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Regulation of Gene Expression by Fatty Acids for IBD

Regulation of Gene Expression by Fatty Acids for IBD

Dietary fat has several essential functions in the human body. First, it functions as a supply of energy and structural components for the cells and second, it functions as a regulator of gene expression, which influences lipid, carbohydrate, and protein metabolism, along with cell growth and differentiation. The effects of fatty acids on gene expression are cell-specific and influenced by structure and metabolism. Fatty acids interact with the genome. They regulate PPAR, and the activity or nuclear abundance like SREBP. Fatty acids bind directly with one another to regulate gene expression.

 

What’s the role of fatty acids towards disease pathogenesis?

 

Alternately, fatty acids behave on gene expression through their effects on specific enzyme-mediated pathways, such as cyclooxygenase, lipoxygenase, protein kinase C, or sphingomyelinase signal transduction pathways, or through pathways that require changes in tissue lipid to lipid raft composition which affect G-protein receptor or tyrosine kinase-linked receptor signaling. Additional definition of these fatty acid-regulated pathways can offer insight into the role dietary fat plays in human health as well as the beginning and growth of many chronic diseases, such as coronary artery disease and atherosclerosis, dyslipidemia and inflammation, obesity and diabetes, cancer, major depressive disorders, and schizophrenia. The effects of fatty acids on gene expression, however, have been widely described on inflammatory bowel disease, or IBD.

 

Fatty Acids and Gene Expression

 

The effect of fatty acids on gene expression was previously determined to result mainly from changes in tissue phospholipids or eicosanoid production. More recently, the discovery of nuclear receptors; such as peroxisome proliferator-activated receptors, or PPARs, and their regulation by fatty acids, has significantly altered this view. PPARs are ligand activated transcription factors that upon heterodimerization with the retinoic X receptor, or RXR, comprehend PPAR response elements in the promoter regions of different genes, that have an impact on gene transcription. PPARs bind various ligands, including nonsteroidal anti inflammatory medications, or NSAIDS, thiazolidinediones (antidiabetic agents) along with PUFAs and their metabolites. Several subtypes of the receptor are recognized (?,?,?) and are expressed in several different cells. PPAR? is extracted from the adrenal gland, with most of its numbers observed in the colon.

 

PPAR? has been implicated in the regulation of inflammation, and it has become a potential therapeutic goal in treating inflammatory diseases, such as IBD. It has been suggested that people with ulcerative colitis, or UC, have a mucosal deficit in PPAR? that could bring about the development of their own disease. Analysis of the mRNA and proteins within colonic biopsies demonstrated decreased levels of PPAR? in UC patients in comparison with Crohn’s patients or healthy subjects.

 

Using colon cancer lines, it has been demonstrated that PPAR ligands attenuate cytokine gene expression by inhibiting NF-?B via an I?B determined mechanism. Further research studies imply that PPAR activators inhibit COX2 by interruption with NF-?B. PPARs impair interactions with STAT and other signaling pathways as well as the AP-1 signaling pathway.

 

Animal studies support using PPAR for autoimmune inflammation. Inflammation decreased by ligands for PPAR. The direction of PPAR and RXR agonists synergistically reduced TNBS-induced colitis, together with improved macroscopic and histologic scores, reductions in TNF? and IL-1? mRNA, and diminished NF-?B DNA binding actions. Though clinical evidence is limited, the results of an open source research study with rosiglitazone, a PPAR? ligand as therapy for UC, demonstrated that 27 percent of patients achieved remission after 12 weeks of therapy. Thus, PPAR? ligands may represent a cure for UC, where double-blind, placebo-controlled, randomized trials have been warranted.

