Dietary Strategies for Colitis Relief - Ask a Nutritionist

Transcript:

BRITNI: Welcome to Dishing Up Nutrition's midweek segment called “Ask a Nutritionist”. My name is Britni Vincent, and I'm a Registered and Licensed Dietitian at Nutritional Weight & Wellness. And on today's show, I will be answering a listener's question. And the question is, “Lymphocytic colitis, what dietary modifications besides pre and probiotics can assist with this condition?”

Overviewing inflammatory bowel disease conditions

So first of all, I want to tell you about what lymphocytic colitis is, then I'll dive into what dietary modifications and even some supplements that could be helpful. Lymphocytic colitis is a type of inflammatory bowel disease, shortened IBD, that causes chronic inflammation to the colon. There are different types of colitis and lymphocytic colitis is a type of microscopic colitis.

The other type of microscopic colitis is collagenous colitis. All the names get confusing. I totally understand that. But these two types are called microscopic colitis because they can only be seen under a microscope. The colon lining will actually appear totally normal during a colonoscopy, but these types of colitis will be discovered during a biopsy.

They can affect the colon differently, but they're generally treated the same; symptoms can include frequent watery diarrhea, cramping, abdominal pain, weight loss, fatigue and then sometimes joint pain, eye inflammation, and skin rashes might happen as well.

And then there is another kind of colitis called ulcerative colitis. This causes the colon lining to appear inflamed and ulcerated. The symptoms are similar. But ulcerative colitis can cause blood or mucus in the stool, and that is not typically seen with the types of microscopic colitis.

And again, all of these are a type of inflammatory bowel disease, IBD. Along with colitis, Crohn's is another type of inflammatory bowel disease. And Crohn's can affect any part of the digestive tract, but typically affects the small intestine in beginning of the large intestine. Whereas I mentioned before colitis only affects the large intestine, also known as the colon.

What is an autoimmune disease?

All of these conditions fall into that IBD category are considered an autoimmune disease. And I'm sure you've all heard the term autoimmune disease, but may not know what exactly that means. So an autoimmune disease means that your immune system gets confused and will actually begin attacking your own body. And in the case of IBD, your body attacks the cells of the intestinal tract, creating the inflammation and all of those symptoms that I listed.

Generally speaking. I think all the recommendations I make can apply to anyone with the different types of the IBD that I talked about, and I'm just going to refer to IBD for most of the rest of the podcast for simplicity sake. But I do want you to keep in mind that everybody's body is unique. So there's definitely not a one size fits all approach.

And I do want to provide some hope. I've seen many, many clients with IBD, specifically colitis over the years. And all these individuals have been able to eliminate all their symptoms. So again, please don't lose hope. I've had those clients that have diarrhea several times a day, and then they just don't want to leave their house.

And then a lot of anxiety comes along with that. And again, all of that goes away and they get their life back by making these changes I'm going to talk about. And in some cases, there might have been more individualized changes as well.

Possible causes of IBD

So I want to touch on the causes of IBD. You know, it's often difficult to pinpoint what causes any type of IBD or lymphocytic colitis. And, I think in many cases, it's probably multiple factors that contribute to that ultimate trigger. Genetics can play a role in any autoimmune disease, but just because a family member has, it doesn't mean that you're going to get it.

So, even if you have the gene for something, it's really your environment and lifestyle factors that will determine whether or not that gene gets expressed or turned on. This is a process known as epigenetics where these external influences can turn on or off specific genes, which is pretty cool. You know, you have a lot more control than maybe you, you realized.

These environmental factors that can contribute to IBD: antibiotics. processed carbohydrates, sugar, smoking, stress, infections: those are just some of them.

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Dietary modifications to help with IBD

So let's dive into dietary modifications that can help with colitis and any type of IBD. So of course, big picture sticking to whole real foods. You know, really limiting or completely avoiding those processed foods, especially those ultra processed foods and that means getting in real protein, meat, fish, eggs, dairy if tolerated, but I'm going to touch on dairy in a little bit here.

And then real carbohydrates sticking to vegetables and fruits. And then those healthy fats, avocados, olives, nuts and seeds if tolerated, butter if tolerated, avocado oil, avocados, all of those would be great, real healthy fats.

