Friday, 15 June 2012

Diet, Arthritis and IBS (and other digestive disorders)

A while ago I wrote about arthritis and tummy troubles in a post about the FODMAP plan. People with arthritis often struggle with digestive concerns and these can make it even harder to eat a healthy diet. In fact, there is some evidence to suggest that having arthritis makes you much more likely to have gastrointestinal problems - whether you have osteoarthritis or inflammatory arthritis. To try to help untangle some facts and fictions, I've put together a list of the most common conditions that affect people with arthritis alongside advice on treatment and diet. I'm definitely not a doctor so do make sure you tell yours if you are having any stomach symptoms. You can also find some general info about all of these conditions here.

IBS - irritable bowel syndrome encompasses all sorts of digestive concerns, from bloating and gas to diarrhoea and constipation. It's exact cause isn't understood and it affects different people in different ways. Some studies have suggested that genetic regulation of inflammatory factors may have a role, and the same pattern of genes has been found in some patients with inflammatory arthritis so there may be a link between the two conditions. However, there isn't any evidence that I could find to suggest that IBS is more common in people with these types of  arthritis. IBS is strongly associated with a type of arthritis known as fibromylagia.  Use of non-steroidal anti-inflammatory drugs (like aspirin or naproxen) has been found to be a risk factor for developing IBS by some researchers, but it is unclear whether this is due to the drugs causing IBS or whether people who take anti-inflammatories may have other conditions or symptoms that are perhaps related to IBS.

IBS is difficult to treat as it has many different causes. A dietician will be able to help you identify your possible triggers and adjust your diet to help. The FODMAP diet has shown great success in treating patients and you can read my post about it here (alongside a cracking chocolate chip cookie recipe). You may also want to see a doctor as there are many medications available to help relieve symptoms.

Coeliac disease - is an auto-immune disease where the body attacks the digestive system in response to exposure to gluten. Gluten is found in wheat, barley, rye and sufferers need to cut it out of their diets entirely. Coeliac disease is not the same as an intolerance or allergy. People with autoimmune, inflammatory arthritis are more likely than the general population to have coeliac disease, and likewise people with coeliac disease are more likely to develop arthritis.

The only treatment is to completely cut out gluten under medical supervision.Some patients are able to tolerate oats, but this varies from person to person. If you suspect you might be coeliac, you must see a doctor to help make the diagnosis before cutting out gluten for the tests to work properly. For more info see Coeliac UK's website and my gluten-free recipes.

Dyspepsia/heartburn/acid-reflux - the enemy of many of an arthritis sufferer, often as a side-effect of steroids, osteoarthritis treatments and anti-inflammatories. High dose NSAIDs have been found to increase the risk of dyspepsia by over 30%. It's important to see your doctor if you have any symptoms of dyspepsia, especially unintended weight-loss, vomiting, difficulty swallowing or blood in your stools.

Taking your arthritis medications with food will help avoid problems. Ginger can help relieve some of the discomfort or try eating probiotic yoghurt. Spicy, fatty and heavy meals can all make it worse.

IBD - inflammatory bowel disease is the term used to describe Crohn's and colitis. Both conditions are auto-immune in origin and cause inflammation in the gastro-intestinal tract. Symptoms include stomach pain, blood and mucus in stools, nausea and weight loss. Spondyloarthropathies (ankylosing spondylitis and psoriatic arthritis) are closely related to IBD, and some patients with IBD will develop arthritis. 

Patients with IBD need to be under the care of a gastroenterologist. A dietician can help with any diet plans. Reducing the amount of fibre you eat during a flare by eating well cooked, easily digestible foods can help. There is mixed evidence about the effectiveness of omega 3 fatty acids. When the condition is in remission it is important to eat a healthy, balanced diet and the arthritis-friendly recipes on this site can help you achieve this.


  1. Thanks for the great post. Have you heard of Small Intestinal Bacterial Overgrowth (SIBO)? Research over the past 10 years showed that upwards of 70% of IBS cases were actually linked to too many bacteria in the small intestine. There's a test for SIBO - a 3 hour hydrogen breath test where you drink a sugar solution and air samples are taken every 20 minutes to measure hydrogen levels as a by product of bacteria in the gut. Antibiotic treatments have been very successful in treating it. Many gastroenterologists are treating IBS this way now.

    Check out these resources.

    1. Thanks and nice to read your blog too, I enjoyed the genetics post.

      Very useful point about SIBO. Prevalence does vary but it has been linked to IBS particularly in those with long term conditions. Interestingly, I found one small study suggesting there my be higher incidence in those with RA but it was a pretty old study and doesn't seem to have been validated by any further research. In case anyone wants to read about it, here's the link

  2. Hey this is a great blog! I really enjoy it! Jus wanted to let you know that I served the Spicy Chickpea burgers for meat free monday today. I bloged about it here
    Do come over for a visit if you find the time.
    Looking forward to keeping up with your blog, have a great week.

  3. Thanks Krisha. Love your post about it and I think the photo is pretty darn good - blurred or not! I adore your craft posts, that sweater with the deer is gorgeous.



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