IBD, IBS, Gut Bacteria - What Works For You?

Amazoniac

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Re: I think gut bacteria is good for us...

Zachs, according to what you posted, seems like your issue is in the large intestine:
- you don't believe that overgrowth in the small intestine can be a big problem, maybe because you never experienced it;
- all of the carbohydrates that you pointed out as being problematic are the more complex ones, those that reach the large intestine the most;
- raw carrots are strong and hard to digest, their benefit comes from resisting absorption and travelling the GI tract acting as an antibiotic. Usually, if you have a problem in the large intestine and ingest fibrous food, it attracts water and gives you soft stools;
- every added fat will contribute to delaying absorption. Maybe that combination are enough to let the complex carbohydrates reach the problematic areas.
 

Amazoniac

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Nutritional Therapy for Inflammatory Bowel Disease | IntechOpen

"Animal studies revealed that change from low-fat, high-fiber diet to “Western style” diet rich in fat and sugar resulted in substantial shift in microbiota within a single day [7]."

"In one study, high intake of proteins found in meat but not in dairy products was found to be positively associated with IBD [16]."

"Many epidemiological studies pointed out that excessive consumption of simple carbohydrates, refined sugars, sweet carbonized drinks, or even artificial sweeteners might represent a risk factor for the development of IBD; however, as many others failed to prove this association [21]. Individual studies even showed that low complex carbohydrates and low refined sugar intake significantly improved laboratory inflammatory markers and fecal calprotectin in patients with IDB [22]."

"On the other hand, consummation of vegetables and fruits rich in both soluble and insoluble fiber has been shown to be negatively associated with IBD [14, 23, 24]. Animal studies confirmed that plant polysaccharides and poorly digestible fibrous plant components have reduced features of experimental colitis [25]."

"[..]some vegetables like broccoli and cabbage are thought to activate the aryl hydrocarbon receptor (AhR), which is highly expressed by intestinal intraepithelial lymphocytes and is involved in immune regulation and defense against attacks of luminal microorganisms [28]."

"It has been hypothesized that emulsifiers, detergent-like molecules that are a ubiquitous component of processed foods, can disrupt intestinal mucus layer, increase intestinal permeability, and enable bacterial translocation across epithelia [29]. In mice, relatively low concentrations of two commonly used emulsifiers, carboxymethylcellulose and polysorbate-80, induced low-grade inflammation in wild-type hosts and promoted robust colitis in mice predisposed to IBD [30]."

"Maltodextrin, a polysaccharide derived from starch hydrolysis, was found to promote adherent-invasive E coli (AIEC) biofilms and increase adhesion of AIEC strains to intestinal epithelial cells and macrophages [31]. Strains of AIEC have been isolated from the ileum and the colon of CD patients [32, 33]."

"Therefore, consumption of maltodextrin and emulsifiers may possibly support growth of intestinal pathobionts, such as AIEC and their translocation across epithelial barrier, where they could survive in macrophages and lead to chronic inflammation."

"According to available data, malnutrition affects 65–75% of patients with CD and 18–62% of patients with UC [34, 35]."

"Main reason for malnutrition in IBD patients is insufficient food intake due to the loss of appetite and avoidance of certain foods presumably worsening the symptoms, resulting in prolonged restrictive diets [38, 39]. Intestinal inflammation and inflammatory cytokines released from immune cells can damage epithelial integrity and impair absorption of nutrients. In addition, bacterial overgrowth and increased intestinal mobility may contribute to malabsorption [40, 41]. Fat and fat-soluble vitamin absorption may be especially impaired in CD patients when terminal ileum is seriously affected due to the biliary salt malabsorption [42]."

"It should be noted that IBD patients with active inflammation have increased metabolic rate, which leads to increased energy expenditure [36, 37, 43]."

"Malnutrition, immobility, low protein synthesis, and increased proteolysis due to inflammation are the main mechanisms leading to sarcopenia, a progressive and generalized loss of skeletal muscle mass and strength with risk of poor quality of life and physical disability [44]. Sarcopenia has various negative health consequences such as pathological fractures due to bone demineralization, cardiovascular disease, and higher probability of hospitalization [44]."

"Micronutrient and vitamin deficiencies are common in IBD patients. Preventions of those deficiencies are mandatory for avoidance of possible clinical complications. The most common micronutrient deficiencies described in IBD patients are known for iron, calcium, selenium, zinc, magnesium, and vitamins, in particular B12, folic acid, A, D, and K [34, 42]."

"One of the important features of IBD is anemia. Its prevalence in pediatric patients is up to 70% and in adult patients up to 50% [48]. The most frequent cause of anemia in IBD patients is iron deficiency (prevalence estimated in 36–90% of CD and UC patients), following vitamin B12 (prevalence estimated in 22% of CD and 3% of UC patients) [34, 49], and folic acid (vitamin B9) deficiencies (prevalence estimated in 29% of CD and 9% of UC patients) [50]. These deficiencies are the consequence of bleeding from mucosal lesions, inadequate dietary intake, impaired absorption and utilization, surgery (ileal resection greater than 60 cm will develop B12 deficiency), systemic inflammation, and medications [37, 50, 51]."

