Charlie Lees
@charlie_lees • 21,655 subscribers
I write about inflammatory bowel disease providing inspiration, education and deep community. I am Professor of Gastroenterology and UKRIFLF. I also run a lot.
Videos
Why do people with Crohn's and Colitis flare? This is the fundamental question we set out to answer when we started the PREdiCCt study in 2016. On Tuesday, the first major results will be published in Gut Journal We wanted to look beyond just the clinical data. We focused on the environment: diet, lifestyle, exercise, sleep, and stress. By combining these factors with the microbiome and genetics, we aimed to understand the true drivers of disease activity over time. This has been a decade in the making. We recruited 2,629 patients across 49 adult and pediatric sites before the pandemic halted recruitment in March 2020. Since then, our team has been busy assimilating years of follow up data. Most participants have now been followed for over four years. In this video, I talk through the background and design of the study. It represents a massive collective effort from clinical trials units, statisticians, and project managers. Most importantly, it represents the dedication of the people living with IBD who gave their time to this research. Our goal is to provide the evidence needed to help patients stay in deep remission and to help clinical teams provide better, more personalized care. I look forward to sharing the findings with you this week. Institute of Genetics and Cancer The University of Edinburgh NHS Lothian Nathan Constantine-Cooke PREdiCCt Beatriz Gros @PlevrisN UK Research and Innovation
Charlie Lees16,215 views • 5 months ago
One of the most common questions in any IBD clinic is: What should I eat? Beatriz Gros, consultant gastroenterologist and researcher, shares the landmark dietary results from the PREdiCCt study, now published in Gut. We studied the habitual diets of over 1,000 patients in remission for up to four years to find clear answers. While we found no consistent signals from fiber or ultra-processed foods, we identified a significant association between meat intake and flare risk in ulcerative colitis. This research provides a much-needed evidence base to help clinicians and patients make informed choices about diet and long-term disease management. Watch the video to learn more about how diet influences IBD flare risk.
Charlie Lees15,437 views • 5 months ago
Managing Crohn’s in 2025: what I actually do in clinic In 8 minutes I walk through a data-driven roadmap: • Early induction for mild disease (budesonide/enteral nutrition) • When biosimilar adalimumab still wins—and when it doesn’t • Why IFX + AZA remains my go-to for fistulising CD • Post-anti-TNF: choosing between risankizumab and upadacitinib • Why I’ve ditched high-dose escalations in favour of smart combos If you treat IBD, grab a coffee and watch the playbook unfold. Video & cheat-sheet below. 👇
Charlie Lees13,089 views • 1 year ago
Positioning of drugs in Crohn's disease ___ 1. Start effective therapy early This means at diagnosis in the vast majority of patients. Don’t make patients earn their way onto an effective drug. And use your best drug first. Please do not “save it in case you need it later”. ___ 2. Which of our effective therapies should you start? This matters less that just starting. Think holistically with a patient-centered approach. Age, co-morbidities, extra-intestinal manifestations, pregnancy, etc all important. Consider efficacy - speed of onset, mucosal healing, durability of remission - and safety. Mode of delivery - intravenous, subcutaneous, oral - is important. But comes after patient factors, efficacy and safety. Access issues will predominate for many. Use what you have. Use what you know. Just use an effective drug. ___ 3. Use a treat-to-target approach Without labouring the points around STRIDE-2, I’ll put it very simply: - monitor, monitor, monitor act on the results of the monitoring. Don’t keep going with a therapy that isn’t working. ___ 4. Know when to dose optimise versus switch Optimising anti-TNF is often a good ploy. But do it properly and don’t wait too long. Double the dose, shorten the frequency and wait 2-3 cycles. If it isn’t working then (objectively), switch out of class. With ustekinumab, I would no longer dose optimise, but rather switch a partial responder to risankizumab. ___ 5. Active disease is more dangerous than any drugs Two bits of data this year show this: i) In Profile, patients in the step-up group had twice as many adverse events as those in the top-down group. Most of this was because of flaring Crohn’s disease - including hospitalisations for severe disease - but there were also fewer serious infections in the top down group. And that was with combination infliximab and azathioprine. ii) Two meta-analyses of the harms from placebo in RCT’s show a very clear signal. Active Crohn’s disease and UC, when left untreated for even a number of week, is associated with increased toxicity. More on this later. ___ 6. Avoid steroids The majority of patients with Crohn’s disease can be managed effectively now without steroids. They will still have a role in sick patients, to bridge to some therapies, and a course of budesonide in mild to moderate ileal Crohn’s disease is often useful. However we have better strategies now, including using JAK inhibitors in place of steroids. We are increasingly using a short course to (re)capture response to a biologic or keeping the JAKi going in combination at a low dose. ___ 7. Other treatment modalities Surgery and nutritional therapy are particularly important. ___ 8. Changing the natural history of Crohn’s disease Disease modification is the end result when following these principles. We see it in the Edinburgh IBD clinic. A decade since we switched to a top-down strategy for Crohn’s disease and our patients have better disease control, less surgery and fewer hospitalisations. Clearly we still have work to do, but this is major progress.
