IBD and Nutrition- Things You Need to Know
Dr. Razvan Arsenescu explains what IBD is, and how nutrition plays a major role in staying healthy.
Featuring:
Dr. Arsenescu completed his internal medicine training at SUNY/Stony Brook, and his gastroenterology fellowship at the University of Iowa. His PhD focused on microbiology, immunology and genetics. He has been conducting numerous basic and clinical research studies with high relevance to gut mucosal immunology, Crohn's disease, ulcerative colitis and celiac sprue. He has established a clinical program for gut microbiota transplant at Morristown Medical Center and is working with other investigators to extend the indications of this form of treatment.
He has published extensively in the area of IBD and has presented his research data at numerous national and international conferences. He is a highly sought-after speaker in various topics in basic and clinical sciences related to inflammatory bowel diseases.
Razvan Arsenescu, MD, PhD
Dr. Arsenescu is chief of the Atlantic Digestive Health Institute and co-director of the Inflammatory Bowel Diseases Center at Morristown Medical Center. Having more than 20 years of diverse experience in gastroenterology, Dr. Arsenescu specializes in inflammatory bowel disease and is an international expert in Crohn's disease and ulcerative colitis. He is affiliated with Atlantic Health System and provides a comprehensive care plan through a multidisciplinary approach to the treatment of IBD.Dr. Arsenescu completed his internal medicine training at SUNY/Stony Brook, and his gastroenterology fellowship at the University of Iowa. His PhD focused on microbiology, immunology and genetics. He has been conducting numerous basic and clinical research studies with high relevance to gut mucosal immunology, Crohn's disease, ulcerative colitis and celiac sprue. He has established a clinical program for gut microbiota transplant at Morristown Medical Center and is working with other investigators to extend the indications of this form of treatment.
He has published extensively in the area of IBD and has presented his research data at numerous national and international conferences. He is a highly sought-after speaker in various topics in basic and clinical sciences related to inflammatory bowel diseases.
Transcription:
Prakash Chandran (Host): If you have digestive disorders, your diet can play a big role in managing or minimizing your symptoms. Today we’ll learn about IBD or inflammatory bowel disease as it relates to nutrition and foods you should eat and avoid if you have it. Let’s talk about it today with Dr. Razvan Arsenescu, the chief of the Atlantic Digestive Health Institute and director of the inflammatory bowel diseases in center at Morristown Medical Center of Excellence. This is Building Healthier Communities, the podcast from Atlantic Medical Group. I'm Prakash Chandran. So first of off Dr. Arsenescu, I’d love to learn about what IDB is.
Razvan Arsenescu MD, PhD (Guest): So inflammatory bowel disease comes in two flavors. One is called Crohn’s disease, the other one ulcerative colitis. They are diseases of the gut. However, other parts of the body can be involved. This is kind of an autoimmune type of condition where the immune system attacks its own body. The fundamentals of these diseases relate to the gut bacteria, the gut microbiome to the genetics of the host but also the environment that includes diet, smoke exposures, and toxins.
Host: Yeah, I want to dive into some of those symptoms. Before we do, I have some friends with Crohn’s disease. From what they’ve told me, this autoimmune disease is one that’s not curable. It’s something that can be treated and managed over time. Is that correct?
Dr. Arsenescu: Yes, it is correct. In fact, ulcerative colitis patients could have a cure on surgery where the whole colon is removed. In the absence of that surgery—and certainly not in the case of Crohn’s—there is no cure. Then we have multiple treatments that are designed to put the disease in a dormant state without any medical therapy that will allow the disease to disappear.
Host: So regardless of whether people have Crohn’s disease or ulcerative colitis, what type of symptoms are they experiencing?
Dr. Arsenescu: So common symptoms to both conditions should be diarrhea, which means loose stools or liquid stools like water. Some gas, some bloating sometimes, abdominal pain in form of cramps. In cases such as Crohn’s disease, we can see symptoms from a blockage, a narrowing the bowel that results in nausea and vomiting. Bleeding can occur with both conditions with blood in the stool. However, that would be more common with the ulcerative colitis. Then in both conditions we can see symptoms relating to inflammation in other parts of the body such as joint pain, back pain. People can experience ulcers, like cold sores in their mouth. They can have similar to a pink eye with a red eye with pain. They can experience ulcers on the skin or nodules that are itchy and painful on the legs. It’s also important to know that a good deal of patients can have significant bowel disease that’s not linked to symptoms. So the absence of symptoms is not necessarily indicating that there is no activity and no disease. The gut sometimes can be tricky to identify activity or disease at the beginning.
Host: Yeah. So what is the clearest indication that something might be wrong and when should you see the help of a professional like yourself?
