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This week's topic: IBD
Gastrointestinal symptoms or conditions are one of the top reasons that patients seek out Functional Medicine care, and IBD (inflammatory bowel disease) is one of those conditions.
Overview of today's email:
- Overview of IBD
- Root causes to consider
- Practical clinical tips
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1. Overview of IBD
There are 3 primary conditions that fall under the category of Inflammatory Bowel Disease (IBD): Crohn's Disease, Ulcerative Colitis, and IBD-U (unexplained IBD).
Common symptoms include chronic diarrhea, urgency, abdominal pain, and nutritional deficiencies, but around 25% of people experience extraintestinal manifestations (most frequently affecting joints, skin, or eyes). Both the chronic inflammation in inflammatory bowel disease (IBD), and the pharmaceutical treatments, can increase the risk of malignancy.
Crohn’s:
- Distinguishing features: Can affect any part of the GI system, from the mouth to the anus. Transmucosal and skip ("cobblestone") lesions are hallmark findings, and it is more common to see extraintestinal manifestations and fistulas.
UC
- Distinguishing features: Only affects the colon and always affects the rectum; common to see bloody diarrhea and mucosal inflammation, as well as a compromised mucosal barrier (resulting in less mucus production).
Since I know a colleague who was sued (after a patient spent a lot of money on functional medicine-specific lab testing and supplements, and was ultimately found to have IBD), I always start with commercial lab testing:
- Fecal calprotectin (anything over 50 should be referred to GI)
- Pancreatic elastase (stool test)
- CBC, CMP
- If diarrhea is present, always check for C.Diff and run a stool culture/O&P
- Celiac panel
- hsCRP, ESR
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2. Root causes to consider
IBD is an autoimmune condition, and in functional medicine, we approach any autoimmune condition in a similar manner:
- Calm down the symptoms (even if it includes pharmaceuticals, and in IBD, this often involves biologics)
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Take a deep dive into potential root causes. I tend to look at the top 7:
- Mindset and Beliefs, with an emphasis on improving self-compassion (autoimmunity = "self attack," which includes self-criticism)
- Nervous system imbalance, especially SNS dominance (stress is still the number one trigger of chronic health issues, but also consider someone's ACE score)
- Gut health and microbiome balance affected by lifestyle triggers (e.g. excessive exercise, overuse of antibiotics or NSAIDS, etc)
- Nutrition (with an emphasis on fat-soluble nutrients and prebiotic foods to support the gut's immune system)
- Chronic infections (oral dysbiosis, gut "bugs", reactivated viruses, etc)
- Other sources of inflammation (especially oxidative stress that affect mitochondria function)
- Toxins and ineffective detoxification pathways (genetics can be at play with this)
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3. Practical Clinical Tips
First, I always involve a GI doctor for proper diagnosis, colonoscopies, and to be on hand for severe flares (...and to CYA).
Second, consider the reason for a treatment:
- Is it to reduce symptoms?
- Will it reduce disease activity?
- Will it reduce inflammation that is a result of disease activity or pharmaceutical use?
- Will it reduce relapse rates?
- Or will it help achieve or maintain remission?
There are many nutraceutical treatments I've learned about in my training, but in this week's Substack, I am sharing the treatments that I reviewed in the literature (spoiler... L-glutamine has NOT been shown to be helpful!) and integrative medicine techniques I use when addressing IBD.
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I hope this was clinically useful!
These emails take a lot of time to create (and I don't receive a lot of feedback on whether they are useful to those that receive them), so I've moved to Substack for an extended version of these at a low monthly cost (available within 24 hours of releasing this email). Why Substack? It has the benefits of being able to comment and ask questions about the posts, you're not bombarded with ads, I'm using the platform as a "mini-mentorship", and it's low cost!
Meg
Additional resources that may be helpful:
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