Inflammatory bowel disease (IBD) includes both Crohn’s disease and ulcerative colitis. Both conditions are the result of an exaggerated or insufficiently suppressed immune response, leading to damage of the mucous membrane, which allow toxins and bacteria to seep through the intestinal wall and into the blood stream, further accelerating the inflammatory process.
Although the diseases have some features in common, there are some important differences. Ulcerative colitis is an inflammatory disease of the large intestine, also called the colon. In ulcerative colitis only the inner lining part of the colon wall (the mucosa) becomes inflamed and develops ulcers. Ulcerative colitis is often the most severe in the rectal area, which can cause frequent diarrhoea. Mucus and blood often appear in the faeces if the lining of the colon is damaged.
Crohn’s disease is different from ulcerative colitis because it commonly affects the last part of the small intestine and parts of the large intestine, although in theory it can attack any part of the digestive tract. The inflammation associated with Crohn’s disease extends much deeper into the layers of the intestinal wall than with ulcerative colitis. Crohn’s disease generally tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel.
Both ulcerative colitis and Crohn’s disease can result in abdominal pain and cramping due to inflammation and ulceration which may also result in thickened and scarred walls of the bowels. Affected areas of the colon may also secrete water and may not absorb excess fluid efficiently, which can also result in diarrhoea, and in some individuals, nausea and vomiting. Appetite may also be reduced.
It is thought that inflammatory bowel disease is caused by a combination of factors such as environment, diet and genetics. IBD may be caused by a genetic defect that affects how our immune system works and how inflammation is turned on and off in response to bacteria and viruses. Normally, the immune system protects the body from infection and once the infection has cleared up, the immune system will return to normal. In the case of IBD, this inflammatory response doesn’t stop. IBD often runs in families, with up to 30% of IBD sufferers having a relative with the disease. Environmental factors such as smoking can irritate symptoms further as can certain foods, which is why sufferers are often restricted in what they can and can’t eat.
The medical approach for treating someone with inflammatory bowel disease is firstly to relieve symptoms of active ulcers by keeping inflammation down using corticosteroids and by prescribing medication to modify immune response. Secondly, treatment may be given to reduce occurrence of flare-ups. For some individuals in severe cases, they may require surgery to remove sections of the bowel if damage is significant.
Living with ulcerative colitis or other inflammatory bowel diseases may restrict lifestyle choices somewhat. During flare-ups, for example, exercise may be difficult or impossible. Accepting that you may have flare-ups, and knowing how to deal with them in certain social situations can help.
Some lifestyle factors may reduce risk and occurrence of inflammatory bowel disease such as refraining from smoking and keeping stress levels to a minimum. Reducing stress isn’t always easy, however leading a lifestyle with limited controllable stressors and taking part in low intensity exercise such as yoga or swimming may help. Exercise and lowered stress can support the immune system which in turn may reduce IBD symptoms.
Following an anti-inflammatory diet is key for someone with inflammatory bowel disease. As its name suggests, an inflammatory condition implies there is excess inflammation in the body and so anti-inflammatory dietary changes should help to reduce symptoms of inflammation.
Foods containing omega-3 EPA such as oily fish have potent anti-inflammatory effects on the body, therefore including oily fish such as mackerel and herring two times a week is ideal. Other fatty acids from plant source such as linseed oil have limited effects on reducing inflammation as there is only some conversion in the body from plant sourced omega-3 fatty acids to omega-3 EPA fatty acids (approximately 5-8% is converted in the body), from which anti-inflammatory by-products are produced. If you are vegetarian, echium seed oil is the most beneficial plant omega-3 fatty acid you can get, as the conversion to omega-3 EPA in the body is much higher.
Incorporating plenty of colourful fruits and vegetables into your diet should also help to support the anti-inflammatory processes and immune health.
Fats that may have the opposite effect in the body include inflammatory vegetable oils such as corn oil and sunflower oils. These types of oils contain high levels of omega-6 fatty acids and are commonly found in processed foods. A high intake of omega-6 fatty acids can upset the balance of inflammation in the body by producing inflammatory hormone-like substances, which may increase the risk of flare-ups. Foods high in sugar and refined carbohydrates such as white flour can also increase inflammation in the body as well as having a negative effect on immune health, so should ideally be limited as much as possible.
Watch out for those faux amis! Some foods generally considered to be anti-inflammatory, such as garlic, onions and ginger, may have health beneficial effects for most individuals, but for those with an already inflamed bowel, these strong foods can sometimes cause direct aggravation to the gut lining, thereby worsening symptoms. Seeds and other foods which have hard to digest shells or sharp edges can often cause discomfort for someone with an inflammatory bowel disease, simply due to undigested pieces of sharp food coming into contact with an already impaired digestive tract lining. Gluten (found in wheat, barley and rye grains) is also indigestible and can pass through a damaged gut barrier, often resulting in an inflammatory response.
