With risks of immune suppressing medication including risk of bacterial or viral illness, what can I do to avoid taking these medications?

5. 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?

6. 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?

Responses to IBD Questions:

1. 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.

2. 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 Can I do" section toward the bottom of this page.

3. 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.

4. 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.

5. 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.

6. 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 fight alone! There is power in numbers!

What I Can Do:

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, almond or coconut 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

Other Considerations:

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

On the Horizon:

Keep an eye out for further research on:

  • Role of omega 3 fatty acid

  • Benefits of limiting sugar intake

  • Is it worth trying other nicotine based strategies?

References & Other Resources:

Basic information about inflammatory bowel disease.

http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.html Excellent resource on nutrition for different medical conditions. It’s meant for physicians and other medical professionals so the medical terminologies may put you off. But if you can handle it, it’s worth having it for reference on a wide array of medical conditions. Nutrition Guide for Clinicians, 2nd edition. For those without any gluten allergy Barley may provide some benefit. Check out the ways you can do some barley! http://www.wholefoodsmarket.com/blog/whole-story/give-your-body-beautiful-boost-barley Engaging vlog of the role of nutrition in ulcerative colitis by Dr Michael Greger. http://nutritionfacts.org/video/preventing-ulcerative-colitis-with-diet/ Nicotine replacement strategies under investigations http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014383/ Role of stress in relapse of inflammatory bowel diseases

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774724/ Resource on finding a support group for ulcerative colitis patients. http://www.ccfa.org/living-with-crohns-colitis/find-a-support-group/?referrer=https://www.google.com/

#UlcerativeColitis #UC #CrohnsDisease #InflammatoryBowelDisease #IBD #mesalamine #sulfasalazine

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