Inflammatory bowel disease: triggers, diet and treatment

Written by: Dr Aathavan Loganayagam
Edited by: Laura Burgess

What are the symptoms of IBD?

The main symptom of inflammatory bowel disease (IBD) is diarrhoea. This is often associated with blood, pus and mucus. Patients can get cramping, abdominal pain and can generally feel tired and unwell. Tiredness could be due to the disease being active, or possibly as side effects of the medication, or from simply waking up in the middle of the night on a regular basis to go to the toilet.


A patient may lose their appetite and have weight loss. This could be because they are not eating enough or not absorbing enough nutrients from their food because of the inflammation in the bowel. They may have anaemia, especially if they are going to the toilet and experience bleeding. Occasionally, some patients may have painful, tiny ulcers in their mouth called aphthous ulcers.

Inflammatory bowel disease can also affect other parts of the body. It can cause arthritis, especially in the joints in the arms, legs, and back. It causes rashes called erythema nodosum and pyoderma gangrenosum. IBD may also affect the eyes where a common condition called episcleritis can occur, which is when the outer lining of the eye becomes inflamed, red, and painful.

What are the risks of inflammatory bowel disease?

There are certain recognised risk factors for inflammatory bowel disease. Living in a western society is a risk factor. This could be due to lifestyle choices such as diet, or possibly even environmental pollution. Recently, there has been an increase in incidences of inflammatory bowel disease, especially in Asia which is possibly related to lifestyle changes such as diet.


Being young is a risk factor. However, there is also an increase in incidences of inflammatory bowel disease towards later stages of life. People don’t know exactly why this is. Having a family history of inflammatory bowel disease significantly increases the risk of developing the condition. Smoking affects ulcerative colitis and Crohn’s disease differently. It is a significant risk factor of Crohn’s disease and makes the symptoms much worse.


Certain gut infections are thought to trigger inflammatory bowel disease, such as campylobacter, salmonella, and E. coli. It is thought that having the appendix taken out is protective against developing ulcerative colitis. This is due to a change in the immune system.

How can I treat inflammatory bowel disease?

There is a range of drugs used to treat inflammatory bowel disease that can be prescribed by a gastroenterologist. Initially, the treatment is given to heal the inflammation and bring about remission so that the patient feels better. Following this, the doctor will keep the treatment going to avoid any more flare-ups and keep the disease under control. This is called maintenance treatment.


Obviously, lifestyle choices will help, such as drinking a lot of fluids, especially if you have lots of faecal loss, avoiding trigger foods, and stressful situations. If you have nutritional deficiencies, then you may need some supplementations such as vitamin D if you’re anaemic. This is the mainstay of medical treatment. Occasionally, when patients have a really bad disease, such as the developed stricture in Crohn’s disease, they may need surgery.

How can IBD be prevented?

The genetic causes of inflammatory bowel disease can be prevented. Making lifestyle choices can release the risk of developing inflammatory bowel disease and also release the chance of relapse. This can be done by eating healthily, exercising regularly, and if a patient has Crohn’s disease, by stopping smoking.

What do I eat if I have IBD?

There is no strict individualised plan that patients must follow. There are basic principles that will help improve symptoms, especially during a flare-up. These include having smaller meals, eating more frequently and in a nice, relaxed atmosphere, and avoiding insoluble fibre such as bran, vegetable and fruit. It is best to avoid greasy foods and trigger foods, which can obviously vary from individual to individual. It is also important to increase the amount of food and water intake. Try to avoid drinks that contain caffeine because caffeine is a stimulant and it can rev up the bowel and make the diarrhoea worse. 


By Dr Aathavan Loganayagam

Dr Aathavan Loganayagam trained in medicine at Guy’s, King's and St. Thomas’ medical schools. He then underwent rigorous structured specialty training in gastroenterology and general internal medicine in the well respected South London training programme.

He then spent two years during postgraduate training as a research and endoscopy fellow at Guy’s and St Thomas’ Hospitals, London. His research was in the fields of pharmacogenetics, inflammatory bowel disease and gastrointestinal malignancy. He has received awards and grants for outstanding research work, including the prestigious NHS Innovation London Award.

Dr Loganayagam has numerous publications in peer reviewed journals on all aspects of gastroenterology. He is actively involved in clinical research. He has particular local expertise in the practice of personalised medicine and the utilisation of novel therapeutic agents in the treatment of complex inflammatory bowel disease. He is currently the lead clinician for endoscopy at Queen Elizabeth Hospital, Woolwich.

Diagnostic and advanced therapeutic endoscopy remains a major part of his clinical expertise, including assessment and treatment of inflammatory bowel disease, strictures, polyps and cancers.

Dr Loganayagam is an approachable doctor who takes pride in his communication skills with patients. He is keen to ensure that patients are fully informed and involved in all aspects of their care.

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