conditions inflammatory-bowel-disease


Inflammatory Bowel Disease

Condition:Inflammatory Bowel Disease (IBD)
Other:Chron's disease, Ulcerative colitis
ICD-10 Codes:K50-51

Naturopathic Treatments

• stress management
• treat hypochlorhydria (See "Conditions: Hypochlorhydria")

• elimination diet
• low disaccharide diet
• avoid fast-food
• total parenteral nutrition (TPN) - may be required during acute exacerbation
• fasting - may help reduce aggravations
• cruciferous vegetables (kale, broccoli, collards)- isothiocyanates decrease inflammation
• blueberries

Caution: high amounts of fiber is contraindicated during serious flare-ups

Specific Foods
• remove dairy - lactose intolerance often develops
• avoid carrageenan - irritates GIT
• apples

Botanicals (internal)
• frankincense (Boswellia serrata)
wormwood (Artemisia absinthium)
turmeric (Curcuma longa)
marijuana (Cannabis sativa)
greater celandine (Chelidonium majus)
• berberine containing herbs
- goldenseal (Hydrastis canadensis)
- barberry (Berberis vulgaris)
Andrographis (Andrographis paniculata)
• Coptis Detoxifying Formula Extract (Oren-gedoku-to; Huang Lian Jie Du Tang)

zinc carnosine - vulnerary, antiulcerogenic
vitamin D - immunomodulating
• probiotics
• proteolytic enzymes

• helminthic therapy (e.g. whipworm) - modulates immune system

• fructo-oligosaccharides (FOS)

Conventional Treatments

• 5-aminosalicylic acid
• corticosteroids
- hydrocortisone
- budesonide
• immunomodulating drugs
- azathioprine
- methotrexate
- cyclosporine
• anticytokine drugs
- infliximab
- certolizumab
- adalimumab
• antibiotics
- metronidazole
- ciprofloxacin

Signs & Symptoms

• colic
weight loss
• malaise
• abdominal distension

Note: unlike ulcerative colitis bloody diarrhea is rarely seen and is associated with fissures and proctatitis in Cron's disease

Other symptoms
• nausea & vomiting,
• epigastric pain
• bowelvobstruction
• RLQ pain
• rebound tenderness

Associated symptoms
• uveitis
• arthritis
• ankylosing spondylitis
• erythema nodosum/multiforme
• primary sclerosing cholangitis
• toxic megacolon
• fistulas
• abscesses
• anemia


• ulcerative colitis
- diarrhea with bloody stools and mucus
- no skip lesions
- no fistulas
• gastroenteritis
• Clostridium difficile infection
• intestinal lymphoma
• acute ischemic colitis
• diverticulitis


• activation of mucosal immune system in GIT
• leads to abnormal mucosal barrier function and increased intestinal permeability
• immune response driven by Th-1 helper cells, IL2 and IFN gamma --> self-sustaining cycle of activation, leading to further increases of the helper T cells and its inflammatory cytokines.
• eventually leads to broad inflammatory response
• most often affects distal ileum and proximal colon although can occur from throughout GIT
• there may be a microbial connection that stimulates the immune system leading to inflammatory problems


• endoscopy
- sigmoidoscopy
- colonoscopy
• radiology tests
- multiphase CT
- MR enterography (MRE)
• QuestionaireL: "Harvey-Bradshaw"


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1: Farzaei MH, Rahimi R, Abdollahi M. The role of dietary polyphenols in the
management of inflammatory bowel disease. Curr Pharm Biotechnol.
2015;16(3):196-210. PubMed PMID: 25601607.

Dains J, Baumann, L, Scheibel P. Advanced Health Assessment and Clinical Diagnosis in Primary Care 2nd Ed. Mosby Elsevier Inc. USA. 2003.

Ferri Fred. 2008 Ferri's Clinical Advisor. Elsevier Inc.. USA. 2006.

El-Hashemy, Shehab. Naturopathic Standards of Primary Care. CCNM Press. Canada. 2007.

First Consult. Elsevier Inc. Taken from

Natural Medicines Comprehensive Database. Taken from

Rakel, David. Integrative Medicine 2nd Edition. Saunders-Elsevier. USA. 2007

HÅkansson A, BrÄnning C, Molin G, Adawi D, HagslÄtt ML, Jeppsson B, Nyman M, AhrnÉ S. Blueberry husks and probiotics attenuate colorectal inflammation and oncogenesis, and liver injuries in rats exposed to cycling DSS-treatment. PLoS One. 2012;7(3):e33510. Epub 2012 Mar 23. PubMed PMID: 22457771; PubMed Central PMCID: PMC3311639.

Paturi G, Mandimika T, Butts CA, Zhu S, Roy NC, McNabb WC, Ansell J. Influence of dietary blueberry and broccoli on cecal microbiota activity and colon morphology in mdr1a(-/-) mice, a model of inflammatory bowel diseases. Nutrition. 2012 Mar;28(3):324-30. Epub 2011 Nov 23. PubMed PMID: 22113065.

Wu LH, Xu ZL, Dong D, He SA, Yu H. Protective Effect of Anthocyanins Extract from Blueberry on TNBS-Induced IBD Model of Mice. Evid Based Complement Alternat Med. 2011;2011:525462. Epub 2011 Apr 14. PubMed PMID: 21785630; PubMed Central PMCID: PMC3135784.

Benjamin JL, Hedin CR, Koutsoumpas A, Ng SC, McCarthy NE, Hart AL, Kamm MA, Sanderson JD, Knight SC, Forbes A, Stagg AJ, Whelan K, Lindsay JO. Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn's disease. Gut. 2011 Jul;60(7):923-9. Epub 2011 Jan 24. PubMed PMID: 21262918.

Zhang M, Long Y, Sun Y, Wang Y, Li Q, Wu H, Guo Z, Li Y, Niu Y, Li C, Liu L, Mei Q. Evidence for the complementary and synergistic effects of the three-alkaloid combination regimen containing berberine, hypaconitine and skimmianine on the ulcerative colitis rats induced by trinitrobenzene-sulfonic acid. Eur J Pharmacol. 2011 Jan 25;651(1-3):187-96. Epub 2010 Oct 20. PubMed PMID: 20969848.

von Felbert V, Hunziker T. [Acrodermatitis enteropathica-like skin lesions due to Crohn's disease-associated zinc deficiency]. Hautarzt. 2010 Nov;61(11):927-9. German. PubMed PMID: 20953572.

Turner D, Shah PS, Steinhart AH, Zlotkin S, Griffiths AM. Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): a systematic review and meta-analyses. Inflamm Bowel Dis. 2011 Jan;17(1):336-45. doi: 10.1002/ibd.21374. Review. PubMed PMID: 20564531.

Dey M, Kuhn P, Ribnicky D, Premkumar V, Reuhl K, Raskin I. Dietary phenethylisothiocyanate attenuates bowel inflammation in mice. BMC Chem Biol. 2010 Apr 27;10:4. PubMed PMID: 20423518; PubMed Central PMCID: PMC2881005.

El-Tawil AM. Smoking and inflammatory bowel diseases: what in smoking alters the course? Int J Colorectal Dis. 2010 Jun;25(6):671-80. Epub 2010 Mar 24. PubMed PMID: 20333390.

Uchiyama K, Nakamura M, Odahara S, Koido S, Katahira K, Shiraishi H, Ohkusa T, Fujise K, Tajiri H. N-3 polyunsaturated fatty acid diet therapy for patients with inflammatory bowel disease. Inflamm Bowel Dis. 2010 Oct;16(10):1696-707. PubMed PMID: 20222122.

Triggs CM, Munday K, Hu R, Fraser AG, Gearry RB, Barclay ML, Ferguson LR. Dietary factors in chronic inflammation: food tolerances and intolerances of a New Zealand Caucasian Crohn's disease population. Mutat Res. 2010 Aug 7;690(1-2):123-38. Epub 2010 Feb 6. PubMed PMID: 20144628.

Elliott DE, Weinstock JV. Helminthic therapy: using worms to treat immune-mediated disease. Adv Exp Med Biol. 2009;666:157-66. Review. PubMed PMID: 20054982.

Guarner F. Prebiotics, probiotics and helminths: the 'natural' solution? Dig Dis. 2009;27(3):412-7. Epub 2009 Sep 24. Review. PubMed PMID: 19786773.

Waeytens A, De Vos M, Laukens D. Evidence for a potential role of metallothioneins in inflammatory bowel diseases. Mediators Inflamm. 2009;2009:729172. Epub 2009 Aug 26. Review. PubMed PMID: 19727408; PubMed Central PMCID: PMC2734936.

Chung HL, Yue GG, To KF, Su YL, Huang Y, Ko WH. Effect of Scutellariae Radix extract on experimental dextran-sulfate sodium-induced colitis in rats. World J Gastroenterol. 2007 Nov 14;13(42):5605-11. PubMed PMID: 17948935.

Choi YA, Kang OH, Park HJ, Tae J, Kim DK, Kang CS, Choi SC, Yun KJ, Choi SJ, Nah YH, Kim YH, Bae KH, Lee YM. Effect of processed Scutellaria baicalensis on dextran sulfate sodium-induced colitis in mice. Int J Mol Med. 2005 Oct;16(4):667-72. PubMed PMID: 16142402.

Scrimgeour AG, Condlin ML. Zinc and micronutrient combinations to combat gastrointestinal inflammation. Curr Opin Clin Nutr Metab Care. 2009 Nov;12(6):653-60. Review. PubMed PMID: 19684516.

Najafzadeh M, Reynolds PD, Baumgartner A, Anderson D. Flavonoids inhibit the genotoxicity of hydrogen peroxide (H(2)O(2)) and of the food mutagen 2-amino-3-methylimadazo[4,5-f]-quinoline (IQ) in lymphocytes from patients with inflammatory bowel disease (IBD). Mutagenesis. 2009 Sep;24(5):405-11. Epub 2009 Jun 24. PubMed PMID: 19553277.

Kim YH, Kwon HS, Kim DH, Shin EK, Kang YH, Park JH, Shin HK, Kim JK. 3,3'-diindolylmethane attenuates colonic inflammation and tumorigenesis in mice. Inflamm Bowel Dis. 2009 Aug;15(8):1164-73. PubMed PMID: 19334074.

Yoshioka Y, Akiyama H, Nakano M, Shoji T, Kanda T, Ohtake Y, Takita T, Matsuda R, Maitani T. Orally administered apple procyanidins protect against experimental inflammatory bowel disease in mice. Int Immunopharmacol. 2008 Dec 20;8(13-14):1802-7. Epub 2008 Sep 29. PubMed PMID: 18824249.

Adorini L, Penna G. Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol. 2008 Aug;4(8):404-12. Epub 2008 Jul 1. Review. PubMed PMID: 18594491.

Feagan BG, Sandborn WJ, Mittmann U, Bar-Meir S, D'Haens G, Bradette M, Cohen A, Dallaire C, Ponich TP, McDonald JW, HÉbuterne X, ParÉ P, Klvana P, Niv Y, Ardizzone S, Alexeeva O, Rostom A, Kiudelis G, Spleiss J, Gilgen D, Vandervoort MK, Wong CJ, Zou GY, Donner A, Rutgeerts P. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials. JAMA. 2008 Apr 9;299(14):1690-7. PubMed PMID: 18398081.

Osman N, Adawi D, AhrnÉ S, Jeppsson B, Molin G. Probiotics and blueberry attenuate the severity of dextran sulfate sodium (DSS)-induced colitis. Dig Dis Sci. 2008 Sep;53(9):2464-73. Epub 2008 Feb 15. PubMed PMID: 18274903.

Singh S, Khajuria A, Taneja SC, Johri RK, Singh J, Qazi GN. Boswellic acids: A leukotriene inhibitor also effective through topical application in inflammatory disorders. Phytomedicine. 2008 Jun;15(6-7):400-7. Epub 2008 Jan 28. PubMed PMID: 18222672.

Billerey-Larmonier C, Uno JK, Larmonier N, Midura AJ, Timmermann B, Ghishan FK, Kiela PR. Protective effects of dietary curcumin in mouse model of chemically induced colitis are strain dependent. Inflamm Bowel Dis. 2008 Jun;14(6):780-93. PubMed PMID: 18200517.

Takaishi H, Matsuki T, Nakazawa A, Takada T, Kado S, Asahara T, Kamada N, Sakuraba A, Yajima T, Higuchi H, Inoue N, Ogata H, Iwao Y, Nomoto K, Tanaka R, Hibi T. Imbalance in intestinal microflora constitution could be involved in the pathogenesis of inflammatory bowel disease. Int J Med Microbiol. 2008 Jul;298(5-6):463-72. Epub 2007 Sep 25. PubMed PMID: 17897884.

Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: a systematic review. World J Gastroenterol. 2007 Jul 7;13(25):3417-24. Review. PubMed PMID: 17659687.

Deguchi Y, Andoh A, Inatomi O, Yagi Y, Bamba S, Araki Y, Hata K, Tsujikawa T, Fujiyama Y. Curcumin prevents the development of dextran sulfate Sodium (DSS)-induced experimental colitis. Dig Dis Sci. 2007 Nov;52(11):2993-8. Epub 2007 Apr 11. PubMed PMID: 17429738.

Fiasse R, Latinne D. Intestinal helminths: a clue explaining the low incidence of inflammatory bowel diseases in Subsaharan Africa? Potential benefits and hazards of helminth therapy. Acta Gastroenterol Belg. 2006 Oct-Dec;69(4):418-22. Review. PubMed PMID: 17343086.

Elliott DE, Summers RW, Weinstock JV. Helminths as governors of immune-mediated inflammation. Int J Parasitol. 2007 Apr;37(5):457-64. Epub 2006 Dec 28. Review. PubMed PMID: 17313951.

Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000542. Review. PubMed PMID: 17253452.

Omer B, Krebs S, Omer H, Noor TO. Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn's disease: a double-blind placebo-controlled study. Phytomedicine. 2007 Feb;14(2-3):87-95. Epub 2007 Jan 19. PubMed PMID: 17240130.

Hanai H, Iida T, Takeuchi K, Watanabe F, Maruyama Y, Andoh A, Tsujikawa T, Fujiyama Y, Mitsuyama K, Sata M, Yamada M, Iwaoka Y, Kanke K, Hiraishi H, Hirayama K, Arai H, Yoshii S, Uchijima M, Nagata T, Koide Y. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006 Dec;4(12):1502-6. Epub 2006 Nov 13. PubMed PMID: 17101300.

Ohkawara T, Takeda H, Kato K, Miyashita K, Kato M, Iwanaga T, Asaka M. Polaprezinc (N-(3-aminopropionyl)-L-histidinato zinc) ameliorates dextran sulfate sodium-induced colitis in mice. Scand J Gastroenterol. 2005 Nov;40(11):1321-7. PubMed PMID: 16334442.

Camuesco D, G Á lvez J, Nieto A, Comalada M, RodrÍguez-Cabezas ME, Concha A, Xaus J, Zarzuelo A. Dietary olive oil supplemented with fish oil, rich in EPA and DHA (n-3) polyunsaturated fatty acids, attenuates colonic inflammation in rats with DSS-induced colitis. J Nutr. 2005 Apr;135(4):687-94. PubMed PMID: 15795419.

Jian YT, Mai GF, Wang JD, Zhang YL, Luo RC, Fang YX. Preventive and therapeutic effects of NF-kappaB inhibitor curcumin in rats colitis induced by trinitrobenzene sulfonic acid. World J Gastroenterol. 2005 Mar 28;11(12):1747-52. PubMed PMID: 15793857.

Kwon KH, Murakami A, Tanaka T, Ohigashi H. Dietary rutin, but not its aglycone quercetin, ameliorates dextran sulfate sodium-induced experimental colitis in mice: attenuation of pro-inflammatory gene expression. Biochem Pharmacol. 2005 Feb 1;69(3):395-406. Epub 2004 Dec 15. PubMed PMID: 15652231.

Winter TA, O'keefe SJ, Callanan M, Marks T. Impaired gastric acid and pancreatic enzyme secretion in patients with Crohn's disease may be a consequenece of a poor nutritional state. Inflamm Bowel Dis. 2004 Sep;10(5):618-25. PubMed PMID: 15472524.

Rohweder J, Runkel N, Fromm M, Schulzke JD, Buhr HJ. [Zinc acts as a protective agent on the mucosal barrier in experimental TNBS colitis]. Langenbecks Arch Chir Suppl Kongressbd. 1998;115(Suppl I):223-7. German. PubMed PMID: 14518248.

Foglio MA, Dias PC, AntÔnio MA, Possenti A, Rodrigues RA, da Silva EF, Rehder VL, de Carvalho JE. Antiulcerogenic activity of some sesquiterpene lactones isolated from Artemisia annua. Planta Med. 2002 Jun;68(6):515-8. PubMed PMID: 12094294.

Dias PC, Foglio MA, Possenti A, Nogueira DC, de Carvalho JE. Antiulcerogenic activity of crude ethanol extract and some fractions obtained from aerial parts of Artemisia annua L. Phytother Res. 2001 Dec;15(8):670-5. PubMed PMID: 11746858.

Krieglstein CF, Anthoni C, Rijcken EJ, LaukÖtter M, Spiegel HU, Boden SE, Schweizer S, Safayhi H, Senninger N, SchÜrmann G. Acetyl-11-keto-beta-boswellic acid, a constituent of a herbal medicine from Boswellia serrata resin, attenuates experimental ileitis. Int J Colorectal Dis. 2001 Apr;16(2):88-95. PubMed PMID: 11355324.

Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges R. [Therapy of active Crohn disease with Boswellia serrata extract H 15]. Z Gastroenterol. 2001 Jan;39(1):11-7. German. PubMed PMID: 11215357.

Zhou H, Mineshita S. The effect of Oren-gedoku-to on experimental colitis in rats. J Pharm Pharmacol. 1999 Sep;51(9):1065-74. PubMed PMID: 10528991.

James AH. Breakfast and Crohn's disease. Br Med J. 1977 Apr 9;1(6066):943-5. PubMed PMID: 856393; PubMed Central PMCID: PMC1605824.

Lahat A, Lang A, Ben-Horin S. Impact of cannabis treatment on the quality of life, weight and clinical disease activity in inflammatory bowel disease patients: a pilot prospective study. Digestion. 2012;85(1):1-8. Epub 2011 Nov 17. PubMed PMID: 22095142.

Kim DS, Kim SJ, Kim MC, Jeon YD, Um JY, Hong SH. The therapeutic effect of chelidonic acid on ulcerative colitis. Biol Pharm Bull. 2012;35(5):666-71. PubMed PMID: 22687399.

Michelsen KS, Wong MH, Ko B, Thomas LS, Dhall D, Targan SR. HMPL-004
(Andrographis paniculata extract) Prevents Development of Murine Colitis by
Inhibiting T-cell Proliferation and TH1/TH17 Responses. Inflamm Bowel Dis. 2013
Jan;19(1):151-64. doi: 10.1002/ibd.22983. PubMed PMID: 23292349.

Tang T, Targan SR, Li ZS, Xu C, Byers VS, Sandborn WJ. Randomised clinical
trial: herbal extract HMPL-004 in active ulcerative colitis - a double-blind
comparison with sustained release mesalazine. Aliment Pharmacol Ther. 2011
Jan;33(2):194-202. doi: 10.1111/j.1365-2036.2010.04515.x. Epub 2010 Nov 30.
PubMed PMID: 21114791.

Sandborn WJ, Targan SR, Byers VS, Rutty DA, Mu H, Zhang X, Tang T.
Andrographis paniculata Extract (HMPL-004) for Active Ulcerative Colitis. Am J
Gastroenterol. 2013 Jan;108(1):90-8. doi: 10.1038/ajg.2012.340. Epub 2012 Oct 9.
PubMed PMID: 23044768; PubMed Central PMCID: PMC3538174.

Michelsen KS, Wong MH, Ko B, Thomas LS, Dhall D, Targan SR. HMPL-004
(Andrographis paniculata extract) Prevents Development of Murine Colitis by
Inhibiting T-cell Proliferation and TH1/TH17 Responses. Inflamm Bowel Dis. 2012
Dec 21. [Epub ahead of print] PubMed PMID: 23287895.

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