Learning About Inflammation

Legal Disclaimer: This site is for education, reference, and encouragement only based on my experience with having Crohn's and my knowledge as a human anatomy and physiology teacher.  I am not a medical professional and this is not medical advice.  

When I was hospitalized three times in one summer for Crohn's I made myself a promise that I would learn as much as I possibly could about Crohn's and about inflammation in general.  After spending a lot of time reading peer-reviewed medical literature, listening to TED talks from credentialed speakers, and using other legit sources (Protip: Random youtubers are not legit research sources, be sure to check the speaker's credentials! To be fair this website isn't either, that isn't it's purpose, see disclaimer above!) I realized that I was doing a lot of things that caused inflammation in my body, which was leading to not only Crohn's but other conditions as well. 

How do you know your surgery didn't just completely eliminate the problem? 

Now that my surgery is over and done with, how do I know that it wasn't just a bad section of intestine that needed removed?  How did I figure out that the problem was body-wide inflammation, and not just localized to the section of my colon that perforated?  Here are my lines of evidence: 

1. Most Crohn's patients who get surgery re-develop Crohn's.  [1]

This is a harsy reality, that many Crohn's patients need multiple surgeries.  The prospect of repeating my experience in the hospital was terrifying, so learning this was a major motivator for me.  It simply illustrates that surgery can't cure Crohn's.  It just removes the parts that have already been damaged by Crohn's. 

2. Crohn's wasn't my only inflammatory condition.  I have also suffered from asthma and bad allergies for many years.  After reducing my body-wide inflammation, I noticed major improvements in these areas.  I am currently training to run a 5K, which is something I would have thought impossible with my asthma beforehand.  I also used to be on double the normal max dose of antihistamines (prescribed by my allergist) for terrible hay fever and sinus congestion.  Since reducing body-wide inflammation my allergies are probably 95% better, most days I don't even take a single antihistamine.  I'm down from taking literally hundreds of pills a year to taking one here or there on really bad pollen days. 

What is inflammation? 

Basically inflammation is one of the tools that your immune system has.  Inflammation is characterized by tissue that experiences redness, swelling, heat, and pain.  If you've ever had hay fever, that's inflammation of your nasal passages.  Inflammation is actually pretty important.  It helps your body fight off infection and can also promote tissue repair.  The problem is when your body gets "stuck" in inflammatory mode, or becomes inflammed inappropriately.  The Cleveland Clinic makes a distinction between acute (good) inflammation and chronic (bad) inflammation as follows: 

• "Acute inflammation: The response to sudden body damage, such as cutting your finger. To heal the cut, your body sends inflammatory cells to the injury. These cells start the healing process." [2]

• "Chronic inflammation: Your body continues sending inflammatory cells even when there is no outside danger. For example, in rheumatoid arthritis inflammatory cells and substances attack joint tissues leading to an inflammation that comes and goes and can cause severe damage to joints with pain and deformities." [2]

Chrohn's disease is basically chronic inflammation of the intestines, and nobody is sure exactly how it works or what mechanism causes it to develop, but there is a lot of information about things that promote chronic inflammation, and things that counteract chronic inflammation. .  

So what was causing my inflammation? 

I realized that I was doing lots of things to my body that was causing it to get inflammed.  This list is not exhaustive, but some of the big ones are: 

• Sugar - Excessive sugar intake has been linked to inflammation including Irritable Bowl Disease or IBD (Crohn's is a type of IBD) [3]
  This was a BIG one for me, I realized I was taking in probably a week's worth of sugar every day. 
  
  For a great explanation on sugar on our diet and it's effects I highly recommend this TEDx talk

• Not enough Vitamin D - I'm extremely light skinned, so SPF 100 sunscreen is a big part of my life during the summer.  And in the winter, of course there isn't much sunlight anyway.  Since our bodies need a moderate dose of UVB radiation to synthesize vitamin D in our skin, and it's nearly impossible to get enough vitamin D via diet alone, I had to start supplementing in addition to getting a moderate amount of sunlight exposure, even 10 minutes a day of direct sunlight or moderate use of an at-home UVB device.
  
  In addition to it's "classic" roles in calcium metabolism and bone maintenance, vitaimin D defieicney has been linked to immune dysregulation which can trigger inflammation.  This includes that vitain D receptors have been discovered on immune cells, indicating that the immune system relies on vitamin D for proper function. [4]
  
  

• Gluten - This one is controversial and you'll probaby find internet sources saying that the "gluten free craze" is a bunch of liberal mumbo jumbo, and to be fair the science is kind of all over the place.  I encourage anyone reading this page to read and consider opposing viewpoints, but also keep in mind it wasn't that long ago that doctors were claiming "there isn't any compelling evidence that tobacco smoke causes lung cancer." 
  
