Green tea and ulcerative colitis

5 Gut-Soothing Teas for People With Ulcerative Colitis

Herbal remedies have been used to treat disease for centuries, across a variety of different cultures. Turmeric fights inflammation, while ginger has antinausea properties. A study published in the January–February 2012 issue of the Saudi Journal of Gastroenterology states that although the evidence on the benefits of herbal medicine are incomplete, they may still be safer to consume than synthetic drugs.

Likewise, a systematic review of the evidence for alternative medicine, including herbal remedies, for treating inflammatory bowel disease (IBD), published in January 2015 in the Journal of Crohn’s and Colitis, found that although more research is needed, such remedies may be effective.

“There’s some evidence to suggest that tea may help with things like inflammation,” says Kelly Kennedy, RD, a nutritionist for Everyday Health. “The unfortunate thing is that a lot of that research has been done in animals, so it doesn’t necessarily translate to the same effect in humans. But if tea helps someone, then it can be an easy tool for easing symptoms.

“For one thing, tea is always hydrating, and that can help with ulcerative colitis symptoms like diarrhea or short bowel syndrome after surgery,” Kennedy adds. “Another benefit is that tea has a warm, soothing quality, which can help because stress can aggravate symptoms. And that’s true regardless of the type of tea you make.”

If a nice cup of tea sounds like just the thing to help ease your belly, try out one of the following.

Turmeric and Ginger Tea

Turmeric, a relative of ginger, has been used in Ayurvedic medicine for millennia to treat inflammatory diseases. Curcumin, the active component of turmeric, “has been suggested to exert positive effects in IBD,” according to a study published online in October 2015 in Mediators of Inflammation. Try out this soothing concoction submitted by nascarrunner71 at AllRecipes.com: Hot or cold, this tea combines ginger, turmeric, and honey or maple syrup for a rich and flavorful tea.

After-Dinner Belly-Soothing Tea

Fennel seed is used for a number of digestive problems. Combine the herb with peppermint, ginger and chamomile for a belly-calming blend that can be taken before or after a meal to prevent or reduce painful bloating or cramping. Check out this recipe over at The Kitchn.

Calendula Tea

Calendula, a type of flower, has many uses beyond tea, including soap and lip balm. Calendula is an anti-inflammatory that can be used to treat ulcerative colitis, notes a page on the University of Michigan Medical School website.

There are a few methods for making calendula tea, using dried or fresh calendula flowers. The Nerdy Farm Wife recommends heating the water in a saucepan or setting a jar of water filled with flower petals in direct sunlight.

Note that calendula can also have side effects. Penn State Hershey Medical Center, in Hershey, Pennsylvania, notes that calendula should be avoided by pregnant or breastfeeding women and by couples trying to conceive, because the flower can interfere with conception and possibly cause miscarriage. People who are allergic to ragweed or plants in the daisy or aster family may experience a skin rash from calendula.

Slippery Elm Tea

The powdered inner bark of the slippery elm tree has been used for centuries to treat inflammatory diseases in traditional medicine. Try out this recipe from the Happy Herb Company to see if it helps with your ulcerative colitis symptoms.

A word of caution: Kennedy says that slippery elm can, at least according to traditional wisdom, induce abortions, and thus should be avoided by anyone who is pregnant or breastfeeding.

Green Ginger Mint Tea

You’ve probably heard that green tea contains antioxidants that can help prevent cancer, but its benefits don’t end there — green tea also contains an anti-inflammatory component that may be effective against ulcerative colitis. Make your next cup of green tea a little more exciting by adding ginger and mint, following this recipe from Canadian Living.

Kennedy notes that the amount of the main anti-inflammatory component of green tea, epigallocatechin-3-gallate (EGCG), is given during research studies in much higher amounts, and to much smaller creatures, than the amount found in a typical cup of tea. “It might be worth having a couple of cups, rather than just one,” she says.

If your ulcerative colitis symptoms are acting up, try experimenting with some of these teas to see if they help. But before you introduce any major changes to your diet, including upping your consumption of one of these remedies, Kennedy recommends talking to your doctor.

“Also, don’t have one cup of green tea and expect to be cured,” she adds. “Track what you’re taking and make note of the effects to see what might be working for you.”

Better Choices

Just because a food is on your problem list doesn’t mean you have to give it up. You have choices.

Try to switch from full-fat to low-fat dairy. Or tweak your cooking method: bake or broil meats instead of frying. Bake or stew vegetables rather than eating them raw or lightly cooked.

You can also swap out items in the main food groups.

Grains

Common problem foods:

  • Whole-grain breads, bagels, rolls, crackers, cereals, and pasta
  • Brown or wild rice

Better choices:

  • Products made from white or refined flour
  • White rice

Vegetables and Fruits

Common problem foods:

  • Veggies such as broccoli, cauliflower, and Brussels sprouts
  • Leafy greens, including mustard, turnip, and collard greens, and spinach
  • Most raw fruits
  • Raisins and other dried fruits
  • Canned cherries and berries

Better choices:

  • Well-cooked vegetables without seeds
  • Ripe bananas, peeled apples, and melons
  • Soft, canned fruits without added sugar

Meat and Protein

Common problem foods:

  • Fried meats, such as sausage and bacon
  • Luncheon meats, like bologna and salami
  • Hot dogs
  • Dried beans, peas, and nuts

Better choices:

  • Tender, well-cooked meats and poultry
  • Fish
  • Eggs

Milk Products

Common problem foods:

  • Whole milk
  • Half-and-half
  • Sour cream

Better choices:

  • Buttermilk
  • Evaporated milk
  • Low-fat or skim milk
  • Powdered milk
  • Plant-based alternatives, such as soy, almond, or coconut “milks”

Herbal Medicines Useful to Treat Inflammatory and Ulcerative Gastrointestinal Disorders: Preclinical and Clinical Studies

Gastrointestinal disorders are among the most common illnesses that affect people nowadays. Their prevalence and incidence have been on the rise during the last decade. This high prevalence and incidence are due to the contemporary lifestyle we live. Such lifestyles include bad dietary habits, consumption of drugs, alcoholic drinks, and stress. It is very common that gastrointestinal disorders are characterized with inflammatory and ulcerative processes from the stomach or gut.

