Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD)

Dale Pinnock
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Published by
Quadrille Publishing
978 184949 543 1

Inflammatory bowel disease is the umbrella term given to a group of disorders that cause inflammation throughout the digestive tract. The two most common disorders that come under the IBD umbrella are ulcerative colitis and Crohn’s disease. Symptoms of IBD can be any combination of acute or chronic abdominal pain, diarrhoea, unexplained weight loss (this must always be referred to a doctor), reduced appetite, fever and bleeding from the bowels (again this must always be referred to a doctor, no exceptions).

The two conditions, ulcerative colitis and Crohn’s disease, are the most common inflammatory bowel diseases and they are very similar. The biggest difference really is the part of the digestive tract that they affect.

Ulcerative colitis affects the large intestine, although associated symptoms from mouth ulcers to joint problems may also be experienced. This condition causes an inflammation of the wall of the large intestine which gets severe enough for open sores/ulcers to form. These can bleed and in some severe cases get infected and leach pus. This condition can sometimes get so severe that bowel perforations occur, causing peritonitis and demanding immediate emergency surgery.

Crohn’s disease on the other hand can affect any part of the gastrointestinal tract, from mouth to anus. In Crohn’s, there can be areas of aggressive inflammation and scar tissue that can lead to narrowing of areas of the intestine, and there have been cases where this has caused obstruction. The inflammatory damage to the gut wall can span the entire thickness of the tissue, way beyond just superficial surface damage. These lesions can also ulcerate.

There are other rarer conditions that are part of the IBD spectrum. These are collagenous colitis and lymphocytic colitis. As these are rare conditions I won’t deal with them here, but some of the principles below will still be of relevance.

In nutritional terms, it is important to remember that with inflammatory bowel disease, more specifically Crohn’s disease, damage to the digestive tract wall will affect the sites that absorb nutrients and patterns of malnutrition are very common in those that are affected badly by the condition.

Potential causes of Inflammatory Bowel Disease

–Autoimmunity: It is believed that inflammatory bowel disease is an autoimmune condition. This describes the phenomena of the body’s own immune system turning upon itself.

The immune system can develop defensive responses to specific types of the body's own tissues and begin a campaign of attack, by suddenly forming autoantibodies. These are similar to the antibodies that we make against certain pathogens (such as chickenpox) that mean we know what plan of attack to instigate if we are exposed to it again.

As well as this occurring, the regulatory systems that usually keep such mishaps in check begin to fail. In the case of inflammatory bowel disease, this response is hitting the inner lining of the gut and some of the muscular tissue beneath.

There is no one specific cause for autoimmune responses and potential triggers are often the subject of medical debate. Environmental factors may be relevant. Changes in the local environment may trigger an immunological reaction that causes the production of autoantibodies.

There is some evidence that came to light in March 2014 to suggest that patients with Crohn’s disease had lower numbers of beneficial bacteria in the gut as well as higher levels of more potentially harmful flora. It is hypothesised that there may be an immunological response to these more problematic flora, which could be the trigger.

–Genetics: There is certainly a strong genetic element to inflammatory bowel disease. It is believed that there are dozens of different genes that may contribute to the onset of the disorders. As with many issues though, genes on their own are unlikely to be the be-all and end-all. It is the interaction between genes and environment that sets the cascade of disease into motion.

Nutrition action plan for Inflammatory Bowel Disease

–Balance your fatty acids: Fatty acids are fat-derived compounds that are massively important in human physiology. It is an area with which, as any of you that are familiar with my work will know, I am completely fascinated and marginally obsessed. This is because they are such small compounds that can deliver life-altering changes and their intake in the modern world has really gone down the shoot.

Fatty acids come from the types of fats we consume in our diet. Our diets have changed massively over the last 50 years and, in this age of fat phobia, the types of fats we are consuming has changed massively. Why is the type of fat we consume relevant to IBD? Well, fatty acids are actually used by the body to produce a group of communication compounds called prostaglandins that, among other things, regulate the inflammatory response.

There are three different classes of prostaglandin: Series 1, Series 2 and Series 3. Series 1 and Series 3 switch inflammation off and down-regulate it, whereas Series 2 switches it on and exacerbates it. Series 3 is the most potent anti-inflammatory prostaglandin.

Different types of dietary fat are metabolised to form different prostaglandins. The building blocks for prostaglandins come from fats called omega fatty acids. There are several, but the most important are omega 3 – the one that most people will be aware of – and its lesser known cousin, omega 6.

Even though both are important, it is vital that we get the balance right. To cut a long story short, it is important that we get more omega 3 than omega 6.

Omega 6 fatty acids are metabolised to form the powerfully pro-inflammatory Series 2 prostaglandins. Omega 3 is metabolised to form the anti-inflammatory Series 1 and Series 3 prostaglandins. If we consume more omega 6 than omega 3, we will essentially force-feed the metabolic pathways that manufacture prostaglandins that switch on and worsen inflammation.

The opposite, thankfully, is also true. If we consume more omega 3 than omega 6, then we force-feed the same metabolic pathways to make more of the anti-inflammatory Series 1 and Series 3 prostaglandins.

This small, simple change can have a massive impact upon any inflammatory condition. So, in practice, reducing your omega 6 means avoiding vegetable oils such as sunflower oil, plain vegetable oil, corn oil and so on, as these are almost pure omega 6. Avoid processed ready meals, crisps and junk food as these have so many of these oils.

The easiest way to increase your intake of omega 3 is turn to the oily fish, such as salmon, mackerel, herrings and so on. These are not only the richest sources of omega 3, but they also have a high proportion of the most active form, EPA, which is rapidly converted in our bodies to help make the potently anti-inflammatory Series 3 prostaglandin.

Plant sources of omega 3 include flax seeds and chia seeds and walnuts. Do bear in mind, though, that the effects will be much less pronounced and take a little longer to deliver, as the plant form of omega 3 – ALA – requires several steps of conversion before it can become the active prostaglandin. Human beings aren’t overly successful at performing this transformation when the source is a plant, rather than a fish. We maybe convert 10 per cent of ALA that we take in, if we are lucky!

–Probiotics and prebiotics: No matter what the digestive issue, probiotics are always part of the armoury, as they regulate so many aspects of digestive health. However, on some occasions, they can have a very specific targeted function. This is certainly the case with Inflammatory Bowel Disease. It is believed that some bacterial strains may offer a direct localised anti-inflammatory activity.

The main benefit of these bacteria, however, comes from when they feed on certain types of sugars. There are some large, complex sugar molecules that actually act as a food source for the good bacteria. These are known as prebiotics. They occur quite broadly in foods such as onions, legumes, root vegetables and so on. They can also be supplemented; look out for something labelled FOS (Fructo Oligosaccharides). These prebiotic nutrients are fermented by the gut flora as they feed upon them. This fermentation creates compounds known as short-chain fatty acids. These compounds have been found to repair damaged areas of the gut and reduce inflammation. I advise supplementing with probiotics and then eating a wide variety of food sources of prebiotics.

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