As a 35-year-old bank executive, completing deadlines and travelling to cities every other day, Sudheer Sharma often skipped breakfast and lunch, grabbing a small bite in between and having that big meal only after work. He never found his routine to be disruptive till the day he crumbled in a heap with severe abdominal cramps and stool in his blood. His work stress and poor meal habits had completely distorted his gut health, resulting in ulcerative colitis — inflammation and ulcers in the colon and rectum. Now a food guidance app helps him tame it.This is a type of inflammatory bowel disease (IBD), which could be caused by genes, an immune system dysfunction, where the immune system mistakenly attacks the digestive tract as the enemy, or when the balance of good and bad gut bacteria is severely disrupted. In Sharma’s case, the stress and poor diet just exacerbated the condition further. “The pain was sharp. And the rectal bleeding was scary. Such were my bouts that my mental health got affected too,” says Sharma, a resident of Agra. After an endoscopy revealed his condition, he consulted several doctors in Agra.However since IBD doesn’t have a cure but needs to be managed with a massive diet and lifestyle intervention, none were able to advise him rightly. Sharma spent Rs 1.5 to Rs 2 lakh in doctor consultation and hospitalisation. Then his haemoglobin levels plummeted to 6.5 g/dL because of bleeding. That’s when he came to the All-India Institute of Medical Sciences (AIIMS), Delhi. That’s where Dr Vineet Ahuja, professor of gastroenterology, prescribed him an anti-inflammatory diet, which slowly returned him to normalcy.What is an anti-inflammatory diet?Dr Ahuja, who has been seeing IBD patients mostly between their 20s and 40s, says although many of them are advised immunosuppressive therapy, this can be very expensive, setting the patient back by anything between Rs 2.5 lakh to Rs 5-6 lakh per year. “Besides, this is a finite therapy. There’s no known cure,” he says. Which is why dietary management is the key pillar of disease management.Initially, Dr Ahuja advised an almost liquid diet for Sharma, which included khichdi at times. Then he and his team of dieticians gradually included curd, pulses, nuts, fruits, rice and gluten-free grains. Sharma was asked to focus on whole, unprocessed foods, healthy fats, lean proteins like fish, fruits, vegetables and whole grains.How to make three meals anti-inflammatory?For breakfast, Sharma takes 250 grams of poha with nuts, khichdi or chilla followed by fruits — all a mix of carbohydrates, proteins and fibre, the last of which clears the gut, flushes out toxins and promotes the growth of good bacteria. He has curd and curd-based products in large quantities. “I make sure I consume curd every day in different forms, including buttermilk or chhaas, raita or yogurt dip and plain curd,” says Sharma. He avoids other milk products, occasionally indulging in paneer. “Curd has a lot of probiotics and has a positive effect on the gut microbiome itself. Lactobacillus-containing yogurt can correct imbalance of gut microbes,” says Dr Ahuja.At lunch, Sharma has ragi or bajra (both millets) roti along with dal and salad, again a mix of complex carbohydrates, protein and fibre. He follows a similar meal plan for dinner. “We took him off red meat, wheat and ultra-processed foods because they trigger inflammation,” says Dr Ahuja. So Sharma effectively stays away from wheat, maida, all-purpose flour, semolina, bread and dairy products.Story continues below this adWith wholesome meals that lend satiety, Sharma does not crave junk food. He now takes home-made food to work and if he cannot, buys only curd and fruits instead of the junk and thali meals he ordered before.How an app helps in monitoring dietsAlthough initially he consulted AIIMS dieticians in person, he now follows their food guidance app called IBD Nutricare, which has been designed to help patients keep to an anti-inflammatory diet. “The patients following the diet have to upload details of what and how much they eat daily. Based on these details, the app tells you where you are going wrong or what you can do to rectify your food combination,” says Sharma. Within a month of using the app, both his cramps and rectal bleeding stopped. “My haemoglobin levels have also gone up to 10g/dL now,” he adds.Why stress is a triggerOnce Sharma got accustomed to a changed diet, Dr Ahuja put him on an exercise schedule that would relieve his severe work stress. He goes for long walks in the mornings and does yoga whenever he gets time. Normally any moderate intensity exercise and strength training should top up the benefits. “I also take care to sleep seven to eight hours so that my body can heal,” says Sharma, who has begun to take mini breaks over weekends.Why is IBD common in India?Dr Ahuja is seeing a spiral, attending to almost 250 cases a week. “It is a very large number. In some cases, prescribed medicines, like 5-amino salicylic acid, are used. But then this is just 50 per cent of the medication. In serious cases, steroids are used. Still if they don’t work, then biological injections are used. Biologics are used to treat IBD because they help the immune system target certain proteins that cause inflammation,” says Dr Ahuja.Story continues below this adIf we look at actual incidence figures, these may be lower than the US and Europe. But because of the population, when we look at absolute numbers, then India has almost the same number of patients as the US for the whole of Europe combined. So that is roughly around 2.5 million patients.Dr Ahuja says there has been a cohort of around 10,000 patients with IBD ever since AIIMS started its specialised clinics in 2004.