 

Of substantial curiosity, the capability to regulate PPAR nutritionally has been examined. Dietary PUFA demonstrated an impact during the regulation of transcription factors on gene expression. Fatty acid regulation of PPAR was originally detected by Gottlicher et al.. A choice of fatty acids, like eicosanoids, and metabolites are proven to activate PPAR. Both PPAR? and PPAR? bind mono- and polyunsaturated fatty acids. Thus, the anti inflammatory effects of n3 PUFA may entail PPAR and its interruption with NF?B, rather than only changes in eicosanoid synthesis.

 

Conclusion

 

Fatty acids regulate gene expression involved in lipid and energy metabolism. Polyunsaturated fatty acids, or PUFA, though not saturated or polyunsaturated FA, suppress the induction of lipogenic genes by inhibiting their expression and processing of SREBP-1c. This impact of PUFA suggests that SREBP-1c may regulate the synthesis of fatty acids to glycerolipids, among others. PPARalpha has a role in the adaptation to fasting by inducing ketogenesis in mitochondria. During fasting, fatty acids are considered as ligands of PPARalpha. Dietary PUFA, except for 18:2 n-6, are extremely prone to induce fatty acid oxidation enzymes through PPARalpha because of specific mechanisms. Signaling functions of PPARalpha pPARalpha is needed for controlling the synthesis of fatty acids. Further research is needed to conclude the full effects of fatty acids in relation to the regulation of transcription factors for gene expression in inflammatory bowel disease, or IBD.

 

Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

By Dr. Alex Jimenez

 

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Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

 

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WELLNESS TOPIC: EXTRA EXTRA: Managing Workplace Stress

 

 

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Glutamine, Fiber & Fatty Acid Intake for IBD

Glutamine, Fiber & Fatty Acid Intake for IBD

Inflammatory bowel disease, or IBD, is a term used to describe inflammation of the gastrointestinal mucosa of unknown etiology. There are a selection of hypotheses associated to the development and perpetuation of IBD. Three main theories emerge from the literature. The first implicates a persistent intestinal infection; the second demonstrates that the upcoming signs of IBD are due to a defective mucosal barrier to luminal antigens; and the next suggests a dysregulated host immune response to ubiquitous antigens.

 

What are the nutritional components, if any, behind inflammatory bowel disease?

 

It is believed that IBD has both genetic and environmental components, therefore it’s immunologically mediated. Information gathered from IBD patients showing cytokine profiles, permeability defects, response to treatment and natural history of disease, may indicate a heterogeneous group of disorders that fall under the headings of ulcerative colitis, or UC, and Crohn’s disease, or CD. Previous epidemiological data on diet in UC and CD are conflicting, partly as a result of the heterogeneity of those diseases, making it difficult to get reliable statistics and publication bias, such as in the case of negative structures from breastfeeding.

 

Glutamine, Fiber and Fatty Acids

 

Diets high in glutamine, a significant source of energy for enterocytes, in addition to being the preferred fuel of the small intestine, are used with varying success. Glutamine is bekieved to exert its trophic effects on the small intestine by increasing protein synthesis and producing alanine for enteric gluconeogenesis. There is proof that glutamine protects the small intestinal mucosa during acute disease. However, oral glutamine supplements do not restore to normal the increased intestinal permeability discovered in patients with CD and these supplements do not beneficially affect the sufferers’ CDAI or C-reactive protein, also abbreviated as CRP, levels. Similarly, a randomized controlled trial demonstrated no benefit was connected to the usage of glutamine-enriched polymeric formulas in children with CD.

 

In animal research studies, dietary fiber has been implicated in keeping the integrity of the intestine, as well as in preventing bacterial translocation from the gut to the mesenteric lymph nodes. Short-chain fatty acids (SCFA, C1 to C6 natural fatty acids), are created by the fermentation of dietary polysaccharides in the common anaerobic bacteria in the colon. These SCFA are a source of energy for the colonocytes, which together improve sodium and water absorption, and promote blood circulation. Decreased quantities of SCFA, particularly butyrate, and a defect in the oxidation of butyrate from colonocytes, are indicated as a mechanism in the pathogenesis of inflammatory bowel disease. Evidence to support that concept requires the observation of the oxidation of C-labelled butyrate, demonstrated to decrease in patients with active UC in comparison with healthy controls. However, researchers have failed to reveal the differences between UC patients and controls in the oxidation of rectally administered C-labelled butyrate.

