The Naturopathic and Integrative Approach to Inflammatory Bowel Disease
Ulcerative Colitis/Inflammatory bowel disease (IBD) is a condition that is very well served by the naturopathic and integrative approach used in our clinic. Conventional treatment of IBD involving corticosteroids, anti-inflammatories, and other immunosuppressive agents, as well as surgery, has limitations in addressing the full range of disease mechanisms, and in meeting patient goals to work more deeply on the root of their condition.
In IBD, patients with an apparent genetic predisposition express a maladaptation response, with inflammatory, immunological, nutritional, and often hormonal dysregulation. The resulting symptoms include intestinal pain, cramps, diarrhea, bleeding, fistula formation, and even obstruction. These are serious and at times debilitating symptoms. For this reason, the naturopathic and integrative method combines conventional therapies, as needed, with complementary and alternative approaches to decrease symptoms, heal the condition, and when possible, put the inflammatory bowel disease into a state of sustainable quiescence, remission, or a state of “cure” in uncommon cases.
The integrative approach “integrates” several perspectives on the disease into one treatment program, treating the whole person and not simply the inflamed bowel.
The departure point for treatment begins with what is known:
• There is genetic predisposition to IBD
• Disrupted “intestinal homeostasis” abounds
• Diet influences the course of disease
• Abnormal flora and organisms are part of a changed intestinal milieu
• The normal cycle of inflammation is out of control
• Free radical, or “oxidative” damage occurs at an alarming rate
• There is “auto-immune” activity and considerable immunological impairment
• Anti-inflammatory and immune-suppressive drugs control the course of acute bouts of the disease
• Psycho-spiritual “states” appear to influence the disease
• Stresses and stress management techniques appear to affect the course of the disease.
• Non-immunological factors such as pancreatic insufficiency, intestinal permeability, and gastric hypoacidity exist in many cases.
• The disease occurs in the context of total health and not in isolation
• Non-conventional understandings of the disease process, as in Chinese Medicine or the field of homeopathy, lead to treatments, which can help patients markedly.
Given this knowledge, the naturopathic and integrative model combines therapies focusing on the components listed below:
- Use of applied therapies to overcome and compensate for genetic predisposition, reducing life style factors that encourage the maladaptation response: diet, stress management techniques, exercises, etc.
- Use of natural therapies, including herbs, vitamins, mineral, and supplements that exert an anti-inflammatory effect on the intestines and body in general
- Restoration of gut ecology and “intestinal homeostasis” using natural therapies
- Reduction of auto-immune activity and allergencity in the body by treating any intestinal permeability, allergy, gastric hypoacidity or pancreatic insufficiency and strengthening body through various detoxification methods
- Application of therapeutic diet, individualized for each patient
- Use of alternative and complementary therapies to modulate immune responses
- Address all stress factors, and screen all patient’s for adrenal insufficiency
- Screen each patient for malnutrition and malabsorption, and support accordingly as healing cannot occur without proper nutrition and absorption which may exist because of the disease itself
The Treatment of Inflammatory Bowel Disease at Pearl Natural Health
Complete medical history: in a one-hour initial appointment, a complete history is taken to establish the role of IBD in the larger context of total health.
Special consideration is given to the following:
• Dietary history
• Life style factors
• Functional endocrine
• Nutritional status and nutritional deficiencies (iron, protein, etc.)
• Stress factors
• Patterns of symptoms as understood in alternative diagnostic paradigms such as Chinese Medicine or homeopathy.
Physical examination: a physical exam is conducted with focus on key areas related to the diagnosis of underlying causes of IBD.
Patient goals: together the patient and doctors define goals, with the patient leading the agenda; some patients have a simple goal of better control of symptoms, reduced corticosteroids, or decreasing their reliance on medication they feel is harming them; other patients have their eyes set on complete remission or even cure. While the integrative approach will never allow a patient to be put in danger by eliminating medication casually, patient goals will be the driving force behind the level of their treatment plan. Patients are always encouraged to maintain their treatment connection with gastro-enterologists and other practitioners.
Laboratory Testing: the patient and the doctor agree on the extent of testing that may be required to diagnose functional patterns that need to be treated. This may include any of the following:
• Standard Blood Chemistry: utilized to determine or confirm protein deficiencies, anemia status, important vitamin and nutrient deficiencies such as iron and magnesium, immune status, etc. Conventional laboratory ranges are narrowed for a functional assessment of key areas, with the goal of optimizing health
• Comprehensive Microbiological Panel: evaluating the microbiology of the intestine through stool cultures and saliva testing, providing extensive information on the degree of gut dysbiosis as well as providing baseline inflammatory markers, digestive enzyme markers, and antibody levels related to intestinal pathogens
• Food allergy testing: to determine the degree of antibody reactivity to common foods
• Intestinal Permeability Testing: to determine if intestinal permeability needs to be treated
• Gastric Ph Evaluation: to determine the degree to which the stomach may be playing a role in maldigestion of foodstuffs.
• Adrenal Stress Testing: to determine if baseline cortisol levels are too low, causing a state of increased inflammation, or too high causing a state of immune suppression
• Liver Detoxification Testing: to assess liver detoxification function
• Fatty Acid Analysis: to assess if fatty acids in circulation are supportive of non-inflammation
• Other tests: as needed
Construction of a treatment plan: based on identification of underlying or related factors, patient goals, physical exam, and laboratory findings, the patient and physician agree on a treatment plan.
Treatment plans and will vary from individual to individual. Common can components that may be utilized over time include:
• DIETARY PLAN: a dietary plan will be recommended, with support given to assure success or help with needed changes.
• STRESS MANAGEMENT PLAN: a stress management plan will be recommended, with support given to assure success of help with needed changes.
• ENDOCRINE BALANCING OR HORMONAL THERAPY: if indicated, therapy to stimulate thyroid or adrenal function will be included. In cases where a low baseline cortisol is diagnosed through salivary testing and control of symptoms is poor, low level bioidentical cortisol supplementation will be strongly considered.
• BOTANICAL OR SUPPLEMENTAL SUPPORT: herbal formulations to help alter the intestinal environment, treat the “dysbiosis, decrease inflammation, treat pancreatic insufficiency, gastric hypo-acidity, intestinal permeability, adrenal fatigue, etc.
• ANTIBIOTIC, ANTI-FUNGAL, OR ANTI-PARASITIC MEDICATION: usually natural agents are favored, but in some cases pharmacological therapies (drugs) are indicated
• CHINESE MEDICINE OR HOMEOPATHIC MEDICINE: If indicated, patients are treated with Chinese Medicine (herbal formulation and “acupuncture”) or Homeopathic Medicine, as needed.
• PSYCHOLOGICAL COUNSELING: if indicated
Timely follow-up: after a treatment plan is commenced, follow-up usually occurs at 1-month intervals until goals are met, after which time there are longer intervals between follow-ups; more frequent visits are possible as needed
When we use complementary modalities to IBD, we remain aware of patients’ clinical responses. We need to work with a patient’s gastroenterologist or other practitioner in tapering their medication as they improve, or adding certain medications when the condition flares up and symptoms become distressing. It is important for the patients to set their own goals (e.g., greater well-being, relief of symptoms, or no medication). Different patients may aspire to different achievable targets.
Energy and wellness are not found in a magic pill or potion. Real change requires a program over time to get desired results. With a careful assessment, and work on the part of patient and physician, Inflammatory Bowel Diseases are well treated with an integrative model using the best of natural medicine.