Calcium and IBD

Calcium is important for the formation of bones and to keep them strong and healthy. The circulation and nervous systems also rely on calcium to function. Teeth also rely on calcium to keep them strong. 

People who suffer with IBD are at a risk of having calcium deficiency. This is due to the importance of vitamin D as it regulates how much calcium circulates in the bloodstream and how much will be used by bones to maintain healthy structure. If we lack vitamin D our body will not be able to regulate the calcium in our body correctly. 

Our body does not make calcium and relies on us getting it from food we eat. If we do not get the calcium it needs the body with start to break down its own bones (where lots of calcium is stored) to get what it needs. This eventually leads to osteoporosis. 

Symptoms of calcium deficiency are:

·         Muscle aches and cramps

·         Tooth decay

·         Weak or deformed bones

·         Brittle nails and dry skin

·         Kidney stones

·         Osteoporosis

Doctors usually diagnoses calcium deficiency through blood tests. 

The doctors have come up with a few theories over the years why we might be deficient in calcium. They are:

·     Calcium is absorbed in the small intestine so people with Crohn’s disease in this are i.e. ileocolitis, ileitis, gastro duodenal and jejunoileitis will find it harder to absorb the calcium. 

·      Steroid medication such as prednisolone interfere with the absorption of calcium, slow down the process of new bone formation and accelerate the breakdown of old bone. Long term use of steroids can lead to significant bone loss so it is very important that people on steroids are given calcium supplements at the same time. Steroid medication is most commonly used to treat flare-ups with Crohn’s disease and ulcerative colitis as it helps to calm down the flares.

·      Most people with IBD may avoid dairy as it exacerbates their symptoms like myself as it is one of my trigger foods so I mainly use soya based products as an alternative. If we do not get enough calcium in our diet it can lead to a calcium deficiency. 

Calcium deficiencies can be treated either by taking a supplement like calci-chew which the doctors are only able to prescribe or a supplement from a health food shop or supermarket. Or we can increase the food which contains calcium such as dairy such as, milk, yoghurt and cheese if you are able to tolerate it with your IBD.

Or non-dairy foods:

·         Bok Choy

·         Leafy greens like kale and spinach

·         Oranges

·         Salmon

·         Shrimp

Or there are calcium fortified foods also available such as fresh orange juice.

Vitamin D and IBD

Vitamin D helps to regulate the amount of calcium and phosphate in the body and it is essential for healthy bones. Vitamin D also helps to reduce inflammation and is important for good general health and growth. There has been studies which have shown a correspondence between people with inflammatory bowel disease and low levels of vitamin D. It is one of the most common vitamin deficiencies seen in people with Crohn’s disease. The studies have found people who have low levels of vitamin D had a higher severity of the disease. It has highlighted the importance of monitoring and treating people with IBD.

Vitamin D is essential for absorbing calcium into the body. This means people who lack vitamin D most often lack calcium as well. A small lack in vitamin D may not cause symptoms but can cause:

·         Tiredness

·         Generalised aches and pains

A severe lack in vitamin D can result in:

·         Bone deformities in children i.e. rickets

·         Bone pain and tenderness in adults (osteomalacia)

People who suffer with an IBD are more prone to osteoporosis and other bone diseases which is attributed to the lack of vitamin D.

Vitamin D deficiency can be diagnosed by a simple blood test by the doctor. 

There are a few different theories as to why us IBDers may have less vitamin D. They include:

·         Due to their symptoms they may be more likely to stay inside, near a toilet or resting and then we do not get much access to sunlight to get natural vitamin D. 

·         More IBDers live in the northern areas which has less sunlight.

·         Vitamin D is a fat soluble vitamin and people with active inflammation in their small intestine poorly absorbs fat meaning less fat for vitamin D to be absorbed in. 

