New review investigates the effects of micronutrient supplementation in IBD
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.
IBD is an autoimmune condition where part of the digestive tract becomes inflamed and ulcerated marked with sores. There is emerging data that Vitamin D supplementation may lengthen the remission in IBD.
According to a review published earlier this month in Frontiers in Immunology, researchers investigated the therapeutic effects of micronutrient supplementation in IBD.
Growing evidence suggests that micronutrient status may have an impact on the course of IBD, however, micronutrient deficiencies are often overlooked in the treatment of IBD patients.
There have been numerous studies on micronutrient supplementation including vitamin D and iron, but the current research is preliminary for other vitamins and minerals. This review investigated the adjunctive therapeutic effects of micronutrient supplementation in IBD. Vitamin D supplementation in patients with IBD reduces inflammation and the risk of clinical relapse, improves responsiveness to anti-TNF therapy, prevents upper respiratory
tract infections in winter and spring and may have a positive effect on mental health.
Vitamin D supplementation should be based on body weight and to reach a certain vitamin D level. The main objective of iron supplementation is to correct iron deficiency and IDA. I would recommend a more bioavailable form like a ferrous glycinate that will not cause gastrointestinal side effects or compete with nutrient absorption.
Patients with IBS are also susceptible to deficiencies of other vitamins and minerals, such as vitamins B, K, A, C, and E, as well as zinc and selenium, due to impaired intestinal absorption, and restricted dietary intake. Supplementation of these micronutrients has also shown some benefits. For example, high-dose oral thiamine improves chronic fatigue in patients with quiescent IBD. Vitamin A supplementation can further reduce inflammation and promote mucosal healing. In addition, vitamin C, vitamin E, and selenium have all been shown to reduce oxidative stress.
In this review, the research team investigates calcium, magnesium, and manganese. Calcium is closely related to osteoporosis in IBD patients, so it is important to pay attention to the serum calcium level in the group of patients treated with steroids. Magnesium levels may affect sleep as well as psychological status and animal models suggest that manganese is essential for the maintenance of intestinal homeostasis
This review summarizes the adjunctive therapeutic effects of micronutrient supplementation in IBD, but supplementation should be personalized in patients with IBD based upon testing.
Low Vitamin D and K intake in patients with Inflammatory Bowel Disease
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.
IBD is an autoimmune condition where part of the digestive tract becomes inflamed and ulcerated marked with sores. There is emerging data that Vitamin D supplementation may lengthen the remission in IBD.
According to a study published last month in Nutrients, researchers investigated the intake of vitamin D and vitamin K in patients with IBD. Disease activity was assessed using the Harvey-Bradshaw Index in Crohn’s disease and the Partial Mayo score in Ulcerative Colitis.
This study included 193 IBD patients (100 men and 93 women) between 2016 and 2020. Eighty-nine patients had Crohn’s disease and 104 patients had Ulcerative Colitis. A dietitian obtained food intake by completing a food frequency questionnaire that was adapted from a 22-item quantitative FFQ, previously validated for calcium and vitamin D intake, and integrated with 6 specific questions. These questions were focused on foods with the highest phylloquinone concentration. Green leafy vegetables including spinach, iceberg lettuce, chicory, beets, turnip tops, and rocket salad, as well as eggs, were the main contributors of vitamin K intake.
The research team demonstrated that IBD patients have a significantly lower intake of
vitamin D and vitamin K more so in active disease cases. In addition, the unfavorable metabolic effects of low Vitamin D intake are further amplified by the inadequate sunlight exposure documented in IBD patients. This is clinically significant as sunlight exposure affects the conversion of vitamin D precursors to its activated form and is more important than diet in determining vitamin D levels.
Also, IBD patients avoid vegetables in the fear of worsening diarrhea. Minimizing the intake of insoluble fiber is advisable in stricturing or perforating CD, but restriction is unnecessary in inflammatory CD and UC. This attitude is not uncommon and has significant metabolic implications.
Green leafy vegetables, which are well represented in the Mediterranean diet are the primary
dietary source of vitamin K.
The present study confirms that the diet of IBD patients often lacks vitamin D and vitamin K. Almost half of the patients in this study limited the consumption of vegetables including green leafy vegetables. This led to an inadequate intake of vitamin K1.
