People with inflammatory bowel disease (IBD) often go through intermittent remissions and flare-ups. But what causes a flare-up? There are several opinions on the topic, but not much in the way of concrete evidence. For most people with IBD, it is trial and error with foods and activities to determine what causes a flare.
The question was asked in my forum -- "What causes your flares?" With nearly 100 posts, the responses to the question were extremely varied. IBD is so individualized that what bothered one person was just fine for another.
Foods That Were Most Discussed
One of the offenders mentioned the most was popcorn. Popcorn contains insoluble fiber. Insoluble fiber does not dissolve in the intestine, and it bulks up stools and makes them looser. Some people may find that insoluble fiber is tolerable in small amounts or along with other foods.
Another food that was mentioned was French fries, or fried food in general. From numerous studies and reports in the media, most of us know that fried foods are generally not healthy. They contain large amounts of fat, which can contribute to diarrhea when it passes through the intestine undigested (it also causes stool to "float").
Nuts were another trigger that was mentioned frequently. Not only are nuts high in insoluble fiber and fat, but they are also a common allergen. It can be difficult to avoid nuts -- they are a common additive to breads, candies, cakes, and many other foods. Since they can cause severe allergic reactions, many foods containing nuts are labeled "may contain nuts or peanuts." In some cases, restaurants will also note that a food (such as a salad) may contain some nuts or peanuts.
Smoking Has a Complex Relationship to IBD
Smoking cigarettes appears to worsen Crohn's disease but supress flares in ulcerative colitis. This doesn't meant that people with UC should take up smoking, but people with Crohn's might want to consider quitting.
Stress Complicates Everything
Another topic that was mentioned was stress. An important distinction to make regarding stress is that it does not cause IBD, but it can contribute to a flare-up. Stress can aggravate most any medical condition -- it makes sense that a person isn't going to start feeling better when they're stressed out. Stress and IBD can forum a vicious circle with a patient being stressed out primarily because of the IBD.
The change in seasons was also mentioned as a possible cause for a flare-up. This topic has been the focus of several studies. One theory is that an allergic reaction to a seasonal allergen contributes to an IBD flare-up. This is only a theory, but many people with IBD still get flares every fall and spring.
These are not all the possible triggers for IBD by any means. IBD is highly individualized, so one person's triggers may be very different from another. Keeping a food and activity diary may help in locating particular triggers.
POLL: What Causes Your Flares?