There’s nothing more basic—or mysterious— in human biology than the digestive system. We put food in our mouths. And waste comes out the other end. In between, in mind-bogglingly complex chemical processes, things like oranges, asparagus, hot dogs, and French fries get converted into energy and the building blocks of human bodies. From apples to skin and bone cells—that’s quite a feat. And we don’t even have to think about it.
For most of us, that process works pretty smoothly. Except for the occasional burp or tummy complaint when we overeat, digestion simply happens. But for the more than a million Americans who have inflammatory bowel disease (IBD), digestion is anything but easy. It involves abdominal cramps, bloody stools, nausea and vomiting, diarrhea, nutritional deficiencies, lost time at work and school, and a great deal of pain.
IBD comes in two main forms. Of the people who have IBD, half have ulcerative colitis, and half have Crohn’s disease, according to the Crohn’s and Colitis Foundation of America. The main difference between the two diseases is that with ulcerative colitis, only the colon and rectum become inflamed, while with Crohn’s, the inflammation can go higher up into the digestive tract, right into the small intestines and even beyond. What’s more, the inflammation can go into deeper layers of the intestines, and in some cases all the way through the intestinal walls.
IBD is an autoimmune disease, which means it’s a disease in which an individual’s immune system gets confused. Instead of reserving its defenses for repelling invading bacteria and viruses, the immune system turns its arsenal of weaponry against the gastrointestinal tract. No wonder it hurts.
No one really knows why this happens, and there is, as yet, no cure. IBD is marked by flare-ups—times during which the symptoms worsen—and by relatively quiet times, when symptoms lessen or even disappear for a period.
People with both forms of IBD face significant nutritional issues, according to Patrick Donovan, ND, adjunct clinical professor of medicine at Bastyr University in Seattle. Dr. Donovan also has a private practice in Seattle where he sees many patients with IBD.
Diet and nutrition play an important role in the life of anyone with IBD, says Dr. Donovan. In fact, he does several kinds of tests related to food. At the top of the list is food sensitivity testing. If you have a disease in which the bowels become inflamed, it just makes sense to know which foods you’re sensitive to—foods that might trigger flare-ups or exacerbate symptoms. He also tests for lactose intolerance (the inability to digest dairy products) and celiac disease (intolerance to gluten, a substance in wheat and certain other grains).
While they aren’t directly food-related, it’s worth mentioning two other tests that Dr. Donovan does. He always tests for parasites and also for a specific kind of bacterial infection. People with IBD often have parasites that contribute to the symptoms, so it’s helpful to clear those up.
The bacteria test is to detect Clostridium difficile infections (or c-diff, as the bacteria is sometimes known). C-diff infections are not at all uncommon and often occur shortly after the extended use of antibiotics, says Dr. Donovan. Antibiotics can wipe out most of the other bacteria in the digestive system, leaving the much tougher c-diff bacteria room to grow. This is important because c-diff bacteria can cause a form of bowel disease that is curable. Dr. Donovan tells the story of one little girl brought in by her mother. The 5-year-old had such a severe case of what appeared to be IBD that she had been scheduled for surgery to remove her colon. Testing revealed that she actually had a c-diff infection, and the appropriate medications cleared it up completely.
That was one fortunate child. Generally, however, people with IBD face a chronic condition that visits them on a regular basis with debilitating symptoms. Thankfully, conventional medicine offers a number of medications that bring symptom relief.
Finally, Dr. Donovan maintains that a good portion of his IBD patients find significant symptom relief by following what’s known as the specific carbohydrate diet—a strict grain-free, lactose-free, sugar-free regimen. After eliminating any foods that tests have shown they’re sensitive to and following the special diet for a time, 75 percent of his patients with Crohn’s disease and 50 percent of his ulcerative colitis patients respond “extremely well,” he says. And the rest typically experience some symptom relief, he says.
Dr. Donovan likes to see people follow the diet strictly for a full year to determine whether it will be helpful for them. To learn details about the diet, he recommends the book Breaking the Vicious Cycle: Intestinal Health through Diet by Elaine Gloria Gottshall.
It’s worth noting that if you have IBD, you might want to make a special point of staying away from fast-food restaurants. Although it’s well accepted that fast foods are not exactly your best choices for preventing and healing diseases, it’s not often that researchers take a look at the impact that fast foods may have on a particular disease.
