Almost 2/3 of patients with inflammatory bowel disease (IBD), who initiate biologic therapy (infliximab, adalimumab, vedolizumab, or ustekinumab) continue to experience persistent fatigue up to 1 year later.
Ongoing inflammation was thought to be the main cause of IBD related fatigue, however research now suggests that gut dysbiosis and a less diverse microbiome may be the prevailing factor.
According to the lead study author, Nynke Z. Borren, MD, “We think that gut dysbiosis might be involved in inducing fatigue,” Dr. Borren said. “In the beginning, we thought that it might be due to ongoing inflammation, but our research has shown that we find a less diverse gut microbiome in those patients with fatigue compared to patients without fatigue while they were in remission. There is something in the gut that influences the central nervous system. We are still exploring this.”
Acupuncture has demonstrated effectiveness in the regulation of gut dysbiosis, intestinal barrier function, visceral hypersensitivity, gut motor dysfunction, depression/anxiety, and pain, and low vagal tone, all of which are factors that can significantly impact quality of life in patients with inflammatory bowel disease.
Fibromyalgia (FM) is a prevalent syndrome, characterised by chronic widespread pain, fatigue and impaired sleep. Those that suffer from FM also have to contend with the fact that it is an “invisible disease” and not immediately apparent to others. FM can be debilitating and will often have a significant impact to the quality of life. It also continues to be challenging to diagnose and difficult to treat. ⠀⠀⠀⠀⠀⠀⠀⠀⠀ A study recently published in Pain (June 18, 2019) reported an altered microbiome composition in individuals with fibromyalgia. There were differences in the serum levels of butyrate and propionate in patients with FM compared to those without FM. ⠀⠀⠀⠀⠀⠀⠀⠀⠀ The promising news is that the study was the “first demonstration of gut microbiome alteration in non-visceral pain”, which is an observation that is likely to pave the way for further studies. The hope is that future studies will foster the exploration of new treatment modalities and offer some hope to FM patients.
There is an emerging amount of evidence in gastrointestinal research that associates gut microbiota with factors that impact host circadian-metabolic axis, such as light/dark cycles, sleep/wake cycles, diet, and eating patterns. ⠀⠀⠀⠀⠀⠀⠀⠀⠀ Researched published in the journal Microorganisms (January 31, 2019) outlines how “gut bacteria possess their own daily rhythmicity in terms of composition, their localization to intestinal niches, and functions.” ⠀⠀⠀⠀⠀⠀⠀⠀⠀ “Current evidence indicates an increase in total gut bacterial mass and firmicutes, in response to the food ingested during the waking/eating phase, and an increase in bacteroidetes, proteobacteria and verrucomicrobia during the sleeping/fasting phase.” ⠀⠀⠀⠀⠀⠀⠀⠀⠀ The research discusses the importance of adhering to a healthy diet. It also stresses that a regular eating schedule and adequate sleep (quality and quantity) are essential for maintaining gut microbial balance. ⠀⠀⠀⠀⠀⠀⠀⠀⠀ NB: We want to see higher bacteroidetes and lower firmicutes as higher firmicutes are associated with elevated intestinal pH, decreased levels of short chain fatty acids, increased dysbiosis, weight gain, obesity, metabolic disease, diabetes, anxiety, depression and a higher incidence of gastrointestinal conditions such as IBS and IBD.
Canada’s long-anticipated revised food guide was released on Tuesday morning. It has sparked much controversy by removing food industry influence and particular food groups, mainly those pertaining to the dairy, cattle and sugar industries.
The new food guide suggests:
~ Eating a variety of vegetables and fruits ~ Choosing whole grains ~ Eating “protein foods” where plant-based proteins, like legumes, beans, and tofu are recommended over animal sources, such as dairy, eggs, meat and fish ~ Making water your beverage of choice ~ Avoiding processed foods and beverages that are high in sodium, sugar and saturated fat ~ Cooking more often and eating meals with others ~ Being mindful of eating habits while still enjoying your food. It focuses less on serving sizes and more on how to eat.
Some of the new considerations also include:
~ Environmental sustainability ~ Cultural diversity ~ Food skills and knowledge
In a world where what to eat and how to eat continues to be incredibly confusing, many of the above changes do make sense. l will always encourage a vegetable laden diet plus whatever works for you (whether that includes plant based protein, red meat, fish, poultry or dairy) and what makes you, as an individual, thrive and feel nourished.
It will be interesting to see if we see any changes in food recommendations in United States, particularly given that the current food pyramid was published over 14 years ago.
The food that you choose to consume is entirely a personal preference. For the most part, I don’t promote a strict paleo, keto, mediterranean, low fat, low fodmap, high carb, low carb, plant based, fruitarian, raw, vegetarian, vegan etc way of eating (WOE).
I will rarely suggest that a patient follows a special WOE unless it is absolutely necessary. Under such circumstances, it generally involves a temporary or more permanent elimination of foods that are contributing to, or exacerbating a medical condition.
In my opinion, it is more about what makes you, as an individual, feel nourished (body, mind and soul), mentally alert and vibrant.
What I do encourage is that the food is predominantly fresh and unprocessed. I am also a fan of local organic produce and lots of variety. Eating seasonally is wonderful. If you do consume meat, I do suggest grass fed or organic wherever possible.
So this leads me to an interesting and perhaps controversial article that was recently published in the European Heart Journal (Dec 10, 2018).
The article reported that “chronic dietary red meat increased systemic TMAO levels through:
(i) enhanced dietary precursors; (ii) increased microbial TMA/TMAO production from carnitine, but not choline; and (iii) reduced renal TMAO excretion.
Discontinuation of dietary red meat reduced plasma TMAO within 4 weeks.”
So you may wonder what this all means and how it may apply to you.
The Cleveland Clinic summarises it well:
“Here’s how it works: When people ingest certain nutrients, such as choline (abundant in red meat, egg yolks, and dairy products) and L-carnitine (found in red meat as well as some energy drinks and supplements), the gut bacteria that break it down produce a compound called trimethylamine (TMA). The liver then converts TMA into the compound, trimethylene N-oxide (TMAO).
The trouble with TMAO is that data shows that high levels contribute to a heightened risk for clot-related events such as heart attack and stroke – even after researchers take into account the presence of conventional risk factors and markers of inflammation that might skew the results.
In their most recent analysis, scientists showed that high blood levels of TMAO were associated with higher rates of premature death in a group of 2235 patients with stable coronary artery disease. Those found to have higher blood levels of TMAO had a four-fold greater risk of dying from any cause over the subsequent five years.
The implications are intriguing. Taken together, the new studies suggest that positively altering the gut microbiota may help to reduce damage to blood vessels, resulting in a stronger cardiovascular system, and they point to targets for potential new heart disease therapies.
The insights also underscore the potential power of TMAO testing, which can help patients determine if their gut microbiome is contributing to their risk for heart disease and whether they might benefit from limiting foods that contain the building blocks of TMAO. TMAO tests are currently only available through the Cleveland Heartlab.”
Despite the results of the above publication, it is always important to do your own research and find the food that is YOUR medicine. Moderation also seems to be key.