Chronic inflammatory bowel disease (CIBD) is marked by chronically recurring or continuous inflammations in the gastrointestinal tract. The two most important forms are Morbus Crohn and Colitis ulcerosa. In these, severe intestinal complaints occur like bloody diarrhea, spastic abdominal pain or fever. In addition, patients frequently suffer from at least one symptom outside of the intestines, a so called extra intestinal manifestation. These are i.e. joint pain, inflammation of the skin, eyes, joints or other internal organs. Moreover, patients with CIBD increasingly suffer from food intolerance and exhaustion, the so called fatigue. The continuing or constantly recurring inflammations also increase the risk to develop intestinal cancer early on.
Each year 6,6 of 100.000 german citizens are developing Morbus Crohn and 3-3,9 are developing Colitis ulcerosa, respectively. The number of afflicted persons has been rising in the last 10 years, reaching more than 300.000 to date, even if the first symptoms do not occur until the 20th to 40th year of one’s life in Morbus Crohn, and not until the 16th to 25th year of life in Colitis ulcerosa. Trigger factors for the disease are unkown so far. Thus, for most of the patients the disease starts during school time or professional training and persists throughout their entire professional life. A particular group of Morbus Crohn patients are children and adolescents. One in five patients is a child or an adolescent. Occasionally the disease starts even in infancy. Except of breastfeeding there is no specific nutritional recommendation for a primary prophylaxis of CIBD.
Since the cause of CIBD is mostly unknown, up to now only symptomatic treatment is performed. In the therapeutical process drugs as well as diet play pivotal roles.
Muscular weakness and muscle loss
Muscle wasting and weight loss occur especially in the inflammatory phases of CIBD. But also during dormant phases of the disease (remission) muscle strength and endurance are often decreased in the patients. The causes and mechanisms of the reduction of muscular mass and function are not yet sufficiently clarified. This muscular mass and function reduction frequently impairs the mobility and quality of life of patients strongly.
Physical training to (re-)build muscle mass positively impacts different, especially extra intestinal, aspects of Morbus Crohn. Furthermore regular physical activity seems to improve fatigue in these patients. In this respect alternative training options should be developed taking any disease- or symptom-related limitations of the afflicted persons into account.
Due to the inflammation of the intestinal mucosa a deteriorated absorption of nutrients, vitamins, important minerals and trace elements takes place, especially if the small intestine is involved in Morbus Crohn. In addition concomitant symptoms like permanent diarrhea and vomiting contribute to a decrease in energy and nutrient uptake. Especially in the acute phases this leads to prominent weight loss and deficiency symptoms in the afflicted persons. Since this influences prognosis considerably and since malnutrition increases the risk of complications after surgery, the maintenance of nutritional status by a full-value diet covering all requirements is of utmost importance.
In Colitis ulcerosa only the colon mucosa is afflicted by inflammatory changes, thus deficiency symptoms appear more rarely. Nevertheless a sufficient fluid and energy nourishment is very important, due to a restricted capacity of the colon to absorb water and due to additional diarrhea in acute inflammatory phases.
Therefore it is of high relevance for CIBD patients to be supported by a diet that is adjusted to their physical situation. At diagnosis and in the course of disease at least once a year a dietary counselling should be performed by a qualified professional.
Complementary to nutritional therapy the muscle building actions should be supported by sports- and exercise therapy.
We support research groups aiming at a sustainable improvement of the situation of patients with chronic inflammatory bowel disease by individualized nutritional and exercise therapy.