My dear patients !
In the last articel I mentioned that nutrition can actually modify inflammation in case of arthritis. And when I talked to one of my patients last week who asked me: “do you have any recommendations on nutrition ?” I just talked and talked and talked for minutes. I was actually afraid that he would hang up on me which he kindly he didn`t.
(Yes, we were talking on the phone, still “Corona-times”).
And that made me actually once agian recognize how much there is to say about nutrition. And to write as well, so that`s why I start today. At least start, that issue as well is never finished.
Do you have a comfortable seat ? This will take a while…
How nutrition can influence inflammation
It is not an approach that is exclusively interesting for patients with inflammatory bowel disease (IBD). It is almost of common interest.
Most of the time you as an IBD patient are not interested in common recommendations on nutrition. Since your situation is not common, and you want to know about your special situation. And that makes a totally different approach to the issue of nutrition necessary very often.
The approach in case of inflammatory bowel disease, Crohn`s disease and ulcerative colitis always needs to take special issues into account. Like malnutrition when in case of inflammation nutrients arent absorbed properly. When a whole segment of the intestine is missing after surgery, that can lead to a totally different situation. All these aspects make a special nutrition necessary.
Osteoporosis is a big issue, I wrote about that in the articles about vitamin D , it`s almost like a accompaning illness for Crohn`s disease and ulcerative colitis.
Development and growth is a big issue for children and young adults. Nutrition is nothing less than therapy for Children. Therapy for Crohn`s disease in childhood enteral nutrition.
And how about adults ? Well, personally I am convincened that nutrition in case of IBD should and must be considered as part of the therapy as well. Nothing less. It is possible, to influence inflammation by nutrition and you will read a lot about that in this article (yet not all there is to say on the issue of inflammation and nutrition. It is just too much to write in one article). And that is why nutrition to me is part of the therapy in adults as well. A part you as a patient can and should contribute to.
When thinking about nutrition in inflammatory bowel disease we should always distinguish between patients with disease activity or relapse and patients in remission. There are certain foods you will not tolerate during disaese activity. Sometimes it is even necessary to stabilize the intestine by not eating at all for a few days. Some nutrients that will really give you a hard time (fibre) during disease activity will be benefitial fo you and your intestine in stable remission.
Some patients do have handicaps such as lactose intolerance, some do not tolerate gluten very well without having coeliacic disease. These circumstances also must be recognized when approaching nutrition.
But I really want to focus in how nutrition can influence inflammation today.
And also for the issue of nutrition in inflammatory bowel disease again the basics are important. In order you now what is happening in your intestine.
When approaching this by “I have to do this or that and eat like this or that” one might not expect to much of success by making some changes in nutrition without getting stressed out about it. When you understand what is happening in your intestine it is easier to change your routine little by little, one step after another.
Always remeber: change takes time to turn into routine.
And meanwhile you know that here on I.M. INFORMATION MATTERS it is all about sharing INFORMATION that help you , to get a better understanding for your disease. To understand your special situation in a better way and have the chance – and you do have this chance when it comes to nutrition – to contribute positively.
Lets get started
To start with and I don`t say that to discourage you – there is not one recommendation that fits all.
I looked at my literature for inflammatory bowel disease and nutrition and realized once again: studies on that issue are small, means that there were very few participants or participants which you cannot really compare to eachother. And of course it is difficult to really do clinical trials on IBD and nutrition since it is mandatory to have comparable patients (same sex, age, disease, course of disease, medication… more than difficult !)
And in so called good trials, which provide objective data and results you actually study “treatment” against “no treatment”. As with medication you test against so called placebo. And without the patient knowing wether he or she receives real medication or the false medication.
Try this with nutrition – it is just not possible.
Patients see what they eat and you cannot have placebo for nutritients. Like a nutritient or food that looks and tastes like the original product but has none of the ingredients.
It is just difficuklt to approach this issue as you normally do when you suspect therapeutic benefit.
As I recognized that I kind of “understood” why some of my colleagues insist on: “Well, we do not have any recommendation for nutrition on inflammatory bowel disease, Crohn`s disease or ulcerative colitis. We just do not have good and valid data.”
I have to admit before I thought about it that way considered them rather ignorant, but when you choose this certain perspective, you can surely argue that way.
I don`t do so.
Since I do know there is quite a lot I can recommend. And I know who else knows it : YOU !
And a lot of colleagues who treat patients with inflammatory bowel disease and have – just like me – the following conversation several times a day or week.
“Hello Mr/Mrs XY ! How are you ?”
” How is the stomach ?”
“Well, it is ok”
“Ok like what ?”
” Well, it`s alright, just when I eat something “wrong”, then…”
Dayle conversation in my consultation hour.
