• Posted December 8, 2022

Just Being Healthy Might Prevent Many Cases of Crohn's, Colitis

Folks who follow a handful of healthy habits can dramatically reduce their risk of developing an inflammatory bowel disease, a new study reports.

Adopting and maintaining a healthy lifestyle can prevent up to 60% of cases of Crohn's disease and ulcerative colitis, according to research published Dec. 6 in the journal Gut.

"To our surprise, we found that a substantial proportion of cases could have been prevented by adhering to these lifestyle factors," said senior researcher Dr. Hamed Khalili, a gastroenterologist at Massachusetts General Hospital in Boston.

Inflammatory bowel disease (IBD) affects more than 3 million adults in the United States, researchers said in background notes. Symptoms can include diarrhea, abdominal pain, cramping and fatigue.

Previous studies have identified individual lifestyle factors associated with IBD, but researchers said it is not known whether sticking to healthy habits can prevent Crohn's or colitis.

So they developed two separate lists of health factors that are thought to influence a person's risk of IBD.

One list included a simple set of "modifiable risk factors" that included:

• Obesity (a body mass index, or BMI, of 30 or more)
• Smoking
• Using NSAIDS like aspirin and ibuprofen more than two times a week
• Lack of physical activity
• Low daily intake of fruits, vegetables, fiber, nuts and seeds
• High intake of red meat

The other was a more specific and detailed list of healthy habits that researchers used to create a "lifestyle risk score" for IBD. The second list included:

• Having a BMI between 18.5 and 25
• Never smoking
• Working out regularly
• Limiting alcohol consumption to one drink a day for women and two drinks for men
• Eating at least eight daily servings of fruit and vegetables
• Limiting intake of red meat to less than half a daily serving
• Eating fish twice a week
• Consuming at least 25 grams of fiber daily
• Munching at least half a serving of nuts and seeds daily

Researchers then tested whether either set of lifestyle factors would predict whether participants in three major U.S. studies developed Crohn's or colitis.

The three studies tracked nearly 290,000 medical professionals for decades, monitoring their lifestyle habits and noting the diseases that some eventually developed.

Researchers estimated that a low score on the modifiable risk factors list could have prevented about 2 of every 5 cases of Crohn's disease and ulcerative colitis.

Similarly, having a low lifestyle risk factor score could have prevented 61% of Crohn's disease cases and 42% of ulcerative colitis cases.

Researchers then verified the positive effect of a healthy lifestyle by testing their scoring systems on data from three large European studies involving more than 480,000 people. The results bore out their earlier findings; the healthy habits identified could prevent a large number of IBD cases.

The lifestyle factors all contribute to IBD risk in different ways, Khalili said. Some promote inflammation, while others might be harmful to digestive microbes in the gut.

These lists also might be of more benefit to older people, he added.

"In older people, environmental factors probably play a bigger role than genetic factors," Khalili said. "It's possible if you apply this same methodology to a younger cohort, you would see a lower proportion of cases that could be prevented as a result of adhering to a healthy lifestyle, because in younger people genetics may play a bigger role."

While these lifestyle factors could help ward off IBD, it's not clear whether they could help people who have already developed Crohn's or colitis, said Dr. Manasi Agrawal, a gastroenterologist at the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital in New York City.

"Unfortunately, we don't have a cure for IBD in terms of modifying the course of the disease," Agrawal said. "Being on IBD medications and ensuring that inflammation in the gut and the body is controlled well is the most important step to maintaining health."

Agrawal added that it's always makes sense to promote a healthy lifestyle because these factors have been linked with other health issues like heart disease and cancer. She noted that the study didn't assess the impact of a healthy lifestyle once disease has occurred.

More information

The Mayo Clinic has more about inflammatory bowel disease.

SOURCES: Hamed Khalili, MD, MPH, gastroenterologist, Massachusetts General Hospital, Boston; Manasi Agrawal, MD, gastroenterologist, Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital, New York City; Gut, Dec. 6, 2022