Inflammatory Bowel Disease
There are a group of conditions that are classified as Inflammatory Bowel Disease. IBD shares many of the same symptoms of IBS, but they are very different problems. The majority of cases are Crohn's disease and Ulcerative colitis (UC). The main distinction between the two is the location of the disease and the nature of the inflammation. Risk factors may include genetics, smoking, and "Western" diets. Lifestyle, medications and stress have been a key factor in many cases. Symptoms run from mild to severe, and include abdominal pain, bloody stools, diarrhea, cramping and fevers. If you suspect you have IBD you should consult with your doctor immediately.
Crohn's Disease & Ulcerative Colitis
It is not certain why people have IBD, but it has been linked to the immune system and is considered an autoimmune disorder, or defined by Mark Hyman, MD as, “a runaway immune response also known as systemic inflammation that results in your body attacking its own tissues.” Unable to differentiate between its normal body tissue and offending foreign invaders results in an accumulation of white blood cells in the digestive tract, causing chronic inflammation of the gastrointestinal tract. It is associated with an increased frequency of colon cancer, so if you have symptoms that match IBD, it is imperative you meet with your doctor to discuss. Crohn's disease manifests anywhere from the mouth to the colon, though is most common in the small intestine and colon. Ulcerative colitis is an inflammation of the colon and/or rectal lining.
- Abdominal pain/tenderness (lower right side for Crohn's - lower left side for Ulcerative colitis)
- Bloody stools
- Mucus in stools
- Joint pain
- Fever; potentially very elevated
- Colon disfigurement
- Mouth ulcers
- Rectal Pain
- Weight loss/Anorexia
- Chronic fatigue
- Failure to thrive in children
In Crohn's disease, people often experience fevers that last one to two days, canker sores and gastrointestinal inflammation. The symptoms usually come and go, and it goes more deeply into the tissues than ulcerative colitis, causing ulcers. Abscesses and fistulas can form over time, leading to other organs, in which case surgery may be recommended.
In Ulcerative colitis, an incessant inflammation of the mucosa lining of the colon and rectum can cause sores, but they are generally milder and easier to treat than Crohn's, much to do with their location. Ulcerative colitis may be more intermittent, including flare-ups and remissions.
- Parasites & infections
- Hereditary: at least 11 genes have been identified in IBD
- Smoking - high correlation with IBD
- High sugar diet
- Low vegetable & fruit diet (fiber)
- Food allergies & sensitivities may exacerbate
- Stress worsens clinical course of IBD
A relatively recent medical article posted here for current concepts of pathogenesis of IBD. It's dense, but comprehensive for those interested.
There are a number of tests that can be ordered by your doctor to help determine if you have IBD:
- Colonoscopy: camera used to examine the colon
- Flexible sigmoidoscopy: examines lower part of the colon (sigmoid) with a flexible, lighted tube
- Computerized tomography (CT) scan: scans the abdomen and pelvis to rule out other issues
- Lactose intolerance test: to find out if lactose intolerance is the cause of symptoms
- Blood test: rules out celiac disease
- Barium enema: X-ray of the large intestines
- Complete Blood Count (CBC)
- Upper GI series and/or a stool culture (rule out other possible causes - parasites, etc)
The Institute for Functional Medicine defines functional medicine as personalized treatment that deals with primary prevention and underlying causes instead of symptoms for serious and chronic disease. It is a science-based field of health care that follows a set of principles; focusing on each person's biochemical individuality.
A functional assessment will look at your particular system and review your medical history. Have you taken many rounds of antibiotics or anti-depressants? These can very seriously compromise your beneficial gut flora and you must restore what they have diminished or destroyed. Make sure to pay attention to all side-effects of any drugs you may be taking, or have taken in the past. Some symptoms can be a result of medications. Were you traveling or working with animals or children and particularly susceptible to parasites? Parasites are a very common cause of IBD. Do you have undiagnosed food allergies, or have you ever attempted or completed an elimination diet? Have you kept a food diary before? You can get to the bottom of these questions with the assistance of a nutritionist or health professional. You and your nutritionist may decide to use a Comprehensive Stool and Digestive Analysis test, which can help you determine the root of your problems. The CDSA and an elimination diet are two powerful tools to use in determining the cause of IBD, but it's imperative to simultaneously work with your doctor.
There is no known cure for IBD. You may experience periods of improvement followed by flare-ups. You are at a higher risk for colon cancer if you have IBD, so be adamant about determining your choice of treatment. Aminosalicylates are medicines that are often prescribed to control symptoms. Corticosteroids, such as Prednisone, create steroids that are normally produced in a healthy system. Antibiotics, including Metronidazole and Cirpofloxacin are also utilized by allopathic doctors. If traditional medicine does not work, some with Crohn's could end up requiring a bowel resection or ileostomy surgery; however, this does not cure the condition and is far from an ideal situation. These are all things to be discussed with your doctor. There are certain medications, such as Accutane, that have been linked to contributing to many digestive disorders including Crohn's and Ulcerative colitis, so evaluate your past and current medical history.
The medications and surgeries mentioned above may not provide long lasting relief, and in some cases, have been known to aggregate the condition. Whether or not you're on medication, you should try to get to the root of the problem. Genetics play a role, so you may need to recognize that and work with your body with better lifestyle and dietary choices. Nutrition is extremely important in IBD. Choosing to eat smaller meals throughout the day has been shown to help people with digestion. Because IBD is an autoimmune disorder, you may want to remove gluten from the diet, as it has been associated with autoimmune conditions. The body can have a very difficult time with the protein found in glutinous grains, however not everyone with autoimmune disorders is affected by gluten. When you eliminate gluten you must do it 100% or you will have chronic low levels of inflammation; this can initially be a daunting task for people. Check out my gluten page on how to do so and hidden gluten sources, such as soy sauce.
Patients are often told to avoid fiber rich foods, but there is some debate about that, or at least, the source of the fiber. It has also been recommended to eliminate dairy products. Many people have shown major improvements on a Specific Carbohydrate Diet, which is gluten, casein, dairy and refined sugar free, based on the book Breaking the Vicious Cycle. It's similar to the "Paleo Diet," in that it recommends consuming only meats, fish, nuts and low-sugar fruits and vegetables that were eaten prior to the introduction of grains, over 10,000 years ago. One study found that people with Crohn's are most likely to react to cereals, dairy and yeast. Clearly, it's a complicated challenge to find out what's triggering your IBD symptoms. For some people it's dairy, for another it's yeast. I would suggest anyone with Crohn's to work with a nutritionist, do an elimination diet and closely track what is triggering symptoms.
Mark Hyman, MD, has done extensive research on autoimmune disorders and cooling the inflammation in our body. Check out this article and read his 9 steps to treating autoimmune disease, naturally.
Following the 4 R Protocol will help the healing process of the digestive tract once you have determined what is causing flare-ups. Be dedicated to taking probiotics and digestive enzymes as well. Head to my healing page for further information regarding supplements and herbs that can soothe the condition.