Let’s talk inflammatory bowel disease (IBD). By that I mean Crohn’s disease and ulcerative colitis (UC). I mentioned in a previous blog post that I was born and partially raised in Trinidad in the Caribbean. Well, in Trinidad, when it comes to donating and receiving blood, we have a different system. I promise this is related. You’ll see in a moment. In Trinidad, resources are far more limited than they are here in the US. Growing up in Trinidad, when a person needed blood, they (or more likely their family) would need to find someone or a few people who were willing to donate the amount of blood that the person needed. That blood would then be exchanged for blood that was the appropriate type (e.g. A+, O-) and already in the blood bank and that’s what would be transfused into the sick person. This way, the person got the type of blood that they needed, and the national blood reserves were less likely to be completely depleted.
Here’s the connection: my grandmother had a pretty severe case of ulcerative colitis. It eventually led to a partial colectomy where a portion of her colon was surgically removed, but before then, she had extremely bad flares. Oftentimes her flares were brought on by high stress levels and they consisted of excruciating abdominal cramping and pain combined with bloody diarrhea and heavy blood loss. A few times, she lost so much blood that she actually passed out and had to be transported via ambulance to the ER. My grandma had to have several blood transfusions throughout her life and I vividly remember walking with my great aunt Joyce in the middle of the night to try to find a taxi that would take us to the hospital to visit grandma and discussing who we could ask to donate blood for grandma this time around. It was pretty stressful, as you can imagine.
IBD and Diet
Whether you live in a developing country or in an industrialized country like the US, inflammatory bowel disease can be pretty stressful. What research is showing, though, is that a lot of the stress associated with IBD can be alleviated by adopting a suitable diet. My grandmother didn’t have the best diet growing up. Typical Trinidadian cuisine is delicious, but replete with white rice, white flour, fried foods, and foods that contain large amounts of sugar and/or suboptimal amounts of fiber. As she grew older, however, and my mom had more control over her diet, we transitioned my grandma to a diet consisting of low-fiber foods like soups and broths during flares and more of a whole-foods, plant-based diet when she was not in a flare. We really saw my grandmother improve with this pattern of eating. I didn’t fully understand the shocking science behind it until years later.
Conflicting Dietary Advice with IBD
Lately I’ve seen people advocating low-carb/high-protein and high-fat/ketogenic-type diets as means of addressing IBD, both Crohn’s disease and UC, but is this really an evidence-based approach? Let’s find out. Here’s what the science really says about what you should be eating if you have IBD:
Research suggests that low-carbohydrate, high-protein, high-fat diets may lead to the development or worsening of IBD over time. In one case study, a man who had no previous signs of IBD and no known family history of IBD developed UC after adopting a low-carb, high-protein diet for the purpose of weight loss. The man was prescribed a more or less whole-foods, plant-based diet (WFPB) while in-patient at the hospital with the exception being that he was given yogurt for its probiotic value. As a result of this dietary change, he actually saw his UC (bloody stool and all) go into remission for over a year. After about 14 months, his bloody diarrhea and other symptoms returned. He stated that this was because he had become too busy to maintain the whole-foods, plant-based diet at that time, but that he would be more diligent and intentional about choosing his foods and adhering to the diet that had been so helpful in putting his symptoms into remission. His attending physician accepted his resolution to change his diet and did not prescribe him any medication at that time.
This doesn’t only apply to UC. Another study showed that adhering to a similar “semi-vegetarian” diet led to 100% remission of Crohn’s disease in the first year and 92% remission in the second year. The results for an omnivorous diet like paleolithic or ketogenic-type diets were 67% in the first year and 25% in the second year. The results seen with the “semi-vegetarian” diet were much better than the results that are typically seen with pharmaceutical medication, including biological agents like Humira and Cimzia.
IBD and Prevention
Not only is more of a WFPB diet beneficial in addressing Crohn’s and UC once the diagnosis has been made, research suggests that a WFPB diet actually protects against inflammatory bowel disease in those who don’t have Crohn’s or UC. We believe this is mainly because of its high fiber content.
Here are the details: Carbs are important in IBD because of your gut bacteria. When we eat dietary fiber, our gut bacteria (provided we have substantial amounts of the right ones, of course) break the fiber down into butyrate. Butyrate is well-known as a short-chain fatty acid that helps to decrease inflammation in and promote normal function of the colon. In fact, it’s even used in the treatment of ulcerative colitis.
The foods we eat have a very strong impact on the makeup of our gut microbiome. While diets high in fiber help decrease intestinal inflammation, diets rich in animal fat and animal protein lead to a decrease in good bacteria in your gut. As you can imagine, since the good bacteria is what changes the fiber to butyrate, decreasing the amount of good bacteria is pretty problematic.
A combination of 19 studies conducted on over 6000 people showed that consuming large amounts of saturated fats, monounsaturated fatty acids, total polyunsaturated fatty acids, total omega-3 fatty acids, omega-6 fatty acids, mono- and disaccharides, and meat increased the risk of being diagnosed with Crohn’s disease. The more dietary fiber and specifically fruit a person eats, the lower their risk of developing Crohn’s disease.
These studies also demonstrated that eating a high total amount of fats, high total amounts of poly-unsaturated fatty acids (found mainly in fish, vegetable oils, and some nuts and seeds), high amounts of omega-6 fatty acids, and eating meat were all associated with an increased risk of developing ulcerative colitis. Having a high vegetable intake decreased the risk of developing ulcerative colitis.
Tips for the Transition
If you’re considering transitioning to more of a WFPB diet, here are a few things that you should keep in mind:
1. Avoid simple carbs and processed foods. The absence of meat and animal products does not necessarily equate a nutritious, WFPB diet. It’s pretty common for a person who is in transition toward a WFPB diet to replace the meat with simple carbohydrates and processed foods. If your aim is to make a healthy transition, you should avoid this at all costs.
2. Variety is key. Be sure to include a variety of fresh fruits and vegetables in your diet, placing an emphasis on whole foods. Include adequate protein and don’t forget to include some healthy, unheated fats.
3. The WFPB diet as a foundation. Based on the evidence, I strongly recommend a WFPB diet for my patients with IBD. Although a WFPB diet is associated with many health benefits, including being backed by research as having “the best result in relapse prevention” to date, adopting a WFPB diet can be a drastic change for many people. If transitioning to a WFPB diet is a difficult step for you, take courage in the fact that you don’t have to do it all at once. You may not be prepared to make a full transition now, but you can incorporate more plant-based whole foods into your diet and decrease your intake of the food groups we discussed as being problematic for IBD. What we’re looking for is a step in the right direction.