Crohn’s, Colitis, and Irritable Bowel Syndrome (IBS)
July 8, 2017
We’re discussing two different autoimmune diseases – Crohn’s Disease and Colitis – both are inflammatory bowel diseases, and for both a healing diet of real food can help eliminate symptoms and get you feeling well again. Listen in!
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Transcript
Tackling Frequent Diarrhea With Nutritional Health
Kara: Welcome to Dishing Up Nutrition. I am Kara Carper, a licensed nutritionist and cohost of Dishing Up Nutrition. Today’s show is brought to you by Nutritional Weight & Wellness, we’re a company specializing in life-changing nutrition education and counseling.
Carolyn: Hi, I am Carolyn Hudson, registered and licensed dietitian, and I would say putting an end to having frequent diarrhea is indeed life-changing. That is really what has happened with many of our clients. Many of these clients were young-teenagers who were struggling with digestive problems. Some clients were older-grandparents who stopped traveling for fear of not finding a bathroom in time. Clients who were carpenters, surveyors, or electricians who were having trouble finding a bathroom when they needed it and actually had to quit working.
Kara: As a nutritionist, and Carolyn and I are both nutritionists, it is so rewarding when I can suggest an eating plan and recommend key nutrition supplements to stop that life-interfering problem of frequent diarrhea. That’s what we do every day and our work as nutritionists is truly life-changing.
Carolyn: I know it is. So today we are going to discuss two different autoimmune diseases-Crohn’s Disease and Colitis, both of these are inflammatory bowel diseases, and diet is so important. We’re also going to talk a bit about Irritable Bowel Syndrome or IBS for short, and that one is not an autoimmune disease. And when I say diet, I don’t mean a low-fat, low calorie weight loss plan. I mean the healing diet of real food.
Kara: Right, I think some people hear the word diet and they just jump to the conclusion that it’s a starvation diet. Let’s just call it a new way of eating, a food plan that sounds better than diet. Before I became a nutritionist, I had no idea what it meant to have Crohn’s Disease or Colitis, I had heard of Irritable Bowel Syndrome but I really didn’t know what all these things were. Sometimes Colitis is called Ulcerative Colitis, those are the same condition. Both are diseases of the intestinal tract and both are considered an autoimmune disease. Whereas Carolyn just mentioned that IBS is not an autoimmune condition.
What are Colitis, Crohn's and Irritable Bowel Syndrome?
Carolyn: Right. So let me explain Crohn’s Disease. This inflammatory bowel disease causes inflammation of the lining of your intestinal tract. When your intestinal lining is inflamed, you can experience gut pain, severe diarrhea, fatigue, weight loss, and feeling like you have ongoing flu and it’s just not fun. And about 1.4 million Americans have inflammatory bowel disease.
Kara: If you are listening today and you have these symptoms and want to ask a question, give us a call at (651) 641-1071. As nutritionists we understand that the type of eating plan and supplements we would recommend depends on you, your symptoms, and it’s going to depend on what medication you’re on or not, how much inflammation you are struggling with because that can vary from person to person, and what foods your body and genetics are sensitive to. Clearly, one plan doesn’t work for every client. It needs to be individualized to meet your specific needs.
Carolyn: You really do need a nutritionist who is willing and able to listen to you and work with your particular sensitive system. We understand Crohn’s Disease will not go away, and our goal is not to know why you have Crohn’s Disease, but to help you eliminate those life interfering symptoms and get well again.
Kara: When we’re working with clients with Crohn’s and Colitis we refer to it as having the symptoms go into remission. Just like any other condition or illness, you go into remission, that’s really what our goal is here.
We have talked a little bit about Crohn’s Disease, so let’s share some information about Ulcerative Colitis. Again, Colitis is an inflammatory bowel disease. Typically the symptoms include diarrhea, sometimes even bloody diarrhea, and of course a lot of gut pain, abdominal pain is often involved. Just like the term sounds, colitis affects the colon, which is the large intestinal tract, with some sores or ulcers in the lining of the colon.
Carolyn: That’s really that inflammation right. Sometimes those ulcers are bleeding and causing that bloody diarrhea.
Kara: And Carolyn we don’t want to forget the third topic today, which is IBS. Which is actually more common than Crohn’s or Colitis.
Carolyn: I kind of think though that doctors, when they can’t figure out what the problem is, they say “You must have Irritable Bowel Syndrome.”
Kara: We hear that from our clients, when they come to us and check the box that says IBS. And it’s almost kind of like the doctor really didn’t know what to do. But we have nutritional solutions to that.
