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Inflammatory Bowel Disease: Contrasting Medical Care Approaches

Inflammatory Bowel Disease: Contrasting Medical Care Approaches

12/4/2017

In honor of National Crohn's and Colitis Awareness Week, SCNM's Dr. Amanda Alexander took some time to write about these inflammatory bowel diseases and what can be done about them.  Read what she had to say below!

Dr. Amanda Alexander, ND, M.Ed.

In the United States, 1.6 million people have been diagnosed with inflammatory bowel disease (IBD). Patients with this uncomfortable condition often experience episodic diarrhea and abdominal pain. Diagnosis often occurs before age 30, but sometimes may occur later in life depending on which type id present – either Crohn's or ulcerative colitis (UC). Diagnosis is often based on which areas of the gastrointestinal (GI) tract are inflamed. For example, in Crohn's disease the small intestine is often involved, whereas UC typically presents with inflammation confined within the colon.

In addition to GI symptoms, some patients with IBD may also experience arthritis (usually involving large joints), eye complications (e.g. inflamed sclera or uvea – the middle layer of the eye underneath the retina), mouth sores (e.g. canker sores or dry, cracked lips), and even cancer in the biliary tract where the liver and gallbladder connect with the small intestines. Also, due to the disruption of proper function in the gut or possible surgical complications, malabsorption often results within the bowels.

Current research suggests that IBD has both autoimmune and immune-modulating characteristics. In UC, the immune system may begin attacking certain bacteria in the colon of susceptible individuals. These events may eventually lead to autoimmune activity against colonic cells, which remains localized within the colon. Additionally in Crohn’s disease, a predisposition may be implicated by genetic variations of the NOD2 (or CARD15) gene. Having two recessive genes may increase risks of developing Crohn’s disease.

Typical medical intervention includes agents that reduce inflammation like oral glucocorticoids. Often during flares the patients are prescribed a corticosteroid for about two weeks, which is later gradually tapered. Although this helps decrease symptoms, recurrent flares are common. Antidiarrheal medications may provide some relief for patients, but fail to address the actual cause of IBD. Other drug therapies include 5–amino salicylic acid (5–ASA), which specifically blocks leukotrienes and prostaglandins and antibiotics like metronidazole or ciprofloxacin, which controls mild disease and may help decrease fistulas specifically in Crohn’s disease. Immunomodulating drugs like Methotrexate may also be prescribed if corticosteroid treatment fails.

The naturopathic approach to addressing IBD may seem similar initially as it relates to investigative labs and imaging to confirm diagnosis. For example, a colonoscopy with biopsy is the gold standard for diagnosis of UC and a stool culture and parasitology may also offer insight regarding dysbiotic flora within the GI tract. However, there are additional labs that can be done to improve patient outcomes. Food sensitivity testing is an option that may provide insight about specific foods that cause an inflammatory response in an individual. Interestingly, the foods one’s immune system may react to could be considered healthy foods in general, but with this type of testing, naturopathic physicians can help patients with IBD further decrease inflammation in the gut. Since IBD involves an immune component, Vitamin D levels are usually tested and monitored as well. Having sufficient levels of Vitamin D can help decrease autoimmune activity and inflammation.

In contrast to typical medical interventions with pharmaceuticals, some naturopathic recommendations for patients with IBD may include fish oil and/or bio-active pepties (a natural anti-inflammatory), mucilaginous herbs to coat and soothe the GI tract, botanical herbal preparations that target dysbiotic organisms in the gut, detoxification protocols to clear out wastes and improve gut function, IV nutrients to replete necessary vitamins and minerals while gut absorption is compromised so the body can heal, proteolytic enzymes to target inflammatory complexes and breakdown old tissue and possibly low dose naltrexone, which may help modulate the immune response.

In addition, lifestyle recommendations may include specific dietary guidelines to decrease sugar and carbohydrate consumption, protocols to reduce stress and improving sleep hygiene – all of which will ultimately provide opportunities for the gastrointestinal system to heal. At the core of the naturopathic approach, the goal is to remove obstacles so the gastrointestinal system can repair. This should eventually lead to decreased episodic flares and improve the quality of life for patients impacted by inflammatory bowel disease.

Click here to request an appointment with Dr. Amanda Alexander, ND, MEd, or call 480.428.3232.