Inflammatory Bowel Disease (IBD), symptoms, causes, and how Functional Medicine can help...
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract.
The two most common types of IBD are ulcerative colitis and Crohn’s disease.
Symptoms of IBD include abdominal pain, diarrhoea, weight loss, and fatigue.
IBD can be debilitating and sometimes even life-threatening.
There is no cure for IBD, but there are treatments that can help manage the symptoms, and a Functional Medicine approach to IBD can make a difference.
Table of Contents
What is IBD?
Inflammatory Bowel Disease (IBD) is an umbrella term used to describe chronic inflammatory conditions that affect the intestinal system.
IBD is a life-long condition, however there can be long periods of remission, and it is possible for the symptoms to become less severe and more manageable.
Remission is what a Functional Medicine approach to IBD aims to achieve.
When symptoms are severe, there can be a significant amount of pain and discomfort.
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Changes in bowel function can make it really tough to go about a normal daily routine.
IBD terminology implies that the inflammation is only in the gut, however extraintestinal symptoms of IBD can manifest too.
This means that the inflammation can affect different parts of the body, such as the joints, skin or eyes (1), not just the intestinal system.
There are two main types of IBD:
Chronic inflammation affecting the colon (large intestine) and rectum. The inflammation can cause damage to the lining of the colon and causes small open sores (ulcers).
Chronic inflammation which spreads deep into all tissue layers and can affect any section of the digestive tract (not just the colon).
About 10% of IBD sufferers cannot be classified as having either Crohn’s or ulcerative colitis because they have features of both conditions.
This is called indeterminate colitis (2), which in many cases can eventually progress to a clear diagnosis of either Crohn’s disease or ulcerative colitis (3).
How common is IBD?
IBD affects over 3 million people in Europe alone (4), and in 2017, there were 6.8 million cases worldwide.(5)
There is a rising incidence of IBD globally, in both developed and developing countries (5,6).
Many researchers have noted a correlation between increased IBD cases and where people live.
There seems to be an increased prevalence of IBD in the Northern Hemisphere (8,9,10) and it has been suggested that this may be related to reduced vitamin D levels (7).
IBD can occur at any age, but it is most common between ages 15 and 35 (13).
There appears to be a second peak in incidence in those between the ages of 50 and 80 (14).
While both Crohn’s disease and ulcerative colitis can affect both sexes, women are more likely to develop Crohn’s, and ulcerative colitis is slightly more common in men (15).
Signs & symptoms of IBD
Signs and symptoms of IBD are often sporadic and their intensity can vary.
Other, less frequently noted symptoms, are;
Malnutrition can be a consequence of IBD due to nutrient malabsorption issues.
This depends on what region of the digestive tract has been affected.
Blood loss through the bowel, which is more common in ulcerative colitis, can also lead to nutritional insufficiencies (which may then go on to cause other symptoms, such as fatigue due to low levels of iron).
The conventional medicine approach to IBD
Conventional medicine offers treatment options that usually focus on suppressing the symptoms of IBD.
Anti-inflammatory medications, antibiotics, immunosuppressant drugs or biologic drugs may be prescribed.
In more advanced stages of IBD, surgery may be offered to help repair the damage caused to the digestive tract, or to remove a portion of the inflamed digestive tract.
Sadly, around 60-75% of people with Crohn’s (16), and around 23-45% of people with ulcerative colitis do not experience symptomatic improvement with medication (17).
When one drug-class of prescribed anti-inflammatories fails to reduce the inflammation sufficiently to provide symptomatic improvements, stronger anti-inflammatories are prescribed.
This is in the hope of seeing better improvements, until the immune system is severely suppressed through medication.
Dietary advice may be provided through specialists, such as hospital dieticians, but in many cases, patients continue to struggle with their symptoms.
What's the root cause of IBD?
While the mechanism by which IBD manifests is not fully understood, there are some known risk factors.
The risk factors for Crohn’s disease and ulcerative colitis are generally the same, even though both conditions present differently.
