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A Closer Look At Ulcerative Colitis

Kathi Head, ND

Whether it’s your own gut or your patient’s gut, inflammation in the colon is no fun – and often difficult to get a handle on. In trying to determine what to do, it might be helpful to know some of the pathology behind one inflammatory bowel disease (IBD) – ulcerative colitis (UC).

The causes of UC are multi-factorial and still being elucidated. Among the pathological findings are:

·A disordered colonic milieu (aka microbiome)

·Increased inflammation

·Signs of oxidative stress

·Increased intestinal permeability

·Increased sulfide production

·Decreased oxidation of short-chain fatty acids

·Decreased methylation

This article focuses on inflammation, which is really at the heart of it all. Pathogenic microbes and their metabolites stimulate an inflammatory response, which initiates a cascade of events. Oxidative stress, for example, can be secondary to inflammation, which can then result in damage to the gut mucosa and a leaky gut barrier – in this case, in the colon. Studies show that markers of inflammation differ between ulcerative colitis patients and healthy individuals, as well as between those with UC and other types of IBD, such as Crohn’s disease.1

Although the potential inflammatory markers, microbial disruptions, and immune dysregulation are too extensive to cover in this article, a Gutbio™test evaluates thousands of pieces of data from a fecal sample to provide an inflammation score.

Specific botanicals can influence inflammation and can provide some benefit for individuals with UC. 

Curcumin, due to its well-established anti-inflammatory efficacy, has been the subject of several studies for inflammatory bowel disease (IBD). In one meta-analysis, which reviewed pooled data from several similar studies, the effect of curcumin for maintenance of remission in UC was examined. The analysis included three placebo-controlled studies that included 142 individuals with UC who were taking the prescription medication mesalamine – the standard of care for UC. Each of the three trials contained a group taking mesalamine plus curcumin and a group taking mesalamine only. The patients taking curcumin plus mesalamine had greater odds of maintaining UC remission compared to mesalamine alone (pooled odds ratio: 6.78).2

Considering its significant cost and the potential side effects of mesalamine, a desirable goal is finding adjuncts or alternatives to conventional interventions that might decrease the medication dose needed to remain in remission or substitute for medication during remission.

In a study of Boswellia bound to phospholipids for enhanced absorption, patients with UC, mostly in remission but still having mild symptoms, were given the option of trying the Boswellia preparation or taking nothing for four weeks. The group who opted for Boswellia experienced decreased symptoms of cramping, diarrhea, and occult blood. Also, fecal levels of calprotectin, an antimicrobial protein that is elevated with bowel inflammation, were measured. At the beginning of the trial, 86 percent of individuals in both groups had elevated calprotectin levels (above 100 mcg/g). After four weeks, 72 percent of subjects in the control group had elevated levels; whereas, only 50 percent of subjects who took the Boswellia preparation had elevated levels.3

Another study looked at the effect of Boswellia and Curcuma longa (turmeric; the source of curcumin) on a test tube model of IBD. The aim was to determine possible mechanisms of action that underlie the clinical benefits observed with the use of these two botanical extracts in IBD.The balance of inflammatory cytokines, the effect on reactive oxygen species, impact on gut barrier function, and effect on immune cell infiltration were examined. 

Both Boswellia and Curcuma longa significantly protected the intestinal epithelium and its barrier function after exposure to an inflammatory stimulus. Curcuma exerted an anti-inflammatory effect by decreasing the levels of IL-6, IL-8, and TNF-α (by 40, 30, and 25 percent, respectively) after inflammatory stimulation. Boswellia exerted its protective effect as an antioxidant by decreasing reactive oxygen species by 25 percent compared to pro-oxidant peroxide stimulation.

These studies underline the importance of evaluating levels of gut inflammation with a test like Gutbio, and add support to the increasing body of clinical evidence for including these two botanicals in an IBD protocol; and moreover, the importance of evaluating levels of gut inflammation.

1.Coufal S, Galanova N, Bajer L, et al. Inflammatory bowel disease types differ in markers of inflammation, gut barrier and in specific anti-bacterial response.Cells2019 Jul 13;8(7). pii: E719. doi: 10.3390/cells8070719.

2.Iqbal U, Anwar H, Quadri A. Use of curcumin in achieving clinical and endoscopic remission in ulcerative colitis: a systematic review and meta-analysis. Am J Med Sci 2018;356(4):350-356.

3.Pelligrini L, Milano E, Franceschi F, et al. Managing ulcerative colitis in remission phase: usefulness of Casperome, an innovative, lecithin-based delivery system of Boswellia serrataextract. Eur Rev Med Pharmacol Sci2016;20:2695-2700.

4.Governa P, Marchi M, Cocetta V, et al. Effects of Boswellia Serrata Roxb. and Curcuma longa L. in an in vitrointestinal inflammation model using immune cells and Caco-2. Pharmaceuticals(Basel)2018 Nov 20;11(4). pii: E126. doi: 10.3390/ph11040126.