WHY YOU SHOULD READ THIS NOW
There are over 3 million people in the U.S. with Inflammatory Bowel Disease (IBD), and the prevalence is rising.
New therapies are here: The FDA approved Rinvoq in 2023, Skyrizi in 2024, and Tremfya in March 2025. Keep reading to get our take on these new treatments
Depression and anxiety are twice as common in people with IBD, which influences disease flares and quality of life.
TODAY’S OPPONENT:
Inflammatory Bowel Disease (IBD)
IBD is the collective name for Crohn’s disease and ulcerative colitis as well as a few less common disorders. These are chronic conditions in which the immune system mounts a misdirected, long-term attack on your gut lining. This results in abdominal pain, bleeding, diarrhea, and/or anemia.
As inflammation loosens the “tight junctions” connecting the cells of the intestinal tract, bacteria and food antigens slip into the tissue, keeping your immune response stuck on overdrive and sustaining damage.
These changes tilt the intestinal microbiome toward pro-inflammatory microbes. In fact, research shows that there is a change in the microbiome years before symptoms of IBD arise.
Because the inflammatory cascade extends beyond the gut, up to 40% of patients also develop “extraintestinal manifestations,” such as joint pain, skin rashes, or eye inflammation. In this way, IBD is a systemic disease, not just a “stomach problem.” Left uncontrolled, ongoing inflammation can scar bowel segments, create fistulas, and raise colorectal-cancer risk.
IBD used to be a rare diagnosis outside major medical centers. Not anymore. New cases per year have risen to 10-20 per 100,000 per year for both ulcerative colitis and Crohn’s disease.
Mental health is suffering too. People with IBD face nearly double the risk of clinical anxiety or depression.
One Reddit user recently shared being hospitalized twice for ulcerative colitis, plagued by C. diff, and terrified to leave home for fear of not finding a bathroom. It was heartbreaking to hear it was putting a strain on her marriage.
Stories like this are what we hear in clinic every week.
In terms of treatment, biologics targeting TNF-α, IL-12/23, and integrins remain mainstays, yet oral agents are finally catching up, such as Rinvoq which is one pill per day
Newer medications such as Skyrizi and Tremfya offer injection options from the comfort of one’s home.
Evidence also keeps piling up that diet, particularly ultra-processed foods, and early-life antibiotic exposure tilt the microbiome toward dysbiosis, priming genetically susceptible people for IBD.
Cutting back on emulsifier-laden snacks, prioritizing fiber-rich plants, and adding fermented foods won’t replace medication, but they complement it by nurturing protective microbial strains and may have some preventative role.
“IBD no longer needs to carry the heavy burden it once did.”
We now have so many different treatment options available as well as more advanced radiologic and endoscopic tools.
Appropriate initial (and longitudinal) evaluation is essential to identify the most fitting treatment and surveillance plan. The goal is to have you feeling normal, your intestinal tract to look normal endoscopically (i.e. “mucosal healing”), and to be back at your normal daily life.
“Medication is foundational, but sleep, stress management, and diet have profound effects on inducing & maintaining remission.”
There are natural adjunctive therapies that can help IBD flares, including sticking to a Mediterranean diet, curcumin, and certain probiotic strains.
WHAT TO TELL YOUR DOCTOR
“I’ve noticed persistent loose stools and urgency for six weeks, sometimes with blood. I know IBD is being diagnosed more often. Can we check stool calprotectin, labs, and discuss early colonoscopy or imaging?”
TIKTOK TREND WE’D (NOT QUITE) BAN
Cabbage Juice to ‘Cure’ Ulcers, Colitis, and Everything Else…
#GutTok is touting fermented or raw cabbage juice as a miracle that “heals ulcers in 10 days” and “balances gut bacteria.” HOWEVER: the original 1949 ulcer study was small, uncontrolled, and focused on stomach (not colonic) ulcers. Not to mention old. No modern trials show cabbage juice puts Crohn’s or ulcerative colitis into remission. HOWEVER (pt. 2):
Cabbage juice a cure-all? Hmm…
Cabbage contains compounds like glutamine and S-methylmethionine (sometimes called “vitamin U”) that have been shown in early studies to support stomach lining repair.
Cabbage is also rich in anti-inflammatory phytonutrients and vitamin C, which may help support your microbiome.
And some patients have reported improved regularity, and less bloating over time.
So if you feel better sipping on some tasty (😱) cabbage juice... go for it. But it’s no magic bullet on its own.
Verdict: NOT Banned.
WHAT’S ON YOUR MIND?
Respond to this email and let us know!
As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
