Tag Archives: Ulcerative colitis

Inflammatory Bowel Disease – Crohn’s Disease and Ulcerative Colitis

“What goes into the gut affects the health of the gut”

Disclaimer: The following information is for educational purposes only. Please consult your health practitioner before making major dietary changes and do not stop your medications without medical advice.

Inflammatory bowel diseases Crohn’s Disease and Ulcerative Colitis are common in affluent, meat, dairy and processed food eating nations and uncommon or non-existent in populations who subsist on minimally processed plant-based diets. Both conditions affect the gut lining, our largest and most intimate interface with the ‘outside’ world, the food, microbes and digestive products of what we put in our mouths. These should be clues as to what causes and maintains these diseases – what goes into the gut affects the health of the gut.

This page is a landing page and resources page for IBD and is best used in conjunction with the Gut Health main page and the Elimination Diets page.

The typical Australian diet is a disaster for gut health. Constituents such as oils, animal fats and endotoxins from meat damage the intestinal barrier, effectively punching holes in the sieve that keeps out protein fragments and other molecules that can provoke an immune response. The result is an inflammatory reaction and further damage to the intestinal lining. Some animal proteins closely resemble our own and can provoke an immune attack on our own tissues, a process known as molecular mimicry. Dairy proteins seem to be most strongly associated with autoimmune disease.

Moving on to the colon: our diet determines what type of microbes predominate – inflammatory microbes that break down animal proteins and fats into toxic products or health supporting microbes that produce butyrate (see CSIRO Hungry Microbiome video) and support healthy gut lining cells. The animal protein that escapes digestion and absorption in the small intestine reaches the colon where it is putrefied by bacteria and releases many toxic, inflammatory molecules including TMA, rotten egg gas, ammonia and mercaptans. This mix is concentrated by the lack of bulking effect of the dietary fibre that only comes from whole plant foods. The further down the colon we travel, the more bacterial breakdown and reduction in volume has occurred, so it is not surprising that the distal colon and rectum are the most common sites for both colitis and bowel cancer.

When you take away the cause of a chronic disease it improves and often resolves. Our bodies are designed to move towards optimal health, at every level, from cells, to organs to the body as a whole. Leading plant-based practitioners have been treating patients with inflammatory bowel disease for long enough to have confidence that improvement or remission will occur. There are a limited number of clinical trials including Chiba et al 2010 from Japan that found that a mostly plant-based diet was highly effective for maintaining remission of Crohn’s disease. We have also included several testimonials from individuals who have used the power of whole plant foods to overcome severe inflammatory bowel disease. We don’t yet have a page for Diverticular Disease so we have included resources for this disease also.

Resources

Peer-reviewed articles:

Success stories

 

Page created 26 June 2017
Page last updated 1 May 2019

Elimination diets

The following information is provided as general education and does not constitute personal dietary advice. Each person’s situation is different and we recommend you consult your health practitioner before making major changes to your diet, particularly if you have a significant medical condition and/or take prescription medications.

Conditions treated by elimination diets

An elimination diet is a short-term restriction in the variety of foods eaten. The core foods are those that have been found to be well tolerated by nearly all patients. A strict elimination diet is difficult to sustain and best reserved for the treatment of severe inflammatory conditions under the supervision of a health practitioner. Lesser degrees of restriction may be more suitable for those struggling with irritable bowel syndrome and suspected food intolerances. In many cases, simply adhering to a low fat, whole foods, plant-based diet will be sufficient to relieve symptoms or promote healing.

Food allergies can be life threatening and food intolerances can cause considerable discomfort. However, the publicity given to these problems has led some people to be too quick to attribute gut symptoms to food allergy or intolerance, the most obvious example being the current over-diagnosis of gluten intolerance. The alleviation of symptoms by excluding a group of foods from the diet does not always mean that these foods are the cause of the problem. For example, excluding legumes or whole wheat from the diet may relieve cramping by reducing gas production without addressing the reason why the gut has become intolerant to small amounts of gas: the real problem may be too many animal protein foods and inadequate fibre and starch intake.

