Nutritional Support for Irritable Bowel Disease (IBD)
NUTRITION
Robert G. Silverman
IBD is a chronic inflammatory disease of the gastrointestinal (GI) tract that affects up to 1.5 million Americans. It accounts for nearly 1.5 million physician visits and more than 160,000 hospitalizations per year. Ulcerative colitis (UC) and Crohn’s disease (CD) are the principal types of IBD and include persistent inflammation of the gut mucosa, alterations in intestinal epithelial barrier function, and destruction of gut tissue. The pathophysiology of IBD is characterized by overproduction of inflammatory mediators, such as interferon gamma (IFN-y) and tumor necrosis factor-a (TNF-a).
The impact of IBD on patients’ lives is substantial. Overall, IBD patients have a reduced quality of life compared to the general population and are at risk for nutritional deficiencies, including protein-energy malnutrition. The causes of malnutrition in IBD include malabsorption of many nutrients leading to loss of nutrients through frequent diarrhea.
Compared to healthy individuals, IBD patients are more likely to experience anxiety and depression, especially during periods of increased disease activity or “flares.” Patient surveys identify concerns regarding ability to work, emotional health, sexual relationships, and fatigue. Importantly, fatigue in IBD patients can affect their ability to work and socialize.
The financial burden of managing IBD is considerable. For CD alone, mean annual direct medical costs are estimated to be $12,400. The lifetime direct healthcare costs for CD have been estimated to exceed $125,000 per patient. Total annual direct IBD healthcare costs are estimated to be $6.3 billion.
Evidence suggests that several specific nutritional components have beneficial effects on intestinal health, which is compromised by inflammation in IBD. High-quality fats, particular amino acids, and specific dietary compounds, such as cur cumin and xanthohumol, positively modulate inflammatory pathways.
Macronutrients for Nutritional Support of IBD • Vegan Proteins and BCAA. IBD can have a deleterious impact on an individual’s nutritional status. Adequate protein may be a concern for those who suffer from IBD, especially those diagnosed with celiac disease, which adversely affects the small bowel. Intestinal inflammation is the key contribu-
tor to nutrient malabsorption in IBD.
• Common protein sources such as soy, dairy, and/or gluten may be poorly tolerated. I recommend using a pea/rice protein combination. Pea protein naturally contains all of the essential amino acids and is highly soluble and easy to digest. Rice protein is also a clean protein source of essential amino acids. Adding amino acids in adequate quantities, including branched-chain amino acids (BCAA) such as leucine, isoleucine, and valine, aids in rapid absorption. Leucine is the star BCAA because it aids in protein synthesis and has been shown to suppress muscle degradation in people with malnutrition.
• Quality fats. The following high-quality fats have demonstrated benefits for digestive health: medium-chain triglycerides (MCT) and flaxseed oil. Flaxseed oil is rich in alpha-linoleic acid, an essential omega-3 fatty acid. MCTs have a reduced chain length compared to other fats, which means that MCTs are more rapidly absorbed by the body and more quickly metabolized.
• Carbohydrates. Patients with IBD benefit from a diet low in refined sugars. Furthermore, consumption of a prebiotic known as isomaltooligosaccharide (IMO) can increase populations of beneficial bacteria. IMO encourages the production of short-chain fatty acids (acetate, propionate, and butyrate), which promote intestinal mucosal health and a healthy intestinal environment.
Micronutrients for Nutritional
Support of IBD
• Glutamine. The GI tract utilizes more glutamine than any other tissue in the body. The epithelial cells of the small intestine utilize glutamine as their principle energy source. Studies of glutamine depletion have reported mucosal ulceration, atrophy of the villi, necrosis of the intestinal tissues, and increased intestinal permeability.
• Glutamine supports the integrity of the intestinal barrier and may promote gut healing. In animal models of IBD and intestinal damage, glutamine has been shown to protect the intestinal mucosa and reduce production of inflammatory mediators.
• Quercetin and Ginger. Quercetin is a flavonoid with anti-inflammatory and antioxidant activities. Ginger has demonstrated similar effects where administration of ginger oil or extract significantly reduced mucosal damage and expression of inflammatory mediators.
• Curcumin. Curcumin is a polyphenol that is a component of the spice turmeric. Over the past several decades, researchers have found that curcumin possesses multiple therapeutic characteristics, including potent anti-inflammatory activity. The proposed mechanisms by which curcumin reduces inflammation include down-regulation of proinflammatory enzymes (COX-2, lipoxygenase, and nitric oxide synthase) and inhibition of proinflammatory cytokines (TNF-a and interleukins [IL]-1, -2, -6, -8, and -12). A key mechanism contributing to these effects is suppression of the transcription factor family nuclear factor kappa B (NF-KB) by curcumin. NF-kB is a central regulator of inflammation and other critical cellular processes. Of particular interest to IBD, curcumin has been shown in research to downregulate inflammation at the intestinal mucosa.
• Selective kinase response modulators (SKRMs). Research suggests that certain polyphenols in foods can selectively modify kinase activity in favor of good health. Kinases aie enzymes that translate dietary signals to positively or negatively influence
numerous aspects of health. They function to chemically modify other proteins and regulate many cellular pathways involved in the transmission of signals within the cell. Subsequently, these enzymes can help regulate eicosanoids, cytokines, reactive oxygen species, and other mediators that may negatively impact the body both locally and systemically. Xanthohumol is one of the most extensively researched SKRMs from hops—the subject of over 250 publications.
• Xanthohumol has been shown to beneficially influence the function of kinases involved in inflammatory processes. It also provides potent antioxidant activity by binding to antioxidant responsive elements (ARE). In addition, research suggests that it may help improve overall redox status by influencing inflammation-signaling molecules, such as NF-KB, COX-2, and PGE2.
Conclusion
IBD is a common and costly condition characterized by alterations in gut function and chronic intestinal inflammation. IBD can impact a patient’s quality of life, overall health, and ability to conduct normal activities.
In my 15 years of practicing functional nutrition, I have found that high-quality fats, prebiotics, vegan protein, curcumin, glutamine, and SKRMs help support normal gut function and address intestinal inflammation, ultimately improving the health status of IBD patients.
Dr. Robert G. Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, SASTM graduated Magna cum Laude from the University of Bridgeport, College ^ _ of Chiropractic. He holds a Masters of Science in Human Nutrition and is a Diplomate with the American Clinical Board of Nutrition and the Chiropractic Board of Clinical Nutrition. He is certified as a sports nutritionist. Certified Nutrition Specialist, and Certified Clinical Nutritionist. Dr Robert G. Silverman (914) 287-6464 e-mail: [email protected] website: www.DrRobertSilverman.com * You can see Dr Silverman at the 2015 Metagenic's Lifestyle Medicine Summit on Sept. 25th held in Phoenix, Arizona!
