IBD – The Role of Supplements
By: Rifka Wells, Nutritional Therapist BSc (Hons) MBANT
Ulcerative Colitis and Crohn’s disease, collectively known as ‘Inflammatory Bowel Disease’ (IBD), affects over 200,000 people in the UK and is becoming increasingly common, with approximately twice as many cases today as there were 30 years ago. Although there are many theories as to the cause of this, genetic, environmental and dietary factors can all contribute. Dietary and lifestyle changes over the past 30 years, as well as the increased use of antibiotics, have a role to play in IBD.
There is a wealth of research to show that there can be significant improvement to both gut healing and a reduction of symptoms through the use of supplements. In my own personal practice as a nutritionist I have seen many patients with IBD and the remarkable effects diet and supplements can have.
It is important to remember that IBD is a lifelong condition that cannot be cured. However, remission can be achieved with symptom-free periods. Although ‘flare-ups’ are a common occurrence, the use of supplements can reduce their length and severity.
The use of supplements for IBD patients can be divided into 4 categories;
- Treatment – the intestinal lining of IBD sufferers has been damaged, making it extremely sensitive, as well as reducing its function. One of the many functions of the gut is selective absorption; allowing nutrients such as vitamins and minerals in and preventing food particles, toxins, viruses and bacteria from entering the blood stream. In IBD sufferers this function is impaired.
- Malabsorption – malabsorption is abnormal intestinal absorption as described above. Crohn’s disease usually affects the small intestine, which is the part of the gut that absorbs most nutrients. This widespread malabsorption, which does not occur in ulcerative colitis, may lead to weight loss and malnutrition. When the lower end of the small intestine (ileum) is involved, a decreased absorption of Vitamin B12 may occur resulting in pernicious anaemia. One of the main symptoms of IBD is excessive diarrhoea and bleeding. Vital nutrients are often not absorbed and lost through the faeces. Bleeding can lead to anaemia as the body cannot replenish iron stores at the rate at which it is lost.
- Risk Factors – IBD sufferers are at a higher risk of osteoporosis due to malabsorption of calcium and magnesium, as well as some having to avoid dairy products due to lactose intolerance. Side effects of various IBD medications may affect the utilisation of certain nutrients, for example, steroids can affect Vitamin C, calcium, potassium, sodium and protein levels.
- Anti-Inflammatories – These are useful and natural supplements that can be used either on a regular basis or during a flare-up to reduce the inflammation and pain associated with IBD. Reducing inflammation reduces the risk of further intestinal damage and scar tissue.
IBD affects each person differently and as such, a personalised programme needs to be devised for the individual. It is important to ascertain any underlying vitamin or mineral deficiencies. A GP can offer screening for iron, Vitamin B12 and D. Private testing may be useful to determine the status of other nutrients. Iron, B12 and D are all common deficiencies. Due to possible malabsorption Vitamin B12 and D can be given via injection. However, the crucial first step is to repair gut function as much as possible.
The amino acid L’Glutamine is used to repair the gut lining, making it more selective – allowing nutrients to pass through and blocking toxins, bacteria etc. It is also ‘food’ for intestinal cells in need of repair and acts as a precursor for the use of the antioxidant glutathione.
The role of prebiotics and probiotics has been widely researched and debated. Billions of bacterial micro-organisms live in the gut. Some are harmful and some beneficial. As long as there are more beneficial bacteria than harmful ones, they are able to live together peacefully. However, once there is an imbalance, known as dysbiosis, the harmful bacteria can cause symptoms such as wind, bloating, diarrhoea or constipation, low immunity and fatigue. Dysbiosis is often a result of antibiotic use and due to the nature of the condition is almost always found in IBD patients. Probiotic supplementation together with prebiotics is highly effective in IBD patients to restore gut balance, providing the correct dosage and strength is used.
Researchers have demonstrated that the use of omega 3 fish oil can double the rate of remission in patients with Crohn’s disease. This is due to the powerful anti-inflammatory nature of fish oil. Other powerful natural anti-inflammatories include quercetin and turmeric. Turmeric, the yellow spice can be taken in capsule form either on a regular basis or when needed. Unlike conventional anti-inflammatories, these have no side effects.
It is advisable to take a good multivitamin and mineral as a foundation to any supplement programme.
Although Ulcerative Colitis and Crohn’s are lifelong conditions, by using a holistic approach combining dietary, supplement, lifestyle and conventional medicine, remission can be achieved.