Are you suffering from Inflammatory Bowel Disease? We will scan you, scope you from top and bottom, and we might even resect your bowel before asking something as controversial as your Diet & Lifestyle.
The number of people suffering from inflammatory bowel disease (IBD) is rising rapidly, according to new research. (The Lancet, 2019)
IBD is an umbrella term for chronic conditions involving inflammation of the gut, which can cause physical damage to it. The most common conditions are ulcerative colitis, Crohn’s disease and non-specific colitis.
Prevalence of IBD is expected to grow by almost a quarter by 2025, and sufferers are at a higher risk of developing colorectal cancer. (Sandwell and West Birmingham hospitals NHS, 2017).
Up to 10% of Emergency Department visits are due to abdominal problems and Joan is one of the many patients I saw who re-presents to ED with ongoing excruciating abdominal pains. She is doubled up on the examination couch, with her teeth clenched and her eyes red from crying all day.
She is in her forties and she explained that she had never had any medical problems before this sudden flare-up that started five months ago. She developed daily watery stools, cramping pains to the extent where she could no longer get on with her everyday life.
On an earlier ED presentation, she had extensive emergency investigations, including a CT scan and blood tests. She had a colonoscopy as an outpatient where they gave her sedation and inserted a camera from her bottom up to examine the internal lining of her bowel. The diagnosis: non-specific colitis.
As her symptoms got worse and her life became unbearable, she was referred to a gastroenterology specialist. She was started on pain killers including morphine, buscopan and had multiple courses of antibiotics and steroid. While her symptoms improved for a few days, as soon as the drugs wore off, her pains came back with a vengeance, and she once again ended up in the Emergency Department.
When I saw her, I was interested in what dietary and lifestyle changes did the specialists advised her. She looked at me curiously and asked what I meant by this strange question.
Once again, I wasn’t surprised to find out that no one has taken a side effect free and cost-effective dietary and lifestyle history from her, and thus she hasn’t received any advice on the subject.
On the contrary, it was entirely reasonable for us to spend thousands of pounds on investigations which themselves carry health risks and not to mention the discomfort that is associated with camera tests.
During our consultation, I have discovered that her usual diet consists of 5–10grams of dietary fibre.
As a side note, aim for 50grams/day for health gains.
She described her kitchen full of packaged and heavily processed foods. For breakfast, she would eat brown flakes with cow’s milk, followed by milky rice pudding, a new addition to her diet to help her “soothe her pains”. Unfortunately, she reported that this new addition had made her symptoms even worse.
Animal-based diets may contribute to the development of inflammatory bowel disease, according to a Harvard study published this week in Nature. Eleven healthy volunteers consumed either animal-based or plant-based diets for five days. The volunteers on the animal-based diet had an eight-fold increase in the gut population of a bacterium that may cause inflammatory bowel disease, Bilophila wadsworthia. Growth of this bacterium may be stimulated by the digestion of dairy products. In contrast, the gut population of B. wadsworthia fell three-fold in the plant-based diet group. In addition, gut concentrations of a compound linked to liver cancer, deoxycholic acid, rose in the animal-based diet group. The authors note that diet may contribute to the development of inflammatory bowel disease via changes in gut microbes.
As she is a very busy lady, for lunch she would have a few biscuits washed down with more milk and for dinner “I would eat some rubbish take away that I didn’t enjoy but could conveniently pick up on my way home”. She has been eating this way for as long as she can remember. She has no time for any form of exercise, doesn’t walk, and has alcohol three times a week.
The above lifestyle and dietary findings are becoming very common in my practice. Joan is one of the many patients who are the victims of our busy lifestyle, where we are made to believe that we do not have time to take care of our bodies.
Culturally it is celebrated when people give in to fast food choices, swapping quality cooking time to scrolling on our phones, and often having to exchange our exercise time for commuting in an ever more globalised lifestyle.
Our political systems thats driven by economic gains and less by patient satisfaction is also pushing us, doctors, to spend less quality time with our patients, and more time on scans, scopes and paperwork.
There is no doubt that western medical practice has served our patients well. Despite this, the incidence of lifestyle-related chronic diseases has continued to increase and now account for 89% of all deaths in the UK.
People like Joan, who has life-altering abdominal pains, which were heavily investigated and medicated with our current standard of care continued to suffer and be at risk of developing bowel cancer until we changed her diet and lifestyle.
Joan was in the position where she would have done anything to alter her faith and improve her symptoms. When we met, she was keen to educate herself and clean up her diet. Shift her lifestyle habits and beat her condition.
Unfortunately, this option was not given to her because of our broken system that ignores the fundamental requirements of our bodies physiology. It seems too trivial and too simple for our health care system to engage with the patient diet, lifestyle and environment.
But until we continue to ignore diet and lifestyle, our patients will continue to suffer and our epidemic of lifestyle-related chronic diseases will continue to rise and inflict unnecessary suffering and early death on our patients.
It’s time for us doctors and patients to think first about lifestyle before we bring out big guns of western medicine, the tech, scalpels and pill! Next time, ask your doctor about diet & lifestyle!
(Name and details changed to protect patient identity.)
If you want to get in touch: www.thinklifestyle.org
- David LA, Maurice CF, Carmody RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2013;505:559–563.