Inflammatory Bowel Disease

What is it and what causes it?

Inflammatory Bowel Disease (IBD), as its name implies, is a chronic inflammatory condition affecting the digestive system. There are two main types of IBD, Crohn’s disease (CD) and ulcerative colitis (UC). Both types of IBD can be debilitating, even life-threatening, and have similar symptoms that may include: diarrhea, fever,  fatigue, abdominal pain, abdominal cramping, blood in the stool, poor appetite, and unintentional weight loss. These symptoms commonly occur in flares with periods of near or complete remission in between. The inflammation that occurs with IBD causes severe damage to the digestive tract or lining of the digestive system. In Crohn’s disease, damage can occur anywhere in the digestive tract, while with UC the damage is limited to the colon. UC is also typified by continuous inflammation of the colon whereas intestinal damage from CD is usually mixed in between healthy areas. UC also only affects the innermost layer of the intestine, while CD can occur within all layers. Typically a diagnosis of IBD is confirmed after damaged tissues are visually identified during a colonoscopy, endoscopy, or other imaging procedures. The appearance and location of the damage along with a microscopic examination of damaged tissue samples can help provide more information and differentiate between UC and CD. Around 10% of IBD cases display some aspects of both CD and UC and are called indeterminate colitis.

The exact cause of IBD remains unknown. However there are several known risk factors that provide clues about the root causes. These risk factors include: family history of IBD, age, race/ethnicity, cigarette smoking, chronic use of non-steroidal anti-inflammatories, and living in a more industrialized portion of the world. Most researchers agree that the mechanism through which the damage occurs is an altered and inappropriate immune response. This means IBD is likely a form of autoimmune disease although specific antibodies for IBD have not been identified and there is no blood test to diagnose or monitor severity IBD effectively (this is not true- calprotectin is a good predictor of severity). The precise cause of this altered immune response is the subject of continued research however most evidence points to a multifactorial origin. The following factors have been associated with IBD and play a significant role in most cases:

• Genetics – As with any immune mediated disease, genes that regulate your immune system are involved. Mutations to specific genes have been associated with IBD and IBD risk is higher in those with a family history of IBD.
• Microbiome – Significant alterations to the bacteria that live within the gut are associated with IBD. These alterations are likely both a consequence and a cause of IBD symptoms. Some research has even hinted that normal gut bacteria may be altered to act as a pathogen in IBD patients.
• Diet – Diets high in animal proteins, fat, and processed foods have been associated with IBD. This type of diet is more common in industrialized nations and may explain the association between IBD and more modern societies. Gluten and other food sensitivities are also common in IBD patients and often play a large role.
• Exposure to pathogens and parasites – Exposure to pathogens and parasites that infect the GI system can both cause and possibly prevent IBD. Early exposure to intestinal parasites may help to educate the immune system to better differentiate between our own tissues and those of potential pathogens. Intentional infection with parasites has even been used as a treatment for some autoimmune diseases. On the other hand, a viral and bacterial infection could also set in motion the abnormal immune response seen in IBD.
• Loss of Intestinal Barrier Function – Also known as leaky gut, damage to the lining of the intestines may also be both a cause and consequence of IBD. When the absorptive surface of the intestines is damaged this allows for greater penetration of pathogens and other inflammatory compounds into the bloodstream and in turn fuels immune dysfunction. The damage that non-steroidal anti-inflammatories and alcohol cause to this lining likely explains their connection to IBD.
• Other Factors – Most people who suffer from IBD developed the disease before they turned 30. The onset of IBD after age 30 is less common and rare after age 60. Stress is also a major factor that contributes to the frequency and severity of disease flares.

Potential complications and traditional treatment

The potential complications of Inflammatory Bowel Disease are wide-ranging and can be very severe if the disease is not well controlled. Perhaps the most feared complication is colorectal cancer (CRC) as individuals with IBD are at increased risk of CRC. The level of risk remains somewhat controversial but the risk appears to rise the longer active disease is present. Inflammation can also spread to other areas of the body, especially during severe flares, and most commonly affects the skin, eyes, bile duct, and joints. Hyperinflammatory states common in IBD flares also increase the risk of blood clots which can cause heart attacks, strokes, and other life-threatening conditions. Damage to the digestive tract itself also increases the risk of complications such as bowel obstruction, malabsorption, malnutrition, ulcers, fistulas, bowel perforations, toxic megacolon, and dehydration.

Traditional treatment for IBD follows the medical and surgical management model. This approach is focused on limiting symptoms and avoiding the most severe complications by utilizing pharmaceutical and surgical options. Many of the medications that are commonly used to treat IBD, such as corticosteroids, impair the immune system, do not correct any underlying cause, and can have significant side effects. Immune suppressing drugs may even increase the risk of cancer. All surgeries have inherent risks, especially those involving the bowel where post-surgical infection rates are elevated. IBD related surgeries often involve the removal of large sections of damaged bowel which can lead to impaired nutrient absorption necessitating the need for specialized diets and nutritional supplements. Severe cases may even require feeding tubes or IV nutrition.

The traditional model of treatment can be effective for some but often leaves patients feeling powerless and fearful of symptom flares, not only because of the symptoms themselves but because of the side effects and complications related to the treatments that will be heaved upon them. Many patients do not receive adequate education and counseling on the contributing lifestyle factors. Some are even told that it does not matter what they eat or do, other than taking their medication of course. Nothing could be further from the truth.

At Plum Spring Clinic we always seek to understand all the contributing factors of a health condition and to address as many as possible through team-based, holistic, and non-pharmaceutical approaches. Pharmaceutical medications and surgery may be a necessary component of treatment for some severe cases of Inflammatory Bowel Disease but we view them only as one component of a comprehensive treatment regimen which is only to be used as a last resort. This approach empowers our patients to be able to participate in their healthcare actively and have a greater understanding of what is occurring within their bodies.

Diagnostic testing can be utilized in order to understand specific factors that are in play. These tests can examine the diversity and health of the gut microbiome, the integrity of the gut lining; the sufficiency of vitamins, minerals, and digestive enzymes; the health of related body systems, and detect food allergies, sensitivities, pathogens, and parasites. Designing effective treatment regimens without adequate diagnostic testing is possible but is a much more difficult, slow, and meandering process.

Once sufficient data has been collected, a holistic and comprehensive approach to healing can be implemented. Common elements of a holistic treatment regimen include nutrition counseling, nutrient repletion, the use of natural disease modifying agents, specialized diet programs, and stress resiliency coaching. Treatment for past traumatic experiences can also be utilized when needed. A broad examination of other key elements of health such as sleep, physical activity, and toxin exposure is also necessary to ensure maximum effectiveness.

Our hope for our patients with Inflammatory Bowel Disease starts with the reduction of symptom frequency and severity but extends far beyond to include freedom from toxic complications, side effects, and cost of pharmaceutical drugs and freedom from the fear and powerlessness too common with traditional treatment. Our goal is to facilitate happiness, security, independence, and optimal health.