Personalized Medicine Strategies for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a major problem in Western society, said Robert Rountree, MD at the Integrative Healthcare Symposium in New York City.

Rountree discussed ulcerative colitis, Crohn’s disease, and other manifestations of IBD.

“We’ve made a lot of progress,” he said. “We understand a lot about the pathophysiology, but we need to do a heck of a lot better.”

The family medicine practitioner and long-standing faculty member of the Institute of Functional Medicine structured his lecture differently and walked the audience through his process and one of his cases. Rountree cited a study, published in TheNew England Journal of Medicine, which said that while targeted therapies are effective in many patients with IBD but up to 30 percent of patients do not have a response to initial treatment, and in up to 50 percent of patients, the response is lost over time. 

Genetics and environmental factors, including excessive early life hygiene, have a large impact response to treatment. Key environmental triggers include stress, smoking, diet, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and infections.

Additionally, specific risk factors specific to Crohn’s disease include family history, geography and ethnicity, cigarette use, antibiotic use, estrogen, high consumption of omega-6 fatty acids, low fiber intake, vitamin D deficiency, gut dysbiosis, and medical history including an appendectomy.

A 2017 study published in The Lancet found that the incidence of inflammatory bowel diseases is increasing worldwide, and is linked to adoption of a Western diet, Rountree said.

“This strongly suggests environmental factors such as microbial dysbiosis are responsible for development of disease in susceptible individuals,” he said.

Rountree presented his strategies to ease gastrointestinal inflammation:

1. Remove triggers
2. Reinoculate microflora with probiotics and prebiotics
3. Repair gut barrier with glutamine, N-acetylglucosamine, anti-inflammatory botanicals, nutraceuticals, and omega-3 fatty acids.
4. Replace enzymes.
5. Rebalance with stress management and mindfulness.

Additionally, Rountree offered recommendations on what to remove from the diet, including environmental triggers like chemicals and pesticides; dietary factors that promote dysbiosis like sugar, alcohol, gluten, dairy, and medications like NSAIDs.

Rountree stressed the importance of a low sodium diet and replacing animal proteins, refined sugars and trans fats with fiber, fruit and vegetables, and omega 3 fatty acids. 

Supplements for IBD, Rountree said, include:

• Probiotics
• Curcumin
• Boswellia serrata
• Omega-3 fatty acids
• L-Glutamine
• N- acetylglucosamine
• Aloe vera gel

He also suggested Propionyl-l-carnitine, olive oil, butyrate, berberine, and GlcNAc. 

Editor's note: This article is part of Integrative Practitioner's live coverage of the 2023 Integrative Healthcare Symposium at the Hilton Midtown in New York City. Click here to catch up on the live coverage.