Inflammatory bowel diseases (IBD) include two distinct illnesses: ulcerative colitis and Crohn’s disease. IBD affects one to two million Americans and the incidence of both illnesses is rising. It is estimated that it costs us about $3 billion each year in direct and indirect costs.

IBD shares many of the symptoms of IBS, but they are very different problems. IBD involves inflammation of the digestive tract, which can occur anywhere from the mouth to the rectum. Symptoms include abdominal pain, bloody diarrhea, and cramping. If you are having these symptoms, go see your physician.

These symptoms may also be accompanied by fever, rectal bleeding, abdominal tenderness, abscesses, constipation, weight loss, awakening during the night with diarrhea, and a failure to thrive in children. Symptoms come and go and can go into remission for months or years, and about half of the people with IBD have only mild symptoms.

The two most common types of IBD are ulcerative colitis and Crohn’s disease. Most cases are diagnosed before age forty. IBD tends to run in families and is more prevalent among people of Jewish descent. IBD affects half a million Americans. Ulcerative colitis and Crohn’s disease are similar but have different characteristics.

Ulcerative colitis is a continuous inflammation of the mucosal lining of the colon and/or rectum. In the descending colon it is sometimes called left-sided disease, and in the rectum, it is called distal disease, ulcerative proctitis, or proctosigmoiditis. If sores are present, they are shallow, and it is generally milder and easier to treat in the rectum.

Crohn’s disease can occur anywhere along the digestive tract, from mouth to rectum, but is most common in the colon and ileum near the ileocecal valve. It is sometimes called right-sided disease. Frequent symptoms are fevers that last twenty-four to forty-eight hours, canker sores in the mouth, clubbed fingernails, and a thickening of the GI lining, which may cause constrictions and blockage.

Inflammation develops in a skip pattern, a little here and a little there, and goes more deeply into the tissues than with ulcerative colitis. In later stages, it can form abscesses and fistulas, little canals that lead to other organs or form tiny caves. If they become serious, surgery may be recommended.

If you require surgery for Crohn’s disease, it is important to know which part of the intestines were removed and which nutrients may have inadequate uptake. (See the absorption chart in Chapter 2.) Leaky gut syndrome (increased intestinal permeability) is prevalent in IBD.

Often an infectious or parasitic condition underlies it. A flare-up of symptoms commonly occurs with infections. The most common microbes involved are E. coli, staphylococcus, streptococcus, proteus, Mycoplasma pneumoniae, Chlamydia psittaci, Clostridium difficile toxin, and Coxiella burnetii.

Bacterial infections occurred in one-quarter of all reoccurrence of IBD. Research implicates measles as a possible cause of Crohn’s disease. British scientists found measles virus in diseased parts of the colon. Swedish researchers found a high incidence of IBD in people who were exposed to measles in utero.

Another British study showed that people who had received live measles vaccines had a threefold increase of Crohn’s disease, while ulcerative colitis rose by two-and-a-half times. This study did not prove that the bowel disease was actually caused by measles, only that there was a correlation.

Some people with Crohn’s disease have flare-ups in a seasonal cycle, which suggests an allergy component to the illness. While studies have shown that allergy is a factor in a small number of people, a survey of members of the National Foundation of Ileitis and Colitis showed that 70 percent of people with IBD listed other symptoms which were probably allergic.

This led one researcher to say “inflammatory bowel disease is just another possible facet of allergy.” Mold sensitivity and allergies to candida and other types of fungus have also been proven to provoke IBD symptoms. IBD is not caused by emotional illness or psychiatric disorder, though the condition may cause emotional problems because of its chronic nature, painful episodes, and lifestyle limitations.

Prolonged treatment with steroid medications can cause side effects of depression, mania or euphoria, and bone loss. There is a higher incidence of IBD in women who take oral contraceptives. Women with a history of IBD or with a family history of IBD may want to choose a different form of birth control.

