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May 26, 2023

How Does Remicade Work? What to Know About IBD Care

Remicade is a medication used to treat IBD, but it’s not without side effects. Learn how Remicade works, plus natural support for IBD care.
Medically Reviewed
Written by
Caitlin Beale
Medically Reviewed by
Dr. Danielle Desroche

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Contents

Inflammatory bowel disease (IBD) is a term that includes the autoimmune conditions Crohn's disease and ulcerative colitis. It’s characterized by inflammation in the digestive tract, which can lead to symptoms such as abdominal pain, diarrhea, and weight loss.

Support for IBD varies depending on the individual, but often medications are used to manage the symptoms. One of these is Remicade (infliximab), a drug prescribed to help reduce inflammation in the digestive tract. While it can help some people, Remicade is not without side effects. Here’s what you need to know about how Remicade works, why it’s prescribed, and what natural alternatives to IBD medication are available.

What Is Remicade?

remicade is a prescription intravenous medication definition infographic

Remicade is a biologic drug (meaning it’s derived from live cells) that belongs to a class of medications called tumor necrosis factor (TNF) alpha-blockers. TNF-alpha is a signaling protein that helps regulate your immune response and drives inflammation. Remicade is given by intravenous infusion rather than being taken by mouth. (Source)

How Does Remicade Work?

Let’s take a quick step back to look at IBD. The two IBD conditions — Crohn's and ulcerative colitis — are autoimmune diseases, meaning your immune system mistakenly attacks healthy tissue. In the case of IBD, this inflammation occurs in the digestive tract. (Source)

People with IBD have increased production of TNF-alpha in the intestines, with higher amounts correlating to more inflammatory activity and disease severity. Inflammation causes symptoms such as abdominal pain and diarrhea, so Remicade blocks the action of TNF-alpha, reducing inflammation and easing symptoms (but also suppressing your immune system as a whole). (Source)

how remicade works infographic

Who Is Remicade For?

Remicade has been approved for adults and children over 6 to treat Crohn's disease and ulcerative colitis (as well as several other autoimmune conditions such as rheumatoid arthritis and plaque psoriasis). It’s usually prescribed when other treatments haven’t helped. (Source)

What to Expect During a Remicade Infusion

Remicade is given through an intravenous infusion by a health care professional. The infusion takes about 2 hours, so you'll stay at the infusion center and be monitored throughout the appointment. (Source)

Follow-up visits vary depending on your care plan. Often the appointments are more frequent in the beginning but then spread farther apart for maintenance doses.

How Long Does the Remicade Infusion Take to Work?

It can take some time for Remicade to start working, although it depends on the individual. Some people see improvement within the first few days, while others take longer. And according to some research, up to 40% of patients don't respond at all to anti-TNF drugs, including Remicade. (Source)

Remicade can lose effectiveness over time, possibly because the body produces antibodies to fight the medication or because of disease progression. If this happens, your provider will often suggest increasing the dosage or switching to a different medication. (Source).

What Are the Side Effects of Remicade?

Side effects from Remicade range from mild to severe. Mild side effects (or allergic reactions) can occur during the infusion or within the first 24 hours after receiving treatment and can include:

  • fever
  • chest pain
  • heart palpitations
  • sweating
  • nausea
  • flushing
  • itching
  • increased blood pressure
  • shortness of breath

Other side effects can occur up to 14 days after the infusion and include:

  • muscle and joint pain
  • itching
  • fever
  • fatigue
  • rash

Other common side effects include respiratory infections, sore throat, headaches, coughing, and stomach pain. (Source)

Remicade Has a Black Box Warning

A black box warning means that the Food and Drug Administration (FDA) has determined that the drug carries a serious health risk. Remicade increases your risk of severe health problems, including potentially fatal fungal infections and certain cancers (especially in children). (Source)

Serious long-term side effects also include liver conditions, heart failure, stroke, seizures, lupus-like syndrome, and more. (Source)

Before committing to any treatment plan, discuss the benefits and risks with your health care provider to make a decision that feels right for your body and your health.

a half of a melon and a sliced lemon

Natural Support for Inflammatory Bowel Disease

While medications can be lifesaving in some cases, they aren’t the only way to feel better. You may decide to limit medication use because of side effects, or because the treatments aren't doing enough to help you feel better. Sometimes medications are used primarily for symptom control without addressing the root causes of the disease.

Research points to the importance and effectiveness of lifestyle habits for IBD support (and even prevention). Natural support for IBD often involves dietary changes, exercise, sleep, and stress management to reduce inflammation and improve gut health. (Source)

Supporting the gut microbiome — the population of beneficial microbes living in the intestines — through diet is also crucial for IBD. Microbial balance and diversity are considered essential but complex factors in the development of IBD. People with IBD appear to have different types of bacteria in their gut than those without. Certain types of bacteria are also linked to intestinal inflammation, while others help maintain balance and preserve the integrity of the gut lining. (Source, Source)

Healing takes a multifaceted, personalized approach, but certain dietary and lifestyle strategies can help. Let's examine each one more closely.

Nutrition for IBD Support

There’s no perfect diet for people with IBD because each person can have individual food triggers or intolerances. If you’ve had surgery due to complications of IBD, or developed strictures (a narrow area in the intestines resulting from scar tissue), certain types of foods may be harder for you to digest or may cause more symptoms. Food recommendations also are different when you're experiencing a flare than when you’re in remission.

