15 Jul Modern Functional Medicine: a promising approach for Inflammatory Bowel Disease (IBD) in Australia
IBD is a “difficult to treat” condition that affects over 75,000 Australians, causing gut pain, diarrhoea, and tiredness among other symptoms.
The incidence of inflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, is rising in Australia. According to official sources, more than 75,000 Australians suffer from IBD. Although there is no cure, there are treatments to alleviate and control the symptoms of the disease. Furthermore, lifestyle changes, like a better diet, can contribute to a normal, fulfilling life in patients with IBD.
What is IBD?
Inflammatory bowel disease is a general term used to describe a group of inflammatory conditions. The two most common IBDs are Crohn’s disease and ulcerative colitis (Table 1). Both conditions are characterised by chronic inflammation of the gastrointestinal (GI) tract with an imbalance of the intestinal microbiota.
|TABLE 1. DIFFERENCES BETWEEN CROHN’S DISEASE AND ULCERATIVE COLITIS|
|CROHN’S DISEASE||ULCERATIVE COLITIS|
|· Can affect any part of the gi tract (from the mouth to the anus). Usually, it affects the ileum, which is the portion of the small intestine before the large intestine.|
|· Affects the large intestine and rectum.|
|· Inflammation occurs in patches, with affected areas next to healthy tissue.||· Inflammation occurs continuously, usually starting at the rectum and spreading further into the colon.|
|· Inflammation may reach through the multiple layers of the walls of the gi tract.|
|· Inflammation occurs only in the innermost layer of the lining of the colon.|
People with IBD have times of active disease (flares) with symptoms present and, times of remission, with little or no symptoms. The most common symptoms of IBD include abdominal pain, weight loss, persistent diarrhea, fatigue, and rectal bleeding/bloody stools. Some people may experience complications including deep ulcerations, bowel obstructions, infections, and malnutrition. Additionally, people with IBD have an increased risk of colon cancer. In children, IBD can cause delayed or impaired growth.
Inflammatory bowel disease should not be confused with irritable bowel syndrome (IBS), a condition that also affects the GI tract but has a completely different pathology and, consequently, requires a different treatment.
What causes IBD?
The precise cause of IBD remains unknown. However, evidence supports the role of four factors in the development of IBD: a genetic component, an environmental trigger, an imbalance of intestinal bacteria and dysfunction of the immune system1-4. Under normal conditions, the immune system defends our body against infection. But, in people with IBD, the immune system mistakes harmless and local bacteria, virus, and other microorganisms in the intestine for foreign substances and launches an attack that triggers inflammation4-6.
Previously, it was thought that diet and stress were the leading factors behind IBD7-10. Now, it is known that IBD is a more complex condition, where stress and diet may influence the symptoms of the disease but are not the causing agents. Nevertheless, it remains important to reduce stress levels and optimise your diet, as this can improve the life quality of people with IBD.
How is IBD diagnosed?
IBD can be diagnosed through several tests11, including:
- Blood tests – Inflammation can be detected by examining levels of different blood factors, such as red and white blood cells, platelets, and C-reactive protein.
- Stool tests – Faecal biomarkers are used to detect inflammation in the GI, as well as infections and alterations to the optimal composition of the gut microbiota.
- Endoscopic procedures – These are non-surgical procedures that use an endoscope, inserted directly into a person’s body through the mouth or anus, to examine the digestive tract. These procedures include colonoscopy, flexible sigmoidoscopy, upper endoscopy, capsule endoscopy and, balloon-assisted enteroscopy.
- External imaging procedures – These procedures generate images of the body, from outside the body, using different technologies. These procedures include X-ray, computerised tomography (CT) scan and magnetic resonance imaging (MRI).
Currently, there is no cure for IBD. Treatment for IBD will depend on the location and severity of the disease, as well as whether the person has Crohn’s disease or ulcerative colitis. The standard medical approach for the treatment of IBD involves the use of medications to control abnormal inflammatory responses. These medications include:
- Aminosalicylates – This class of drugs contains 5-aminosalicylic acid (an aspirin-like compound) and reduces inflammation in the lining of the intestine. They are used in mild to moderate cases of IBD.
- Corticosteroids – These steroids suppress the ability of the immune system to begin and maintain inflammation. They are used as a short-term treatment during flares.