Vitamin D is made under our skin due to the reaction to sunlight so increasing your exposure to sunlight can help increase your vitamin D levels. However, you need to make sure you do this safely. In the northern areas which includes the most of Europe there is not thought to be enough sunlight during the winter months to get the sun exposure which is needed. 

It is therefore important to get vitamin D from other sources, such as through your diet or through supplements. It is also found naturally in a small number of foods including:

·         Oily fish such as salmon, sardines and mackerel

·         Eggs

·         Fortified foods with vitamin D such as cereals

If you choose to take an over the counter vitamin D supplement make sure you do not exceed the recommended dose.

Iron and IBD

Low iron or a lack of it commonly causes iron deficiency anaemia. This type of anaemia leads to a reduction in the production of red blood cells and this can mean a reduced amount of oxygen being carried around the body in your blood. Iron deficiency is a common complication for people who suffer from inflammatory bowel disease but it is very easily treated.

The most common symptoms of iron deficiency are:

·         Tiredness

·         Lack of energy

·         Heart palpitations

·         Pale complexion

Less common symptoms include:

·         Headaches

·         Tinnitus

·         Altered taste

·         Itchiness

·         Sore or abnormally smooth tongue

·         Hair loss

·         Desire to eat non-food items like coal

·         Difficulty swallowing

·         Ulcers in the corner of your mouth

·         Spoon shaped nails

If the iron deficiency is left untreated it can lead to:

·         Increased risk of infections

·         Heart and lung problems

·         Restless leg syndrome

Iron deficiency can be diagnosed through a blood test by your doctor.

People who suffer from IBD who lose blood and also iron through bleeding in their stools from their intestines are usually at a higher risk of developing iron deficiency. This can happen in both people who suffer from both Crohn’s disease and Ulcerative Colitis. People with Crohn’s disease in their small intestine in the duodenum are at further risk as this is where the iron is absorbed. If this is where you have your Crohn’s disease you might have an issue absorbing the iron. Some people with IBD and on a restricted diet due to the foods they can eat will not be getting enough iron through their diet. 

Most people with iron deficiency will be able to take and iron supplement orally from the doctor on a daily basis. Others will need to be given iron intravenously. This will help to boost the iron levels in your body. 

Most people find they have side effects from taking iron supplements such as cramping and constipation. 

You can also help boost your iron intake through your diet by eating foods like:

·         Dark green leafy vegetables like kale or spinach

·         Brown rice

·         Pulses and beans

·         Nuts and seeds

·         Meat, fish and tofu

·         Eggs

·         Dried fruit

·         Also some cereals and bread are also fortified with iron.

If you cannot eat all these just eat what you can tolerate to help boost your iron. I know I have dips every so often that I need to get an infusion every so often and it means 2 trips to the hospitals day case unit for a few hours. I do try to eat what I can to prevent me from having to get an infusion by eating the foods I can tolerate like beef, fish, eggs and cereals.

IBD and is the person you love a keeper?

Every relationship I have been in, a large portion of every one of them we have had to deal with many health issues from passing out with anaemia and being doubled over in pain on the toilet or not being able to walk up or down the stairs without having to crawl up or down them in pain. Most of the guys I have been with have walked out the door or ran out in some cases and never looked back or never got in touch again after they seen the worst I have been with my health.  There are a few things most people look for when they have chronic illnesses and looking for a partner or that very special person. 

1.  They hold your hair back while you have your head in the loo puking your guts up

When you live with chronic illnesses such as Crohn’s disease, you have more than your fair share of puking.  A real man will stand by your side, he will hold your hair back for you and if you happen to miss the toilet he will help clean it up.

2.  They will love you even at your worst moments

Between our periods and the lovely devils tic-tac’s Prednisolone, we can be well… difficult to live with ha-ha.  A real man who you want to stay around, will stand by your side and love you no matter what.  He will understand that behind all the angry faces, fighting, arguing and mood swings that there is a loving and caring creature.  Prednisolone is most definitely not for the faint hearted and if he is a keeper he will look past all that.