Carolyn: And the symptoms of IBS are very similar, you could have that diarrhea, usually not bloody diarrhea, but you could have diarrhea definitively. You could also have constipation.
Kara: Yes, alternating, it’s not like you would just have constipation, sometimes people go back and forth.
Carolyn: And that gas, and bloating, and pain. All of those are part of IBS.
We have talked about frequent diarrhea. Well, we have seen clients with Colitis experiencing 10 to 20 times a day. That truly is life interfering, right? I can’t imagine.
Kara: I can’t either and I assume people listening, that’s really hard to imagine you’re in those shoes. Wow, would that affect your life.
Carolyn: Recently I have had clients with a form of Colitis called Microscopic Colitis. So what does that mean? Microscopic Colitis is an inflammation of the colon that a healthcare provider can only see with a microscope. They are seeing an increase in the number of lymphocytes, which is a type of white blood cell within the layer of cells that lines the colon.
Kara: Interesting. So that was getting pretty technical, but I’m glad you described that especially for people that have that diagnosis of Microscopic Colitis. But, nutritionally, how do we help people with either Crohn’s Disease or Colitis? These are both diseases of inflammation, and it can be inflammation of the entire intestinal tract, and that is the case with Crohn’s Disease, it could happen anywhere in the intestinal tract, the small or large. Or it can be inflammation of the lining of the colon, again, that’s the large intestinal tract, so that’s Colitis. In either condition, our job as nutritionists is to reduce the inflammation and get people symptom free and into remission.
Carolyn: Talking about colitis, did you notice the article in the Star Tribune newspaper about 6-foot-4-inches, 200 lb Texas Ranger relief pitcher who has struggled with Ulcerative Colitis for the past 18 years?
Kara: I did, I did actually see that and I thought “How timely for our show.”
Carolyn: Jake Dichman actually came down with Ulcerative Colitis when he was 11 years old. He has had many flare ups but is determined to continue to be a relief pitcher.
Kara: I think Jake said something very profound: Having inflammatory bowel disease can be very painful. It is a day-to-day disease you have to deal with. We do have to take a quick break, how about if we finish talking about him after we get back from break.
BREAK
Carolyn: Kara, before we went to break we were talking about Jake Dichman and his Ulcerative Colitis.
Living with Inflammatory Bowel Conditions
Kara: I was just about to quote something he said that I thought was profound, he said “Having inflammatory bowel disease can be very painful. It is a day-to-day disease you have to deal with.” The reason we think that’s profound is because many people with an inflammatory disease have to deal with it on a day-to-day basis. Let’s face it, you cannot grab a candy bar for energy because you know that all the sugar and bad fats in the candy bar will no doubt cause you to be inflamed either that day or probably for several days. Dealing day-to-day means people with inflammatory conditions must focus on their anti-inflammatory diet and lifestyle every day, every meal. Every single thing that goes in their mouth, really. It’s a full time job and it’s totally worth it. We do this all the time and when people get this stuff figured out, it’s a huge incentive to really stay away from the candy bars and things like that.
Carolyn: You really have to say no to the beer and pizza on Saturday night with your friends because you will have symptoms the next day. In fact, I know of a client that believed he was cured but after drinking beer and eating pizza his body told him something different. Fourteen trips to the bathroom the next day and he realized beer and pizza was not worth all the misery. I was really happy when he finally put two and two together and said, “Ok, I get it Carolyn. I believe you now.”
Kara: Unfortunately it took that type of a situation. We’ve seen that too, people think they get all the bad food out of their diet and they’re feeling great and they think “Oh good, now I can just sneak a little or cheat a little bit with whatever.” But you can’t do that.
Over the past few years many prominent athletes have been diagnosed with Crohn’s Disease, including Kathleen Baher, a member of the U.S. Olympic swim team and then also NFL quarterback, David Garrad. These athletes have been determined to continue their passion even though inflammatory bowel disease can seriously get in the way of everyday life, not to mention their performance. So how can you deal with Colitis, Crohn’s or IBS nutritionally? That is a great question and everything we’re going to talk about applies to all three of them. Remember, we did said earlier in the show that each person needs their own food and supplement plan, but we have some great general guidelines for you today.
Carolyn: Often helping people overcome the symptoms of Crohn’s, IBS or Colitis requires the client to make a number of what we would call proven changes to their diet and certain lifestyle habits. Because when we do these and the client actually commits to those changes, those symptoms start getting much, much less and very good. They get back into that well feeling that “I’m finally good.”
