Case Study: Overcoming Crohn’s Disease

Let me tell you about a patient who came into the clinic to see me. His name was Jared and he was 34 years old. In 2016, after several years of working in the tech industry, he was diagnosed with Crohn’s disease. Jared had all the classic signs of the disease:  abdominal pain, diarrhea, fatigue, and malnutrition. 

He noticed that his job was too demanding, but remember, stress is only an aggravator. Not the root cause. Something had shifted for Jared before he started a career in tech. 

After our initial meeting, I concluded he had high levels of inflammation throughout his digestive tract. He had been treated with extensive antibiotics and immunosuppressants over the course of his life. It left Jared increasingly unable to fully heal gut function, which made it even more difficult to easily digest food and absorb nutrients. I was also concerned because several antibiotic courses and immunosuppressants make one highly susceptible to recurrent infections.

Treating Crohn’s is doable if the patient is willing to make significant lifestyle changes. Fortunately, Jared was ready to do anything.

First: How can you tell if you have leaky gut?

There are several ways to gain insight into the gut.  One way is measuring zonulin levels. Zonulin is a protein in cells that holds cells together. It is an intercellular tight junction protein--very small, but very mighty. Increased zonulin levels are associated with increased intestinal permeability. Thus, they are an adjunctive marker for assessing gut permeability (Malíčková et al., 2017). 

Malíčková and colleagues assessed zonulin levels in the fecal and serum of subjects with active IBD and found that Crohn’s was associated with significantly higher levels of fecal and serum zonulin compared to Ulcerative Colitis; additionally, and irrespective of IBD-type, smoking was associated with high fecal levels of zonulin.

Where are we now?

Cutting edge research suggests that bacteria and fungi may be synergistically creating biofilms in Crohn's disease, and this gives us an opportunity to act. A recent review article by Hager and Ghannoum (2017) supports the biofilm hypothesis, but states that there are not enough research incentives to find specific probiotics that could be helpful after fungicides are used. "Unfortunately, since probiotics are considered to be food supplements and not drugs that are regulated by the US Food and Drug Administration (FDA), conducting such trials is challenging due to the lack of funding, leaving companies with very little impetus to perform long, expensive, placebo-controlled studies." 

In a mouse model of Crohn’s disease, Pizarro and colleagues (2003) came to the conclusion that Crohn’s happened if, and only if, germ-free mice were colonized with aggressive dysbiotic bacterial communities. Crohn’s did not happen if germ-free mice were colonized with wild-type, non-aggressive communities. They hypothesized that focal lesions in the gut drove inflammation and permeability in genetically susceptible individuals (in this case, transgenic mice). 

While healthy individuals may be more able to heal those lesions, genetically susceptible individuals may not recover as quickly. Inflammation then upregulates the expression of virulence genes in aggressive bacteria. Those bacteria may further exert selection pressures on beneficial bacteria. Stated differently, focal lesions drive inflammation that fuels changes in the microbiota that may create a positive feedback loop, eventually resulting in IBD. What kinds of insults might cause those types of lesions in humans? All of the usual culprits, including dietary and stress-related ones.

How’s Jared Doing?

Jared’s case is unique as is every Crohns’ patient.  He cannot be treated via a protocol as is often done in conventional medicine since it does not work.  

When Jared was diagnosed with Crohn’s, he felt he had to identify with a chronic illness which made him feel vulnerable, helpless, and broken.  We were able to turn his story around by first optimizing his diet away from animal protein and other inflammatory foods (aka., items not grown locally from the Earth but instead modified and sprayed heavily with pesticides).  We were also able to help Jared connect with when his body needed fuel versus just mentally and physically pushing through via intermittent fasting. As Jared began to physically feel better and no longer experience frequent bouts of abdominal pain or bloody stools, he began to regain hope.  Jared no longer felt alone in his healthcare journey and hence, was able to actually address the deeply rooted problems which had driven his immune system to collapsing in the first place. After 2 years of closely working together, Jared is on the road to reversal of Crohn’s.   

Patient Testimonial

“I had no idea I was so inflamed and that my diet was leading to my worsening symptoms. I’m so thankful for a doctor who could finally get to the root cause of my Crohn’s disease.”

References

Argollo, M., Fiorino, G., Hindryckx, P., Peyrin-Biroulet, L., & Danese, S. (2017). Novel therapeutic targets for inflammatory bowel disease. Journal of autoimmunity. 

Blatchford P, Stoklosinski H, Ansell J, et al. (2017). Consumption of kiwifruit capsules increases Faecalibacterium prausnitzii abundance in functionally constipated individuals: a randomised controlled human trial. Journal Of Nutritional Science, 6, :e52.

Benjamin, J., Makharia, G. K., Ahuja, V., Kalaivani, M., & Joshi, Y. K. (2008). Intestinal permeability and its association with the patient and disease characteristics in Crohn's disease. World Journal Of Gastroenterology, 14(9), 1399-1405.

Hager C, & Ghannoum M. (2017). The mycobiome: Role in health and disease, and as a potential probiotic target in gastrointestinal disease. Digestive And Liver Disease, 11.

Hoarau, G., Mukherjee, P. K., Gower-Rousseau, C., Hager, C., Chandra, J., Retuerto, M. A., … Ghannoum, M. A. (2016). Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease. mBio, 7(5), e01250–16.

Krebs S, Omer T, Omer B. (2010). Wormwood (Artemisia absinthium) suppresses tumour necrosis factor alpha and accelerates healing in patients with Crohn's disease - A controlled clinical trial. Phytomedicine: International Journal Of Phytotherapy And Phytopharmacology, 17(5), 305-309.

Lopes-Lutz D, Alviano D, Alviano C, Kolodziejczyk P. (2008). Screening of chemical composition, antimicrobial and antioxidant activities of Artemisia essential oils. Phytochemistry, 69, 1732-1738.

Malíčková, K., Francová, I., Lukáš, M., Kolář, M., Králíková, E., Bortlík, M., … Zima, T. (2017). Fecal zonulin is elevated in Crohn’s disease and in cigarette smokers. Practical Laboratory Medicine, 9, 39–44.

Palumbo, V. D., Romeo, M., Marino Gammazza, A., Carini, F., Damiani, P., Damiano, G., et al. (2016). The long-term effects of probiotics in the therapy of ulcerative colitis: A clinical study. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 160(3), 372-377.

Pizarro, T. T., Arseneau, K. O., Bamias, G., & Cominelli, F. (2003). Mouse models for the study of Crohn's disease. Trends In Molecular Medicine, 9218-222.

Vivinus-Nébot, M., Frin-Mathy, G., Bzioueche, H., Dainese, R., Bernard, G., Anty, R., ... & Hébuterne, X. (2014). Functional bowel symptoms in quiescent inflammatory bowel diseases: role of epithelial barrier disruption and low-grade inflammation. Gut, 63(5), 744-752.

AUTHOR

Dr. Payal Bhandari M.D. is one of U.S.'s top leading integrative functional medical physicians and the founder of SF Advanced Health. She combines the best in Eastern and Western Medicine to understand the root causes of diseases and provide patients with personalized treatment plans that quickly deliver effective results. Dr. Bhandari specializes in cell function to understand how the whole body works. Dr. Bhandari received her Bachelor of Arts degree in biology in 1997 and Doctor of Medicine degree in 2001 from West Virginia University. She the completed her Family Medicine residency in 2004 from the University of Massachusetts and joined a family medicine practice in 2005 which was eventually nationally recognized as San Francisco’s 1st patient-centered medical home. To learn more, go to www.sfadvancedhealth.com.