Fitness Friday: Inflammatory bowel disease – Have you got an angry gut?

If your tummy often feels sore, you regularly suffer with diarrhoea, have experienced weight loss and/or feel extreme tiredness, you could have an angry gut.

Whether it is just your intestines that are inflamed or your whole digestive tract is affected, the first step (once the inflammation has been confirmed) is to reduce your intake of any aggravating foods and drink.

But even before that, it is important to have a proper understanding of your condition and how it affects your body, so that you can take the right steps to adjust your lifestyle and diet to best address your inflammatory bowel disease.

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease is an umbrella term used to describe a group of conditions that cause the gastrointestinal tract to become inflamed and ulcerated in both adults and children.

It is important to note that an IBD is not the same as Irritable Bowel Syndrome (IBS), and mostly the term is used to refer to ulcerative colitis and Crohn’s disease.

As the inflammation tends to persist for a long time (often for life), it is called chronic. However, IBDs tend to vary in severity from person to person and often change over time. Flare-ups can alternate with (often extended) periods of calm, but symptoms usually return – particularly if appropriate dietary changes are not made.

Over time, the swollen tissues in the lining of the intestinal tract can lead to discomfort and digestive problems. For example, the intestines can become less efficient at absorbing nutrients from digested food as a result of the chronic inflammation and resultant tissue damage. This, in turn, can lead to the common symptoms of weight loss, diarrhoea and vomiting.

Unfortunately, IBDs are quite common, with around 1 in every 250 people in the UK thought to be affected. More particularly, it is thought that approximately 120,000 people in the UK have ulcerative colitis and 90,000 have Crohn’s disease.

What causes inflammatory bowel disease?

There are a number of theories as to how IBDs come about, but the definitive cause is not yet known. However, stress, poor diet, poor digestion and food allergies are all known to be contributory factors at the very least.

A popular theory is that inflammatory bowel disease is due to an autoimmune process that is triggered by a genetic predisposition, a viral illness and/or an environmental factor.

Inflammatory bowel disease symptoms

Early signs of inflammation are often subtle, which can mean that an IBD goes undiagnosed for months or even years until the person begins to develop more severe symptoms, which might include:

– abdominal pain and cramps
– frequent bouts of watery and/or bloody diarrhoea
– unexplained weight loss
– fever
– exhaustion
– bleeding from the intestines.

Ulcerative colitis

Colitis, one of the main types of inflammatory bowel disease, affects only the colon (or large intestine). The inner lining (mucosa) and rectum become inflamed and develop open, painful ulcers.

People with colitis may experience stomach pain, but discomfort is often worst in the rectal area as a result of frequent diarrhoea. Depending on the severity of the inflammation, mucus and blood may be present in the stool.

Crohn’s disease

Crohn’s disease, the other main form of inflammatory bowel disease, can affect any part of the digestive tract. Having said that, it usually affects the small intestine and the colon.

It affects the deeper layers of the digestive tract lining and can appear as “skip lesions” between healthy areas.

IBD diet

Inflammatory bowel diseases tend to respond very well to nutritional therapy (but it is, of course, important to first discuss any new diet or supplement program with your doctor).

As IBDs are most common in Caucasians who live in industrialised countries, it is logical to assume that diet is a major factor in the development of the disease, or at least in the aggravation of symptoms.

While there is no definitive inflammatory bowel disease diet, there are some helpful guidelines.

Since there is inflammation, it makes sense to avoid any foods or drinks that might contribute to, or aggravate inflammation. For example, acid-forming foods like red meat, dairy, saturated fats, sugar, alcohol and coffee, which all place a strain on the digestive system.

Instead, opt for an alkalising diet, packed with vegetables, fruit, lean protein (such as fish) and green leafy plants. These foods tend to be high in:

– alkalising mineral salts (which can help to neutralise acids)
– digestive enzymes (which help to ensure the proper breakdown of food and absorption of nutrients)
– non-irritating dietary fibre (which helps food to pass more easily through the digestive tract and prevents the build-up of toxins and bacteria often associated with constipation)
– protective nutrients like antioxidants, phyto-chemicals, essential fats, flavonoids, vitamins and minerals (which can act as anti-inflammatory agents, helping to relieve some of the strain on an angry gut).

A few other factors should be considered when formulating an IBD diet and supplement program. For instance, sensitivity to certain foods (most commonly gluten and dairy), can aggravate inflammation, so avoiding them might help too.

What’s more, as is often the case with anyone with digestive complaints, levels of good bacteria in the gut are likely to be low. Replenishing these with probiotic foods and supplements can be a good way to support overall digestive health and immunity.

Another important point to bear in mind relates to fibre. Your natural instinct may be to pack your diet with fibre when you have a problem with your digestion. While fibre is a natural and important constituent of any healthy diet, the wrong kinds of fibre can actually aggravate an IBD.

For example, be particularly careful with insoluble fibre, found in bran and whole grains. It is harsh on the bowel and doesn’t tend to suit a sensitive or inflamed digestive system. On the other hand, soluble fibre (found in oats, lentils, beans, fruit, vegetables and flaxseeds) is highly beneficial.

A food intolerance (otherwise known as non-allergic food hypersensitivity), is a condition of the digestive system.