People with IBD often develop complications, which include inflammation of the eyes or skin, arthritis, liver disease, kidney stones, and colon cancer. Of people with ulcerative colitis, 20 to 25 percent eventually require surgery because of massive bleeding, chronic illness, perforation of the colon, or risk of colon cancer.

Five percent of people with ulcerative colitis ultimately develop colon cancer, and the degree of illness correlates with its incidence. For example, cancer levels aren’t higher for people who are only affected in the rectum and distal end of the colon. IBD is considered an autoimmune disease (your body begins attacking itself ).

The causes are many and have produced much debate. Current theories suggest that Crohn’s and ulcerative colitis have a genetic component, which is triggered to a greater or lesser extent by either infection, a hypersensitivity to antigens in the gut wall, an inflammation of the blood vessels that causes ischemia (a lack of blood supply to the tissues), and food sensitivities.

The first gene to be associated with Crohn’s disease has been found, called NOD2. This gene apparently gives the person a rapid response to gut bacteria and/or their toxic by-products, which causes an overstimulation, and production of NF-kappa B and cytokine, which stimulate inflammation.

The NOD gene is only found in 10 to 15 percent of people with Crohn’s. Obviously, much work still needs to be done to explore the genetics of IBD. Where this takes us on a practical level is to look at what we can do to have a healthy gut bacterial environment.

Numerous studies have shown that use of probiotic supplements is beneficial for people with IBD. They have been shown to help maintain remission of flare-ups in Crohn’s disease, ulcerative colitis, and pouchitis (infection of the diverticuli).

Probiotic bacteria, like L. acidophilus, bifidobacteria, and the Nissle strain of E. coli, provide competition for other microbes and push them out. Commensal bacteria stimulate our immune response, increase beneficial antibodies such as sIgA, IgM, and IgG, balance pH, and enhance tight junction integrity.

Probiotic therapy with E. coli Nissle strain has been shown to be effective in treatment for ulcerative colitis and was found to be equivalent to the drug mesalamine for short-term maintenance of the disease and after use of steroid treatment for remission.

VSL#3 is a formula with eight different probiotic species and has been used for pouchitis. Much more research needs to be done on IBD and probiotics. Different combinations will work for different people and to greater or lesser effect. You’ll have to experiment with different brands and see which are most helpful.

Remember to begin with a small dosage and increase slowly. You are changing your gut ecology and you want to do it gradually. You can think of them as a medicine that you’ll probably need to take daily for life. A 2004 study tested probiotic bacteria in mice.

The exciting part of this study showed that sterilized probiotics worked as well as live probiotics in chemically induced ulcerative colitis. If the DNA in the dead probiotic bacteria work as well as live ones, there may be less possibility of adverse effects, but further studies need to be done.

Medical treatment for IBD consists of anti-inflammatory drugs, steroids, immune modulators, and sometimes antibiotics. While these medications can often relieve symptoms of IBD, they carry their own risks. Some specific drug side effects include bone loss due to use of steroid medications, and folic acid deficiency from use of sulfasalazine (Asulfadine).

Infliximab is a new drug now in use for Crohn’s disease and the fistulas caused by it. A monoclonal antibody, infliximab has a high specificity for tumor necrosis factor (TNF-alpha). This is an entirely new approach that focuses on stimulating the immune system to stop inflammation in people with severe disease.

Many people are able to stop taking steroid medications and quality of life is increased. Research on infliximab in ulcerative colitis is in its infancy, but keep your heads up, it looks promising. A very new approach to IBD is with the use of a protease inhibitor, called BBI; testing is in initial stages.

BBI is derived from soybeans and is naturally found in all legumes. You’d need to eat huge amounts to get the same effects, but you might find them to be helpful. Remember that legumes are loaded with fiber, help lower serum cholesterol levels, and offer a vegetable protein of high quality.

Medications are often necessary, but use of complementary therapies can reduce the need, so that when you really need medication during a flare-up it works effectively. For example, repeated use of prednisone can lead to its failure as an available therapy.

