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Fertility, inflammatory bowel disease and the gut microbiota; how are these connected?

“According to Crohn's and Colitis Australia, 1 in 250 people, between the ages of 5-40, are affected by inflammatory bowel disease. The two main types are Crohn’s disease (CD) and Ulcerative colitis (UC). It is not clear how IBD is caused except that genetic and environmental factors could be responsible.

In Crohn’s disease, inflammation can happen anywhere in the gastrointestinal tract (gut). This includes the food pipe, stomach, and small and large intestines. In Ulcerative colitis, inflammation and ulceration happens in the large bowel that is the colon and/or rectum. IBD can affect both men and women, causing debilitating pain that impacts their quality of life in a negative way, and this includes those who are trying to conceive. So does IBD affect fertility? The answer is ‘yes’ and maybe ‘no’. Let me explain.

Nutrition is very important for a person living with IBD just as it is for anyone else. When the gut is inflamed, IBD e.g. Crohn’s, is said to be ‘active’ or what is commonly known, there is a ‘flare up’. The gut is swollen and this impacts it's ability to function as it should. This inturn impacts the nourishment that the body usually receives from a fully functioning gut.

Dietitians, trained in tube feeding or the exclusion diet, would provide recommendations for nutritional (drink) supplements through tube feeds known as ‘Exclusive Enteral Nutrition’ (EEN) and/or the Crohn’s Disease Exclusion Diet (CDED). This is very important as it allows the affected parts of the gut to heal while the body gets nourished to prevent nutrient deficiencies and malnutrition. There are also other diet types that can be recommended to manage IBD lifelong but that can be a topic for another blog.

Once the ‘flare up’ subsides or ‘calms down’, this phase is known as being in ‘remission’ which means the gut is now able to slowly resume it's role of digesting and absorbing the foods we eat and develop and defend our immune system. The gut is the place where nutrients are absorbed (small intestine) or are made by gut bacteria and then absorbed into the blood and body (large intestine).

What we eat impacts fertility outcomes. Therefore in the case where an individual lives with IBD and is trying to conceive, they have to ensure they keep their IBD in remission because an inflamed small intestine is incapable of absorbing nutrients from food and an inflamed large intestine means that there is already an imbalance in the variety of microorganisms living in the gut. This means that the microorganisms that increase in IBD will thrive (grow) more than other microbes that decrease in IBD . It is important to not take your gut health for granted and ensure that you nourish your gut as nutrition is important to promote and keep a healthy gut in IBD. Nutrition plays a critical role in an individual living with IBD who is also trying to conceive because fertility outcomes are improved with nutrients and a healthy gut; which makes for another blog post !!

Tying to conceive when IBD is in remission, is not impossible and if an individual living with IBD is concerned that the IBD gene would pass down to their future children, nutrition can help change the way our children’s genes express themselves. Since the cause of IBD is linked with genetic and environmental factors, there is a good chance that nutrition can have some positive impact on gut health in both parents and their future children. This involves the first 1000 days of life needlesss to say good for another blog post.

If you like to learn more about nutrition for IBD and fertility, reach out and I can help !!


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