In 1992, researchers in Stockholm did just that for IBD. They looked at the dietary habits over a 5-year period for 152 people with Crohn’s disease, 145 people with ulcerative colitis, and 305 similar individuals who did not have either disease. They found that the relative risk for the disease was higher in those who consumed more sugar and less dietary fiber. But the real surprise was the increased risk for both diseases in people who consumed greater amounts of food from fast-food restaurants.
There are numerous individual nutrients that can be helpful for people with IBD. Let’s begin by taking a look at a macronutrient—protein.
Getting enough protein can be an issue for anyone who has Crohn’s disease, according to Dr. Donovan. People with Crohn’s, besides being prone to damage to the intestinal walls, also can experience abdominal abscesses, blockages, and fistulas (holes). Sometimes this leads to blood serum leakage. That’s actually protein leaking out, Dr. Donovan explains. So these people may need to take a protein supplement. He prescribes freeform amino acids, a particularly absorbable form of protein.
These folks need to get significantly more protein than the Daily Reference Value of 50 grams, says Dr. Donovan. He has them take up to 120 grams daily for a time to make up for their deficiency. That kind of treatment should be done under a doctor’s supervision.
However, says Dr. Donovan, anyone with IBD can benefit from taking free-form amino acids, as these can both help with flare-ups and also help heal intestinal villi—the microscopic little “fingers” inside the intestines that get damaged by inflammation.
Another way to get healthy, helpful protein, says Dr. Donovan, is to make a stock with beef or lamb bones and use that as a basis for soups and other dishes. You don’t need to wait for a flare-up to do this. The broth, he says, is hypoallergenic (not likely to trigger reactions), nutrient dense, and, because of its high iron content, can help prevent anemia. And anemia, he says, is a big concern for anyone with IBD.
There are a number of other individual nutrients that might prove helpful for anyone with IBD.
Crohn’s and Colitis Foundation of America, ccfa.org
Breaking the Vicious Cycle: Intestinal Health through Diet by Elaine Gloria Gottshall
Vitamin B12 and folic acid are of particular concern for people with IBD. If you’re anemic, you may need extra B12, and if so, your doctor will probably provide it in the form of shots, says Dr. Donovan.
“Folic acid is important because medications used for IBD inhibit the absorption of folic acid,” says Dr. Donovan. “And folic acid is very, very important for replication and repair of cells in the small intestine.” He recommends taking 1,000 micrograms daily.
B vitamins work in concert with each other and help provide the increased energy output that you need for repairing damage in the intestines, explains Dr. Donovan. He suggests taking either a good multivitamin or a B-complex supplement that provides 25 to 50 milligrams of each B vitamin across the board.
Dr. Donovan recommends taking 800 milligrams daily in the form of calcium citrate.
Your body needs certain minerals known as electrolytes in order to move water in and out of your cells. The digestive system plays a key role in maintaining the proper balance of electrolytes. Electrolytes include sodium, chloride, potassium, calcium, and magnesium. People who have IBD often have bouts of diarrhea, which cause the loss of electrolytes, says Decker Weiss, NMD, a naturopathic medical doctor in private practice in Scottsdale, Arizona. Losing electrolytes can even precipitate a medical emergency and is a special concern for children with IBD.
It’s a good idea, says Dr. Weiss, to keep products that replace electrolytes on hand to use during episodes of diarrhea. There are products especially for children, such as Pedialyte. Adults might sip a sports drink or simply use an emergency packet of electrolyte replacement powders. These are readily available in pharmacies and natural food stores.
“Fish oil is a must,” says Dr. Donovan. The oils from fatty fish, such as cod, salmon, and anchovies, are highly anti-inflammatory because of their essential fatty acid content, especially EPA and DHA fatty acids. By all means enjoy more of these kinds of fish in your diet, but you’re not likely to get enough of the target nutrients without taking a supplement. Dr. Donovan recommends taking fish oil, not capsules, and reading the product label to figure out how much you need to take to get 2 to 3 grams total of EPA and DHA.
“These essential fatty acids help reduce the risk of colon cancer tremendously and can even reverse precancerous legions in the GI tract,” says Dr. Donovan.
