The IBD-Malnutrition Connection

28 January 2016 by Larissa Long (VRP)

An estimated 1.6 million people in the U.S. suffer from inflammatory bowel disease (IBD), a category of conditions characterized by chronic inflammation in the digestive tract.

The two most common IBDs are ulcerative colitis and Crohn’s disease. Crohn’s can affect any part of the gastrointestinal tract, from the mouth to the rectum/anus, while ulcerative colitis is limited to the large intestine (colon).

Both, however, present similar symptoms: Diarrhea, rectal bleeding, bowel urgency, cramping, pain, constipation, weight loss, fatigue, night sweats and/or fever. Over time, IBD can lead to more serious complications, including bowel obstruction, ulcers, anal fissures (tears in the tissue around the anus that can trigger infection), colorectal cancer and malnutrition.

Both illnesses have another common thread: They are marked by an abnormal, inappropriate immune system response. Typically the immune system fights substances that could cause harm, such as viruses or disease-causing bacteria. But in cases of IBD, the body mistakes beneficial microbes or other normal cells as foreign invaders and attacks them. The result is chronic inflammation and the other symptoms of IBD.

Heredity and genetics may also play a role in the development of IBD, compounded by risk factors such as cigarette smoking and use of certain medications such as nonsteroidal anti-inflammatories (ibuprofen, naproxen sodium) and isotretinoin (an acne medication).

Nutrient Deficiencies

Many aspects of IBD still remain a mystery. But slowly, research is starting to uncover some of the deeper complexities.

One recent discovery, published in November 2015, highlights the strong connection between IBD and nutritional deficiencies—specifically several of the B vitamins, along with vitamins D and K, selenium and zinc. While these deficiencies can occur in anyone with IBD, they tend to be more common in Crohn’s disease than in ulcerative colitis, and more in active disease than at times of remission.

The researchers claim, “Micronutrient deficiency is associated with prolonged and complicated course of disease.” Being aware of this link and identifying deficiencies as early as possible can help prevent long-term and/or irreversible consequences of IBD.1

Proper Treatment Leads to Remission

Currently, there’s no real cure for IBD. Conventional treatments (drug therapy and surgery) aim to reduce inflammation, alleviate symptoms and lower the risk of other complications. But more and more research is finding that lifestyle changes, particularly dietary adjustments and supplementation, may provide even more significant benefit—and, ultimately, remission.

Up Your Fiber

In regions where the low-fiber, high-carbohydrate Western diet has not been adopted, IBD tends to be pretty rare. But in countries like America, cases continue to rise. According to one study, “Changes in the composition of the intestinal microflora and diet are indicated as very important in initiating and sustaining inflammation in patients with IBD.”2

Fiber appears to be the most important component in the fight against IBD. In fact, this same study states that supplementation of dietary fiber can prolong remission and reduce lesions in the intestine.

In reality, fewer than five percent of Americans eat enough fiber. The average fiber intake in the U.S. is about 15.7–17 grams per day—when it should be closer to 25 grams for women and 35 grams for men.3

By simply adding fruits, vegetables, lentils, whole grains, legumes and/or beans to every meal, you can increase your fiber intake dramatically. And, if all else fails, fiber supplements are an option, though they tend to be made from single sources and lack the variety of fibers found in whole foods.

At the same time, eliminate refined carbohydrates and sugar from your diet. Sugars can raise the pH in the lower bowel, making it much more acidic and prone to bacterial imbalances, infections, diarrhea and other symptoms.

Protect with Probiotics

Speaking of bacterial imbalance, research is starting to recognize the importance of restoring microbial balance in the gut—especially when it comes to ulcerative colitis. Supplementing with probiotics is the best way to ensure the gastrointestinal tract is inundated with beneficial bacteria that maintain a balanced, healthy environment.

One study followed 29 children with ulcerative colitis treated with either a probiotic preparation called VSL#3 or placebo for one year. Thirteen out of 14 patients taking the probiotics responded to treatment and went into remission, compared to four patients in the placebo group. Furthermore, only three out of 14 on probiotic therapy relapsed a year later, compared to 11 out of 15 in the placebo group.4

Another probiotic, Escherichia coli Nissle 1917, has also been shown to bring about remission in ulcerative colitis.5

Simply put, taking a daily probiotic supplement definitely won’t hurt—and more than likely may help.

Multis Are a Must

Finally, to help replenish low levels of certain nutrients often seen in IBD patients, taking a daily multivitamin/mineral supplement is a must.

In some cases, a premium-quality multi may be all that you need to bring nutrient levels back into a healthy range. In other cases, additional supplements may be warranted, such as B12 shots, prescription iron or high-dose vitamin D capsules that can help to ensure that blood levels reach the ideal 40–50 ng/mL range.

Dealing with a condition for which there is no “cure” can be frustrating. But fortunately, taking a proactive, lifestyle-centered approach can help calm IBD to the point that it no longer affects your everyday life.


  1. Weisshof R and Chermesh I. Curr Opin Clin Nutr Metab Care. 2015 Nov;18(6):576-81.
  2. Pituch-Zdanowska A, et al. Prz Gastroenterol. 2015;10(3):135-41.
  3. Grooms KN, et al. Am J Med. 2013 Dec;126(12):1059-67.
  4. Miele E, et al. Am J Gastroenterol. 2009 Feb;104(2):437-43.
  5. Bernstein C. Nestle Nutr Inst Workshop Ser. 2014;79:83-100.


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