The main inflammatory and ulcerative disorders associated with the gastrointestinal tract include gastritis, ulcers, colitis, Crohn’s disease, and mucositis. These disorders are difficult to treat. The recurrence and side effects are very common after treatment with available drugs. Based on that, there is an urgent need for the search for more effective and safe pharmacological options for the treatment of inflammatory and ulcerative gastrointestinal disorders. In the recent years, plant extracts and natural products have been sought for the important role in the treatment of the previously mentioned disorders. Thus, a great deal of effort and research has been undertaken to find suitable natural plants and compounds with proven potential. For this reason, hundreds of plant extracts and isolated active compounds have shown a promising potential. However, for the majority of them, it is necessary to conduct preclinical studies followed by the clinical studies in humans in order to be approved for human use. This special issue is focused on this topic. The edition consists of seven articles including a clinical study, three preclinical studies, and three reviews, which are briefly described below.

The clinical study was performed by B. Liu et al., who reported that the use of Chinese medicinal herbs mix composed of seven plants (CIF) and mesalazine in the treatment of ulcerative colitis (UC). In this study, 60 patients with chronic UC were treated only with either oral mesalazine or mesalazine in combination with CIF enema. The results showed that combination of mesalazine and CIF significantly improved the clinical symptoms, the colon mucosal conditions, the Mayo Clinic Disease Activity Index, and quality of life, when compared to mesalazine alone.

Considering the preclinical studies, one of the contributions is the work of T. Mao et al., who explored the mechanism of Qingchang Wenzhong Decoction (QCWZD), preparation derived from eight plants, in UC in rats models. The authors showed that QCWZD administration significantly alleviated colitis-associated inflammation, upregulating serum macrophage-stimulating protein (MSP) and receptor d’origine nantais (RON) expression in the colon, reduced the pAkt (protein kinase B , phosphorylated Akt) levels, promoted zona occluden 1 (ZO-1) expression, and depressed claudin-2 expression. Of this mode, it was possible to conclude that QCWZD appears to attenuate DSS-induced UC in rats by upregulating the MSP/RON signaling pathway, contributing to understanding of QCWZD benefits in UC.

Still considering the preclinical studies, Y. Yang et al. described the anti-inflammatory effects and the underlying mechanisms of GCZX-pill, Chinese herbal formula composed of six herbs, on trinitrobenzene sulfonic acid- (TNBS-) induced UC in rats. The results demonstrated that the GCZX-pill can attenuate colitis in rats and the anti-inflammatory effect of the GCZX-pill may be related to the reduction of enterochromaffin colonic cells hyperplasia and serotonin availability.

The third preclinical study was done by H. Zhang et al., who tested the effects of two Chinese herbal formulations, Erchen decoction (ECD) and Linguizhugan decoction (LGZGD), on insulin resistance in rats. The results indicated that ECD and LGZGD have protective effects against high-fat diet-induced liver insulin resistance and their underlying mechanisms involve the TNF-α and insulin pathway.

In the review articles, P. Ren et al. reported a comprehensive review concerning the efficacy and safety of Kangfuxinye enema (Chinese herbal medicine extracted from the Periplaneta americana) combined with mesalamine for the ulcerative colitis (UC) patients and in addition evaluated the grade of the quality of evidence by using the GRADE (grading of recommendations, assessment, development, and evaluation) approach. With this revision, the authors concluded that although Kangfuxinye enema seems to be effective and safe for treating UC patients in this systematic review, Kangfuxinye enema combined with mesalamine was weakly recommended due to very low to moderate quality of available evidence by the GRADE approach.

In another review, C. Wang et al. discussed another Chinese herbal formula known as Huangqin-Tang (HQT), composed of four ingredients: the roots of Scutellaria baicalensis Georgi, Glycyrrhiza uralensis Fisch, Paeonia lactiflora Pall, and the fruit of Ziziphus jujuba Mill. The authors concluded that available reports suggested that the efficacy of HQT or its components on UC is related to the intestinal environment improvement, immune modulation, and regulation of inflammatory pathways or cytokines. However, most of the data were based on animal studies or in vitro experiments; thus, the effects and mechanisms of HQT in UC patients remain to be explored or verified.

Finally, L. M. da Silva et al. did a review concerning the potential role of propolis in the treatment and prevention of gastrointestinal disorders. They reported and critiqued the studies showing the beneficial effects of propolis and its active compounds in the treatment of gastrointestinal diseases; however, they concluded that only few clinical trials have been conducted to prove their effectiveness and safety against human ulcers and their associated pathologies.

Thus, this special issue included different investigations related to the efficacy of herbal medicines in the treatment of inflammatory and ulcerative gastrointestinal disorders, based on clinical and preclinical studies as well as the revision of the literature related to the objective of this special issue.

Sérgio Faloni de Andrade
Luisa Mota da Silva
Shahram Golbabapour
Steve Harakeh

The Therapeutic Capabilities of Slippery Elm Bark

What Is Slippery Elm Bark?

Slippery elm, or Ulmus rubra, is a tree native to the central and eastern United States and Ontario, Canada.

The tree is known for its dark brown to reddish brown bark and can reach a height of 60-80 feet. Native Americans would peel its slimy, red inner bark from twigs and branches and use it as a remedy for many common ailments, like fevers, wounds, and sore throats.

They found that when the bark is mixed with water, it generates a sticky material known as mucilage, which is therapeutic and soothing to anything it touches. The Native Americans would also wrap the inner bark of the slippery elm around their meat to keep the meat from going bad.

Slippery elm bark was later picked up by American soldiers to heal gunshot wounds during the American Revolution.

Slippery elm is also called red elm or Indian elm. The inner bark is the only part used for therapeutic purposes.

What’s It Used For?

Slippery elm can be used to soothe a number of symptoms.

