According to the Centers for Disease Control and Prevention, in 2015, there were three million American adults diagnosed with inflammatory bowel disease (IBD), which was a significant increase compared to the two million in 1999. Inflammatory bowel disorders, including Crohn’s disease and ulcerative colitis, can present with various and non-specific symptoms, making these conditions complex to diagnose and address in clinical practice. As a result, most cases are not diagnosed until early adulthood, between 20 and 30 years olds. (2)
Here we provide an important primer on inflammatory bowel disease.
What is IBD?
Inflammatory bowel disease (IBD) includes two conditions, Crohn’s disease, and ulcerative colitis. These conditions differ slightly but are both characterized by chronic inflammation of the gastrointestinal (GI) tract. (8) Several techniques may be used by healthcare providers in order to diagnose IBD including:
- Blood tests
- Endoscopic images (9)
Crohn’s disease-related inflammation can extend from the bowel lining throughout the entire thickness of the bowel wall. Crohn’s disease can also affect any part of the GI tract, though typically it affects the ileum, the tail end of the small intestine that connects to the colon (large intestine). (8) Crohn’s disease most often begins gradually and worsens over time, it can develop in patches and may go into periods of remission for weeks or years. Researchers estimate that Crohn’s disease affects more than half a million North Americans. (20)
Ulcerative colitis causes inflammation and produces ulcers (sores) along the inner lining of the bowel wall. Unlike Crohn’s disease, ulcerative colitis doesn’t impact the entire GI tract, only the colon and rectum. Ulcerative colitis usually begins in the rectum and lower colon, though it can spread throughout the entire colon over time. (8) Symptoms of ulcerative colitis tend to flare up for certain periods, then go into remission for weeks to years. (21)
In about 10 to 15% of cases, it can be difficult to determine whether IBD is a result of Crohn’s disease or ulcerative colitis. In these rare instances, a temporary diagnosis of indeterminate colitis is given. With further tests, most individuals with indeterminate colitis receive a definite diagnosis of Crohn’s disease or ulcerative colitis. (10)
Did you know? IBD can also be confused with irritable bowel syndrome (IBS) because some of the symptoms are similar, but the two are not the same.
IBD vs. IBS: Understanding inflammatory bowel disease
When comparing and contrasting inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), you will find similarities and differences. (7) IBS is considered a syndrome (group of symptoms) and does not cause intestinal damage. IBD, however, is a disease that can cause permanent damage to the intestines. (6)
IBS and IBD symptoms
One of the hallmark symptoms of IBS is changes in the frequency of bowel movements and the form of stools. This can present as constipation, diarrhea, or alternating constipation and diarrhea. Another key symptom of IBS is abdominal pain and cramping. (6)
The symptoms of IBD, however, depend on where the inflammation is located and whether it’s related to Crohn’s disease or ulcerative colitis. With IBD, diarrhea, abdominal pain, and cramping can be common symptoms just like with IBS. However, additional IBD symptoms may include:
- Blood in the stool
- Loss of menstrual cycle
- Night sweats
- Reduced appetite
- Unintended weight loss (8)
While there is overlap in some symptoms and both conditions can be inflammatory, the inflammation with IBD can be damaging, while in some cases of IBS, there is no inflammation at all. (6) IBD can lead to complications such as colorectal cancer, damage to the bowel, and malabsorption of nutrients. (16)(26)
Inflammation of the small intestine can interfere with the absorption of nutrients, including amino acids, fatty acids, sugars, vitamins, and minerals. (5) Malnutrition is considered a major complication of IBD and is estimated to affect 65% to 75% of patients with Crohn’s disease. (23) A 2017 review published in the journal Gastroenterology Research and Practice provides a detailed analysis of common nutrient deficiencies that can occur with IBD. Vitamins and minerals of concern include:
- Vitamin A
- B vitamins (B9, B12)
- Vitamin D
- Vitamin K
- Zinc (23)
Poor absorption or inadequate intake of calcium and vitamin D can cause decreased bone mineral density, which may lead to osteoporosis and increase the risk of a bone fracture. Calcium strengthens bones and teeth, while vitamin D assists the body in using calcium. Low physical activity, inflammation, and long-term corticosteroid use can also contribute to the development of osteoporosis. (5)
An abnormal narrowing of a body passage, or stricture, is developed in the bowel in about 25% of individuals with Crohn’s disease. (3) Chronic inflammation and the presence of scar tissue can cause intestinal strictures, which make digestion difficult. A modified low-fiber diet, liquid diet, medication, or surgery may be required to manage the stricture. (5)
“The exact etiology of IBD is not well known,” report the authors of a 2014 review published in the Journal of Inflammation Research. “There are several factors that have been postulated to have an effect on the development of this group of diseases, which include but are not limited to bacterial contamination, a change in the immune system, and genetic variations.” (9) While the exact cause is not known, immune function can definitely be a factor.
In addition to immune and genetic factors, other IBD risk factors include:
- Chronic stress
- Long-term use of certain medications (NSAIDs, oral contraceptive pills)
- Cigarette smoking (past or present) (4)(18)
Did you know? Reports indicate that there are more than 200 genes related to IBD susceptibility. (17)
Though IBD is not curable, certain approaches can help manage IBD symptoms and keep the condition in remission. Medication is typically prescribed to address IBD, however, diet, lifestyle, and supplement interventions may also be effective in supporting remission.
