Inflammatory bowel disease

Inflammatory bowel disease (IBD) is not a single disease but 2 slightly different inflammatory bowel conditions, namely ulcerative colitis and Crohn’s disease. IBD affects one in every 350 people in the UK, with 100,000 people suffering from ulcerative colitis and 52,000 suffering from Crohn’s disease. Ulcerative colitis typically only affects the large intestine, whereas Crohn’s disease affects the entire digestive tract, from mouth to anus, however it can be difficult to tell the difference between the two in the early stages of the disease.

IBD is not the same as IBS, but the symptoms such as abdominal pain, gas, bloating, constipation or diarrhoea are often the same. However there are a few symptoms that can distinguish IBD from IBS – urgent and/or bloody diarrhoea, weight loss, fatigue, nausea and fever. The symptoms can manifest as severe flare-ups followed by periods of remission.

Much like in IBS the causes of Crohn’s disease and ulcerative colitis are unknown, though it appears there may be an environmental trigger, perhaps certain foods, bacteria or chemicals that cause the disease to manifest in genetically susceptible people. This environmental trigger then causes the immune system to malfunction and start attacking healthy gut tissue that leads to inflammation.


Both Crohn’s disease and ulcerative colitis are treated with medications such as corticosteroids and immunosuppressants. Surgery to remove inflamed sections of the gut may be required in cases that fail to respond medication.

There are some experimental treatments and nutritional management strategies that can be used for people with IBD. One new treatment gaining acceptance is faecal oral transplant. It sounds quite disgusting but in preliminary research it has been shown to be effective in treating clostridium difficile infections and it may have a use in treating people with IBD. Research is being conducted to establish if it works. Faecal material from a healthy donor is transplanted orally via a tube into the stomach of a person suffering IBD. It is thought that the healthy bacteria from the faecal donor can help to regulate the bacteria in the person with IBD and thus settle the symptoms.

Another method to help reduce the symptoms of IBD is to use probiotics. It is thought the probiotics help to suppress the immune system and enable it to recognise the gut tissue as self and to stop attacking it, reducing inflammation.

An experimental and yet to be researched nutritional management strategy to use for IBD includes doing the LOWFLEX diet. It is a 3 step plan that should be initiated after an IBD flare up. London nutritionist Steve Hines can help you with a LOWFLEX diet plan. Here is an example 3 step plan:

  1. After the next flare up cut out all food and have 8 prescribed liquid meals a day for 4 weeks. This needs to be done under the supervision of a nutritionist. Products such as Ultra Clear pH Plus from Metagenics would be suitable.
  2. The next step is to start the LOWFLEX diet (low fat, fibre limited, exclusion diet). In this case you would eat white rice and pasta (preferably gluten free), fish, fermented soy products, fruit (but without the seeds), vegetables (but without the skins) and essentially avoid everything else.
  3. The final step is to carefully re-introduce 1 potentially problematic food at a time noting any problem foods, such as gluten, wheat, dairy etc. Over the course of a few weeks you build back to eating a normal diet but exclude the problematic foods.

It is pertinent to point out that trying the FODMAPSCD or GAPs diet may also be worthwhile if the LOWFLEX diet seems too hard to do. It is important to work with a nutritionist during this stage to make sure you are getting adequate nutrition and not generating any nutritional deficiencies.

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