Elimination diets may be used to treat:

  • Irritable bowel syndrome (IBS) – characterized by pain, bloating, diarrhea – the diagnosis is based on the symptoms and normal medical investigations
  • Coeliac disease – 100% avoidance of gluten is required
  • Inflammatory bowel disease (IBD) – including Ulcerative Colitis and Crohn’s disease
  • Rheumatoid arthritis, Lupus (SLE) and other autoimmune diseases

Low FODMAP diets have been found to be effective for treating irritable bowel syndrome. However, we consider that this often only provides symptomatic relief rather than treating the cause, particularly for those eating a typical Australian diet. This may even apply to some vegan diets that are fat-rich, fibre-poor and lacking in basic starchy foods. Restoring the healthfulness of the gut microbiome with fibre-rich starchy foods and vegetables should result in a gradual reduction in gut irritability, and permit the reintroduction of high FODMAP foods such as legumes.  An elimination diet may help to identify particular foods that trigger irritable bowel symptoms. This often made difficult by all of the other physical and psychological factors that influence IBS – a food that causes bloating and cramps one day may cause no symptoms, or just happy gas, on another day.

There is some evidence that gluten exclusion alone may not eliminate gut inflammation in coeliac disease. Some degree of elimination diet may be needed, particularly during the healing phase when the gut lining has been damaged by gluten exposure.

Ulcerative colitis, as the name suggests, is an inflammatory reaction in the lining of the colon. Pain, diarrhea and bleeding are typical symptoms and the condition can become so severe that surgical removal of part of the colon may be recommended. It would seem obvious that what’s inside the colon – partly digested food and gut microbes – to a large degree, determines the health of the colon. In keeping with this is the observation that there are populations who subsist on starchy whole plant foods who do not get ulcerative colitis or bowel cancer. Experienced clinicians and their patients report great success in treating ulcerative colitis with a modified whole food, plant-based diet, usually involving some degree of elimination diet.

Crohn’s disease is the other common inflammatory bowel disease (IBD). The pathology is different to ulcerative colitis and it can be more difficult to diagnose as it can be limited to the small intestine, too far from either end of the gut to be inspected endoscopically. It too can be a severe disease, causing pain, malabsorption and intestinal obstruction. Resection of parts of the small intestine are sometimes required. A Japanese study (Chiba et al 2010) demonstrated that a mostly plant-based diet was the most effective treatment to date for preventing relapse.

The link between rheumatoid arthritis and food/gut health is biologically plausible. Fragments of food and microbes can enter the blood stream and provoke autoimmune disease, particularly when the intestinal barrier is damaged and more permeable – leaky gut syndrome (‘increased intestinal permeability’ to medical experts). The influence of the gut microbiome on the whole immune system is an emerging area of research. Suffice it to say that the number of people who have put rheumatoid arthritis into long term remission with a WFPB diet seems to be beyond what might be expected by chance alone. See our Arthritis page.

Elimination Diet Protocols

We have presented elimination diets in three tiers – from modest dietary restrictions through to a full elimination diet. The baseline, a low fat, whole foods, plant-based diet, may be enough to put many diseases into long term remission – a month of strict adherence to this baseline diet may obviate the need for an elimination diet. The ultimate elimination diet is water-only fasting – a powerful therapy that should only be used under medical supervision e.g. True North Health Center.

While a strict elimination diet followed by gradual easing of restrictions may seem logical and perhaps an imperative for those with severe disease, a more moderate approach may be easier to implement whilst continuing one’s usual life.

Protocol for a mildly restricted elimination diet:

  • This is a whole foods plant based diet with no oil, dairy or other animal protein foods
  • Avoid coffee and other caffeinated drinks
  • Avoid processed food products, particularly ones containing added salt, added oils and emulsifiers
  • Avoid yeast products, including nutritional yeast (especially those with Crohn’s disease, but could also be appropriate for other autoimmune diseases)
  • Eat more starches (brown rice, rolled oats, wholegrain pasta, potatoes)
  • Reduce, but not eliminate FODMAPs
  • Eat only moderate quantities of fruit
  • Eat more vegetables cooked rather than raw
  • Beverages – avoid alcohol, soft drink and juices, drink plenty of water (6-8 glasses per day)

Protocol for a moderately restricted elimination diet:

In addition to above –

  • Eat plenty of starch, but avoid gluten containing grains (wheat, barley, rye)
  • Minimize high FODMAP foods, including legumes
  • Limit fruit to 2 serves per day of low FODMAP non-citrus fruits
  • Avoid nuts and soy products
  • Cook most vegetables
  • Beverages – drink plenty of water (6-8 glasses per day)

Protocol for a strict elimination diet, eliminate all foods except:

  • Brown rice
  • Cooked sweet potatoes (white potatoes can be included if well tolerated but avoid green and sprouted areas)
  • Pumpkin
  • Cooked green and yellow vegetables (avoid tomatoes)
  • Cooked fruit (avoid citrus)
  • Avoid all condiments, use a little salt if necessary
  • Drink plenty of water (6-8 glasses).

