Welcome to episode 76 of the Inside Knowledge podcast for people with IBS. I’m Anna Mapson. The reason we’re all so worried about inflammation all the time is that there’s a lot of misinformation out there.
What are inflammatory foods?
A lot of social media posts will suggest that gut inflammation is the cause of your problems. And we all have to reduce inflammatory foods. You’ve probably heard me say before, there are no things as inflammatory foods. It’s all about dietary pattern overall, and there are no foods that are toxic and that are unclean or inflammatory.
So if anyone says that to you, this is food is inflammatory, ask them which particular Inflammatory markers are raised by eating this particular food. How much of it would you have to eat in order to see that raise? And does it actually have a negative impact on your overall health or your digestive symptoms?
These are really important factors when we’re thinking about what is inflammation, okay? So I’m going to talk a bit about that. But I just wanted to open with saying there’s so much information about inflammatory foods and things that you should be avoiding. It’s really natural to worry that you have got this raging inflammation inside you that you need to control.
And I think it’s quite unhelpful when it’s presented in that way. So hopefully we can get a little bit more nuance today. And help you really understand what it is we’re actually looking at.
What is inflammation?
Put very simply, inflammation is just our body’s way of responding to foreign invaders or injury in the cell.
It’s our body’s way of defending itself. If we come into contact with an infection. Like a virus, or maybe we have an injury.
The three kind of main triggers for inflammation would be like microbes.
- If you have a cut on your finger and then you get it infected by some certain germs, bacteria as we now call them, that will trigger inflammation.
- You also might get tissue damage, so perhaps like for an injury as well. Or potentially from something infecting you inside as well. If we think about things like cellulitis or sepsis, these are inflammations of our tissues inside the body.
- And then also you can get, uh, metabolic stress that causes significant inflammation. And it could be like significant exercise. If you listen to my episode about running with IBS, in there I talk about inflammation that is caused by short term acute excessive exercise, like running a marathon or something that’s really intense. That can raise up our inflammation markers. It’s just part of our oxidative stress.
There are things that can cause higher levels of inflammation, including, metabolic disease. So, that’s where you have raised lipid levels in your blood. You have maybe high cholesterol.
Obesity, those things are also known to trigger some levels of inflammation in our body.
Dealing with the inflammation
Basically, it’s like our body’s way of involving the immune system in order to correct something that needs to be dealt with. In an acute situation, that’s really helpful. It’s your immune system getting to attack foreign invaders like toxins. Bringing new blood to repair these damaged structures.
Maybe if you think about the cut on your finger again when it’s red and if it’s infected, maybe it becomes hot and red and sore and those are the things that you can see and you can feel.
Acute inflammation response
But what you can’t see is all your immune cells rushing in to zap the pathogenic bacteria. They’re turning up the heat, which can kill off the pathogens. Then they’re turning them to pus because they’re kind of enveloping them, crushing them and dealing with them. And we know we need that acute inflammation response.
It’s very helpful and it helps to protect us from viruses and other things that want to get in affect our body. In people who have inflammatory bowel disease, so that’s ulcerative colitis or Crohn’s, they have a lot of inflammation going on in the gut.
That is a lot of immune activation responding to an upset gut lining to bacteria in their gut, potentially. There’s a whole host of reasons why people get Inflammatory Bowel Disease, but it is different from IBS. And so I’m only talking today about what kind of inflammation you get in IBS, rather than IBD.
For years, people have thought that IBS is purely functional, meaning that there is no markers, no signs of disease, but there are a few studies that show that some immune markers may be raised, and we can talk a bit about what.
IBS and IBD inflammation levels
But overall, generally, you will not see raised inflammation markers in people who have IBS, or they might be very mild compared to people who have IBD. It’s very different.
How to measure gut inflammation
Some of the ways we would measure inflammation in the gut include, blood tests, stool tests, and also using cameras to go in and look at the state of your intestines.