3.  They think you are beautiful even when you are really sick or have loads of scars

Living with a chronic illness makes you feel ugly (well it makes me feel ugly for definite).  You look at yourself in the mirror, or you have a moon face from taking steroids, or you have an extra bit of weight due to the steroids, or you have lost a lot of weight due to a flare with your Crohn’s disease.  Whatever the case may be having an illness or multiple illnesses does not make you feel like a beauty queen.  Scars, hair loss, the pale complexion… if he does not see your true beauty, he is not worth keeping.  A real man will remind you frequently of how beautiful you are then he is definitely a keeper.

4.  They will yell at the doctors for you instead

There are hundreds of doctors out there.  If you have been suffering for any length of time with an inflammatory bowel disease, you will know there are also a lot of bad doctors out there.  Sometimes you just do not want to deal with it… either because you are too sick to voice your opinions or you are too tired to put up a fight.  In those moment you would want a man who will take up the sword and put up a fight and help fight your battles for you.  If he loves you the way he says he does he will fight for you until the best possible care is found.  If he shows any signs of being a hero then he is most definitely a keeper.

5.  They will stand by your side when everyone else does a runner

I have dated a few guys in my time, yes I know I am still young.  Most of them had ducked at the first sight of a sniffle.  To be honest, most guys who do that are most definitely not that into you in the first place.  But you really do not want a man like that anyway as he would run away eventually. You need a man who loves you no matter what the future will hold.  You want a man who is willing to ask for your hand in marriage or stick with you no matter what happens even if you are diagnosed with an incurable illness or diagnosed with secondary illnesses with your IBD.  You will need a man who will stick with you for better or worse.  You need a man who will love you come what may and you deserve that.  A man who lives up to the vow “in sickness and in health” will be the man who is a keeper even if he is not married to you as long as he stick with you through every up and every down in your life that is what matters the most.

To anyone who has had a man scorn at you because you are too sick due to your illnesses.  REMEMBER you are still very valuable.  The man who runs away at the slightest sign of trouble is not worth your time.  You want a man who will love you and respect you with every ounce of his being.  Ladies you are worth it.  DO NOT ever settle for, or get hung up on, any man who makes you feel like you are not worth his time.  If he gets on like he does not care about your health or wellbeing then he is not worth any second crying over if you split up or he eventually does a runner on you when you are at your lowest or the worst time of flare up and end up being admitted into the hospital.  Apart from running away and leaving you to cope on your own being sick, manipulating and controlling relationships are definitely not good either.  They are not good especially when he manipulates everything you say and tries to make it look like you are actually not sick or tries to make himself look like he is more ill than you are for example, you have a flare up with your IBD and he is suffering from man flu, instead of him helping you out he makes it look like he is needing you to lift and lay everything for him especially when you are unable to move out of bed yourself apart from just about getting up and out of bed to get to the toilet in time before being sick.  If you have someone like that he is most definitely not a keeper.

Crohn's disease and Fibromyalgia

Fibromyalgia is a result of a number of sensitivities throughout the body from head to toe.  Digestive issues are extremely common with those who suffer with fibromyalgia.  These include GERD or acid reflux issues, gluten intolerance, irritable bowel syndrome (IBS).  Other digestive issues that are common with fibromyalgia are Crohn’s disease and Ulcerative Colitis which are the two most common inflammatory bowel diseases (IBDs).  Over a period of time it can cause a lot of discomfort.  Why are they intertwined?

IBDs attack the bowels and make them so sensitive to different types of stimuli and to what we ingest.  With IBDs your whole gastrointestinal tract is inflamed to the point it is not functioning properly.  This inflammation can be extremely painful as well so it is good to keep track of what goes into your body so you know what causes the pain and can end up doing a lot of damage too.  Crohn’s disease however, does not just affect the gastrointestinal tract and symptoms can vary depending on your case.  In many cases the symptoms can be debilitating and make it very difficult for the person to eat and digest their food properly.

