A Gut Feeling: Putting Intestinal Disorders In Order
By Dan Lukaczer, N.D.

In recent years, irritable bowel syndrome (IBS) has become a familiar term and an even more common condition. Affecting 10­20 percent of the U.S. population, IBS is characterized by symptoms including abdominal pain, constipation, diarrhea and abdominal distention. This painful and perplexing condition has no known cause and is generally diagnosed only after other intestinal disorders have been ruled out. The condition has gone largely unresolved by conventional medicine, thus serving as an open area of exploration for many alternative therapies. Herbs, diet and Traditional Chinese Medicine (TCM) have played significant roles in treating IBS, but the intestine has upped the ante and shed light on yet another pain in the gut: inflammatory bowel disease (IBD). The more serious IBD, also called colitis, is characterized by gut-wall inflammation and involves actual physical changes that can be detected via diagnostic laboratory tests. Although it is not as prevalent as IBS, IBD affects about 250,000 people in the United States, or approximately one in every 1,000 people (Cecil's Textbook of Medicine, W.B. Saunders Co.).

The most common conventional treatments for IBD involve heavy-hitting pharmaceuticals such as steroids and immunosuppressive drugs. Accompanying these are side effects including anemia, easy bruising, frequent infections and mood swings. Because of the frequency and severity of these side effects, many people prefer the symptoms of the disease to the problems that accompany treatment.

IBD can be a chronic, relapsing and debilitating condition affecting one's lifestyle and mental state, often causing social embarrassment and isolation. Many patients with IBD face the possibility of long-term drug use with significant side effects and even multiple hospitalizations and surgery to remove diseased sections of the intestine.

Complementary medicine, however, offers another option. By addressing the root of the problem rather than just the symptoms, alternative therapies empower individuals to be more involved and proactive with their own health and treatment.

A Downward Spiral
Chronic IBD is generally of two types: Crohn's disease and ulcerative colitis. Although some significant differences exist in their location and in the way they affect the intestinal wall, they both cause abdominal pain and cramping with frequent, urgent, loose bowel movements marked by blood, mucus and pus. Complications of both can include abscesses and infections, fistulas, hemorrhoids, intestinal wall perforations, weight loss and malabsorption of nutrients. IBD in general can increase the risk for gastrointestinal cancer. Additionally, the disease can have systemic effects including arthritic symptoms and fatigue.

Considerable debate has centered on IBD's underlying cause. Because 20 percent of IBD patients have a relative with the disease, some researchers suggest genetic predisposition plays a significant role in its onset. In children who develop IBD, the likelihood of another immediate family member having the diagnosis is greater than 40 percent (Cecil's Textbook of Medicine, W.B. Saunders Co.). However, the etiology of IBD is obviously more complicated than simple genetic inheritance. Environmental factors undoubtedly contribute. One theory proposes that changes in the bacteria residing in the gut may lead to an improperly regulated immune response, resulting in chronic inflammation. Another theory suggests an intake of dietary allergens contributes to IBD development. These allergens disrupt immune system function, again resulting in inflammation. In both scenarios, a leaky gut ensues. In this case, things like food allergens and bacteria can cause inflammation and damage to the gut wall.

Whatever the cause of the breakdown, the link between IBD and compromised intestinal integrity is clear. The cells in the lining of the small intestine and colon are the first to interact with ingested food particles or bacterial organisms. This interaction can result in immune activation and an inflammatory response, damaging the mucus barrier and the intestinal lining. This further activates exposed immune cells, and a vicious inflammatory cycle ensues (European Journal of Gastroenterology and Hepatology, 1997, vol. 9). The two areas of focus in IBD, then, are improving bacterial balance and decreasing food allergens.

A Bacterial Balancing Act
With more than 400 different species of bacterial microorganisms residing in the gastrointestinal tract, their overall balance—and imbalance—can profoundly influence gut ecology and health. Intestinal bacteria, including probiotics, are responsible for a plethora of jobs: They produce toxins and antitoxins, alter chemical composition of foods and drugs, produce and break down vitamins, degrade dietary toxins and inhibit the growth of certain pathogens.

