Inflammatory Bowel Disease

There are two main conditions that affect the intestines with inflammation as the primary sign of intestinal disease: Crohn’s disease (CD) and Ulcerative colitis (UC). CD is a severe form of colitis that involves chronic inflammation of any part of the gastrointestinal tract from the mouth to the anus – although it usually occurs at the end of the small intestine. UC is a form of colitis that is characterized by chronic inflammation and ulceration of the lining of the large intestine and rectum. UC is generally in the rectum or sigmoid colon and then spreads partially or completely through the large intestine. It does not affect the small intestine.

The cause of these diseases is unknown, it may be a response to infectious organism or perhaps genetic – but now both are regarded as autoimmune diseases. Autoimmune diseases are conditions where there is a problem the immune system, it does not function properly. Our body’s immune system is designed to correctly identify and differentiate between self and nonself—that is, between the cells of our body and what is foreign to it, like a microbe. In these conditions the immune system specially attacks the cell of the intestines.

Both conditions are chronic, and some people may opt for surgery. In UC there is an increased risk of colon cancer, so early detection and treatment is important.

Symptoms of IBD

Symptoms of both conditions have a similar pattern although they effect different locations. Both are characterized by chronic inflammation of the gastrointestinal tract, which can cause abdominal pain and cramping. Diarrhoea that may contain mucous and blood is always present in UC (especially during flare ups), and common in people with CD as well. In some cases the colon may have such problems as nausea and vomiting, with or without a fever. Because of these conditions involving the immune system, there are frequent symptoms outside of the digestive area such as joint pain, inflammation of the in the eye, ores in the mouth and skin conditions. A serious problem is fatigue, weight loss and deficiencies due to malabsorption of vitamin (especially fat soluble vitamins), minerals and essential fatty acids.

Lifestyle and Dietary Modifications

People with IBD are more likely to smoke, and unknown reasons, smokers have a lower risk of UC. The nicotine patch has actually been used to induce remissions in people with UC, although this treatment has been ineffective in preventing relapses. Despite the possible protective effect of smoking in people with UC, a strong case can be made that risks of smoking outweigh the benefits; even the use of nicotine patches carries its own side effects and remains experimental. Smoking is associated with several serious diseases and conditions, quitting is one of the best thing one can do for health.

Alcohol consumption is known to promote folic acid deficiency and has also been linked to an increased risk of colon cancer. People with IBD, especially UC should, therefore, keep alcohol intake to a minimum.

A person with IBD might consume more sugar than the average healthy person, and it is speculated that a high sugar diet can increase the risk getting the disease, especially UC. A high-fiber, low-sugar diet mat led to a reduction in IBD exacerbations when compared to people who consume high amounts of sugar. While details of how sugar injures the intestine are still being uncovered, doctors often suggest eliminating all sugar (including soft drinks and processed foods with added sugar) from the diets.

Many people with IBD have food allergies and do better when they avoid foods to which they are allergic. More than a half-century ago, several doctors reported that food allergies play an important role in some cases of UC and CD. Since that time, many doctors have observed that avoidance of allergenic foods will often reduce the severity of condition and can sometimes completely control the condition. People who wish to explore the possibility that food sensitivities may wish to consult with an appropriate healthcare provider and get a food intolerance test or get help performing an elimination diet.

There is some evidence that people who eat fast foods at least two times per week more than triple their risk of developing Crohn’s disease, and nearly four times the risk of developing UC, than people who do not eat fast food. This means that reducing the amount of saturated fat and trans-fatty acids can decrease the risk of getting IBD. For example, in studies people with a high intake of animal fat, cholesterol, or margarine had a significantly increased risk of UC, compared with people who consumed less of these fats. Although these associations do not prove cause-and-effect, reducing one’s intake of animal fats and margarine is a means of improving overall health and possibly UC as well. As with many other health conditions, it may be beneficial to eat less meat and dairy fat and more fruits and vegetables.

Nutritional Factors Shown to be Beneficial

Omega 3 fish Oils

EPA and DHA, the omega-3 fatty acids found in fish oil, have anti-inflammatory activity. Fish oil supplementation reduces inflammation, decreases the need for anti-inflammatory drugs, and promotes normal weight gain in people with IBD.
Dose: 2-6 grams a day

Probiotic supplementation

Diarrhoea caused by IBD has partially responded to supplementation with beneficial bacteria Saccharomyces boulardii, Lactobacillis acidophilus, Lactobacillus GG, and Bifidobacterium bifidus. Dose: One to two billion colony forming units (CFUs) per day of acidophilus are considered to be the minimum amount for the healthy maintenance of intestinal microflora.

