An integrative approach to Inflammatory Bowel Disease

By Dr. Alexandra Shustina, DO

Crohn’s Disease and Ulcerative Colitis are both chronic, inflammatory, autoimmune disorders They can present with diarrhea, constipation, abdominal pain, weight loss, rashes and joint pain.   Crohn’s disease can occur anywhere in the digestive tract, while Ulcerative Colitis is localized to the colon.  They can both present with abdominal pain and diarrhea.  Although the gene for Crohn’s and Ulcerative Colitis has not been found, genetics plays a definitive role (1). First degree relatives are far more likely to be affected. Environment also plays an important role. In the far east, with a traditionally healthy, anti–inflammatory diet rich in fish and fermented foods, Inflammatory Bowel Disease was very rare. Since the spread of the American diet far and wide and the westernization of the world, there has been a significant rise in the rates of Crohn’s disease and colitis in these areas (2).

Most of us have heard of the gut microbiota or the microbiome, the bacteria living in and outside of our bodies. We have learned that different populations of bacteria are seen in Crohn’s disease and Ulcerative colitis and these are distinct from “normal” guts (3). In fact, the increased and dysregulated immune response or autoimmunity has been suggested to be triggered by a bacterial or viral infection.

There also appears to be a psychosocial component involved. This is not surprising, considering the importance of the brain and gut connection. Emotional stress has been suggested to be a trigger for the disease and associated with flares. Higher rates of depression and anxiety are seen in in Inflammatory Bowel Disease patients. (4).  Patient’s with Ulcerative colitis have a decreased “happy response” to positive exposure (5). Patients with both Crohn’s and Ulcerative Colitis perceive their relationships with their parents as relatively negative compared to patients without the disease (6).

Conventional therapy targets symptoms and decreases inflammation and immunity. It can be effective and sometimes necessary. It is important, however to find the root cause. Leaky gut is usually involved in many digestive disorders including Inflammatory Bowel Disease (7). Eating an organic diet, often avoiding gluten, dairy, processed foods, and refined sugars is a great start. Managing stress is a vital part of the healing process. Emotional stress can worsen leaky gut, alter the gut microbiome, and increase inflammation. Visceral manipulation has been particularly effective in managing inflammation, improving immunity, and balancing emotional stressors. Probiotics have been particularly useful in Ulcerative Colitis (8). Bovine colostrum (9) and glutamine (10) can help repair the leaky gut, and mixed Chinese herbal combinations can improve inflammation (11).

References

1. Van Heel, D. A. et al. Inflammatory bowel disease susceptibility loci defined by genome scan meta-analysis of 1952 affected relative pairs. Hum. Mol. Genet. 13, 763–770 (2004)
2. Ng, S.C., Tang, W., Ching, J.Y. et al, Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohns and colitis epidemiology study. Gastroenterology. 2013;145:158–165 e2.
3. Knights D, Lassen KG, Xavier RJ: Advances in inflammatory bowel disease pathogenesis: linking host genetics and the microbiome. Gut. 2013, 62: 1505-1510. 10.1136/gutjnl-2012-303954.
4. Agostini A^1,2, Ballotta D³, Righi S³, Moretti M¹, Bertani A⁴, Scarcelli A⁴, Sartini A⁴ , Ercolani M^1,2, Nichelli P³, Campieri M, Benuzzi F³. Stress and brain functional changes in patients with Crohn’s disease: A functional magnetic resonance imaging study. Neurogastroenterol Motility. 2017 Oct;29(10):1-10. doi: 10.1111/nmo.13108. Epub 2017 May 30.
5. Agostini A¹, Filippini N, Cevolani D, Agati R, Leoni C, Tambasco R, Calabrese C, Rizzello F, Gionchetti P, Ercolani M, Leonardi M, Campieri M. Brain functional changes in patients with ulcerative colitis: a functional magnetic resonance imaging study on emotional processing. Inflamm Bowel Dis. 2011 Aug;17(8):1769-77.
6. Agostini A¹, Rizzello F, Ravegnani G, Gionchetti P, Tambasco R, Ercolani M, Campieri M. Parental bonding and inflammatory bowel disease. Psychosomatics. 2010 Jan-Feb.
7. Hollander D, Vadheim CM, Bretholz E, Petersen GM, Delahunty T, Rotter JI. Increased Intestinal Permeability in Patients with Crohn’s Disease and Their Relatives: A Possible Etiologic Factor. Ann Intern Med. ;105:883–885.
8. Bibiloni R, Fedorak RN, Tannock GW,Madsen KL, Gionchetti P.,Campieri,M, Desimone C, Sartor RB. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. American Journal of Gastroenterology. 2005 July;100(7): 1539–1546.
9. Playford RJ, Floyd DN, Macdonald CE, et al Bovine colostrum is a health food supplement which prevents NSAID induced gut damage. Gut 1999;44:653-658.
10. Math Eq , M. Carè, F. Falco, C. Spanò, R. Bernardi, G. Gasbarrini. Effect of oral glutamine of intestinal permeability and nutritional status in Crohn’s disease. Gastroenterology , Volume 108 , Issue 4 , A766.
11. Langmead, L. , Dawson, C. , Hawkins, C. , Banna, N. , Loo, S. and Rampton, D. S. (2002), Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study. Alimentary Pharmacology & Therapeutics, 16: 197-205.