The gastrointestinal system may seem pretty simple. After all, it’s basically a tube that winds its way from one end of the body to the other. But when that tube gets inflamed in the intestines, there’s nothing simple about it. In fact, inflammatory disorders like Crohn’s and colitis can be very complex to address in clinical practice. Here we provide an important primer on inflammatory bowel disease (IBD).
According to the Centers for Disease Control and Prevention (1) in 2015, there were three million American adults diagnosed with IBD (either Crohn’s or colitis), which was a significant increase compared to the two million in 1999.
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There are also many cases that go undiagnosed for a significant amount of time. This is because the symptoms can vary and be non-specific. 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 symptoms
When comparing and contrasting inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), you will find similarities and differences. (2) Both IBD and IBS have times when symptoms are present and times when there are few or no symptoms.
One of the hallmark symptoms of IBS is changes in the frequency and form of bowel movements. This can present as constipation, diarrhea, or alternating constipation and diarrhea. Another key symptom of IBS is abdominal pain and cramping.
The symptoms of IBD depend on where the inflammation is located and whether or not it is Crohn’s or colitis. With IBD, diarrhea, abdominal pain, and cramping can be common symptoms just like with IBS. In addition, however, these other IBD symptoms can occur:
- Blood in the stool
- Fatigue
- Fever
- Reduced appetite
- Unintended weight loss
While there is overlap in some symptoms, IBD is considered a more serious condition because it can lead to complications such as damage to the bowel and malnutrition. (3) In addition, while both conditions can be inflammatory, the inflammation with IBD is more extreme and in some cases of IBS, there is no inflammation at all. While the symptoms are clear, the cause or causes of these conditions presently remains a bit of a mystery.
IBD causes
“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.” (4)
While the exact cause is not known, the immune system can definitely be a factor. When the immune system fights invading viruses or bacteria in the intestinal tract, it can also attack healthy cells in the digestive system causing increased inflammation.
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There is also a link between IBD, IBS, and small intestinal bacterial overgrowth (SIBO). IBD is also more common in people who have a family history of the disease. (5)
In addition to family history, the Mayo Clinic (6) identifies the following risk factors:
- Age
- Race or ethnicity (whites have the highest)
- Cigarette smoking
- Nonsteroidal anti-inflammatory medications
- Where you live (industrialized countries have a higher risk)
The Mayo Clinic also warns that stress and diet can aggravate symptoms of IBD.
IBD diet and supplements
Dietary interventions can be an effective adjuvant to IBD treatment. As mentioned previously, malnutrition is a key concern when it comes to IBD and this is where diet and dietary supplements can be effective.
Micronutrient deficiencies
A 2017 review published in the journal Gastroenterology Research and Practice provides a detailed analysis of common nutrient deficiencies that can occur with IBD. (7) The authors write that “The most common micronutrient deficiencies in IBD are iron, calcium, selenium, zinc, and magnesium depletion. Vitamin deficiencies include all vitamins and in particular B12, folic acid (water soluble), and vitamins A, D, and K (fat-soluble).”
Supplementation for IBD
When looking at supplementation for patients with IBD, integrative health expert Ronald Hoffman, MD, provides this reminder: “Supplementation is not just a matter of replacing missing nutrients in IBD; certain vitamins and minerals have therapeutic effects beyond just staving off deficiency.”
Diet
There is much debate as to which is the best IBD diet. An individualized approach is likely the most effective course to take. A 2018 review published in the Indian Journal of Gastroenterology provides an overview of several popular diets for IBD including the specific carbohydrate diet, lactose-free diet, anti-inflammatory diet, low FODMAP, and Paleolithic. (8) The authors of that review also discuss key vitamins, curcumin, and polyphenols found in blueberries that have been shown to help patients with IBD.
A 2015 randomized, placebo-controlled, double-blind study published in the journal Clinical Gastroenterology and Hepatology involving patients with colitis showed that when curcumin was combined with their medication, their symptoms improved compared to placebo plus medication, and 8 of the 22 patients in the curcumin group experienced remission. (9)
In addition to curcumin, other herbs showing efficacy for IBD include aloe vera gel, wheatgrass juice, Andrographis, and Boswellia. (10)
The bottom line
It’s true that IBD can be challenging to treat. The best approach to IBD treatment is an integrative protocol that looks at 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.