ULCERATIVE COLITIS & CROHN’S DISEASE: CAUSES,TESTING,TREATMENT

What is IBD?
IBD is Inflammatory Bowel Disease which is caused by inflammation in the GI tract thought to be from an autoimmune reaction where the body is attacking it’s own tissue. Approximately 1 in 350 people worldwide have IBD. IBD is more serious and less common than IBS even though symptoms can be the same. Those suffering from IBD generally have frequent diarrhea, abdominal pain and sometimes blood in stools. IBD is an umbrella term for Ulcerative Colitis and Crohn’s disease which both have changes to the gut tissue and increased risk for some cancers, unlike IBS.

Is IBD an autoimmune disease?
IBD acts like many other autoimmune diseases in that it misreads our own tissue and attacks it, but is also immune-mediated, meaning the immune system is in hyperdrive, working over-time. So yes, it is an autoimmune disease, but with some additional factors at play. One of the unique autoimmune components to IBD is the body doesn’t respond as well to the beneficial bacteria in the gut flora that helps to regulate inflammation and keep infections from taking over. This along with side effects of medications cause those with IBD to be more susceptible to infections of all types.

Difference in UC and Crohn’s Disease
Ulcerative Colitis is localized tissue damage in the colon, where Crohn’s disease can be anywhere in the GI tract from the mouth to the anus. As the disease progresses surgery can be required to remove damaged parts of the GI tract- this occurs more often in Crohn’s than UC. As ulcers form along the GI tract, the bowel wall thickens as a result of the inflammation and blockages of food can occur sometimes requiring surgical removal. If the ulcers penetrate the bowel wall, the infection can spread which can cause serious complications. There are some subtle differences in symptoms of Crohn’s disease and UC. In Crohn’s disease rectal bleeding is less common, whereas in UC, bleeding from the rectum is much more common as well as mucus and blood in the stools. In UC, inflammation occurs only in the inner lining of the bowel wall- the mucosa but in Crohn’s disease, this can go all the way through the bowel wall to the digestive tract. In Crohn’s continuous abdominal pain is more common and perianal problems such as fistulas, anal sores and skin tags, can occur. In contrast, people living with ulcerative colitis usually have pain with bowel movements. Perianal issues are uncommon in UC.

Symptoms of Crohn’s and UC
Symptoms of Crohn’s disease and UC present quite similarly. Differences in severity and number of symptoms differ from person to person and include the following:

What Causes IBD?
IBD is caused by a malfunction in the immune system from an external trigger, but the trigger that causes the malfunction is often unknown and different for each person. Conventional treatment will not investigate the cause of the trigger since it does not change the treatment. However, identifying the potential trigger of IBD for a functional medicine practitioner is part of the deeper investigative work that aides in developing the personalized healing protocol. Environmental/external triggers that contribute to the immune system’s malfunction include:

• Environmental toxins: Heavy Metals, PCBs (Polychlorinated biphenyls), Dioxins, Pesticides, Phthalates, VOCs (Volatile Organic Compounds), Asbestos, Chlorine, Lead, Volatile Organic Compounds (VOCs), Fluoride
• Genetic polymorphisms: specifically genetic mutations that affect methylation and detoxification pathways which increases susceptibility to toxicity of all kinds as well as cancer
• Severe leaky gut: leaky gut further perpetuates the immune system’s aggressive response by keeping it on high alert. Leaky gut is also indicative of imbalances of gut bacteria which further contribute to immune system dysregulations.
• Infections: Acute infections often obtained during foreign travel or chronic infections that the body was not able to fight effectively can trigger the immune system to keep fighting, but then become confused as to what the target is. This can contribute to the immune system’s shift to attacking your own tissue.

It is important to note regarding environmental toxins that we are talking about normal everyday exposures. Due to the high number of environmental toxins we are exposed to from the “womb to the tomb” the level of each type does not need to be abnormally high to completely overburden the body’s detoxification pathways. This combined with genetic mutations and poor food quality set the immune system up for confusion. Avoiding plastics, choosing organic foods, avoiding GMOs, using non-toxic cleaners, body care and cosmetics are an important part of keeping the immune system on track.

Complications and Risk Factors Associated with IBD
IBD is truly a life altering disease when you consider not only the pain and fatigue associated with malabsorption of nutrients as the gut become more and more damaged, but also the social implications of having to go to the bathroom sometimes 10+ times a day and missing work/school for flare ups. Risk factors include family members with IBD, people ages 25-50, and those of northern Jewish descent. Complications with IBD come in many forms but the most severe include a significant risk for developing cancer. In addition to the tissue damage from IBD increasing cancer risk, the autoimmune response also increases cancer risk. Lastly, there is a risk for developing cancer with the use of most medications used for IBD.

