Inflammatory bowel disease (IBD) is an umbrella term used to describe a group of inflammatory disorders of the gastrointestinal tract. Each of these disorders involves some degree of inflammation (redness, swelling, erosion and sometimes bleeding) of the gastrointestinal mucosa or lining that commonly leads to ulceration of the mucosa to varying degrees. The inflammation is usually a result of an immune reaction of the body against its own intestinal tissue. Therefore, the diseases included in IBD are considered to be autoimmune disorders.
IBD Treatment - Repair the Gut
This is Part 5 of a 5-part article including:
The following nutritional and botanical products have been demonstrated to be safe, effective anti-inflammatory compounds beneficial in the treatment and management of IBD (according to the existing peer-reviewed scientific literature). As stated above, any use of additional medications or changes in treatment should only be made with your physician’s guidance and knowledge.
Butyrate and Short-Chain Fatty Acids (SCFAs)
SCFAs are produced in the colon by the digestive action of “good bacteria” on dietary fiber. Butyrate is a SCFA that acts as the fuel or food for the mucosal cells of the colon (colonocytes) and promotes their regeneration and repair. SCFAs, particularly butyrate, can modulate inflammation and promote regeneration of the colonocytes damaged by ulcerative colitis or Crohn’s colitis. (22)
Butyrate stimulates sodium and water absorption in the colon and promotes intestinal mucosal restitution and repair. It also prevents the development of colon cancer by promoting healthy cell differentiation and destruction of cancer-transformed colonocytes. (23) SCFAs can be given orally or used in an enema, particularly when there is proctitis and/or distal colitis. As researchers found, SCFA enemas are “a new and promising treatment for ulcerative colitis.” (24) I commonly prescribe butyrate enemas through a compounding pharmacy and suggest daily use for 2 to 4 weeks in acute flare-ups.
L-Glutamine
L-glutamine is a single amino acid that is an important metabolic fuel for the mucosal cells of the small intestine (enterocytes) and has been shown to preserve the intestinal barrier functions and reduce leakiness of the gut. L-glutamine also stimulates repair and regeneration of the small intestinal mucosa important in Crohn’s disease and celiac disease.
Zinc
Zinc is commonly deficient in children with Crohn’s disease. This is a contributing factor to poor growth and development in children with Crohn’s. Zinc has also been shown to improve intestinal barrier function (leaky gut) in Crohn’s disease. (25)
Gastrocrom (oral chromolyn)
Gastrocrom is the oral form of chromolyn, a safe and effective antihistamine flavonol used safely for years in the treatment of asthma. It is a synthetic cousin of the natural, medicinal flavonoid called quercitin. Research has shown Gastrocrom strengthens the epithelial/mucosal barrier reducing “leaky gut.” (25) It also reduces local mucosal allergic inflammation and is used to treat eosinophilic gastroenteritis, a form of allergic inflammation of the gastrointestinal tract.
Probiotics (Lactobacillus, Bifidobacterium and others)
Simply put, probiotics are “friendly bacteria” to the gastrointestinal tract. People have more bacteria in their colon then they have cells in their body. These bacteria produce beneficial immunomodulatory effects in the gastrointestinal tract and induce immune homeostasis (balance). Due to this “normalizing action,” researchers have suggested probiotics can be “a suitable treatment for mild to moderate IBD.” (26)
The evidence for the use of probiotics in the treatment of IBD is strongest in the case of ulcerative colitis and pouchitis (inflammation of the remaining pouch after removal of the colon). (27) By far, the research has shown a human-sourced, multi-agent mixture of various friendly bacteria “may be better suited in ulcerative colitis and pouchitis.” (28)
Probiotics (Saccharomyces boulardi)
S. boulardii is a spore-forming yeast that commonly does not set up home in the colon. However, S. boulardii and its secreted-protein(s) inhibit gut inflammation and reduce IBD pathology. This is especially true in Crohn’s disease and pseudomembranous colitis, a form of antibiotic-induced infectious colitis caused by the bacteria Clostridium difficile. S. boulardii inhibits the production of the proinflammatory chemicals called cytokines by interfering with the global mediator of inflammation, nuclear factor kappa B. (29) S. boulardii further protects against intestinal inflammation by modulating host inflammatory signaling pathways to exert its beneficial effects. (30)
The list of S. boulardii’s beneficial actions in IBD is impressive. It suppresses bacterial overgrowth in the small intestine and inhibits adherence of invasive bacteria to the intestinal mucosal cells. It releases an enzyme (protease) that cleaves C. difficile toxin A and its intestinal receptor then stimulates antibody production against toxin A so that it cannot damage the colon resulting in a bloody colitis. S. boulardii also interferes with the development of IBD by trapping specific lymphocytes (T cells) in intestinal-related lymph nodes thereby, stopping their ability to induce an immune reaction against self-proteins. (31) Finally, in clinical studies, S. boulardii was found to reduce gut permeability and relapse of symptoms (6% vs. 36%) in Crohn’s disease patients. (32, 33)
This is Part 5 of a 5-part article including:
References
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Dr. Donovan is a Naturopathic Physician, author, educator, and a professor of clinical medicine at Bastyr University's Natural Health Clinic. In 2010 he was voted by his professional peers as one of Seattle’s Top Doctors in the Seattle Metropolitan Magazine. Dr. Donovan writes and lectures on the transformational process of healing and believes a person’s healing journey is ultimately a quest for his/her identity, purpose and meaning. He has more than 35 years of patient care experience as a Registered Nurse (RN) and a Naturopathic Physician (ND), representing a wide range of clinical settings from hospital-based surgical and intensive care as a registered nurse to outpatient primary care as a physician.
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