Inflammatory bowel disease (IBD) is an autoimmune condition where, in most cases, there are multiple triggers stimulating the immune system in multiple ways over a long period of time. The immune system ends up in an overloaded, overwhelmed state and loses its ability to function. This leads to chronic inflammation, causing issues that can include anemia, diarrhea, abdominal pain, and other debilitating issues.
According to a study published four days ago in Nature Microbiology, individuals with IBD commonly have dramatic shifts in gut microbiome compared to that of healthy people.
Although it is well known that there are differences in the gut microbiome in IBD patients, this is one of the largest studies to follow the microbiome over a period of time. The most significant difference researchers saw was how the microbiome shifted, describing it as a "volatile dysbiosis." These patients were shown to have a much less stable microbiome than healthy individuals.Researchers have known that there are some differences in the microbiomes of patients with IBD compared to healthy individuals, such as fewer beneficial microbes and often high amounts of Enterobacteriaceae and E. coli.
It is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms either exacerbate or improve.
In this study, researchers followed 137 individuals for two years, including patients with ulcerative colitis, Crohn's disease, and healthy individuals. They collected stool samples and monitored patients' symptoms every three months for up to two years.
The research team found that in healthy people, the gut microbiome was much more stable than those with IBD. The patients with IBD had dramatic shifts in their microbiomes, with some bacteria disappearing almost completely at times. In addition, over 50% of their microbiome was displaced by other microbes in just a few months. The biggest swings were seen in patients with ileal Crohn's disease who had had part of their intestine removed to improve their symptoms.
Also, the researchers noted that changes in medication to treat IBD affected the microbiome. Individuals who had taken steroids for part of the treatment had a greater amount of fluctuations in their microbiome, and those who were experiencing a flare-up in their symptoms were more likely to have more dramatic fluctuations in their microbiome.
These results further support the integrative functional medicine approach to assess the microbiome regularly in these patients so an individualized approach can be taken to manipulate the microbiome and keep these IBD patients in remission, especially if the use of corticosteroids can be averted, since these medications can shift the microbiome and lead to an exacerbation of the disease.
I shared a study published last month in the Journal of Clinical Gastroenterology in which researchers demonstrated that a specific carbohydrate diet (SCD) can bring patients with active IBD into remission. We must also look for environmental triggers that can cause inflammation (e.g., food sensitivities, toxins, molds), any toxins that can affect the status of the immune system (e.g., heavy metals, xenobiotics), and the overall total toxic burden in the body. It is also critical to assess the nutrient status of the patient, including antioxidant status, vitamins, essential fatty acids, and vitamin D.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
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Source: Jonas Halfvarson, Colin J. Brislawn, Regina Lamendella, Yoshiki Vázquez-Baeza, William A. Walters, Lisa M. Bramer, Mauro D'Amato, Ferdinando Bonfiglio, Daniel McDonald, Antonio Gonzalez, Erin E. McClure, Mitchell F. Dunklebarger, Rob Knight, Janet K. Jansson. Dynamics of the human gut microbiome in inflammatory bowel disease. Nature Microbiology, 2017; 2: 17004 DOI: 10.1038/nmicrobiol.2017.4