Inflammatory Bowel Disease

Kelly Brown
BSc, ND
https://www.drkellybrown.ca
11 September 2014

Language English

Inflammatory bowel disease (IBD) causes extensive inflammation in the gastrointestinal tract causing multiple symptoms, most commonly chronic diarrhea. IBD has periods of flare ups during which times the symptoms come and go. IBD is comprised of two separate conditions of the GI tract, Crohn’s disease and Ulcerative Colitis (UC). Both of these conditions cause extensive inflammation of the GI tract but also can often be distinguished by different manifestations.

Crohn’s disease is intermittent, causing flare ups during certain periods of life. Typically it initially occurs in the 20s and again in the late 40s or early 50s. Crohn’s disease appears in the small intestines 80% of the time. The inflammation is scattered throughout the intestines with patches of intestine in between that show no inflammation at all. Crohn’s often causes fistulas or abscess, which are holes that have formed through the intestines. Due to the inflammation, absorption of nutrients is decreased, resulting in diarrhea ^[1]. Ulcerative colitis also consists of inflammation but is found in the colon of the digestive tract. It always starts at the rectum and works upwards. The inflammation of the colon walls causes ulcers in the colon which creates bloody diarrhea. Both Crohn’s disease and UC will cause abdominal cramping or abdominal pain.

**Differences Between Crohn’s Disease and Ulcerative Colitis**
Crohn’s Disease	Ulcerative Colitis
Fistula’s present	No fistulas. Ulcers occur
Diarrhea and abdominal cramping	Bloody Diarrhea and abdominal cramping
Occurs in upper GI tract	Occurs in the colon
Inflammation in patches	Inflammation is uniform

IBD is a combination of these two diseases causing a variety of gastrointestinal problems. Having IBD can also cause multiple associated conditions not occurring in the gut. Malabsorption of nutrients results in mineral deficiencies such as iron deficiency (anemia), Vitamin B12, magnesium, and/or calcium deficiency. This can lead to multiple health problems. One such problem is extreme fatigue. Often arthritis and inflammation can appear in the body as a result of IBD. This can occur in large joints, in the eyes, the stomach and so on. Liver diseases also occur in 3-5% of patients ^[1]. Management of IBD involves symptomatic medication therapy as well as medication to decrease inflammation. Symptomatic medication would include pain killers such as acetaminophen (Tylenol ®), and two different types of diarrhea medications. Arthritis or inflamed eyes would also be addressed separately. Other anti-inflammatory and special immunosuppressive medications can also be prescribed, usually by a Gastroenterologist. Examples of these are, Corticosteroids, 5-Aminosalicylic Acid, and others respectively. The immunosuppressive drugs are to help patients who do not respond to corticosteroids^[1]. Naturopathic Medicine can be extremely beneficial to patients with IBD. Anti-inflammatory herbs, supplements, dietary and lifestyle changes are all used in treatment. Research is rapidly growing on IBD including research on dietary and lifestyle modifications.

Probiotics

Probiotics have recently had a lot of media attention! They are often talked about in yogurt advertisements or supplement commercials claiming to be a cure for all of one’s gut problems. What probiotics essentially are, are the “good” bacteria that live in your gut. The bacteria in the digestive system helps break down food to extract nutrients to be used in the gut, throughout the body, or to be eliminated ^[2]. The probiotics in the gut also help with immune function and with decreasing inflammation. This is done by helping with the tissue of the gut in secretion (dispersing nutrients), barrier function (warding off infection) and antibacterial effects. Probiotics can also blunt the inflammatory effects of certain cells, called Tcells, which are present in the inflammation in IBD ^[3].

Probiotic supplements have one or a variety of different bacteria in them. The most common are Acidophilus lactobicillus, and Bifidobacterium. A combination probiotic is the best way to treat IBD. Using a probiotic that only contains one of these bacteria may not result in a significant change. By supplementing with bifidobacteria assists in remission of Ulcerative colitis and prevention of relapsing ^[4]. Preliminary studies show that supplementing with bifidobacteria may be more effective than conventional treatment alone and beneficial in managing ulcerative colitis. Lactobacillus also has multiple studies involving supplementation and IBD. A small study of 20 patients showed that a bacterial probiotic combination which contained lactobacillis resulted in 15 of the 20 patients in remission ^[5]. Based on another study, 77% of patients who took a combination probiotic with IBD had an induction of remission ^[6]. This indicates that the patients started the probiotic while they were experiencing a flare up with symptoms, and then were changed to a state of remission. Based on this evidence it is very important for patients with IBD to take a probiotic containing lactobacillus and Bifidobacterium at high doses. This will keep IBD in remission and decrease the need for any medications.

Natural Anti-Inflammatories

The two most common anti-inflammatories in naturopathic medicine are fish oils (Omega 3 essential fatty acids) and Quercetin. Both of these supplements are used in reducing inflammation in the gut of patients with IBD.

Fish oils

Along with probiotics, fish oils are a very popular supplement. Although, they have been around for a while, most of the baby boomer generation can remember their grandparent’s cod liver oil supplements. Buying and using oils for treatment of conditions can also be very confusing. There are a lot of products on the market with, some stating to have Omega 3s and others having Omega 3, 6, and 9. For treating IBD, the studies show that using the fish oils that contain only Omega 3s can have many beneficial effects. Omega 3 fatty acids are derived from the fish oils. In a study of 78 patients who had Crohn's disease, fish oils decreased the degree of inflammation by decreasing what is called inflammatory prostaglandins. These inflammatory prostaglandins tend to be increased in patients with Crohn's disease ^[7] and therefore show and increase in inflammation in the gut. Omega 3s derived from fish oils are helpful in decreasing prostaglandins and are confirmed to help in the treatment of IBD.

