Cory Greenberg was just about to start a professional cycling race when he noticed the first signs of the chronic illness that would change his life. While using the toilet before a cycling event, blood and discomfort marked the start of the young Los Angeles athlete’s battle with ulcerative colitis.
“I realised something wasn’t right, but I finished the race,” Greenberg tells Happiest Health during a 70-minute conversation from Los Angeles.
Having battled the gastrointestinal condition since its diagnosis in his early 20s, Greenberg, now 35, looks back at his struggles with mucus in stool, bloating and abdominal pain. From his first face-off with it, he says he has learnt to manage the problem.
Difficult to diagnose
The first red flag was when his relatives mentioned that digestive problems ran in his mother’s side of the family. But when he visited a general physician, he was diagnosed with and treated for haemorrhoids. ” I was relieved and went on with my life normally [without] listening to my symptoms,” he says.
This is a common misdiagnosis, says Dr Tuhin Mitra, associate consultant gastroenterologist at Fortis Hospital, Kolkata. “Ulcerative colitis can be mistaken for other conditions such as piles or haemorrhoids,” he says adding that this happens if the individual’s medical history is not taken in detail, or an in-depth visual examination is not done.
However, the time came when Greenberg could no longer ignore his symptoms. After a trip to the gastroenterologist for a sigmoidoscopy (a test that looks at the rectum and lower part of the large intestine,) he was diagnosed with ulcerative colitis.
What is UC?
Ulcerative colitis is a chronic gut disorder that affects the colon (large intestine) and the rectum. The exact cause of UC is still unclear, but a combination of factors is responsible. These include genes, environmental triggers as well as an abnormal immune response.
“Ulcerative colitis is an inflammatory bowel disease in which one’s own immune system acts against the gut which leads to symptoms of inflammation and rectal bleeding,” Dr Mitra explains.
It is considered an autoimmune disease, in which the immune system attacks the gut tissue. This leads to chronic inflammation of the colon and the rectum.
As of 2023, five million people worldwide are estimated to have UC and their number is only increasing.
“Ulcerative colitis can be diagnosed at any age. It can occur in childhood and some people can also develop the condition later in life,” Dr Mitra says.
“We first start by taking a detailed history of a person to understand the symptoms such as the frequency of bowel movement and the consistency of the stool,” he says.
Once this is done, there is a visual examination of the large intestine using colonoscopy to detect any ulcers.
“The diagnosis is [confirmed] by taking a biopsy of the ulcer and visualising it in the laboratory,” Dr Mitra adds.
Treating ulcerative colitis
As it is a chronic condition, people with UC remain on medication throughout their lives. Treatment and prognosis depend on the severity and extent of the condition. Medications are given to control inflammation.
“Usually, immunosuppressants in the form of steroids are given along with other biologics to manage the symptoms,” says Dr Mitra.
The diagnosis was just the beginning for Greenberg. Suddenly his cycling ambitions collided with a challenging new regimen of enemas, suppositories, and powerful biologics. “As a young person using an enema or suppository, that’s a big change in your lifestyle and something that you don’t want to tell people about,” says Greenberg adding that it wasn’t something he talked about with his teammates.
Yet he persevered, pursuing his professional goals while privately managing the condition. For a time, the illness seemed under control, barely affecting his rising career. “I continued to travel [to races] and started to gain some notoriety in the bicycle world. My goal of becoming a professional was drawing closer,” he recalls.
But the reprieve was brief. Stress and inattention to his health during his college years proved disastrous. “I remember getting tired and feeling anaemic. I couldn’t eat. It got to the point where the pain was so debilitating, I could no longer go to school, and I was sleeping in the bathroom,” says Greenberg.
He was hospitalised and diagnosed with pancolitis— a severe form of ulcerative colitis where the entire colon is inflamed.
The serious flare was a turning point. Leaving the hospital determined to take charge of his health, Greenberg approached ulcerative colitis as he would his training —as a focused athlete.
“I needed a coach (in my case, my gastroenterologist) and a training plan (a treatment plan),” he explains. He set out to learn as much as he could about the condition, working with nutrition and sports experts, and those who had expertise with autoimmune diseases.
Within six months Greenberg was racing nationally again. And in two years, he had turned professional, but keeping gut health his top priority.
Medicine as the foundation
Today, Greenberg is free of symptoms of UC. In addition to medication, he focuses on a holistic approach to his condition, one that involves nutrition, regular exercise, and stress management.
The medication given by the gastroenterologist is only the foundation to treat the disease. But we need to build on it, he says.
To maintain his condition, he takes a monthly biologic to control inflammation. “You should also be looking at other aspects like nutrition and stress as all these other elements play a role,” he says.
Envoy of healthy gut
Greenberg also delved deep into his gut by testing his microbiome to see the type of bacteria living in there. Aided by this information he tailored his nutrition to allow the good bacteria to thrive.
“I had my last colonoscopy two years ago and it was a perfectly healthy colon,” says Greenberg.
Currently he plays an active role in helping other individuals with inflammatory bowel disease (IBD) and spreading the knowledge on what he has learnt about his condition.
“[In] 2024, I’m starting my own team that’s focused on gut health awareness”, says Greenberg. He hopes to take on some bold international cycling events to challenge the narrative and show what is possible with gut health-related issues.