 

TPN supplemented with SCFA improved function adaptation to intestinal resection in rats. It remains to be discovered when patients with short bowel syndrome may make the most of SCFA.

 

Butyrate (C4 fatty acid) administered to UC patients contributed to remission levels like corticosteroids and mesalamine. In patients with CD, both intestinal biopsies and lamina propria cells packaged with butyrate had substantially decreased levels of inflammatory cytokines (TNF), possibly due to a reduction in NF?B stimulation and I?B degradation.

 

Eicosanoids are inflammatory mediators, which have also been implicated in the pathogenesis of chronic inflammatory damage in the intestine. Specimens from patients with IBD show enhanced eicosanoid formation. High dietary intake of omega-6 polyunsaturated fatty acids, abbreviated as PUFAs, which reduces omega-3 intake, and may contribute to IBD development. The benefits of fish oil, which contain n3 fatty acids, that were shown in certain inflammatory disorders, such as psoriasis and rheumatoid arthritis. Epidemiological observations of this very low prevalence of IBD in Japanese and Inuit populations consuming substantial n3 fatty acid fish provided a justification for utilizing n3 fatty acids in IBD. The n3 fatty acids are considered to compete with n6 fatty acids as precursors of eicosanoid synthesis. The n3 products reveal a series of 5 leukotrienes, which have considerably less physiological activity when compared with the arachidonate established series 4 counterparts. In addition, fish oil might have an anti inflammatory effect.

 

Rats fed with fish oil that had TNBS-induced inflammatory lesions in the intestine showed less prostaglandin- and leukotriene-mediated resistant response. Parenteral lipid emulsions enhanced with n3 fatty acids reduce diarrhea, weaken morphological changes and decreased colonic concentrations of inflammatory mediators in an animal model of acetic acid induced colitis.

 

Loeschke et al conducted a placebo-controlled trial of n3 fatty acids in preventing relapse in UC. Patients in remission who got n3 fatty acids experienced fewer relapses than did those receiving placebo. Unfortunately, the favorable results of this research study did not last throughout the total amount of the two year research, possibly due to diminished compliance punctually. In a multicenter placebo controlled relapse prevention trial, Belluzzi et al found a significant drop in the relapse rate in CD patients given an exceptional formula designed to allow postponed ileal release of n3 fatty acids. A fish oil diet has been shown to increase eicosapentanoic and docosahexanoic acids in the intestinal mucosal lipids of IBD sufferers, also demonstrating a reduction in arachadonic acid. A gain in the synthesis of leukotriene B5 along with a 53 percent decrease of leukotriene B4 was shown in UC patients, whereas the fish oil treatment revealed a nonsignificant trend to faster remission. Fish oil supplementation results in clinical improvement of active mild to moderate disease, but was not associated with a significant reduction in leukotriene B4 production. Consequently, fish oil supplementation of the diet may provide some short-term benefit to people with CD or UC. Using probiotics and prebiotics has received much attention; the interested reader is referred to recent reviews in this area.

 

Clinical Implications

 

It is widely known that nutritional deficiencies are common in people with CD and UC, and people have to be expected, diagnosed and treated. There are no special diets which may be recommended for all patients with IBD; dietary therapy needs to be individualized. TPN or TEN may be necessary to restore nutrient equilibrium in selected IBD patients with malnutrition, but in adults these interventions do not provide an essential decision to modify disease activity. The omega-3 PUFAs in fish oil may reduce disease activity in UC and CD when used at the short term together with regular medical therapy. Their mechanism of action is to enhance the activity of the amino acids PPAR, or peroxisome proliferator-activated receptors, in the intestine, inhibiting the AP-1 signaling pathway and NF-?B, weakening pro-inflammatory cytokine receptor expression. Future research will focus on the identification and use of certain dietary lipids to reduce intestinal inflammatory activity and also to maintain long-term disease remission.

