Inflammatory bowel disease (IBD) consists of two chronic diseases, Crohn's disease and ulcerative colitis. They both tend to cause malabsorption and thus lead to nutritional deficiencies. Medications often interfere with nutrient absorption and diarrhea causes mineral loss. The diseases are similar in nature but attack different areas of the digestive system. Ulcerative colitis effects the rectum and sigmoid colon, where as Crohn's impacts the ileum, small intestines, and entire gastrointestinal tract. Crohn's typically attacks in a segmented manner, with patchy or skipped areas affected. Ulcerative Colitis consists of continuous lesions.
IBD may be caused by a combination of genetics, environmental toxins, infections, and autoimmune disorders. The general consensus is that a person has a genetic predisposition for IBD; the condition surfaces in response to a trigger, possibly some ingested toxin or a viral or bacterial infection. There is no cure for Crohn's, but it can be medically and nutritionally managed. Without careful care of this disease, much of the intestinal tract will be irreversibly damaged.
The GI tract is full of immune cells that respond to any offending substance. It responds by producing a cascade of inflammatory processes and produces antibodies to attack the antigen. Proteins in foods can trigger this response. Also, permeability of the intestinal wall is increased during inflammatory states, allowing food molecules and cell fragments to escape. This further increases the risk for food allergies and sensitivities. IBD is an autoimmune disease, therefore the body cannot always distinguish between foreign invaders and the body's own cells. These diseases may also cause inflammation in other parts of the body including the joints, whites of the eyes, gall bladder and its ducts, spine, and other areas.top
Severe abdominal pain; vomiting, nausea, bloating, diarrhea; bloody diarrhea; multiple bowel movements or diarrhea; flatulence; constipation; fever; weight loss; poor growth (in children), decreased bone density; vitamin and mineral deficiency; anemia; low energy; muscle wasting.top
Since IBD begins with inflammation, preventing infection and keeping the immune system strong is crucial. Reducing inflammation and preventing intestinal permeability through diet (online or in person) and supplementation is also essential.
Food allergies and intolerance are twice as likely in persons with IBD compared to the general population. The extensive food intolerance knowledge of the EB Dietitians can facilitate the otherwise daunting task of pinpointing the triggering foods or substances. The Food Allergy Panel, which tests over 100 commonly eaten foods and chemicals, can also assist in this process. When removing allergens from the diet, it is crucial to replenish the nutrients that have been depleted from the aggravating substance.
Regular medical management often involves corticosteroids, anti-inflammatory agents, immunosuppressants, antibiotics, and anticytokine medications. All of these pharmaceutical agents have nutritional implications. For example, blood sugar levels will often elevate on corticosteroid therapy, so carbohydrate intake must be strictly controlled. Steroid medication can also cause bone and muscle wasting, fluid retention, and weight gain, all of which can be prevented through nutrition intervention (online or in person). In addition, antibiotics can change the bacterial flora of the digestive tract, sometimes leading to Candida overgrowth, but with dietary modifications, a healthy bacterial balance can be achieved.top
Mahan LK, Escott-Stump S. Kraus's Food, Nutrition, & Diet Therapy. 11th Ed. Philadelphia: Saunders; 2004: 721-727.
Reinhard T. Gastrointestinal Disorders and Nutrition. New York: McGraw-Hill; 2002.top