The good news is that effective natural therapies address the underlying factors of the disease, reduce the need for prescription medications, and heal the bowel. Among the hundreds of patients with IBD that Drs. Jonathan Wright and Alan Gaby, two nutritionally oriented M.D.s, have seen, most have improved, many dramatically.

The key to success appears to be getting people into remission. To do this effectively, a combination of medication and supplements may be necessary. Once a flare-up has died down, natural therapies are highly successful in preventing a recurrence.

It’s also really important to take care of yourself when you are well and to practice stress-management techniques to help reduce the number and severity of flare-ups. Diet plays an important role in IBD. The incidence of IBD is growing rapidly in Western countries, but is rare in cultures where people eat a native diet.

People who eat a high amount of sugars and low-fiber diets have a higher incidence of IBD, and there are correlations of IBD with cigarette smoking and eating fast foods. Food sensitivities play a significant role in IBD. Many IBD patients report significant improvement with use of an elimination diet over a three-week period.

After this, they gradually add foods back into their diet to see which ones provoke bloating, pain, diarrhea, bleeding, or other symptoms. One study found that 13 percent of children with IBD were allergic to cow’s milk during infancy. It is essential to check for food allergies and food sensitivities.

Studies have shown reduction in symptoms and inflammation in people who adhere to a hypoallergenic diet. People with bowel disease are especially sensitive to most grains. Chemicals from some foods are irritating to the bowels. Truly, nearly any food can cause irritation and inflammation.

In various studies, citrus, pineapple, dairy, coffee, tomatoes, cheese, bananas, sugar, additives, preservatives, spices, beverages other than water, bread, and so forth have been implicated. You’ll need to be tested for both IgE and IgG antibodies. Testing of IgA and IgM antibodies is also useful.

No one diet will help all people with IBD, although the Elemental Diet and Haas Specific Carbohydrate Diet (details of the Haas program are discussed in “Healing Options”) work especially well for people with Crohn’s disease. The Elemental Diet, which has resulted in a reduction of intestinal permeability as well as its symptoms, includes synthetic foods you drink or are given through a tube.

It has been found to be as good as steroids in reducing inflammation in a flare-up of Crohn’s disease. But there are problems with use of the Elemental Diet. It is unpalatable to many people and they won’t drink it. Newer products that are tastier are coming on the market.

The Haas Specific Carbohydrate Diet eliminates all simple sugars. As discussed under IBS, many people are unable to split disaccharide sugars (lactose, sucrose, maltose, and isomaltose) into single molecule sugars. This may explain, in part, why the diet is so successful.

The Haas Specific Carbohydrate Diet also eliminates grains, which generally cause inflammation of the intestines in people with IBD, and it works especially well for people with Crohn’s disease. A low-sulfur diet may be of benefit in Crohn’s disease.

Studies have shown an increase in sulfur-eating bacteria in people with bowel disease in comparison with other people. In one study, people were advised to avoid high-sulfur foods including eggs, cheese, whole milk, ice cream, mayonnaise, soy milk, mineral water, sulfited drinks (including wine), nuts, and cruciferous vegetables (e.g., broccoli, cabbage, cauliflower, brussels sprouts, and so forth), and to reintroduce red meats.

They were advised to get protein from fish and chicken. The researchers found significant changes—people had no relapses or attacks while on the diet, and there were no adverse effects from the diet itself. The expected relapse rate had been 22.6 percent.

Of the four people in the study, one was able to stop taking steroid medication and had been attack-free for eighteen months, compared to the four attacks experienced in the eighteen months before the dietary changes. The other three showed microscopic improvement of inflammation.

The number of daily bowel movements in all four was reduced from six to one and one-half. Although there is not much research on the yeast connection and IBD, clinicians have often found antifungal therapies to be useful. Friendly flora have been found to be dramatically out of balance in people with IBD, so use of probiotic supplements is highly recommended.

