Crohn's Disease And Metabolic Syndrome Part 1

Crohn’s disease (CD) is of particular interest to me because I know someone close to me that was diagnosed with CD. It was a scary time.

During medical school about 30 years ago, we were taught that CD is only seen in young Caucasian males in their 20s. Presently, as people adopt a “westernized lifestyle” characterized by decreased physical activity and dietary changes, other races, and the female sex are starting to get IBD.

That person, I will refer to as GS (not her real initials) is non-caucasian and was in her 50s at that time. Not the typical CD patient.

Symptoms of CD include diarrhea, nausea, vomiting, abdominal pain, weight loss, and fatigue. Extra-abdominal signs like joint pains, skin, and eye involvement can also occur. The symptoms are secondary to the chronic and recurrent inflammation not only of the intestinal tract but also the whole body.

Before developing the symptoms of CD, GS gained weight around the middle and probably acquired metabolic syndrome (MetS).

The cause of IBD is multifactorial and involves genetic but mostly environmental factors. The genetic factors for CD are only 13.6% and 7.5 % for UC. What we eat, and the number and biodiversity of the microorganisms in the gut (microbiome) play a significant role. IBD starts with a defective inner wall of the intestines (mucosa) that allows microbes to cross the barrier and induce an immune response. Why the mucosa becomes defective is subject to research. Still, my hunch is that the genetically modified foods (GMO), trans-fats hidden in the foodstuff, GMO soy, and gluten play a significant role in causing a leaky gut that initiates an inflammatory response.

800Px-Patterns_Of_Crohn'S_Disease.svg — Crohn’S Disease Most Commonly Involves The Ileum

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Similarities of Metabolic Syndrome and Crohn’s Disease

MetS and CD both have insulin resistance. In metabolic syndrome, there is a surplus of intraabdominal fat (visceral adipose tissue, VAT) that stimulates a specific type of white blood cells called the macrophage. The macrophages infiltrate the fat and induce an immune response to the microorganisms or anything unhealthy that crosses the inner lining of the intestines. During that immune response, cytokines are produced that can spread throughout the body. The inflammation in the gut explains nausea, vomiting, abdominal pain, and diarrhea. The symptoms can be acute or chronic. The more dangerous, the more severe the symptoms.

VAT also produces more pro-inflammatory signaling proteins (cytokines) like resistin, visfatin and IL-6, TNF-∝, and MCP-1. Cytokines can cause inflammation locally within the intestines and throughout the whole body because they are carried in the bloodstream.

Like in other diseases related to the Mets, the risk of developing cardiovascular diseases like heart attacks and strokes is 20% higher than in the general population. That is because of the formation of atherosclerosis secondary to the cytokines that spread all over the body. Any blood vessels from head to toe can be affected. The inflammation leads to the thickening of the inner lining of the blood vessels that eventually leads to dysfunction and loss of blood supply.

GS saw a gastroenterologist at that time, and the work-up pointed to CD. GS was started on salicylates and Lialda. In spite of her medications, GS went to the emergency room at one time because of intractable vomiting after a snack of spicy wasabi soybean. She was sick enough to be admitted for intravenous steroids and antibiotics for several days.

The treatment of IBD involves the use of anti-inflammatory drugs like corticosteroids, aminosalicylates, immune suppressors, and sometimes antibiotics. Immune-suppressants and anti-inflammatories lower the resistance to infection, increase the risk for cancers, diabetes, hypertension dyslipidemia, peptic ulcers, liver, and kidney injury.

GS is well educated and knows about the long term consequence of Crohn’s disease and the adverse effects of the medications.

GS had to make a decision. Lifestyle change and medications or just change the diet and exercise change? Will it work? Why would an educated person like GS do that? How can skeletal muscles that are physically separated from the intestinal tract have anything to do with Crohn’s? How can exercise be better than any other medication produced by modern science? Did GS survive? Is she still alive?

References:

Tigas S, Tsatsoulis S. Endocrine and metabolic manifestations in inflammatory bowel disease. Ann Gastroenterol. 2012; 25(1): 37–44.

K. Bente, B. Pedersen, M. Febbraio. Muscle as an endocrine organ: focus on muscle-derived interleukin-6. Physiol Rev, 88 (2008), pp. 1379-1406

Pedersen B.K. et al., Role of myokines in exercise and metabolism. Journal of Applied Physiology. 01 SEP 2007https://doi.org/10.1152/japplphysiol.00080.2007

Y. Chen, E. Noble. Is exercise beneficial to inflammatory bowel diseases? An implication of heat shock proteins.Med Hypotheses (2009), pp. 84-86

Bilski et al. Can exercise affect the course of inflammatory bowel disease? Experimental and clinical evidence. Pharmacological Reports. Volume 68, Issue 4, August 2016, Pages 827-836

Michalak A. Common links between metabolic syndrome and inflammatory bowel disease: Current overview and future perspectives. Pharmacological Reports Volume 68, Issue 4, August 2016, Pages 837-846

Photo Credits:

Terminal Ileum By Samir, vectorized by Fvasconcellos – w:Image: Patterns of CD.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1359310

Colitis Samir at English Wikipedia