IBD: Inflammatory Bowel Disease

Not to be confused with IBS this is an autoimmune condition that can be severely debilitating. IBD can be further classified into Crohn’s Disease CD, or Ulcerative Colitis, UC. This overly aggressive immune response by the body causes damage to the gut mucosal lining. A characteristic symptom of IBD is blood in the stool/rectal bleeding which is why if you experience this it’s important you get this checked out by your GP ASAP.

The main difference between the two is that CD affects any part of the whole digestive tract (but usually targets the terminal ileum) with the breakdown of the lining causing holes right the way through, whilst UC is located in the rectum/colon only, and causes only the top layer of the gastrointestinal tract to be damaged, forming ulcers.

The cause is not fully understood, but its known to be a mixture of genetics, a confused immune response by the body, and environmental triggers (including smoking, alcohol, the oral contraceptive pill, antibiotics, paracetamol/ neurofen, infections etc).

IBD Is characterised by ‘flare-up’s’ of symptoms that come and go. Including urgency for the toilet, diarrhoea, rectal bleeding (often quite severe), abdominal pain (usually on the right hand side for CD, & left in UC). This in the end may lead to complications like severe weight loss, nutritional deficiencies (as you’re not able to digest your food properly) - B12 deficiency most notably, osteoporosis, anaemia, obstructions/fistulas, haemorrhage, and in some cases colorectal cancer.

One diagnostic test for IBD includes a blood test looking at C-reactive protein CRP, which is a marker of inflammation in the body, showing very high results of 500-600+.

Interestingly, stool tests of IBD patients show a different breakdown of gut bacteria. Much less diversity is seen (remember we want as many different good species as possible - hence, eat the rainbow), with much higher levels of pathogenic bacteria such as E coli present, and much lower levels of Short Chain Fatty Acid, SCFA producing bacteria. SCFA’s like butyrate are food for our gut cells, and so without this, the gut lining is weaker and the gaps between cells are larger, meaning more toxins can get through from the gut into our blood stream causing further systemic inflammation.

From a TCM perspective, IBD comes from ‘liver qi stagnation’ which comes from too much red meat, alcohol and bad fats (trans-fats/veg oils etc) creating an excess of arachidonic acid in the body, or in TCM terms: heat or dampness in the gut. From an emotional perspective, this can also be related to repressed anger.

See here for what I’ve written about dampness:

Most treatment options in the western world include going on harsh immunosuppressants and anti inflammatories, often prescribed for life, and sometimes ending with surgery that removes part of the bowel. Many people live on steroids for life, but they do cause damage to the body, even if it’s not immediately noticeable - corticosteroids for example, are a huge causative factor of osteoporosis, literally weakening your bones.

What is the naturopathic approach? It’s hard to give a generalised plan as everyone’s individual triggers are different, but here are some tips/foods which might help, mostly things that lower inflammation, which is the real problem - I’ve given the explanation too so you can adapt/include for yourself accordingly! Please do NOT stop taking your medication nor add in supplements without supervision of your doctor, but also know that you may be able to live a completely normal life, free of flare up’s and medication if you give it a go

What to add in:

- Chew food well, don’t overeat, try and practice mindful eating. The more you chew the more your stomach acid + enzymes are secreted, and the more coated in saliva the food is, meaning the better you digest it.

- WELL cooked, HOT foods: soups, stews, broths are nourishing and easy to digest. A slow cooker is your new best friend. Raw, cold foods irritate the gut and are harder to digest, your gut is having a hard time, make life as easy for it as possible.

- During a flare up (especially in CD) try and go for low FODMAP foods (google these), FODMAP foods ferment in your gut, making flare ups worse.

- A vegan diet is generally less inflammatory, certainly avoiding red meat is beneficial. If you do eat animal products please make sure to go for organic + free range.

- Bone broth - If you’re not 100% veggie/vegan I urge you to include this as your one exception. Make it yourself, its really easy, and only please from organic meat/chicken/fish. it contains collagen and glutamine (literally helping heal your gut lining) and is full of nutrients that are super easy to absorb/digest.

- Optimise your omega 3 levels. Omega 3 is HIGHLY anti inflammatory. If you’re vegan/veggie then get supplements (they have vegan ones made from algae), if you’re not, I’d probably still go for supplements as these days even wild fish is full of heavy metals and other crap. I like bare biology fish oils they are by far the best on the UK market.

- Support your struggling mucosal lining with demulcents such as a combination of: slippery elm 50%, marshmallow root (30%) and liquorice root (20%) powder – 1tsp 3 x day btwn meals in water. MAKE sure to be well hydrated with this & take it away from any medication or it can lower your absorption rate. You can find them as supplements/powders or teas.