Vitamin D supplements are an important part of the therapeutic strategy targeted at IBD patients. Vitamin K supplementation is advised in bone and inflammatory rheumatic disease, chronic renal failure and for the prevention of vascular calcification and cardiovascular disease
however, is it not mentioned in the nutritional guidelines for IBD patients. This attitude
should change to reduce the adjunctive risk factor of osteoporosis in already
high-risk patients, prevent coagulation defects and possibly help modulate inflammatory
responses in IBD. These fat-soluble vitamins have strong interrelationships and should be provided in a supplement together.
Vitamin D deficiency has been linked to many autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus, multiple sclerosis, and Crohn’s disease, with studies finding a higher prevalence of these diseases in those who are deficient in vitamin D
There is plenty of evidence regarding the benefit of vitamin D supplementation on a multitude of health benefits not just with autoimmune disorders. Given the fact that supplementation of vitamin D in its natural form is harmless and inexpensive, many more people should get their vitamin D levels checked regularly and supplement according.
New review investigates the role of nutrition in inflammatory bowel disease related colorectal cancer
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 new review published recently in Nutrition, researchers investigated the role of nutrition in the prevention of in IBD related colorectal cancer.
The study’s intent was to review the role of nutrition in preventing IBD related colorectal cancer specifically in human studies. There is often a big disconnect between the medical research and clinical practice. Often many traditional doctors will tell patients that diet has nothing to do with their condition. Many of these individuals can change the trajectory or their condition with diet, lifestyle changes, and nutritional therapeutics. This review demonstrates that nutritional interventions based on eating nutrient-dense whole foods high in fiber, vegetables, fruits, omega-3 fatty acids, and a low amount of animal proteins, processed foods, alcohol, combined with probiotic supplementation can reducing IBD severity and reduce the risk of IBD related colorectal cancer through several mechanisms; therefore, personalized nutritional interventions represent a promising approach for the prevention and management of IBD associated colorectal cancer.
Other nutrients such as glutamine, polyphenols, and mucilaginous botanicals can be helpful in immunomodulation and for their anti-inflammatory properties. Other common deficiencies include magnesium, vitamin D, and iron. A low FODMAP diet or elimination diet can improve gastrointestinal function and decease disease activity.
Autoimmunity can occur a few different ways. First, there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction and it appears to be foreign to the body. Second, is called molecular mimicry. This occurs when the body makes an antibody (a protein in the body that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins in the body and the antibodies attack our body’s own tissues. Third, is the development of the T cells (the immune system). This can be affected by genetics, stress, and environmental triggers.
Environmental triggers are what integrative doctors mainly work with in functional medicine. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Also, gut health. This includes “leaky gut” and dysbiosis. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Cassotta M, Cianciosi D, et al. Possible role of nutrition in the prevention of inflammatory bowel disease-related colorectal cancer: A focus on human studies. Nutrition. 2023 Feb 3;110:111980.
New study investigates magnesium intake and older adults in cognitive impairment
Alzheimer’s disease and related disorders (ADRD) are a group of conditions that cause mild cognitive impairment (MCI) or dementia. These conditions affect one’s ability to function socially, personally, and professionally. It’s important to recognize that Alzheimer’s disease begins long before symptoms start just like many other conditions. There is evidence that simple prevention strategies can reduce the risk of ADRD by as much as 50%.
According to a new study published last month in Nutritional Neuroscience, researchers investigated sex differences in the effect of dietary magnesium intake and the risk of different types of cognitive impairment.
This study included 612 individuals ages 55 years of age and older from 2018 and 2019 to investigate the relationship between dietary magnesium intake and the risk of mild cognitive impairment (MCI). Dietary intake was assessed using a food frequency questionnaire about the frequency of foods and intake of 81 food items and/or groups over the past 12 months. Magnesium content of the food and participant intake of each food was used to calculate the total daily dietary magnesium intake per person by summing the daily magnesium intake contributed by each food group. The Montreal Cognitive Assessment Scale (MoCA) was
used to assess cognitive function of the participants, and overall cognitive function of each participant was reflected by their total MoCA score.
As a result, the research team found that dietary magnesium intake was associated with a
reduced risk of aMCI in women and these associations remained significant after adjusting for macronutrient intake, associated diseases, and sociodemographic information. This is similar to the results of previous studies.
