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Gutsy Moves: Inflammatory Bowel Disease and How To Manage it


Inflammatory bowel disease (IBD) refers to multiple conditions that result in repetitive occurrences of inflamed tissue throughout the gastrointestinal (GI) tract. The inflammation is due to an abnormal immune response, ultimately triggered by diet and environmental factors. IBD is acknowledged worldwide, but Canadians surprisingly have some of the highest rates of IBD in the world. From 2002 to 2023, the IBD occurrence went from 400 per every 100,000 people to 825 per every 100,000, meaning over 320,00 Canadians are living with IBD today. IBD is projected to rise to 470,000 of the total Canadian population by 2035 (Coward et al., 2023). IBD predominantly occurs in teenage to early adult years, ages 15- 30, but 25% of IBD is projected to occur during adolescent years or younger (McDowell et al., 2023).



There is not a single cause of IBD, but genetics can play a role for people who are diagnosed with it. People with particular genetics, coupled with exposure to environmental factors, poor nutrition and lifestyle habits, have an increased risk of developing IBD. These environmental factors can also manipulate a person’s gut microbiome by increasing “bad” bacteria and decreasing healthy bacteria, which increases inflammation in the gut. Traditional medicine usually involves high-risk medication and surgical approaches to treat IBD. However, many people have shown remarkable improvements and even remission from utilizing Eastern medicine and a holistic approach. An IBD diagnosis can be daunting, but with lifestyle changes, including proper nutrition targeting anti-inflammation, rebalancing the gut microbiome, reducing Western diet foods, and eliminating environmental toxins, we can find healing, and we highlight all the ways to go about this in this blog!


GI Tract Pathway and Functions

Gut Microbiome

Our gut and body have millions of microorganisms living in it. There are helpful microbes, harmful microbes (pathogens) and neutral microbes. Harmful microbes can bring on infection and trigger the inflammatory response, whereas healthy microbes help us digest food and get the nutrition our body needs. These healthy microbes are known as probiotics. Foods that are rich in probiotics are fermented and can consist of:


  • Kimchi

  • Yogurt

  • Kefir

  • Sauerkraut

In order for probiotics to thrive in the gut, these microbes also need to be fed, and they get their fuel from prebiotic microbes:


  • Onion

  • Garlic

  • Bananas

  • Asparagus

  • Ground flaxseed

  • Seaweed

Neutral microbes do not hurt us, but if our environment changes in our gut, neutral microbes can change into harmful microbes. Examples of these harmful microbes are:

  • H.Pylori

  • Candida

  • C. Difficile

  • E. Coli

Mouth and Esophagus

We break food down in our mouth, and digestive enzymes in our saliva start to digest it further. Food flows down the esophagus, passing through our lower sphincter into the stomach.

Stomach

In the stomach, our food is held and mixed with strong digestive enzymes, breaking it down into usable forms of energy. The stomach’s environment is very acidic, and most microbes cannot exist in this environment, but one exception is H.Pylori. H. Pylori can be very difficult to eradicate from the stomach and can be the cause of peptic ulcers and stomach cancer. Some people go without having symptoms of H.Pylori in the stomach, but others can have symptoms of:

-Abdominal burning pain

-Bloating

-Nausea

-Lack of appetite

-Trouble breaking down protein


Traditional treatment of H.pylori is with antibiotics, but H.pylori can even outsmart this. Healthy bacteria from probiotics in the stomach can help create a more robust environment for antibiotics to work. It can even prevent H. Pylori from inhabiting the stomach in the first place. H.pylori can also lead to decreased stomach acid, known as Hypochlorhydria. Stomach acid contains enzymes that help digest foods, eliminate bacteria and viruses and provide mucus that protects the stomach lining. With low stomach acid, the stomach does not thrive in its functions and can lead to an array of issues, from damage to the stomach to infections and chronic illnesses. Symptoms of low stomach acid are:

-Bloating

-Burping

-Heartburn

-Gas

-Nutrition deficiencies

-Fatigue

-Less digestion of foods

Aside from H.pylori, low stomach acid can also be caused by aging (+65), stress, ongoing medication use, smoking, stomach surgery and low zinc and B vitamins intake. Larger foods enter the small intestine more than usual when less food breaks down due to a lack of stomach acid. Larger foods can feed harmful bacteria and lead to extra harmful bacteria in the small intestine. An imbalance of harmful bacteria to healthy bacteria can lead to other health conditions, including Small Intestinal Bacterial Overgrowth (SIBO).