It involves some form of negative reaction, which is caused by the body’s inability to properly digest a particular food, food additive or other compound found in food (or drink).

Food intolerance is far more common than true food allergies. They also tend to occur more commonly in women, and one reason for this may be hormone differences as many food chemicals act to mimic hormones.

Only approximately 5% of people are born with an allergy. In the majority of cases, both food allergies and intolerances develop over time; so a food that was once tolerated well might suddenly begin to make you feel ill.

Symptoms may begin at any age and, while they can be wide-ranging, some of the most common ones are:

– stomach bloating
– water retention
– irritable bowel syndrome (IBS)
– inflammatory bowel disease
– diarrhoea
– skin rashes
– weight gain
– head aches
– mood changes
– cravings (ironically, often for the foods responsible for the intolerance or allergy)
– mouth ulcers
– recurrent bladder infections
– and fatigue.

What causes a food intolerance?

In simple terms, food intolerance can be caused by various chemicals (both natural and artificial) that are present in a wide variety of foods. The reaction experienced is usually the result of a deficiency in, or absence of, particular chemicals or enzymes in the body that are needed to digest a particular food substance.

The role of digestive enzymes

While we eat food for the nourishment of our bodies, our digestive systems can’t actually absorb food in its whole form; instead it absorbs nutrients.

So before it can be useful, food has to be broken down into its constituent parts, such as amino acids (from proteins), fatty acids (from fats) and simple sugars (from carbohydrates), as well as vitamins, minerals, and a variety of other plant and animal compounds.

Without this efficient process of digestion, which converts nutrients into a form that is absorbable by the body, we would not be able to survive.

Digestive enzymes are central to this process. They occur naturally in whole foods (such as fruit, vegetables and plants), but they are also manufactured by the body to assist digestion. While this mainly takes place in the pancreas and small intestine, digestive enzymes are also made in the stomach and even the saliva glands of the mouth.

If you don’t eat a diet that contains enough enzyme-rich foods (e.g. a diet high in refined and processed foods), or your body does not produce enough of its own enzymes (e.g. because you are sick, elderly or under stress), it will struggle to properly break down food. This can lead to certain digestive complications and complaints, including:

– fermentation of food in the stomach and small intestine
– putrefaction in the colon
– increased activity and overgrowth of harmful bacteria and parasites
– poor absorption of nutrients.

In particular, the inability to efficiently digest food can contribute to the development of food intolerances. This is because, if you have poor digestion, your intestinal lining can become irritated and what is known as “leaky gut syndrome” can develop.

In susceptible people, any partially digested food particles can seep into the bloodstream, strain the immune system and lead to food intolerances, and even allergies in extreme cases.

Food allergy vs intolerance

Food intolerances and allergies are very different.

As mentioned above, an intolerance is a digestive system response. In contrast, a food allergy is an abnormal response to food, which is triggered by the body’s immune system.

A true food allergy requires the presence of certain antibodies against the offending food, but a food intolerance does not. What’s more, the antibodies tend to lead to an immediate reaction whenever the offending food is eaten.

This distinction is important because, while a food intolerance may lead to some unpleasant symptoms, it is not life-threatening and symptoms tend to come on more gradually – usually within half an hour, but sometimes as long as 48 hours. An allergy, on the other hand, is usually a lot more serious and may even be fatal in extreme cases (e.g. through anaphylaxis).

Some common examples of food intolerance include:

Lactose intolerance – The most common food intolerance is to lactose, found in milk and other dairy products. It is caused by the body’s inability to properly digest high amounts of lactose, the predominant sugar in milk, because of a shortage or absence of the enzyme lactase.

Gluten sensitivity – Gluten is a protein composite found in foods processed from wheat and related species, including barley and rye. The term “gluten sensitivity” is used to describe those individuals who can’t tolerate gluten and experience symptoms similar to those with coeliac disease, but yet lack the same antibodies and intestinal damage as seen in cases of coeliac disease.

Interestingly, although coeliac disease is an autoimmune disorder caused by an immune response to gluten, it can also result in gluten sensitivity, as well as temporary lactose intolerance.

How is food intolerance identified?

Food intolerances are often more difficult to diagnose than food allergies, because they tend to be more chronic, less acute and therefore less obvious in their presentation. For example, there are no antibodies present to look for.

As such, they are most often identified through a simple trial and error approach – a dietitian or nutritionist will go through a process of elimination with the individual, removing suspected problematic foods and systematically re-introducing them back into the diet, looking for corresponding improvement and worsening of symptoms.

Other methods of diagnosis include hydrogen breath testing for lactose intolerance and fructose malabsorption and ELISA testing for IgG-mediated immune responses to specific foods.

Living with a food intolerance

Once the offending food or foods have been identified, the best advice is to avoid them wherever possible. This is likely to lead to a reduction, and hopefully over time, the total elimination of symptoms.

Fortunately, nowadays there are a number of specialised “free from” foods and health supplements available online, in supermarkets and in health food shops, which help to make life a lot easier for those with food intolerance.

However, with any diet where there is restricted food choice, it is important to ensure that you are still getting all of the nutrients you need on a daily basis. Severe food intolerance can, for example, lead to excessive weight loss and, occasionally, can even result in the individual becoming malnourished. Optimum nutrition can be achieved through careful meal planning and appropriate supplementation.