Inflammatory Bowel Disease and The Microbiome
The connection between digestive wellness and the microbiome seems intuitive, after all they share the same location in the body.
The interactions between the gut itself and microorganisms inside the digestive system are complex and essential.
We are learning more about the microbiome and health every day.
Inflammatory bowel disease, or IBD, affects millions and highlights the relationship between the microbiome and the immune system.
In today’s article, we will discuss these connections and what new research reveals.
Keep reading to learn more about:
- IBD and the Functional Medicine perspective
- The connection between IBD and the microbiome
- New IBD research: stress
- New IBD research: gut immunity
- Action steps to explore
What is IBD?
Inflammatory bowel disease, or IBD, is a family of autoimmune diseases that affect the gut. It includes both Crohn’s disease, which occurs throughout the colon, and ulcerative colitis that affects the lower colon.
IBD is associated with chronic inflammation, ulcers, and scarring to the lining of the digestive system.
Symptoms include:
- Intestinal pain
- Intestinal cramping
- Chronic diarrhea
- Blood in the stool
- Fatigue
- Weakness
- Weight loss
- Malabsorption
- Nutrient deficiencies
Rates of IBD are increasing globally, including an increase in diagnosis among children. It affects around three million people in the United States alone.
IBD is very disruptive to life, affecting all aspects, including the ability to work. It also increases the risk of colorectal cancer.
Western treatment and management of IBD focuses on anti-inflammatory and immune-suppressing medication as well as surgical removal of affected areas of the colon. These interventions may be necessary at times but don’t address the root causes of the disease.
In Functional Medicine, we take a different view.
Like other autoimmune diseases, people with IBD have a genetic susceptibility to the disease and increased intestinal permeability (also known as leaky gut). When exposed to environmental triggers, such as pathogens, a poor diet, toxins, or stress, the autoimmune process flares.
Luckily, there is a lot we can do to affect genetic expression, improve the health of the gut lining, and reduce or eliminate triggers.
One place to start is with the health of the microbiome.
IBD And the Microbiome
IBD is often associated with dysbiosis or an imbalance in the microbiome. High levels of certain pathogens may trigger autoimmunity. For IBD, specifically, these include:
- Candida, or fungal overgrowth
- Increased Enterobacteriaceae, a family of bacteria that includes E. coli
IBD is also associated with low levels of beneficial bacteria, including Akkermansia muciniphila. Akkermansia is important for supporting the mucosal lining of the GI tract, protecting against leaky gut, and helping to maintain microbiome balance.
Robust levels of beneficial bacteria also help to crowd out pathogens and keep their numbers in check.
New research sheds light on some of these connections. Let’s take a look.
Stress and Crohn’s Disease
We’ve long known the connection between stress and autoimmune disease, from both a scientific standpoint and clinically. Just about anyone with autoimmunity will tell you that symptoms are worse during times of high stress.
A recent article, published in Nature, explores the connection between the gut’s immune system, pathogenic bacteria and stress.
The epithelial cells are a single layer of cells that line the digestive system. They create a protective mucosal barrier, are needed for absorption of nutrients and directly interact with the body’s immune cells and pathogens. These cells are subject to damage and are replaced quite quickly compared to other cells in the body. They have a big job!
The epithelial cells, collectively the epithelium, rely on the immune system for protection, but when the immune system isn’t working properly, the barrier can break down (hence leaky gut) and microbes, like E. coli, can invade, leading to an IBD flare.
The Nature article discusses an animal study using mice. Mice, when under stress, develop imbalances in the microbiome including an increase of Eterobacteriacea (like E. coli), impairing the immune system’s ability to effectively protect the lining of the gut. The result is a Crohn’s- like inflammatory flare.
In contrast, when the stress hormones in mice were blocked, the flare was prevented, and the epithelial barrier remained strong. Thus, this study provides insight into the mechanisms by which stress affects the microbiome and immunity in Crohn’s disease.
Candida and Crohn’s Disease
In another Crohn’s disease study, scientists wanted to learn more about what pushes the immune system into overdrive. What goes wrong between the microbiome and the gut?