Calprotectin is a marker of inflammation
Starting off, calprotectin is a protein that is found with our white blood cells. It’s released into the stool when we get inflammation in your intestines.
And so this is something that is used to diagnose inflammatory bowel disease. Some people have mildly raised levels when they have IBS. Basically you will have this level of this protein in your poo if you have inflammation in your colon. It suggests that you’ve got inflammation in the lining of your gut.
Check for IBD with calprotectin levels
Often this is a test that will be done if you’ve got IBS and they don’t know whether you’ve got IBS or IBD. Because if it’s raised in conditions like Crohn’s or Ulcerative Colitis, that is a way you can identify it and make sure that you’re getting the right treatment. Typically, Calprotectin levels higher than about a hundred. The NHS will ask for a retest within two weeks. And then, if you have got IBS, it’s typically less than 50.
But if it’s slightly raised, you may get a retest to do it again. And if it’s slightly raised again, then they might do some other investigative tests. But generally people can have up to a level of about 50 micrograms per gram of calprotectin and it wouldn’t necessarily indicate that you’ve got inflammation that needs treating with medication. But it could just show there’s some sort of disruption in your digestive system.
Microscopic colitis
The one slight difference with that is if you have microscopic colitis, which is a slightly different form of IBD. You don’t often get high calprotectin levels in your poo, and so sometimes it can be missed.
And I have worked with people who have gone on to have that diagnosed, but at first they had a calprotectin test which showed it was normal. They didn’t have raised levels, but then in further tests they had a diagnosis of microscopic colitis from a doctor. That’s a stool test.
C reactive protein can measure inflammation
Another test that you can get is C reactive protein, which is a blood test. This is not a specific gut inflammation marker, like the faecal calprotectin. But it shows that you have got some kind of infection or inflammation in your body. Sometimes your doctor will measure this CRP. C Reactive Protein is produced in your liver when you have some kind of inflammation.
Sometimes people with IBS may have mildly elevated levels, but again, it doesn’t necessarily mean you need anti inflammatory medication. It just may show that there is some sort of mild disruption. It’s typically higher in people who have IBS D in the small amount of studies that have shown a link between CRP and IBS.
So, it doesn’t tell you where the inflammation is, but it can be part of the way your doctor puts together a picture about whether there is inflammation in your digestive tract. If you’re doing a blood test anyway, then sometimes they can just measure the blood for this as well.
Full blood count to check inflammation markers
Another sort of blood test that your doctor may want to do is a full blood count. So, this will be looking at, amongst other things, Your white blood cells. These are often raised, neutrophils, eosinophils, these are raised when you have an acute infection or inflammation. This is a good indication whether your immune system is activated.
Also, sometimes they will look at like platelets or your red blood cells just to see what else might be going on. Because sometimes you can have knock on impact of ongoing high levels of inflammation in the gut on your ability to digest and absorb key nutrients.
This is part of the picture, that your doctor might want to put together to look at inflammation patterns in your body.
Blood in the stools
It would also be helpful to look for blood in your stools. This is called a FIT test, which stands for Faecal Immunochemical Test. And it’s basically looking for hidden blood. They do a small poo sample and it will check whether there’s any tiny particles of blood in the poo.
Often, You don’t see them, and the very microscopic particles of blood could indicate that there’s bleeding within the colon or even higher up. And so it’s just checking that you don’t have any hidden bleeding. So that’s another stool test that can be done by your doctor and is really helpful for ruling out inflammation.
Colonoscopy or endoscopy
And then if some of those tests indicate that there could be potentially some kind of inflammation, you might get a camera inside you. Whether that is going down your throat into your stomach, looking for inflammation. Or up your bottom, looking into your colon, so a colonoscopy. The other one’s called a gastroscopy.
They are looking at the lining of your digestive tract. Sometimes they’ll take a little biopsy as well. So take a very small piece and send that off to see if there’s any immune activation there. But also they can just see with the camera a lot of the time whether there is inflammation in the lining of your digestive tract.