 

Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

By Dr. Alex Jimenez

 

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Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

 

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WELLNESS TOPIC: EXTRA EXTRA: Managing Workplace Stress

 

 

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Nutritional Regulation for Inflammatory Bowel Disease

Nutritional Regulation for Inflammatory Bowel Disease

Inflammatory bowel disease is an umbrella term used to describe a group of gastrointestinal diseases characterized by chronic, ongoing inflammation of all or part of the gastrointestinal tract, or GI tract, such as Crohn’s disease, or CD, and ulcerative colitis, UC. While many factors have been determined to cause inflammatory bowel disease, research studies have concluded that nutrition can increase the risk of gastrointestinal diseases, including inflammatory bowel disease.

 

How does nutrition affect inflammatory bowel disease?

 

Nutrient deficiencies are common among individuals with inflammatory bowel disease, or IBD. Both complete parenteral and enteral nutrition can provide significant supportive treatment for patients with IBD, however, in adults those alone may not be helpful as a form of primary treatment. Clinical intervention using omega-3 polyunsaturated fatty acids found in fish oil could be beneficial for the nutritional regulation of IBD patients and recent research studies have emphasized the function of PPAR on NF?B action towards its possible beneficial impact on dietary lipids for overall intestinal functioning.

 

Nutrition in Inflammatory Bowel Disease

 

Specific antibody isotypes of essential milk proteins are located in both UC and CD patients. In CD, the antibodies are associated with disease. Although cultural origin, rather than the IBD disease condition, seems to be the primary cause of lactose intolerance, the avoidance of milk products by IBD patients is extensive. Lack of breast-feeding during infancy was associated with CD but not UC. Additionally, higher carbohydrate intake was recorded in CD. Others have suggested a deficiency of dietary fiber as a predisposing factor for IBD. The growth of UC has also been associated with higher intakes of polyunsaturated fatty acids (MUFA), n6 polyunsaturated fatty acids (n6 PUFA), sulphur-containing diets and vitamin B6.

 

Deficiencies

 

Inflammatory bowel disease is related to several nutritional deficiencies, such as anemia, hypoalbuminemia, hypomagnesia, hypocalcemia and hypophosphatemia, including deficiencies in folic acid, niacin, vitamins A, B12, C, and D, in addition to deficiencies of iron, magnesium and zinc. Further research studies are needed to determine if reduced levels of micronutrients are of some significance to the result of gastrointestinal diseases. Plasma antioxidant concentrations are lower in IBD patients, especially those who have an active form of the disease. Antioxidant action, evaluated by measuring selenium levels and erythrocyte glutathione peroxidase activity, is inversely associated with inflammatory biomarkers, such as TNF?. Hyperhomocysteinemia is more prevalent in patients with IBD, and is characterized with low serum as well as reduced concentrations of vitamin B12, folate and B6.

 

Several mechanisms are responsible for the malnutrition observed in IBD patients. Primarily, there’s a decline in the oral consumption of nutrients due to abdominal pain and anorexia. Second, the mucosal inflammation and related diarrhea reduces blood, protein, minerals, electrolytes and trace components. Paradoxically, multiple resections or bacterial vaginosis might have an adverse nutrient impact; and finally, herbal remedies may also cause malnutrition. By way of instance, sulfasalazine reduces nitric acid absorption, and corticosteroids reduce calcium absorption in addition to negatively impacting protein metabolism. Alterations in energy metabolism may result in increased resting energy expenditure and lipid oxidation in patients with inflammatory bowel disease. There are many effects of malnutrition and each can decrease bone mineral density, in addition to growth retardation and delayed sexual maturity in children. Osteoporosis may also be involved as a consequence of pro-inflammatory cytokine profiles.

 

Nutritional treatment may take on a range of forms including Total Parenteral Nutrition (TPN) and Complete Enteral Nutrition (TEN). The diets used are elemental, polymeric, and exception diets. Elemental diets contain nutrients reduced to their fundamental elements: amino acids, such as proteins, sugar for carbs, and short-chain triglycerides, such as fats. Polymeric formulas contain entire proteins, such as nitrogen, glucose polymers for carbs and long-chain triglycerides for fat or starch.

 

Total Parenteral Nutrition (TPN)

 

Using TPN for the nutritional regulation of IBD is based on specific theoretical benefits, including how: gut rest may be beneficial since it reduces motor and transportation function in the diseased intestine; a drop in antigenic stimulation can remove the immunologic reactions to food, particularly in the presence of diminished intestinal permeability; TPN promotes protein synthesis in the gut which provides cell renewal, recovery, and alteration of impaired immunocompetence.

 

Researchers demonstrated remission rates of 63 percent to 89 percent with TPN in a large retrospective collection of CD patients which were difficult in standard medical management. But, Matuchansky et al highlighted that there have been high relapse rates (40%-62%) after two decades. It’s been implied that TPN be utilized exclusively in a nutritionally supportive function. In UC, there’s absolutely no evidence for much better results with TPN. Though remission rates of 9 percent to 80 percent are reported, TPN provided to patients with acute colitis seems to be beneficial as perioperative nutritional support. In patients with moderate disease, TPN is significantly more successful but isn’t better than steroid treatment, and so the invasiveness and price of TPN are unjustified. Any advantages related to TPN might be due to the nutritional regulation, rather than gut rest, as gut rest alone has no impact on disease activity. Accordingly, though TPN has a function in patients using a non-functioning gut or the brief gut syndrome because of excess resections, TPN is of limited use as a primary treatment in IBD. This isn’t designed to be an extensive breakdown of TPN, but it needs to be cautioned that in specialist centers, TPN is associated with complications like sepsis and cholestatic liver disease.

 

Total enteral nutrition (TEN), Elemental & Defined Formula Diets

 

TEN prevents possible toxic dietary variables and antigenic exposure, because there are only amino acids, sugar or oligosaccharides and very low lipid content. TEN isn’t associated with cholestasis, biliary sludge or gallstone formation, as can be observed with TPN. Atrophy of the small intestinal mucosa was discovered in animal models receiving long-term TPN, yet this atrophy is prevented with TEN. Additionally, a 6-wk TPN therapy in dogs led to marked decrease in pancreatic fat, a reduction in small intestinal mass as well as a decline in intestinal disaccharidase activity in puppies. Because of this, TEN is more preferable than TPN.

 

The subject of nutrition in gastrointestinal disorders which occur in IBD has been recently reviewd. In comparison to TPN, enteral nutrition yielded similar outcomes towards preventing and combating malnutrition. Though Voitk et al suggested that elemental diets could be an effective treatment for IBD, enteral nutrition as a primary therapy has failed to produce consistent results in several clinical trials. It’s correct that quite a few trials have shown remission levels in CD patients getting elemental diets, like the rates observed with prostate cancer treatment. But, it’s important to note that greater remission rates were detected in patients receiving steroid therapy versus standard diets when including all of the diet category fall outs (i.e., in an intent-to-treat foundation). The question remains concerning the best means of assessing the results when a sizable proportion of individuals receiving diet treatment fall out due to unpalatibility or intolerance. What’s more, a few research studies have demonstrated no distinction with elemental diets compared to steroid treatment. In children, elemental diets have been associated with higher linear gain, whereas in adults those diets maintain nitrogen equilibrium. The use of supplements in the context of pediatric onset illness was also reviewed. Therefore, enteral nutrition is simpler to use, is less costly, and it’s also a far better choice than TPN. Unfortunately, its unpalatability limits individual agreement, but with powerful encouragement this might be partly overcome.