Still, there are some basic principles to follow that can address inflammation and help you meet nutrient needs, including:

  • Eat smaller, more frequent meals to help with digestion.
  • Avoid ultra-processed foods with many additives or artificial sweeteners that can be hard on the digestive system.
  • Include anti-inflammatory foods such as fatty fish, olive oil, and turmeric.
  • Limit foods that can irritate the gut, such as coffee, alcohol, and spicy or fried foods.
  • Include protein at every meal. Protein needs are often higher for people with IBD, especially during and after flares.

(Source, Source, Source)

Special Diets for IBD

Special diets may help reduce inflammation and improve gut health for those with IBD. One study published in the journal Gastroenterology compared the effectiveness of the Mediterranean diet and the Specific Carbohydrate Diet (SCD) for improving symptoms of Crohn’s, finding that both diets effectively reduced inflammation and symptoms. After 6 weeks, 43.5% of those following the Mediterranean diet and 46.5% following the SCD had achieved remission. The researchers concluded that the Mediterranean diet is likely the better choice for most people, as it is easier to follow and has proven health benefits in addition to easing IBD symptoms. (Source)

Another study found that people with IBD who followed the autoimmune protocol (AIP) diet had noticeable symptom improvement and reduced intestinal inflammation. On the other hand, diets high in sugar are linked to an increased risk of IBD. (Source, Source)

These diets differ in complexity and how restrictive they are. Working with a health coach or nutritionist can help you customize a diet that meets your specific needs and preferences.

a small white bowl of supplements

Supplements for IBD

In combination with diet, supplements can also help with symptom support. To start, IBD increases the risk of nutrient deficiencies as chronic diarrhea and inflamed intestines can interfere with nutrient absorption. Chronic inflammatory conditions also bump up your nutrient needs. As a result, a multivitamin may be recommended to fill in the gaps.

Other supplements could help with pain or other symptoms. For example, resveratrol, a polyphenol from red grapes, may help reduce gastrointestinal symptoms and improve the quality of life for people with IBD. Synbiotics, which are combinations of probiotics and prebiotics, may also support inflammation and balance the microbiome. (Source, Source)

Curcumin, an active compound found in turmeric, may help with inflammation. One study found that people taking curcumin with their medication for ulcerative colitis were more likely to achieve remission than those taking medication alone. (Source, Source)

Fish oil, which contains omega-3 fatty acids, can also help reduce inflammation. Studies suggest that fish oil supplements help reduce inflammation and improve rates of remission for people with ulcerative colitis. Omega-3s may also reduce inflammation and disease activity while increasing the quality of life for people with Crohn’s. (Source)

These are only some examples of supplements for IBD. Some help with symptoms, while others address autoimmunity or are targeted to the individual condition. It’s ideal to work with someone specializing in IBD support to determine which supplements would be best for you.

Stress Reduction and IBD

There’s a close, bidirectional relationship between stress and IBD, where one influences the other. Studies report that around 30% of people with IBD symptoms also report higher stress levels. In contrast, asymptomatic patients report less stress related to the disease. This makes sense, since living with IBD and the symptoms can seriously impact your daily life. (Source)

Stress is a vicious cycle because higher levels of perceived stress — how much stress you feel you’re under — can also lead to more intense symptoms and flares. Major life stressors have also been linked to the likelihood of having an IBD diagnosis in the first place. (Source)

It’s nearly impossible to keep stress out of your life, but you can work on managing it to limit its effect on your health. For example, one study found that yoga significantly reduced disease activity while improving perceived stress and quality of life for people with ulcerative colitis. (Source)

Effective stress reduction means finding what works for you. This could be walking, journaling, or even watching a funny TV show — whatever brings you pleasure and helps you stay present.

a woman walking outside

Movement and IBD

Exercise, especially to maintain a healthy weight, is beneficial but also can be tricky for people with IBD. Studies show that exercise may even help reduce the risk of developing IBD, but getting moving after a diagnosis can be challenging if symptoms are severe. (Source)

Physical activity can reduce inflammation and support a healthy immune response. Studies suggest that exercise could reduce the risk of relapse for people with IBD in remission. Alternatively, obesity is linked to more disease activity, relapse, and adverse outcomes with IBD. (Source)

Obesity is influenced by more than physical activity, but it’s an essential factor. Starting with even 10 minutes of gentle yoga or walking to get your body moving and help with stress management could be a ­place to start.

Sleep and IBD

Similar to movement and stress, IBD can interrupt sleep, but sleep deprivation can also increase the risk of relapse, disease flares, and diminished quality of life. Studies suggest that up to 80% of people with IBD report sleep issues. (Source)

Telling someone who is struggling that they need to sleep more is easier said than done, but there are many ways to improve how restful your sleep is. Technology such as blue light-blocking glasses, blackout curtains, and sleep-supporting supplements such as lavender or magnesium may help.

The Bottom Line on Remicade for IBD Care

Remicade is a medication used to treat IBD. It can provide relief and even help achieve remission, but it is not without potential side effects. Before starting Remicade, it’s essential to talk with a health care provider about how the medication works and how the side effects could affect your life.

In addition to medications, evidence-backed lifestyle strategies may help manage IBD symptoms. Diet, stress management, movement, and sleep all affect inflammation and the immune system, but learning what works best for you and your body is essential. The WellTheory membership provides the tools and guidance for a personalized healing journey.

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