1. Inflammatory Bowel Diseases

Slippery elm bark is a demulcent. This means that it is capable of soothing the lining of the stomach and intestines and reducing irritation. Demulcents are sometimes referred to as mucoprotective agents.

Recent studies have shown that slippery elm bark can help treat the symptoms associated with inflammatory bowel diseases like Crohn’s disease, ulcerative colitis, and irritable bowel syndrome (IBS).

One small clinical study found that a mixture containing slippery elm enhanced bowel movements in patients with constipation-predominant IBS; however, the bark was part of a mixture of ingredients, and no study to date has supported these findings. Another study found that slippery elm had an antioxidant effect in people with Crohn’s disease.

More research is needed to confirm these effects.

2. Soothing a Cough and Sore Throat

Slippery elm contains mucilage, a sticky mixture of sugars that can’t be broken down by the human digestive tract. The mucilage coats the throat, so it’s no surprise that slippery elm is found commercially in many brands of throat lozenges.

Slippery elm is believed to be an antitussive, meaning it’s great for coughs and for symptoms of other upper respiratory ailments like bronchitis or asthma. Again, there are no studies to support or refute these claims.

A study examining the bark’s use in people with laryngitis or throat inflammation and voice problems has also shown some potential soothing effects. More research is needed.

3. Irritation of the Urinary Tract

Slippery elm is sometimes recommended to people who experience unexplained inflammation of the urinary tract, like those with interstitial cystitis (painful bladder syndrome). Slippery elm powder is thought to soothe the lining of the urinary tract. Therefore, it might help alleviate the painful irritating symptoms. Again, studies are needed to either support or refute these claims.

As a mild diuretic, it also helps increase the flow of urine and eliminate waste from the body.

4. Heartburn and GERD

Slippery elm may be helpful for treating occasional heartburn, also known as acid reflux. It’s also considered an herbal remedy for gastroesophageal reflux disease (GERD).

GERD is a chronic disease that occurs when stomach acid flows back into esophagus and irritates the lining.

The mucilage of slippery elm coats the esophagus and may help prevent the irritation and inflammation that occurs when stomach acid flows up the esophagus.

If you experience heartburn or GERD, check with your doctor. He may agree to you trying a mix of 1-2 tablespoons of slippery elm with a glass of water and drinking it after a meal as a natural remedy.

How Do I Use Slippery Elm Bark?

The inner bark is dried and powdered. It’s available in the following forms.

  • lozenges
  • tablets
  • fine powder for making teas and extracts
  • coarse powder for making a poultice

For tea, pour 2 cups of boiling water over roughly 2 tablespoons of the powder and steep for a few minutes. To make a poultice (for applying to the skin), mix course powder with boiling water and let cool. Apply the poultice to the affected area.

As with any supplement, be sure to read product labels and to consult with your doctor before trying a supplement.

Safety of Slippery Elm Bark

Slippery elm is approved for over-the-counter use as a demulcent for soothing sore throats and mucus membranes. However, there have been few clinical studies done to date to test the safety and efficacy of slippery elm bark.

While there isn’t enough information to determine whether or not slippery elm bark is completely safe and nontoxic, there haven’t been any reports of toxicity or side effects yet. However, since slippery elm is a mucilage, it could potentially decrease how much medicine your body can absorb and decrease its effectiveness.

To be safe, take slippery elm bark at least one hour after taking another medication by mouth. As with all dietary supplements, consult your doctor before use.

Where to Buy Slippery Elm Bark

Slippery elm bark powders can be found in health stores and online, including on Amazon.com. Here are some options.

Nature’s Way Slippery Elm Bark Capsules— $12.15 — 4.5 stars

Heritage Slippery Elm Bark Powder for Tea — $12.53 — 4 stars

Thayers Slippery Elm Lozenges— $11.35 — 4.5 stars

Ulcerative Colitis

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What is ulcerative colitis?

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). Inflammatory bowel diseases involve chronic inflammation of the intestine, and can take two basic forms. As ulcerative colitis, inflammation damages the lining of the colon. As Crohn’s disease, it is a more serious condition – inflammation harms the whole wall of the colon, not just the superficial lining.

Who is at risk for ulcerative colitis?

Ulcerative colitis seems to run in some families: about 20 percent of patients have a blood relative with some form of IBD inflammatory bowel disease. Men and women are affected equally. The disease can occur at any age but is most frequently diagnosed in those between the ages of 15 and 30. People of Ashkenazi Jewish heritage are at greater than normal risk, while African Americans have a decreased risk. Cigarette smoking, which seems to increase the intensity of flare ups in Crohn’s disease, appears to reduce the risk of ulcerative colitis. Any benefit of smoking, however, is offset by its multitude of negative health effects.

What are the symptoms of ulcerative colitis?

Symptoms of ulcerative colitis usually occur in “flare-ups” (lasting days to weeks) that involve loss of appetite, chronic diarrhea which is often bloody, cramping, pain in the abdomen, and weight loss. Severe flare-ups can involve high fever, intolerable abdominal pain, and peritonitis. If the inflammation is located higher in the colon, frequent stooling (as many as 20 a day) can occur. Stress can worsen symptoms but doesn’t necessarily cause the disease. The disorder can lead to a number of complications, including bleeding, toxic colitis, and even intestinal blockage. This occurs as a result of the swelling and scar tissue that can thicken the intestinal wall, narrowing the passage. In addition, sores or ulcers can tunnel through the affected area to surrounding tissues including the bladder, vagina, or skin, including the areas around the anus and rectum. These tunnels, called fistulas, can become infected and may require surgery.

Ulcerative colitis patients can also develop various nutritional deficiencies due to a less-than-optimal diet, loss of protein via the intestine, or poor absorption (malabsorption) of nutrients. Other possible complications include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and bile systems.

In addition, after several years of extensive inflammation, the large intestine has a greatly increased risk of developing tumorous growths and colon cancer.

What are the causes of ulcerative colitis?