 

The fat composition of enteral diets can influence the results that are obtained in the several clinical trials. Elemental diets include a reduced fat content, although a lot of healthier diets generally contain more fat, such as more lactic acid, which can be a precursor for the synthesis of possible pro-inflammatory eicosanoids.

 

Defined formula diets are often more palatable and more affordable than would be the elemental diets. When some researchers reported no gaps between utopian and defined formula diets in patients with severe CD, Giaffer et al discovered elemental diets are far more successful for active CD. A randomized double-blind study in Crohn’s patients revealed that elemental and polymeric, or characterized, diets differing only in their own source of nitrogen, were equally effective in lessening the Crohn’s disease activity index, or CDAI, also inducing clinical remission. Though defined formula diets supply less gut rest, they have the possible benefit of exposing the GI tract to the typical dietary substrates, which permit thereby for the complete manifestation of intestinal, biliary and pancreatic action. In animal research, it has also been discovered that luminal nutrition has trophic impacts on the intestine.

 

Can there be a beneficial effect of supplementing polymeric formulas with TGF-?1? In pediatric CD, reductions in pro-inflammatory cytokine concentrations and mRNA, paired with an up-regulation of TGF-? mRNA, was associated with enhanced macroscopic and microscopic mucosal inflammation. A meta-analysis along with a Cochrane review have demonstrated that in adults, corticosteroids are more effective than enteral diet treatment. It’s uncertain what is the use of supplements in adults with CD, even though there are some signs in Japan that enteral nutrition enjoys support as principal treatment. In contrast to this generally agreed part in adults of enteral nutrition being used to enhance the patient’s nutritional status because its principal advantage, in children with CD enteral nutrition has a far clearer benefit to enhance clinical, biochemical and growth parameters, and may as well have a steroid sparing effect.

 

Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

By Dr. Alex Jimenez

 

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Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

 

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WELLNESS TOPIC: EXTRA EXTRA: Managing Workplace Stress

 

 

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Clinical Evaluation and Treatment for Inflammatory Bowel Disease

Clinical Evaluation and Treatment for Inflammatory Bowel Disease

Inflammatory Bowel Disease: The gastrointestinal mucosal barrier is an effective and powerful defense and repair mechanism, which allows for the proper absorption of energy, nutrients and water when we eat. The functioning of the digestive system with its balanced gut microbiota depends on the function of the mucosal barrier. The intestinal barrier has to be permeable to allow the passage of nutrients, however, when this permeability increases beyond what is necessary, it can lead to a variety of issues, in some instances, even causing disease.

 

What’s the connection between intestinal permeability and IBD?

 

Intestinal barrier dysfunction has been determined in a variety of gastrointestinal diseases, or GI diseases, such as inflammatory bowel disease, or IBD. It has now become more accepted that proper gastrointestinal mucosal barrier function plays a major role in the pathophysiology of inflammatory bowel disease. However, further understanding as well as research data is required to determine treatment and therapy options for such gastrointestinal diseases, particularly IBD.

Clinical Evaluation of Intestinal Permeability in Inflammatory Bowel Disease

 

Changes to intestinal permeability generally manifest early in the development of intestinal inflammation due to Crohn’s disease and other gastrointestinal diseases. Several risk factors, including the conditions themselves, may even exacerbate intestinal inflammation through increased intestinal permeability. According to recent research studies, nonsteroidal anti-inflammatory drugs, or NSAIDs, and stress can also induce symptoms of inflammation through increased gastrointestinal, or GI, mucosal permeability and the release of corticotropin-released factors. Additionally, changes to intestinal permeability can determine a patient’s risk of relapsing Crohn’s disease. Patients who’ve had an altered lactulose/mannitol test, or L/M test, are often 8 times more at risk of relapsing, even when asymptomatic and results demonstrate normal biochemical indices.