NB There are no universally ‘safe’ foods – if symptoms are not alleviated on a strict elimination diet try cutting down to just one starchy food for a few days at a time. We have heard of people even reacting to sweet potatoes or rice.

After one to two weeks eating this way your symptoms should have gone or at least eased. Add one food back in at a time (in a sizeable quantity) and give it a day or two before trying each new food. Do not introduce two new foods at once. If you have a reaction to a food, wait several days before trying another new food. Consider starting a course of probiotics once symptoms have eased (take with food).

Expanding food options (one at a time):

  • Small amounts of raw vegetables (introduce raw cruciferous last)
  • 1-2 servings fruit (introduce citrus last)
  • Non-gluten containing grains, e.g. buckwheat, quinoa, millet, oats
  • Lentils – start with ¼ cup, then other legumes in small amounts
  • Tempeh

It can take time to heal a severely inflamed gut, and some individuals may have long term problems with some foods (e.g. wheat), but in general you can expect to enjoy a wide variety of whole plant foods once healed. Reactions to particular foods can be unpredictable – a food that causes bloating one day may be tolerated on another occasion.

Even when an intolerance is determined, one may decide that the enjoyment (“pleasure” in Doug Lisle’s Motivational Triad) that the item brings (think delicious fruit or coffee) outweighs the expected discomfort (“pain”) that will likely follow.

See related pages:

Resources

Peer reviewed articles

Return to Gut Health section

Page created 23 June 2017
Page last updated 21 September 2017

Gut Health

The number of Australians with gut problems seems to have increased in recent years. Most of these individuals do not have Coeliac disease, proven food allergies or inflammatory bowel disease but suffer frequent abdominal pain, bloating and bowel disturbances. Emerging research is pulling together an understanding of the complex interaction between the gut, the food we eat and the role of the gut bacteria. We share with you some ideas on why there has been a rise in gut problems and offer some possible solutions.

Note: If you have persistent gut symptoms, please seek medical advice.

In recent years there has been a great deal of speculation about the pre-agricultural diet and what type of diet is best for the genetic heritage that evolution has given us. What we can tell you is that the humans have a herbivore type gut, very similar to that of apes and monkeys. The relatively smaller size of the human gut can be attributed to our long evolutionary history of cooking food, which reduces the digestive work required. More in Humans are Herbivores.

We evolved in tandem with our gut microbiome, the bacteria and other microbes that inhabit our gut. They are just as much a part of our digestive system as our own cells. They feed on dietary components that are not absorbed in the small intestine, such as dietary fibre and resistant starch. The microbiome pays its fare by providing us with energy and nutrients that would otherwise have been lost. The large bowel or colon is essentially a fermentation vat. This explains the gas.

We have all heard of “good bugs” and “bad bugs” thanks largely to the marketing of probiotic supplements. Recent medical research is finding links between the type of gut bacteria present and certain diseases such as Crohn’s disease. More recently Faecal Transplants have been successfully used to eradicate clostridium difficile infection. However, the current paradigm is still very much about putting the right kind of bacteria into the gut with little consideration of the type of growth medium, the food. This is like planting rice seeds in a wheat paddock with no irrigation and expecting to grow a crop of rice. “Good bugs” can only thrive and persist on the right food mix, the “pre-biotic”. A recent study (David et al 2014) found that it only takes three days of an all plant based diet vs an all animal product diet to produce a completely different balance of gut bacteria. More in Gut Microbiome.

Animal protein foods not only lead to a less favourable gut microbiome but their constituents can also damage the gut lining. Some of these such as saturated fat and endotoxins have a direct inflammatory effect while other such as methionine and carnitine produce inflammatory bacterial products. The loss of the bulking effect of dietary fibre further contributes to these effects. When the gut lining, which is only one cell thick, is damaged by this combination of “bad” gut microbiome and animal protein foods it loses it integrity and leaks like a sieve. Potential allergens and proteins that may trigger autoimmune disease are then able to pass into the blood stream. This state is known as “Leaky gut syndrome” and is thought by some to be responsible for many diseases including auto-immune diseases. Note the correct medical term for ‘leaky gut’ is ‘increased intestinal permeability’, a recognised feature of inflammatory bowel and coeliac disease. More in Leaky gut syndrome (under construction).