It is best to use a good bioavailable form of magnesium such as glycinate or malate instead over oxide. The best form of magnesium that crosses the blood brain barrier is magnesium L-threonate. This form is designed to support cognitive function, memory, and overall brain health.
Other brain supportive nutrients to consider are GPC, CDP-choline, gingko biloba, and phosphatidylserine, and curcumin. GPC and CDP-choline are water soluble forms of choline that can cross the blood brain barrier and support brain health. These help make more acetylcholine, neurotransmitters, as well as phosphatidylcholine in the cell membranes.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
New study investigates the role of the microbiome in sarcopenia
Aging is associated with chronic low-grade inflammation, sarcopenia and functional decline. The loss of muscle mass between the ages of 40 and 80 is approximately between 30% and 60% and is associated with disability, illness, and death. Age-related musculoskeletal decline is a significant risk for falls in the elderly.
Exercise and nutritional supplementation are currently recommended as preventative against the loss of muscle and muscle strength, however, most of the nutritional studies have focused on protein supplementation. Since sarcopenia is associated with increased inflammation and impaired glucose homeostasis, omega-3-fatty have also been investigated.
According to a new article published earlier this month in Nutrients, researchers investigated the role of gut dysbiosis and the development of sarcopenia.
This was a case-control study investigating the gut microbiome composition in 50 cases in elderly women between 65 and 75 years of age with sarcopenia and 50 healthy controls. A food frequency questionnaire was obtained for the average food intake over the previous 3 months. A physical exam was performed, and assessments included height, weight, grip strength, and body composition.
As a result, grip strength, body weight, body mass index (BMI), skeletal muscle mass, energy intake, and high-quality protein intake were lower in cases than in controls. The gut microbiome testing demonstrated that the Bacteroides was significantly reduced in the case group compared to the Prevotella which was more abundant. Elderly women with sarcopenia had significantly different gut microbiota compositions than healthy individuals. Bifidobacterium longum was significantly higher in the controls. Animal and human studies have showed improved muscle function such as grip strength and muscle endurance as well as recovery from muscle atrophy. Probiotics such as Bifidobacterium longum contribute to the absorption and utilization of vitamin D and minerals and provides a protective factor for sarcopenia. There was also an increase in the Firmicutes to Bacteriodetes in the case group. Prebiotics such as xylo-oligosaccharides (XOS) can increase Bifidobacterium and improve this ratio as well. Prebiotics and probiotics have been shown to reduce low grade inflammation seen in those with sarcopenia.
These findings demonstrate a role of the microbiome and sarcopenia. Other nutrients to consider besides prebiotics and probiotics include vitamin D, magnesium, vitamin C, collagen, BCAAs, HMB, protein supplementation, and tocotrienols.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
New review investigates the role of the microbiome in pre-clinical rheumatoid arthritis
There has been a significant increase in the incidence of autoimmune disorders over the past several decades. Most individuals have a less-than-perfect diet and over the years Americans have lost much of the diversity in their diet which plays an essential role in the gut microbiome and a contributing factor in the epidemic of autoimmune disorders. More and more research demonstrates that the food one eats affects what bacteria populations are in their gut.
A significant environmental trigger in autoimmune disease is the diet. Dietary approaches provide the most effective means to returning balance and dysfunction with the gastrointestinal system.
According to a new review published 3 days ago in the Journal of Autoimmunity, researchers investigated the the role of the gut microbiome in pre-clinical rheumatoid arthritis.
Studies published over the past several years have demonstrated the correlation between gut microbiome and pre-clinical RA. The research on the microbiome in patients with RA suggests the presence of alterations in the gut microbiota and a potential link between RA development and intestinal dysbiosis. Recent clinical studies of pre-clinical RA individuals (including those with autoantibodies or genetic risk factors) showed that the dysbiosis occurs before the onset of RA.
The function of the intestinal barrier also plays a significant role in autoimmunity. An impaired intestinal barrier can increase intestinal permeability leading to a leaky gut. The disruption of intestinal barrier function and increased intestinal permeability were reported in RA patients, especially those with higher disease activity.
The most used approaches to treat RA include glucocorticoids, NSAIDs, and TNF-a inhibitors but these carry significant side effects.