 

The lactulose/mannitol test is specifically used to evaluate small intestinal permeability by measuring urinary excretion after oral administration of these sugars. Lactulose�is a large sized oligosaccharide that generally doesn’t carry out paracellular transport and can be adsorbed in the instance of leaky intercellular junctions while mannitol is a smaller molecule that can freely move across the intestinal epithelium. Both probes are equally affected by gastrointestinal dilution, motility, bacterial degradation, and renal function; consequently, the ratio allows for the correction of possible confounding factors. The lactulose/mannitol test is utilized in clinical practice because of its noninvasiveness, its high sensitivity in detecting active inflammatory bowel disease, or IBD, and its ability to distinguish functional versus organic GI disease, or gastrointestinal disease. An altered L/M test has been reported in approximately 50 percent of patients with Crohn’s disease. Other sugars have also been routinely used to evaluate the upper gastrointestinal tract, for instance, sucrose which has been degraded by duodenal sucrase, may indicate the permeability of the stomach and the proximal duodenum. Accordingly, multisugar tests have been developed, with the latest inclusion of sucralose, which can be barely absorbed through the human intestine, allowing a functional assessment of the entire gastrointestinal tract, extending its use for ulcerative colitis as well.

 

Other functional tests, such as 51Cr-EDTA or the Ussing chambers, have demonstrated great precision in diagnosing gastrointestinal disease, however, their invasiveness and complex detection methods make their use impossible in humans. Whereas promising results have been demonstrated by novel imaging techniques, particularly confocal laser endomicroscopy. This endoscopic technique allows an in vivo evaluation of the epithelial lining and vasculature with the use of intravenous fluorescein as a molecular contrast agent, which generally doesn’t carry out paracellular transport. Confocal laser endomicroscopy is currently widely utilized to identify and classify gastrointestinal tumors but it has also been used in nonneoplastic conditions, such as celiac disease, collagenous colitis, and irritable bowel syndrome, or IBS. Discovering cellular and subcellular changes, such as cell shedding, is possible through this procedure, which makes it a highly effective technique for the imaging of intestinal barrier dysfunction in inflammatory bowel disease, or IBD. Confocal laser endomicroscopy demonstrated increased density of mucosal gaps after cell shedding in the small intestine of patients with Crohn’s disease as well as in macroscopically normal duodenum in both Crohn’s disease and ulcerative colitis. These alterations could represent impairment of intestinal permeability possibly predicting subsequent clinical relapse. Recently, confocal laser endomicroscopy has been utilized in patients with ulcerative colitis, demonstrating that the occurrence of crypt architectural abnormalities may predict disease relapse in patients with noticeable endoscopic remission, as seen on Figure 1.

 

Confocal Laser Endomicroscopy Images Figure 2

Figure 1: Confocal laser endomicroscopy images from a healthy subject (a) and an ulcerative colitis (UC) patient with inactive disease (b). UC patients display increased crypt diameter, intercryptic distance, and perivascular fluorescence.

 

Intestinal Permeability Treatment for Inflammatory Bowel Disease

 

Agents routinely used in the therapeutic armamentarium of inflammatory bowel disease, or IBD, may cause and maintain mucosal remission not only for their immunomodulating effect, but also through the recovery of epithelial integrity and permeability, as was demonstrated for anti-TNF-? drugs and medications in Crohn’s disease. Since similar effects are obtained using elemental diets for Crohn’s disease, raising interest is based on dietary strategies with the use of immunomodulatory nutrients and probiotics.

 

Western diets, with its high content of fat and refined sugars, is a risk factor for the growth of Crohn’s disease, where they’re believed to induce a low-grade inflammation through gut dysbiosis and increased intestinal permeability. Furthermore, there is increasing concern about the use of industrial food additives towards promoting immune-related diseases. A recent research study demonstrated how additives can increase intestinal permeability by interfering with the tight junctions, or TJs, increasing the passage of immunogenic antigens. In addition, certain fatty acids, such as propionate, acetate, butyrate, omega-3, and conjugated linoleic acid, amino acids, such as glutamine, arginine, tryptophan, and citrulline, and oligoelements, which are essential for intestinal surface integrity, when supplemented to experimental subjects with gastrointestinal diseases, GI diseases, can decrease inflammation and restore gastrointestinal mucosal permeability. However, their therapeutic effectiveness, especially in inflammatory bowel disease, remains debatable: butyrate, zinc, and probiotics have the strongest evidence in this aspect.

