Treatment Precautions Background
Treatment Guidelines

The Fundamentals of Treatment,
Essential Principles to Follow

A promise for patients with ulcerative colitis and Crohn's disease to prevent recurrence
and move toward full recovery.

"Failure to follow the next 5 rules
may result in treatment failure or recurrence."

These are non-negotiable, essential lifestyle guidelines
for treating ulcerative colitis and Crohn's disease.

5 Mandatory Rules

5 Essential
Compliance Rules

These are items that must be strictly followed to enhance treatment effectiveness and protect the intestinal mucosa.

Alcohol consumption, in particular, is a major factor in the recurrence and worsening of ulcerative colitis and Crohn's disease. You must refrain from drinking during treatment, and even after treatment, consuming alcohol can lead to recurrence.

The use of chemical drugs such as antibiotics, painkillers, cold medicine, anesthetics, vaccinations, and surgeries can exacerbate your condition. Many patients report worsening symptoms, especially after the use of antibiotics and anti-inflammatory painkillers. Antibiotics do not just kill bacteria at the site of infection; they indiscriminately kill bacteria in our body's microbiome within the large intestine.

Antibiotics and the Microbiome

The microbiome, which resides in the large intestine, consists of approximately 38 trillion bacteria and has a close impact on our body's immune system. The administration of antibiotics destroys this microbiome, causing immune system disturbance and triggering diarrhea. Research reports indicate that even after 4 days of using a 3-drug complex antibiotic, it takes more than 6 months for the destroyed microbiome to recover. (Recovery of gut microbiota of healthy adults following antibiotic exposure - PubMed)

[Countermeasures] The reckless abuse of antibiotics must be avoided. In South Korea, there is a tendency for indiscriminate use, such as using antibiotics in 80% of cold medicines, and antibiotics are often prescribed to patients with ulcerative colitis and Crohn's disease without much alarm. Therefore, unnecessary use of antibiotics must be avoided, and if they must be used due to unavoidable circumstances, they should be used cautiously while increasing probiotic intake 2-3 times. Always remember that symptoms may worsen when using antibiotics, and if symptoms do worsen, you must contact the Korean medicine clinic immediately.

Eating food with chemical seasonings once or twice will not necessarily stop treatment or cause symptoms to recur. However, poor dietary habits hinder treatment, making the treatment period longer, and continuous intake of instant food can lead to the recurrence of symptoms.

In particular, frequent intake of sugar, fructose, and refined carbohydrates can prevent symptoms from improving quickly and cause them to worsen. Avoid the following foods:

  • Sweet foods containing sugar
  • All beverages containing fructose, and fruits high in fructose
  • Refined carbohydrates such as wheat flour

Cold foods: Patients who are sensitive to cold foods should be careful about eating them in the early stages of treatment. Once treatment progresses, hypersensitivity to cold foods will be treated and disappear, and there will be no issues with eating cold foods after treatment.

Spicy foods: Reactions to spicy foods vary greatly by country and culture. However, patients with ulcerative colitis or Crohn's disease tend to be hypersensitive to spicy foods. Eating spicy foods can lead to heartburn, abdominal pain, or diarrhea (even if it doesn't feel spicy in the mouth), and can cause anal burning sensation. These reactions are largely due to personal and cultural differences and are not treatment targets corrected by medication. Therefore, hypersensitivity to spicy foods often remains even after treatment.

The intestinal mucosa of patients with ulcerative colitis and Crohn's disease is about 1/3 as thin as that of healthy individuals. Therefore, they are much more vulnerable to infections. For this reason, there are times when everyone shares the 'same food' but 'only I (the patient with ulcerative colitis or Crohn's disease)' get sick.

[Prohibited and Recommended Foods] The safest thing for patients with ulcerative colitis and Crohn's disease is food that has been heated and cooked right before eating, or food that has been sterilized. Raw foods, sashimi, sushi, beef tartare, ice cream, etc., have a high possibility of containing bacteria and are foods that should never be eaten. Also, ready-made buffet food or food sold after being stored is also high-risk.

[Lifestyle Rules] Habits such as picking up food with dirty hands, nail-biting, or sucking fingers increase the risk of infection. Especially in summer, these infections occur frequently, so be sure to wash your hands cleanly and frequently with soap. If a patient with ulcerative colitis or Crohn's disease develops food poisoning or enteritis, abdominal pain and diarrhea become more severe and bloody stools increase. It can take anywhere from 1-2 weeks to 1-2 months to recover.