Some major symptoms of Crohn’s disease can clash with the symptoms of fibromyalgia symptoms.  These symptoms can include lower back pain, muscle pain, problems with the joints.  Other symptoms include swelling of certain areas of body, blood in stools, cramps, weight loss, dry skin, severe itching and poor general nutrition.

In the worst cases surgery is needed to be performed on patients and they have to create a stoma which is when a part of the intestinal tract is missing because it is unable to work properly so part of the intestine is put through the abdominal wall to create a stoma to attach a bag to collect the waste produced.  With the research done so far no one has found the cause or the cure for Crohn’s disease.  There are a wide range of theories out there like the presence of viruses and bacteria, from irritable bowel syndrome and genetics.  The only solid evidence found at present is that there is a particular gene that all people who suffer with Crohn’s disease seem to share but no one has been able to make the full link between it all at this point in the research.  At some point in the future they will hopefully be able to come up with the solid reason behind why it happens to certain people but not all of us.

There is no solid link between Crohn’s disease and fibromyalgia.  This is mainly because researchers have still not been able to determine exactly what the causes are for each of the illnesses.  It is not common to find someone with both fibromyalgia and Crohn’s disease but it is not unknown of someone to have both illnesses (like myself as I was diagnosed with Fibromyalgia on May 2^nd 2017 after years of suffering with pain, fatigue and headaches alongside my symptoms of Crohn’s disease).  Researchers are still trying to determine exactly why they seem to be connected to one another, but like with both of their causes there is only one huge link that many doctors ascribe to.

Irritable bowel syndrome (IBS) is the disorder of the bowels that makes it hard to eat certain types of foods due to sensitivities to them.  Those who have diagnosed with fibromyalgia frequently have IBS as a symptom they are dealing with on a daily basis.  Due to many people who have fibromyalgia end up getting treated for IBS and looking at some of the theories behind why Crohn’s disease happens in certain people.  Both fibromyalgia and Crohn’s disease have something to do with IBS, there are some theories out there that people with IBS and fibromyalgia are more likely to end up with Crohn’s disease in the future.

What does that mean for treatment for those with Crohn’s disease and fibromyalgia?

Those with Crohn’s may notice that you do not have to deal with the symptoms on a daily basis if the illness is in remission.  Other periods you may have to deal with the symptoms for an extended amount of time due to a flare up.  During flare ups you want to make sure that you are getting treatment to help reduce the amount of pain that you ate coping with.  These can include a variety of different things, from medications to control your symptoms, surgery to take out part of the intestine that is suffering from Crohn’s disease or a variety of other treatment plans agreed with your gastroenterologist.  Always keep your doctor in the loop about any symptoms you are suffering from as you may end up seeing that the Crohn’s disease or another illness has started to come up alongside your fibromyalgia symptoms.

It is very important to look after yourself because the other illnesses that can often occur with fibromyalgia can be mistaken as a worsening of the fibromyalgia or Crohn’s disease.  Be sure to keep an eye on all your symptoms and keep a journal and if there are any changes or something new has started then you can show the journal to your doctor when the changes started or how the severity has changed.

Crohn's Disease and Intestinal Blockages

The most common complication of small bowel Crohn's disease is bowel obstruction due to swelling. However, in a patient with small bowel Crohn's, the wall becomes swollen due to chronic inflammation. Not only does it swell outward, it swells inward too. 

Other Types of Blockages

Strictures

The chronic intestinal inflammation that characterises Crohn's disease may also lead to the development of scar tissue in the intestinal tract. 

As the cycle of inflammation and scarring continue, a segment of the tract may be become narrowed in what is known as a stricture (sometimes called stenosis). If a stricture narrows far enough, it may eventually obstruct the intestinal tract. 

