• Inflammatory bowel disease (IBD) is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

According to a study published last Wednesday in Nature, researchers demonstrated the chemical and molecular events that shift the microbiome and exacerbate disease activity in patients with IBD.

Although previous research has shown differences in the gut microbiome in IBD patients, this study investigated how the microbiome changes contributes to an inflammatory response.

This study included 132 individuals followed for one year and compared Crohn’s disease and ulcerative colitis patients to a control group that did not have IBD. Each individual provided stool samples every two weeks, blood samples every 3 months, and colon biopsies at the start of the study. A total of 2,965 stool, biopsy, and blood samples were analyzed along with molecular, cellular, and clinical tools to understand the detailed biochemistry of the disease.

It is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms exacerbate or improve.

As a result, during periods of disease activity patients with IBD had higher levels of polyunsaturated fatty acids, including adrenate and arachidonate. In addition, nicotinuric acid was found almost exclusively in the stool of patients with IBD and that levels of vitamins B5 and B3 were insufficient in IBD patients. Also, a group of bacteria related to the genus Subdoligranulum commonly found in almost every individual is depleted during inflammation, which have not been previously isolated.

Previous research has identified that in healthy people, the gut microbiome was much more stable than those with IBD. Patients with IBD have dramatic shifts in their microbiomes with some bacteria disappearing almost completely at times.

Medication to treat IBD can also affect the microbiome. Individuals who take steroids for part of their treatment have more fluctuations in their microbiome and those who were experiencing a flare-up in their symptoms are more likely to have dramatic fluctuations in their microbiome.

These results further support the functional medicine approach to assess the microbiome regularly in these patients so one can take an individualized approach to manipulate the microbiome and keep IBD patients in remission, especially if medications like corticosteroids can be shift the microbiome leading to an exacerbation of the disease.

High dose probiotics, fish oil, glutamine, and mucilaginous botanicals are helpful in immunomodulation and for their anti-inflammatory properties. Other common deficiencies include magnesium, vitamin D, and magnesium. A specific carbohydrate diet (SCD) or elimination diet can improve gastrointestinal function and decease disease activity.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Jason Lloyd-Price, Cesar Arze, et al. Multi-omics of the gut microbial ecosystem in inflammatory bowel diseases. Nature, 2019; 569 (7758): 655 DOI: 10.1038/s41586-019-1237-9

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