There is an increasing rate of Inflammatory Bowel Disease (IBD) across North America. IBD develops through a combination of genetic, environmental, and dietary factors. In Canada alone, more than 300,000 individuals are affected by Crohn’s disease, with some of the highest rates of paediatric Crohn’s and colitis reported worldwide. Research also suggests that individuals who have experienced food poisoning or infectious gastroenteritis are about 1.6 to 4 times more likely to develop IBD compared to those who have not. Inflammatory Bowel Disease is an umbrella term that includes conditions such as Crohn’s disease and Ulcerative Colitis, which cause chronic inflammation of the digestive tract and can significantly impact quality of life.
Crohn's disease is a chronic gastrointestinal GI tract inflammation. Crohn's disease is typically differentiated from Ulcerative Colitis and other forms of IBD based on the location. It can affect and cause inflammation anywhere in the digestive tract mostly affecting small and beginning of large intestine. The lesions typically look like skip lesions (inflamed tissues between healthy tissue). This inflammation can affect all layers of the intestinal walls, leading to thickening, ulceration, and formation of tunnels or fistulas. It is a lifelong condition that typically involves periods of flares and remissions, with symptoms varying in severity.
Typically there would be a lower right abdominal pain with frequent non-bloody diarrhea. Symptoms of Crohn's disease can vary depending on the location and severity of inflammation in the gastrointestinal tract. Common symptoms include abdominal pain and cramping, diarrhea (which may be bloody), fever, fatigue, weight loss, and reduced appetite. Some patients develop mouth sores, while others might experience complications like anal pain or drainage if fistulas form near the anus. Severe cases may lead to bowel obstructions, ulcers, malnutrition, and increased risk of colon cancer.
Ulcerative colitis (UC) is a long-term, chronic inflammatory condition that affects the lining of the large intestine, particularly the colon and rectum. It involves inflammation and ulceration of the mucosal layer, leading to symptoms that can significantly impact an individual's quality of life. Although the exact cause remains unknown, it is believed to result from a combination of genetic, immune, microbiome, and environmental factors that trigger an abnormal immune response, causing the immune system to attack the colon's lining.
The primary symptoms of ulcerative colitis include recurring diarrhea, often bloody, containing mucus or pus, along with cramping and abdominal pain. The severity of these symptoms can vary widely, ranging from mild to severe, with some individuals experiencing frequent bowel movements and urgent urges to defecate. Other common symptoms consist of weight loss, fatigue, fever, dehydration, and anemia. Extraintestinal symptoms may also occur, such as joint pain, mouth ulcers, skin sores, and inflammation in the eyes. Symptoms tend to fluctuate, with periods of flare-ups and remission, where symptoms lessen or disappear entirely.
When discussing nutrition it is important that during active phases you should allow for bowels to reset. Removing common triggering foods such as
- Artificial sugar: Artificial sweeteners like sucralose and saccharin can worsen gut inflammation by altering gut microbiota, increasing intestinal permeability, and promoting bacterial overgrowth and immune activation. They reduce beneficial short-chain fatty acids and can increase susceptibility to colitis flare-ups.
- Raw vegetable: They are high in insoluble fibre and can be difficult to digest, irritating an already inflamed colon. The rough texture may physically aggravate the mucosa leading to discomfort, cramping, and increased bowel movements.
- High fibre food: Foods rich in insoluble fibre can increase stool bulk and frequency, causing mechanical irritation in the gut wall and exacerbating diarrhea and cramping during a flare.
- Nuts: Nuts contain fibre and fats that may be hard to digest during active inflammation, potentially causing irritation, bloating, or discomfort.
- Gluten: Some patients with ulcerative colitis report that gluten-containing foods worsen their symptoms by triggering immune responses or sensitizing the gut, though evidence varies. Gluten can sometimes increase gut permeability or cause additive irritation
- High processed food: Highly processed foods commonly contain additives, preservatives, and emulsifiers that can disrupt gut microbiota and promote inflammation, aggravating symptoms.
- Spicy food: Spices can irritate the gastrointestinal lining and exacerbate symptoms such as diarrhea, pain, and urgency.
- Caffeine: It is a bowel stimulant that can increase motility and stool frequency, worsening diarrhea and cramping.
- Alcohol: Alcohol can irritate the gut lining, increase inflammation, disrupt the microbiota, and worsen diarrhea and malabsorption.
Some foods to include are:
- Elemental diet is a hypoallergenic liquid formula that are used in medical protocols for IBD cases s it is loaded with nutrients that are pre-digested so that it is easy on the gut.
