By Dr. Joseph Mercola
Inflammatory bowel disease (IBD) is an autoimmune condition with serious consequences. This is not the same as irritable bowel syndrome (IBS), which is a functional bowel disorder with no significant physical conditions that contribute to the problem.
The two most common health conditions falling under the umbrella term of IBD are Crohn's disease and ulcerative colitis.1 While ulcerative colitis often is localized to the large intestines and rectum, Crohn's disease can affect any part of the gastrointestinal tract beginning in the mouth and ending in the anus.
More frequently, portions of the small intestines are affected. Common symptoms of both include persistent diarrhea, weight loss, fatigue and abdominal pain. Physicians use radiographic imaging, endoscopic testing and stool tests to diagnose IBD.
The CDC reports that in 2015 and 2016, 3 million Americans were diagnosed with either Crohn's or ulcerative colitis, which was 1 million higher than the number of people diagnosed in 1999. Women and those who live in suburban areas, who are unemployed, and who are divorced, separated or widowed are at higher risk.
Those with ulcerative colitis or Crohn's disease may experience complications from the condition.2Complications common with both conditions include a higher risk of colon cancer, blood clots, skin, eye and joint inflammation and primary sclerosing cholangitis.
Complications associated only with Crohn's disease include bowel obstructions, malnutrition, ulcers and fistulas. Those with ulcerative colitis are at higher risk for toxic megacolon, perforated colon and severe dehydration.
Small Changes Raise Risk of Chemical Colitis
One trigger for the rapidly rising incidence of IBD is a Western-style diet that increases inflammatory bowel disease activity. To further understand this pathway, researchers from the University of Alberta undertook an animal study to “identify the effect of a short-term diet high in sugar on susceptibility to colitis.”3
After only two days of eating a high-sugar diet, mice exhibited more severe symptoms to chemically induced colitis. The group was initially fed either regular food or a high-sugar diet. Severity of the disease was assessed daily and tissues were analyzed for cytokine expression. Additionally, gut microbiota were analyzed by RNA sequencing and short chain fatty acid (SCFA) concentrations.
Researchers found that the mice who were fed a high-sugar diet demonstrated an increase in gut permeability and a reduction in microbial diversity with concurrent reduction in SCFA. They also had an increased susceptibility to colitis and higher concentrations of proinflammatory cytokines.
Karen Madsen, professor of gastroenterology in the department of medicine at University of Alberta, specializes in the effect that diet has on IBD. She reports that the results of the study are in line with what she has heard from her patients who suffer with colitis: “Small changes in their diet can make their symptoms flare up.” She went on to say:4
"It's been previously shown that the type of diet that you are on can change your susceptibility to disease. We wanted to know how long it takes before a change in diet translates into an impact on health. In the case of sugar and colitis, it only took two days, which was really surprising to us. We didn't think it would happen so quickly."
Fiber Feeds Beneficial Bacteria, Forms Short Chain Fatty Acid
Their findings were consistent with those from recent literature, supporting an increased risk of inflammatory bowel disease flare-ups with a high-sugar diet and the additional protective role of SCFAs on the intestinal wall.
In evaluating their results, they found the loss of SCFA-producing microbes were especially meaningful to the symptoms as a high sugar diet reduced the production. The loss of microbial groups was important to the production of SCFAs and may have highly influenced the physiological response.
The symptomatic mice were then given acetate, one type of SCFA, which demonstrated a reduction in symptoms. Eating fiber-rich food acts as a fuel for beneficial bacteria that produce SCFAs. This is crucial to an efficient immune response.
However, eating a high sugar diet feeds the harmful microbes associated with a defective immune response and a higher inflammatory rate. Madsen believes the results debunk the idea you can eat well all week and splurge all weekend, saying:5
"Surprisingly, our study shows that short-term sugar consumption can really have a detrimental impact, and so this idea that it's OK to eat well all week and indulge in junk food on the weekend is flawed. There is an increasing amount of evidence that suggests there's a link between the bacteria present in our gut and neurodegenerative diseases such as Alzheimer's and Parkinson's.
Because our study showed that gut permeability increased quite dramatically in the mice on the high-sugar diet — which means that bacterial products are free to move from the gut, where they normally stay, to the rest of the body — it raises the possibility that this phenomenon might be driving these diseases, but this needs to be looked into."
SCFAs play a crucial role in the prevention of disease.6 Since SCFAs have a large effect on health and their levels are regulated by food consumed, researchers believe they may provide a basis for the explanation of an increasing incidence of inflammatory disease in those eating a Western diet.