Alternately, if a person with an intestinal stricture eats something that is difficult to digest—for instance, raw vegetables, corn, popcorn, or nuts—the food itself may lead to a bowel obstruction. Acute inflammation on top of a stricture may cause the intestine to become blocked as well. 

Because Crohn's disease affects the entire thickness of the bowel wall, strictures are much more common than they are in ulcerative colitis, which typically affects only the inner lining. With strictures, bowel obstructions may be either acute (temporary) or chronic (permanent). 

Adhesions

Adhesions are bands of scar tissue that develop normally after a patient has surgery on the gastrointestinal (GI) tract. 

Adhesions will run from the point of the surgery to other parts of the intestine, other organs, or to the lining of the abdominal cavity (also known as the peritoneum). 

For most people, adhesions are painless and don't cause any problems at all. However, for some patients, the adhesion may cause the intestine to become "fixed." If a fixed intestine becomes twisted, it will cause an obstruction. 

Most bowel obstructions caused by adhesions will get better without surgery, although, rarely, surgery will be required to cut the adhesions and untwist the bowel. New adhesions will form but will likely not cause problems. 

Symptoms

The symptoms of a chronic blockage will be a "crampy" abdominal pain, bloating, and nausea, which occur shortly after a meal. The elapsed time between the meal and the symptoms will determine the site of the blockage. 

If it’ is less than one hour, the small intestine is usually the culprit. Longer than one an hour suggests the blockage is in the colon. If the symptoms happen all or most of the time after eating, it’ is likely the patient is dealing with strictures as well as swelling. 

In addition to the other symptoms, vomiting, increased diarrhoea, or alternately, constipation, may sometimes occur as well. 

Treatments

A person with acute small bowel obstruction will usually get better within 48 hours of beginning a clear fluid diet or taking prednisolone (a powerful anti-inflammatory). In more serious cases, steroids and a sterilized liquid (enteral) diet will usually help to reduce the swelling. 

However, when the blockage is predominantly due to strictures, drugs, are usually of limited effectiveness. In those more serious cases, the first option for many patients is an endoscopy. In an endoscopy, a doctor passes an inflatable balloon through an endoscope, thus dilating the area of scarring. Success rates are as high as 75 percent with the endoscopy procedure. An endoscopy may relieve symptoms for weeks, months, or even years for some people. However, if the area isn't accessible with an endoscope, surgery will be necessary.

Surgery

The two types of surgery performed on patients with small bowel Crohn's are resection, which involves removing the scarred area of the intestine, and strictureplasty, which is like plastic surgery on the intestine.

The two types of Crohn's patients who are candidates for strictureplasty include those who have had a previous resection, or for those for whom the disease is very severe. Many of those who receive a strictureplasty are able to stop taking medications that help heal the disease and maintain the remission of their Crohn's. 

Strictures that are opened with strictureplasty usually remain open as well, and patients will generally only require surgery again if new strictures form elsewhere in the small intestine or bowel. In addition, most people will begin to eat normally (prior to their blockage) and even gain weight after the operation.

Colonoscopy Preparation

Preparing for a colonoscopy can be extremely difficult especially when friends and family eat in front of you and you just want a bite of their food.  Depending on your preparation choice (Picolax or MoviPrep) it influences when you have to start your preparation for the colonoscopy.  MoviPrep is the day before the procedure whilst Picolax is 3 days before the procedure.  For both preparations you can take your usual medications but avoid all iron medication and any other constipating drugs for one week before the procedure.

BOTH preparations cause diarrhoea!  And both may cause stomach cramps and vomiting.  These preparations are to clean the bowel out for the colonoscopy.  If you cannot handle the pain and cramps drink the preparations more slowly over 30mins to ease the side effects and if it still persists seek medical advice from the endoscopy unit or GP (if open).

To reduce irritation from wiping use soft or moist tissue paper and apply petroleum jelly (Vaseline) to your bum before and after each visit.