Small Intestine


From the stomach, food moves through the lower sphincter into the small intestine, which has three sections from start to finish: the duodenum, the jejunum and the ileum.

The duodenum breaks down the food content with enzymes provided by the liver, bile duct and pancreas. The jejunum and ileum are responsible for reabsorbing the broken-down nutrients into the bloodstream and delivering them to the liver to be processed and stored. In this part of the digestive tract, SIBO can occur when the healthy and unhealthy microbes are not balanced. Unhealthy microbes outweigh the healthy and start to feed on the food content from the stomach. More digestion from unhealthy microbes results in more digestive byproducts and fermentation of the content, creating more gas. SIBO can be caused by:

-Decreased gastric acid in the stomach, bringing less digested food and bacteria into the small intestine

-H.pylori infection

-Stomach surgery

-Gastroparesis

-Prolonged use of medications like antibiotics, narcotics, and gastric acid suppressants

SIBO symptoms:

-Abdominal pain and distention

-Nausea

-Bloating

-Gas

-Diarrhea

-Constipation

Large Intestine (Colon)

-Any content not reabsorbed by the end of the small intestines is passed to the large intestine and considered waste.

-The colon starts with the cecum and moves into the right ascending colon, the transverse colon (across), the left descending colon, and the sigmoid colon.

-The colon removes excess water from stool so it can then be stored in the sigmoid before it is emptied.

Rectum

-Connects the colon to the anus.

-Holds stool until it is safe for the person to have a bowel movement.

-When the rectum receives stool or gas, it tells the brain it is time to have a bowel movement

IBD: Diagnoses

  • Ulcerative Colitis

  • Crohn's Disease

  • Celiac disease

  • Leaky Gut Syndrome

Ulcerative Colitis & Crohn's Disease

Ulcerative Colitis (UC) and Crohn's Disease (CD) are the two main conditions of IBD. Both consist of chronic irritation, inflammation and ulcers in the GI tract—the difference lies in the location and the severity of the symptoms.


UC & Crohns

Symptoms & Characteristics

-Abdominal pain

-Cramping

-Diarrhea

-Rectal Bleeding

-Blood in Stool

-Weight Loss

-Decreased appetite

-Fatigue

-Fevers


Risk Factors

Complications

Ulcerative Colitis

Symptoms & Characteristics

-Urgency and rectal bleeding/ bloody diarrhea are more common in UC

-Mucus in stool

-Risk is equal for men and women for UC

-Medical management practiced is drug therapy (anti-inflammatory drugs, steroids, biological therapies) and surgical intervention (removing part of the colon affected)

-Risk of bowel perforation

-Higher risk for ex-smokers

Risk Factors

Location

Crohns

Symptoms & Characteristics

-Females are more at risk than males

-Sores in the mouth and anus

-Growth failure in children

Increased risk of -Osteoporosis

-At risk for fistulas between organs (passageways), abscesses and sores in the GI tract

-Bowel obstructions, resulting in scar tissue

-Surgical intervention to repair fistulas, remove obstructions and remove scarred bowel tissue

-Increased risk for current smokers


Location

Celiac Disease

Celiac disease is an autoimmune disorder that triggers an inflammatory response when the protein gluten is in the digestive tract. Gluten is in wheat, grains, rye and barley. Gluten can occur naturally but can also be concentrated and added to food to give flavour and texture. Gluten is very sticky, so it is often added to processed food to make them stick together and add shape.