 

Butyrate is a short chain fatty acid produced by intestinal microbial fermentation of dietary fibers, which in experimental versions, stimulate mucus production and expression of tight junctions, or TJs, in vitro but a broader selection of action is anticipated. It’s essential for the overall homeostasis of enterocytes that its lack, measured as faecal concentrations, has been taken as an indirect indicator of altered intestinal barrier function. In clinical practice topical butyrate had demonstrated effectiveness in refractory distal ulcerative colitis. Other fatty acids with similar properties have also been proposed as an adjuvant treatment in inflammatory bowel disease, namely, omega-3 and phosphatidylcholine, but their usage in clinical practice remains limited. Zinc is a trace element essential for cell turnover and repair systems. Inflammatory conditions and malnutrition have been known to be risk factors for zinc deficiency and many research studies demonstrated the effectiveness of its supplementation during acute diarrhoea and experimental colitis. Oral zinc treatment may restore intestinal permeability in patients with Crohn’s disease, perhaps through its capacity to regulate tight junctions, or TJs, both in the small and the large intestines.

 

The reason for the use of probiotics in inflammatory bowel disease is for the above mentioned dysbiosis that characterizes these GI diseases, or gastrointestinal diseases. Several trials have tested the effectiveness of various species of probiotics in inflammatory bowel disease, or IBD, with contradicting results. Those which have demonstrated to be effective are Escherichia coli Nissle 1917, Bifidobacterium, Lactobacillus rhamnosus GG, or the multispecies VSL#3, which consists of eight unique probiotics. Nevertheless, their use remains confined to ulcerative colitis and are frequently aimed at maintaining remission rather than treating the active disease, as emphasized by the meta evaluation by Jonkers et al.. The mechanisms of their effect in ulcerative colitis have yet to be fully understood but likely, together with direct anti-inflammatory effects, they can restore the intestinal barrier and decrease intestinal permeability, regulating tight junction, or TJ, proteins. The favorable effect of probiotics in pouchitis seems to be about the improvement of gastrointestinal mucosal barrier function. Another potential mechanism of action is the recovery of butyrate-producing bacteria: patients with ulcerative colitis have decreased bacterial species like Faecalibacterium prausnitzii, but supplementation with butyrate-producing species or probiotics together with preformed butyrate demonstrated effectiveness in experimental models.

 

Finally, vitamin D can also be involved to preserve intestinal barrier function. Polymorphisms of its own receptor have been related to the development of inflammatory bowel disease, or IBD. While the expression of vitamin D receptor on intestinal epithelium prevents inflammation-induced apoptosis, its removal contributes to faulty autophagy that boosts experimental colitis. But, additional data and clinical trials are needed to rationalize vitamin D use in inflammatory bowel disease management.

 

Conclusion

 

The impairment of intestinal barrier function is just one of the critical events in the pathogenesis of inflammatory bowel disease, or IBD. Whether it precedes and predisposes disease development remains under analysis, particularly in Crohn’s disease, but it perpetuates and enriches chronic mucosal inflammation by increasing paracellular transport of luminal pathogens. Novel imaging and functional techniques allow us to assess intestinal permeability in vivo and help identify patients at risk of relapse guiding therapeutic management. Manipulation of intestinal permeability is a fascinating therapeutic approach but more research on its effectiveness and safety are required before nutritional immune-modulators may be utilized in clinical practice. Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

By Dr. Alex Jimenez

 

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Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

 

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