Inflammatory Bowel Disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC) which seem to be caused by inappropriate activation of the mucosal immune system, facilitated by regulatory defects in the mucosal immune response and failure of the mucosal barrier that separates immune response cells from the contents of the intestinal lumen. The normal gut flora acts as a trigger for the inflammatory response and appears to play a central role in pathogenesis.

• There seem to be four components that are involved in the development of IBD. They include (1) the input of multiple genetic variations that govern intestinal barrier function, repair, and immunity; (2) alterations in the intestinal microflora; (3) acquired aberrations of innate and adaptive immune responses; and (4) global changes in environment and hygiene.
• It seems that a combination of various factors is probably needed to bring about CD or UC in individual patients. This model implies that each patient may have a distinctive illness with his or her own clinical manifestations and a personalized response to therapy.
• CD and UC have distinct differences in pathophysiology.
• Response to diet and probiotics is often different for the two disorders.
• Nutritional deficiencies are common in patients with IBD and can include vitamin C, vitamin A, Vitamin E, beta-carotene, magnesium, selenium, copper, and zinc amongst others. Micronutrient deficits may favor self-perpetuation of IBD by causing defects in the mechanisms of tissue repair.

Recommended Laboratory Tests

• Some of the recommended tests include CBC- complete blood count, ESR- erythrocyte sedimentation rate, CRP- C-reactive protein, and serum albumin amongst others.
• Useful markers of nutritional status in IBD also include plasma zinc and homocysteine, serum and urine magnesium, serum iron, ferritin and transferrin, and 25-OH vitamin D.
• In steroid-treated patients with refractory disease, serum dehydroepiandrosterone sulfate (DHEA-S) may be useful.
• Patients with recent onset, relapse, or exacerbation of IBD—especially those with diarrhea—should undergo stool testing for parasites, pathogenic bacteria, Clostridium difficile toxins, and yeast.

Treatment: All patients with inflammatory bowel disease (IBD) should be under the care of a gastroenterologist for regular endoscopic examination and prescription of appropriate drug therapy. The main role of the integrative practitioner is to help patients develop effective self-management strategies and enhance conventional treatment with an individualized nutritional prescription and the use of nutritional and botanical supplements.

1. Diet:

• Find and eliminate food allergies and sensitivities
• Increase fiber in the diet (at least 25 g per day). Recommend oat bran, 60 g/day, for patients with mild-to-moderate ulcerative colitis (UC)
• Omega-3 fatty acids from animal and vegetable sources should supply at least 1% of calories, and omega-6 fatty acids should supply no more than 7% of calories.
• Reduce fat and avoid vegetable oils except for olive oil, flaxseed oil, or coconut oil (1 to 2 tablespoons/day).
• Reduce the consumption of beef or poultry (UC)
• Reduce or stop alcohol and tobacco.
• See Specific Carbohydrate Diet (SCD)
• Foods and ingredients not allowed on the SCD include:
• Sugars: lactose, sucrose, high-fructose corn syrup, fructose, molasses, maltose, isomaltose, fructooligosaccharides, and any processed sugar
• All canned vegetables
• All grains: anything made from corn, wheat, wheat germ, barley, oats, rye, rice, buckwheat, soy, spelt, and amaranth
• Some legumes: chickpeas, bean sprouts, soybeans, mung beans, fava beans, and garbanzo beans
• Starchy vegetables: potatoes, yam, parsnips, seaweed products, agar, and carrageenan
• Canned and processed meats
• Dairy: milk, milk products, ice cream, whey powder, commercial yogurt, heavy cream, buttermilk, sour cream, and the following cheeses: ricotta, mozzarella, cottage cheese, cream cheese, feta, processed cheeses, and cheese spreads
• Canola oil, commercial mayonnaise, commercial ketchup, margarine, baking powder, and balsamic vinegar
• Candy, chocolate, carob

Other effective treatments can include supplements and medications recommended by a knowledgeable practitioner after a complete set of tests are performed.