How to Eliminate Inflammatory Foods
We start with eliminating inflammatory foods such like sugar. Sugar is inflammatory, I wish everyone knew that. That is so key.
Kara: The number one inflammatory food.
Carolyn: So what do you need to give up? Candy bars, pie, soda, cookies, cake, M&M’s, Twizzlers, and donuts. Those are things that are full of sugar, obviously. So remember, sugar can cause inflammation and then that inflammation leads to these disease states that we’re talking about.
Kara: Right, so like the candy bar we talked about earlier, or the soda. So after eliminating sugar, the next thing we would recommend eliminating are foods that contain gluten grains. Gluten is a protein in wheat, rye and oats but even a little bit further than that, we would recommend getting rid of all grains and even rice, at least for a few months. So what would you have to stop eating to get rid of gluten and grains? Things like bread, bagels, muffins, and pancakes. And even some of those other grains that we think are very healthy, like rice or quinoa or millet but just be too much, so it’s a good idea to get rid of that and just heal the digestive tract for a few months. And no more sugar or flour and the diarrhea goes away!
Carolyn: Exactly, yeah. Actually I have a client story about that one. I have a client who has been diagnosed with Crohn’s Disease and it wasn’t initially diagnosed, it took a while to get that diagnosis and she was suffering a lot with that bloody diarrhea. So we took away the gluten grains and she would sneak one every once in a while. She was sneaking a little bit of bread and there were times when family gatherings and everything she felt she couldn’t avoid it (gluten) and then she would end up with those episodes of diarrhea and gas and bloating.
BREAK
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Kara: You are listening to Dishing Up Nutrition. You may be asking, what has food got to do with Crohn’s disease or Colitis? As Nutritionists we believe a lot of intestinal troubles for many start with dairy products, such as milk, cheese, cottage cheese and also with products made, we had mentioned this before break, products made from flour such as bread, pasta, bagels, muffins, cookies, cakes or pizza. Kind of think about what you’re eating, what symptoms and do you need to eliminate these foods to feel better? Also, just wanted to remind you to give us a call today at the studio (651) 641-1071 if you have any questions.
Carolyn: While we were on break we got a caller and her question was about can corn and corn chips cause problems, this inflammation, the diarrhea, gas and bloating. And we both believe, absolutely, the vegetable corn can be very irritating to some people and also the grain corn. So you really have to be very, very careful. We mentioned earlier that we should be thinking of all grains, not just gluten. Some of my clients have to eliminate all grains for that period of 6-12 weeks and when the symptoms start subsiding and the gut and intestinal tract is more healed than you can start reintroducing some of those things. This is for many people, we can get them back to some of these things but some foods are purely inflammatory for some people so that’s why this whole individualized with a nutritionist is so important, because everybody is so important.
Kara: Exactly, but I think we’re giving some good general guidelines like gluten free for sure, but then a lot of people just do so much better with gluten free at least in the beginning.
Carolyn: And when we were just coming back from break we were mentioning dairy. We also eliminate dairy products also for both Crohn’s Disease and Colitis and IBS. So what do you need to give up? Things like, probably all these things that you love, pizza, ice cream, milk, yogurt, and cheese. I know those are some of my favorites, but just think of the pay off. Usually it is a big reduction of diarrhea episodes. There are no more, “Can I make it to the bathroom fears.” Yes, giving up ice cream is really necessary.
Kara: Necessary and definitely worth it. I would like to share a client story. Actually I have a couple, but I’d like to share one client who came to me, this was a couple years ago and she had been in the hospital for an acute colitis attack. So basically just diarrhea, a lot of pain and actually she called or texted me and was asking for some nutritional advice and so basically she changed her diet. I worked with her and we got rid of sugar is the first thing, and the second thing, gluten, and then we had dairy as well. So she has to focus on protein, vegetables and healthy fats. She can do a little bit of butter, olive oil, avocados, and things like that. She’s able to do salads, but sometimes she really needs to have cooked vegetables. She can’t have too many raw vegetables and we’ll talk more about that, and supplements, but I’ll just kind of give a teaser here that she really needs to take good bacteria, in the form of bifidobacteria on a daily basis. She knows when she runs out because she starts having intestinal problems. And she takes anti-inflammatory fish oil. So these are all things we’ll talk about in a few minutes, but she is doing great and doesn’t have her acute colitis symptoms anymore.