The cause is unknown but the most widely accepted theory holds that the disorder is autoimmune in nature – that is, it occurs when the immune system mistakes bacteria, foods, and other substances in or on the digestive tract as threats to health and responds by attacking the tissues of the colon. This process leads to the chronic inflammation that underlies the disease.

However, rather than being triggered by irritants or allergens, the autoimmune response itself could be the cause, not the result, of the disease. Some evidence suggests that an immune system protein called anti-tumor necrosis factor (TNF), is a primary contributor to the inflammation.

Although we still don’t know for sure exactly what causes ulcerative colitis, a recently discovered gene may point the way to new treatments and perhaps even to a way to prevent the disease from occurring in the first place. The gene is linked to a cellular receptor for interleukin-23 (IL-23), a protein involved in immunity and the inflammatory process. New anti-inflammatory drugs under development may work for ulcerative colitis and for other forms of IBD.

How is ulcerative colitis diagnosed?

At present there is no laboratory test that can specifically identify the disease, but routine blood tests may reveal anemia, high numbers of white blood cells, and indications of inflammation, such as a high Sed Rate and increased levels of C-reactive protein.

Ulcerative colitis is often considered based on a patients symptoms and examination of their stool. Colonoscopy is then typically used to confirm the diagnosis and objectively assess the amount and extent of inflammation. Barium enema and abdominal x-rays can also be used to determine the severity of the disease. Biopsies are used to confirm diagnosis and differentiate UC from an acute bacterial infection. Newer tests include CT scan and wireless capsule endoscopy, where a small camera is swallowed and sends images as it passes through the digestive tract.

What is the conventional treatment?

Ulcerative colitis and other forms of IBD can’t be cured, but it can be managed successfully and remain in remission for long periods of time. Even so, the disease tends to recur unpredictably. Treatment goals are to control inflammation, correct nutritional deficiencies, and relieve symptoms. To achieve this, conventional medicine relies on a variety of drugs, nutritional supplements and, when necessary, surgery.

Iron supplements can help address the anemia that can follow prolonged bleeding with stooling, and patients are often advised to avoid raw fruits and vegetables, which can further irritate an inflamed digestive tract.

Anti-diarrheal drugs, such as antihistamines, diphenoxylate, loperamide and codeine may be prescribed for both mild and intense diarrhea, but patients are monitored closely to prevent complications involving loss of muscle tone in the intestine.

Most UC patients are treated with drugs to control inflammation. The most common of these is Sulfasalazine. If that doesn’t help, other anti-inflammatory drugs in this class (Aminosalicylates) are available.

Corticosteroids such as prednisone may be prescribed initially in large doses to get severe symptoms under control. Because these drugs can cause serious side effects, the dosage is lowered as soon as possible. Immunosuppressive agents to block the immune reaction causing the symptoms may also be prescribed, sometimes in combination with corticosteroids. If these drugs don’t help, a newer compound, Infliximab (Remicade) may be used.

What therapies does Dr. Weil recommend for ulcerative colitis?

Initially, patients should see practitioners of traditional Chinese medicine. Their modern approach includes acupuncture and herbal remedies in addition to dietary adjustment and, possibly, massage and energy work, an integrated solution that can yield very good results. Ayurvedic medicine, radical dietary change, and long-term fasting (under supervision) can also be helpful. A low fat, high fiber diet may also provide a benefit, but during the active stages of the illness, it is best to avoid raw fruits, raw vegetables, seeds and nuts because they will irritate the digestive system.

Here are some other measures that can help:

  • Avoid coffee, including decaffeinated varieties (which may still contain some caffeine), all other sources of caffeine and all stimulant drugs.
  • Avoid milk, milk protein (casein) and all milk products. Remove any products made with carageenan from your diet. (Read labels on soy products carefully).
  • Avoid products sweetened with sorbitol, xylitol, or other sugar alcohols.
  • Take slippery elm in the form of gruel: Combine one teaspoon of the powder with one teaspoon of sugar and two cups of boiling water. Stir well. Flavor with cinnamon and drink one or two cups twice a day.
  • Take turmeric in supplement form for its anti-inflammatory effects. Choose a brand that provides two grams of curcumin daily.
  • If cramping is a problem, take enteric-coated capsules of peppermint oil between meals to relieve the spasmodic component of inflammatory bowel disease.
  • Practice breathing exercises for relaxation.
  • Because stress can worsen symptoms, take a course in biofeedback or experiment with hypnotherapy and guided imagery to use the mind/body connection to heal the gut.
  • Consider psychotherapy or cognitive behavioral therapy to work on emotional conflicts that can exacerbate symptoms.
  • To address inflammation, increase your dietary omega-3 fatty acids by taking supplemental fish oil, start with one gram a day and increase slowly to two to four grams a day. If there is any increase in diarrhea, and cut back the supplement dose if necessary.

Slippery elm

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Slippery elm is not known to have serious side effects. Because it coats the digestive tract, it may slow down the absorption of other drugs or herbs. You should take slippery elm 2 hours before or after other herbs or medications you may be taking.

Some scientists think slippery elm is safe in pregnancy and during breastfeeding, but no scientific studies have been done to confirm this. The outer bark of the elm tree may contain substances that could increase the risk of miscarriage, so sometimes pregnant women are advised to avoid slippery elm. There is some folk herbal history that Slippery elm may cause miscarriage, however, it is unclear whether this refers to the practice of inserting Slippery elm preparation vaginally or taking the herb orally. DO NOT take any herbal supplements when pregnant or breastfeeding unless you’re under a provider’s supervision.

Signs and Symptoms

Ulcerative colitis

Also listed as:

Table of Contents > Conditions > Ulcerative colitis

Signs and Symptoms What Causes It? Risk Factors What to Expect at Your Doctor’s Office Preventive Care Treatment Options Other Considerations Supporting Research

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes ongoing inflammation and ulcers (open sores) in the innermost layers of the large intestine (colon) and rectum. The ulcers bleed and produce pus and mucus, and the inflammation causes the colon to empty frequently, causing diarrhea. Ulcerative colitis is similar to Crohn disease, another IBD. Crohn disease can happen anywhere in the digestive tract, often in patches, and can spread deeper into tissues. Ulcerative colitis, on the other hand, is usually confined to the innermost layers of tissue and is uniform throughout the colon. Ulcerative colitis can be painful and have life-threatening complications.