Dietary supplements and prebiotics are commonly used by functional medicine practitioners and nutritionists for the support of RA by rebalancing the gut microbiota composition. Prophylactic treatment with dietary supplements and prebiotics can regulate T cell polarization, improve Treg and Th1/Th17 levels, reduce pro-inflammatory cytokine levels, and reduce the risk of RA. Probiotic supplementation can competitively inhibit the colonization of pathogenic Prevotella and suppress autoantibody production.
In addition to an anti-inflammatory or Mediterranean diet, other nutrients to consider include vitamin D, fish oil, resveratrol, curcumin, and probiotics.
Autoimmunity can occur a few different ways. It is also important to look at any environmental triggers such as food sensitivities, nutrient status, toxins, and gut health. Each person's biochemical individuality exerts a major influence on his or her health. The level of nutrient intake, lifestyle choices and environmental exposures filtered through genetic predisposition are major factors in the expression of disease, and a successful treatment approach must investigate these factors.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
New review investigates the efficacy of Palmitoylethanolamide supplementation in chronic pain
Pain is a complex experience that many times is difficult to manage, which can significantly impact one's quality of life. Traditional approaches include medications such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), but have side effects and can lead to addiction and dependence. In addition, many older adults cannot take them due to the other medications they are prescribed. As a result, many individuals seek alternative therapies to manage their pain. One consideration is Palmitoylethanolamide (PEA), which a naturally occurring fatty acid that has been shown to have anti-inflammatory and analgesic properties.
PEA is an endogenous compound produced by the body in response to inflammation and injury and is found in various foods such as egg yolk, soybeans, and peanuts. It is also available in supplement form and has been studied extensively for its pain-relieving properties.
According to a review published last month in Nutrients, researchers examined the efficacy of PEA in the treatment of chronic pain.
This review consists of 11 double-blinded randomized controlled trials including 774 patients using PEA supplementation for chronic pain. The primary outcome was pain intensity scores with secondary outcomes including quality of life, sleep quality, functional status, and side effects. The dosage of PEA varied quite a bit between the studies ranging from 300 mg to 1200 mg per day in single or divided dosing and a duration in treatment between 8 to 12 weeks. PEA was found to reduce pain scores with additional benefits of improving quality of life and functional status with no major side effects.
This review demonstrates that PEA supplementation is an effective nutritional therapeutic for chronic pain. It is also good to use a micronized form for optimal bioavailability.
Research has shown that PEA is effective in managing various types of pain, including chronic pain, neuropathic pain, and inflammatory pain. In one study, patients with chronic lower back pain were given PEA for eight weeks. The results demonstrated a significant reduction in pain intensity and an improvement in quality of life. Another study showed that PEA supplementation was effective in reducing neuropathic pain in patients with multiple sclerosis.
In addition to its pain-relieving properties, PEA has also been shown to have anti-inflammatory effects and plays a role in the immune response. There is also additional on sports performance and sleep with PEA.
Other nutrients to consider include omega-3 fatty acids, phyocannabinoids, curcumin, and vitamin D.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
New study demonstrates the impact of curcumin supplementation on systemic lupus erythematosus and lupus nephritis
There are only a few natural products that have demonstrated the wide range of protective properties as curcumin. Turmeric has three main bioactive components which are curcumin, desmethoxycurcumin and bisdemethoxycurcumin. These curcuminoids have many biological effects including anti-inflammatory, antioxidant, antitumor, antibacterial, and antiviral properties.
According to a new study published yesterday in Lupus, researchers investigated the efficacy of curcumin on systemic lupus erythematosus (SLE) disease activity.
This review consisted of three double-blind, placebo-controlled, randomized clinical trials, three human in vitro studies, and seven mouse-model studies. In human trials, curcumin decreased 24-h and spot proteinuria. In these studies, the trials were small ranging from 14 to 39 patients with varied curcumin doses and different study durations ranging from one to three months. On average, patients took three capsules a day, but the total constituent curcumin dose ranged from 60 mg to 150 mg a dose. There was no change in C3, dsDNA, or the Systemic Lupus Erythematosus Disease Activity (SLEDAI) scores. The mouse-model trials and human trial data demonstrated that it requires at least an average of 12-16 weeks of curcumin use to have an immunological effect. In addition, I would expect a greater and possibly sooner effect with a higher dose of curcumin.
This review demonstrates that curcumin can be a potential therapeutic for the management of SLE.