It is highly recommended that you strictly follow these prohibitions.
If you think about it and follow them, it is not that difficult.

Food Allergy Test

Delayed Food Allergy
Test (IgG)

Some patients have allergies to immediate immune responses that cause shock, but allergies to delayed immune responses are present in everyone. For healthy individuals, these delayed allergies are not an issue at all because they do not trigger a rapid immune response. However, for patients with dermatitis like atopy or psoriasis, or enteritis like ulcerative colitis or Crohn's disease, inflammation worsens depending on the food, so it is recommended to identify allergy-causing foods through a delayed immune response test.

Immediate vs. Delayed Immune Response

Comparison of Reaction Time

Why should we know about delayed allergies?

For example, for patients with ulcerative colitis and Crohn's disease, the frequency of diarrhea varies slightly from day to day even for the same patient. On some days it happens 5 times, and on other days 8 times. Why does this difference occur? It is due to the food consumed 1-2 days prior.

Since the reaction appears between a minimum of 5-6 hours and a maximum of 2-3 days after food intake, it is very difficult to think of a direct connection to food on your own. Delayed food immune responses appear more frequently in younger people (teens to 20s) and less frequently as you get older (50s-60s). This is because we are continuously exposed to food in our daily lives, reducing allergic reactions.

Treatment Strategy and Application

It is recommended to identify allergies to specific foods (rice, tofu, beans, oranges, flour, milk, etc.) and avoid those foods until the middle of treatment when symptoms have mostly improved. Blocking allergy-causing foods through allergy tests will greatly reduce aggravation reactions to food during treatment. After symptoms improve and treatment ends, you can eat all foods again.

Lifestyle Guide

General Lifestyle Precautions

Dietary Habits and Nutritional Management

  • Supplements: You may take them. Vitamin D, in particular, is often reported as deficient in patients with ulcerative colitis and Crohn's disease, so it is recommended to take it.
  • Probiotics: It is recommended to take 2 or more different types of probiotic products. It is better to take products in capsules rather than powder. Sometimes probiotic formulations can cause diarrhea, so if you experience diarrhea after taking a specific probiotic, try changing the product.
  • Chew slowly: Always chew thoroughly and do not eat in a hurry.
  • Meat consumption: If you have no allergies, there is no problem with consuming meat. However, it is better to avoid processed meats like ham and sausages, and avoid eating fried meat. Even if you don't have meat allergies, eating meat with too much fat can cause diarrhea. Boiled meat is the safest.
  • Beware of fats: Avoid fried foods, trans fats, and foods high in saturated fats.
  • Vegetable consumption: It is good to eat plenty of vegetables. The fiber in vegetables serves as food for good bacteria in the gut, improving the intestinal environment. However, avoid eating them raw (salads) and it is better to lightly steam or blanch them.
  • Hydration: It is better to drink water than other beverages. While recommended amounts vary by weight, it is recommended to drink at least 1L per day.
  • No Milk: Many Koreans and Asians have lactose intolerance. Therefore, do not drink milk.

Lifestyle Habits and Clinical Management

  • Other diseases: Symptoms will worsen if you catch other illnesses such as colds. If you have ulcerative colitis or Crohn's disease and catch additional illnesses, symptoms will worsen, so be careful to prevent infections.
  • Endoscopy: It is recommended not to undergo endoscopy during treatment. Endoscopy is an invasive procedure, and depending on the skill of the practitioner, it can cause scratches on the intestinal wall or, in severe cases, perforation, worsening inflammation. It is essential when treatment ends, but do not do it too often.
  • Aerobic exercise: Aerobic exercise suitable for your physical strength is recommended. It is better to do it lightly without overexertion.
  • Correct bowel movement posture: When having a bowel movement, it is recommended to use a footrest so that your knees are higher than your hip joints and lean slightly forward to create a correct bowel movement posture.
  • Cleanliness of the anal area: Always keep the anal area clean. Do not just finish with toilet paper; it is better to clean thoroughly using a showerhead, bidet, or wet wipes.
  • Anal itching: Occasionally, the area around the anus may itch; sometimes fungal infection is the cause. You may need to use antifungals, so if it itches, be sure to consult medical staff.

F.A.Q

Frequently Asked Questions

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