You’ve been diagnosed with inflammatory bowel disease. That initial diagnosis of a chronic condition can be overwhelming. It’s scary. It’s confusing. Most of all, it’s lonely and can leave you feeling alienated from your old life and your loved ones. The impact of IBD goes beyond the physical symptoms and, for most, it impacts their entire life, relationships, work or school, social situations, and even body image.
I hear you. I’m here to guide you through this new diagnosis.
As a Crohn’s and Colitis (IBD) specialist, it is my job to guide my patients through this journey, from diagnosis to healing, and I hope to be your go-to educator for all things IBD. Your doctor and care team are your first line for all medical questions regarding your disease, but let me be your take home companion; a place where you can continue reading and learning to expand your knowledge of your condition and empower you to change the things you have control over, like nutrition and lifestyle, with my integrative approach to health.
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The Internet’s Cure for IBD
There is so much information thrown at you constantly through the internet and social media about IBD. Many of them are quick fixes, anti-inflammatory regimens, and tons of supplements. And worst of all, many are not based on evidence or research studies in humans! Meaning how well they work and how safe they are has still not been proven.
Trust me, if there was a quick fix for this disease, I would have been the first person to use it. My husband was diagnosed with severe Crohn’s disease when he was 17. When he was 22, he had to have part of his small bowel removed. I have known him since we were 12 years old and have been alongside him through most of his journey.
So no, the internet doesn’t know of a superfood or mega-supplement for IBD. There is no magical fix. But with a well designed therapy plan that includes nutrition, lifestyle, complementary, and traditional therapies, most people can live and thrive with IBD.
IBD does not define you! You are more than your disease.
What is IBD?
Inflammatory Bowel Disease is characterized as chronic inflammation of the gastrointestinal tract with periods of remission (where the disease is quiet) and flares (when the disease is acting up). As of 2015, approximately 1.3 million Americans are living with IBD.
IBD is different from Irritable Bowel Syndrome (IBS). IBS is a dysfunction between the way the digestive tract, nervous system, and brain communicate, causing hypersensitivity and altered motility through the digestive tract. In contrast to IBD, IBS does not cause inflammation in the digestive system, although it does cause many similar symptoms such as diarrhea, constipation, bloating, and abdominal pain.
IBD can also be confused for Celiac’s Disease. While both cause inflammation, like food intolerances, diarrhea, bloating, and malabsorption of nutrients, Celiac’s disease has a known cause: an antibody reaction to gluten. When you’re on a strict gluten-free diet, the symptoms typically resolve.
These conditions can also be hard to diagnose. Without the proper evaluation by an IBD team, you may be told you have IBS or chronic constipation without actually getting to the real cause of your symptoms.
What is the difference between Crohn’s disease and ulcerative colitis?
Crohn’s disease can affect any part of the digestive tract. Damaged areas are often next to healthy areas, and inflammation can reach through multiple layers of tissue within the GI tract.
Ulcerative colitis is different in that the inflammation is typically only found in the large intestine (colon) and the rectum. The damaged areas are usually all together, start at the rectum, and spread into the colon. Inflammation with ulcerative colitis usually only occurs in the innermost layer of the colon lining.
Since Crohn’s disease can affect any part of the digestive tract, when it is limited to the colon, it may be confused with ulcerative colitis.
It is this inflammation that your care team will target with different types of therapies. We currently have many different medications, and the evidence shows that nutrition and lifestyle help manage IBD.
Causes of IBD
Although we can’t pinpoint one specific cause of IBD, like a protein or virus, we do know that it is a result of an overly activated immune system. Your body is responding incorrectly to environmental factors that have caused a disruption in your microbiome. And although over 100 genes have been identified in IBD, most patients diagnosed with IBD don’t have a family member with this condition. Additionally, inheriting a gene does not mean you will manifest the disease.
70 – 80% of your immune system is in your gut, separated by a thin layer of colonic epithelial cells from the gut microbiome. These two systems, the immune system and the gut microbiome, are in constant communication and have been influencing each other since you were born. When there is a disruption in one, it affects the other.