Gluten can be a trigger

And like other autoimmune conditions and digestive conditions, gluten can absolutely be a big trigger. So gluten is the protein in wheat, barley, rye, spelt, and kamut. And it's usually a contamination issue with oats. And gluten is what provides the elasticity to those grains. So gluten free products tend to have a very different texture, and that's why.

And I would think in terms of naturally gluten free, that's really the best way to go. Because even in the case of gluten free processed food, like gluten free bread, that could still potentially be a trigger in this situation. So all of those real foods that I mentioned earlier, the meat, the fish, vegetables, fruits, the healthy fats, those are all naturally gluten free, which is pretty amazing.

And I did a whole “Ask a Nutritionist” podcast on gluten just in October". And I also touch on the difference between gluten sensitivity and celiac. So, you'd probably find that helpful to listen to if you're considering going gluten free just for some additional information. There are some individuals, especially during a flare that may even need to eliminate the gluten free grains, like rice, wild rice and quinoa.

Dairy can be problematic for some

I mentioned dairy a little bit earlier. Dairy can also be problematic for some individuals, and that includes cheese, yogurt, milk for sure, and sour cream, cream cheese, cottage cheese; butter may or may not be problematic. So, if you've eliminated gluten, you're still having some symptoms, you may want to consider eliminating dairy as well. Or if you're feeling super motivated, eliminating both of them together.

Stick to cooked vegetables

And I would do this for at least a month to see if it benefits you, you know, along with eliminating the gluten and potentially the dairy, I would very much recommend sticking to cooked vegetables. If you have an IBD flare, your gut is irritated and inflamed, so asking your body to break down raw vegetables can just exacerbate all of those symptoms.

And sometimes individuals have a hard time with some of those cooked vegetables, particularly the higher fiber vegetables, and sometimes those cruciferous vegetables, broccoli, cauliflower, cabbage, things like that, during a flare may be difficult for your body to break down. And all of this seems to vary quite a bit from person to person, and then along with fruit, you know, sometimes those also need to be cooked or peeled to be able to tolerate them.

Usually you're not reacting to that specific fruit or vegetable itself, but it's likely that your body is just so inflamed that your gut’s having a very difficult time breaking it down.

Nuts can be a trigger for colitis

You know, the same can be said about nuts, those can be a trigger for colitis or IBD, and again, nuts, especially those harder nuts can be really difficult for your body to break down. So they might also just be exacerbating that inflammation and irritation. In that case, maybe you do better with a nut butter, and it is possible that nuts themselves are a trigger and it's not just the process of breaking them down.

Include probiotics & prebiotic rich foods for IBD

Let's touch a little bit on probiotics. The listener did mention that as well. If you've never taken a probiotic, I would recommend starting with Bifido Powder, a small amount, like an eighth of a teaspoon or a quarter of a teaspoon, slowly increase as tolerated. Anytime you're taking a probiotic or you're doing something that can potentially kill off the bad bacteria or other bad pathogens in your gut, you can develop what's called die off symptoms.

So these pathogens can't release their own toxins when they're being killed off. And those can cause what's called die off symptoms. Most commonly it's diarrhea. Sometimes it's headaches, fatigue, rashes, things like that. So it means that the probiotics, they're doing their job and it's a good thing, but you don't want to feel worse.

So for that reason, I would recommend starting really slow and increasing as tolerated. Ultimately, I would recommend getting to the point of a multi-strain probiotic where there's a variety of different bacteria in there, just to offer some diversity.

And then don't forget about those probiotic rich foods like kimchi, sauerkraut, yogurt, if tolerated, or maybe it's a coconut yogurt to be dairy free, kefir, again, if tolerating dairy; pickles without the vinegar because the vinegar is going to kill off that bacteria.

Those would all be some great probiotic rich foods. However, if you are in a flare, again, you may not tolerate these as well. But once your symptoms calm down, it can be a wonderful addition to your healing plan. The listener also mentioned prebiotics. Prebiotics are going to feed the good bacteria in your gut. So you can think of them as the fertilizer to your microbiome, whereas the probiotics are the seeds. So prebiotics are going to be fiber.