Dr. Arsenescu: So I think that the most important thing is chronicity. So if somebody has symptoms that last for weeks, that is definitely a reason to see a specialist. Especially worrisome findings such as blood in the stool, weight loss that should trigger a fairly early presentation. Also, obviously, a block of symptoms like nausea, vomiting, inability to eat, unexplained fevers and chills. They should be sort of flags. They should trigger a fairly soon meeting with a specialist.
Host: Okay. So I get—Today we’re talking about IBD and nutrition, and I’d love to learn a little bit more about that relationship and other potential risk factors that could cause IBD.
Dr. Arsenescu: Sure. So starting with the risk of inflammatory bowel disease. Having parents, siblings with inflammatory bowel disease will increase your chances. Depending on how close those relatives are to you in terms first or second degree, you could have a risk that can vary anywhere from 5% to 30-40%. Even starting from the pregnancy, a premature birth, for instance, can lead to abnormal development of the immune system, a change in gut microbiome that can alter the risk of these conditions. Delivery, for instance, vaginal delivery can lead to different exposure to bacteria and alter the risk.
A big factor that we see is use of antibiotics in the first two/three years of life can be a major determinant of disease onset. Also relating to this time of life, nursing can be a protective factor. So children that were nursed for more than six months appear to have protection from development of the disease. Later in life, I think exercise plays a role and diet as we discuss as we’re gonna discuss it. Especially the lack of fresh vegetables, meals having animal fat, salt typically are more likely to lead to these problems.
Host: Yeah. So let’s talk specifically about the role of nutrition in managing IBD. Let’s say you get it. Talk about how diet plays a role in this.
Dr. Arsenescu: So when we talk about diet, we have to sort of talk about goals of diet. We can think of diet as calming down symptoms. We can talk about diet helping to heal the colon, which may not necessarily always mean the symptoms will be better or worse. Preventing cancer. Then looking at nutrition, obviously, as a means of bringing nutrients that are needed to the building blocks of the body to the daily activities. Then looking at diet even as a lifestyle since obesity, which is connected to what we eat and how we eat, is a major determinant of the complications and the degree of inflammation in patients with inflammatory bowel disease.
Host: You know one of the things that I'm curious to learn about is you talked about some of the potential barriers to someone getting IBD, but when do you usually see these autoimmune disease manifest? Is it generally earlier in life and then someone at a young age will have to kind of live with it through treatment options and diet throughout their life, or does it manifest later?
Dr. Arsenescu: So the highest peak of the disease is anywhere from 10 to 20 years old patients. Then a second peak is around the age of 40. However, we see this disease happening either super early—like right after birth—and then we see the disease happening in the sixth, seventh, or eight decade. The earlier the disease is diagnosed, the more genetic components we see. Whereas in patients that develop these later we believe that environment, including diet, probably plays a higher role.
Host: Got it. So coming back to the nutrition, what foods should people avoid if they have an IBD disorder like Crohn’s or ulcerative colitis?
Dr. Arsenescu: So this is a great question. One thing that we see over and over in terms of research and other large registry data is that the lack of fresh fruits and vegetables in particular is a risk factor for both. The reason is that the fresh products are partially digested, and the undigested part becomes food for the gut microbes. Especially for those that produce molecules that block inflammation and may even have a role in preventing cancer. Some of the specific elements in the diet are everyday things that we probably don’t think about, but salt, for instance, has been connected to specific inflammatory pathways that lead to gut inflammation. Vitamin D, for instance, that people only think about bone disease and bone prevention actually now has been found to play a significant role in the healing of the gut in both Crohn’s and ulcerative colitis and even in prevention of cancer.
Host: Right. So lots of vitamin D, lots of fresh fruits and vegetables are strong proponents for things that they should eat if they have this. Is that correct?
Dr. Arsenescu: Correct. Then there are some vigorous sort of components of many of the food items we buy, and we don’t pay attention. For instance the emulsifiers, carrageenan that we find as additives. In fact, knowledge have been found to be major destructors of the gut microbiome and the secondary leading to aggravation of autoimmune conditions such as Crohn’s an ulcerative colitis.
Host: So, you know, if someone listening to this has one of the two diseases that you mentioned and they want to live with it in the most comfortable way possible, what’s your best recommendation to them? Like we’ve talked to them a little bit today about some of the things that they should be eating and some of the things that they should stay away from, but how have you seen people manage it the best? What are they eating? What are they doing? Any advice that you might have for just helping them deal with it a little bit more effectively.
Dr. Arsenescu: So the most important thing to know is that diet is not a replacement of medication. It’s complementary to that. Then diet will not—it may help symptoms in a short term, but to make a difference in terms of healing it is a long term change. So probably the diet that really has most of the requirements for healing and for symptom control is what we call a Mediterranean diet. This diet is heavily represented of these fresh vegetables, having more white meat than red meat, having a couple of days of wild caught seafood, incorporating olive oil, nuts, and seeds. So this is overall probably the best diet to follow for inflammatory bowel disease. However, some of the fresh vegetables can lead to more fermentation and can create symptoms, although without inflammation.
