Functional Medicine for Inflammatory Bowel Disease (IBD)

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a chronic (long-lasting) disease. In IBD, abnormal reactions of the immune system cause inflammation in the digestive tract. Common types include Crohn's disease, ulcerative colitis and microscopic colitis. IBD is not the same as irritable bowel syndrome (IBS).^{1, 2, 3, 6}

Crohn's disease most often affects the end of the small intestine and the beginning of the large intestine. But it can affect any part of the digestive tract, from the mouth to the anus.^{1, 4}

Ulcerative colitis causes inflammation and ulcers (open sores) on the inner lining of the large intestine. It begins in the rectum. It may stay there or spread higher up the large intestine, but it does not skip areas.^{1, 2, 5}

Microscopic colitis causes inflammation on the inner lining of the colon (large intestine). Doctors can only see this inflammation by looking at colon tissue under a microscope. Unlike the other types of IBD, it does not raise your risk of colon cancer.^{3, 5}

IBD symptoms can come and go. Times with symptoms are called flares. Times when symptoms go away are called remission, and they can last for weeks or years.^{1, 2, 4}

Researchers estimate that 1 million people in the United States have Crohn's disease. About 600,000 to 900,000 have ulcerative colitis, and about 700,000 have microscopic colitis.^{1, 2, 3}

IBD can start at any age. Crohn's disease is more likely to start between ages 20 and 29, and ulcerative colitis between ages 15 and 30. On average, people are diagnosed with microscopic colitis at ages 60 to 65. Research suggests microscopic colitis is three to nine times more common in women than in men.^{1, 2, 3}

Having a parent, brother, sister or child with IBD makes it more likely. Smoking may double your chance of developing Crohn's disease, and people who smoke are more likely to develop microscopic colitis. Some medicines may also raise the risk of microscopic colitis. One example is nonsteroidal anti-inflammatory drugs (NSAIDs), a type of pain reliever.^{1, 2, 3}

Doctors aren't sure what causes IBD. Experts think genes, abnormal immune reactions, the environment and the microbiome may all play a role. The microbiome is the bacteria, viruses and fungi that live in your digestive tract. Studies have found differences between the microbiomes of people with and without IBD. Researchers are still studying how these factors work together.^{1, 2}

Common symptoms of IBD

Over time, IBD can lead to other problems, such as anemia (fewer red blood cells than normal), low bone mass and malnutrition (not getting enough nutrients). Ulcerative colitis, and Crohn's disease in the large intestine, raise the risk of colorectal cancer. Your doctor may recommend colonoscopies (a camera exam of the colon) to check for it.^{1, 2}

Symptoms vary from person to person and can range from mild to severe. They depend on the type of IBD and where the inflammation is. Common symptoms include:^{1, 2}

• Diarrhea^{1, 2, 3}
• Cramping and pain in the belly^{1, 2}
• Blood, mucus or pus in your stool, or bleeding from the rectum²
• An urgent need to have a bowel movement, or feeling that you need to go even when your bowel is empty^{2, 3}
• Watery diarrhea without blood, sometimes at night, which is the most common symptom of microscopic colitis³
• Weight loss^{1, 2, 3}
• Feeling tired (fatigue)^{1, 2, 3}
• Fever^{1, 2}
• Nausea, vomiting or loss of appetite^{1, 2}
• Joint pain, red or painful eyes, mouth sores, or red, tender bumps under the skin^{1, 4}

How IBD is diagnosed and treated

To diagnose IBD, doctors review your medical and family history, do a physical exam and order tests. They will also ask about the medicines you take and about smoking. Blood tests can check for anemia and inflammation. Stool tests can look for inflammation and rule out infections.^{1, 2, 3}

For Crohn's disease, endoscopy is the most accurate test. In this test, a doctor uses an endoscope to look inside the digestive tract. An endoscope is a long, flexible, narrow tube with a light and a tiny camera. The doctor can also take small pieces of tissue, called biopsies. Doctors use colonoscopy with biopsies to diagnose ulcerative colitis and microscopic colitis. In microscopic colitis, the colon lining most often looks normal, so the tissue must be checked under a microscope. Imaging tests, such as CT scans or MRI, may also be used.^{1, 2, 3, 5}

There is no cure for Crohn's disease. But medicines can reduce inflammation and help bring on and keep remission. The goals of treatment are to lower inflammation, prevent flares and keep you in remission. Your doctor may prescribe medicines that reduce inflammation, such as aminosalicylates or short-term corticosteroids. Other options include medicines that quiet the immune system, and biologics. People with ulcerative colitis typically need lifelong treatment with medicines unless they have surgery to remove the colon and rectum. For microscopic colitis, medicines most often work well.^{1, 2, 3, 4, 5}

Some people need surgery. Reasons include a blocked bowel, a fistula, or symptoms that medicines don't improve. A fistula is an abnormal tunnel between two organs, or between an organ and the outside of the body. Between 30% and 55% of people with Crohn's disease will need surgery within 10 years after diagnosis.^{1, 2}

For mild pain, doctors may recommend acetaminophen instead of NSAIDs, which can make IBD symptoms worse. Talk with your doctor before taking any over-the-counter medicine.^{1, 2}

Researchers have not found that specific foods cause or worsen Crohn's disease or ulcerative colitis. Still, some foods can make diarrhea and gas worse, especially during a flare. Your doctor may suggest keeping a food diary to find foods that seem to make your symptoms worse.^{1, 2, 4, 5}

How our care fits alongside your gastroenterologist

Avicenna Functional Medicine does not replace your gastroenterologist or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as the gut microbiome, environmental exposures, nutrition, smoking and stress, alongside the care you already receive. Research links the microbiome and the environment to IBD. Stress may also change the gut microbiome in ways that can worsen Crohn's disease symptoms. Researchers are still studying these links.^{1, 2, 3}

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. For safety, talk with your gastroenterologist before you take dietary supplements or try other complementary products.^{1, 2}

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Contact your gastroenterologist promptly if you have very bad belly pain, rectal bleeding or diarrhea you can't control. Also contact them if you have nausea and vomiting that lasts more than a day. Do the same for a fever that lasts more than 2 or 3 days, or a fever higher than 100.4°F (38°C) without another illness. Tell them about weight loss, new symptoms and any side effects from your medicines.^{4, 5}

Some IBD complications can develop quickly and be life-threatening. Examples are a blocked bowel, severe bleeding from the rectum, or a very severe ulcerative colitis flare with more than 10 bloody bowel movements in a day. These need treatment in a hospital. Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:^{1, 2, 7}

• Chest pain or pressure that lasts two minutes or more⁷
• Trouble breathing or shortness of breath⁷
• Sudden confusion, unusual behavior or trouble waking up⁷
• Fainting or passing out⁷
• Sudden dizziness, weakness or changes in vision⁷
• Being unable to speak⁷
• Severe belly pain, or sudden severe pain anywhere in the body⁷
• Coughing up or vomiting blood⁷
• Thoughts of suicide or of harming someone else (you can also call or text 988)^{7, 8}