Use of the comprehensive digestive and stool analysis with parasitology screening and intestinal permeability tests will uncover many of these problems. Because of bleeding and continued irritation, malabsorption of nutrients is often found in people with IBD.

These same nutrients are often vital for repair, so the cycle worsens. Low serum levels of zinc, an important nutrient for wound repair, are often found in people with IBD. Folic acid helps repair tissue and prevents diarrhea. Prolonged bleeding can cause deficiencies of copper, zinc, iron, folic acid, and vitamin B12.

Studies have shown an increased need for antioxidant nutrients such as vitamins A, E, K, and C, selenium, calcium, iron, zinc, glutathione, and superoxide dismutase (SOD). People with IBD have an increased level of leukotrienes, produced by neutrophils, which increase pain and inflammation.

Many natural substances can modulate these effects. For instance, omega-3 fatty acids, found in cold-water fish, can reduce inflammation caused by leukotrienes and the arachidonic acid cascade. When supplementing with antioxidants, use more than you’d expect.

One unusual twist in the story is that nicotine appears to be protective for ulcerative colitis. While normally I wouldn’t recommend nicotine patches, the severity of the disease could warrant a try. It’s certainly less toxic than the usual drugs that are used.

The studies show positive results, using 15- to 25-milligram patches over periods of four to six weeks along with mesalamine. Many people stayed in remission for up to three months after stopping the patch. One study gave people who were in relapse either nicotine or prednisone with mesalamine for five weeks.

The relapse rate was much better in the nicotine group—only 20 percent in comparison to a 60 percent relapse rate for those on prednisone. In the long term, nicotine patches appear to help with flare-ups and maintenance when used with mesalamine.

There are many additional approaches for IBD. One promising approach involves photopheresis, a process that exposes blood to light and many herbal therapies. Natural COX2 inhibitors, like curcumin and boswellia, also show promise.

You won’t believe this, but researchers took three men and three women with ulcerative colitis and gave them colonic enemas with the bowel movements of healthy people for five consecutive days. Four of the six had total remission of their symptoms within four months.

One to thirteen years later, they were still completely well and without use of any medications. They call this method fecal bacteriotherapy. We’ll keep our ears open for more research on this! Several studies have shown bone loss in people with Crohn’s disease and ulcerative colitis.

While incidence of loss in some studies is correlated with use of steroid medications, in others it appears to be independent. It is advisable to do at least a baseline bone density study to see if you are at risk. If so, increasing all bone nutrients would be advised.

A study on low-impact exercise in people with Crohn’s disease found that bone density was significantly increased. So get out there and exercise regularly. Exercise is not optional for any of us! A new lab test can help monitor people with ulcerative colitis and Crohn’s, and can also distinguish them from people with irritable bowel syndrome.

Calprotectin is an indicator of inflammation and increased levels are seen in people with inflammatory bowel disease, GI infections, and inflammatory arthritis, like rheumatoid arthritis. Calprotectin can be used to monitor the effectiveness of treatment and to screen people to see if a flare-up of the disease is likely.

Healing Options

• Make dietary changes. Eliminate simple sugars, alcohol, and fast foods (one study showed that flare-ups occurred almost four times as frequently when fast foods were eaten twice a week in people with ulcerative colitis). Grains and dairy products often aggravate the condition.

• Try the Specific Carbohydrate Diet. Many people have found relief from using the Specific Carbohydrate Diet outlined in Elaine Gottschall’s book Breaking the Vicious Cycle. Foods that are allowed are beef, lamb, pork, poultry, fish, eggs, fruits, nuts, pure fruit juices, weak coffee or tea, and peppermint and spearmint teas.

Also allowed are corn, soy, safflower, sunflower, and olive oils. No grains, dairy products, legumes, potatoes, yams, or parsnips are allowed on the diet. No sugars or alcoholic beverages are consumed. For delicious recipes and more detail, read the book.