"Calcium and Vitamin D deficiency are often in IBD patients, especially in those with duodenal and jejunal disease, when their absorption is disturbed [34, 42]. Their prevalence is 70% in CD and 40% in UC patients. Besides its influence on bone metabolism, vitamin D have important role in preserving mucosal integrity and mucosal healing capacity. In case of its deficiency, the risk for mucosal damage and for IBD is higher [34, 42]. It was shown that high levels of active vitamin D not only reduce the risk of developing CD, but also the risk of developing UC [52, 53]."

"Vitamin A deficiency in IBD patients is high up to 90%. Vitamin A deficiency results in impaired wound healing, night blindness, and xerophthalmia [34, 42]."

"Vitamin K deficiency in IBD patients is also reported, but the prevalence is unknown. Most important source of vitamin K is intestinal production by gut microbiota. Dysbiosis, use of antibiotics, and malabsorption may contribute to this deficiency [34, 42]."

"Inadequate dietary intake and chronic loss because of diarrhea are the main reasons for selenium, zinc, and magnesium deficiencies in IBD patients for which the exact prevalence is not known. Symptoms associated with deficiencies include bone health impairment, cartilage degeneration, fatigue, and poor wound healing [34, 42]."

"As already mentioned, indigestible carbohydrates, especially the fermentable ones may play an important protective role in IBD, as they represent the main substrate for production of SCFAs by intestinal bacteria. The only patients that may benefit from fiber restriction are those with strictures and obstructive symptoms."

"Significant proportion of IBD patients also suffers from functional irritable bowel syndrome-like symptoms even in remission independently of actual level of the inflammation [81]. Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet results in symptom relief in many of such patients [82]. However, low-FODMAP diet is very restrictive, so it should be carefully planned by professional dietetics to prevent development of specific nutritional deficiencies."

"Recently, an investigator group from USA developed the IBD-anti-inflammatory diet (IBD-AID) to be offered to IBD patients who are refractory to pharmacological therapy, or for whom the treatment is not as effective as desired [95]. The IBD-AID has five basic components. The first is the restriction of certain carbohydrates, including lactose, and refined or processed complex carbohydrates. The second is the use of pre- and probiotics and foods rich in the components that help to restore the balance of the intestinal microbiota (e.g., soluble fiber, leeks, onions, and fermented foods). The third is distinctive use of saturated, trans-, mono-, and polyunsaturated fats. The fourth principle is to review the overall dietary pattern, detect missing nutrients, and identify specific food intolerances. The last component is a modification of food textures to improve absorption of nutrients and to minimize the adverse effect of intact fiber. In practice, the IBD-AID consists of lean meats, poultry, fish, omega-3 eggs, particular sources of carbohydrates, select fruits and vegetables, nuts, and legume flours, but restricts the consumption of wheat, rye, and barley products as well as milk and dairy products other than yogurt, kefir, and limited aged cheeses. A retrospective review of their case series including both patients with CD and UC revealed that approximately one-third of the patients chose not to attempt this diet, while the vast majority of those who followed the diet for 4 weeks or more reported symptom reduction and were able to discontinue at least one of their prior IBD medications [95]."

"Several studies have shown that specific nutrients when supplemented in quantities exceeding their nutritional role may affect the immune system, metabolism, and gastrointestinal structure and function."

"A detailed review on the effects of specific amino acids on intestinal inflammation can be found elsewhere [96]. Although these amino acids may have some positive effect in IBD patients, their efficacy has not been adequately studied yet."

"Besides its role in calcium metabolism and bone mineralization, vitamin D is regarded as an important anti-inflammatory agent. It regulates immune cells trafficking and differentiation, intestinal permeability, and antimicrobial peptide synthesis [98]. Several studies revealed an inverse association between serum concentration of 25-hydroxy-vitamin D and mucosal inflammation in IBD patients [105, 106]."

"Curcumin is the active compound found in turmeric. It possesses anti-inflammatory, anti-oxidant, anticancer, and neuroprotective properties [99]. Several studies and systematic reviews reveal that supplementation with curcumin when provided simultaneously with medications is both effective and a safe option for maintenance treatment of UC [108, 109]."
 

Dolomite

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@Amazoniac , thanks for the information nutritional therapies post. I really think milk has restored my intestinal lining. I was never a milk drinker but since going all in with the OJ and milk (lactose free for me), I can tell my gut is better. Lately, I have been trying to add regular whole milk and I can tolerate it with meals. So I think that is another indication that my gut is better.
 

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