Crohn’s disease and Ulcerative Colitis are chronic inflammatory conditions of the intestinal tract and together are known as Irritable Bowel Disease (IBD). Symptoms can be mild, with only intermittent episodes, or can be chronic and recurrent. Severe cases are characterized by abdominal pain, fever, vomiting, diarrhea, rectal bleeding and weight loss and can be not only debilitating, but life threatening. The disorders are usually identified in people in their teens and twenties but the incidence of IBD in children is escalating rapidly, although no one is sure why this is so.
IBD is common in the United States, England and Northern Europe, and rare in Eastern Europe, Asia and South America. This may be a factor of genetics, lifestyle, environment or a combination of these. Traditional management includes treatment of symptoms with drugs that reduce inflammation and modulate the immune system, but there is no medical cure. These medications can have serious side effects, especially when taken long term, so research on safer and more effective options is ongoing. Surprisingly, safe and effective options do exist, which are rarely discussed or offered to patients at a typical doctor’s visit, but which can be very successful when implemented properly.
Probiotics and Prebiotics
Probiotics are the good bacteria that reside in our intestinal tract, and are essential for normal digestive, immune and brain function. Alterations in the balance of this desirable bacteria and pathogenic strains is very common in IBD, causing frequent loose bowels among other symptoms. A few specific strains of these microbes have been shown to be effective at reducing IBD symptoms. One type of bacteria, Lactobacillus GG, has been shown to increase the immune response and improve the mucosal barrier in Crohn’s patients. Another bacteria, Nissle strain E. Coli (not the dangerous type known for food poisoning), can reduce the growth of pathogenic bacteria. In one study, patients taking E. Coli Nissle in conjunction with medication had a relapse rate almost half as frequent as those on medication alone. Another microbe, Saccharomyces Boulardii, is a type of yeast which is very effective at treating and preventing diarrhea in Crohn’s patients. It is considered a prebiotic because it feeds the good bacteria and supports normal digestive and immune functions. Anyone suffering from IBD should make probiotics an important part of their regimen.
Specific Carbohydrate Diet
When Elaine Gottschall’s daughter Judy was just a child, she was diagnosed with Crohn’s disease so severe that she was in constant pain, with daily episodes of bloody diarrhea, and as a result was so malnourished that the disease was affecting her brain. On the verge of agreeing to a total colostomy for the suffering 7 year old, Elaine was referred to Dr. Sidney Haas who put her daughter on a diet special he had devised. In less than two weeks Judy’s neurologic problems resolved and her bowels began to improve. After two years on the diet she was free from Crohn’s disease and her mother had found a new calling.
Elaine returned to graduate school to study nutrition and biochemistry and in 1987 authored a book about Dr. Haas’ diet called Food and the Gut Reaction. The title was later changed to Breaking the Vicious Cycle and described the Specific Carbohydrate Diet (SCD). It has sold more than a million copies and turned Elaine (who passed away in 2005) into somewhat of a cult hero in the Crohn’s/Ulcerative Colitis community.
It would seem that a diet this effective would be adopted by all IBD sufferers, but there are a number of reasons this is not the case. SCD is essentially a diet free of starches, and is comprised predominantly of animal protein, vegetables and fruits, and a small amount of nuts and beans which are added slowly and in limited quantities. Absolutely no additives or fillers can be eaten so most food must be homemade. The diet is implemented in clearly defined stages, with only a handful of foods allowed in the very first weeks, and more and more foods slowly added back in over time. It can be time consuming and socially challenging to follow such a regimen. On the positive side, SCD can heal the gut, ultimately allowing for a much wider variety of foods, and the reintroduction of many that previously caused symptoms. Constant pain and discomfort can be reduced or eradicated, and the social limitations of chronic bowel distress disappear. As some SCDers state “more time in the kitchen and less in the bathroom”. Despite its food limitations, when done correctly, SCD can be very nourishing, as it includes nutrient-dense foods instead of commonly eaten processed items, while also increasing nutrient absorption. The diet is an excellent weapon in the IBD arsenal, but should only be implemented under the care of a knowledgeable nutrition professional well versed in the SCD protocol.
Mediator Release Testing (LEAP)
Research shows that symptoms of IBD can be caused by an immune system response to specific foods or chemicals, when “mediators” are released which cause pain and inflammation in the intestines. By identifying the trigger foods and chemicals, and removing them, symptoms of IBD can be reduced or completely resolved. The MRT tests for reactivity to 150 foods, and based on the results, an individualized 6 Phase LEAP (Lifestyle, Eating and Performance) diet protocol is developed, which incorporates only the least reactive foods at first, slowly adding progressively more reactive foods as tolerated. This protocol allows the intestines to rest, reduces the inflammatory onslaught, and promotes healing of the gut lining. Many people experience at least a 50% reduction in symptoms while some achieve complete resolution. As with SCD, the removal of trigger foods and the reduction of gut inflammation can result in a profound improvement in IBD symptoms both in conjunction with, or instead of, medication.
Any and all of these options can be incorporated into the health plan of a Crohn’s or Colitis sufferer, and they can be effective in conjunction with or often instead of medication. To fully serve the needs of IBD patients, and offer every opportunity to healing, these choices should always be considered.
Vicki KoblinerMS RD, CD-N isa Registered Dietitian andowner of Hol- care Nutrition (www.holcarenutrition.com). Vicki works with infants, children and adults with digestive disorders, food allergies, ADHD, autism and other chronic illness, and provides fertility and prenatal nutrition counseling. Vicki has extensive experience in using dietary modification, appropriate supplementation and functional lab testing to achieve optimal wellness. She can be reached at 203.834.9949 or vicki@holcarenutrition.com.