Science Update

New study identifies how the microbiome is disrupted in inflammatory bowel disease

Inflammatory bowel disease (IBD) is an autoimmune condition where, in most cases, there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways. When this happens, the immune system becomes overloaded and overwhelmed, losing its ability to function. This, in turn, leads to chronic inflammation and can cause diarrhea and abdominal pain, as well as other debilitating symptoms.

According to a study published last Wednesday in Nature, researchers demonstrated the chemical and molecular events that shift the microbiome and exacerbate disease activity in patients with IBD. Although previous research has shown differences in the gut microbiome in IBD patients, this study investigated how the changes in the microbiome contribute to an inflammatory response.

This study followed 132 individuals for one year, comparing those with Crohn's disease and ulcerative colitis to a control group that did not have IBD. Each individual provided stool samples every two weeks, blood samples every three months, and colon biopsies at the start of the study. A total of 2,965 stool, biopsy, and blood samples were analyzed along with molecular, cellular, and clinical tools to understand the detailed biochemistry of the disease, as it is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms exacerbate or improve.

Results showed that during periods of disease activity, patients with IBD had higher levels of polyunsaturated fatty acids, including adrenate and arachidonate. In addition, nicotinuric acid was found almost exclusively in the stool of patients with IBD, and levels of vitamins B5 and B3 were insufficient in IBD patients. Also, a group of bacteria related to the genus Subdoligranulum commonly found in almost every individual (which had not been previously isolated) was shown to be depleted during inflammation.

Previous research has identified that in healthy people, the gut microbiome is much more stable than those with IBD. Patients with IBD have dramatic shifts in their microbiomes with some bacteria disappearing almost completely at times.

Medication to treat IBD can also affect the microbiome. Individuals who take steroids for part of their treatment have more fluctuations in their microbiome and those who were experiencing a flare-up in their symptoms are more likely to have dramatic fluctuations in their microbiome.

These results further support the functional medicine approach to assess the microbiome regularly in IBD patients in order to take an individualized approach to manipulate the microbiome and keep these patients in remission, especially if medications like corticosteroids can shift the microbiome, leading to an exacerbation of the disease.

High dose probiotics, fish oil, glutamine, and mucilaginous botanicals are helpful in immunomodulation and for their anti-inflammatory properties. Other common nutrient deficiencies seen in these patients include magnesium and vitamin D. A specific carbohydrate diet (SCD) or elimination diet can improve gastrointestinal function and decrease disease activity.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Jason Lloyd-Price, Cesar Arze, et al. Multi-omics of the gut microbial ecosystem in inflammatory bowel diseases. Nature, 2019; 569 (7758): 655 DOI: 10.1038/s41586-019-1237-9