What causes IBD and how to best manage flare-ups?

Inflammatory Bowel Disease (IBD) affects 1 in 123 people in the UK. On World IBD Day, we're here to share what it means to have IBD, and how to manage flare-ups, food intolerances, and fibre.

What is IBD?

IBD is a chronic and relapsing intestinal disease characterised by high levels of inflammation. While inflammation normally helps protect the body from harmful infections and pathogens, in IBD the immune system responds inappropriately (becomes hyper-reactive). Crohn's disease and ulcerative colitis are the two major forms of IBD in the UK. Both of these conditions impact greatly on the affected individuals, with symptoms including:

• Pain, cramps, and swelling in the tummy
• Recurring or bloody diarrhoea
• Weight loss
• Extreme tiredness

Not everyone has all of these symptoms, and some people may have additional symptoms including a high temperature, vomiting, and anaemia.

What causes IBD?

Based on what the research tells us, IBD is caused by a combination of genetic factors and environmental triggers. While IBD can occur at any age, many people develop the condition in early adulthood (between 15 and 30 years). This means that many individuals live with the condition for most of their life. New research commissioned by Crohn's and Colitis UK shows that the number of people living with IBD has been vastly estimated. It's now thought that IBD affects 1 in 123 people in the UK.

How does IBD affect digestion?

As inflammation in IBD affects the gastrointestinal tract (where foods are digested and absorbed), nutrition is often impacted in a number of ways.

In Crohn’s disease, the ability of the small intestine to absorb nutrients is affected. This means that food might remain undigested as it travels through to the large intestine, resulting in diarrhoea and abdominal pain. 

In Ulcerative colitis, the small intestine functions normally while the lower sections of the large intestine become inflamed. This means that water is not absorbed well, resulting in diarrhoea, urgency to go to the toilet, and increased frequently of bowel movements.

How does IBD affect diet and nutrition?

IBD makes diet choices more challenging, as some foods may worsen or trigger symptoms. These foods vary a lot between individuals – while some might not be able to tolerate spicy food, others might be sensitive to caffeine. Many people with IBD find food journaling to be particularly beneficial to help identify food-related symptom triggers. It’s also really important to maintain a well-balanced, nutrient-rich diet as the absorption of key nutrients may not be as effective (particularly during a flare-up). 

Is there an ideal diet for IBD?

Unfortunately there’s no “ideal” or one-size-fits-all approach to diet. Due to the large variability between different people with IBD, dietary recommendations need to be personalised. However, there are some basic guidelines that can apply to most people with IBD:

• Focus on maintaining diversity in your diet, from fruits, vegetables, nuts, and wholegrains
• Eat smaller, more frequent meals
• Eat in a relaxed environment
• Identify and minimise your trigger foods
• Reduce the amount of greasy or fried foods
• Limit foods with insoluble fibre (e.g. wheat bran)
• Drink plenty of water and low-sugar drinks
• Avoid excessive caffeine (from coffee, tea, and diet soda) and ice-cold liquids (these may cause cramping)

What about dietary fibre?

Dietary fibre is a type of complex carbohydrate that cannot be broken down by the human body. Instead, fibre travels to the colon undigested where is it partially or completely broken down by our gut microbes. The trillions of microbes that reside in our gut (mostly in the colon) are collectively known as the gut microbiota. We keep our gut microbes healthy and thriving by feeding them with plenty of dietary fibre. In fact, it’s their favourite food. When our gut microbes ferment fibre, they produce Short Chain Fatty Acids (SCFAs), including butyrate and propionate.

The overall anti-inflammatory effects of butyrate and propionate is achieved through several mechanisms, with the joint goal of inhibiting the expression and production of pro-inflammatory cytokines. Individuals with IBD often have lower levels of butyrate, and fewer butyrate-producing bacteria residing in their guts. In fact, acute administration of butyrate to patients suffering from Ulcerative Colitis show clinically significant reductions in endoscopic scores of inflammation. 

What type of fibre is best for IBD?

Not all fibres will be beneficial in IBD, including insoluble fibres. Insoluble fibres (found in wheat bread, seeds, apple skins, and some vegetables) draw water into the gut and makes food move quickly through the gut. This type of fibre might aggravate IBD symptoms like diarrhoea, gas, bloating, and pain. During a flare-up, consuming insoluble fibre can lead to worsening of symptoms and a blockage in the intestinal tract.  

In comparison, soluble fibres (found in oats, avocado, sweet potato, carrots, etc.) help to feed the beneficial gut bacteria and produce SCFAs. Highly soluble fibres also help to enhance stool consistency and slow gut motility. This means that soluble fibres may help to maintain low levels of inflammation in the gut (and body) and promote regular, well-formed bowel movements.

How to choose the right types of fibre

At myota, we’ve dedicated years of scientific research to understand which types of fibres are best for those with IBD. As a product of this research, we’ve developed the Immunity Regulator Fibre Mix. This mix is exclusively made up of soluble fibres, and maximises the production of anti-inflammatory SCFAs, like butyrate, in the gut.

We've been totally overwhelmed by your interest in the product, and we apologise that we've been sold out for the past two weeks. But the good news is, it's almost back in stock! If you want to be first on the waiting list and receive a discount code for your purchase, enter your contact details with the comment "Immunity Regulator Waitlist" here.