Lab Tests for IBD
Standard lab tests

• Blood tests to check for infections, anemia, and autoimmune disease markers
• Stool sample since white blood cells in your stool can indicate ulcerative colitis. A stool sample can also detect as infections caused by bacteria, viruses and parasites which can contribute to immune system dysregulation.
• Colonoscopy to view your entire colon which helps determine the extent of damage, as well as obtain a tissue sample for biopsy. This helps to confirm the disease and sometimes will be used to check for cancer.
• Flexible sigmoidoscopy is used if the colon is severely inflamed to just see the last portion of the colon since a whole colonoscopy may be too irritating to the gut .
• Abdominal X-ray may used to rule out a serious complication like a perforated colon.
• CT scan of your abdomen or pelvis may reveal how much of the colon is inflamed.

Additional functional lab tests

• Comprehensive Metabolic Panel can be used detect a chronic infection when the practitioner knows what they are looking for. This can be a big piece of the autoimmune response puzzle.
• Comprehensive stool panel to see clearly the balances of good and bad bacteria in order to target probiotics specifically to what the GI tract needs. This test also helps to detect parasites, bacteria and other pathogens that would hinder the immune system from self-regulating
• Food sensitivity test can identify foods causing inflammation which helps to decrease inflammation in the entire body and give the GI tract a fighting chance at healing
• Zonulin , Actin, LPS testing can determine the integrity of the intestinal barrier which shows if leaky gut is occurring. Leaky gut will always be a source of inflammation and a contributing factor in IBD, autoimmune conditions, chronic disease, mood disorders and more.
  • Zonulin: the intestinal barrier is dependent on tight junctions to keep things in that should stay in the GI tract and allow out the sizes of particles (nutrients) that should be absorbed into the bloodstream. When tight junctions are damages or are not tight enough, particles of food, bacteria, fungus, and viruses can then enter the bloodstream where they are not supposed to be. This causes the immune system to react. This is leaky gut. Zonulin is part of this tight junction process that helps regulate the integrity of the intestinal barrier. Research has found that high Zonulin levels can detect damaged intestinal barrier/leaky gut
  • Actin: Particularly in Celiac disease, but also associated with leaky gut, Actin antibodies can help detect intestinal damage better than some of the standard Celiac disease testing
  • LPS: Lipopolysaccharies (LPS) are derived from bacteria in the gut and are directly linked to the inflammatory process of IBD. Although there is a lot to learn about LPS, what we do know is that plays a role in mediating intestinal inflammation with how it affects the intestinal barrier. Measuring LPS can help determine inflammation and damage occurring in regard to the intestinal barrier or tight junctions. Tight junctions need to remain tight and undamaged in order to not contribute to systemic inflammation in the body. LPS also plays a role in how intestinal permeability affects mental health.

Conventional Treatment
Anti-inflammatory drugs, immune system suppressors, pain medications, antibiotics, and antidiarrheals are home base for conventional treatment. Diet interventions are generally limited to avoiding high fat and trigger foods. Within the conventional allopathic world – there is a general lack of understanding and acceptance that the lifestyle factors such as healing foods, non-toxic living, supporting detoxification/methylation pathways, and gut healing protocols can calm down and shift the immune system. Managing symptoms with medication and avoiding surgery for as long as possible is the general plan for conventional treatment.

Biologics are a newer type of medication that is seen in the conventional paradigm to be treating the underlying cause rather than covering up symptoms. This view is assuming that stopping the inflammatory process in the gut is addressing the underlying cause without regard to how the medications cause inflammation in other areas of the body or what triggered the inflammatory process in the first place. Stopping, interrupting, and changing natural pathways within the body is still covering up the root cause, not healing it. Biologics are medications like Humira, Remicade, and many others that stop or block various elements of the immune system acting on different proteins, white blood cells or pathways involving the blood brain barrier. All biologics have serious side effects including infections like sepsis and tuberculosis (if already exposed). Types of cancers like lymphoma have been known to occur. The side effects like nausea, mood changes, muscle/joint pain and fatigue associated with taking biologics can be as debilitating for some as the IBD itself. These are serious medications that should be avoided if possible. If you are currently on biologics, there is hope to live without them… we’ve done it!