Quercetin

Quercetin is a plant pigment found in many plants and foods. It can be found in onions, St.John’s wort, red wine, and Ginkgo biloba. It is called a favonoid. Flavonoids are the molecular structure that can reduce inflammation in many conditions. Quercetin specifically contains multiple enzymes which help in the reduction of inflammation in the body. It used as a safe systemic anti-inflammatory for most inflammation based diseases ^[8]. In ulcerative colitis, when inflammation occurs there is an activation of cells called mast cells. This is not seen in Crohn’s however. Mast cells are further damaging to the gut. Quercetin has been studied to help in stabilizing these mast cells, so they don’t become destructive to the gastrointestinal lining ^{[2, 9]}. Querctin showed a reversal of inflammatory effects as well as healing of any lesion in the gut^[10]. Quercetin supplementation has been demonstrated to have a major role in treatment of IBD. Taking high dose of Quercetin supplements before meals will help patients achieve great outcomes in managing IBD.

Diet

Diet is a major complementary “treatment” to consider because IBD occurs in the gastrointestinal tract and so does digestion of food. It is also a safe and economical way to keep IBD in remission. A few different dietary modifications have been studied in IBD. The most recent research is on removing gluten from the diet. Gluten is a protein found in wheat. It is found in breads, pasta, and baked goods. It can also be found in rye, barley, spelt, and hidden in salad dressings, soy sauce, processed meats and many other products. The recent research was conducted on 1647 patients with inflammatory bowel disease. In this large number of patients who attempted a gluten free diet; the majority of them had improvement or remission ^[11]. Another study used an elimination diet to see how long Crohn’s disease would stay in remission. Elimination diets are associated with foods that cause intolerances; most commonly, these are wheat, dairy, eggs, and corn. By eliminating certain foods, long term remission was found in 1/3 of the participants in the study ^[12]. Diet and effects on ulcerative colitis were also studied on 191 patients. Diets that were high in alcohol and processed meats showed an increased likelihood of UC relapsing ^[13]. Eliminating gluten, alcohol, processed meats, and any food intolerances from the elimination diet will help in the management of IBD. Dietary changes can be determined by a Naturopathic doctor and often will help in lifestyle adjustment.

Conclusion

Western diet and lifestyle are demonstrating an increase in IBD in North America, United Kingdom and Scandinavia^[2]. Genetic factors are also shown to play a role in the disease. Crohn's disease seems to be more associated with genetics than Ulcerative colitis^[1]. Naturopathic medicine can play a major role in management and remission of IBD. As shown here a few supplements and nutrition can have an impact. Having the proper gut flora (gut bacteria) demonstrated a decrease in any inflammation and allows longer periods of remission. This is achieved by supplementing with the proper probiotcs.

Fish oils are also known to show a significant decrease in inflammation throughout the body and in the gastrointestinal tract of people with IBD. Quercetin is an important treatment to help decrease inflammation and further damage to the gut. Finally reviewed in this article is the treatment of IBD with elimination diets. With these dietary modifications IBD was shown to have long term remission. Due to the growing rise of IBD it is important to see a doctor in diagnosis of this disease. If experiencing any symptoms such as; abdominal cramping, blood in the stool, fatigue (due to malabsorption), weight loss, loss of appetite, and/or rectum fissures, please see your doctor. Research is always growing on IBD and new studies are being released on supplementation and dietary changes to help with management and discovering causes of the disease. If diagnosed with IBD it is important to seek help from your medical doctor, naturopathic doctor, and support of family and friends, to get to a state of remission.

References

1. Beers, Mark; et al. “The Merck Manual of Diagnosis and Therapy” Eighteenth Edition. 2006; 149-159.
2. Prousky, Jonathan. “Principle and Practices of Naturopathic Clinical Nutrition” First Editon. 2008; 161-167.
3. Boirivant M, Strober, W. “The Mechanism of action of probiotics” Curr Opin Gastroenterol. 2007; 23:679-92.
4. Ishikawa, H.; et al. “Randomized controlled trial of the effect of bifidobacteria-fermented milk on ulcerative colitis” J Am Coll Nutr. 2003 Feb; 22 (1):56-63.
5. Gionchetti, P; et al. “Impact on the composition of the faecal flora by a new probiotic prepration: preliminary data on maintenance treatment of patients with ulcerative colitis” Aliment Pharmacol Ther. 1999 Aug: 13 (8):1103-8.
6. Bibiloni, R; et al. “VSL #3 probiotic-micture induces remission in patients with active ulcerative colitis” Am J Gastroenterol. 2005 Jul; 100 (7):1539-46.
7. Belluzi. A; et al. “Effect of an enteric-coated fish oil preparation on relapses in Crohn’s disease” N Engl J Med. 1996; 334: 1557-60.
8. Hoffmann, David. “Medicinal Herbalism, The Science and Practice of Herbal Medicine” 2003; 100-105.
9. Raithel, M; et al. “Release of mast cell tryptase from human colorectal mucosa in inflammatory bowel disease” Scand J Gastroenterol. 2001; 36:174-79.
10. Dodda, D; et al. “Protective effect of quercetin against acetic acid induced inflammatory bowel disease (IBD) like symptoms in rats: Possible morphological alterations” Pharmacol Rep. 2013. Feb; 66(1): 169-73.
11. Herfarth, et al. “Prevalance of a Gluten-free diet and improvement of clinical symptoms in patients with inflammorty bowel disease” Inflammatory bowel Disease. 2014 May 23. (Epub ahead of print)
12. Candy, S; et al. “The value of an elimination diet in the management of patients with ulcerative colitis” S Afr Med J. 1995;85:1176-79.
13. Jowett , St; et al. “Infulence of dietary factors ont he clinical course of ulcerative colitis: a prospective cohort study” Gut 2004;53: 1479-84.

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