What Came First — Disruption or Disease?
Historically, disease research begins after the disease presents itself. Past studies have catalogued microbiome disturbances in those with IBD. Researchers from Harvard University7 sought to understand why these changes occur with IBD and how the changes may provoke the inflammatory reaction.
Their study was part of the second phase of the National Institutes of Health’s Human Microbiome Project. The goal of the project was to characterize the gut microbiota found in healthy adults and in those with diseases associated with disturbances in the microbiome.
In this study researchers followed 132 people over one year and compared those with Crohn's disease and ulcerative colitis to a control group of healthy individuals. Stool samples were collected every two weeks and blood samples every quarter. At the beginning and end of the analysis each participant had a colon biopsy.
During flare-ups, those with IBD had fewer chemicals produced by the microbiome. The researchers speculated it may be due to a combination of a reduced microbial metabolism, poor nutrient absorption and higher levels of fluid in the bowels. Their findings provided a detailed look at gut microbiota activity during active and inactive disease states of IBD.
Other researchers have also found dysregulation in the gut microbiome plays a crucial role in the origination and development of IBD.8 These changes are fueled by the foods you eat and, as Madsen commented, they happen more quickly than you may have imagined.
Since the majority of your immune system originates in your gut, optimizing your gut microbiome is a worthwhile pursuit with far-reaching effects on your physical and emotional health. As pointed out in the featured study, your first stop should be to eliminate sugar from your diet, especially from processed foods.
Sugar Responsible for Remarkable Amount of Disease
Unfortunately, consuming sugar has become a daily habit for most of us over the past 100 years. Before this, it was not consumed on a daily basis and reserved only as a treat for the wealthy. From a nutritional standpoint, your body does not require refined sugar, as it manufactures all the glucose it needs in your liver through a process called gluconeogenesis.
In addition to changing your gut microbiome, sugar in the diet has demonstrated the potential for feeding the growth of cancer cells. Research from Belgium has shown a strong link between high levels of glucose and mutated proteins inside human tumor cells, increasing cell growth in cancer cells.
The scientists pointed out that while added sugar increases aggressive cancer growth, it does not prove that sugar is the original factor in the mutation for cancer cells. However, results from past research demonstrate the mutations as a downstream effect of mitochondrial dysfunction, and excessive sugar consumption as one trigger for mitochondrial dysfunction.
Sugar is a primary factor in the development of other health conditions and chronic diseases including heart disease, high blood pressure, Type 2 diabetes, chronic liver disease and Alzheimer's disease. Although all forms of sugar are harmful in excess, the most commonly found sugar in processed foods — processed fructose — appears to have the most harmful effect.
While high fructose corn syrup tastes like sugar, your body metabolizes it differently, placing a greater burden on your liver. Over the long term, sugar promotes chronic inflammation, disrupts normal functioning of the immune system and raises your risk of other diseases.
Feed Your Gut Microbiome and Protect Your Health
There are two basic ways to protect your gut microbiome and your overall health, and it's important to pay attention to both. You can positively impact beneficial gut bacteria by providing them with the nutrients they need to flourish — prebiotics — and by helping to improve or restore the gut flora by providing probiotics.
Prebiotic foods provide the beneficial bacteria with the nutrition they need to thrive and are primarily found in fiber-rich foods. There are two different types of fiber important for your digestive system. For more information about how to incorporate healthy fiber to reduce your risk of disease, see “Higher Daily Fiber Intake, Less Risk for Disease.”
Healthy foods with high amounts of fiber include artichokes, baked sweet potatoes with the peel intact, spinach, broccoli, cauliflower and many other vegetables. As I often mention, you can help promote beneficial gut bacteria populations by eating fermented foods. Culturing vegetables is easy and inexpensive and can be done at home.
Some fermented foods are outstanding sources of vitamin K2, which helps prevent osteoporosis and atherosclerosis. Fermented foods are also powerful detoxifiers and contain a natural variety of microflora.
When your gut microbiome becomes unbalanced it affects your immune system, mental health and even your brain function. If you choose to use a probiotic supplement, these factors will help identify a high-quality option:
- Seek out a trustworthy brand manufactured according to current Good Manufacturing Practices; be sure the manufacturer sources non-GMO ingredients
- Look for a potency count (colony forming units or CFUs) of 50 billion or higher
- Check the shelf life of the CFUs and avoid capsules only declaring CFUs at the "time of manufacture"
- Choose a product containing multiple species of bacteria; products containing species of Lactobacillus and Bifidobacteria are generally recommended