After my diagnosis with Crohn’s disease I initially fell into a period of denial and depression. Accepting a diagnosis with an autoimmune disease was very difficult for me. I knew what opinions I secretly held in the back of my mind when I saw a patient who had an autoimmune disease. Their body is attacking itself. This person doesn’t have self-esteem or self-love. This person is unhappy in life but unwilling to make the changes that are required to find that happiness. This person doesn’t know who she is.
Life is funny and strangely brutal in how it can mirror back at you repeatedly your own weaknesses or wounds, and yet how easily we dismiss it, unwilling to recognize and embrace these shadow parts of ourselves.
It took me several months of taking heavy anti-inflammatories, both natural and pharmaceutical, as well as a steroid medication called Entocort with moderate improvement to realize that this was not going to be a simple fix.
I knew I needed someone else to take the lead and sought the advice and counsel of a well-known ND in the Seattle area who had been my teacher while in school, Dr. Patrick Donovan.
I credit him entirely with shaking me out of my denial and helping me see that I had work to do if I was ever going to heal. During my first visit with him, I told him I didn’t even want us to say the words Crohn’s disease out loud. I didn’t want it to be real or to give it more power or energy. He immediately cut me off and stated very clearly that unless and until I accepted that I had Crohn’s disease, embraced it fully as my current reality and disease state, there was NO WAY I could move beyond it.
He was right. This internal acceptance galvanized and focused my inherent stubborn, single-mindedness on one goal: the path back to health.
As an ND, the next most important question to ask is “Why did this happen to me?”
In order to strategize a path back to health, I first needed to find all the triggers along the way that pushed me out of balance, and off the path of wellness and health.
Here is my current list of contributing and precipitating factors that resulted in the activation of Crohn’s disease in my body:
Genetics
A couple years after my diagnosis with Crohn’s, two of my cousins received the same diagnosis. Many other cousins and aunts in my large extended family suffer with chronic digestive disorders and I suspect autoimmune conditions, albeit undiagnosed in many circumstances. This is a trend commonly seen with Crohn’s disease, but less commonly with other forms of Inflammatory Bowel Disease. For this reason there is a consideration that the predisposition to develop Crohn’s Disease is carried in the genetics of the family line. I firmly believe that although one may carry the genes, they still have to be activated by a precipitating event. Cue my precipitating event…
Repeated Gastroenteritis
Until my travels abroad, I have no recall of major intestinal infections. I’m certain I had the odd stomach flu and perhaps even a food poisoning event. However, none of this came close to what I experienced while living in Ecuador for a year. It is still unclear to me how much of what I experienced was actually infectious in nature and how much of it was the beginning of an inflammatory bowel situation. I did have repeated stool testing performed while living abroad and each time it was positive for some organism or another and it was treated. What I now know to be true is that even one severe episode of Bacterial gastroenteritis can be enough to cause damage to the bowel on the neurological level, and repeated antibiotic use can decimate the microbiome and disrupt the balance of immune function. I am convinced that this process of repeated infection, inflammation and antibiotic exposure is what activated the Crohn’s genes in my genetic code. I was never the same after this year.
Post Infectious IBS and SIBO
After years of struggle, and trial and error I discovered some up and coming research in the world of Gastroenterology: the concept of Post- infectious IBS being caused by something called Small Intestine Bacterial Overgrowth (SIBO). Whereas my previous approach to managing my IBD was food elimination, restrictive diets, and anti-inflammatory products geared at controlling my over-active immune response, I started to realize the problem was more complex than that. I began to understand that there was deep dysfunction in the physiology of my digestive tract. It wasn’t simply a problem of infection or overactive immune response. More accurately, the problem was one of neurological dysfunction of the small intestine (dysmotility) and an overgrowth of bacteria in the wrong location. This concept is extremely important and we will devote several blog entries to explaining it in depth and address how to reverse it.
Concussion
As you will learn in further blog posts regarding SIBO and bowel “dysmotility”, trauma to the head can be a major trigger for disruption of nervous system activity in the intestinal wall muscles. I definitely had my share of head trauma in childhood and adolescence. The current theory is that impact trauma to the cranium can result in a shock to a very important Cranial Nerve, the Vagus Nerve. The Vagus nerve is part of a circuit that links the neck, heart, lungs, and gut to the brain. It is crucially important in regulation of the autonomic nervous system, managing the fear response, and regulating digestive function, breathing and heart rate, just to name a few. Clearly, disruption to the function of this nerve equates to disruption of digestive function.
Overactive Stress Response and Sympathetic Dominance
The Autonomic Nervous System (ANS) controls most of our unconscious bodily functions. There have two basic settings within the ANS: Fight or Flight or Rest and Digest. To briefly summarize in the context of digestive health, when your body is in Fight or Flight mode your digestion is turned OFF. You will not turn your digestion ON unless and until you move yourself out of Fight or Flight mode and into Rest and Digest mode. We will discuss more in depth the other stress hormones in the body that can mess with this very basic regulatory system, but when we live our lives in a state of stress, worry, agitation, and tension we create an environment that breeds unhealthy and inadequate digestive power. This is the foundational trigger of IBS for many people, although they are completely unaware of it.
Lack of clear boundaries between myself and others
The process of working my way back to balance and health, involved physical healing and repair, but most importantly it involved carefully deconstructing the image of who I thought I was. I now understand that, at least for myself, the small intestine represents integrity and boundaries. Immunology teaches us that our immune system has to learn the difference between self and non-self. This is a process that needs to happen in early childhood. If this is disrupted for whatever reason, the immune system can lose that knowledge or that “tolerance” of self and become reactive to anything that it decides is foreign. If we do not have a strong sense of where the boundary of self ends and the rest of the world begins, how can we differentiate self from non-self? If I do not know what my needs are, what my limits are, what my boundaries are, how can I clearly define and communicate them to other people? This is the mental-emotional representation of autoimmunity in the physical body.