The story of IBD
I’m working hard to tell the “story of IBD” and I get a lot of questions about the biological mechanisms of IBD. Here is my belief and understanding of what’s going on:
A breakdown of the integrity of the epithelial membrane of the gut is perhaps the major structural defect observed in the pathogenesis of Inflammatory Bowel Disease.
A variety of scenarios can cause the “tight-junctions” or the spaces between cells to “leak” bacterial organisms through this thin layer of cells to a space called the “lamina propria.” In the lamina propria, the immune system mounts a defense against this invasion and in the crossfire – intestinal tissue can be damaged resulting in the ulcerations and sores observed in IBD.
Most medications for IBD work to stem the immune response by acting as anti-inflammatories or immune system suppressors targeting cytokines like TNF or different inflammatory interleukins (immune system signaling molecules), or even by inhibiting DNA synthesis of white blood cells (cells of the immune system). These medications (albeit some anti-TNF drugs) do not generally work to repair the damaged lining. Just stopping the immune response without an accompanying barrier repair strategy does not always fix the underlying causes of the issue.
Maintaining the integrity of GI Epithelium
People with IBD are often predisposed to bacterial leakage through tight junctions because we often have genetic defects in them (in addition to other genetic differences and environmental impacts). There are dozens of interventions you can take to maintain the integrity of the membrane and prevent microbiological leakage. I am going to point out 4 big approaches:
1. Enhance Cellular Structure
2. Reduce TNF
3. Neutralize Reactive Oxygen Species
4. Promote Butyrate
Rebuilding the epithelial membrane and the associated tight junctions are just one of many components to my own personal systems-based protocol in the management of my IBD. And rebuilding the “wall” is not just going to come from one miracle intervention, it’s going to come about through a multi-faceted approach that we can implement every day. Nothing is a straight shot, and one intervention or a group of interventions may work for some but not others. Here are some of the most important things I do to enhance the cellular structure of my epithelial membranes, neutralize reactive oxygen species, promote butyrate, and reduce TNF among many other things I do every day to achieve and maintain remission from IBD:
1. Phosphitdylcholine (PC) – if the inflammation is far down, people have used this in enema form, or placed in an enteric coating capsule which you can find on Amazon. PC helps with the fluidity of the cellular membrane along with having potent anti-inflammatory effects. Glutamine also helps with leaky tight junctions.
2. Antioxidants like Glutathione, or Alpha Lipoic Acid which help to neutralize free radicals which left to their own devices can inflict damage to GI-linning.
3. Eating lots of soluble fiber in the form of blueberries, bananas (slightly unripe if you can take it), avocados and other plants that promote butyrate-producing bacteria. Avoiding all processed foods. It’s possible to also take a butyrate supplement, but I have not found the need to do this at this time for me personally and the evidence, as usual, is unclear.
4. Controlling TNF. So many things have been found to reduce TNF including: Curcurmin, CBD, Boswellia in addition to medications both on and off label including: bupropion (Wellbutrin), biologics (Remicade, Humira), and Mesalamine (like Lialda) *note I am completely medication-free but medications are critical and powerful tools for many people with IBD.
Okay, that was a ton of information and this is honestly just the tip of the iceberg. The most important thing I believe is to find a pattern that works for you, and once you find that pattern – to stick with it. It’s rarely ever just one thing that works in isolation. In the IBDCoach program, we have unique tools to help our members design their own custom protocol in close collaboration with their health and medical team. So far IBDCoach is the only program in the world helping people to uniquely and effectively discover this pattern of interventions that work for them. This is the future of medicine, coaching, and healthcare as we know it.