Inflammatory Bowel Disease and Functional Medicine

Crohn’s disease and ulcerative colitis are the two main forms of inflammatory bowel disease. In both diseases, the gut becomes chronically inflamed. This interferes with proper digestive function and can lead to poor absorption of nutrients.

In ulcerative colitis, it’s the lining of the large intestine and rectum that is affected. The pattern of inflammation is one continuous area of damaged tissue.

In Crohn’s disease, any part of the digestive tract can be affected from the mouth to the anus. It can affect all the layers of the digestive tract and typically appears as multiple patches of inflamed tissue with areas of healthy tissue in between.

The symptoms can range from mild to severe. Inflammatory bowel disease is often characterised by periods where symptoms are very severe interspersed with periods of no symptoms (remission). The pattern of symptoms can vary but typically include:

  • Abdominal pain and cramping
  • Diarrhoea (this may contain blood or mucus)
  • Tiredness and fatigue
  • Feeling generally unwell or feverish
  • Loss of appetite
  • Weight loss
  • Anaemia (a reduced level of red blood cells)
  • Nutrient deficiencies

In some cases, there may also be symptoms outside of the digestive system such as joint pains and eye problems.

Diagnosis of inflammatory bowel disease often starts with blood tests and stool tests to see whether there is inflammation in the body. Blood tests can also identify nutrient deficiencies. If the blood tests and stool tests are positive for inflammation, findings will be confirmed with a colonoscopy or endoscopy. These processes involve using a long thin, usually flexible, tube with a camera in its tip to examine your digestive system. This will allow the specialist to see any areas of inflamed tissue.

The cause of inflammatory bowel disease isn’t fully understood. Current understanding is that it arises from a combination of genetic susceptibility and environmental triggers. The trigger could be a course of antibiotics, an intestinal infection, a long course of painkilling medication or anything that dramatically alters the balance of the persons gut flora. In a healthy person these challenges will cause a short-term upset then everything will return to normal. In inflammatory bowel disease, the inheritance of particular genes can cause these triggers to lead to a chronic inflammatory response in the gut. This then leads to the development of the areas of ulcerated tissue and the associated symptoms.

In the short to medium term, the inflammation in the digestive system causes diarrhoea, bleeding and malabsorption. This can lead to nutritional deficiencies. Low levels of iron, folate and B12 can lead to anaemia and poor absorption of calcium increases the risk of osteoporosis.

In addition, the areas of inflamed gut lining can become stuck together. This is called a stricture and it can obstruct the passage of food through the intestines. The ulcers in the gut lining may also extend all the way through the layers of the intestinal wall creating an open passageway to other parts of the body. This is called a fistula. Finally, the presence of long-term inflammation in the gut increases the risk of intestinal cancers. Managing the inflammation in Crohn’s disease and ulcerative colitis is vital to minimise the risk of these complications.

Conventional medical treatments focus on medications that suppress inflammation and the immune system. Patients may also be offered antibiotics or anti-diarrhoea meds. In severe cases, where drug treatment can’t keep symptoms under control, surgery may be suggested. This usually involves removing the affected part of the intestines.

The functional medicine approach to inflammatory bowel disease aims to work on the underlying causes of the inflammation, as well as maximising nutrient status, and prolonging periods of remission.

A typical protocol will include:

  • Dietary analysis to identify any foods that may be triggering the inflammation in the intestines or making it worse.
  • Full assessment of intestinal microflora to assess for any imbalances. These can then be targeted with a personalised diet and supplement protocol to rebalance the gut flora.
  • Advice on therapeutic foods, herbs and supplements that can support a healthier inflammatory balance.
  • Evaluation of nutrient status and a personalised diet and supplement regimen to restore nutrient status.