Carolyn: That’s wonderful. Guess what, we’ve got a caller on the line. Sarah?
Constipating Foods to Avoid
Caller: Yeah, I am here. I have a friend, who is a friend, not me, who suffers from bulimia and anorexia and she recently sought treatment for it and one of the biggest issues she’s having is IBS with constipation and it’s one of the hardest parts of her recovery. The mental aspect is allowing her to eat food again but the physical aspect is that every time she eats food she gets backed up, she gets constipation. And it’s really hindering the recovery because her stomach is in so much pain and she’s having a hard time identifying what foods, because it’s IBS and constipation and it just makes her not want to eat. In her treatment they didn’t really tackle this, they just assumed it was abuse from the disease for so many years and once she started eating food her stomach would be fine. But that’s not the case. And she does have a nutritionist but I was just curious about those aspects of it and how she can tackle that when you have an eating disorder going on as well.
Carolyn: Obviously we have to address the constipation that is a key issue. We would probably use a number of different techniques. We’ve already talked a little bit about that bifidoabacteria, but we would definitely be talking to her about her food triggers and helping her to identify those food triggers. What else would you say Kara?
Kara: We even have a sheet in our office that comes to mind, foods that tend to be constipating. And bread, any bread product is going to be pretty constipating, also cheese can be pretty constipating.
Carolyn: All the dairy products really, maybe not the dairy fats, but the dairy products.
Kara: Exactly. I would avoid dairy and gluten, and nuts for some people can be very constipating.
Carolyn: And apples and bananas can be constipating, but the other thing that we often use is a food journal. So we really rely a lot on our clients to think about what it is they ate that caused the problem. And if the constipation is constant, than we really have to eliminate a number of different things and see how we can improve it. And of course we’d do some supplements. But I think the other key here is that she really needs to work with her nutritionist one on one. I know that our initial appointments are two hours. We really go in depth with our client, but we can’t solve it on one visit or even two visits. So this is going to take this very individualized approach.
Kara: Is she working regularly with her nutritionist?
Caller: She is and with the disease she calls it her ED, the eating disorder disease, it’s just been a struggle because mentally she knows she needs to eat but it’s just a balance of what is damage to my body and what is food related. What is things I eat and that sort of thing and trying to prevent that whole, the food needs to stay in you but it also needs to go through properly.
Kara: Right, and it needs to be the right nourishing food not just any food is going to nourish her body effectively.
Carolyn: And healing her gut is really, really important and that’s obviously not going to happen overnight either.
Caller: She’s been drinking a turmeric tea, and ginger tea, for stomach issues.
Carolyn: Ok, well that’s good. I would definitely recommend the bifido supplement.
Kara: Yeah, keep listening. We’re going to talk more about the bifido and the omega-3’s. I think both would be very helpful for her constipation. Thank you so much for calling in for your friend today.
You are listening to Dishing Up Nutrition brought to you by Nutritional Weight and Wellness. I am Kara Carper, licensed nutritionist and joining me today is Carolyn Hudson, a licensed and registered dietician. We are discussing the nutritional connection to Crohn’s Disease and Colitis. We understand these are very complex health problems and with limited time, we can just touch on what an important solution food is. We understand you may have more in depth questions, personal questions. We believe each consultation needs to be individualized to meet every clients concerns. That is what we strive to do and answer all your personal questions.
BREAK
Kara: Ok, so before break we were talking about Crohn’s, Colitis and IBS and a lot of the food triggers. So far we’ve covered sugar, gluten but also other grains like corn and rice, and dairy. Those all can be very inflammatory and can be triggers. I would also warn people about food chemicals such as MSG and food dyes. A very common food dye is Red #40 and I would strongly suggest people start reading labels and if you’re avoiding processed foods you won’t find this stuff, but if eating something with a label, read it and be sure to avoid all of this. But there’s even chemicals in tap water can lead to diarrhea.
Carolyn: I know. I always tell my clients to try to do filtered water, purified water. That’s really a good start on that. But also, nitrates and nitrites, those are really common chemicals.
Kara: Yes. And those have been linked to cancer as well. Those are in a lot of processed meats, think about hot dogs, bacon, sausages. You’ve got to look for nitrate-free in deli meat as well.
Carolyn: It looks like we have another caller. Helen?
When to Avoid Dairy Products for Bowel Conditions
Caller Two: You had talked about dairy products to avoid and I don’t think you mentioned and I was wondering about these – cream cheese, cream, and sour cream.
