Functional Medicine Approaches for Treating Colonic Inflammation
A low FODMAP diet is the most effective functional medicine treatment for colonic inflammation, showing benefit in at least 50% of patients with inflammatory bowel disease (IBD) who have ongoing symptoms despite controlled inflammation. 1
Dietary Interventions
Low FODMAP Diet
- Primary dietary intervention with strongest evidence
- Reduces indigestible and slowly absorbed carbohydrates that cause symptoms through luminal distension
- Randomized controlled feeding studies show FODMAP intake is associated with increased symptom severity in Crohn's disease 1
- Blinded re-challenge studies confirm FODMAPs as likely dietary culprits for functional symptoms in patients with quiescent IBD 1
Other Dietary Approaches
- Lactose-reduced diet - beneficial for those with lactose malabsorption
- Gluten-free diet - may provide symptomatic relief in approximately 25% of patients 1
- Mediterranean diet - shows promising results due to high content of biologically active foods 2
Important Considerations for Dietary Therapy
- Nutritional adequacy must be monitored, especially in IBD where undernutrition is common 1
- Dietary instruction should be delivered by a dietitian to prevent nutritional deficiencies 1
- Vitamin D status should be routinely measured and deficiency corrected 1
Psychological Therapies
Several psychological techniques have shown efficacy for abdominal symptoms:
- Cognitive behavioral therapy
- Gut-directed hypnotherapy
- Mindfulness therapy
- Psychodynamic psychotherapy 1, 3
While evidence for these techniques is stronger in irritable bowel syndrome (IBS), the high prevalence of psychological co-morbidities in IBD patients makes psychological strategies valuable for managing functional GI symptoms 1.
Pharmacological Approaches
Symptom-specific treatments include:
For Constipation
For Diarrhea
- Loperamide - effective in Crohn's disease
- Bile acid sequestrants - effective for bile acid malabsorption
- Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency 1
For Pain
- Antispasmodics for acute pain
- Tricyclic antidepressants - one retrospective cohort study showed clinically relevant benefit for symptoms in IBD patients 1
- Avoid opiates for chronic abdominal pain management - increases risk of overdose and contributes to opioid-induced GI side effects 1
Microbiome Modulation
Antibiotics
- Rifaximin shows promise for small intestinal bacterial overgrowth (SIBO) in IBD
- In a small randomized study of Crohn's disease patients with inactive ileal disease and breath-test diagnosed SIBO, all patients receiving rifaximin had negative follow-up breath tests compared to only 29% on placebo 1
Probiotics
- May have potential benefit with low risk of harm
- Limited evidence specifically for functional symptoms in IBD 1
Physical Therapy and Exercise
- Biofeedback therapy beneficial for pelvic floor disorders (dyssynergic defecation)
- Regular physical exercise likely beneficial with low risk of harm 1
Common Pitfalls to Avoid
Misdiagnosing active inflammation: Always distinguish between functional bowel symptoms and active IBD using objective markers (histology, fecal calprotectin, CRP) 1
Nutritional inadequacy: Restrictive diets can lead to nutritional deficiencies if not properly supervised 1
Overlooking psychological factors: Anxiety and reduced vitality independently predict IBS-like symptoms in IBD 1
Opioid use for chronic pain: Leads to poor outcomes and opioid-induced GI side effects 1, 3
Overtreatment with immunosuppressants: Using these medications for functional symptoms rather than inflammation can cause unnecessary harm 1
The functional medicine approach to colonic inflammation requires identifying the underlying pathophysiologic mechanisms and tailoring therapies accordingly. While evidence for many interventions is borrowed from IBS management, the low FODMAP diet has the strongest evidence specifically for functional symptoms in IBD patients.