- Probiotic-rich fermented foods like plain yogurt, kefir, miso, tempeh, kimchi, and sauerkraut to support beneficial gut bacteria. Prebiotic foods that feed good intestinal bacteria, such as steel-cut oats, bananas, garlic, onions, asparagus, leeks, and cooked leafy greens.
- Soft, cooked vegetables like squashes, carrots, green beans, and leafy greens (cooked or blended) to provide soluble fiber which is easier on the gut.
-
Healthy fats from olive oil, avocado, nuts, and omega-3 fatty acids found in fatty fish. Olive oil, particularly extra-virgin olive oil, contains polyphenols like oleocanthal that target inflammation and help lower inflammatory markers. Avocados are rich in monounsaturated fats and vitamin E, which can reduce inflammation. Nuts provide healthy fats, fiber, and antioxidants, all contributing to anti-inflammatory effects. Fatty fish such as salmon, mackerel, and sardines contain omega-3 fatty acids EPA and DHA, which the body converts into compounds like resolvins and protectins that actively resolve inflammation by reducing pro-inflammatory cytokines linked to chronic inflammation and various diseases.
When looking at Crohn's disease important supplements to consider are
- Boswellia: It contains boswellic acids which inhibit inflammatory enzymes like 5-lipoxygenase, reducing inflammation and swelling in the bowel that disrupt normal function. Studies have shown Boswellia can help induce remission in inflammatory bowel diseases (IBD) including Crohn's by restoring normal bowel cell structure and improving symptoms such as abdominal pain and diarrhea.
- Artemisia: It inhibits tumour necrosis factor alpha (TNF-α), a key pro-inflammatory cytokine that plays a central role in Crohn's disease inflammation. Clinical trials showed that wormwood significantly reduced serum TNF-α levels and led to remission of symptoms in many patients.
- Vitamin D: Vitamin D levels being low are common in Crohn's disease which is also associated with severe symptoms. Supplementation with vitamin D has been shown to reduce the risk of disease relapse and improve quality of life in some patients. Although some studies have mixed results, maintaining adequate vitamin D levels is believed to preserve intestinal integrity and reduce inflammation, helping to manage Crohn's disease more effectively
- Omega-3-fatty acids: They reduce the production of pro-inflammatory cytokines and eicosanoids involved in the inflammation process in the bowel. Although large studies have shown that omega-3-fatty acids are ineffective for preventing relapse
- Zinc: Those with Crohn's have lower levels of zinc. Studies show that zinc supplementation can significantly reduce intestinal permeability, normalizing the gut barrier in patients in remission, which may lower relapse risk. Zinc also has anti-inflammatory and immune-modulating effects, helping to regulate immune responses and oxidative stress that play a role in Crohn's disease pathology.
- L-glutamine: L-glutamine may help Crohn's disease patients by supporting the integrity and repair of the intestinal mucosa, reducing inflammation, and potentially improving gut barrier function. It is a key fuel for intestinal cells and helps maintain gut lining health, which is important since increased gut permeability ("leaky gut") is implicated in Crohn's disease.
When looking at Ulcerative Colitis disease important supplements to consider are
- Butyrate: Butyrate is beneficial for ulcerative colitis (UC) primarily because it plays a key role in reducing inflammation, improving intestinal epithelial barrier function, and maintaining intestinal homeostasis.
-
Curcumin: Curcumin is beneficial for ulcerative colitis (UC) because it has strong anti-inflammatory, antioxidant, and immune-modulating properties. Systematic reviews and meta-analyses of randomized controlled trials on curcumin as an adjunctive therapy in UC patients show it significantly improves clinical remission, clinical response, and endoscopic outcomes compared to placebo, often nearly tripling the odds of a clinical response when combined with standard treatments
Living with Inflammatory Bowel Disease can be challenging, but early recognition and a holistic approach to management can make a significant difference. Paying attention to diet, stress, and lifestyle habits can help support digestive health alongside conventional medical care. It is always important to speak with your healthcare professional if you suspect you may have IBD or would like guidance on managing your symptoms.
About the author:
Hi, I’m Abinaa, a fourth-year naturopathic medical student at the Canadian College of Naturopathic Medicine with a deep-rooted passion for natural healing, inspired by my South Asian upbringing. Through this blog, I hope to share my journey, explore topics in holistic health and wellness, and offer simple, thoughtful insights that support a more balanced and mindful way of living.