And again, having a lot of fiber in a flare could potentially make your symptoms worse. So once again, once your symptoms reduce, adding in a prebiotic is very helpful for overall gut health and preventing future flares. There's plenty of prebiotic products out there, but you're also going to get prebiotics naturally in a lot of fiber rich foods.

Some prebiotics that I'll mention: garlic, onions, asparagus, bananas, especially the slightly green bananas, chicory root, artichokes, legumes, ground flax seed, chia seeds. Those are just some prebiotic rich foods that you could incorporate, and a lot of times if you're getting a good variety of vegetables and fruits, you're naturally getting a lot of prebiotics.

Heal the gut with L-glutamine

Another supplement that might be helpful for the healing process is an amino acid called glutamine. So this is the most abundant amino acid in our body, and we do get it from food, mostly meat. And we have an article or a blog post titled, “Could You Benefit From Extra Glutamine?” So you could check that out for some more detailed information.

But basically what L-glutamine does is it helps to heal wounds. So you, in the case of IBD, there's going to be some leaky gut, and we've talked about leaky gut a lot on previous podcasts, but as a quick recap, that is when there's little holes, like microscopic holes that develop in the lining of your gut.

So then bacteria, food, other toxins are escaping your gut, going into your bloodstream, creating an immune response, creating inflammation. And so the glutamine, or a leaky gut, you can think of that as basically a wound of your intestinal tract. So the glutamine is going to help to heal that lining of the gut; make sure that there's tight junctures in the lining again, so that things cannot escape.

I often recommend 1 scoop of our glutamine powder or product called Glutashield, which has glutamine along with some other ingredients that also help to heal the lining of your gut. Everything that I mentioned, the food piece, some of these supplements , that's a really great place to get started.

Treat candida in some cases

I do want to mention another connection that I have noticed with most of my clients that have IBD. They make the food modifications. They add some supplements. Generally, their symptoms really improve pretty dramatically, but sometimes there's just these lingering symptoms that are not going away.

Oftentimes, they have some sort of overgrowth of a bacteria or a yeast, oftentimes candida, which you may have heard of. That's a type of yeast. And clinically, I've seen that some individuals with IBD aren't able to completely eliminate their symptoms until they treat their overgrowth problem.

So, doing everything I mentioned again, helps a ton, but there may be some lingering symptoms. And I saw this pattern enough. So, at some point, I decided to look to see if research supported this. And yes, there is research to support this idea. 1 study published in the journal, Gut, compared the microbiome of patients with IBD, compared to healthy subjects without IBD and found that there is higher amounts of fungus in the IBD subjects.

And also had some higher amounts of specific bacteria and decreased amounts of some of those good bacteria compared with the healthy subjects. And this study specifically did call out that candida, that overgrowth of candida in these IBD subjects. So in your gut, everybody has good and bad bacteria, yeast, all of that, but it's the balance of it all that really makes a big difference.

So we want more of the good guys than the bad guys, but if you have too much yeast or too much bad bacteria, that's when it can be a problem. Some other signs of candida could be fatigue, sugar cravings because yeast and bacteria, the bad bacteria are going to feed on sugar; skin issues can be a sign, oral thrush, like a white coating on your tongue, frequent vaginal yeast infections, or sometimes skin infections.

If you have been prescribed a shampoo called ketoconazole or an ointment with that same name, that is an antifungal; ringworm is also a fungal infection. Sometimes mood changes, joint pain, brain fog can be a sign, vaginal itching, anal itching, itchy ears, toenail fungus.

All of those could potentially candida. So if you are resonating with this, I would highly recommend making an appointment with one of our nutritionists. I would not recommend trying to treat this yourself.

So to recap, thinking food is medicine, modifying your food really does have a huge impact. So sticking to those whole real foods. I'd recommend going gluten free, oftentimes going dairy free. Sticking to those cooked, soft vegetables, incorporating a probiotic could be very helpful. And then if your symptoms don't completely go away after that, you could potentially have an overgrowth of candida or bacteria in your intestinal tract. So I would recommend talking to your practitioner about that or making an appointment with us.

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