Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) doesn’t just mess with your bowel; it plays with your head. Symptoms appear randomly and viscously, not only causing pain and discomfort, but also affecting your mood and wiping out your energy for days at a time.

The two main forms of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn’s disease. They are discussed here together as many of their symptoms are similar, as is the naturopathic treatment.

Ulcerative colitis is a disease primarily of the colon (large intestine), and rarely affects the small intestine. Crohn’s disease, however, is not fussy, affecting all the way along the bowel from the small intestine on into the colon, albeit in an erratic manner, skipping bits here and there.

IBD is marked by periods of remission and exacerbation. It is important you become well acquainted with your inner beast. Does he (she?) react badly to stress, alcohol or pasta? Watch and learn how to tame your beast, and even when times are good, play nice and don’t tempt fate.

Symptoms

• Urgent need to have a bowel movement.
• Diarrhoea.
• Bleeding on the stool, toilet paper or in the bowl.
• Fever.
• Abdominal pain.
• Malaise.
• Fatigue.
• Depressed mood.
• Mucus (more common with ulcerative colitis) on the stool or toilet paper.
• Mouth ulcers (only with Crohn’s disease).
• Anal fistulas (only with Crohn’s disease, an anal fistula is a small tunnel that forms between the anal canal and the skin, usually close to the anus, which is caused by an abscess that forms within the bowel wall).

What causes it?

• Genetics plays a role, so search your family tree. The incidence of IBD is slightly higher within the Jewish population.
• Dysbiosis, otherwise known as bad bugs in your gut.
• Viral trigger. Although not necessarily a cause, there is some evidence that a virus may trigger the onset of IBD. There may be a long hiatus between having the virus (eg measles) and suffering the disease, so there may not seem to be an obvious connection.
• Again, while not a cause, stress can initiate the onset and is almost always behind exacerbations of this disease.
• There is debate whether or not IBD is an autoimmune condition. If so, this explains why they are triggered by events such as viruses and stress. This is something that is often noted by people with other autoimmune conditions such as multiple sclerosis and rheumatoid arthritis.
• Curiously, smokers and those who have had their appendix removed are less likely to suffer from ulcerative colitis.

What to do

Diet

For when there are symptoms of intense pain, bleeding and mucus

• When symptoms are in full flight, the best thing to do is fast for a day or so, drinking only water or juice. This allows the bowel to rest and recover. 
- Although high-fibre foods are recommended to keep the bowel healthy, in times of pain and bleeding, you need food that is not going to rub or chafe the inflamed bowel wall. White rice, peeled and mashed potatoes, sweet potatoes and pumpkin. Stewed peeled pear and apple (stew with a little honey not sugar). Banana. Good quality unsweetened yoghurt (unless you are lactose intolerant). Soups made on beef stock, chicken stock or miso are excellent, pureed if necessary. Steamed chicken breast, white fish, eggs and tofu are good sources of protein.
• Avoid red meat (the stock is fine), dairy foods (except unsweetened yoghurt), salads, raw vegetables, corn, uncooked fruit, nuts, seeds and wholegrain products, chilli, spicy food, coffee, alcohol.
• Avoid sugar. Not just sugar added to tea and coffee, but sugar in packaged foods, like breakfast cereal, fruit yogurt and, of course, biscuits, pastries and cakes (see below).
• Avoid gluten. Even if you are not gluten intolerant it can increase inflammation. Avoid wheat, rye, oats and barley.
• Drink herbal tea using a combination of ginger, peppermint, chamomile, meadowsweet and/or lemon balm.

For when there are no, few or mild symptoms

• Avoid sugar like the plague. Sugar feeds the bad bugs of the bowel. As your bowel microflora (microbiome) is already in disarray due to this disease, the last thing you should do is encourage more malevolent microflora. This includes sugar in packaged foods as well as adding sugar to coffee, tea etc.
• Fibre is very important for the health of the bowel. Fibre allows for regular bowel movements and also provides fuel for the good bugs, which in turn improves the health and integrity of the bowel wall itself. Vegetables, fruits, nuts, seeds and legumes are all to be eaten and enjoyed on a regular basis.
• Avoid or reduce gluten in your diet. Many people with IBD have gluten intolerance.
• Eat prebiotic and probiotic foods. Prebiotics include asparagus, Jerusalem artichokes, leeks and onions, legumes such as baked beans, chickpeas and lentils. Probiotic yoghurt, miso, sauerkraut, kefir, natto, tempeh and the Korean delicacy, kimchi (see below).
• Increase foods rich in omega 3 for their anti-inflammatory properties. Fish, linseeds, chia seeds, walnuts.
• Avoid trans-fatty acids and deep-fried foods; they may cause further inflammation.
• Have a carrot and cabbage juice in the ratio of 2:1. Carrots contain betacarotene that converts to vitamin A, a healer of epithelial cells and cabbage contains a substance known as S-methylmethionine, which is effective in the treatment of ulcers.
• Mucopolysaccharides are substances that improve wound healing and tissue regeneration for the inflamed digestive tract lining. Foods containing mucopolysaccharides include oysters, tripe, shellfish, aloe vera, slippery elm, pig’s trotters, wheatgerm, okra and cactus (spikes removed).