  I can definitely say that for myself ditching gluten made a difference even though I do not have celiac disease.  Different people have different levels of sensitivity, obviously celiac disease is the worst, but there are varying levels of gluten sensitivity.  Keeping in mind that this website is about what worked for me, in the hopes that it can work for you too, please consider the following: 

  • • Research published in the European Journal of Immunology shows that, in mouse models exposure to gluten led to an increase in inflammatory chemicals including in the gut. [5]

    • Non-celiac gluten sensitivity is starting to gain recognition within the medical/research community, even though it is not fully understood and more research is needed. [6] and [7]

    • It's really easy to try it for yourself.  All you have to do is get off gluten for a few weeks and see if it makes a difference, and then you can decide if you want to "re-challenge" your gut and introduce gluten and see if symptoms return.
      
      

• An unbalanced population of gut bacteria.  Tons of bacteria live in your gut.  I frequently enjoy telling my science students that, in terms of cell count, you are more bacteria than human, as those bacteria cells actually outnumber your own human cells! (Bacteria are much smaller than human cells however).  [8] We are often raised to think of bacteria as being "bad" but many of these bacteria are important to us, and we can't live without them.  But other types of bacteria that can live in our gut are harmful and damage the gut.  Having too many bad bacteria and not enough good bacteria can create an unbalanced gut, a condition known as dysbiosis.  This can be improved by eating fermented foods or, more effectively, by taking a probiotic, but you have to make sure that the probiotic good bacteria will actually get past your stomach acid and enter your gut alive in the first place.  

These are not the only problems that I believe were contributing to my symptoms, but I think they are most likely the biggest factors.  For how I dealt with them, and others, see my Gameplan for Beating Crohns. 

Sources: 

1. Connelly TM, Messaris E. Predictors of recurrence of Crohn's disease after ileocolectomy: a review. World J Gastroenterol. 2014 Oct 21;20(39):14393-406. doi: 10.3748/wjg.v20.i39.14393. PMID: 25339826; PMCID: PMC4202368.

2. https://my.clevelandclinic.org/health/symptoms/21660-inflammation

3. Ma X, Nan F, Liang H, Shu P, Fan X, Song X, Hou Y, Zhang D. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022 Aug 31;13:988481. doi: 10.3389/fimmu.2022.988481. PMID: 36119103; PMCID: PMC9471313.

4. Yin K, Agrawal DK. Vitamin D and inflammatory diseases. J Inflamm Res. 2014 May 29;7:69-87. doi: 10.2147/JIR.S63898. PMID: 24971027; PMCID: PMC4070857.

5. Larsen J, Dall M, Antvorskov JC, Weile C, Engkilde K, Josefsen K, Buschard K. Dietary gluten increases natural killer cell cytotoxicity and cytokine secretion. Eur J Immunol. 2014 Oct;44(10):3056-67. doi: 10.1002/eji.201344264. Epub 2014 Sep 18. PMID: 25043259.

6. Igbinedion SO, Ansari J, Vasikaran A, Gavins FN, Jordan P, Boktor M, Alexander JS. Non-celiac gluten sensitivity: All wheat attack is not celiac. World J Gastroenterol. 2017 Oct 28;23(40):7201-7210. doi: 10.3748/wjg.v23.i40.7201. PMID: 29142467; PMCID: PMC5677194.

7. Rostami, K.; Ensari, A.; Marsh, M.N.; Srivastava, A.; Villanacci, V.; Carroccio, A.; Asadzadeh Aghdaei, H.; Bai, J.C.; Bassotti, G.; Becheanu, G.; Bell, P.; Di Bella, C.; Bozzola, A.M.; Cadei, M.; Casella, G.; Catassi, C.; Ciacci, C.; Apostol Ciobanu, D.G.; Cross, S.S.; Danciu, M.; Das, P.; Del Sordo, R.; Drage, M.; Elli, L.; Fasano, A.; Florena, A.M.; Fusco, N.; Going, J.J.; Guandalini, S.; Hagen, C.E.; Hayman, D.T.S.; Ishaq, S.; Jericho, H.; Johncilla, M.; Johnson, M.; Kaukinen, K.; Levene, A.; Liptrot, S.; Lu, L.; Makharia, G.K.; Mathews, S.; Mazzarella, G.; Maxim, R.; La Win Myint, K.; Mohaghegh-Shalmani, H.; Moradi, A.; Mulder, C.J.J.; Ray, R.; Ricci, C.; Rostami-Nejad, M.; Sapone, A.; Sanders, D.S.; Taavela, J.; Volta, U.; Walker, M.; Derakhshan, M. Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study. Nutrients 2022, 14, 2487. https://doi.org/10.3390/nu14122487

8. https://www.nih.gov/news-events/news-releases/nih-human-microbiome-project-defines-normal-bacterial-makeup-body