Dietary fibre is essential to gut health and is protective against other diseases such as heart disease, diabetes and breast cancer. Our page, Nutrient Density explains that adequate dietary fibre cannot be obtained by simply adding a supplement or particular food to an otherwise low fibre diet. Many gut problems are simply symptoms of inadequate dietary fibre. Constipation is not always apparent as one can have a transit time, from eating to elimination, of 5 days but still be “regular”. There is a group of NutritionFacts videos in the Resources section below which covers this in more detail. More in Fibre (under construction).

There is a group of carbohydrates known as FODMAPs which can ferment too quickly and produce large amounts of gas leading to abdominal pain and distension. A low FODMAP diet can often reduce these symptoms but may not be addressing the underlying cause of why the gut is so sensitive to gas. An inflamed gut lining, a “bad” mix of gut bugs and inadequate dietary fibre may be behind many FODMAP intolerances including whole wheat. Avoiding wheat, other whole grains, or even all starches, will reduce gas production and relieve symptoms for some people but it will not cure the unhealthy gut situation. In fact, the gut health is likely to be worse as fibre intake is further reduced and “good” gut bacteria are starved of fermentable carbohydrates. See FODMAPs.

Many individuals suffering from gut problems protest at the suggestion that their overall diet could be causing the problem. After all, they may be lean and healthy and following the advice of experts to eat more fish, chicken, yoghurt and olive oil, whilst restricting carbohydrates. What’s more, the gut problems may not have followed a change in diet. The onset of gut problems may be delayed for months or years following a change in diet or a habitual low starch diet. There may be a tipping point, an irreversible shift to one side of a precarious balance in an already stressed system that follows some event such a course of antibiotics (see Blaser 2011) or an episode of gastroenteritis. Once the gut bacteria and gut lining have gone past this tipping point they may not readily recover due to positive feedback mechanisms which maintain the new dysfunctional state.

A whole foods plant based diet is part of the solution for most gut problems. Having said this, we wish to make it clear that none of the information we provide is intended to be taken as medical advice and that persistent gut symptoms should be assessed by a qualified health practitioner. If you have Crohn’s disease, Diverticular disease or Ulcerative colitis you might find it interesting to look at the resources, including Success Stories on our page Inflammatory Bowel Disease – Ulcerative Colitis and Crohn’s Disease.

The transition to a whole foods plant based diet may be problematic for some. It can take several months to adapt to the higher dietary fibre content and greater bulk of whole plant foods. Focusing on increasing the intake of starchy foods (eg grains, potatoes) may be better tolerated than trying to eat large amounts of fruits and raw vegetables. The FODMAP information may assist in choosing a less gassy range of whole plant foods during this transition phase. Legumes, for example, may need to be introduced gradually – which may mean abandoning the standard plate model of a “protein” food comprising a quarter of the plate. There is plenty of protein in the food on the rest of the plate.

While there is no question that those with Coeliac disease must avoid all gluten containing grains, wheat, barley and rye, the evidence does not support the avoidance of wheat as a general health measure. Gluten free diets are associated with worse health outcomes (see Lebwohl et al 2017), probably because of the lack of whole grains. This need not be so as there are many other whole grains to choose from and no one is intolerant to all of them.

Plant-based practitioners often prescribe an elimination diet to treat flare ups of ulcerative colitis, Crohn’s disease and autoimmune diseases such as rheumatoid arthritis. A regular whole foods, plant-based diet may not be enough to bring severe gut inflammation under control. Elimination diets are also used to diagnose and treat suspected food intolerances that are not resolved by following a low fat, whole foods, plant-based diet. See our page on Elimination Diets.

Related pages:

Resources

Podcast & video interviews with gastroenterologists and other plant based practitioners:

There are many interesting resources about gut health on Dr Michael Greger’s NutritionFacts website. The peer-reviewed papers referred to in each video are listed under ‘Sources’ beneath the video. The blog posts link to relevant videos so they serve as a summary on the various topics. Here are a few of our favourite links:

Gluten, wheat & grains:

Peer reviewed articles

Success stories

Page created 5 October 2013
Page last updated 1 May 2019