There are several inflammatory bowel conditions that involve either or both the small bowel and colon (large bowel). Ulcerative colitis, Inflammatory bowel disease (IBD) and Crohn’s Disease are the three most discussed. We will interchangeably use them for this discussion. Symptoms can vary in severity from mild to severe. Since any section of the GI tract can be affected, symptoms may differ from person to person just based upon the location of the involvement. Obvious symptoms include abdominal pain and cramps, persistent diarrhea, fever, rectal bleeding, constipation, urgent need to move bowels (has associated pain with this), loss of appetite, weight loss, fatigue, and night sweats. The less obvious symptoms include acne, rosacea, skin eruptions, irregular cycles, brain fog, agitation, mood disturbances. These symptoms are the trickle-down effect from a severely “leaky gut.” The epidemiology of the disease tries to provide windows to see into the possible mechanisms that cause it. In functional medicine all facets are considered including genetic, environmental (toxicities and deficiencies), dietary, psychosocial, energetic, and infectious triggers. Thus far we know that higher rates of IBD are seen in northern, industrialized countries. Onset is usually before age 35. Minnesota has been purported to have the highest rates in the states. There is a higher prevalence among Caucasians and Ashkenazic Jews, although other racial groups are rising which is possibly indicates that environmental factors are becoming more of a contributor than genetic influence. Inflammatory Bowel Disease has multiple genes involved and as our gut bacteria has been implicated in so many illnesses and conditions thus far, IBD is no exception. There is a dysfunctional mucosal immune response to normal commensal bacteria in the pathogenesis of IBD. One possibility for this trigger includes a chronic inflammatory response that started by an infection with a particular pathogen or virus causing a defective mucosal barrier. As a reminder, pathogens can include bacteria, fungi, parasites, and even energetic exposures to harmful EMF waves and our ever-growing electrosmog.
For many sufferers, the exact trigger is hard to identify because of the many insults and environmental toxicities that exist in an industrialized world. In the US we have many pollutants with heavy metals, organic waste, fertilizers, cement dust and smoke in addition to the EMF smog. We could also reasonably conclude that there is a cumulative effect of this burden on the human body. Some of the food we consume has been sprayed with pesticides and grown in minerally depleted soils. The processing afterword with our grains, snacks, cereals, and junk food has extraordinarily little nutritional content and high levels of synthetic chemicals. The gut is a large area of our immunological defense strategy. It is weighing in, evaluating, and processing all these compounds and trying to absorb what is needed for nutritional survival while kicking out, destroying, and eliminating those times which are harmful to us. Stress has been purported to be a factor (imagine being in a constant battle zone in your gut) as well as certain drugs in the anti-inflammatory (NSAIDS) category. In the US we give the gut a great deal of digestive stress!
How do we diagnose IBD? The gold standard is via a direct look with a colonoscopy. To the naked eye sections of the small or large intestine may appear red. In severe cases there may be aphthae, ulcerative pockets, or frank bleeding in severely destroyed sections. Microscopically the intestinal lining differs from the small to the large bowel, but they both contain a microscopic “shag carpet” of microvilli that behave as the absorbing surfaces to help absorb our nutrients and work the immune cells of the gut. When IBD or Crohn’s is severe, those microvilli are destroyed, can no longer work, and any absorption of nutrients will not happen. We also must remember all the billions of gut bacteria and yeast that are needed for our survival in the gut, and they also cannot survive in the inflamed bloody areas. And if we need the gut microbiome to aid in our digestion and immunity, no wonder we are left with an “autoimmune” and nutritionally deplete situation. I propose that the normal intact gut system with no toxicity and completely clean food will not “attack itself” (which is the theory of autoimmunity).
An integrated physician (MD) has the full array of diagnostics and treatments in the medical arsenal. There is a place for the biologics and disease modifying antirheumatic drugs (DMARDS). If the intestinal tract is severely affected with ulcerations and bleeding, the best dog comes to the fight. I often coach patients and parents that you cannot bring a water-pistol to a forest fire! These pharmaceutical options can literally be lifesaving when all else has failed and the patient is decompensating faster than a foundational approach is taking hold. Some of the more well-known medications are Humira, Entyvio, Stelara, Cimzia, and Tysabri. There are much older agents that shut down immunity altogether and are less specific to the gut lining immunology. Steroids and methotrexate are exactly these types of medications. There are some budding opportunities with the use of LDN (low dose naltrexone) as well as cannabis in the form of CBD and THC.
