Looking back at the last decade I’ve wanted to touch on what I believe is the largest advance in understanding and addressing Inflammatory Bowel Disease and frankly many other GI and inflammatory chronic conditions.
It’s the microbiome folks. And yet we are still at the cusp of our potential and understanding.
Perhaps the largest (or at least most tangible) application to address the microbiome in IBD is in the understanding of how dietary strategies rapidly alter the gut’s composition of these microbes.
For example, it is widely understood that dietary fiber from plants feeds beneficial bacteria that produce an essential short-chain fatty acid called Butyrate. Butyrate, in turn, feeds enterocytes (gut cells) helping them to thrive and maintain a tight gut barrier – unsurprisingly a fundamental dysfunction observed in IBD. The benefits of butyrate are near endless – and it appears the best way to get it is indirectly through prebiotics (AKA soluble fiber, but its also found in other things like butter).
Fiber is a long non-starch polysaccharide (meaning its a string of sugar molecules that bypass digestion in the small intestine). There are two main types of fiber: soluble and insoluble. Every plant contains both types, but it’s soluble fiber that is able to feed beneficial bacteria.
However, historically the overarching recommendation from gastroenterologists who treat IBD is to avoid all types of fiber at all costs given that it can cause immense pain as it scrapes the epithelial lining.
Newer dietary strategies like IBD-AID from the UMASS medical school acknowledge that this view is outdated and even harmful, and promotes the use of prebiotics in IBD.
The key take away is that plants that are high in insoluble fiber (AKA roughage) like leafy greens (while packed with micronutrients and great for remission) can cause a lot of physical pain during flares, but incorporating soluble fiber like sweet potatoes, blueberries, avocados, papaya, and other fruits and vegetables may be essential to a robust microbiome. One key is to consider modifying the texture of these foods into a smoothie or puree form that in many individuals cause less pain and increases digestibility.
I drink a blueberry, avocado, (green, unripe) banana, cacao smoothie nearly every morning – packed with prebiotics and micronutrients. I add in some pure almond milk (free of additives) and sheep yogurt (high in butyrate). I feel this has been a huge factor in my continued health with IBD.
But are there other ways to systemically feed your gut cells other than with dietary fiber? In next week’s post, I’ll be discussing emerging views of the microbiome and IBD.