Crohn’s Disease and Metabolic Syndrome Part 2

 

This article was a continuation of a post about the story of GS when she was diagnosed with Crohn’s disease.

While in the hospital, she was seen by a hospitalist and she was advised to be mindful of gluten intake too. GS was told that gluten can also cause symptoms similar to CD

Knowing that soybeans are the last food that she ate before being hospitalized, GS avoided all soy products and bread even up to the present. GS also started an exercise program at home consisting of bodyweight exercises and weight lifting. 

How can the skeletal muscle system that is not connected physically with the gastrointestinal system do anything about Crohn’s disease or the metabolic syndrome?

Exercise Cuts Down the Source of Inflammation

Exercise exerts an indirect anti-inflammatory effect by making the skeletal muscles use the stored fuel source (glycogen) within the skeletal muscle fiber. That muscle glycogen has to be replaced right away. If the food intake is not enough to refill the glycogen stores, then the body turns the intraabdominal fat or visceral adipose tissue (VAT). The body changes the fat to glycogen for storage. The smaller the VAT, the lower the number of proinflammatory cytokines, the lesser the inflammation, the better the disease.

Skeletal Muscles also produce myokines that affect the different parts of the body and exert beneficial effects.

Myokines that Exert Anti-inflammatory Effects in Crohn’s Disease

• IL-6 is a defense mechanism against the pro-inflammatory effect of the other cytokines like the TNF-alpha. IL-6 also increases the secretion of glucagon-like peptide (GLP-1) that stimulates the repair of the damaged intestinal mucosa. (Good for Crohn’s)
• Heat shock proteins (HSP) can also decrease the secretions of pro-inflammatory cytokines.
• PGC-1alpha that reduces the activity of nuclear factor-KB that is the master regulator of pro-inflammatory gene regulation leading to less inflammation
• Irisin changes the white adipose tissue that is pro-inflammatory into brown fat cells that becomes a fat burner.
• IL-15 reduces the visceral fat that produces the inflammation.
• Metrnl increases whole-body energy expenditure,  exert anti-inflammatory effects, and improves glucose tolerance in obese/diabetic mice.
• Peroxisome proliferator-activated receptor PPAR – γ decreases inflammation

Other Beneficial Effects of Exercise for Crohn’s Disease

• Exercise increases the diversity of the microbiome in the gut and exerts a protective action.
• Muscle wasting, sarcopenia, and decreased muscle strength leading to disability are common in IBD. The mechanisms are secondary to reduced appetite, malabsorption, and increased metabolic rate. Resistance training can prevent and even reverse the progression of sarcopenia.
• The appetite is also improved by modifying the release of adipokines and ghrelin and lowering leptin.
• Since inflammatory cytokines lead to decreased bone mineral density and osteoporosis. Resistance exercises mitigate against bone loss and future pathologic fractures.

If GS did not watch her diet and did not exercise and continued her medications for CD, she would have been diabetic by now because of the steroids. GS would have had multiple calls and visits to her physicians, the emergency room, and possibly been admitted to the hospital numerous times because of the continued symptoms and adverse effects of diabetes and her medications. She could have had surgery (bowel resection) to remove part of her intestines.  Her lifestyle would be much different. Those are my thoughts based on my 18 years in the emergency room as a doctor.

The point in this article is that medications are not enough. Dietary modifications, being mindful, and avoiding what food causes the symptoms and exercise are the hallmarks of Crohn’s disease treatment.

GS likes traveling and enjoys her family.  She has no more symptoms of CD and is free from medications. She watches what she eats and stays away from soy and gluten. She practices intermittent fasting and exercises regularly. 

Related Readings:

Crohn’s Disease and Metabolic Syndrome Part 1

Diseases Associated with the Metabolic Syndrome

How does Exercise Burn Visceral Fat?

References: