Crohn’s Disease, The Microbiota & The Path to Better
Imagine living with a chronic inflammatory digestive disease marked by multiple daily trips to the bathroom, debilitating pain and fatigue. An illness that is so severe that it often requires surgery to remove diseased sections of the gut. One for which there is no cure.
This is Crohn’s disease. We are still uncertain as to why Crohn’s disease occurs and appears to be increasing in incidence; however, researchers now believe that interactions between genetics, the immune system of the gut and the gut microbiota play a critical role1-3.
Beyond Irritable Bowel
Crohn’s disease is marked by intense inflammation that can occur anywhere along the length of the gut, most often affecting the lower sections of the small intestine and the colon. Often more severe than ulcerative colitis (another form of inflammatory bowel disease), the inflammation in Crohn’s disease extends throughout the layers of the gut, penetrating deep into the tissues.
In Crohn’s disease, it appears that the immune system loses tolerance to the normal presence of gut microbes; there have been genetic variations identified, such as the NOD2/CARD5 gene that result in those with Crohn’s Disease having an increased immune response to the normal presence of gut microbes1-3. Instead of recognizing gut microbes as partners, the immune system attempts to fight off the ever-present bacteria leading to increased inflammation, damage to the tissues of the gut, and gut barrier dysfunction that can lead to bacterial fragments entering the circulation3. It is this cycle of intolerance, inflammation and damage that appears to perpetuate the disease.
Although the immune system appears to be hostile to even beneficial bacteria in Crohn’s disease, harmful intestinal dysbiosis is also evident. The gut microbiota of someone with Crohn’s disease is markedly different than someone with a healthy gut; whether these adverse changes in the gut microbiota precede, occur alongside, or as a result of the disease is unknown1-3. Studies looking at the microbiota in Crohn’s Disease have found lower levels of bacteria with anti-inflammatory properties such as Faecalibacterium prausnitzii and increased levels of Eschericia coli1,2. In fact, researchers have noted an unusual type of E. coli bacteria that can invade the intestinal wall and even survive in macrophages – which are immune cells designed to kill bacteria – further increasing pro-inflammatory pressures3. In addition to population changes, it is thought that the function and metabolism of gut microbes are also altered, including a lowered production of butyrate, a protective short-chain fatty acid1.
Is it Crohn’s?
Often diagnosed in young people, Crohn’s disease also has another spike in diagnosis around the age of 50. Crohn’s disease is marked by diarrhea (as often as 10-20 bowel movements a day), rectal bleeding, pain, and weight loss. Characterized by periods of flare up and remission, the aggressive inflammation damages the absorptive surface of the digestive tract, leading to malabsorption and nutrient deficiencies that can cause chronic pain and fatigue. Anemia is common, as are symptoms extending to the skin and the eyes. Arthritis and joint pain, possibly connected to gut barrier dysfunction that allows bacterial fragments into the bloodstream, may be present. Gallstones and kidney stones are also common in those with Crohn’s disease.
A Crohn’s diagnosis is typically confirmed through endoscopy, where inflammatory damage to the gut can be visualized and tissue biopsies taken for examination. Levels of inflammatory markers such as fecal calprotectin can determine ongoing inflammation and be used to monitor disease progress.
On the Path to Better
Nutrition has a critical role in improving quality of life and disease outcomes. Interestingly, dietary patterns high in red meat, saturated fat, iron and omega-6 fats are associated with increased risk of the disease and inflammation4. Alternately, intakes of omega-3 fats, a more plant-based dietary pattern and vitamin D appear to be protective4. As a baseline, the best diet for Crohn's disease is an anti-inflammatory diet that includes extra virgin olive oil, colourful high fibre plant foods and turmeric is beneficial for helping to oppose inflammation and promote the growth of beneficial bacteria in the gut. However, dietary ideals also need to be balanced with the ability of a damaged gut to tolerate these healthy plant foods.
Because of the intensity of the disease, Crohn’s is often intensively managed, both to improve quality of life and to reduce the necessity for bowel surgery. Nutritional deficiencies must be addressed to avoid complications such as anemia or osteoporosis. Multiple medications are often used to manage symptoms and control inflammation, such as antidiarrheals, corticosteroids and biologic drugs such as Remicade that block the inflammatory process. Antibiotic use is also common; it has been demonstrated to intensify dysbiosis in Crohn’s disease and as a potential risk factor for the disease2. And in some cases, surgery is required to remove the diseased part of the bowel.
Because of the central role of the microbiota in Crohn’s disease, probiotics seem a valuable therapy, and in fact, in my practice, I have seen excellent results using Bio-K+ with my clients. Looking at the research on Crohn’s and probiotics, results have been mixed3. In one trial, the yeast Saccharomyces boulardii did not effectively prevent disease relapse5, where other trials looking at different species of Lactobacilli bacteria have shown to be effective3.
How might probiotics be of benefit?
Probiotics may lower intestinal pH, encouraging the growth of beneficial strains and inhibiting the growth of pathogenic bacteria; they may increase short-chain fatty acid production and potentially augment the inflammatory response3. Talk with your doctor or dietitian about adding a probiotic like Bio-K+ to your nutritional strategy; I often recommend you begin slowly if your symptoms are more severe. Start with ¼ bottle of Bio-K+ (12,5 billion probiotic bacteria per day) and gradually work up to the full bottle dosage (50 billion probiotic bacteria per day) as your tolerance dictates.
Crohn’s disease can be challenging, but there is hope. As we learn more about the interplay between diet, immunity and the microbiota, we are getting closer to understanding how best to prevent and treat the disease. If you have Crohn’s disease, talk to a registered dietitian to ensure optimal nourishment and consider using an evidence-based probiotic like Bio-K+.
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