Functional Medicine Treatment
While conventional medicine aims to contain the disease, functional medicine treatment aims to heal the immune system by decreasing inflammation, improving detoxification pathways, healing the gut and balancing the Th1, Th2, and Th17 portions of the immune system. This is a comprehensive approach that requires commitment to lifestyle changes and is unique to each individual and essentially reprograms the immune system’s faulty signaling. Here are ways this healing is done:

Healing the Gut with Food
While there are many ideas of how to heal the gut with food, higher level diet interventions are often utilized for IBD in order to rest and heal the gut quickly since symptoms can be quite severe. The type of diet that works best depends on your ability to digest and absorb minerals, bacteria, fat, fiber and certain types of carbohydrates. Medications, level of intestinal inflammation and production of digestive enzymes all play a role in how food is tolerated and which therapeutic eating approach may be utilized. Types of eating plans that are sometimes considered are low fat, low fiber, SCD or GAPS are useful tools in eliminating symptoms and healing the gut quickly. As the GI tract heals, as wider variety of foods are tolerated. It is important to work with a functionally minded dietitian/nutritionist to help you navigate these restrictive eating plans since they are designed to be for therapeutic use, not long term. Changing your diet is one of the most effective, simplest and natural ways to decrease inflammation from UC or Crohn’s disease. Here is a simplified, quick reference list of diet changes that support the low inflammatory diet needed for IBD:

What to avoid- gluten, dairy, refined seed oils, processed grains and high glycemic foods, high amounts of sugar

What to alter- limit seeds and nuts if they are bothersome to you and always chew, chew, chew chew to help break them down well; consider cooking all fruits and vegetables for easier digestion until gut irritation and symptoms subside.

What to increase- water intake, frequency of meals- smaller meals 5-6 time a day can be better tolerated than 2-3 larger meals, quality fats as tolerated, grass-fed/pastured meats, prebiotic fiber as tolerated (banana, honey, oats, potatoes cooked and cooled, rice, beans), bone broth at 2 cups daily can provide protein and healing amino acids as well as replenish minerals.

Quality Supplementation
Supplement plans need to be customized to your specific needs which is why dosages are not given there, but supplement strategies to consider are:

• Probiotics: high quality, live probiotics from supplement or food sources can improve the immune system, increase vitamin/mineral absorption, enhance body’s ability to make B12 which is a common deficiency in Crohn’s, and improve diarrhea.
• Slippery Elm, Calendula and L-Glutamine: these can soothe an irritated gut which can be used to calm down a flare
• Vitamin/Mineral support: since absorption of vitamins/minerals is usually compromised in IBD, adding extra in forms that are very bioavailable can help restore the body and prevent further nutrient loss.
• Medical foods: there are many options for shakes that provide healing and valuable protein when there is limited tolerance of foods, poor absorption, and decreased appetite from nausea, vomiting, pain, diarrhea, etc. UltraGI Replenish by Metagenics is an example of a medical food shake that has been very beneficial for a variety of GI related disorders.
• Omega 3 Fatty Acids: since inflammation is the cornerstone of IBD, using pure and potent Omega 3’s can help decrease inflammation through the whole body aiding in quicker healing and support for the GI tract
• The right enzymes specific to the individual based on what dietary or food intolerances they may have

Reduce Stress
Stress a well known contributor to IBD, often triggering diarrhea and poor absorption. Stress is an inevitable part of life, but being aware of how physically taxing emotional and mental stress can help the healing process. Those in acute phases of IBD should consider lightening their social calendar, getting help around the house, allowing space for relaxation, meditation and mindfulness. Using apps like Headspace or Calm.com can bring cortisol levels down which physiologically will decrease inflammation. These lifestyle interventions help get you out of the “fight or flight” phase. I situations of prolonged physical, emotional, mental, and/or relational stress, the body can be in a sustained “fight or flight” mode churning out high levels of cortisol and keeping inflammation exceptionally high. Managing stress cannot just be wishful thinking when trying to heal from IBD, it must be an integral part of the healing protocol. In our view, many parts of how to heal IBD are optional or flexible, but this simply is not. Stress drives too much of gut and immune dysregulation to be considered optional. For some, this may require utilizing a life coach, mentor, pastor, or licensed professional counselor.

Final Thoughts
Healing Crohn’s and UC can be done. These are both diseases of inflammation that primarily affect the immune system but the body is incredibly resilient and when given the tools, will heal. No one should settle for life-altering, debilitating medications to manage a chronic condition. There is more to the story and there is hope for normal bowel function, weight restoration, and elimination of pain associated with IBD. While we provided some solutions to consider above there are numerous other approaches to consider in place or or in conjunction with those mentioned above. Essential oils also play a useful role in healing would be one example of those other approaches. Oils to consider, from only sources you know and trust, would be:

• Frankincense
• Copaiba
• Neroli
• Lemongrass

Inquire with us if you need a quality essential oil source.

You do not have to live your life around the schedule of your IBD symptoms. There is too much life to be lived. We firmly believe you have too much to offer the world and we are here to help you navigate these conditions and have the health you need for the life you want.

in2GREAT Integrative Health specializes in finding the root cause of disease. It has been found that most modern diseases today are linked to inflammation. in2GREAT uses the principles of functional medicine, functional nutrition, and IV nutrition therapy alongside convention medical treatments to help people regain health. in2GREAT Integrative Health is conveniently located in Overland Park KS to serve the greater Kansas City area. Contact us today.