Our microbiome is constantly experiencing small transient changes. If it suffers a big change for a prolonged period, however, the immune system creates a cascade of inflammation which can take over the body. This results in a chronic inflammatory condition.
You’re likely dealing with a combination of symptoms including persistent diarrhea or constipation, abdominal pain, bloody stool, weight loss, and fatigue. When we see these symptoms, physicians usually order an upper endoscopy and a colonoscopy to check for possible causes, including ulcers, infections, celiac disease, microscopic colitis, and Crohn’s disease and ulcerative colitis. Since these procedures are only able to reach a certain depth of your digestive tract, we may also need to order imaging, like an MRI or a CT scan, to gain a different perspective on what is happening in your GI tract or visualize an area not reached with endoscopy.
We’ll also normally collect a stool sample to test for traces of infection, inflammatory markers, and for some other conditions, like pancreatic insufficiency or hypo/hyperthyroidism. While this might seem like a lot, it is important that we do a thorough workup to arrive at the correct diagnosis. Otherwise, we might waste your time on unnecessary or useless treatments. And more importantly, without a proper diagnosis, you won’t be properly treated, leaving your inflammation festering and potentially causing irreversible damage.
The earlier to an IBD diagnosis, the earlier to treatment and prevention of irreversible bowel damage.
Treatment of IBD
While there is currently no cure for IBD, research has come a very long way! We’re now able to provide you treatment options to decrease inflammation, save your bowel, and give you good symptom control. All the while allowing you to thrive in your daily life.
The most common prescribed treatment for IBD is medication. Typically, we start with anti-inflammatory drugs, to bring down the inflammation, and immune system suppressors, to keep your immune system from causing further damage to your bowel.
If those are not effective, we’ll move on to biologic therapies. Or, in certain cases of severe disease, your doctor may go to biologic therapies from the beginning. These medications target different inflammatory processes in your body. While these medications are more aggressive and are more akin to chemotherapy style drugs, the inflammation caused by uncontrolled IBD is far worse. Low lying and lingering inflammation causes long term bowel damage, even after a few months. This damage eventually turns into scar tissue. Once it does, there is no medication that can heal that area – it may need to be taken out surgically. Biologic therapies are effective and have become even safer, as the newer options are less immunosuppressive than previous versions.
The take home is that the faster we control inflammation, the less damage your bowel will sustain.
The main goal of treatment is remission. There are different types of remission, however.
Clinical remission means that you are free from symptoms and have a good quality of life! You might even feel like you don’t have a disease at all.
The tricky thing with IBD is that symptoms and inflammation don’t always go together. For example, you can be symptom free and still have a lot of inflammation. Or vice versa – you can have no inflammation and have a lot of symptoms. This may signify something else is occurring, like irritable bowel, celiac, disease or SIBO in addition to your IBD.
So our goal for your disease actually goes beyond clinical remission into endoscopic remission. This means that we confirm, with endoscopy or imaging, that the inflammation is no longer present. Studies have shown that this is a better sign of disease remission and signifies better outcomes for your health.
This is a lot of information I’ve thrown at you, I know. But there is still more coming. Stay tuned to my blog for the next update, where we’ll go over all the lifestyle modifications I use with my patients to help control their inflammation. Or better yet, subscribe to my newsletter! This way, you’ll be the first to know when more of this valuable content comes out.
Do you need help managing your IBD right now?
You can always book an appointment with me or my amazing colleagues at Planted Forward. We offer Family Medicine, Gastroenterology, and Cardiology services, all provided by trained integrative physicians. We also have IBD and integrative registered dietitians and health coaching services to further support your health.
Do you need help managing your gastrointestinal symptoms? Or are you simply looking to be as healthy as possible? I’m here to help! If you want to maximize your gut health, you can purchase Doctor Méndez Introduction to Gut Health here or book an appointment with me today to get the support you deserve.