It is known, for example, the immune response to gut bacteria is altered in IBD (18, 19) and that the chronic inflammation in the gut is partially due to a cytokine response to certain gut bacteria (20).
Cytokines are inflammatory signalling molecules produced by the immune system.
IBD is an autoimmune condition, and you can read more about autoimmune diseases is our full article on the Functional Medicine approach to autoimmunity.
Autoimmune diseases can occur when there is:
Factors involved in the development of IBD
There are two main factors involved in the development of inflammatory bowel disease, genetics and environment:
1/ Genetic predisposition – first-degree relatives have a 5 to 20 fold increased risk of developing IBD (21). Over 163 different genes have been identified as being involved with IBD
2/ Environmental factors – what we are exposed to or consume (e.g. food antigens, stress, cigarette smoke) can alter the immune response to gut bacteria and dysregulates immune function (22).
Pathogenic organisms, for example certain bacteria or viruses, can cause inflammation in the gut wall, and an altered immune response, leading to IBD.
Some examples of these pathogens, that are implicated in IBD, include;
Results of a study published in the American Society for Microbiology journal (23) showed much higher prevalence of Candida tropicalis in the stool of people suffering from Crohn’s disease.
Researchers also found a higher levels of a fungus (Saccharomyces cerevisiae) in those with Crohn’s disease.
These fungi were found grouped with pathogenic bacteria (E. coli and S. marcescens) which are associated with dysbiosis in Crohn’s.
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Mycobacterium Avium Paratuberculosis (MAP)
MAP is a bacteria that causes inflammatory bowel disease in domestic livestock – a condition called Johne’s disease.
Johne’s disease shares some similarities with Crohn’s disease in humans.
MAP bacteria has been found to be higher in patients with Crohn’s disease, compared to those with ulcerative colitis, or no IBD.
For these reasons, it is possible that there may be a link between the MAP bacteria and Crohn’s disease (24).
Epstein-Barr Virus (EBV)
EBV is linked to many digestive conditions associated with inflammation, including ulcerative colitis and Crohn’s disease.
One study found that EBV was present in the mucosal lining of 55% of Crohn’s sufferers, while there was no EBV in healthy gastrointestinal mucosa (28).
Another study detected EBV in 63.6% of CD cases and 60% of UC cases (29).
EBV can be reactivated by immunosuppressant drugs (e.g. long term steroid medication) 31), such as those prescribed for ulcerative colitis and Crohn’s disease.
These drugs make it more difficult for the immune system to respond to the virus appropriately.
Yeast (Candida species and Saccharomyces cerevisiae)
Candida is a common problem in Crohn’s and ulcerative colitis.
Some studies showed that high level of colonisation is associated with several diseases of the gastrointestinal tract (32).
Crohn’s disease patients are more often, and / or more heavily, colonised by Candida Albicans than those without IBD (33).
Yersinia is a bacteria which disrupts the intestinal barrier, can move through the gut lining and colonise different areas in the body.
It has been suggested that people with a yersinia infection are more likely to develop Crohn’s disease (36, 37). Patients with Crohn’s have increased immune reactivity against this bacteria (38).
Helicobacter Pylori (H.pylori)
H.pylori is a bacteria found in around 50% of humans.
In many people, it doesn’t cause any issue.
However, in some people, it is linked to increased risk of gastric ulcers, GERD, and nutrient malabsorption issues.
In terms of a link with IBD, the research is currently inconclusive as to whether H.pylori can cause IBD (or in fact, if the bacteria is protective against IBD).
But as H.pylori can cause increased intestinal permeability (leaky gut) and immune system responses, it is possible that it may contribute to the development of autoimmune processes and inflammation (40,41, 42) (such as those observed in IBD).
E.Coli is present in the intestinal tract, and helps to maintain normal intestinal homeostasis (49).
However, some strains of E.Coli bacteria can promote intestinal inflammation and one of them, called adherent‐invasive Escherichia coli, has been shown to be linked to Crohn’s (50).