With Picolax you have to start a low residue diet Day 1 (3 days before the procedure).  So if your procedure is on the Monday you start your diet on the Friday.  See the below for the list of foods and drinks you are allowed and the ones you have to avoid when following a low residue diet.

Day 2 (2 days before the procedure) you must follow a clear liquid diet.  See below for the list of drinks allowed when following a clear liquid diet.

Day 3 (day before the procedure) you have to continue the clear fluids to prevent you from becoming dehydrated.  At 8am dissolve the powder containing one sachet of Picolax with 150ml of cold water and drink.  At 4pm dissolve the powder of the second sachet of Picolax and drink.

On the day of the procedure if you are only having a colonoscopy, keep drinking clear liquids up until your appointment time to satisfy your thirst.  After your procedure you can start eating and drinking as normal again.

With the MoviPrep the preparation starts the day before the procedure.  You have to have a low residue breakfast BEFORE 8am.  After 8am follow a clear fluid diet.  To prepare the MoviPrep take one of sachet A and one of sachet B and dissolve both in one litre of luke-warm water.  Start drinking at 1pm and finish at 2pm, drink one glass every 15mins.  And do the same with the second set of sachets and drink between 6pm and 7pm.  Drink each glass as quickly as possible instead of sipping it slowly.

A low residue diet can include any of the following:

• Boiled potatoes
• Cheese
• Chicken – grilled, roasted, boiled (not fried)
• Chocolate with NO fruit/nuts
• Clear strained soups – chicken, beef, vegetable (ensuring there are not bits left)
• Cornflakes
• Couscous
• Crisps
• Custard
• Eggs
• Fish – grilled or poached (not fried)
• Frosted flakes
• Ice cream
• Jelly
• Milk
• Peeled, well-cooked, soft/mashed vegetables
• Plain biscuits e.g. rich tea
• Potatoes (no skins)
• Rice Krispies
• Rice pudding
• Seedless jam
• Semolina
• Smooth yoghurts
• Soft/ripe, peeled fruit without pips or seeds e.g. tinned fruit, melon, ripe bananas, apples, pears
• Spices/pepper
• Sponge cakes with NO fruit/nuts
• Squash/fizzy juice
• Stock cubes
• Tea/coffee
• White bread/flour
• White pasta
• White rice

AVOID

• All cereals containing dried fruits/nuts
• All dried fruits
• All seeds, pips, tough skins
• All whole wheat cereals e.g. shreddies, Weetabix, etc.
• Avoid all nuts including coconut and almonds
• Baked beans
• Berries e.g. strawberries, raspberries
• Brown rice
• Celery
• Chocolate, toffee, fudge with dried fruits/nuts
• Citrus fruits
• Digestive biscuits
• Horseradish
• Lentils
• Marmalade with peel and jam with seeds
• Marzipan
• Pearl barley
• Peas
• Pickles/chutneys
• Pies/egg dishes containing vegetables as listed below
• Popcorn
• Porridge and muesli
• Potato skins
• Prunes
• Puddings/cakes/biscuits made with wholemeal flour, dried fruit or nuts e.g. mince pies, fruit crumbles etc.
• Quinoa
• Raw vegetables/salads
• Relish
• Skin and bones of fish
• Smoothies and fruit juices with bits
• Split peas/lentils
• Sweetcorn
• Tough, gristly meats
• Vegetable soups
• Wholemeal pasta
• Wholemeal/granary bread/flour
• Yoghurts and cheeses containing fruit/nuts

A clear liquid diet includes:

• 100% cranberry juice (not from concentrate or ones with dyes)
• Clear strained soups
• Flavoured waters
• Fruit cordial/squash ( not dark red or purple coloured)
• Fruit juices (strained if containing not bits) [also avoid cloudy apple juice]
• Jelly (not dark red or purple colours)
• Lucozade and fizzy drinks
• Oxo, Bovril, marmite drinks
• Sports energy drinks
• Tea and coffee with NO milk