Although ulcerative colitis condition most commonly affects people between the ages of 10 to 20, with a smaller peak at 50 to 80 years of age, infants and children may also develop the disease. Ulcerative colitis occurs 5 times more frequently in those with a Jewish heritage than it does in the general population. There is no cure for ulcerative colitis, but diet and medications can help control the disease.

The signs and symptoms of ulcerative colitis vary depending on the severity of inflammation, and where it is located. The most common symptoms include abdominal pain and bloody diarrhea, ranging from mild to severe. They may come on either very suddenly or more gradually.

Other common symptoms include:

  • Frequent, even continuous diarrhea
  • Rectal bleeding
  • Bloody stool
  • Urgent need to defecate
  • Abdominal cramps and pain
  • Weight loss
  • Anemia
  • Joint aches
  • Fever
  • Dehydration

People with ulcerative colitis are at increased risk for malnutrition. The condition is also associated with other health problems, including arthritis, eye infections, liver disease, skin rashes, blood clots, or gallstones. No one is sure why such problems occur outside the colon. But some researchers think they may be linked to a faulty immune system response.

What Causes It?

No one knows what causes ulcerative colitis. The most likely theory is that it is caused by several factors ranging from genetics, faulty immune system reactions, and environmental influences. For example, some people are genetically at risk for the condition (it runs in their family). Bacteria or a virus may then trigger their immune system, which causes inflammation. Because ulcerative colitis is more common in the developed world, it is possible that a diet high in saturated fat and processed foods contributes to the disease.

Risk Factors

Risk factors for ulcerative colitis include:

  • Family history of the disease
  • Jewish heritage, especially Ashkenazi (European) Jews
  • A diet high in sugar, cholesterol, and fat (particularly from meat and dairy products)
  • Psoriasis. Studies show that psoriasis is associated both with Crohn disease and ulcerative colitis.

What to Expect at Your Doctor’s Office

Your doctor will do a physical exam and a series of tests to diagnose ulcerative colitis. Blood tests may show anemia (due to a significant loss of blood) and a high white blood cell count (a sign of inflammation somewhere in the body). Stool samples may show whether there is bleeding or infection in the colon or rectum.

The following procedures may also help distinguish between ulcerative colitis, Crohn disease, and other inflammatory conditions.

Colonoscopy and sigmoidoscopy: In a colonoscopy, a doctor uses a long, flexible, lighted tube with a camera to take pictures of the colon. These pictures can reveal inflammation, bleeding, or ulcers along the entire colon wall. Your doctor may also take a biopsy of colon cells to see whether you have ulcerative colitis or Crohn disease. The person is sedated during the procedure. A sigmoidoscopy is similar, but is used to examine the rectum and lower part of your colon. It can be done without sedation, but may miss inflammation higher in the colon or the small intestine.

Barium enema: This test examines the large intestine with an x-ray. You receive barium (a dye) as an enema, which coats the lining of your large intestine and rectum. It is generally not as reliable as colonoscopy and is not used when symptoms are severe because of the risk of complications.

Small intestine x-ray: In this test, you drink a barium “shake” and the doctor takes an x-ray of your small intestine. This test allows doctors to see the small intestine (which cannot be seen with colonoscopy). It can help distinguish between ulcerative colitis and Crohn disease.

Preventive Care

There is no known way to prevent ulcerative colitis, but you can usually manage the condition with a combination of medication, diet, and lifestyle changes. A low-fat diet rich in fruits, fluids, magnesium, and vitamin C; exercise; and stress-reduction techniques (including hypnosis) may also help prevent recurrences.

Treatment Options

The primary goals in treating ulcerative colitis are to control acute flares of the disease and to maintain remission. The type of treatment often depends on the severity of the disease is. For example, people with mild-to-moderate ulcerative colitis are usually treated with medications that reduce inflammation and suppress the immune system. More severe cases may require surgery.

Many people with inflammatory bowel diseases (IBD) use complementary and alternative remedies along with prescription medication. Preliminary studies indicate that lifestyle changes may be useful additions to treatment, including:

  • Stress reduction
  • Dietary adjustments (such as eating a variety of fruits and vegetables and avoiding saturated fat and sugar)
  • Specific herbs and supplements
  • Mind-body techniques (such as hypnosis)

Lifestyle

Many people with ulcerative colitis report that stress makes their symptoms worse. Relaxation and stress-reduction techniques can be helpful, particularly when used with other forms of treatment. Some techniques to consider:

  • Biofeedback: teaches you to control stress-related physical responses (muscle tension, rapid heartbeat). First, you use a feedback machine that lets you see how your body responds. As you learn to control these responses, you no longer need the machine and can practice the technique anywhere.
  • Yoga, tai chi, or meditation: These techniques all help you learn to reduce your response to stress.
  • Progressive muscle relaxation: This popular technique involves tightening and then relaxing specific muscle groups one by one. It is simple to learn and can be done anywhere and any time.
  • Deep breathing: Breathing in from your diaphragm (allowing your belly to expand, then contract as you exhale) induces a relaxation response. It may also help relax your abdominal muscles, which can support normal intestinal health.
  • Hypnosis: A trained and licensed hypnotist can help you relax muscle tension, reducing pain and abdominal bloating.

Exercise may help people with ulcerative colitis, both in terms of maintaining health and reducing stress. Although exercise is considered safe for those with ulcerative colitis, anyone with a chronic illness should talk to their doctor before starting a new exercise regimen. It is especially important for people with ulcerative colitis to drink water before and during exercise to prevent dehydration.