Sometimes we do modification of this diet by selecting fresh fruits vegetables from a list that also belongs to a diet called a low FODMAP. This is an acronym for some complex sugars but having a Mediterranean diet with a selection of fresh vegetables that are in agreement with this low FODMAP selection I think overall will likely help many patients with this disease. Again, paying attention not to have high salt, having the right amounts of vitamin D, B12, and zinc is most likely to hep overall manage the disease.
Host: Alright Dr. Arsenescu. Really appreciate your time today. That’s Dr. Razvan Arsenescu, the chief of the Atlantic Digestive Health Institute and director of the inflammatory bowel diseases center at Morristown Medical Center of Excellence. Thanks for checking out this episode of Building Healthier Communities. Call 973-971-7507 to schedule an appointment or to find out more. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
Prakash Chandran (Host): If you have digestive disorders, your diet can play a big role in managing or minimizing your symptoms. Today we’ll learn about IBD or inflammatory bowel disease as it relates to nutrition and foods you should eat and avoid if you have it. Let’s talk about it today with Dr. Razvan Arsenescu, the chief of the Atlantic Digestive Health Institute and director of the inflammatory bowel diseases in center at Morristown Medical Center of Excellence. This is Building Healthier Communities, the podcast from Atlantic Medical Group. I'm Prakash Chandran. So first of off Dr. Arsenescu, I’d love to learn about what IDB is.
Razvan Arsenescu MD, PhD (Guest): So inflammatory bowel disease comes in two flavors. One is called Crohn’s disease, the other one ulcerative colitis. They are diseases of the gut. However, other parts of the body can be involved. This is kind of an autoimmune type of condition where the immune system attacks its own body. The fundamentals of these diseases relate to the gut bacteria, the gut microbiome to the genetics of the host but also the environment that includes diet, smoke exposures, and toxins.
Host: Yeah, I want to dive into some of those symptoms. Before we do, I have some friends with Crohn’s disease. From what they’ve told me, this autoimmune disease is one that’s not curable. It’s something that can be treated and managed over time. Is that correct?
Dr. Arsenescu: Yes, it is correct. In fact, ulcerative colitis patients could have a cure on surgery where the whole colon is removed. In the absence of that surgery—and certainly not in the case of Crohn’s—there is no cure. Then we have multiple treatments that are designed to put the disease in a dormant state without any medical therapy that will allow the disease to disappear.
Host: So regardless of whether people have Crohn’s disease or ulcerative colitis, what type of symptoms are they experiencing?
Dr. Arsenescu: So common symptoms to both conditions should be diarrhea, which means loose stools or liquid stools like water. Some gas, some bloating sometimes, abdominal pain in form of cramps. In cases such as Crohn’s disease, we can see symptoms from a blockage, a narrowing the bowel that results in nausea and vomiting. Bleeding can occur with both conditions with blood in the stool. However, that would be more common with the ulcerative colitis. Then in both conditions we can see symptoms relating to inflammation in other parts of the body such as joint pain, back pain. People can experience ulcers, like cold sores in their mouth. They can have similar to a pink eye with a red eye with pain. They can experience ulcers on the skin or nodules that are itchy and painful on the legs. It’s also important to know that a good deal of patients can have significant bowel disease that’s not linked to symptoms. So the absence of symptoms is not necessarily indicating that there is no activity and no disease. The gut sometimes can be tricky to identify activity or disease at the beginning.
Host: Yeah. So what is the clearest indication that something might be wrong and when should you see the help of a professional like yourself?
Dr. Arsenescu: So I think that the most important thing is chronicity. So if somebody has symptoms that last for weeks, that is definitely a reason to see a specialist. Especially worrisome findings such as blood in the stool, weight loss that should trigger a fairly early presentation. Also, obviously, a block of symptoms like nausea, vomiting, inability to eat, unexplained fevers and chills. They should be sort of flags. They should trigger a fairly soon meeting with a specialist.
Host: Okay. So I get—Today we’re talking about IBD and nutrition, and I’d love to learn a little bit more about that relationship and other potential risk factors that could cause IBD.
Dr. Arsenescu: Sure. So starting with the risk of inflammatory bowel disease. Having parents, siblings with inflammatory bowel disease will increase your chances. Depending on how close those relatives are to you in terms first or second degree, you could have a risk that can vary anywhere from 5% to 30-40%. Even starting from the pregnancy, a premature birth, for instance, can lead to abnormal development of the immune system, a change in gut microbiome that can alter the risk of these conditions. Delivery, for instance, vaginal delivery can lead to different exposure to bacteria and alter the risk.