So let`s start from the beginning once again: Inflammatory bowel disease, Crohn`s disease and ulceratice colitis are diseases we see in the intestine, which occur in the intestine but which are linked very closely to the immune system and actually take place on that level.
The immune system in the gut reacts to what it ecognizes in the intestine. Which is intestinal content, nutritients, gut bacteria also called microbiome.
I really do not want to write about the microbiome here in exstension. But what we know is that the diversity of the microbiome in patients with Crohn`s disease or ulcerative colitis is a lot smaller than in non IBD patients. Wether this is cause or consequence of inflammatry bowel disease nobody knows. And that`s why I do not like to write about the microbiome that much. We always think we know a lot about it but maybe we do not know anything at all, that is at least my impression every once in a while.
Yet it is generally accepted, that it is better for our health and for our intestinal health to have a more diverse microbiome
And there are some nutrients which seem to reduce the diversity of the microbiome and some which seem to increase their diversity.
Today I will start by introducing and writing about nutrients that have a positive effect and some that have a negative impact on the intestine. And that is the beginning, I will write about nutrition here frequently.
First to start with nutrients which increase the diversity of the microbiome. Example: fibre.
There has been some research on that: when patients eat more fibre, the diversity of the microbiota is increasing. And according to that the metabolites of the bacteria, which also have a positive effect on the intestine, increase as well. Short fatty acids are kind of a famous example, some of you might even have heard about it before.
These short fatty acids develop as beneficial metabolits from bacteria and are able to reduce inflammation.
So you can imagine it simplified as a circle: intake of fibre results in more diversity of the microbiome, which results in more “good”, beneftitial metabolites of “good”, beneficial bacteria like short chain fatty acids, which again have a positive effect on the gut and contribute to reduction of inflammation.
And – with restriction to that we do not know which is the hen and which the egg when we recognize patients with IBD do have a less diverse micobiome – one could assume that with less inflammatory activity chances are better for a higher diversity of gut bacteria (microboime).
So what foods contain fibre ?
Good whole grain products (use whole grain flower), fruits , vegetables, legumes. You can change to whole grain peoducts on bread, pasta, rice. Eat vegetables, eat definetly more vegetables than meat, sausage or cheese.
The decision to have a high fibre intake from this day on can really make a difference.
Exemption !: You do have higher disase activity or a flare. In that case fibre really can give you a hard time. Please while suffering a flare stick to easy digestive products as toast or rusk.
So we already have one point for better nutrition, which can influence inflammation in a positive way (reduce inflammation).
What else do we have ?
First of all back to the intestine, the inflammation in the intestine, the immune system of the intestine. Because it should become as clear as for fibre why something is beneficial or not beneficial.
To what extent does the immunsystem react on the intestinal content, the microbiome, the bacteria ? Exactly to the extent, in which it get`s in contact with it.
There the gut barrier or better to say barrier disorder of the intestine plays an important role. This barrier normally consists of a mucus layer, which already limits the contact of intestinal content with the gut mucosa and the immune cells of the intestine and it consists of the very tight junctions between the cells in the mucosa. It is almost like they would bild a line grabbing their hands, standing very close to each other in order to make it impossible for anybody to cross this line. (Just for the sake of completeness: cells of course do not have hands, so that they could grab each other. That I like pictures is something you probably know by now.)
In case of Inflammatory bowel disease there is a disfunktion of this gut barrier, that is a basic principle in the disease. The mucus layer is damaged and the junctions betwenn the cells are not tight anymore. Tiny gaps between the cells lead to direct contact from intestine content with the immune cells, which is also exactly the mechanism that is everywhere discribed as “leaky gut”. And which in case of inflammatory bowel disease, Crohn`s disaese or ulcerative colitis leads to severe inflammation.
And what affects the mucosal barrier, the protective shild of the intestine ?
Again: whatever is in the lumen of the intestine. It is the micribiome, it is nutrition, the nutrients.
Do you know what is a common phrase on congresses, educational courses or in literatur on inflammatory bowel disease ?
“The occurence of inflammatory bowel disease, Crohn`s disease and ulcerative colitis has a strong correlation to western lifestyle and western diet”.
Which means – regarding lifestyle – lack of physical activity, lack of a certain rhythm or order in daily life and life in general (in example working shifts, having changing shifts without a normal day-night rhythm, in general a lot of hours people spend on a certain stress level at work without rest, no certain time for having meals, in general eating in an unconscious way. Lets be honest – how many of us eat in front of the screen of the computer or the television. How often do we just grab something to eat on the job and almost continuing work while eating. For many people this is their every day life and I don`t want to talk that down. Whether it is benefitial for our health is a different story.
(Did you actually recognize yourself while reading this ?)
Also to western lifestyle smoking counts as well as alcohol, medication , “stress” and overstimulation or information overload.