Location

Small intestine When someone has celiac disease, the inflammatory cells are activated when gluten enters the small intestine. Our bodies cannot completely break down gluten, so when it comes into the small intestine, someone with celiac disease’s body reacts by wanting to destroy it. The small intestinal cell lining becomes compromised during this process. The cell lining becomes manipulated, and this damage changes shape, decreasing surface area and nutrients' reabsorption.

Risk Factors

Symptoms


Leaky Gut Syndrome

Our intestinal walls contain semi-permeable membranes, meaning some material can get in and some can get out, but there are restrictions. Our intestinal walls have tight junctions that control the material passing through. Leaky gut syndrome refers to these junctions being more permeable or very permeable, impairing nutrient and waste absorption and excretion. Large gaps, typically in the small intestine, allow waste products or toxins to reabsorb back into our system, which can trigger an inflammatory response.


Risk Factors

  • Autoimmune diseases (diabetes, arthritis)

  • Chronic inflammatory states (UC, CD, Celiac disease)

  • Asthma

  • Alcohol and drug abuse

  • NSAID overuse

  • Chemotherapy and radiation therapy

  • Diet (food triggers)

  • Stress

Symptoms


Nutritional Factors and IBD

We know that diet can significantly increase the risk of acquiring IBD, but once diagnosed with IBD, certain foods can trigger flare-ups, and certain foods help reduce them and stay in remission.

The Standard Westernized Diet (SAD) and Its Impact on IBD

Research has shown that the Westernized diet contributes to the development of IBD and is responsible for its rapidly growing rate of diagnosis. Our gut microbes are influenced by diet, and the Westernized diet allows for greater consumption of less nutrient-dense food. Our bodies are not receiving enough nutrition through this diet, and more specifically, our helpful microbes are not, which makes them weak, creating an imbalance between them and harmful microbes which hinder the gut's overall function.


Characteristics of the Western Diet:

  • Low fiber

  • High saturated fat

  • Refined sugar

  • Refined carbohydrates

  • Refined grains

  • Processed foods

Typical Western Diet Foods:

  • Prepackaged foods

  • Fried foods

  • Red Meat- beef, lamb, pork, veal, venison

  • Pasta, bread, pizza dough, cookies, cereals

  • High-fat dairy- full-fat milk, butter, yogurt, cream

  • Processed meats- deli meats, bacon, hot dogs

  • Sugar drinks- Pop, juice concentrates

  • Candy

Food Irritants of IBD

When diagnosed with IBD, understanding what food triggers create a flare-up or irritate a flare-up further should be understood so one can avoid them. Although we can generalize food irritants for IBD, certain foods can affect a person more or less than another. When living with IBD, a person will learn what foods work for them and which ones do not.

Trigger Foods During A Flare-Up

  • Fibre: When the bowel is inflamed, it is narrower, so during this time, fibre should be avoided as it can bulk up the stool and irritate the bowels further or even lead to an obstruction. During flare-ups, avoid fibrous foods like:

  • Breads, cereal, granola bars with bran and whole grains

    • Whole Nuts and Seeds

    • Raw fruits and vegetables like tomatoes and red peppers

  • Fats: “Bad” fats containing linoleic acid and “fat-free” foods containing emulsifiers should be avoided during a flare-up as they can increase inflammation in the gut and are hard to digest. These include:

    • Red meat

    • Lard

    • Margarine

    • Seed oils

  • Trans fats also increase inflammation and should be avoided:

    • Highly processed, fatty, fried and greasy foods

  • Lactose:

Lactose can be harder to digest for some than others, even without IBD. Some people do not have enough lactase enzymes to break down lactose, so they are intolerant. During an IBD flare-up, lactose could irritate it further. Liquid lactose products like milk are more irritating than hard cheese or yogurt.