A big factor that we see is use of antibiotics in the first two/three years of life can be a major determinant of disease onset. Also relating to this time of life, nursing can be a protective factor. So children that were nursed for more than six months appear to have protection from development of the disease. Later in life, I think exercise plays a role and diet as we discuss as we’re gonna discuss it. Especially the lack of fresh vegetables, meals having animal fat, salt typically are more likely to lead to these problems.
Host: Yeah. So let’s talk specifically about the role of nutrition in managing IBD. Let’s say you get it. Talk about how diet plays a role in this.
Dr. Arsenescu: So when we talk about diet, we have to sort of talk about goals of diet. We can think of diet as calming down symptoms. We can talk about diet helping to heal the colon, which may not necessarily always mean the symptoms will be better or worse. Preventing cancer. Then looking at nutrition, obviously, as a means of bringing nutrients that are needed to the building blocks of the body to the daily activities. Then looking at diet even as a lifestyle since obesity, which is connected to what we eat and how we eat, is a major determinant of the complications and the degree of inflammation in patients with inflammatory bowel disease.
Host: You know one of the things that I'm curious to learn about is you talked about some of the potential barriers to someone getting IBD, but when do you usually see these autoimmune disease manifest? Is it generally earlier in life and then someone at a young age will have to kind of live with it through treatment options and diet throughout their life, or does it manifest later?
Dr. Arsenescu: So the highest peak of the disease is anywhere from 10 to 20 years old patients. Then a second peak is around the age of 40. However, we see this disease happening either super early—like right after birth—and then we see the disease happening in the sixth, seventh, or eight decade. The earlier the disease is diagnosed, the more genetic components we see. Whereas in patients that develop these later we believe that environment, including diet, probably plays a higher role.
Host: Got it. So coming back to the nutrition, what foods should people avoid if they have an IBD disorder like Crohn’s or ulcerative colitis?
Dr. Arsenescu: So this is a great question. One thing that we see over and over in terms of research and other large registry data is that the lack of fresh fruits and vegetables in particular is a risk factor for both. The reason is that the fresh products are partially digested, and the undigested part becomes food for the gut microbes. Especially for those that produce molecules that block inflammation and may even have a role in preventing cancer. Some of the specific elements in the diet are everyday things that we probably don’t think about, but salt, for instance, has been connected to specific inflammatory pathways that lead to gut inflammation. Vitamin D, for instance, that people only think about bone disease and bone prevention actually now has been found to play a significant role in the healing of the gut in both Crohn’s and ulcerative colitis and even in prevention of cancer.
Host: Right. So lots of vitamin D, lots of fresh fruits and vegetables are strong proponents for things that they should eat if they have this. Is that correct?
Dr. Arsenescu: Correct. Then there are some vigorous sort of components of many of the food items we buy, and we don’t pay attention. For instance the emulsifiers, carrageenan that we find as additives. In fact, knowledge have been found to be major destructors of the gut microbiome and the secondary leading to aggravation of autoimmune conditions such as Crohn’s an ulcerative colitis.
Host: So, you know, if someone listening to this has one of the two diseases that you mentioned and they want to live with it in the most comfortable way possible, what’s your best recommendation to them? Like we’ve talked to them a little bit today about some of the things that they should be eating and some of the things that they should stay away from, but how have you seen people manage it the best? What are they eating? What are they doing? Any advice that you might have for just helping them deal with it a little bit more effectively.
Dr. Arsenescu: So the most important thing to know is that diet is not a replacement of medication. It’s complementary to that. Then diet will not—it may help symptoms in a short term, but to make a difference in terms of healing it is a long term change. So probably the diet that really has most of the requirements for healing and for symptom control is what we call a Mediterranean diet. This diet is heavily represented of these fresh vegetables, having more white meat than red meat, having a couple of days of wild caught seafood, incorporating olive oil, nuts, and seeds. So this is overall probably the best diet to follow for inflammatory bowel disease. However, some of the fresh vegetables can lead to more fermentation and can create symptoms, although without inflammation.
Sometimes we do modification of this diet by selecting fresh fruits vegetables from a list that also belongs to a diet called a low FODMAP. This is an acronym for some complex sugars but having a Mediterranean diet with a selection of fresh vegetables that are in agreement with this low FODMAP selection I think overall will likely help many patients with this disease. Again, paying attention not to have high salt, having the right amounts of vitamin D, B12, and zinc is most likely to hep overall manage the disease.
Host: Alright Dr. Arsenescu. Really appreciate your time today. That’s Dr. Razvan Arsenescu, the chief of the Atlantic Digestive Health Institute and director of the inflammatory bowel diseases center at Morristown Medical Center of Excellence. Thanks for checking out this episode of Building Healthier Communities. Call 973-971-7507 to schedule an appointment or to find out more. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.