This diet is beneficial because it eliminates most foods that cause sensitivities—grains and dairy products. Similar to the candida diet, it helps restore intestinal balance. While going on the diet alone may be effective, it is most effective after laboratory testing has determined your unique biochemistry.

Explore possible lactose intolerance. Hydrogen breath testing or elimination of all dairy products and foods containing dairy from your diet for at least two weeks can help determine whether lactose intolerance is contributing to your problem. Definitely eliminate dairy during a flare-up of your illness.

• Consider food sensitivities. Food sensitivities play a significant role in ulcerative colitis and Crohn’s disease, occurring approximately half the time. The most common offenders are dairy products, grains, and yeast, followed in frequency by egg, potato, rye, coffee, apples, mushrooms, oats, and chocolate.

Some people are sensitive to more than one food or type of food. Going on an elimination-provocation diet is a simple way to eat foods that are less likely to trigger symptoms. The slow addition of new foods in the challenge stage will give you an idea of which foods make you feel worse.

You can also do a blood test for food sensitivities. For example, if you find that you are not sensitive to grains or dairy products, you’ll be able to include them in your food plan. Most foods can be added back into your diet within six months, while fixed sensitivities must be avoided long-term.

• Take glutamine. Glutamine is the first nutrient I recommend for bowel and intestinal health. It is the most abundant amino acid in our bodies. The digestive tract uses glutamine as the primary nutrient for the intestinal cells, and it is effective for healing stomach ulcers, irritable bowel syndrome, and ulcerative bowel diseases.

Douglas Wilmore, M.D., has been using high doses of glutamine to heal digestive tracts in people with IBD who have had surgery in which part of the colon was removed. When only a short portion of the colon remains, people develop chronic diarrhea, a condition called short bowel syndrome.

With a high-fiber, high-glutamine diet, and short-term use of growth hormones, Dr. Wilmore is able to help normalize bowel function. Studies have shown reduced glutathione levels specifically in colon cells. Glutathione is also synthesized from glutamine.

Glutathione levels are low in both inflamed and normal bowel tissue. Glutamine is also great for building muscle mass. Begin with 8 to 20 grams daily for a trial period of four weeks. In clinical settings, up to 40 grams daily have been used.

• Take folic acid. One of folic acid’s main functions is to help with the repair and maintenance of epithelial cells, such as those in the bowel. The drug Asulfadine causes a 30 percent loss of folic acid. Even those who don’t take Asulfadine may benefit greatly from folic acid supplementation.

In a study, twenty-four people with bowel disease were given either a placebo or 15 milligrams of folic acid daily. Beneficial changes to the cells were observed in those receiving the folic acid. Take 5 to 15 milligrams when the disease is active, less for maintenance.

• Increase consumption of omega-3 fatty acids. Omega-3 fatty acids are found in cold-water fish and have been used to reduce inflammation in rheumatoid arthritis, psoriasis, and ulcerative colitis by reducing the production of leukotrienes. Salmon, mackerel, herring, tuna, sardines, and halibut are all excellent sources of EPA/DHA oils.

Eating these fish several times a week can supply your body with these essential fats. Seaweeds also provide generous amounts of omega-3 oils, but carrageenan, an extract from seaweed, may increase the inflammation in the colon.

While carrageenan is used in animals to produce IBD, in humans the research is not yet clear. To be on the safe side, avoid red and brown seaweeds. You can also take capsules of EPA/DHA oils daily. In a recent study, it was found that use of Max/EPA decreased disease activity by 58 percent over a period of eight months.

No patient worsened, and eight out of eleven were able to reduce or discontinue use of medication. The dosage was 15 capsules of Max/EPA, which contained 2.7 grams of EPA and 1.8 grams of DHA, per day. Many other studies also show the benefit of fish oils with dosages between 3.5 and 5.5 grams daily.

• Take quercetin. Quercetin, the most effective anti-inflammatory bioflavonoid, can be used to reduce pain and inflammatory responses and control allergies. Take 500 to 1,000 milligrams three to four times daily.