- Immunomodulators – These drugs, like corticosteroids, suppress the ability of the immune system to maintain inflammation. However, they are used for long-term treatments.
- Biological therapies – These antibodies, produced in the laboratory, block the action of proteins that cause inflammation.
- Surgery – Procedure performed to remove sections of severe inflammation or to repair any damage.
Additionally, antibiotics are used to fight infections produced by the disease itself or by post-surgical procedures.
Besides medical treatment, attention to diet and other factors, such as stress, may help people with IBD to control their symptoms. Diet is not the cause of IBD nor it is the cure. However, once IBD has developed, a well-balanced, healthy diet can help to maintain adequate nutrition, as nutritional deficiencies are common in people with IBD. Furthermore, diet can affect IBD symptoms, for example, during flare-ups, abdominal discomfort and cramping can be reduced by:
- Avoiding foods with high-fat content, which can cause diarrhea and gas when fat absorption is incomplete12.
- Limiting consumption of some high-fibre foods, which can cause contractions once they have entered the large intestine, as well as cramping when there is a narrowing of the bowel. These foods may also cause diarrhea13.
- Avoiding “trigger” foods, such as “gassy” or spicy food, which aggravate symptoms.
- Food rich in fats and sugar is bound to worsen multiple IBD symptoms in susceptible patients.
However, there is no single diet that works for everyone with IBD. Diet plans must be individualised based on the disease and the part of the GI affected. Furthermore, the diet should be regularly adjusted, as IBD changes over time. For example, foods that should be avoided during flare-ups may not be a problem during remission times. Therefore, nutritional support, to correct deficiencies and keep symptoms under control is an important component of IBD treatment. Become a patient today and we will discuss your case with the help of a dietician, which would help us find a diet that is right for you.
Living with IBD
People with suffering from IBD may experience symptoms and side effects from their medications, including faecal incontinence and altered appearance (weight gain, hair growth, acne), which can cause high levels of stress and even worsen symptoms. In some people, particularly children and adolescents, adverse psychosocial and psychological effects, such as depression and anxiety can occur. Appropriate counselling should be immediately pursued by anyone experiencing these problems.
IBD and Functional Medicine in Australia
Inflammatory bowel diseases are chronic conditions that require long-term care. Usually, IBD involves periods of flares, remission, and relapses. In Australia, as many as 75,000 people are affected by IBD, most of whom are diagnosed before age 35. The number of affected Australians is estimated to increase to 100,000 by 2022, according to a report from Chron’s and Colitis Australia.
The Australian Department of Health has identified two main problems related to IBD: the high cost of healthcare and, the inadequate and inconsistent care. Currently, there is a critical need for improvement relating to the management of IBD in Australia.
In this scenario, functional medicine stands as a multidisciplinary and innovative approach to treat IBD.
Functional Medicine as implemented by the Australian Centre for Functional Medicine (AUSCFM), in Perth, Western Australia, take a comprehensive approach in the treatment of IBD, which is effective and unique in Australia. The goal is to address the underlying mechanisms driving disease, not just controlling symptoms.
A central aspect of the approach taken by AUSCFM involves the development of personalised diets that target different aspects of a patient’s body. For example, some patients will need to improve their intake of certain fibres, to promote the growth of beneficial gut bacteria. In addition, most patients will need to make significant changes in the amounts and types of food they consume every day.
BECOME A PATIENT TODAY
Experience a different approach to healthcare. At AUSCFM we seek to understand the underlying problems that drive your IBD symptoms. Treatments are only prescribed after comprehensive testing and evaluation of multiple aspects of your health.
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- Bernstein CN. The brain-gut axis and stress in inflammatory bowel disease. Gastroenterology Clinics. 2017 Dec 1;46(4):839-46. Read it!
- Tontini GE, Vecchi M, Pastorelli L, Neurath MF, Neumann H. Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives. World journal of gastroenterology: WJG. 2015 Jan 7;21(1):21. Read it!
- Ananthakrishnan AN. Epidemiology and risk factors for IBD. Nature reviews Gastroenterology & hepatology. 2015 Apr;12(4):205-17. Read it!
- Pituch-Zdanowska A, Banaszkiewicz A, Albrecht P. The role of dietary fibre in inflammatory bowel disease. Przeglad gastroenterologiczny. 2015;10(3):135. Read it!