So those would be some of the main tests that your doctor might do to look for inflammation based on the symptoms that you’re describing.
What causes gut inflammation?
If we think about why this immune activation might even be there. If you do have a low level of inflammation, how did it get there? What was causing it? And what can you do about it?
Sometimes, it can be down to foods that you’re eating that are triggering an immune response, and it’s not an allergy. As I spoke about on the previous episode, episode 75, about food intolerance testing, there are ways that you can get an immune activation that doesn’t necessarily mean you’ve got a food intolerance.
Think about the IgG antibodies, that is down to food tolerance, not intolerance. What we need to, work out is are there particular foods that are causing you to have a reaction that could be created by your immune system? So this might be removing something, a key trigger from your diet, something like the FODMAP diet where we’re taking out a lot of foods.
Elimination diets
You may also want to trial a strict diet of gluten free, maybe, or even dairy free. Those three options are different However, I say that with a big caveat that gluten is not necessarily an inflammatory food. I know there’s so much misinformation about it. There really is no clear evidence that eating gluten containing foods raises your inflammation markers. Now there is a study that actually only just came out a few months ago, so in August 2024, that showed that people who have non celiac wheat sensitivity, so this was particular to wheat rather than gluten, but they showed that they had a raised calprotectin level of up to 41.
So remember, like I said, below 50 is, not considered to be worth treating. However, Obviously, though, people are still getting symptoms. They’re getting diarrhoea, or pain, or abdominal gas, and all of those things. We still want to treat your symptoms, but you don’t need medication to manage the inflammation by dampening down your immune system, for example.
Calprotectin in non-coeliac wheat sensitivity
They took some people who had, IBS, and compared them to people who had non celiac wheat sensitivity, and they measured that by taking wheat out of their diet for six months and then showed that their faecal calprotectin did go down. So this was a mild level of inflammation in the gut and it was made better by removing wheat from their diet.
Now, it was not gluten, so they may have had other gluten containing products. But it was wheat and these people, most of them seemed to have the genes for coeliac disease.
But were negative for actual celiac disease. This is where there’s quite a lot of again slight misinformation about What is the thing that’s actually triggering your symptoms?
Finding the trigger for your gut issues
So is it gluten and do you need to cut out foods containing gluten. Or is it more down to the fact that you’re eating pattern in is very wheat heavy. Are you having a bit of toast for breakfast or maybe cereal, even a healthy cereal like a muesli that could have bran flakes in it and wheat flakes.
Maybe you’re having sandwiches for lunch. Maybe you have a little biscuit in the afternoon and then perhaps you have pasta for dinner. You’re basically eating wheat based carbohydrates throughout the day and changing your diet is going to be beneficial.
Because it’s removing some of that reliance on wheat. But it’s also bringing in other things that can also be beneficial. Maybe you eating more rice more potatoes and it’s just giving you a slightly different nutrient profile.
Your overall dietary pattern
So really important when we think about inflammation is One food is generally not the cause of it But I did mention that study because I thought it was quite interesting showing that where there is a mild level of inflammation It is worth seeking out what the cause could be.
So yes, it may be down to your eating pattern, and I mentioned wheat, but it could also be low levels of other foods like FODMAPs that are triggering a kind of response.
We know that it gives our body a break by removing some of those foods that are constantly drawing in water, creating gas, extra fermentation. Like when you can give your body a little break from all of that for a few months and then bring all the foods back in again, sometimes people feel it really does improve their digestion.
Low FODMAP diet for IBS
So even if you don’t find a particular trigger through the FODMAP diet process, you can sometimes really, get some benefit. When I talk about an overall inflammatory diet pattern, I’m talking about high levels of saturated fats, low levels of fibre, low levels of fruits and vegetables. So a typical diet like that would be someone who ate a lot of protein.
processed packaged food, very low levels of fresh fruit or even frozen fruits or vegetables. So you’re not getting much fibre, you’re not getting many key vitamins and nutrients. Eating quite a lot of saturated fats and fast food, which is typically high in energy density, low in nutrient density, burgers, pizzas, or ready meals that are packaged up. Maybe high levels of salt and sugar.
