Dr. Neeraj Narula
Associate Professor of Medicine, McMaster University & Director of the IBD Clinic and Staff Gastroenterologist, Hamilton Health Sciences
Despite the challenges of living with ulcerative colitis, long-term disease management strategies can help patients thrive
When Rasheed Clarke crossed the half marathon finish line at the 2017 Mississauga Marathon, the moment was especially sweet. A decade earlier, he had been training for a half marathon that he never got to run.
In 2007, Rasheed, by all accounts a healthy 23-year-old man, began experiencing symptoms including diarrhea and blood in his stool. He also suddenly needed to go to the bathroom more than 30 times a day. Despite his initial alarm, and disappointing search for answers, his symptoms gradually abated. A year later, however, his symptoms reappeared and he was diagnosed with ulcerative colitis (UC).
It can be disheartening at times, but you can keep trying. I’m very grateful for the research that has gone into this disease because I know that I’m the beneficiary of a lot of people’s efforts. It makes me feel very lucky.
A lifelong disease with an unknown cause
According to Crohn’s and Colitis Canada, ulcerative colitis is one of two main forms of inflammatory bowel disease (IBD); the other is Crohn’s disease. These diseases inflame the lining of the gastrointestinal (GI) tract and disrupt your body’s ability to digest food, absorb nutrition, and eliminate waste in a healthy manner. While Crohn’s disease may affect any part of the GI tract, ulcerative colitis is limited to the colon and rectum.1
Both Crohn’s and ulcerative colitis are lifelong diseases and people can experience acute periods of active symptoms (active disease or flare), and other times when their symptoms are absent (remission). The exact cause of IBD remains unknown.2
While ulcerative colitis can occur at any age, it usually begins before the age of 30.3
It was the opportunity to work with this younger patient population, in the area of immunology (the study of the immune system4) that drew Dr. Neeraj Narula, an Associate Professor of Medicine at McMaster University and Director of the IBD Clinic and Staff Gastroenterologist at Hamilton Health Sciences, to his work as an IBD specialist.
“Newly-diagnosed IBD patients are often at pivotal times in their lives,” says Dr. Narula. “It is rewarding to help these young adults understand their condition and symptoms, so they can continue to think about life goals such as getting jobs, getting married, and having families.”
Learning to live with IBD
Dr. Narula notes that since ulcerative colitis is a chronic condition, patients will need to think about long-term disease management strategies.
While maintaining an ongoing relationship with a healthcare team likely to include specialists such as a gastroenterologist (a physician specializing in disease of the GI tract and liver) is one important factor5, Dr. Narula adds that lifestyle factors can be important components of IBD care.6
“Reducing stress – or learning to manage it better through activities like meditation or yoga — and eating a healthy diet are great places to start for those looking to better manage their UC,” says Dr. Narula.7,8
In a recent study published in The BMJ, Dr. Narula and his team further explored the link between diet and IBD.9 “We found that those who have more than five servings of ultra-processed food per day had almost twice the risk of developing IBD as compared to those who had less than one serving per day,”10 he says.
Advanced treatment options
For some patients, however, lifestyle and dietary factors aren’t enough to manage their IBD. In 2014, after many attempts to manage his condition, Rasheed had J-pouch surgery. In this procedure, the surgeon removes the colon and rectum and creates a pouch shaped like the letter J from the end of the small intestine, which attaches to the rectum.
“It’s been life-changing. It’s been terrific to be able to get back to the life I remember, that is more or less normal,” says Rasheed, who is back to doing the things he loves, including cycling and hiking. When he completed the half marathon, he did it as part of a team called Guts to Run, which raises money for Crohn’s and Colitis Canada. Crohn’s and Colitis Canada is the only national, volunteer-based charity focused on finding the cures for Crohn’s disease and ulcerative colitis and improving the lives of children and adults affected by these diseases. And they are transforming the lives of people affected by Crohn’s and colitis through research, patient programs, advocacy, and awareness.11 Rasheed says he was grateful to be able to complete the half marathon after all he had gone through. He wants others with ulcerative colitis to know that a better life can be possible.
Through ups and downs, keep trying new things to find what works
“Learning all I could about UC help put me on the path to taking more control of my life,” Rasheed says. “It can be disheartening at times, but you can keep trying. I’m very grateful for the research that has gone into this disease because I know that I’m the beneficiary of a lot of people’s efforts. It makes me feel very lucky. It will be exciting to see even more progress in terms of research, so that other people can live the best life they can.”
New research and promising developments are happening regularly in the IBD field. “We’re exploring novel ways to provide a lot of promise for the future of treating IBD,” says Dr. Narula.
This article was made possible with support from Pfizer Canada
1 Living with Ulcerative Colitis. Crohn’s and Colitis Foundation. https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/living-with-ulcerative.pdf
2 Crohn’s and Colitis Canada. About Crohn’s and Colitis. https://crohnsandcolitis.ca/About-Crohn-s-Colitis/What-are-Crohns-and-Colitis
6 Rozich JJ, Holmer A, Singh S. Effect of Lifestyle Factors on Outcomes in Patients With Inflammatory Bowel Diseases. Am J Gastroenterol. 2020 Jun;115(6):832-840. doi: 10.14309/ajg.0000000000000608. PMID: 32224703; PMCID: PMC7274876. https://pubmed.ncbi.nlm.nih.gov/32224703/
7 Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Front Pediatr. 2019;7:432. Published 2019 Oct 24. doi:10.3389/fped.2019.00432 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821654/ Accessed October 26, 2021. (p 1-2)
8 UMass Chan Medical School – Center for Applied Nutrition. Anti-Inflammatory Diet for IBD (IBD-AID). Available at: https://www.umassmed.edu/nutrition/ibd/ibdaid/ Accessed October 26, 2021.
9 Narula N, Wong E C L, Dehghan M, Mente A, Rangarajan S, Lanas F et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study BMJ 2021; 374 :n1554 doi:10.1136/bmj.n1554 Available at: https://www.bmj.com/content/374/bmj.n1554 Accessed October 26, 2021. (p 2)