FIRST UP! I’m not a doctor, pharmacist, dietitian, therapist, rocket scientist, or anything other than someone living with IBD and sharing what I’ve learned through lived experience. This is for education, not diagnosis.
Let’s start with the basics… what actually is IBD?
Inflammatory Bowel Disease (IBD) is a term used to describe a group of chronic conditions driven by immune system dysregulation. The two most common forms are:
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Crohn’s disease
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Ulcerative Colitis (UC)
Both involve inflammation in the gut, but they’re not caused by something you ate, stress, trauma, or a vague “gut imbalance.” They’re caused by a dysregulated immune system, one that mistakes healthy cells for a threat.
And in IBD, that target is your gastrointestinal tract.
But that doesn’t mean Crohn’s and Colitis are the same. Far from it.
What Actually Happens in IBD?
Your immune system exists to protect you. It’s trained to recognise harmful invaders, like viruses or bacteria, and eliminate them.
In IBD, that system misfires. Instead of targeting true threats, it starts attacking the epithelial cells, the cells that make up the lining of your gut wall.
Here’s what that means in plain English:
Think of your gut lining as the security fence around a property. In IBD, the immune system mistakes the fence itself for the threat, and launches an attack. Not because something broke in, but because the alarm system itself is faulty.
That’s what makes IBD an autoimmune or more accurately, immune-mediated inflammatory disease. The inflammation isn’t a response to food or lifestyle. It’s your immune system targeting your own healthy tissue.
To “turn it off,” you’d have to remove the very cells it’s attacking (own gut lining ) and that’s not exactly an option!
So What Is Crohn’s Disease?
Crohn’s disease can affect any part of the digestive tract, from your mouth to your anus but most commonly impacts the end of the small intestine (ileum) and the start of the colon.
Key features:
- Inflammation can occur in patches (known as skip lesions)
- It affects all layers of the bowel wall, not just the surface
- Can cause strictures (narrowing), fistulas (abnormal connections), and abscesses
- The damage can run deep and result in long-term complications if unmanaged
Crohn’s is unpredictable. You can have one part of the bowel severely inflamed, while another section looks completely healthy.
This complexity is what often leads to late diagnosis, misdiagnosis, or people being told it’s just IBS, until it clearly isn’t.
And What Is Ulcerative Colitis?
Ulcerative Colitis only affects the colon (large intestine) and always starts at the rectum, moving upwards in a continuous line.
Key features:
- Inflammation is continuous, not patchy
- It affects the innermost lining of the bowel wall
- The disease is limited to the colon and rectum, but symptoms are severe
- Causes painful ulcerations, open sores in the colon that can bleed, ooze, and become infected
- In rare cases, deep ulcers can lead to perforation (a hole in the bowel wall), which is a medical emergency
- In some cases, if the colon is removed, the disease can be considered cured however extra-intestinal manifestations (e.g. joint pain, eye inflammation) can persist even post-colectomy.
So Why Are They Both Called IBD?
They share the same underlying issue: immune-mediated inflammation of the gut.
That’s what classifies them under the IBD umbrella, along with less common types like Microscopic Colitis and Indeterminate Colitis.
But the location, depth, and pattern of inflammation is different in each and that changes the lived experience significantly.
Let’s talk about diet, symptoms, and the “I’m in remission without meds” narrative.
Some people claim to be in remission using diet alone. But here’s the thing, if you're flaring every time you eat a “trigger food,” you're not actually in remission. You're managing symptoms while underlying inflammation is still active, and likely doing long-term damage.
When you're on the right medical treatment, you should be able to eat without triggering symptoms because the immune system is being properly managed.
That's the point.
So does diet matter?
Yes, for many of us, eating in a way that supports overall health makes a difference. I follow an anti-inflammatory diet myself. But I can eat anything without symptoms, because my inflammation is under control. That’s the part that matters.
Some forms of dietary therapy have shown remission potential in Crohn’s disease, particularly in children or early-stage cases under medical supervision.
But for Ulcerative Colitis, there’s no strong evidence that diet alone can induce or maintain remission.
What I eat is a personal choice, not a treatment plan. And there’s a big difference.
Where the confusion starts
Everyone’s gut reacts to something. People without IBD still experience food sensitivities, intolerances, and allergies. That’s not unique to chronic illness. That’s just being human.
You don’t need Crohn’s to react to dairy. You don’t need an inflamed colon to feel terrible after a dodgy meal.
And if you do have IBD, it’s still possible to have other gut issues alongside it, like IBS, which can make food reactions more noticeable. But that doesn’t mean food is causing the disease.
IBS is a functional gut disorder.
IBD is an immune-mediated inflammatory disease.
They are not the same and they can’t be managed the same way.
So while diet might play a role in how you feel, it doesn’t explain why you’re sick and it won’t be what treats the root cause. That’s what proper medical care is for.
Let’s talk about the “I’m in remission because of diet” claim
If you flare every time you eat something outside your strict food list, that’s not remission. That’s restriction.
And it might explain why you feel “better” on that diet. When the gut is inflamed, certain foods especially high-fibre, fatty, or hard-to-digest ones, can trigger symptoms. Cutting them out can reduce those symptoms. But that doesn’t mean the inflammation is gone. It just means you’re working around it.
That’s not disease control. That’s symptom management.
The bigger problem? Silent inflammation is still happening underneath.
Even without obvious symptoms, damage to your gut wall can continue. Over time, that untreated inflammation can lead to serious complications
This is well-documented. It’s not fear-mongering, it’s the reality of what happens when IBD goes untreated. And it's the reason we have medical treatment options in the first place.
Choosing to avoid medication in favour of diet alone is a personal decision, but it’s not a risk-free one. And it's often based on the mistaken belief that "no symptoms" means "no disease."
It doesn’t.
You can feel okay and still be inflamed. You can look well and still be at risk. And by the time complications show up, the damage is often already done.
There’s nothing brave or clean or natural about letting your gut get wrecked in silence.
And while we’re here, let’s talk supplements
It’s easy to fall into the trap of thinking you can heal your gut with powders, pills, or protocols. But no supermarket supplement, no matter how expensive, can stop immune-mediated inflammation.
You can spend hundreds on gut repair products, probiotics, anti-inflammatory herbs, or microbiome-focused blends. But if your immune system is in overdrive, it will just keep attacking, including whatever you put into your body.
That’s not to say you can’t try things. If something helps you feel better in a flare, that’s valid.
But let’s be clear: these products don’t address the root cause of IBD. And they definitely don’t replace actual treatment.
About the microbiome...
Yes, people with IBD often show microbiome imbalances. But the current research shows that this is a consequence of the inflammation, not the trigger.
In other words: your gut bacteria didn’t start the fire. They’re reacting to it.
The good news? When inflammation is treated and the gut heals, the microbiome often begins to restore itself, without needing to micromanage it with endless interventions.
The Bottom Line
Crohn’s and Ulcerative Colitis both sit under the IBD umbrella but they are not the same disease.
They affect different parts of the gut, behave in different ways, and need different kinds of care. If you're living with IBD, understanding which type you have isn't just about using the right label, it's about getting the right treatment, tracking the right symptoms, and making informed decisions about your health.
The more you know, the more you can advocate for yourself and the less likely you are to get swept up in advice that was never made for your condition in the first place.
