IBD: A Very Special Post Part 2

So not too long ago I did my first post on IBD or Inflammatory Bowel Disease- which encompasses both Crohn’s and Ulcerative Colitis (UC). In that post I discussed what those names mean and briefly discussed what it can mean in terms of lifestyle to have IBD. But now I want to delve a little more into the treatment.

With both diseases there are basically three options for treatment: medications, diet/nutrition, & surgery.

Medications for Crohn’s/UC:

-The meds for Crohn’s disease are designed to suppress the immune systems’ abnormal inflammatory response (it’s the inflammatory response that causes the symptoms of crohn’s), suppressing this response will not only help with symptoms but also helps the intestinal tissues heal. Additionally these medications can also reduce the frequency of “flare ups”- which is a positive because that can mean less tissue damage over time.

-According to the Crohn’s and Colitis Foundation there are essentially five different groups of drugs to treat/manage crohn’s. The primary goals of medication management are to allow the intestinal tissue to heal and relieve symptoms of any fever- and ideally reduced the frequency of these flare ups by extending the period of “remission” (non-flare times)

1) Aminosalicylates- this is a class of drugs. These drugs are not specially approved by the FDA for use in Crohn’s & UC, but they apparently are able to work with the lining of the GI tract to decrease inflammation. They tend to be more effective in the large intestine versus the small.

Some adverse side effects with 5-ASAs: GI pain and ulceration, hearing loss, hepatotoxicity (liver damage), kidney damage, central nervous system alterations, dermatologic problems, interstitial lung disease….. to name just a few

2) Corticosteroids- (prednisone), these “nonspecifically” (this means that these don’t target one part of the immune system that plays a role in inflammation and but rather suppresses the entire immune system) suppress the immune system and are used to treat moderate to severely active Crohn’s & UC (during a flare up). These steroids have SIGNIFICANT short & long term side effects, and once you are on them you cannot just be taken off of them willy nilly- you need to be weaned off of them carefully. The list of side effects is so far reaching that they are broken down by the system the influence, these include but are not limited to: weight gain, protein/muscle wasting, elevation in serum liver enzymes, increase in liver size, pancreatitis, peptic ulcers, anxiety, congestive heart failure, high blood pressure, abnormal fat deposits, decreased carbohydrate tolerance…. to name a few

3) Immunomodulators- (mercaptopurine) – these suppress the immune system so it cannot cause ongoing inflammation, these are typically used for people who do not have success with aminosalicylates, and corticosteroids. These are also effective in extending remission periods but also have a hefty list of adverse effects (including but not limited to): elevation in liver function tests (people on this typically need to have these checked on a regular basis), anorexia, cough, ulceration of intestine, decreased resistance to infections, renal failure, pancreatitis, hyperpigmentation of the skin…..

4) Antibiotics- these will are necessary should an infection arise, such as abscess occurs, or in very severe cases a fistula develops- they are not used in long term treatment/management

5) Biologic Therapies – (Humira, Remicade) Also known as anti-TNF agents – these represent the latest class of therapy for moderate to severe Crohn’s and Colitis. Tumor necrosis factor (TNF) is a chemical produced by our bodies to cause inflammation. Therefore anti-TNF will attach to the chemical and allow the body to destroy it, and decrease inflammation. Again these come with hefty side effects that include but are not limited to: antinuclear antibodies, infection, upper respiratory infection, nausea, infusion reactions (because some of these need to be infused via IV), serious infections and increased likelihood for malignancies.

So yeah- these meds help- and are absolutely necessary but come with a hefty price both fiscally and physically (some of these meds are pricey), and the physical side effects sometimes need to be monitored as much as the disease itself- but they are a very necessary evil.

Nutrition & Diet and IBD

In terms of nutrition & diet this plays an equally significant role, but a tricky one. As I said in my previous post- the GI tract is very long- one part or multiple parts can be affected. There are general diet recommendations for Crohn’s and UC that have been proven to be successful, however each individual may need to tailor these recommendations to fit their lifestyle, and additionally may discover that further eliminations and modifications in diet prove to be beneficial.

There is a lot of back and forth regarding dietary restrictions for a non-flare period. During periods of remission there is some room to be a little bit more lax however- depending on the individual however sometimes there are just “problem foods” that will cause feelings of cramps, abdominal pain, possibly even diarrhea- even in periods of remission.

The general recommendation for individuals with Crohn’s and UC- based on the Academy of Nutrition and Dietetics is:

-Eat smaller meals every 3-4 hours

-Stick to foods lower in fiber during symptomatic periods, however, fiber in moderate amounts can be beneficial during non-symptomatic periods because it can help add bulk to stools.

-Drink plenty of fluids

-Eat foods that have natural pre- and probiotics

-Use a multivitamin- however I am not a fan of using an MVI, I prefer to what I call “spot supplement”. Meaning instead of using a big supplement and get more of what you don’t need- figure out what you’re in need of, as well as understanding which parts of your small/large intestine(s) are affected.

My additional recommendations from what I have experience with:

-Adequate sleep

-Physical activity as tolerated

-Work with a dietitian to determine problem foods and non-problem foods as well as a tolerance for fiber. Some “problematic” foods included but are not limited to: lactose products, different types of sugars, and sugary beverages, fats, fermented foods etc.

-Limit caffeine and alcohol intake

In basically every case I think it HIGHLY important someone with any GI issue such as IBD, IBS etc works with a Registered Dietitian who can help them find trigger and problem foods and efficiently eliminate them from the diet, while including foods that are healthy but do not cause GI disturbances

Surgery & IBD

Surgery- as in most cases- is only used when the other treatments aren’t quite measuring up. According to CCFA 66-75% of individuals with IBD require a related surgery at some point in their life, even with the diet and medications. An important distinction is that surgery will not cure Crohn’s – in the least ideal cases a fistula, fissure, intestinal obstruction, and/or necrosis develop because the diet and meds are unable to control the symptoms. Surgery is done with the primary goal of returning individuals to the most normal life possible with the best quality of life as well.

With necrosis, a fistula, and/or obstruction- a resection is typically what is done to remove the damage, and the two healthy ends are joined together. While this sounds simple this is an invasive procedure. And the small intestine, and large intestine are insanely important – as they absorb all of our nutrients so even with a small portion removed a nutrient deficiency could easily develop. Additionally it is surgery so there are risks involved with any surgery as well as the recovery time.

However in the case of surgery and ulcerative colitis – if meds and nutrition therapy do not work, sometimes a colectomy is necessary (removal of the colon) will cure UC (again unlike Crohn’s – where symptoms can/will return following surgeries.

Again this is something very important to me, and important to a lot of people. I think it is vital that awareness is brought to this area, with awareness comes understanding. Remember IBD affects an estimated 1.4 million Americans- so just by you having a better understanding of this, and not being grossed out or weirded out- you can make all the difference in the world.

CCFA

All of the information from the blog was acquired from:

The Crohn’s & Colitis Foundation of America

The Mayo Clinic

The NIH

The Academy of Nutrition & Dietetics

and my own personal experience

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