Charlie Lees15,650 views • 1 year ago
Have you ever noticed that the lifestyle advice we give to IBD patients is often the same as general health advice? It's a simplifying realisation. Here are my six core pillars for a healthy lifestyle, whether you have IBD or not: ________ 1. Sleep Well Aim for 7-8 hours of actual sleep per night, not just time in bed. I use a Whoop to track mine, and I've learned I need an extra hour in bed to hit my sleep target. Measure your sleep - you might be surprised. ________ 2. Eat Right This sounds simple, but it's challenging in our current food environment. Any urban dwelling human spends most of his days dodging armies of delivery bikers bringing tepid fast food to people’s sofas. A whole ecosystem has come into existence to solve a problem we did not have. Here's what to aim for: • Cook from fresh ingredients when possible • Eat mostly plants +/- some good quality meats • Avoid processed foods where possible • Cook with healthy oils • Limit sugary foods • Try to eat communally - it's how we've evolved to eat. This is the cornerstone of the Mediterranean diet. If you have IBD, particularly small bowel Crohn’s disease, then much of this advice is turned on it’s head, as we look to limit fibre intake. I would say consult with your dietitian but we both know full well that this is a luxury that few people have, especially in the UK. ________ 3. Manage Stress Stress is unavoidable, so develop a system to handle it. This could be: • Talking to a friend • Journaling • Exercising • Meditating or practicing breathwork Find what works for you to sit with your emotions and deal with stress effectively. I have found a combination of exercise, journaling, and regular therapy works best for me. But like everyone, very much just a work in progress. In an ideal world I would recommend that IBD patients speak to a psychologist but this is something very few are able to access. One day maybe … until then hopefully these small pieces of advice are helpful. ________ 4. Exercise Regularly In my opinion, there's no better medicine than exercise. Aim for a mix of: • Cardio • Strength training • Stability/mobility work (especially important as we age) If you are new to exercise start slow and find something that you a) enjoy and b) can commit to on a regular basis. It might start with a 30 minute brisk walk each lunchtime. Those with dogs have a definite head-start here! There is some emerging evidence that exercising regularly may help patient with IBD stay in prolonged remission and avoid flares! ________ 5. Get Outside Spend time outdoors, preferably in nature. There's something uniquely beneficial about being in open spaces, living as we're meant to. ________ 6. Nurture Relationships Foster close friendships and family ties over time. Human existence is meant to be shared. In our increasingly tech-driven, solitary lives, it's crucial to remember the importance of human connection. These pillars can help you stay well physically, mentally, and spiritually, whether you're already healthy or living with a chronic illness like IBD. Many of these practices, particularly diet, stress management, and exercise, are great for your gut microbiome - which is especially crucial for those with IBD. ________ Remember, there's no one-size-fits-all approach. My hope is that you might find something in here helpful, wherever you are in your journey through life with, or without, IBD.
Charlie Lees12,537 views • 2 years ago
No more content to load