Inflammatory Bowel Diseases: chronic inflammation must be fought
Inflammatory bowel disease is the name given to a group of diseases related to the digestive tract: Crohn's Disease, Ulcerative Colitis and Microscopic Colitis.
More than 20 thousand Portuguese are affected by these pathologies, whose international day is celebrated on May 19th and whose awareness campaigns are already common every year.
They are not high mortality pathologies, are a reason for of loss of quality of life.
A chronic inflammation is the common feature of Crohn's disease and ulcerative colitis, where Crohn's disease can affect the entire digestive system and ulcerative colitis usually presents in the colon and rectum. With regard to the extent of the disease, in Crohn's disease it is greater, noting that the intestinal wall itself is more extensively affected, than in ulcerative colitis. In both cases, the effects can end up being noticed throughout the body (eyes, joints, skin, among others). These are considered immune diseases, since the immune system reacts against the body itself.
The pathophysiology of ulcerative colitis and Crohn's disease are distinct, yet have some similarities.
In both, the change in the bacterial diversity of the intestinal flora, alteration of the epithelial barrier and of the mucosal barrier through the disruption of the so-called "tight junctions" are the starting point for the activation of the immune system. This alteration of the intestinal permeability causes the immune system to come into contact with bacteria from the intestinal flora leading to the production of inflammatory mediators that will have numerous effects (TNF-α, IL-5, IL-6, and IL-13 in the case of colitis and TNF-α, IL-6, and IL-23 in the case of Crohn's disease). The pathways that activate after this are distinct and we can discuss them another time.
The digestive symptoms turn out to be similar: cramps, frequent bowel movements (usually towards diarrhea), lots of gas formation. Weight loss, fever, night sweats, tiredness, anemia,... are also common symptoms over time. These symptoms can all go away and come back for no apparent reason (periods of remission and flare-ups). It is the inflammation behind these symptoms that is chronic and must be somehow controlled.
Here is where the heart of the matter lies. The inflammation.
This ally of ours, which ceases to be when it becomes chronic. And immune modulation.
The method of diagnosing these diseases is through the patient's report (signs and symptoms), clinical evaluation, and tests such as blood tests(detecting for example the existence of inflammation), stool evaluation(calprotectin, lactoferrin, among other markers), endoscopy or ileocolonoscopy, computed tomography tests, magnetic resonance imaging, and capsule videoenteroscopy. In more serious cases, it may be necessary to operate the affected area. Usually action is taken by giving some dietary instructions and/or suggesting medication (anti-inflammatory drugs that act on the intestine - aminosalicylates), corticoids, antibiotics, immunosuppressive drugs, or biological drugs).
There are patients who simply take their medication all the time and do well with it (everyone chooses their own way). But, there are medications that you can't take continuously and there are patients who prefer other options anyway. For those who might want another path, there are other choices.
Let's imagine, as an analogy, that in our car the engine oil light comes on. We know well what this light means, and therefore ideally we refill the oil tank. But if we just wanted to get rid of the symptom (the engine oil light coming on), we could fill the tank with water or, as a last resort, even break the signal display. The symptom goes away (light on), but the problem is still in the car.
What we do by taking medications for years without doing anything else in terms of controlling inflammation and immunity, is like putting water in the engine or breaking the dial.
We may even have tests showing lower inflammatory values, or a more controlled immunity, but, the cause of the inflammation is still untreated. It is simply lower because a medication is forcing it.
I'm not saying that we know a cure for the disease, because its causes are still unclear. There are situations in which medications are necessary, even if only temporarily; or others in which the clinical picture has already evolved very negatively (intestinal obstruction, fistulas,...), requiring more aggressive approaches such as surgery. But, we can somehow (and we already do it) try to fight in another way the inflammation that is in a chronic state, allowing a better immune modulation, giving tools to the body to do it(putting the right oil in the engine).
Environmental factors involved in Inflammatory Bowel Disease.
Let's go back for a moment, to the causes that are still unknown, but of which we have some clues. It is known that there is an genetic component associated disease (if you have a relative with the disease, you are more likely to have it), but also that it is environmental factors that trigger this susceptibility. Factors such as sleeping habits, stress and physical inactivity, intestinal flora (microbiome), smoking habits, bad eating habits (mainly very industrialized), use of medication ( antibiotic use for example).
Some of the mechanisms suggested for the association between diet and the development of Inflammatory Bowel Disease.
If we know that these are the factors that possibly lead to the appearance of these conditions, then this is also where we should act in the treatment. The suggestions for action in cases of inflammatory bowel disease are therefore quite comprehensive.
If you want to take care of yourself, you have to look at yourself as a whole that deserves a new plan of action, because what you have done so far has not worked. Nutrition is an integral part of it, but not only:
Stay active. Being sedentary increases the risk of a number of problems and also of inflammatory bowel disease. This exercise thing again? Yeah, have you ever thought that if you talk about it so much it's because you really need to get moving! Physical activity is directly associated with a decrease in inflammatory markers.
Decrease your intake of simple sugars and pay attention to your daily food combinations. Yes, if you spend your day snacking and/or going into hyperglycemia you are having a pro-inflammatory (inflammation promoting) effect. Every time you eat you are sending a message to your body. What kind of message do you really want to send?
Control stressControl stress, or at least the way you interpret stressful situations in your life. It is not realistic to ask you to eliminate stress from your daily life, but it is realistic (and necessary) to look at stress in a different way, to find your own strategies to deal with it, and yes, maybe get rid of one or another toxic situation or person from your life. Your gut will thank you.
Improve nutritional status. You have normal vitamin D (it is now even common to measure it), but you can and should improve it. You may be one of the people with the greatest need. Do you have a low value? What are you waiting for to take care of it?
Further improve nutritional status.Other vitamins and minerals should be put on the table: magnesium, zinc, iron, vitamin B6, vitamin C, vitamin E. Phytochemicals and other antioxidants.
Sleep well: more than 6 hours of sleep, but less than 9 seems to be ideal. Try to have a quiet end of the day, so that your melatonin rises and you can sleep well.
Avoid the use of antibiotics can lead to changes in the intestinal flora that increase the risk of intestinal disease. Thus, take only in strictly necessary cases.
Use extra supports like with turmeric, omega 3 , resveratrol, ginger (very interesting effect on intestinal flora and anti-inflammation), probiotics,.... depending on the case we can try different elements.
Feed yourself with antioxidant and immunity-boosting sources. You could be talking about a Mediterranean diet, ketogenic, low FODMAPS, or any other kind of approach. The important thing is to get the necessary nutrients, focusing first on what seems to be lacking, quality fats, enough but not too much protein. Each patient's tolerance will dictate the path.
The nutritional and/or medical follow-up has to be truly personalized, because each patient is effectively unique.
If you want to start your health journey with us, you can contact us:
E. info@cristinasales.pt
T. (+351) 911 082 191