How are diabetes and inflammatory bowel disease connected? Jennifer Okemah, our founder and clinical director, was invited to talk about the connection between diabetes and inflammatory bowel disease, as well as the treatments for both conditions.
Written by Jewels Doskicz.
Interviewee: Jennifer Okemah, MS, RDN, CSSD, BC-ADM, CDCES
If you have diabetes, you may be at higher risk for inflammatory bowel disease (IBD), an autoimmune condition that affects the gastrointestinal (GI) tract. While there is no cure, there are treatments and medications to improve everyday life for people with IBD and diabetes.
IBD affects roughly 1 in 100 people in the U.S. and causes a range of issues in the GI tract and other parts of the body. Moreover, people with diabetes are at an increased risk for bowel-related conditions, with up to 75 percent reporting gut issues such as diarrhea, constipation, and stomach pain.
Research is ongoing to better understand what triggers IBD attacks, and why they happen to some people and not others. When left untreated, tissue inflammation in the GI tract can be harmful to the body. That’s why it’s important to speak to a healthcare provider about any GI symptoms you may be having so they can help pinpoint the cause.
On the flip side, there is also an increased risk of developing diabetes in people who have IBD. Part of the risk is related to the use of steroids as a treatment for IBD. People with both type 1 and type 2 diabetes have been implicated in the increased risk of IBD.
What is IBD and what causes it?
“IBD is a lifelong, chronic inflammatory condition of the digestive tract with ulcerative colitis and Crohn’s disease being the two most common types,” said Jennifer Okemah, a certified diabetes care and education specialist and owner of Salute Nutrition, a diabetes and nutrition private practice in Washington state.
“While ulcerative colitis generally affects the large intestine, Crohn’s disease can affect the entire digestive tract (from mouth to anus). Both of these conditions can be very painful and have ongoing exacerbations,” said Okemah.
Although IBD can happen to anyone, studies suggest an increased risk of ulcerative colitis (UC) and Crohn’s disease in people living with diabetes.
Like other autoimmune conditions, the exact cause of IBD remains uncertain. There isn’t a single cause of IBD. Rather, studies show a combination of genetic, environmental, and immune system factors at play.
It’s thought that specific genes, plus environmental triggers, cause defects in the immune system. In turn, that begins an attack on the body’s healthy digestive system. This results in tissue inflammation and a variety of symptoms that can cause significant emotional and physical distress.
What are the symptoms of IBD?
Both UC and Crohn’s disease are different for different people. Symptoms may wax and wane, as well as their intensity, from minimal to severe. Both usually involve episodes of flares (worsening of symptoms) that may require taking corticosteroid medications for inflammation or switching to a new IBD medication.
Common symptoms of IBD may include:
- Diarrhea or constipation
- Bloody stools
- Mucous or pus
- Abdominal cramping
- Abdominal pain and bloating
- Malnutrition
- Malabsorption or weight loss
With IBD, people will often develop “extra-intestinal” symptoms. In other words, it’s common to have symptoms and conditions that aren’t gut-related throughout the body.
Extra-intestinal symptoms of IBD may include:
- Fever
- Exhaustion
- Depression and anxiety (the “feel-good” hormone serotonin is produced in a healthy gut)
- Skin rashes and mouth sores
- Joint pain
- Eye issues
- Hair loss
How is IBD treated?
IBD is unique to each individual, so the treatments are, too. There are a variety of medications that can help to treat IBD symptoms, decrease inflammation, and temper the immune system. While people often start on drug therapies, they may also try alternatives for stress reduction (like yoga, meditation, and exercise), acupuncture, and other complementary therapies.
It can take some time to refine treatments to support remission. That’s why building a support team for personalized care is so important. Having a registered dietitian with broad IBD knowledge, as well as professional support for your emotional well-being, is key to living your best life with IBD.
How do I know if I have UC or Crohn’s?
If you’re having bothersome GI symptoms, it’s never too early to seek care from your primary care provider. They’ll do a physical exam, order testing, and likely refer you to a gastroenterologist (an expert in the digestive system).
“Receiving a diagnosis is vital in providing targeted therapy for someone’s condition,” said Okemah. “And it’s a fairly straightforward process with blood and stool testing, imaging, or endoscopy procedures.”
While the prep for an endoscopy procedure isn’t something anyone looks forward to, it’s important to find out exactly what’s going on. Preventative colonoscopy screening recommendations begin at age 45, so even if you don’t have GI issues, it’s important to schedule an appointment.
Diabetes and other gastrointestinal conditions
“With diabetes, there can be a lot of dysbiosis – or an imbalance in good and bad gut bacteria,” explained Okemah. “I want to know if someone is consuming high levels of sugar alcohols, erythritol, and mannitols, which can be a common source of gut issues with diabetes.”
“As a registered dietitian, I work backward to discover what’s going on with a person’s intake and identifying what can be gut-disruptive. What may seem like a mystery can be peeled away quicker than you would think,” said Okemah.
IBD isn’t to be confused with other GI conditions such as:
- Irritable bowel syndrome (IBS)
- Celiac disease
- Gastroparesis
- Small intestine bacterial overgrowth
- Small intestine fungal overgrowth
- Exocrine pancreatic insufficiency
- Chronic pancreatitis
- Non-alcoholic fatty liver disease (NAFLD)
How do food choices affect gut health?
“With diabetes, there are a lot of mixed dietary messages coming in, which is unfortunate,” said Okemah. “And while certain foods may worsen IBD symptoms, they do not cause IBD.”
Okemah explained that it’s common for people to self-treat GI conditions before seeking help. A good example is switching to a gluten-free diet, which they may not need. Unless it’s medically necessary like in the case of celiac disease, going gluten-free isn’t the best choice for diabetes as many foods have been stripped of fiber.
“As registered dietitians, we start building a diet of what people ‘can’ eat and focus on what’s working. Our goal is to reintroduce healthy anti-inflammatory foods and widen diets so people with IBD can eat foods they once enjoyed,” said Okemah.
If you’re wondering what’s one easy thing you can do to improve your gut health, Okemah suggested eating more prebiotic foods. Easy to find at your local grocery store, prebiotic foods offer protective benefits to the gut and are found in miso, kimchi, pickles, sauerkraut, and ciders – to name a few.
When should I see a healthcare provider?
“It can be a confusing time when someone isn’t feeling well and they don’t know what to do, but there needs to be a diagnosis,” said Okemah. “While it may be a natural inclination to go to Dr. Google and self-diagnose, GI issues necessitate a trip to the doctor, and likely, a scope.”
“Diabetes already has its set of difficulties, and if you’re dealing with a digestive disorder on top of that, we need to know exactly what it is. Then we can work on a methodical and systematic plan of attack, so you know what your gut can handle and start to feel better,” said Okemah.
There’s no need to suffer in silence. While GI symptoms may feel embarrassing to discuss at first, your health is a priority. So don’t wait, speak up, and make an appointment with your provider today.