After severity has been determined and medications are ruled in or out of the equation it is time to really work on the functional pieces of the healing wheel. The tactics I will share take dedication, time, and persistence. The very first foundational piece is diet. This is not as simple in an IBD patient. If there is a food allergy or intolerance this is toxic to the gut! This must be tested as soon as possible. Timing will be important such that if steroids are on board OR the gut is highly inflamed, results can be skewed; but it is well worth the investment to craft a specific diet catered to the patient’s own gut and microbiome. A severe patient who is bleeding and losing weight may almost have to bypass digestion and go on an elemental diet. There are several good companies making these, and in essence, an elemental diet has liquid nutrients in an easily assimilated form. It is usually composed of amino acids, fats, sugars, vitamins, and minerals at the base levels. It may have to be fed directly to the unaffected gut or even through an intravenous format. For most other patients, however, start with the elimination of all processed foods, rancid oils, wheat, cow’s milk, cruciferous vegetables (such as broccoli, brussels sprouts, cabbage, cauliflower, radish), corn, yeast, tomatoes, citrus fruit, and eggs. There are proponents of a low sulfur containing diet and in that strategy patients stay away from beef, pork, eggs, cheese, whole milk, ice cream, mayonnaise, soy milk, mineral water, nuts, cruciferous vegetables, dried fruits, sodas and alcoholic beverages containing sulfites (such as wine). The carbohydrates in the diet recommend easy to digest ones such as those in the organic vegetables, rice, and yams but avoid all grains and products made from grains (including sweeteners other than honey), legumes, potatoes, lactose-containing dairy products, and sucrose. The best nutrition comes from a well-balanced diet that is LOW in saturated fat, refined sugar, and animal protein, and HIGH in organic fruits and vegetables, fish, fiber, and omega-3 fatty acids. At first this approach seems overwhelming, but once some calmness is restored the gut can start its healing process. The bacteria can regenerate. Weight and nutrients can be maintained.
For children and adults lifestyle and energetic work is imperative to heal and maintain remission. Smoking and alcohol should be avoided at all costs. Common personality traits amongst IBD sufferers included neuroses and perfectionism. There is a higher proportion of patients with alexithymia, the inability to be emotionally aware or to be able to describe emotions experienced by oneself or others. By nature of the disease with a strong gut-brain axis, these patients are prone to depression. Because of an integral mind - body connection energetic and therapeutic work needs to be part of the routine. Exercise can help reduce stress and stay healthy. Reducing stress reduces inflammation. Mind-body approaches such as yoga, meditation, tai chi, or hypnosis can quiet the gut as well. Finding an energetic practitioner who understands the interplay between the biofield, chakras, and influences of those energies on the total body harmony will certainly advance the healing of the gut with the understanding that the gut is part of the manifestation of the body, mind, and spirit behaving as one whole unit.
We need to mention the supplemental approaches to augment the foundational dietary approach. Dr. Joel Wallach subscribes to the deficiency theory of many of our disease states. Certainly, a nutrient poor diet in our American food supply may be to blame. For the Crohn’s patient he suggests folic acid, vitamin A as beta carotene, B12 via injection, and vitamin C pushed to the levels one could tolerate until diarrhea. He also recommends calcium and magnesium daily with selenium, chromium, and zinc at 50 mg. If you note his concentrations and amounts, these are tremendous levels required for healing. These should be managed by a physician. D3 and B6 is also recommended by most naturopathic and medical dieticians. We also want to consider replacing gut flora that has been stripped in the process of the destruction of the villi. Caution should be used because of prebiotic “food” may cause a lot of gas and bloating. Bifidobacterium, Lactobacillus, and Streptococcus and Saccharomyces boulardii have traditionally been recommended but as the science of the gut microbiome is revolutionizing our understanding of our disease states, we will certainly be learning more sophisticated ways to dial in and supplement to our own personalized microbiome profile. I believe that we will shortly be able create specific probiotics that are fine-tuned to our own unique needs. Many good plant-based foods can help us get good prebiotics and probiotics without having to buy them in formulations. Finally, there are some herbal approaches with Boswellia serrata (in Indian frankincense), Curcumin, oral aloe vera gel, and Pistacialentiscus resin (a.k.a. mastic gum), green tea, and marshmallow.
Crohn’s Disease, ulcerative colitis, and IBD and associated gut disorders are within your power to modulate and create remission. The integrative and functional approach is necessary. It requires a lot of work and education, so stick closely to an integrative physician and a good nutritional coach.