Due to possible internal bleeding, iron deficiency is common following a flare-up. Iron levels should be checked regularly, and an iron supplement may be needed in some cases to avoid anaemia, symptoms of which include tiredness and dizziness. Always check iron levels before supplementing so as to avoid potential toxicity (which can arise through high doses of iron). Iron-rich foods include beef, lamb, liver, pulses, whole grains and dark green leafy vegetables.
If weight loss has occurred as a result of the inflammatory bowel disease and there are many foods causing digestive discomfort, blended foods containing high amounts of fat such as ground nuts and avocadoes can often help. Blending fruits with rice milk / oat milk and protein powders can also provide lots of good, easy digestible nutrition.
As discussed above, omega-3 EPA is one of the most effective ingredients for controlling inflammation and is found in fish. It can be difficult to achieve optimum levels of EPA from fish alone, due to the high levels of toxins such as methyl mercury, PCBs and dioxins, found in fish. To bypass the toxins, and to achieve a therapeutically high intake of omega-3 EPA, supplementing with a purified and concentrated form of EPA fish oil is a good option.
Prostaglandin formation from omega-3 and omega-6 fatty acids uses different pathways that share common enzymes. The ratio of omega-3 to omega-6 will therefore affect which pathway is the most active. The prostaglandins produced from the omega-6 fatty acid arachidonic acid (AA) are considered primarily responsible for inflammatory processes and the intestinal inflammation seen in inflammatory bowel disease.
“The ability of EPA to reduce the inflammatory response indicates great potential for alleviating symptoms of inflammatory bowel disease.”
Omega-3 EPA helps to regulate inflammation in the body with the use of hormone-like substances called prostaglandins. Prostaglandins are effectively by-products of fatty acids consumed in the diet, since specific omega-3 and omega-6 fatty acids are converted into different families of prostaglandins, being either inflammatory or anti-inflammatory.
Omega-6 arachidonic acid (AA) produces prostaglandins responsible for inflammatory processes and the intestinal inflammation seen in inflammatory bowel disease. AA is particularly high in grain fed meat. Omega-3 EPA on the other hand inhibits the production of inflammatory prostaglandins. The ability of EPA to reduce inflammatory response indicates great potential for alleviating symptoms of inflammatory bowel disease. Unfortunately the ratio of inflammatory omega-6 fatty acids in the diet is much higher than that of anti-inflammatory omega-3 fatty acids.
A high dose EPA supplement, ideally providing 1000mg per day, can help to balance your omega-3 to omega-6 ratio, which can help to control inflammation in the digestive tract. Standard fish oils only provide 18% of the active ingredient EPA, a dose which is generally inadequate to significantly reduce inflammation, however a concentrated EPA supplement such as Igennus Healthcare Nutrition’s 90% concentration Pharmepa Step 1 supplement provides 1000mg of EPA in small easy-to-swallow capsules.
Anti, M., Armelao, F., Marra, G., Percesepe, A., Bartoli, G.M., Palozza, P., Parrella, P., Canetta, C., Gentiloni, N., De Vitis, I., et al. Effects of different doses of fish oil on rectal cell proliferation in patients with sporadic colonic adenomas. (1994) Gastroenterology. 107(6):1709-18.
Calder PC. (2008) Polyunsaturated fatty acids, inflammatory processes and inflammatory bowel diseases. Molecular Nutrition and Food Research 52:885-97.
Courtney ED, Matthews S, Finlayson C, Di Pierro D, Belluzzi A, Roda E, Kang JY & Leicester RJ. (2007) Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas. International Journal of Colorectal Disease 22:765-76.
Hamamura K, Nakaya M, Nakagawa M, Miyazaki M & Miki C. (2011) [A case of stage IV rectal cancer with whom EPA oral nutritional supplements could resolve cachectic condition and promote patient compliance with cancer chemotherapy]. Gan To Kagaku Ryoho. 38:845-8.
Lipkin, L, Reddy B, Newmark, H. & Lamprecht, SA (1999) Dietary factors in human colorectal cancer. Annual Review of Nutrition 19: 545-586.
Obajimi O, Black KD, MacDonald DJ, Boyle M, Glen I & Ross BM. (2005) Differential effects of eicosapentaenoic and docosahexaenoic acids upon oxidant-stimulated release and uptake of arachidonic acid in human lymphoma U937 cells. Pharmacological Research 52:183-191.
Reddy, A. & Lawrence, R.A. et al. (2002) Inhibition of intracellular peroxides and apoptosis of lymphocytes in lupus-prone B/W mice by dietary n-6 and n-3 lipids with calorie restriction. J Clin Immunol 22(4): 206-19.
Schmidt C & Stallmach A. (2005) Etiology and pathogenesis of inflammatory bowel disease. Minerva Gastroenterologica Dieteologica 51:127-45.
Trabal J, Leyes P, Forga M & Maurel J. (2010) Potential usefulness of an EPA-enriched nutritional supplement on chemotherapy tolerability incancer patients without overt malnutrition. Nutrition Hospital 25:736-40.
West AB & Losada M. (2004) The pathology of diverticulosis coli. Journal of Clinical Gastroenterology 38:S11-6.