Autoimmunity can occur a few different ways. First, there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction, and it appears to be foreign to the body. Second, is called molecular mimicry. This occurs when the body makes an antibody (a protein in the body that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins in the body and the antibodies attack our body’s own tissues. Third, is the development of the T cells (the immune system). This can be affected by genetics, stress, and environmental triggers.
Environmental triggers are what integrative doctors mainly work with in functional medicine. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Also, gut health. This includes “leaky gut” and dysbiosis. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
New review demonstrates the association of vitamin D and magnesium with insulin sensitivity and effect on glycemic control
Healthcare providers know the importance of assessing vitamin D status on their patients. When vitamin D levels are low, supplementation is recommended or the dosage is often increased. More and more research demonstrates the intricate interrelationships with other nutrients. It is important to maintain optimal levels of all the fat soluble vitamins but one cannot forget magnesium either.
According to a new review published last month, researchers investigated the association of vitamin D and magnesium with insulin sensitivity and their influence on glycemic control. Researchers have found that patients with good glycemic control have high magnesium levels. In addition, magnesium is closely related to vitamin D and is required for the transport and activation of vitamin D.
Several studies have reported that vitamin D deficiency is common among patients with type II diabetes, suggesting a possible correlation between low vitamin D levels and pancreatic insulin secretion and action.
Vitamin D is also known to have immunomodulatory and anti-inflammatory effects, which can improve insulin resistance by altering low-grade chronic inflammation involved in insulin resistance. In addition, low vitamin D levels increase parathyroid hormone concentration, resulting in secondary hyperparathyroidism, which can lead to glucose intolerance.
Most studies agree that both vitamin D and magnesium are important regulators of glucose
homeostasis and play an essential role in the management of type II diabetes. Vitamin D and magnesium levels were found to be significantly lower in diabetic patients. This was demonstrated by a study on diabetes patients that showed those with poor glycemic control had significantly lower vitamin D and serum magnesium levels than those with good glycemic control.
Vitamin D and magnesium insufficiency are a common issue among many patients. Over 75% of individuals have calcium to magnesium ratios greater than 2.5 and up to 80% of people do not consume enough magnesium in a day to meet the recommended dietary allowance (RDA) and most of these individuals are also vitamin D deficient.
It is essential to recommend patients consume foods including dark leafy greens, beans, whole grains, dark chocolate, fatty fish such as salmon, nuts and avocados as deficiencies in magnesium and vitamin K can contribute to vascular calcification and supplement with vitamin D accordingly.
The role of vitamin D and magnesium in enhancing insulin sensitivity has been confirmed by previous studies. Vitamin D supplementation increases vitamin D levels and supplementation of magnesium alone in patients with diabetes shows insignificant effects on glycemic control, however, studies have shown the combination of vitamin D and magnesium supplementation improves glycemic control in patients with diabetes.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
New review investigates the role of Akkermania muciniphila in inflammatory bowel disease
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 new review published last month in Frontiers in Immunology, researchers investigated the role of Akkermansia muciniphila in patients with IBD.
Although previous research has shown differences in the gut microbiome in IBD patients, this review investigates how changes in the microbiome can contribute to an inflammatory response.
This review has demonstrated the potential protective effect of A.muciniphila in the process and development of intestinal inflammation. An abnormal decrease in the abundance of A.
muciniphila maybe a hallmark of IBD, which is associated with dysbiosis, decreased intestinal barrier function, and altered immune response.
It is important to note that the role of commensal A. muciniphila in IBD is still controversial as in too high of levels it can contribute to intestinal inflammation, which might be due to difference in genotypes and strain specificity of A. muciniphila.
Therefore, we should always hold a reasonable dose of expectation and skepticism in terms of the overwhelming “good effects” of A. muciniphila in health and disease states.
A. muciniphila therapies are now considered a valuable therapeutic approach to treat IBD patients. There is an A. muciniphila probiotic that has recently become available. In addition, A. muciniphila can also be increased with an increased intake of foods rich in polyphenols or supplementation with polyphenols including blueberry, cranberry, pomegranate, and quercetin.
It is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms exacerbate or improve.
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.
Probiotics, fish oil, glutamine, polyphenols, and mucilaginous botanicals are helpful in immunomodulation and for their anti-inflammatory properties. Other common deficiencies include magnesium, vitamin D, and iron. A low FODMAP diet or elimination diet can improve gastrointestinal function and decease disease activity.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS