3 Tips for IBD Flare-Up: STOP FLARE NOW
What’s a “flare”?
An auto-immune flare-up, or “flare,” is essentially whenever the immune system goes crazy and begins destroying itself. There’s a wide range of auto-immune diseases — including ulcerative colitis (UC), chrons, lupus, multiple sclerosis (MS), and arthritis — each of which may come with periods of time where our bodies are triggered to attack our own cells, leading to dreaded, uncomfortable inflammation. In my case of ulcerative colitis, my immune system attacks the cells in my stomach as though they are harmful to my body, leaving me unable to eat and digest most foods.
How do you know when you’re entering flare territory? For me, I start noticing itchy dry skin before my stomach starts telling me something is wrong.
Flare-ups are episodic, meaning you can be fine one day and hit with all the symptoms of your disease the following day. In the example of inflammatory bowel disease, these symptoms include bloating, diarrhea, rectal bleeding, abdominal pain, fatigue, and weight loss. During these flare-ups, I personally have a hard time getting through normal daily tasks such as working, exercising, or walking my dogs. Any attempt at eating or consuming food usually results in a trip to the oval office leaving me weaker than before I ate.
In the past when I’ve flared, all I had the energy for was to lay on the floor and rush to the restroom when needed for days at a time. As I’m writing this, however, it’s now been over a year since my last debilitating flare! How did I achieve this once-unimaginable victory? During my five years of learning to manage my UC and studying the science behind the suffering, I’ve developed a protocol to stop a flare in its tracks. I hope it can help you break your days-with-no-flare record too.
3 part protocol to calming a flare:
Remove irritants to reduce inflammation
Add in probiotics to support a healthy microbiome
Rebuild the gut lining with collagen and glutamine
Remove irritants to reduce inflammation
During an auto-immune flare, our body becomes triggered to attack our own cells as a result of genetic and environmental factors often outside of our control. What we experience as a flare is inflammation — which, unfortunately, is regarded as the ultimate disease starter. Don't get me wrong: genetics play a huge role in disease, especially in cases like inflammatory bowel disease. However, in order to take back some control and give our body the best fighting chance, we have the power to reduce disease and harm by tackling inflammation head-on.
A little inflammation is actually healthy. Chronic, consistent inflammation is not. I like to equate inflammation to fire. Just as controlled forest fires are necessary to prevent wildfires, controlled inflammation is necessary to aid the immune system in fighting disease and injury. An example of this is _____. However, with chronic and systemic inflammation, the immune system gets overwhelmed and confused: starting fires where they’re not needed and ultimately doing more damage to the body than good.
Controlling inflammation is tricky and, as a result, has become a billion-dollar industry. With so much out there, I know it can feel overwhelming (and expensive) to decide which route to take to recovery. However, there are some simple changes in our diets we can try first, that don’t require you to be wealthy, but instead, be Whealthy, and invest in conscious eating.
The priority in calming a flare is to calm the current inflammation while avoiding creating more inflammation. Avoiding high inflammatory foods are as important if not more important than eating anti-inflammatory foods. You are very sensitive to certain foods while you are in a flare, so it is important to be aware of what foods trigger your flare-ups. This list may change depending upon the quality of your gut. Foods that are good for you during the good times are not always good for you during a flare.
We know gluten-containing foods like bread, beer, pasta, cookies, cakes, flour, crackers, pretzels, and sugar create inflammation, so it is best to avoid those entirely. In addition, you may want to avoid high fiber foods and fruits, dairy, and foods that contain sulfites. Anything challenging for your digestive system should be avoided. The list of foods to avoid can be overwhelming and it is often difficult to identify which foods are “safe.” I know it feels like you can't eat anything, but I will go over which foods should be safe during a flare-up in our microbiome section. For now, I’ll just say to look for natural anti-inflammatory foods including turmeric/curcumin mixed with black pepper and healthy omega-3 fatty acids. One of my favorite recipes includes turmeric & ginger salmon with a soy sauce glaze (stay tuned for that recipe coming soon.) You can also get a healthy serving of anti-inflammatory molecules through supplements. A few of my favorite anti-inflammatory supplements are from Thorne, including their Super EPA for omega3, and meriva-SF 500 for curcumin.
2. Add in probiotics to support a healthy microbiome
The second part of our flare protocol is actively creating a healthy microbiome. The microbiome is the makeup of the cohabitating bacteria in our body found on our skin, in our mouth, and most significantly, all throughout our gut. The gut houses 70% of our immune system and the health of our immune system directly relates to what type of bacteria can be found in our intestinal system. It’s a big deal!
A flare-up is the result of an imbalance of bacteria in your gastrointestinal system known as dysbiosis. Dysbiosis is when harmful bacteria outnumber good bacteria. Whatever you were eating is letting the bad bacteria GROW and THRIVE while killing off the healthy bacteria. This of course leads to inflammation and destruction of our gut lining. The good news is you know what not to eat in order to avoid this bacterial imbalance. Now let’s cover what to eat to enhance healthy bacterial growth.
I created the resource “Probiotics vs. Prebiotics: Naturally change your microbiome with these 10 foods” which already discusses the difference between prebiotic and probiotic-containing foods and how to get more of each in your daily diet. Among this list of fermented goodies are sides such as kimchi, sauerkraut, and pickles. One of my favorites, which I find very helpful when a flare is approaching, is a warm and comforting bowl of miso soup.
More importantly, I want to discuss which type of probiotic you should be supplementing. While supplementation of probiotics may not always be necessary, it is important for those with inflammatory bowel disease to find a reliable probiotic proven to improve the quality of their gut. I find Visbiome probiotics particularly helpful in managing my ulcerative colitis and IBD symptoms. Visbiome is by far my favorite probiotic among the many others I have researched, and it’s the first brand I recommend (and no, Visibiome does not pay me for endorsements…I wish). While quite pricey the product has an ample amount of research behind it specifically for people struggling with IBD/IBS. Check out more on Visbiome and other probiotics I love here “Top 6 Probiotic Supplements: Choosing the Best for You and Your Gut Health.”
3. Rebuild the gut lining with collagen and glutamine
Moving on to the third and final(ish) part of the flare protocol: it’s time to rebuild the gut lining. Chronic inflammation located inside the gut results in damaged microvilli, a critical part of our gut that helps us digest food. The degradation of our microvilli leads us to digest food directly on the stomach lining. This then leads to holes being poked in our gut barrier, which opens our GI system to the outside world. This damaged gut barrier allows food to leak into our bloodstream. A damaged gut barrier also means a disruption in our gut-brain communication creating confusion, memory problems, and my personal enemy, brain fog.
Rebuilding the gut lining is possible but takes real dedication and patience. On top of a healthy microbiome, we must provide our body with the nutrients it needs. The key players here are collagen and glutamine.
By far my favorite way to consume collagen and glutamine is through bone broth. Bone broth is my number one flare food for good reason. It’s warming, filling, easily digestible, and full of essential vitamins and nutrients. This provides a real sense of comfort because in a flare almost all food seems unappetizing. While collagen and glutamine are naturally and readily available in bone broth, they are also affordable and easy to consume via powder supplementation.
Bonus advice: avoid stressors
While not as well researched and fully understood, there’s one factor in my experience that can determine whether this whole protocol succeeds or fails: stress. When I’m on vacation it seems as though my gut is stronger than ever, giving me more flexibility to eat and drink whatever I please (within limit). Stress levels are a major factor in disease and health overall, and this undoubtedly applies to our gut health. While it is becoming increasingly clear that stress can lead to disease and immune malfunctions, the mechanism of action is not as clear. What is clear is that learning to process stressors and avoiding as much stress as possible can lower inflammation, positively impact microbiome health, and strengthen your gut.
Let's be real, in today's society it is pretty much impossible to avoid all forms of stress. Stress is a part of daily life so instead of avoiding it completely, we can try to manage stress through techniques such as therapy, meditation, exercise, and controlled breathing. If you are fortunate enough to take time off from work during a flare-up, that may be a wise decision. Work can often be a stressor, even if you love what you do.
The topic of stress and chronic disease warrants its own article and a deep dive into the latest research, so I look forward to diving deep into this subject and following up in another post.
Another bonus: Popular advice for flares that I DON’T recommend (and why).
Conflicting information about what to do during a flare-up can be hella frustrating, especially if fatigue and brain fog are in the mix. I’ve experienced trying tips from mainstream health blogs, which I quickly found through research and personal experimentation to be straight-up wrong, and sometimes dangerous. For example, the following is a list from a popular health site, with recommendations of foods to consume when you’re experiencing an IBD flare-up. I highlighted the items in red that I find are dangerous suggestions, in yellow if they should be consumed with caution, and in green, if they actually are safe to consume, in my experience.
white bread without seeds
white pasta, noodles, and macaroni
white rice
crackers and cereals made with refined white flour
canned, cooked fruits
cooked vegetables without skins or seeds
pureed vegetable soups
tender, soft meats (no gristle or skin), and fish
peanut butter and other nut butter
oils like olive oil and coconut oil
Most fruit juices are fine to drink, but only with the pulp removed
So while this “healthy foods” list as a whole may work for some people, it definitely, definitely, doesn’t work for me. Here’s why my body rejects so many of the above suggestions, and why you might want to avoid them too.
High Fiber and whole-grain foods: High fiber foods may be really good for a person without a compromised colon, but for those with IBD, high fiber foods will wreak havoc on your colon. These grains still have the fibrous endosperm, germ, and bran that can irritate UC and may trigger a flare-up. High fiber foods can lead to pain, bloating, gas, indigestion, and internal bleeding.
AVOID brown rice, quinoa, buckwheat, oats, wild rice, barely, millet, spelt.
AVOID legumes, peas, beans, lentils, corn, chickpeas, soybeans.
AVOID high fiber fruits & fruits with seeds & all dried fruits, like raspberries, apples, oranges, strawberries
REPLACE high fiber green leafy vegetables, with green juice, with limited sugar, to get proper vitamins and nutrients during flare up.
2. Gluten: I am not celiac nor ever been diagnosed as gluten intolerant, but is gluten still bad for me? The answer that I’ve found time and time again, is it is hella bad. Gluten creates inflammation (small fires) all over my body. It is absolutely not ok during flare-ups to choose white breads and pastas made from enriched white flour, as may be stated in some other articles. Daily gluten consumption leads to chronic inflammation, gut permeability issues, and disease. Even if you do not have a gluten intolerance you may want to avoid gluten at all cost, ESPECIALLY when experiencing a flare.
AVOID gluten- like wheat, rye, barely, bread, beer, pasta, cookies, cakes, flour, crackers, pretzels.
PRO TIP: “gluten free” does not mean it is good for you. Gluten-free foods are often substituted with additional sugar and other fillers. So even if it’s gluten free it can still bother your belly. Which leads me to the the next “avoid” category…
3. Sugar: Pretty simple one here. Sugar is not good for anyone, unless you are a diabetic and you already know sugar intake may be necessary.
AVOID processed sugar, candy, fruit juice, soda, liquid sugar in all forms including fruit juice (pulp or no pulp)
4. Dairy: Dairy is yet another thing that is hard for many to digest. This may be a more personal food choice to avoid, but dairy definitely does not benefit you when experiencing a flare. There are many dairy free options for milk and yogurts that can be substituted without noticing a difference. In addition, hard cheeses are very low in lactose and can potentially be handled in small amounts.
REPLACE cheese and milk with alternatives like lactose free options.
5. Sulfates & sulfides: Sulfates and sulfides, like all food sources, determine the number of good bacteria versus bad bacteria in our stomach. These two feed bacteria that produce gas, which for UC people is already a challenge. Consumption of sulfates and sulfides will leave you feeling bloated, likely with an unsettled stomach feel. I understand that sometimes wine with dinner is too good to give up, but it may be worth it to pass on the glass while experiencing stomach upset.
REDUCE sulfate and sulfide-rich foods like red meat, dairy milk, beer and wine, apple and grape juice, cruciferous vegetables, eggs, cheese, dried fruit, and some well water.
6. Caffeine: Last but definitely not least is to avoid caffeine. As someone who looks forward to my first sip of coffee literally every morning, I must use all my willpower to avoid caffeine while in a flare. The reason is simple:caffeine is an irritant to the gut lining and makes you go to the restroom. This should be avoided by a person already experiencing frequent bathroom trips.
AVOID coffee and other high caffeine drinks, at least until you’re feeling all the way better.
More bonuses? The food that’s my best friend during a flare-up
After giving you a list of what seems like every food imaginable that you cannot eat, here’s the good stuff: foods that not only don’t bother me, but actually help me feel better during a flare.
While experiencing a flare, I think it helps to think about diet like you're a brand new baby, re-establishing your microbiome (feeding the good bacteria, and starving the bad). Eat foods that repopulate & repair your gut.
CONSUME: Mama Whealthy’s Ginger Carrot Soup (meant for sensitive stomachs), dairy-free kefir, dairy-free yogurt, chicken, fish, fully cooked veggies without seeds or skin, white rice, soups, kombucha, kimchi, sauerkraut, sweet potatoes, green/yellow bananas, miso, pickles, green juice (no sugar added), caffeine-free tea (I recommend peppermint, lavender route, and tumeric).
And of course: don’t forget to drink your bone broth.
Last bonus(es)!
Check you poo to determine your gut health.
If you are experiencing serious flare symptoms such as continuous bleeding you should always inform your doctor. Check out additional Whealthy tips, such as bone broth combined with fasting to boost your recovery. As well as what vitamin & supplements you can take to help fuel your recovery.