Prebiotics and Probiotics

Naturopaths have long proselytised that illness begins in the gut and good health starts with a healthy digestive tract. Hippocrates didn’t hold back when he claimed that ‘death sits in the bowel’. There are 10 times more bacteria within the digestive system than there are cells in the body. Known as microflora, this internal ecosystem weighs up to 2 kg and makes up most of the dry weight of faeces. Before reaching for a bottle of antiseptic, it is good to know that many of these bacteria are beneficial to our health. The good guys are referred to as probiotics and breed in the bowel. They can be found in food or taken as a supplement. Every person’s assembly of microflora is unique to him or her, akin to their fingerprint or DNA. How long before we see this featured on CSI?

Only a few of the more than 500 different species of bacteria found in the bowel have been studied in depth. Some are known to create vitamins such as K, B5, B9 and B12. Others help improve the absorption of magnesium, calcium and iron. The good bugs defend their turf from pathogenic intruders, which is why a timely course of probiotics before travelling can prevent a bout of Delhi belly or Montezuma’s revenge. A large percentage of the immune system is located bowel-side, and probiotics are important for the maintenance and regulation of immunity, helping prevent coughs and colds and more serious infections. In addition to IBD, other conditions that respond well to probiotics include diarrhoea, IBS, prevention of colon cancer, even eczema and asthma.

Prebiotics is food for probiotics. Prebiotics are found in certain vegetables (especially asparagus, Jerusalem artichokes, leeks and onions), legumes such as baked beans, chickpeas and lentils and supplementary fibres including psyllium, pectin, guar gum and slippery elm.

Foods from many cultures include foods that contain probiotics including yoghurt, miso, sauerkraut, kefir, natto, tempeh and the Korean delicacy, kimchi. To seed and maintain a healthy microbiome, probiotic foods need to be consumed several times a week.

Remedies

The following remedies can be taken in conjunction with prescription medication. The best scenario is when you can work with your doctor or specialist to reduce prescription medication as symptoms improve. – Fish oil is brilliant for reducing the inflammation of IBD. A large dose is needed (10–15 ml daily, less for children) and you will need to wait a few weeks for it to take full effect. Keep taking it even after the symptoms have abated. – Probiotics are needed to restore harmony to the bedlam within. Don’t stint when buying probiotics which include any and all of the following: lactobacillus casei, lactobacillus plantarum, lactobacillus acidophilus, lactobacillus GG, escherichia coli nissle 1917, bifidobacterium longum, bifidobacterium breve, bifidobacterium infantis. – When you experience diarrhoea and bleeding, and particularly if ulceration is affecting the small intestine as is the case with Crohn’s disease, your absorption and retention of nutrients will be compromised. A daily multivitamin tablet is recommended, even better if you can find a multivitamin in a liquid form as this will be more readily absorbed. – Herbs to help IBD include aloe vera, marshmallow, licorice, chamomile, calendula, peppermint, cat’s claw, andrographis and echinacea. – If you have experienced a lot of bleeding, you may be low in iron. If this is the case, take a gentle liquid herbal iron tonic. – Vitamin A and zinc are needed for the health and repair of the mucous membrane lining the bowel. – Glutamine is an amino acid that is excellent in repairing and feeding cells that line the bowel. – Psyllium husks are very effective for this condition. Not only do they absorb excess fluid and slow down transit time, helping to reduce diarrhoea, psyllium husks are also an excellent prebiotic. – Aloe vera is healing and calming to inflamed mucous membranes. Take a dose morning and night. – Slippery elm powder is both healing and a prebiotic. – Magnesium is excellent for muscle spasm. Take to ease and avoid abdominal cramps. – If you experience bloating, flatulence or notice undigested food in your stool, take one digestive enzyme with each meal.

Other

• Stress is the wild card with IBD. It is the major trigger. Whatever causes you stress –whether it be work, study, relationships, travel – if you can change the stressor, do it. Otherwise you must learn how to change your way of handling stress. Try counselling, meditation, prayer. Find the method that works for you.
• Corticosteroids are a common medical treatment for IBD. Long-term use of steroids can affect your bone density, however. Get this checked.
• IBD can be very severe – bad enough to warrant surgery to resect parts of, or the entire bowel itself. If your IBD is in this category you might want to consider radical treatment: a water fast. Fasting allows the bowel to heal undisturbed by the passage of food and the taxing effort of digestion. This approach does not suit everyone, of course. A proper fast needs to be longer than 5 days and up to several weeks and must be supervised, with blood pressure and urine samples taken daily. There are only a few centres that cater for fasting.
• Regular gentle exercise such as walking or swimming.
• Given that stress is a major trigger with IBD, it is not too long a bow to draw to say you hold your stress in your guts. Belly breathing not only reduces stress, but also relaxes the bowel itself. Belly, abdominal or diaphragmatic breathing is the way we were meant to breathe. Over time, and especially for anxious people, breathing travels further up the body. Look at a dog or young child at rest. Belly breathing. Initially, lie on your bed with a pillow beneath your head and knees. Place your hands palm down on your lower belly. Breathe in through your nose, counting slowly to 3 or 4. Feel your tummy rise with the breath. Breathe out just as slowly, allowing the belly to drop. Once you feel comfortable with this, progress to doing this seated, and then try to belly breathe all the time.