Drinks:

  • Alcohol

  • Orange juice

  • Caffeine - Soda

  • Sports drinks with high sugar content

  • Spicy foods

  • Corn and snack foods made with corn

*The foods listed above are to be avoided during flare-ups but not for the long term. Well, not all of them! Removing inflammatory foods like 'bad' fats and ultra-processed foods listed is a way to keep the body healthy and prevent illness, but having good fibre intake in the diet is also a way to do this.

Ways to Start Healing There are many potential culprits to IBD, and everyone will have a different starting point. A good place to start is with fundamentals: diagnostic testing, nutrition, supplements, physical activity, stress management, and optimal Sleep.

1. Testing for IBD

Find a trusted certified nutritionist or holistic gut & hormone specialist who can provide you coaching and supportive care. When testing for IBD, tests can start with non-invasive measures and move to more invasive measures:

Blood Testing

  • CBC- when investigating IBD, a total blood count can show if the white blood cell count is high, indicating an inflammatory response is happening. It will also show if the red blood cell count is low, which with IBD could indicate bleeding from the inflamed bowel tissue or malnutrition as nutrients are not being absorbed. It could result in anemia when a person is not getting enough iron.

  • Iron level -Iron is a mineral in the blood that allows hemoglobin (oxygen-carrying protein in the blood) to bind to the red blood cell. Low iron levels can indicate bleeding or inflammation.

  • Ferritin Level- Ferritin is a blood protein that binds to iron; low levels can indicate low iron storage, anemia, or bleeding.

  • Folic Acid level - Folic acid is needed to make red blood cells, white blood cells and platelets. Low levels can cause diarrhea.

  • Vitamin B12 level- Vitamin B12 is needed to make red blood cells. Low levels can indicate anemia and bleeding.

  • C-Reactive Protein (CRP)- CRP is a protein released during an inflammatory response from the liver. High levels indicate inflammation in the body.

Gi Stool Testing **A good place to start!

Endoscopic Testing

2. Improve diet

Although focusing on a specific diet can feel restricting and disempowering, knowing this does not have to be forever is motivating. Taking the time and effort to let the gut heal through certain foods and food restrictions can later let one reintroduce previous food triggers without inflammatory reactions. Everyone is different, and the process and length of time it takes for healing from one person to another varies, but just know that it is possible to heal on your journey!

Foods to Improve Flare-Up Symptoms

During a flare-up, one should eat foods that are easy to digest.

  • Fibre: Fibre should be avoided during a flare-up, but it should be consumed during remission as it brings nutrients into the bowels and helps aid in regular bowel movements, increasing one’s overall health

  • Fats: Monounsaturated fats that are easily digestible and foods with a good source of Omega-3’s (anti-inflammatory) can help reduce symptoms during a flare-up. Foods like:

  • Olive oil, peanut oil, flaxseed oils (not to be grouped under seed oils)

    • Avocados

    • Cold water fish (salmon & tuna)

    • Eggs

    • Ground flaxseed

  • Proteins: Protein at every meal allows for more calories and nutritional intake during a flare-up *Digestive bitters eaten before meals can help digest and breakdown protein

    • Meats

    • Fish

    • Eggs

    • Beans

    • Lentils

  • Lactose-Free:

    • Lactose-free milk, lactose-reduced yogurt

    • Soft cheeses like cottage cheese and cream cheese

One specific diet that is beneficial is the Mediterranean diet. Countries around the Mediterranean Sea traditionally practice eating this diet. These countries show fewer diseases linked to death compared to North America. The Mediterranean diet consists of:


  • Fruit & Vegetables

  • Whole grains

  • Beans

  • Nuts and seeds

  • Olive oil

  • Moderate consumption of dairy

  • Fish, chicken and eggs weekly

  • Limiting red meat

  • Limiting sugars

3. Supplements for IBD

IBD conditions affect the absorption of nutrients from our gut. When we become malnourished and depleted of our nutrients, we become even more susceptible to illness and decreased immunity. Supplementing these nutrients into someone's diet with IBD will give their body the nutrients their gut cannot reabsorb as it should.



