Naturopathic strategies for ulcerative colitis

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By Carolina Brooks, BA, IFMCP

When I start working with an ulcerative colitis patient, they usually aren’t well. These patients are often experiencing severe fatigue, urgency, and frequent mucus and blood in the stool. Many also develop fear and confusion around food. Additionally, research has pointed to extraintestinal manifestations of systemic inflammation, which are common in ulcerative colitis patients, including enteropathic arthritis, uveitis, and primary sclerosing cholangitis.

On a stool test, one might observe higher levels of sulfidogenic bacteria such as Bilophila wadsworthia, a pathobiont organism that has been linked to the development of inflammatory bowel disease in mice, feeds on bile acids, and is often present in higher levels when the diet is high in saturated fat. A 2012 study in the journal Nature discussed the role of this organism in increasing incidence of colitis and inflammatory response in mice, resulting in gut dysbiosis. The hydrogen sulfide gas it produces has been shown to inhibit butyrate oxidation by colonocytes, damaging and inducing abnormalities in colonocytes, and inducing oxygenation of the gut epithelium, which increases growth of aerobic dysbiotic bacteria.

Key mucin-degrading strains such as Akkermansia municiphila, normally associated with a healthy mucosa and reduced inflammatory cytokine activity, are often absent or present in very low levels upon testing. A 2019 review paper in Frontiers in Microbiology discussed the possible role of Akkermansia a probiotic agent in treatment of colitis. Crucial colonic Lactobacilli and Bifidobacteria species are often reduced.

When looking at lifestyle factors which play a role in the pathogenesis of this disease, cigarette smoking reduces risk by up to 40 percent, while quitting smoking increasing risk of both developing ulcerative colitis and undergoing colectomy. A 2011 review in World Journal of Gastroenterology confirmed that current smoking has been shown to delay disease onset in men but not women, although I have seen numerous middle-aged women in my clinic who were diagnosed after they recently gave up smoking. It’s not yet clear whether prenatal smoke exposure or passive smoke exposure during childhood impact development of disease.

Other lifestyle factors that confer risk include the use of antibiotics, being breastfed for less than six months, and eating a standard Western diet high in processed and refined foods, inflammatory fats such as trans fats, and low in fiber and phytonutrients. Supplementing with omega-3 fatty acids and gamma-linoleic acid offers therapeutic benefit for ulcerative colitis benefit by modulating inflammatory cytokine activity.

By stabilizing immune function, enhancing assimilation of nutrients, and increasing antioxidant-rich plant food diversity in the diet with a view to supporting microbiome shift towards more favorable strains in the gut, patients see significant improvements and finally feel confident about coming off their aminosalicylate medication.

Emphasize to patients that relapse risk is increased with a higher intake of high sulfur foods such as red meat, dairy, eggs, dried fruit, fish, and alcohol. I recommend increasing plant protein sources such as legumes and soy, while limiting animal protein to oily fish to minimise protein putrefaction, which negatively impacts butyrate oxidation. A 1993 review in the Journal of Immunology discovered that 95 percent of study subjects with ulcerative colitis had antibodies reactive to tropomyosin, found in many fish, crustaceans, and dust mites, so I always ask patients to gauge reactivity to foods and environmental exposures.

If cruciferous vegetables are not well tolerated, because these foods contain beneficial compounds such as sulforaphane, which induces the Nrf2 pathway and protects against oxidative damaged triggered by inflammation, I always suggest that the patient consider eating smaller quantities and increasing diversity of foods to reduce reactivity risk, rather than completely excluding these foods. I have also found minimizing histamine accumulation on food, avoiding large quantities of high histamine foods, oxalates, and lectins by way of pressure cooking helpful, and some patients respond very well to eliminating nightshades.

Another common finding with ulcerative colitis is a depletion of short-chain fatty acids, especially butyrate, which provides energy to colonic cells, and plays a role immune regulation and controlling inflammation in the gut, and is a compound I regularly supplement my patients with as it has such diverse health benefits.

I usually include prebiotic fiber supplements with meals to increase diversity in the gut and stabilize blood sugar. A 1999 review in the American Journal of Gastroenterology discussed the impact of butyrate enemas as effective in the treatment of active distal ulcerative colitis. The study also looked at the impact of psyllium seeds in maintaining remission of ulcerative colitis compared to mesalamine. 105 patients were split into three groups and given either a dose of 10 grams twice a day of psyllium seeds, 500 milligrams three times a day of mesalamine, or both psyllium and mesalamine in the same doses for twelve months. Not only did the psyllium group see a significant increase in fecal butyrate levels, but remission was as effective in maintaining remission as mesalamine, and in combination with mesalamine.

Key herbal compounds, which have been demonstrated to provide significant benefit, include turmeric (Curcuma longa), particularly when used in enemas and andrographis (Andrographis paniculate). I also use decoctions containing demulcent herbs such as marshmallow (Althaea officinalis), gentle antimicrobials such as marigold (Calendula officinalis), anti-inflammatories and antihistamine herbs such as frankincense (Boswellia serrata) nettle (Urtica dioica), plantain (Plantago major), and polyphenol-rich strawberry leaf (Fragaria vesca) to regulate digestive function.    

Other useful supplements include vitamin D to restore integrity of the mucosal barrier and colonic epithelium, and specific probiotic combinations, which have been shown to maintain remission after treatment and significantly improve quality of life. Castor oil packs and frequency specific microcurrent are additional therapies I incorporate to expedite healing and reduce localized inflammation.

References

Bastida, G. and Beltrán, B. (2011) Ulcerative colitis in smokers, non-smokers, and ex-smokers. World Journal of Gastroenterology. Retrieved from: https://doi.org/10.3748/wjg.v17.i22.2740

Bian, X., Wu, W., Yang, L., Lv, L., Wang, Q., Li, Y., Fang, D., Wu, J., Jiang, X., Shi, D., and Li, L. (2019) Administration of Akkermansia municiphila ameliorates destran aulfate sodium-induced ulcerative colitis in mice. Frontiers in Microbiology. Retrieved from: https://www.frontiersin.org/articles/10.3389/fmicb.2019.02259/full

Das, K.M., Dasgupta, A., Manda, A., and Geng, X. (1993) Autoimmunity to cytoskeletal protein tropomyosin. A clue to the pathogenetic mechanism for ulcerative colitis. Journal of Immunology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/8450225/

Devkota, S., Wang, Y., Much, M.W., Leone, V., Fehlner-Peach, H., Nadimpalli, A., Antonopoulos, D.A., Jabri, B., and Chang, E.B. (2012) Dietary-fat-induced taurocholic acid promotes pathobiont expansion and colitis in Il10^−/− mice. Nature. Retrieved from: https://doi.org/10.1038/nature11225

Fernández-Bañares, F., Hinojosa, J., Sánchez-Lombraña, J.L., Navarro, E., Martínez-Salmerón, J.F., García-Pugés, A., González-Huix, F., Riera, J., González-Lara, V., Domínguez-Abascal, F., Giné, J.J., Moles, J., Gomollón, F., and Gassull, M.A. (1999) Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn’s Disease and Ulcerative Colitis (GETECCU). The American Journal of Gastroenterology. Retrieved from: https://doi.org/10.1111/j.1572-0241.1999.872_a.x

Lukas, M., Bortlik, M., and Maratka, Z. (2006) What is the origin of ulcerative colitis? Still more questions than answers. Postgraduate Medical Journal. Retrieved from: https://doi.org/10.1136/pmj.2006.047035