Drug Therapies

Although medications cannot cure ulcerative colitis, they can reduce symptoms and help you control your condition. Sometimes, they can bring on remission of the disease for a period of time. Doctors often prescribe the following medications commonly to treat ulcerative colitis:

Aminosalicylates: Anti-inflammatory drugs used to treat mild-to-moderate symptoms. Up to 80% of people respond within 4 weeks to orally-administered aminosalicylates. They include:

  • Sulfasalazine (Azulfidine): An older drug that is usually taken with folic acid. Side effects include abdominal discomfort, nausea, and lowered sperm count. Sulfasalazine can be effective, but newer drugs are available.
  • Mesalamine (Asacol, Rowasa): This drug reduces inflammation during acute flare ups and helps prevent recurrences. It generally has fewer side effects than sulfasalazine.
  • Balsalazide disodium (Colazal): A different formulation of mesalamine that is designed to deliver the dose directly into the colon. It has fewer side effects.

Corticosteroids (such as budesonide, prednisone, and prednisolone): These drugs can reduce inflammation throughout your body but have many side effects, including acne, and an increased risk of infection, osteoporosis, high blood pressure, excessive hair growth, diabetes, and disorders of the eye including glaucoma and cataracts. Budesonide (Entocort) may have fewer side effects. Corticosteroids also suppress your body’s production of the hormone cortisol and cannot be stopped abruptly. They are not for long-term use, but may be used to control flares.

Immune system suppressors: These medications reduce inflammation by suppressing the immune system. They are sometimes used in combination with steroids to reduce the dose of the steroid medication. These drugs can take several months to work, and all may have significant side effects. Drugs include azathioprine (Imuran), mercaptopurine (Purinethol), and cyclosporine.

Biologics: Infliximab (Remicade) is used to treat moderate-to-severe symptoms. It keeps a protein produced by immune system from causing inflammation in the body. Researchers are testing other drugs in this class, such as adalimumab (Humira).

Nicotine patches: Researchers are not sure why, but nicotine patches seem to help some people find short-term relief during flares, particularly if the person used to be a smoker. The risks of smoking greatly outweigh any potential benefits, so no one who has ulcerative colitis should start smoking.

Antidiarrheal medications (such as diphenoxylate, loperamide, or psyllium): Medications that treat diarrhea must be used only under medical supervision and with extreme caution. They can slow down the normal movements of the gastrointestinal tract and, in severe cases, may cause a complication known as toxic megacolon.

Surgical Procedures

20 to 30% of people with ulcerative colitis must eventually have their colon or colon and rectum removed (colectomy or proctocolectomy) because of massive bleeding, severe illness, rupture of the colon, or the risk of cancer. The surgery often eliminates the disease. To allow for the elimination of waste, the surgeon creates an internal pouch from the small intestine, which empties into the anus. It may result in having 5 to 7 watery bowel movements a day, and up to one-third of people who undergo this procedure develop pouchitis, an inflammation of the pouch that is treated with a short course of antibiotics.

Complementary and Alternative Therapies

Diet

Although diet cannot cure ulcerative colitis, some studies suggest that people who eat foods high in saturated fat and sugar, and who eat less amounts of fruits and vegetables, may be at greater risk of developing the disease. Certain foods may also reduce symptoms.

  • Limit intake of dairy products, which may help reduce diarrhea.
  • Eat fruits and vegetables and pay attention to fiber. Although fiber is crucial to a healthy diet, some people with inflammatory bowel disease find that fiber makes symptoms worse. If fiber bothers you, steam or bake your vegetables instead of eating them raw, and avoid high-fiber foods such as broccoli, cauliflower, and raw apples. Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
  • A bland, low-fiber diet may be best during acute flares.
  • Eat 5 to 6 small meals a day.
  • Certain foods may aggravate symptoms of ulcerative colitis (including chocolate, beans, spicy foods, fats, and artificial sweeteners).
  • Avoid refined foods, such as white breads and pastas.
  • Avoid caffeine, alcohol, and tobacco.

People with significant malnourishment, severe symptoms, or those awaiting surgery may require parenteral (intravenous) nutrition.

Nutrition and Supplements

Many people with ulcerative colitis have vitamin and mineral deficiencies (because of loss of appetite, reduced absorption by the colon, and chronic diarrhea). Some medications may also lower important nutrients in the body. For example, sulfasalazine reduces the body’s ability to absorb folate (folic acid), and corticosteroids can reduce calcium levels. Making sure you get enough nutrients is a crucial part of treating ulcerative colitis. Your doctor may recommend taking a multivitamin daily.

  • Folic acid: Many people who have ulcerative colitis have low levels of folic acid in their blood. In addition, some medications, such as sulfasalzine, may cause levels of folic acid in the body to drop. People with ulcerative colitis also have a higher risk of developing colon cancer, but some studies have found that taking folic acid can reduce that risk. Folic acid can mask a vitamin B12 deficiency. If you take folic acid for a long period, your doctor should monitor your levels of B12.
  • Omega-3 fatty acids found in fish oil: At least one study has found that, compared to placebo, fish oil supplements containing omega-3 fatty acids may reduce symptoms and prevent recurrence of ulcerative colitis. Other studies show different results, however. Some experts suggest that omega-3 fatty acids may be valuable when used in combination with sulfasalazine or other medications. DO NOT take high doses of fish oil if you take blood-thinning medication.
  • Probiotics: Several studies indicate that taking probiotics, or “good” bacteria, can help reduce symptoms. One study found that giving Lactobaccillus, Bifidobacteria, and a nondisease causing type of Streptococcus to people with chronic pouchitis helped prevent the condition. Sacchromyces boulardi may also help improve the overall health of the intestine. Consult your doctor to be sure probiotics are appropriate for your case.
  • Vitamin D: is necessary to maintain strong bones. People with ulcerative colitis, especially those who take corticosteroids, often have low levels of vitamin D and are at risk for osteoporosis.
  • Calcium: is also needed for strong bones. Ask your doctor if you need a calcium supplement. Calcium at certain doses may interfere with some medications.
  • N-acetyl glucosamine: Preliminary research suggests that N-acetyl glucosamine supplements or enemas may improve symptoms of inflammatory bowel disease. More studies are needed to know whether glucosamine would have any effect on ulcerative colitis. N-acetylglucosamine can potentially interact with certain medications, including, but not limited to, medications used for blood thinning, such as warfarin (Coumadin) and aspirin.