Vitamins and Minerals to Support the Gut

Vitamin/Mineral

Uses

Zinc

Helps the body fight off bacteria and viruses.

Folic Acid

Folic acid helps produce new cells and digest fats and carbohydrates. Folic acid’s role is to help break down foods to give our body more nutrients.

Helps assist with all cellular reactions in the body, and more specifically, it helps with sleep, protein synthesis, hormone production, muscle relaxation, and brain health.

Vitamin D

Helps decrease intestinal inflammation. It is best to get from the sun, but when taken as a supplement, take it with calcium and potassium food sources or calcium and K2 supplements.

Vitamin E

Contains antioxidant properties and may help gut health by reducing oxidative stress, supporting the immune system, and having anti-inflammatory effects. It can positively affect the integrity of the mucous membranes in the gastrointestinal tract.

Essential Fatty Acids (EFA)

DHA is an omega-3 fatty acid with anti-inflammatory properties and can help reduce inflammation during an IBD flare-up.

CAlcium D-Glucarate

The liver is an essential organ involved in detoxification, and some research suggests that calcium D-glucarate may promote liver health by supporting its detoxification function.

NAG

Helps heal and build mucous layers of the gut, and some research suggests that it may help support the health of the gastrointestinal tract.


Curcumin

Curcumin contains anti-inflammatory and antioxidant properties. Research has shown that curcumin can help reduce IBD flare-ups and help remain in remission from IBD.

Boswellia Serrata

This extract can target different immune cells and help reduce inflammation during flare-ups.

Aloe Vera Gel

Aloe vera gel also has anti-inflammatory properties. It can be taken orally, through a capsule, extracts, or in juice, or applied topically to the stomach during a flare-up.

4. Physical Activity Physical movement allows for increased blood flow and energy burning within our bodies. When we think of physical activity and health promotion, cardiac health and diabetes usually come to mind. Blood pumping through our bodies during physical exercise keeps our vessels clean, preventing heart disease and strokes. Exercise also allows blood sugar to be burned as energy and stored in our muscles, which decreases our blood sugar levels, increases insulin resistance, and decreases our risk of diabetes. Good blood flow throughout our body also allows optimal oxygen to be supplied to our gut, letting it perform all its functions adequately, leading to a healthy environment.

5. Stress Management High stress results in our bodies releasing cortisol into our bloodstream. Cortisol turns on the body's fight-or-flight mode. Our body feels in danger in times of high stress, so blood is shunted to where we need it the most to survive an emergency, like our heart, lungs, and muscles.

Blood flow is shunted away from our digestive tract during times of high stress. Rest and digest mode refers to our body being in a calm state, and this is when the blood is optimally supplied to our gut, therefore, when our gut and its functions can flourish. Stress increases the chances of digestive issues and potentially IBD when the gut is not getting enough oxygen that it needs to perform its functions.

6. Optimal Sleep Getting optimal sleep is imperative to health, as sleep is when the body’s cells heal. Having a lack of sleep results in cells not recuperating from their daily functions, becoming worn out, and not functioning correctly, leading to degeneration, illness, and disease. More specifically, the gut and the brain have a strong connection. The gut operates similarly as our body’s hormones fluctuate throughout our circadian rhythm (night and day cycles). Our gut microbiome can communicate with the brain, influencing mood, appetite and stress. Having enough sleep not only helps our microbiome function optimally within the gut, but it also plays a part in helping other parts of our daily processes.

By taking these steps you can heal your gut and live a life of food freedom. Written By: Lauren O'Malley, RN Edited By: Bree Lowry, BKin


If you are in need of supplement support, lifestyle habit rejuvenation, strength training, mindset or nutrition, please reach out and connect with us for a free 20-minute journey call!


*This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, website or any linked materials are not intended and should not be considered or used as a substitute for medical advice, diagnosis or treatment.*

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