And while we’re on the topic of fats and oils, Dr. Donovan says that anyone with IBD should reduce their intake of saturated fats—anything containing solid shortening or partially hydrogenated vegetable oils. Olive oil should be your oil of choice, he says.
People with IBD are at great risk of developing anemia. If your doctor determines that you are low in iron—and only if your doctor determines that you are low in iron—you should take an iron supplement, says Dr. Donovan.
“Don’t use iron unless you need to replace it,” he says. “Iron feeds inflammation, and when you don’t need it, you don’t want to feed inflammation.”
If your doctor determines that you are low in iron, he or she will tell you what kind and how much to take.
The amino acid L-glutamine “helps restore the gut and helps the intestinal villi heal,” says Dr. Donovan. It also “feeds the cells of the gut,” he says. Both he and Dr. Weiss recommend taking 3 grams two or three times a day.
L-glutamine is particularly helpful in dealing with intestinal flare-ups, according to Dr. Weiss. If you’re not taking L-glutamine as a daily supplement, start taking the supplement at the first signs of a flare-up. It works better than steroids for dealing with IBD flare-ups, he says.
Vitamin A supports certain cells in the intestinal tract (squamous epithelial cells), says Dr. Donovan. He recommends taking 5,000 IU daily of preformed vitamin A (not beta-carotene).
In 2008, researchers in Japan examined 70 people with IBD, looking at their bone mineral density (BMD) as well as their blood levels for both vitamin D and vitamin K. They found that even though these people were consuming dietary amounts of these vitamins in excess of the amounts recommended by the Japanese government, their blood levels came up short. They also found reduced bone density in these people. Vitamins D and K are both required for building and maintaining strong bones. The researchers speculated in their conclusions that people with IBD likely have problems absorbing both vitamins.
Vitamin D is an important anti-inflammatory nutrient, especially for people with Crohn’s disease, says Dr. Donovan. It can help reduce the risk of colon cancer, a particular concern for people with Crohn’s.
Anyone with IBD can benefit from taking 1,000 IU daily of vitamin D3, says Dr. Donovan. Doctors may have people with Crohn’s take amounts considerably higher than that, he says, even as much as 10,000 IU daily for 8 to 12 weeks.
Adequate Intake for vitamin K is set at 120 micrograms for men, 90 micrograms for women. You’ll get about 30 micrograms in a typical multivitamin. Good food sources include spinach, parsley, tofu, and sunflower seeds. Ask your doctor whether a separate vitamin K supplement is appropriate for you.
Vitamin E has mild anti-inflammatory properties, says Dr. Donovan. He recommends taking 200 to 400 IU daily in the form of vitamin E succinate, which has more anticancer action.
For Both Ulcerative Colitis and Crohn’s Disease
Anyone with IBD should be under the care of a physician. Discuss any supplements you wish to take with your doctor.
Amino acids |
Full-spectrum blend of free-form aminos. Ask your doctor how much to take and follow the package directions. |
Calcium |
800 milligrams in the form of calcium citrate |
Essential fatty acids |
Take enough liquid fish oil to get 2 to 3 grams of EPA and DHA. (Read product labels.)* |
Folic acid |
1,000 micrograms |
Iron† |
Discuss with your doctor |
L-glutamine |
3 grams, two or three times a day |
Vitamin A |
5,000 IU |
Vitamin B12† |
Discuss with your doctor |
Vitamin D‡ |
1,000 IU |
Vitamin E* |
200 to 400 IU in the form of vitamin E succinate |
Vitamin K§ |
120 micrograms for men, 90 micrograms for women |
For Flare-Ups of Both Ulcerative Colitis and Crohn’s Disease |
|
Electrolytes |
Take emergency electrolyte replacement products as needed for bouts of diarrhea. |
L-glutamine |
3 grams, two or three times a day for the duration of the flare-up |
*Fish oil has a blood-thinning effect. So does vitamin E. If you’re taking any kind of blood-thinning drug, talk to your doctor before taking these supplements.
†Take iron and/or vitamin B12 supplements only if your doctor determines that you are anemic. Your doctor will determine how much you need to take. B12 may be given in the form of a shot.
‡If you have Crohn’s disease, your doctor may have you take considerably higher amounts.
§Ask your doctor if you should be taking a vitamin K supplement.