- Flax seeds: lower inflammation, help bulk stools etc.

- Green juices (VEG NOT FRUIT), but add berries and I’d rather the vegetables were cooked rather than raw, but the chlorophyll in vegetables and anti oxidants will help lower inflammation.

- Pomegranates - ellagitannins in pomegranate inhibit growth of pathogenic bacteria + promote growth of beneficial gut bact. Punicic acid in pomegranate seed oil decreases intestinal inflam.

- Vitamin D - yes, it’s summer, but… most of us live in England. Our weather is shocking. Take a vitamin D (with K2) supplement daily. This stabilises the cell junctions of the gut, regulates gut inflammation and supports getting that diversity of gut bacteria up. Low VitD levels have been massively associated with IBD + flare ups.

- Probiotics are great but NOT if you are on immunosuppressants or during an active flare up so caution here please.

- General anti inflammatories: ginger, turmeric (with black pepper), camomile teas. You could try curcumin (the active ingredient in turmeric) supplements.

- Aloe Vera helps reduce gut inflammation/ulceration, is anti-inflammatory & speeds up would healing generally. Make sure it’s not pasteurised and check as some contain laxatives (its generally a mild laxative).

- Lions mane and chaga mushrooms (1g of one/each x 3times/day) - caution if taking immunosuppressants - contains beta-glucans, anti inflammatory, anti oxidant rich, anti viral, immune regulating generally and prevents cytokine storms (the over reaction of the immune system that damages healthy tissue which occurs in conditions like UC). You can find online powders, tinctures etc that can be added to smoothies/juices/soups!

- Eat cabbage, cauliflower, spinach, seaweed, spirulina, chlorella and kale. They contain glycine an amino acid which helps make collagen for repairing your damaged gut. Raw cabbage juice during a flare up with UC helps repair ulcers.

- Green tea, maybe the only caffeine I’d have and in small amounts. Its super anti inflammatory and contains a lot of anti oxidants.

- Up your water intake generally. Being dehydrated is going to make it all worse.

Supplements to think about/speak to your doctor about:

- Vitamin D daily (better you vitD + K2 spray daily)

- Cysteine (2x 600mg/day)

- Zinc (supports rapidly dividing cells like in intestine)

- Glutamine (what you get from cabbage juice, but can take as a supplement)

- Phosphatidycholine (106g/day, divided doses)

- N-Acetyl Glucosamine (6g/day - divided doses) supports the gut lining by helping increase mucin levels.

- Think about getting your nutrient levels checked, and think about supplements, it’s likely you are low in B12 (especially in CD as the area most affected, is the area where B12 is usually absorbed) and potentially folate, iron, zinc, Calcium, potassium, magnesium and vitamins A,D,E and K (as these are the fat soluble vitamins).

- Bare biology omega 3.

What not to eat:

- Remove vegetable oils from your diet (they become toxic when heated, and generally are very processed - they are inflammatory and will worsen your issues). Olive oil is your friend. Try to cook on non stick pans with no oil and drizzle organic extra virgin olive oil on top, it’s super anti inflammatory + full of anti oxidants.

- Stop smoking. We all know smoking is bad. For you, it’s really, really bad. It’s a 100% known trigger and worsens symptoms. There are a LOT of studies showing correlations.

- Remove gluten and refined sugar (all white carbs - go brown!), even if you are not coeliac, gluten is inflammatory.

- Caffeine and alcohol are not your friends. Even if they don’t cause a flare up each time, they are adding to the problem. Chicory tea is a great alternative and DOES taste like coffee.

- Work on your stress levels… easier said than done, but it’s a known cause of flare ups. Stress (cortisol) = inflammation, it’s really that simple.

- Don’t eat dairy, this is especially true for UC, this causes flare ups and inflammation.

- Don’t. take. NSAIDs. (Paracetamol, Neurofen etc). They might help stop pain, but they really mess with your gut.

- Maltodetrin/binding agents - found in a lot of supplements/meds - make sure to check yours don’t have this in.

- Also, E466 and E433 (generally E400’s) and any sulphur containing preservatives/emulsifiers (eg sulphur dioxide found in dried fruit and sulphites found in wine), these can form hydrogen sulphide in your gut and is linked to UC development... also are made from the metabolism of animal protein (opt for organic to lower levels if you eat meat) Really just try go organic/home made and you won’t need to worry about this one!

Hope some of these tips help!