• Take acidophilus, bifidobacteria, E. coli Nissle strain, or Saccharomyces boulardii. Imbalance of friendly flora allows for proliferation of pathogenic microbes, such as candida, bacteroides, citrobacter, and more. It is believed that dysbiosis is a primary cause of IBD in many cases. Use of probiotic supplements can help restore balance of intestinal flora. Take 1 to 2 capsules three times daily.

• Take gamma oryzanol. Gamma oryzanol, a compound found in rice bran oil, is a useful therapeutic tool for gastritis, ulcers, and irritable bowel syndrome. (See previous discussion of gastric ulcers and gastritis.) Try taking 100 milligrams three times daily for a period of three to six weeks.

• Take boswellia. Boswellia has been used in Ayurvedic medicine as an anti-inflammatory for ulcerative colitis. Only one study has been done so far, but in comparison with sulfasalazine it was equivalent. Take 350 milligrams three times daily.

• Try butyrate enemas. Butyrate is the preferred fuel of the colonic cells. It is produced when fiber in the colon is fermented by intestinal flora, predominantly bifidobacteria. A few studies have shown that butyrate enemas, taken twice daily, helped heal active distal ulcerative colitis.

• Explore herbal remedies. Demulcent herbs—marshmallow, slippery elm, acacia, chickweed, comfrey, mullein, and plantain—are beneficial and soothing to the intestinal membranes and help stimulate mucus production. All are gentle enough to be used at will; try them in capsule or tea form.

Other herbs used by people with bowel disease include wild indigo, purple cornflower, echinacea, American cranesbill, goldenseal, cabbage powder, wild yam, bayberry, agrimony, neem, aloe vera, chamomile, feverfew, ginger, ginkgo biloba, St.-John’s-wort, milk thistle, valerian, peppermint, hawthorn, and La Pacho.

• Take a multivitamin with minerals and antioxidant nutrients. Because of general malabsorption and poor dietary habits in people with Crohn’s disease and ulcerative colitis, it is wise to add a goodquality multivitamin with minerals to your daily routine.

Deficiencies of many nutrients have been found in people with IBD: calcium/magnesium; folic acid; iron; selenium; vitamins A, B1, B2, B6, C, D, E; and zinc.

Because oxidative damage plays a significant role in IBD, the supplement should contain adequate amounts of antioxidant nutrients: at least 10,000 IU of beta-carotene or other carotenoids, 400 IU of vitamin E, 250 milligrams of vitamin C, 200 micrograms of selenium, 5 milligrams of zinc, plus other nutrients.

It may also contain CoQ10, glutathione, NAC, pycnogenol, superoxide dismutase (SOD), and other antioxidants. It is best to buy a supplement that is free of foods, herbs, colorings, and common allergens.

• Try wheat grass juice. People with ulcerative colitis have had great results reducing flare-ups of the disease by drinking wheat grass juice. In 2002 Israeli researchers finally put it to the test.

Twentythree people with active distal ulcerative colitis were given either 3½ ounces of wheat grass juice daily or a green placebo daily for one month. People who received the wheat grass juice had less severe flare-ups of the disease and less blood loss. This is certainly a nontoxic and easy remedy to try.

• Drink aloe vera juice. Aloe vera juice has been used as a traditional remedy for digestive disorders of all types. A randomized, doubleblind, placebo-controlled trial was done using oral aloe vera gel in people with active colitis.

Forty-four people were given 3½ ounces daily of either aloe vera gel or a placebo for four weeks. People who received the aloe vera had a significant reduction of all disease symptoms in comparison with people who received the placebo.

• Try bovine cartilage. Bovine cartilage is shown to have antiinflammatory and wound-healing properties. Its benefit has been documented in many illnesses, including ulcerative colitis, hemorrhoids and fissures, rheumatoid arthritis, and osteoarthritis.