Herbs

Because of the presence of inflammation and the nature of the disease, ulcerative colitis should not be treated with herbs alone. However, herbs may be a useful complement to traditional medical treatment. Herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

  • Psyllium seeds (Plantaginis ovatae): In one study, people with ulcerative colitis who took 20 g of ground psyllium seeds 2 times per day with water stayed in remission when they took the prescription drug mesalamine. More research is needed to confirm this finding. Psyllium is a type of insoluble fiber, and may be irritating to some people, especially during flares. Talk to your doctor to determine if psyllium can help you. Some people may have better results using soluble fiber, such as flax seed or oat bran, in combination with or instead of psyllium. Constipation could occur, however. Talk to your doctor about whether this combination is right for you. Psyllium can interfere with certain medications.
  • Boswellia (Boswellia serrata): Boswellia has anti-inflammatory properties. One small study suggests that people who took boswellia had similar improvement as people who took the prescription drug sulfasalazine. More research is needed. Boswellia may interact with other drugs and supplements, so talk to your doctor before taking it.
  • Curcumin or turmeric (Curcuma longa): shows anti-inflammatory properties in test tubes. One small study found that people with inflammatory bowel disease who took curcumin reduce their symptoms and their need for medications. However, more research is needed. People with gallbladder disease or gastro esophageal reflux disease (GERD), hormone-related cancers, or people who are taking blood-thinning medications, should not take curcumin without first consulting with their doctors.

Other evidence for using herbs to treat ulcerative colitis is mostly lacking. Among the herbs that have been used traditionally to treat inflammation within the digestive tract are:

  • Slippery elm (Ulmus fulva): is a demulcent (protects irritated tissues and promotes their healing). Slippery elm may interact with certain medications. Women who may be pregnant should never take slippery elm.
  • Marshmallow (Althaea officinalis): is a demulcent and emollient. Avoid marshmallow if you have diabetes or take certain medications, including, but not limited to, Lithium. Speak to your doctor.
  • Chamomile (Matricaria recutita): is often used to soothe digestive tract. It is usually taken as a tea. Chamomile can cause allergic reactions in some people, particularly those who are sensitive to ragweed. It can also have estrogenic qualities, so it should be used with caution, especially if you have a history of hormone-related diseases. Speak to your doctor about potential interactions before you begin using chamomile. People with allergies to ragweed should use caution when taking camomile due to potential sensitivities.

Acupuncture

Acupuncture is often used in Traditional Chinese Medicine to treat inflammatory bowel disease. Several studies indicate that it can provide relief from symptoms in ulcerative colitis. It may be especially useful when combined with traditional medical treatment because it can help relieve stress, as well as pain. Acupuncturists treat people with inflammatory bowel disease based on an individualized assessment of the excesses and deficiencies of qi located in various meridians.

Other Considerations

Pregnancy

Symptoms of ulcerative colitis often become worse during pregnancy. About 50% of women in remission have a recurrence of the disease, usually during the first trimester or during the postpartum period. For this reason, women with ulcerative colitis who are or wish to become pregnant should keep taking medications under the guidance of their doctor. Corticosteroids or sulfasalazine are considered safe during pregnancy. Unlike Crohn disease, pregnant women with ulcerative colitis are not at increased risk for stillbirths or premature deliveries.

Pregnant women should avoid high doses of vitamins. An obstetrician can provide instructions about multivitamin use during pregnancy.

Prognosis and Complications

If left untreated, people with ulcerative colitis can develop a wide range of chronic, sometimes dangerous complications. Fortunately, however, most of these complications can be treated successfully.

  • Hemorrhage (excessive bleeding)
  • Perforation of the colon
  • Narrowing of the colon, which may cause obstruction
  • Abscesses (pus-filled pockets of infection) in the colon
  • Toxic megacolon (grossly swollen colon that may rupture)
  • Colon cancer
  • Nutritional problems (including weight loss and reduced muscle mass)
  • Joint pain and arthritis
  • Eye infections/inflammation
  • Mouth ulcers
  • Liver damage
  • Blood clots
  • Depression and anxiety
  • Osteoporosis

Although there is no cure for ulcerative colitis other than surgical removal of the colon, many people with the disease lead active lives by controlling their symptoms with medication. In fact, drug treatment is effective for about 70 to 80% of all people with the condition. About 45% of all people with ulcerative colitis are free of symptoms at any given time, but most have at least one relapse in any 10-year period. People who have ulcerative colitis are at increased risk of developing colon cancer, however this increased risk has decreased steadily over the last 6 decades.

Supporting Research

Abela MB. Hypnotherapy for Crohn’s disease: a promising complementary/alternative therapy. Int Med. 1999;2(2/3):127-131.

Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16. Review.

Anton PA. Stress and mind-body impact on the course of inflammatory bowel diseases. Semin Gast Dis. 1999;10(1):14-19.

Ball E. Exercise Guidelines for patients with inflammatory bowel disease. Gastroenterology Nursing. 1998;21(3):108-111.

Biasco G, Zannoni U, Paganelli GM, et al. Folic acid supplementation and cell kinetics of rectal mucosa in patients with ulcerative colitis. Cancer Epidemiol Biomarkers Prevent. 1997;6:469-471.

Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.

Bope & Kellerman: Conn’s Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.

Castano-Milla C, Chaparro M, Gisbert JP. Systematic review with meta-analysis: the declining risk of colorectal cancer in ulcerative colitis. Aliment Pharmacol Ther. 2014;39(7):645-59.

Cravo ML, Albuquerque CM, Salazar de Sousa L, et al. Microsatellite instability in non-neoplastic mucosa of patients with ulcerative colitis: effects of folate supplementation. Am J Gastroenterol. 1998;93:2060-2064.

Devlin S, Panaccione R. Evolving Inflammatory Bowel Disease Treatment Paradigms: Top-Down Versus Step-Up. Medical Clinics of North America. 2010;94(1).

