IBD: A path towards recovery, better maintenance and optimal health
To begin to heal from Inflammatory Bowel Disease (IBD)—and actually most health issues—we should start with the gut. This means rethinking what we eat, and then adding in advanced gut microbiome testing and treatment.
Remember when we talked about the many underlying drivers of IBD and how no two people may have the same drivers? Well, the more we understand about our individual causes and triggers for IBD, the better we can manage it, improve response to treatments, decide what treatments are best for us, and fully maximize our overall health and vitality.
The first step in treating IBD is to heal the gut microbiome. What’s that?
For autoimmune disease in general, and IBD especially, we should start with treating the gut microbiome. This means examining what we eat, and may also include gut microbiome testing and treatments.
What is the gut microbiome?
It shouldn’t be surprising that gut inflammation is highly influenced, if not caused by, disturbances in the gut microbiome.
According to the American Academy of Microbiology, the gut microbiome is a vast and complex ecosystem of approximately 100 trillion microbes—10 times more than the 10 trillion cells typically found in an adult body. What the heck!
On top of this, that ecosystem is where your immune system resides. About 75% of your immune system exists in your gut in the “gut associated lymphatic tissue” (GALT). Your GALT is knit into and around your intestines.
The whole job of your intestines and GALT is to police what you let in (food, nutrients) and assess what you need to keep out (microbes, toxins). Your gut microbiome programs your immune and other major bodily systems.
A healthy gut microbiome is key not just to optimizing IBD treatment, but—according to pioneering intestinal permeability researcher Alessio Fassano—treating all autoimmune disease. That makes the gut our most powerful place to start when dealing with IBD.
How do we heal the gut microbiome?
Treating and healing the gut is a process. We can start by breaking it down into two main steps.
Step 1: Eat a gut healthy diet.
What we put in our mouth is what feeds our gut microbiome. There is no one diet that is the ideal diet for IBD (remember: one person’s reasons for IBD can be different than someone else’s), but IBD management can be made or broken by finding the proper diet.
These are the main two diets I recommend with which to start:
The Autoimmune Paleo Plan (AIPP), or a more general version of the Paleo Diet
The Specific Carbohydrate Diet (SCD)
How ‘strict’ do you need to be? Only by trying will you be able to tell. The more flared and sick you are, the more narrow and soft the diet with which you should start. That means either the “Intro SCD” diet or the AIPP.
Stick with cooked, soft foods (the “low residue” diet, like your gastroenterologist may tell you). As you heal, you can slowly reintroduce new, unprocessed foods. You may be surprised at the amount of fiber and bulk you can, and should, be able to eat.
Remember this is not a diet in the sense that you are trying to restrict calories. Eat as much as you’d like, though if you are flared, smaller, more frequent meals are probably better.
Some people may have trouble maintaining their weight with IBD and it is important to make sure you eat enough to maintain a healthy weight and give fuel to your immune system and muscles as you recover.
Step 2: Test and treat gut microbiome dysbiosis.
Remember the 100 trillion gut microbes living in your intestines? Well, those microbes are made up of over 1500 species and counting. This is a literal ecosystem, that we are barely beginning to understand.
While it is foundational, diet alone may not be enough to rectify an imbalanced gut microbiome. This is where it can help to use additional lab testing to give us a clearer picture of what else your gut needs to get healthy.
Current gut microbiome testing includes both stool and breath tests. These give us solid diagnostic markers for targeted treatment. However, since so much of the microbiome is still on the cutting-edge of research, I’m excited for the next 10 years as we continue to develop a better understanding of and new diagnostic markers for the gut.
The main ways we investigate parameters that can be out of balance in the gut microbiome-immune system interface is with these tests:
Stool testing, such as Genova’s GI Effects or Doctor’s Data’s Comprehensive Stool Analysis, 1- or 3-day tests
Breath testing, to test for Small Intestine Bacterial Overgrowth (SIBO)
The stool and breath tests look at your overall amount of: good bacteria; bacteria that is good up to a certain amount; bacteria and other microbes (yeast, fungus) that are not good at any amounts; and parasites. They also measure inflammation and assess digestive sufficiency and the prevalence of essential components to gut health such as short-chain fatty acids (SCFAs).
Other tests that are important include:
Food intolerance testing. This is different from what your allergist may test. Food intolerance is different from a food allergy, and is measured by our IgG and A response.
Food allergy testing. Food allergies are different from food intolerances, and are measured by our IgE response.
These tests can help provide a clearer picture of what else may be affecting your gut.
Why doesn’t my gastroenterologist do this?
Beats me. I see some beginning to use these kinds of testing. It is sort of mind-blowing that gastroenterologists aren’t even all that aware of the importance of addressing the gut microbiome and diet when treating IBD. But I’m confident that this will become the foundation of conventional gastroenterology in the future.
Until then, start with an AIPP or intro-SCD diet and find a qualified Functional Medicine practitioner who knows how to conduct and properly interpret in-depth gut microbiome testing.