Beneficial bacteria are present in foods including yogurt and kefir, but dietary supplements are also helpful and more concentrated. Frequently supplemented species include Bifidobacterium bifidus, B. longum, B. breve, Lactobacillus acidophilus, L. bulgaricus, L. thermophilus, L. sporogenes and L. casei.

Several studies suggest probiotics have a positive effect in IBD patients. One small study measured the effect of the probiotic Lactobacillus casei GG (LGG) in patients with Crohn's disease. The authors concluded LGG may have the potential to promote and fortify the gut immunological barrier (Annals of Nutrition and Metabolism, 1996, vol. 40).

More recently, a double-blind comparison trial concluded that probiotics offer an option for maintenance therapy in patients with ulcerative colitis in remission (Alimentary Pharmacology and Therapeutics, 1997, vol. 11). In another study, 15 patients with ulcerative colitis were treated with a combination of probiotics. After one year, 80 percent of the patients (12 of 15) were in remission (Gastroenterology International, 1998, vol. 11). While research is still preliminary, it strongly suggests that probiotics can produce beneficial effects in IBD patients. Supplementing with prebiotics is also important. Prebiotics—really a subset of fiber—are defined as food sources that friendly bacteria prefer. Some important prebiotics include fructo-oligosaccharides (FOS) and inulin, which exist in foods such as asparagus, chicory, garlic, Jerusalem artichoke and onion. All support this indirect bolstering process (Journal of Nutrition, 1995, vol. 125).

Another interesting fiber source is arabinogalactan, which naturally occurs in the fiber found in fruits and vegetables such as carrots and tomatoes. It is also found in particularly high concentrations in the larch tree (Larix occidentalis). Certain strains of beneficial bacteria appear to preferentially feed off of arabinogalactans (International Journal of Food Microbiology, 1994, vol. 24), contributing to overall intestinal health.

You Are What Antigens You Eat
During the course of a lifetime, the gastrointestinal tract processes more than 25 tons of food; in other words, the intestine is responsible for the largest antigenic load confronting the human immune system. An antigen is something the body recognizes as foreign, including food proteins that have not been broken down. In a healthy intestine, only a small proportion of whole-food proteins are absorbed. Most are broken down, thus greatly decreasing their antigenic potential. In a compromised gastrointestinal environment, with impaired digestion or increased intestinal permeability, significantly more antigens can penetrate those barriers and cause reactions. Some people don't have to have a leaky gut to have problems with food allergens. It may just be heredity; these individuals are genetically predisposed to food reactions.

Can identifying a food allergy or intolerance be useful for treating or improving the symptoms of IBD? Are there specific foods or food groups that can be linked to the initiation or aggravation of IBD? For both questions, the answer seems to be a qualified yes. Elemental or elimination diets, which limit many possibly allergenic foods, showed remission rates of 85 percent with Crohn's disease patients (Alimentary Pharmacology and Therapeutics, 1997, vol. 11). Effects are noted generally within two to four weeks. Elemental diets seem to be particularly effective in children.

Several studies have identified foods that cause reactions in some IBD patients. The culprits may include beans, citrus fruits, eggs, fish, milk, peanuts, wheat and salicylate-rich foods such as certain berries and other fruits. Unfortunately, the prevalence of these sensitivities among IBD patients varies. For instance, dairy may account for only 20 percent of the food allergic reactions in patients with IBD.

Managing IBD symptoms is challenging, and sustaining remission can also be quite difficult. Yet it does appear possible, through trial and error, to establish diets on which individual patients achieve long-term remission. However, there is no universal diet that will help all IBD patients manage all IBD symptoms.

IBD is a serious, chronic, perplexing health disorder. As with so many chronic diseases, it is the combination of genetics and environment—the persistent stimulus in an individual who has a genetic predisposition to this disease—that determines the outcome. For alternative or complementary strategies in managing IBD, health care practitioners and patients should work with the nutritional tools of probiotics and elimination diets. And, ultimately, you should always trust what your gut is telling you.

Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.