Crohn’s disease and ulcerative colitis are both classified as inflammatory bowel disease (IBD.) The two are similar in that they are both the result of an autoimmune/inflammatory process, but manifest in different regions of the GI tract. While Crohn’s disease can affect any part of the gut from mouth to anus, UC is localized to the colon, especially the rectum. The abnormal immune response found in IBD is speculated to result from cross-reactions against the microflora of the gut, as well as pro and anti-inflammatory cytokine imbalance (1.)
Conventional medicine addresses IBD most frequently with immune suppressing drugs, such as prednisone and TNF-alpha blockers like Humira and Remicade. These drugs reduce inflammation in the gut. Naturopathic medicine addresses IBD through lifestyle interventions like diet, exercise, and sleep, as well as targeted nutritional supplementation and botanical medicine. In many cases, this adjunct approach to autoimmunity is the "missing piece" for people who are already taking drugs but still not feeling 100%.
1. Find and remove triggers of autoimmunity & inflammation such as:
Pro-inflammatory diet that is rich in gluten, grains, dairy, and refined sugar, saturated animal fat, red meat, and lack of fruits and vegetables, lack of exercise, regular exposure to harmful and toxic substances like mold and harsh cleaners, excessive daily stress, chronic infections, presence of genetic SNPs affecting proper metabolism of nutrients and toxin clearance, sleep deprivation, poor sleep quality, hormone imbalances, lack of proper hydration, and more.
2. Heal the gut & promote intestinal cell wall integrity
Eat an anti-inflammatory diet with emphasis on fruits, vegetables, and lean meats, healthy fat sources like coconut and olive oil, and reduction or elimination of grains, refined sugar, red meat, and dairy. If tolerated, emphasize complex carbohydrates and fiber. Find and eliminate food sensitivities. Specific diets that have good anecdotal evidence are low FODMAPs and the specific carbohydrate diet (SCD), however, no specific diet has been extensively studied (2.) Glutamine for enterocyte repair (3) and supplemental pancreatic enzymes can help restore gut function by allowing the breakdown of difficult-to-digest foods (4.)
3. Use immunomodulatory substances to decrease inflammation
Immunomodulation: Refers to influencing immune cells to mature into anti-inflammatory T-regulatory cells, rather than pro-inflammatory Th17 cells (5.) The 3 substances listed below up-regulate T-regulatory cell activity and reduce Th17 cell activity by inhibiting the release of pro-inflammatory cytokines and other factors.
-Omega 3 fatty acids EPA/DHA (6)
-Vitamin D (7)
4. Re-establish healthy gut flora (9) (10) (11)
Supplementation with a high quality probiotic as well as eating a diet consistent with establishing and maintaining normal, healthy flora is beneficial for reducing inflammation and calming the autoimmune response seen in IBD. Ideally, a diet low in simple carbohydrates and high in complex and fibrous carbohydrates is ideal for beneficial, commensal bacterial species in the gut. Preferred food sources for gut bacteria include “prebiotics” like inulin and fructooligosaccharides, however, note that some therapeutic diets encourage eliminating foods that contain these compounds from your diet.
5. Green tea extract-EGCG (12)
Polyphenols like green tea show promise in their overall reduction of pro-inflammatory cytokines and free-radical scavenging ability. It is also speculated that green tea and other flavonoids can assist in modulating the gut microbiome, increasing the proportion of beneficial species and therefore inhibiting the production of Th17 inflammatory cells and increasing the production of anti-inflammatory cytokine IL-10. (13)
Wondering about doses? When it comes to supplementation in autoimmunity, frequency, duration, and amount is highly dependent upon the individual and their condition severity. For example, very sensitive individuals often have to start with a very low dose, however, RDA of certain vitamins and minerals are often just "the bare minimum." Please consult with your doctor regarding a safe dose for you!
Want to learn more about what Naturopathic medicine can offer for IBD?
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