Your overall diet can influence inflammation
That, as an overall dietary pattern, if that’s the majority of foods you’re eating, then yes, there is a connection between dietary patterns and inflammation markers in our body.
But one of those particular foods is not enough to be called inflammatory. If you have one pizza, that’s not inflammatory. If you have one, session where you have lots of ice cream and some sweets, that’s not inflammatory.
And FODMAPs themselves aren’t inflammatory. So we’re talking about dietary patterns rather than particular foods.
What about with SIBO?
If you have a bacterial overgrowth in your small intestine or you have what’s sometimes termed dysbiosis in your large intestine which is a collection of bacteria that are commonly associated with poor bowel function. Gut symptoms, such as pain or erratic bowel movements, maybe constipation or diarrhoea.
There are bacteria that are more associated with those kind of things. And we know generally changing your gut bacteria over time is reliant on your diet. You can take probiotics or prebiotics that feed good bacteria, but the majority of actions that are going to be long lasting in terms of improving your overall microbiome is about diet.
Lowering inflammation through healthy diet
it’s eating more fibres, eating a good range of fruits and vegetables and lots of diversity and, you know, keeping yourself healthy. So that picture is about your overall dietary pattern that is helpful and one of the reasons it’s helpful is because it helps your gut bacteria.
Dysbiosis and inflammation
Sometimes inflammation can be triggered by bacteria or parasites or, you know, infections in your digestive tract. So we might be talking about SIBO, that’s the overgrowth of microbes in your small intestine, or maybe it’s in your large intestine. That can activate your immune system as well. And because if you think about it, your immune system is trying to get rid of these bacteria that it knows is not good. And it can do that for bacteria that are in the gut. If there’s a collection of bacteria that we might term as pathogenic or infectious, then you may have this low level of infection. As your immune system is constantly trying to deal with the bacteria that are there that are deemed unhelpful.
Your immune system’s always on the go, always trying to get rid of it. And some of the process of getting rid of the infectious bacteria is creating redness, creating soreness. It can also trigger your nervous system. So this is why we can get visceral hypersensitivity because the nerve endings in our gut are often really tightly wound up with our immune system cells.
And so when they’re on high alert, It can also trigger nerve response and you can feel that pain much more intensely.
Summary
This episode has tried to explain what the actual markers are that you could be looking at. Some of the reasons why we might get low level chronic inflammation in IBS because what we actually find is that majority of IBS will prove negative for all of these inflammation responses. Actually if you do find high levels of inflammation in one of these tests with your doctor, then you can get that treated.
This would indicate that there’s something else going on, that it’s not IBS, because IBS doesn’t typically have high levels of any of these inflammation markers. It might be reassuring to get all these negative tests all the time. But in reality, it always leads you back to what am I going to do about it now?
And where am I going to go? What should I eat? What should I do in order to feel better because having a negative test that comes back and says, yep There’s no inflammation. You’re all fine. It might be reassuring in a way that you know. There’s nothing more serious going on. But it still leaves you in a position where you don’t really know what to do about it.
Work with me on your gut health
If you’re in that position right now and you’re stuck and not knowing where to go, then get in touch with me. I work with people over three months. My three month gut reset is all about helping you identify a diet that works for you, something that you can do and change in your own life the way you eat. What you’re eating and how you’re living to try and reduce your symptoms. Try and start feeling better again and get back off the toilet. And back to living a better life.
So if you are interested in that, do drop me an email. You can book a free consultation call from my website or I will put a link in the show notes. But always happy to hear from you as well if you’ve got questions that have come up from this episode or you’ve got a topic you’d like me to focus on in a future episode of the Inside Knowledge.
Thanks for listening to this episode though. Better digestion for everyone.