These are just a few examples of pathogens that may be associated with IBD.
Other gut bacteria imbalances have been noted in IBD and advanced stool testing can help provide specific information on your microbiome (and the gut environment).
Advanced stool testing, which we’ll cover further below, is an important part of the Functional Medicine approach to IBD.
The Functional Medicine approach to IBD
The Functional Medicine approach to IBD, from a Functional Nutritional Therapist perspective, focuses on understanding the unique predisposing factors, triggers and drivers of the condition, for each person.
At Coho Health, our Functional Medicine approach to IBD considers:
– what factors preceded the onset of the signs and symptoms
– what imbalances there may be in all body systems (not just the gut), with the understanding that imbalances in other areas of the body, could be playing a role in the immune dysregulation that exists in IBD
Testing can add another layer to our understanding as to what specific areas require focus.
From here, an effective, tailored protocol, can be designed to help heal the intestinal lining, reduce inflammation and modulate immune function.
As with any chronic condition, the Functional Medicine approach to IBD isn’t a quick fix.
Our approach can be combined with the medical treatment you are receiving for IBD.
We work carefully to ensure that diet and supplements do not negatively interact with any medication, that nutrient depletions caused by medications are addressed, in some cases the approach can also assist the medication to work more efficiently.
The aim, of course, is for:
What testing can help us to understand IBD?
A faecal calprotectin test is the ‘go-to’ test to assess for IBD, and to track progress.
Calprotectin is a measure of colonic inflammation.
The lower the calprotectin test result number, the better.
This test is commonly performed by doctors, and it is also included in most comprehensive stool tests that we perform at Coho Health.
C-reactive protein (CRP), is a non-specific inflammatory marker, that can shoot up quickly when there is inflammation.
This is the most widely used blood test to check for inflammation in IBD.
A colonoscopy can be also performed to take a look in the colon and assess for inflammation and ulcers.
Further testing options that can help us to understand underlying causative factors include:
Coeliac disease testing can be helpful as coeliac seems to be more common in IBD.
One systemic review and meta-analysis determined there was a nine-fold increase of IBD, in people with coeliac disease.
While coeliac disease can be assessed through the anti-transglutaminase IgA antibodies, it is important to request that total IgA is also checked at the same time.
For a more in-depth understanding on whether gluten is causing you an issue or not, we think that the Cyrex Array 3X (Wheat/Gluten Proteome Reactivity And Autoimmunity) test is one of the best options.
IgG and IgA antibodies are measured to 16 markers – 16 antigens which are proteins, peptides or enzymes found in wheat or gluten.
Comprehensive stool test – assessing levels of ‘good’ bacteria, levels of ‘potentially bad’ bacteria, yeast and parasites. This test helps to determine if there are any gut infections and tells us about the overall balance of the microbiome.
Additionally, these tests include markers concerning digestion, absorption, gut inflammation, and metabolic markers.
Comprehensive stool testing can help to determine if there may be microbiome imbalances linked to IBD.
Food sensitivities and allergies can be explored either through testing or a well-designed and planned Elimination Diet.
An Elimination Diet is where the most problematic foods are avoided for a specified period of time, and then re-introduced one at a time (in a specific, planned manner) to observe for any changes.
Identifying underlying gut imbalances in IBD is key as it helps us to design an individualised protocol where areas of concern can be optimised.
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We understand from working with many people with IBD over the past 10 years, that it can be debilitating, and can have a really profound effect on your quality of life.
We know that both ulcerative colitis and Crohn’s Disease can be difficult to treat, and that it can be a really arduous journey to get the answers you want.
With a Functional Medicine approach to IBD, we can help you to find those answers and start to regain control of your health, so that periods of remission last for longer, flare ups are less distressing, and the pathway towards ever stronger immunosuppressive drugs can be avoided.
To your optimised, healthy future,
Aga & the Coho Health team
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