By Dr. Hilary Booth, ND
Canada has the highest rate of inflammatory bowel disease (IBD) in the world1. In a country where we’re fortunate to have excellent healthcare, relatively healthy diets, and a high socioeconomic status, this statistic completely shocked me. According to a 2012 report from Crohn’s and Colitis Canada, nearly a quarter of a million Canadians have IBD, with over 10,000 new cases diagnosed annually1. The incidence of Canadian children under 10 who have been diagnosed with Crohn’s has doubled in the last 20 years1.
Unfortunately, IBD is a lifelong disease with no cure and an often-difficult road involving invasive scopes, multiple medications, and life-changing symptoms. With a growing need for practitioners, and a gap in efficacy of mainstream care, there is a lot that naturopathic doctors can offer to help patients living with IBD.
What should you know about IBD?
IBD includes three digestive diseases: Crohn’s disease, ulcerative colitis, and indeterminate colitis. Each is an autoimmune condition where the body’s immune system attacks its own digestive tract causing inflammation, pain, cramping, gas, bloating, fatigue, diarrhea, and (usually) blood in the stool. The ability to absorb nutrients is diminished, which causes fatigue, affects bone density, and is associated with increased anxiety, depression, infertility, kidney stones, and arthritis2,3.
Why is IBD affecting Canadians?
There is no simple answer about why Canadians in particular are affected. However, there are a some factors that are generally agreed-upon:
1. Vitamin D Deficiency
- Vitamin D deficiency is extremely common in Canada, with the average blood level being just 67 nmol/L, where >75 nmol/L is considered adequate, and 100-150 nmol/L is protective for bowel disease and certain cancers4.
- Vitamin D deficiency is a major risk factor for IBD because it helps regulate the immune system and controls the intestinal barrier5.
- OHIP no longer covers vitamin D testing, so fewer Canadians are aware of their vitamin D status and are left untreated.
- Some individuals have a genetic predisposition to autoimmune disease, and so far, over 160 genetic variants have been found that can contribute to the development of IBD6.
- This information is not yet used in clinical practice, but eventually in theory it can be used for early detection and prevention of disease progression with dietary and lifestyle advice
3. Gut Flora
- Research has found that our genetic predisposition to developing IBD can be turned on and off by the bacteria living in our gut7.
- 70% of our immune system is in our gut, and our immune system profoundly affected by the microbes living in our digestive tract. The widespread use of antibiotics and other medications, as well as our dietary habits and lack of breastfeeding alters our gut microbiome, which impacts our immune system7,8.
4. Dietary and Lifestyle Habits
- Antibiotic use and NSAID use (i.e. Ibuprofen) have been shown to both induce and reactivate IBD by altering the gut microbiome and physically irritating the digestive tract9.
- Stress and depression have been shown to exacerbate IBD through hormones like cortisol and serotonin impacting the gut lining8.
- Diets high in vegetables, fish, fibre, and omega-3 fatty acids are protective against IBD, but unfortunately very few of us achieve adequate amounts of these foods in our diets10.
- Diets high in total fats, omega-6 fatty acids, and meat are shown to increase risk of developing IBD11.
The Naturopathic Approach
As Canadians, we do have many risk factors for developing IBD. As a Naturopathic Doctor, my goal is to minimize these risks by ensuring adequate vitamin D status, balancing and replenishing the gut flora, and supporting a healthy diet.
For people living with IBD, the naturopathic treatment approach goes beyond mitigating the above risk factors. We will work to heal ulcers in the digestive tract, reduce inflammation, improve absorption of nutrients, and support prevention of flare-ups. Naturopathic doctors should be viewed as part of a comprehensive prevention and treatment strategy for IBD, working alongside gastroenterologists and family doctors to improve quality of life for people living with these conditions.
References and Resources
- Impact of IBD report: http://www.crohnsandcolitis.ca/About-Us/Resources-Publications/Impact-of-IBD-Report
- Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management https://www.ncbi.nlm.nih.gov/pubmed/19161177
- Comorbidity in inflammatory bowel disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122260/
- Vitamin D blood levels of Canadians: http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11727-eng.htm
- Vitamin D and inflammatory bowel disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427008/
- Advances in IBD genetics: https://www.ncbi.nlm.nih.gov/pubmed/24614343
- Advances in inflammatory bowel disease pathogenesis: linking host genetics and the microbiome: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822528/
- Microbiome, metabolome and inflammatory bowel disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029486/
- Nonsteroidal anti-inflammatory drugs activate quiescent inflammatory bowel disease: https://www.ncbi.nlm.nih.gov/pubmed/3498419
- Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children: https://www.ncbi.nlm.nih.gov/pubmed/17617201
- Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature: https://www.ncbi.nlm.nih.gov/pubmed/21468064