Diet and lifestyle
A diet that contains pro-inflammatory foods is an important risk factor for developing ulcerative colitis. The Western pattern diet, also known as the Standard American Diet (SAD), includes high amounts of refined carbohydrates and processed foods combined with a low intake of fruits, vegetables, and fiber. Researchers suggest individuals with IBD should focus on incorporating anti-inflammatory foods into the diet in order to support remission. (12) Colorful fruits and non-starchy vegetables are nutrient-rich anti-inflammatory choices. (24)
In general, a dietary pattern consisting of small, frequent meals that contain whole, plant-based foods, soluble fiber, and antioxidants is suggested. It’s also important to drink plenty of water and stay well-hydrated. (5) Depending on individual needs, further dietary recommendations may be provided by your practitioner. A 2018 review published in the Indian Journal of Gastroenterology found the following diets are often suggested for individuals with IBD.
Other factors that may help reduce symptoms of IBD include:
- Limiting caffeine intake
- Limiting insoluble fiber consumption
- Moderating alcohol consumption
- Reducing greasy and fried food consumption (5)
Supplements for IBD
Dietary and herbal supplements may be recommended by your practitioner to prevent or address a nutrient deficiency or to facilitate or maintain IBD remission. (5)(19) At least 50% of patients with IBD report using supplements. (19) Research indicates the following supplements may be effective therapeutic agents for addressing IBD.
1. Boswellia serrata
Boswellia serrata is a tree native to India and the Middle East. It contains a resin that is retrieved by tapping the tree, a process commonly used to retrieve maple syrup. Boswellia resin contains many anti-inflammatory compounds and essential oils and was historically used as an arthritis remedy. In vitro and animal studies have demonstrated the anti-inflammatory properties of Boswellia serrata; however, its efficacy toward IBD-related inflammation is not well understood. (25) Research suggests that Boswellia may be effective toward colitis and Crohn’s disease, but not as effective as commonly prescribed medications. (14)
Curcumin, a biologically active phytochemical substance found in turmeric, has demonstrated anti-inflammatory and antioxidant properties in laboratory and animal studies. In a randomized, double-blind study, 89 individuals with inactive ulcerative colitis were provided a curcumin supplement or placebo to take daily for six months. Compared to the placebo group, individuals taking curcumin had a significantly lower relapse rate, suggesting that curcumin supplementation can help support ulcerative colitis remission. (19)
3. Omega-3 fatty acids
Omega-3 fatty acids are essential fatty acids that can’t be produced in the body and must be acquired through diet or supplement sources, such as fish or fish oil. Omega-3 fatty acids are well-known for their anti-inflammatory health benefits, yet consumption tends to be low in the Western diet. (17) It’s believed that as little as 500 mg of omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may bring health benefits. (1) However, the results of an analysis using observational data from the National Health and Nutrition Examination Survey 2003-2008 found that adults consumed on average only 86 mg of combined EPA (63 mg) and DHA (23 mg) per day. (22) Clinical trials show regular omega-3 consumption can decrease the risk for developing ulcerative colitis and may reduce intestinal inflammation in those with IBD. (17)
Probiotics are live microorganisms that when administered in the proper dose, provide health benefits by improving gut flora. The intestinal tract is lined with flora of commensal bacteria that work closely with the immune system. A disturbance in these bacteria is thought to contribute to the onset of intestinal inflammation. Probiotic supplementation may return gut flora to a healthy state.
Lactobacilli administration was found to prevent and attenuate colitis in mice. (13) In a clinical trial, an anti-inflammatory drug alone or in combination with Saccharomyces boulardii was prescribed to individuals with inactive ulcerative colitis. The relapse rate was significantly lower for those taking both medications. (11) It’s important to note that bacterial strains, dose, and duration are all factors that have not been well established. Further human trials are necessary in order to fully understand the potential benefits of probiotics in IBD. (13)
The bottom line
It’s true that IBD can be challenging to treat. The best approach to IBD treatment is an integrative protocol that includes diet, lifestyle factors, and dietary supplements that contain targeted nutrients and herbs for IBD. This strategy can also complement conventional pharmaceutical interventions for optimal results that benefit you holistically.
- Marcil V, Levy E, Amre D, et al. A cross-sectional study on malnutrition in inflammatory bowel disease: is there a difference based on pediatric or adult age grouping. Inflammatory Bowel Diseases. 2019;Feb 22.
- Fakhoury M, Negrulj R, Mooranian A, Al-Salami H. Inflammatory bowel disease: clinical aspects and treatments. Journal of Inflammation. 2014;7:113-120.
- Ek WE, D’Amato M, Halfvarson J. The history of genetics in inflammatory bowel disease. Annals of Gastroenterology. 2014;27(4):294-303.
- Scaldaferri F, Pizzoferrato M, Lopetuso LR, et al. Nutrition and IBD: malnutrition and/or sarcopenia? A practical guide. Gastroenterology Research and Practice. 2017;2017.
- Limdi JK. Dietary practices and inflammatory bowel disease. Indian Journal of Gastroenterology. 2018;37(4):284-292.
- Lang A, Salomon N, Wu JC, et al. Curcumin in combination with mesalamine induces remission in patients with mild-to-moderate ulcerative colitis in a randomized controlled trial. Clinical Gastroenterology and Hepatology. 2015;13(8):1444-9.
- Ng SC, Lam YT, Tsoi KKF, et al. Systematic review: the efficacy of herbal therapy in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics. 2013;38(8).