Carolyn: Well those are usually in the dairy fat category and they, I have clients that can’t do any dairy fats or any of the other, cheese, cottage cheese, etc. But then I have clients who can do a little bit of butter, or a little bit of sour cream every once in a while. So again it’s that really individualized approach. We have to experiment with our clients and see what their triggers are. Do you have anything to add to that Kara?
Kara: No. Just the client that I was talking about, I had mentioned that she can have a little bit of butter. She’s someone who can have a little bit of butter, a little bit of heavy whipping cream. But I also work with plenty of clients who have to stop eating their cream cheese and sour cream. So step one is getting rid of the ice cream and the milk and the regular cheese and cottage cheeses and yogurt and then if there are still issues take it a step further and look at cream cheese, butter, whipping cream and heavy whipping cream as potential triggers as well.
Carolyn: And I have one client who can do the clarified butter called Ghee, but she can’t do anything else and she can only do a little bit of that. So she has probably about a teaspoon of clarified butter every day and she’s able to deal with that. Thanks very much for your call, Helen.
So what do you eat, what can you eat. Fish is great for most people. Chicken, turkey, and pork works well, especially if cooked in a crockpot so the meat is well done but soft in texture. So this is easier to digest for people who have this real inflammation going on in Crohn’s, Colitis and IBS.
Kara: Vegetables, vegetables are wonderful to incorporate, they're anti-inflammatory. I always tell people to sauté their vegetables in olive oil or coconut oil and to cut the vegetables into small bite sizes so they will break down and digest easier. Vegetables sautéed in good fats are much easier to digest and an interesting thing is that your body can access the nutrients more easily when vegetables are cooked in good fat, such as olive oil or coconut oil. That might shock you. What I am saying is sautéed vegetables are better for you than steamed vegetables, but, it is important to sauté them in olive oil or coconut oil.
Carolyn: We recommend eating smaller meals five to six times a day. Then we just mentioned this, that drinking filtered water is very important, no coffee or soda. De-stress that intestinal tract for best results. I often recommend eliminating nuts, which I think we mentioned earlier as well and when you’re symptom free, that’s when you slowly add some nut butter such as almond butter.
How often should you eat meals if you have bowel diseases?
Kara: We often recommend almond butter in lieu of peanut butter. Peanut butter can be more inflammatory for a lot of people. When you sit down with a nutritionist from Nutritional Weight & Wellness, we individualize the plan for you. We also understand you may be worried about all the weight you have lost, because this is really common. Most people with Colitis or Crohn’s Disease struggle to maintain a healthy weight, but eating small meals frequently through the day will help you regain your muscle mass and strength. Both muscles and strength need protein to rebuild. I recommend eating small amounts of protein, probably a little bit less than palm size, about 3oz, several times a time, we would say four five times a day. This helps to rebuild muscle mass and also strength that’s probably been lost from the weight loss.
Carolyn: When adding vitamin supplements, we are very careful at first because usually an intestinal tract that is diseased or inflamed with Crohn’s Disease or Colitis is very sensitive to both food and supplements. We need to be very careful. One of the things that we do is we need replace the bad bacteria with good bacteria. I usually start with a very small amount of the probiotic, bifido bacteria, as small as 1/8 of a teaspoon of Bifido Powder three to four times a day and then slowly increase to 1 teaspoon of Bifido Powder three to four times a day. The goal is to eliminate the diarrhea, not to take a supplement that will increase it. It is a fine balancing act. You’ve got to the find the right balance. We know how to help manage the intestinal tract because of the number of clients we have helped and we’ve been very successful.
Kara: Another supplement that we would recommend for many people would be Omega-3 fish oil. Omega-3 is very anti-inflammatory and research really backs that up, using that for Crohn’s and Colitis.
Carolyn: To recap our nutritional approach is to help eliminate symptoms of Colitis, Crohn’s and IBS. We remove the stressful foods from our clients’ diet. For the most part, those are all grains, all dairy products, even yogurt, and eliminate nuts. Then, feed the gut with clean, simple whole foods such as meat, vegetables, and good fats. At first cooked foods are easier to digest and they work much better than raw vegetables.
Kara: We really want to thank you for tuning in today and listening to Dishing Up Nutrition. If you found this show interesting please share it with a friend or family member. We have a great message each week and it’s how eating real food supports your health. It is a simple but powerful life-changing message. Be sure to tune in next week to listen to Brenna and Kate talk about breast cancer risk and its link to sugar and alcohol.
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