Ewaschuk JB, Tejpar QZ, Soo I, Madsen K, Fedorak RN. The role of antibiotic and probiotic therapies in current and future management of inflammatory bowel disease. Curr Gastroenterol Rep. 2006 Dec;8(6):486-498. Review.

Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana L, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol. 1999;94:427-433.

Ferri: Ferri’s Clinical Advisor 2016. 1st ed. Ulcerative colitis. St. Louis, MO: Elsevier Mosby; 2016.

Gionchetti P, Rizzello F, Venturi A, Campieri M. Probiotics in infective diarrhea and inflammatory bowel diseases. J Gastroenterol Hepatol. 2000;15:489-493.

Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2:37-43.

Haas L, McClain C, Varilek G. Complementary and alternative medicine and gastrointestinal diseases. Curr Opin Gastroenterol. 2000;16:188-196.

Harris MS, Lichtenstein GR. Review article: delivery and efficacy of topical 5-aminosalicylic acid (mesalazine) therapy in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2011;33(9):996-1009.

Heilpern D, Szilagyi A. Manipulation of intestinal microbial flora for therapeutic benefit in inflammatory bowel diseases: review of clinical trials of probiotics, pre-biotics and synbiotics. Rev Recent Clin Trials. 2008 Sep;3(3):167-184. Review.

Joachim G. The relationship between habits of food consumption and reported reactions to food in people with inflammatory bowel disease — testing the limits. Nutr Health. 1999;13(2):69-83.

Joos S, Wildau N, Kohnen R, et al. Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study. Scand J Gastroenterol. 2006;41:1056-1063.

Kleigman: Nelson Textbook of Pediatrics. 18th ed. St Louis, MO: Elsevier Saunders; 2007.

Kruis W, Jonaitis L, Pokrotnieks J, et al. Randomised clinical trial: a comparative dose-finding study of three arms of dual release mesalazine for maintaining remission in ulcerative colitis. Aliment Pharmacol Ther. 2011;33(3):313-322.

Latella G, Sferra R, Vetuschi A, Zanninelli G, D’Angelo A, Catitti V, Caprilli R, Gaudio E. Prevention of colonic fibrosis by Boswellia and Scutellaria extracts in rats with colitis induced by 2,4,5-trinitrobenzene sulphonic acid. Eur J Clin Invest. 2008 Jun;38(6):410-420.

Levenstein S, Prantera C, Varvo V, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000;95(5):1213-1220.

Lindberg A, Fossum B, Karlen P, Oxelmark L. Experiences of complementary and alternative medicine in patients with inflammatory bowel disease – a qualitative study. BMC Complement Altern Med. 2014;14:407.

Ling SC, Griffiths AM. Nutrition in inflammatory bowel disease. Curr Opin Clin Metab Care. 2000;3(5):339-344.

Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr. 2001;73(suppl):430S-436S.

Meister D, Ghosh S. Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues in organ culture: differential effects on ulcerative colitis and Crohn’s disease. World J Gastroenterol. 2005 Dec 21;11(47):7466-7472.

Ng SC, Kamm MA. Therapeutic strategies for the management of ulcerative colitis. Inflamm Bowel Dis. 2008 Nov 4. .

Oliva S, Di nardo G, Ferrari F, et al. Randomised clinical trial: the effectiveness of lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis. Ailment Pharmacol Ther. 2012;35(3):327-334.

Onken JE, Greer PK, Calingaert B, Hale LP. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro. Clin Immunol. 2008 Mar;126(3):345-352.

Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon ATR. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomized trial. Lancet. 1999;354:635-639.

Salvatore S, Heuschkel R, Tomlin S, et al. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in pediatric chronic inflammatory bowel disease. Aliment Pharmacol Ther. 2000;14:1567-1579.

Sturniolo GC, Mestriner C, Lecis PE, et al. Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis. Scand J Gastroenterol. 1998;33(6):644-649.

Review Date: 8/6/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Healthy Teas

Is what you are drinking affecting your health when living with Crohn’s or Ulcerative Colitis?

For a lot of people, if they changed nothing about their diet other than some of what they drink, they would notice MASSIVE changes to their health.

I’m not just talking about alcohol here…

Things such as a can of coke, or a glass of orange juice, can contain as much sugar as one person should consume in a whole day!

Now it’s all very well saying that you should just stop but what can you drink in its place?

Well something that I love to drink is a variety of teas. At home my cupboards are FILLED with all different kinds of tea bag. Here’s a few that I like to drink right now….

Tulsi

Tulsi tea is GREAT for people who are quite stressed.

Also known as ‘Holy Basil’, Tulsi is what’s known as an ‘adaptogen’ which means it helps to control the stress response in your body.

I like to drink a cup most mornings and find that it really helps to relax me through the day.

Bearing in mind that most of us are stressed, and that stress can be a huge trigger for Ulcerative Colitis and Crohn’s symptoms, then drinking the occasional cup of Tulsi tea is normally really beneficial.

Green Tea

The benefits of green tea probably won’t surprise you (high in antioxidants especially) but what you may have not considered is just how many flavours are available. Nobody can just dismiss green tea because “they don’t like it” because there is such a variety out there

I personally buy the Twinings ones and love the Lemon, Cranberry and Mango and Lychee flavours. The rest of their range, much of which I haven’t tried, includes Salted Caramel (which, I’m afraid, wasn’t as good as it sounds), Orange and Lotus Flower, Peach and Cherry Blossom, Apple and Pear and Pineapple and Grapefruit.

Chamomile

Finally, before bed, I like to have a nice cup of relaxing chamomile tea. You can get the normal flavour which is great, but I also love the honey and lemon. If you struggle to get a decent night’s sleep, try a cup of this in evening, it can work wonders.

Give some of those a try, or just check out the tea aisle next time you are at a supermarket and buy something you haven’t had before. What’s the worst that can happen?

Speak soon,

Greg

Feeling Better When Living with Crohn’s / Colitis (free report)

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