Multivitamin/ Mineral supplement

IBD often leads to malabsorption. As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with IBD to take a high potency multivitamin-mineral supplement. It should contain fat soluble and B vitamins.
Dose: as recommeded

Vitamin K

In people with IBD, vitamin K deficiency can result from malabsorption due to intestinal inflammation or bowel surgery, from chronic diarrhoea, or from dietary changes necessitated by food intolerance. In addition, Crohn’s disease is often treated with antibiotics that have the potential to kill beneficial vitamin K–producing bacteria in the intestines.
Dose: 1 gram a day

Vitamin D

Since malabsorption is common in people with IBD, bone problems are a risk.
Dose: 1000 IU per day

Digestive Enzymes

People with IBD may be deficient in pancreatic enzymes. By taking digestive enzymes and thoroughly breaking down food particles, deficiencies may be reduced.
Dose: 1-2 capsules with meals

Aloe Vera

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. Cathartic preparations of aloe should be avoided.
Dose: 100 ml twice a day

Bowellia (Boswellia serrata)

Boswellia is an anti-inflammatory herb. Its use has been compared to the medication sulfasalazine, and better results forremission.
Dose: 550 mg three times a day

Antimicrobial Herbs

Herbal antimicrobial therapy to treat pathogenic organisms in the digestive tract can be helpful by decreasing gut permeability and reducing inflammation. Grapefruit seed extract has been shown to be effective against both bacteria and the fungus Candida.
Dose: Grapefruit seed extract 300-500 mg a day Neem is an ayurvedic herb that also is very effective in treating dysbiosis of the digestive tract as well as skin conditions. Dose: Neem 500 mg twice a day.

Diagnosis and Pharmaceutical Interventions

To diagnosis IBD a very through history and examination is needed. To differentiate between the two conditions, more extensive tests and imaging is required. CD can be diagnosed by x-ray, UC by a sigmoidoscopy or colonoscopy. For both conditions it is important to rule out other conditions such as infections.

Pharmaceutical Medication

Although ulcerative colitis and Crohn’s disease appear to be two distinct conditions, the same pharmacologic agents are used to treat both. Strong therapies are used, including 5-aminosalicylic acid derivatives, corticosteroids, agents such as mercaptopurine or azathioprine, methotrexate, and infliximab.

5-Aminosalicylic Acid (5-ASA) is a topically active agent that has a variety of anti-inflammatory effects. It is used in the active treatment of ulcerative colitis and Crohn’s disease and during disease inactivity to maintain remission. Commonly used formulations of 5-ASA are sulfasalazine, mesalamine, and azo compounds. Sulfasalazine may cause side effects in 15–30% of patients. Dose-related side effects include nausea, headaches, leukopenia, oligospermia, and impaired folate metabolism. Allergic and idiosyncratic side effects are fever, rash, haemolytic anaemia, neutropenia, worsened colitis, hepatitis, pancreatitis, and pneumonitis. Despite its side effects, sulfasalazine continues to be used because it is significantly less expensive than other 5-ASA agents. It should always be administered in conjunction with folate. Oral mesalamine agents have uncommon side effects of but include nausea, rash, diarrhoea, pancreatitis, and acute interstitial nephritis. Eighty percent of patients intolerant of sulfasalazine can tolerate mesalamine. Azo compounds are Balsalazide and olsalazine. Compared with mesalamine, there is less systemic absorption of 5-ASA and lower systemic side effects.

A variety of intravenous, oral, and topical corticosteroid formulations have been used in inflammatory bowel disease. Long-term use is associated with serious, potentially irreversible side effects and is to be avoided.

Mercaptopurine and azathioprine are drugs that are used in many patients with refractory Crohn’s disease and, increasingly, in patients with ulcerative colitis. About 1 person in 300 has a genetically acquired complete deficiency of one of the enzymes needed to metabolize these drugs placing them at risk of profound immunosuppression. Allergic and nonallergic side effects of mercaptopurine and azathioprine occur in 10% of patients, including pancreatitis, bone marrow suppression, infections, hepatitis or jaundice, and, potentially, a higher risk of tumours.

Methotrexate is increasingly used in the treatment of patients with Crohn’s disease, especially those who are intolerant of mercaptopurine. Methotrexate was originally used a chemotherapy for cancer, but at low doses it has anti-inflammatory properties. Side effects of methotrexate include nausea, vomiting, infections, bone marrow suppression, hepatitis, hepatic fibrosis, and life-threatening pneumonitis. Infliximab is an immunomodulating agent. Acute infusion reactions (nausea, headache, palpitations, shortness of breath, chest pain, fever, hypotension) occur in 6% of infusions Serious infections may occur in up to 5% of patients, including sepsis, pneumonia, abscess, and cellulitis. Patients treated with infliximab are at increased risk for the development of disseminated tuberculosis as well as other opportunistic infections. Prior to use of infliximab, patients should be screened for latent tuberculosis It is speculated but unproven that infliximab may increase the risk of lymphomas.

Related Blog Posts

Apple cider vinegar

Digesting the Facts #ChewOnThis

With the festive season around the corner and the overindulgence…