And the western diet – which means nutrition in the western world or better in industrialized countries – contains a lot of sugar – and I would definetly add sweeteners and food additives – a lot of meat and red meat, a lot of animal protein (which means also milk products) and just small amounts of vegetables and fruits.
And when we want to have a closer look at the western nutrition or western diet here, let us have a look at food preparation. Thats an important aspect. I it is not necesseraly about spending hours in the kitchen 3 times a day to prepare a meal. Let`s start on recognizing how the western diet makes it possible, that we do not have to spend a lot of time and yet have so called fresh food or better: ready meals.
Our foods are processed. In order to look fresh, have a nice color should look healthy and fresh) and in order to have a long expiring date (should look fresh for at least 3 days in the opened cooler in the supermarket). Almost everything is available all the time. And there is an extreme diversity.
Which food you should avoid
My favorite example for explaining how processed food works is yoghurt. Natural yoghurt is white and tastes – as yoghurt does. Fresh, but it is not very tasty actually. It is definetly not sweet, doesn`t have a strawberry flavor, doesn`t have a rasberry flavor either, neither vanilla or straciatella.
And when you add some good fresh strawberries or scrape out a vanilla-pod and add the vanilla you will taste the strawberrys, you will taste the vanilla (probably in a less intense way, I havn`t tried it actually) but the yoghurt will still taste like yoghurt. . But it doesn`taste sweet and it will definetly not have the strawberry flavor you buy with the usual strawberry yoghurt, strawberry cereal or muesli or the other strawberry flavored products.
There are so many pre-prepared foods, in cans, in a package, in a glas or frozen foods as well or the supposed fresh foods from the refrigerated section. At almost every corner you will find bakery, which look freshly baked, smell very good taste extremily chocolaty and which you can buy for remarkebly small money.
And there are light products, without sugar and without fat as it says on the package. But instead there are a lot of food additives which make sure the products have a nice color, are durable, have a nice texture and taste.
We know that some of the food additives used by food industry influence gut bacteria, the microbiome not in a positive way and can lead to a damage of the mucosal barrier.
And that`s exactly how these nutrients the food additives promote inflammation in the gut (and maybe at other sides of the body as well, I didn`t do research on that).
For every patient with inflammatory bowel disease, Crohn`s disease or ulcerative colitis where active inflammation is a problem already the described western diet will cause anything but health. It will actually impair the situation.
So what I want to recoomend you as a patient with inflammatory bowel disaese, Crohn`s disease or ulcerative colitis: avoid processed food. Avoid pre-prepared foods. Avoid canteen food which is prepaired at 8:00 in the morning for hunderts of people for low cost and is kept warm or is warmed up several times so it can be sold at 2:00 p.m..
Avoid frozen foods and convenience food as ready-made meals, prepared sauces. Avoid low- calorie or low fat or any kind diet products (even though I can not imagine you as a person with Crohns disease or ulcerative colitis are much into it. But in case you are : leave it)
And avoiding nutritional additives also means drinks and fluids. On that list you find all soft drinks, zero sugar drinks, ice-teas, energydrinks, juices.
Try to drink lots of water and tea, thats the best you can do.
I always tell my patients: “You are allowed to eat everything but know what you are eating !”
Know what is in your food. As mentioned : if you want strawberry in your yoghurt, buy yoghurt, buy strawberris, put the strawberrys in the yoghurt – period.
Avoid white sugar or sweeteners.
But when you want to do something good for your intestine do not buy and eat the strawberry-straciatella-dream from … I don`t know who sells it.
I could continue on milk products in case of inflammatory bowel disease right away. Another important issue and as well a wide field which I certainly will write about at one point.
As you can see: nutrition is an inexhaustable issue.
And this article is getting loner and longer.
Once again my recommandation: eat fibre like good whole grain products, fruits, vegetables, legumes
– only requirement: no disease activity, no flare –
Don`t do it because I or anybody else tells you so but because after reading this you understand and know: it is good for you microbiome, which can gain more diversity and produce more healthy metabolites for your intestine so that it can stay in a good balance.
And because it can reduce inflammation.
Avoid pre-prepaired foods, convenience foods, flavored products, diet products, low fat products, everything which you will finde for 2 days in the refridgerator in the supermarket and which is supposed to stay there for another 2 days lokking all fresh and colorfull and healthy.
And here as well, not because someone tells you that it is “bad food”, but because you understand that these products can cause more inflammation in your intestine. And the last thing you need is more inflammation in your intestine.
And: Yes. This will be a change at different levels.
In the beginning some food will taste boring. After a few months your will wonder how on earth you were able to eat this articial flavors and consistencies.
And by now I have written quite a bit here about fibre and food additonals. The rest is actually up to you.
What I will write about next time I don`t know yet.
Once again: take care !
Dr. med. Susanne Weyrauch
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