There are a lot of immune cells in the gut. In fact, about 70 percent of the body’s immune system resides there, providing the body’s first line of defense against pathogens that enter the body via food or beverages.
Secretory IgA, or sIgA, is the most abundant antibody secreted by the immune cells in the gut and key to intestinal immunity. Each of us produces between three and five grams each day, and it can be measured in the stool.
Some sIgA targets pathogenic fungi, like Candida albicans, one of the organisms implicated in yeast infections or yeast overgrowth. In Crohn’s disease, this antibody protection against fungi is disrupted and altered, as shown by data in another recent Nature study.
Using mouse models, researchers found that in healthy mice sIgA binds to Candida albicans and stops its proliferation. SIgA can bind to harmful fungi vs. normal ones that are part of a healthy gut. However, in mice with Crohn’s disease, this mechanism doesn’t occur, possibly contributing to fungal overgrowth.
Not everyone with Crohn’s disease or IBD has fungal overgrowth, as pathogens and microbiomes vary between people, but this may be an important factor for those who do. It could lead to antibody treatments that target specific microbes to protect the mucosal lining of the gut from an overactive immune response.
It is not uncommon for me to find a low-grade parasitic infection that, once treated, the patient’s condition improves. Modifying the diet to meticulous gluten, dairy, and oat-free is foundational in the healing process.
IBD Action Steps
If you or someone you know has IBD and is open to a Functional Medicine approach, please work with a knowledgeable practitioner for guidance.
Here are some action items to consider, that can be personalized for each individual:
1. Get a functional stool test. The GI MAP test is an indispensable tool for looking at microbiome balance and the health of the digestive system.
This test provides:
-
- SIgA levels
- Calprotectin – an important inflammatory marker for IBD
- Candida albicans levels and other pathogenic yeast
- Pathogenic bacteria
- Levels of beneficial bacteria, including Akkermansia
2. Use a 5 R protocol to heal the gut. Based on test results, symptoms, diet, health history and other factors, a 5 R functional medicine framework for gut healing can be used to help restore microbiome balance and address root causes of IBD.
The 5 R approach may include specific dietary and supplement considerations. For example, red polyphenol compounds, such as those found in tart cherries and pomegranates (or a Reds powder for ease), help restore Akkermansia.
3. Manage stress. Given the effect that stress has on gut immunity and the microbiome, as discussed, but stress management often has its challenges to implementing. Tools like meditation, breathing exercises and limbic retraining are helpful. Find what works for you, and practice consistently.
4. Dial in your diet. While some doctors maintain that diet has nothing to do with disease, that couldn’t be further from the truth. What you eat influences inflammation and may even be a trigger for autoimmunity, as is often the case for gluten and glyphosate found in the food supply.
Starting with the Every Life Well Paleo protocol helps to eliminate potential inflammatory triggers, including allergens and chemicals found in processed foods. From there, some may benefit from a trial of an autoimmune Paleo protocol, where additional foods including nuts, eggs and nightshades (tomato family) are eliminated short-term and then reintroduced while observing symptoms.
5. Uncover additional triggers. Environmental toxins, like heavy metal toxicity or mold exposure, could exacerbate IBD symptoms and prevent the gut from fully healing. Testing for a wide range of toxins help uncover these pieces to the healing puzzle. Then, work with your Functional Medicine provider for personalized treatment solutions.
While an IBD diagnosis is devastating and implementing the changes necessary to reverse autoimmunity is challenging, it is also an opportunity to learn more about what your body is asking of you.
Understanding the connection with microbiome health and how to optimize the microbiome, while limiting triggers is paramount. Often, simple changes in diet and lifestyle yield significant shifts in symptoms, improving the quality of life for those with IBD.
References
- https://pubmed.ncbi.nlm.nih.gov/29132528/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886036/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685307/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8667969/
- https://www.nature.com/articles/s41467-021-26992-4
- https://www.nature.com/articles/s41564-021-00983-z
