Micronutrient therapy
| Definition | |
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Ulcerative colitis and Crohn's disease, which both have similar symptoms and are associated with digestive disorders and inflammation, are grouped together under the term Inflammatory Bowel Disease (IBD). The exact cause of IBD is still unknown, but it is believed that certain factors contribute to the development of these diseases, including genetics itself, an unhealthy diet and an inappropriate immune response. Although both ulcerative colitis and Crohn's disease have their own challenges and side effects, current knowledge suggests that a variety of treatment options can help patients maintain a good quality of life despite the disease. |
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| Causes | |
| The causes of IBD still remain unclear, but some studies underline the role of environmental and genetic factors, as well as the intestinal mucosa with its associated intestinal flora. Studies have shown that patients with Crohn's disease have higher levels of bacteroidetes and enterobacteria and lower levels of lactobacillus and bifidobacterium in their intestinal flora compared to healthy people, although it still remains unknown which intestinal microbiota influence the development of IBD. In this context, some studies also highlight the protective effect of lactobacillus and bifidobacterium in the pathogenesis of IBD. Furthermore, from a scientific point of view, genetics also seems to play an essential role in the development of IBD. Researchers have studied the influence of genetic factors on the prevalence of IBD and showed that the prevalence is higher in young people, when the family shows a history of the disease. In addition, scientists have found that not only proper nutrition plays a major role in ulcerative colitis and Crohn's disease, but breastfeeding also reduces the prevalence of these diseases. The reason for this is the protection against gastrointestinal infections caused by breast milk. This not only promotes the development but also the growth of the mucous membrane system in the gastrointestinal tract. Current studies also suggest a possible association with infections caused by Salmonella, Campylobacter, Yersinia, Shigella, Clostridium difficile, E. coli and Aeromonas and the occurrence of IBD. Researchers reported that infectious diarrhea in childhood is associated with an increased prevalence of both of these diseases. |
| Symptoms | |
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Ulcerative colitis and Crohn's disease both have a similar clinical picture and are predominantly characterized by inflammation of the gastrointestinal tract (GIT) and digestive disorders such as abdominal pain, diarrhea, weight loss and rectal bleeding. In comparison to other inflammatory diseases, IBD is not easily suppressed, leading to a stimulation of the immune system and a destruction of parts of the intestine, resulting these specific symptoms. Although both Crohn's disease and ulcerative colitis have similar symptoms, the affected areas of the digestive tract vary. According to Farmer, Hawk and Turnball Crohn's disease often has an impact on the ileum and also a section of the large intestine, but the disease can affect any area of the gastrointestinal tract (GIT), from the mouth to the anus. The ulcerative colitis is confined to the large intestinal, inclusively the colon and the rectum, with inflammation in the large intestine, whereas in Crohn’s disease the small intestine is usually inflamed. In contrast to Crohn's disease, in which there is only a risk of bleeding in severe cases, ulcerative colitis manifests itself mainly through severe pain, diarrhea and also blood in the stool. Malnutrition is very common in Crohn's disease because there is damage to the small intestine which is responsible for the absorption of nutrients. According to this, 50% of people with ulcerative colitis have an iron deficiency, whereas people with Crohn's disease often suffer from a deficiency of vitamin D and folate. |
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| Diagnostics | |
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Although the diagnosis of IBD, especially in the early stages, is not always easy, it is usually done in 3 steps, including a medical history with physical examination, laboratory tests including blood and stool analysis, and imaging procedures. In particular a blood count can provide information about potential IBD. In cases of severe inflammation, for example, elevated levels of C-reactive protein (CRP) and white blood cells (leucocytes) can be found. The micronutrient status can also indicate the presence of IBD. The focus here is primarily on the levels of iron, vitamin B12, folic acid, zinc and calcium. Stool diagnostics can also be used to determine whether the patient could be affected by a bacterial infection and can also provide additional information on the bacterial composition of the intestinal flora. The analysis of calprotectin also shows how pronounced the inflammatory activity is in the intestine. This protein is produced by neutrophil granulocytes in increased quantities, for example in inflammatory reactions, and is sometimes massively increased, especially in IBD. In addition, imaging procedures such as invasive gastroscopy (gastroscopy) and/or colonoscopy (colonoscopy), as well as non-invasive sonography (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI) play a major role in the diagnosis of IBD. While the invasive methods allow the analysis of changes in the intestinal mucosa with the possible removal of a biopsy, the non-invasive methods are used to detect potential thickening of the intestinal wall, constrictions (stenoses), fistulas or abscesses. |
| Therapy | |
| Since Crohn's disease and ulcerative colitis cannot yet be treated causally, the reduction or elimination of inflammation in the bowel segments, as well as a prolongation of pain-free phases (remission) while maintaining the highest possible quality of life, is the main focus of therapy. This depends on the activity (active flare-up or remission) and the spread of the disease and is individually determined by the physician. Treatment may be composed of drug and diet therapy as well as supplementation with micronutrients, with surgical measures if necessary. As food enters the digestive tract it is scientifically assumed that diet can influence the prevalence of IBD to a certain level. The extent to which diet and individual foods can influence Crohn's disease and ulcerative colitis is still not fully understood, but the evidence suggests that there is both a preventive and curative effect. The focus of scientific studies is primarily on the low FODMAP diet, the Specific Carbohydrate diet (SCD), the Anti-inflammatory diet, the Paleo diet, but also on the consumption of omega-3 fatty acids and their potential health benefits. |
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| Relevant micronutrients | |
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The curcuminoids contained in turmeric (Curcuma longa) have anti-inflammatory, antioxidant and immunomodulatory properties. The anti-inflammatory effect of the curcuminoids is achieved by inhibition of cyclooxygenase-2 (COX-2) and lipoxygenase (LOX) and by normalization of NO-synthase (iNOS). The imbalance in the activation of COX-2 and/or iNOS seems to be related to tumor diseases and inflammatory processes. Acute inflammatory processes often show a high level of pro-inflammatory and immunosuppressive eicosanoids, which are formed from arachidonic acid. An increased supply of the omega-3 fatty acid eicosapentaenoic acid (EPA) inhibits this conversion process – which means more anti-inflammatory eicosanoids are formed. Frankincense extract (Boswellia serrata) contains boswellic acids, which have a direct anti-inflammatory effect on the affected cells by inhibiting the leukotriene B activity. Due to its astringent effect, green tea extract can reduce the permeability of the intestinal mucosa and prevent the penetration of pathogenic germs. The constituent epigallocatechin-3-gallate is an electron donor and thus acts as an effective antioxidant in the inflammatory process. These effects have been demonstrated in both the small and large intestine. Chamomile extract strengthens the healing process through its antiphlogistic and granulation-promoting properties. L-glutamine plays a central role in the formation and maintenance of cell systems. Cells with high division rates, such as the cells of the immune system and the mucosa cells of the small intestine, depend on an adequate supply of the amino acid glutamine. In addition, L-glutamine, as a precursor of glutathione biosynthesis, is a central component for maintaining antioxidative status. Zinc and vitamin C are closely associated with immune and healing processes and promote the restoration of a healthy intestinal mucosa. Bovine colostrum contains immunoglobulins (IgG, IgA, IgM) and glycoproteins such as lactoferrin and proline-rich polypeptides (PRP), whose mode of action lies primarily in broad spectrum immunomodulation. Damage to the intestinal mucosa, which occurs as a side effect of certain drug groups (e.g. NSAIDs), is also mitigated by the concomitant use of colostrum. Plant extracts, such as ginger, gentian, licorice, quassia and garlic, also support the digestive processes, increase resistance to unfavourable microorganisms and support the immune system. In people with an inflamed intestinal mucosa the small intestine, caused by gluten intolerance (celiac disease), a deficiency of certain micronutrients is often found. Particularly affected are vitamins and minerals that are absorbed through the small intestine. There is good evidence of an increased deficiency of iron, copper, zinc, folic acid, vitamin B12, vitamin B6, vitamin A and vitamin D. In the presence of low moods and mood swings associated with intestinal dysfunction, a sufficient supply of L-tryptophane should be considered to compensate for malabsorption-related deficiencies. |
