Environmental Risk Factors for IBD | India News

DDuring the past 60 years, experts have documented a massive increase in the incidence of both ulcerative colitis and Crohn’s disease — the two medical conditions that make up the majority of cases of inflammatory bowel disease (IBD). For decades, this growth was confined to North America, Western Europe and other industrialized countries. Although there is some evidence that the increase in IBD has slowed or even plateaued in those places, IBD is becoming increasingly common in newly industrialized countries in Asia and other parts of the world.

There’s no doubt that genetic factors play a role in a person’s risk of inflammatory bowel disease—and Crohn’s disease in particular. But the increase in the incidence of IBD and the clear geographic patterns of the disease strongly suggest that environmental factors are also at play. “After World War II, we saw a rapid increase in the incidence of IBD across the developed world,” says Dr. Gilead Kaplan, a professor and gastroenterologist at the University of Calgary in Canada. “It seems that something about the Western lifestyle is allowing this disease to flourish.” what is that something? This is the unsolved mystery.

Many theories are—or rather, questionable. Researchers have found links between IBD and air pollution, food additives, early-life antibiotic exposure, and other environmental variables. Kaplan says that many of these risk factors, not just one, reduce the likelihood of an increase in IBD. And they all have one thing in common: the gut microbiome. “Most people think that what we’re seeing is the inflammatory response, where the body’s immune system attacks the intestines, contained in the intestinal microbiome,” he says.

Your gastrointestinal tract is filled with billions of microorganisms that are vital to the health and functioning of your gut. These bacteria help you digest the foods you eat, and the metabolites they produce help regulate your immune system. Kaplan says that a strong and diverse microbiome is a hallmark of a healthy GI tract, while anything that disrupts or imbalances the microbiome is associated with GI dysfunction, including IBD. “A lot of environmental risk factors that have been studied extensively are now being looked at through the lens of the microbiome,” he says. This new approach is providing important insights, including some related to the treatment of IBD.

Here you’ll find a detailed description of the environmental risk factors that researchers have linked to IBD, as well as expert guidance on limiting those risks.

Air Pollution and IBD

For the first study of its kind, published in 2010, researchers examined the association between ambient air pollution and the incidence of IBD. They found that young people who grew up around high concentrations of nitrogen dioxide were twice as likely to develop Crohn’s disease than other children.

Since that groundbreaking study, more work has linked air pollution to higher rates of IBD. “We have found that early life exposure to both nitrogen dioxide and ozone is associated with increased exposures,” says Eric Lavigne, a senior epidemiologist at Health Canada (the Canadian government’s counterpart to the US Department of Health and Human Services).

Both these pollutants are associated with automobile traffic. Cars and trucks that burn fuel emit nitrogen dioxide in their exhaust. When that nitrogen dioxide combines with heat and sunlight, it undergoes a chemical reaction that produces ozone. “In areas where there is a lot of traffic, we can see higher levels of this combination,” Lavigne says. “Living close to those areas may be a risk factor for IBD.”

How can air pollution affect gut health? Research has shown that after breathing in pollutants, the lungs can actually push them into the throat so they can be swallowed. This process is known as mucociliary clearance. Once in the gut, Lavigne says, these pollutants can damage the gut microbiota in ways that promote inflammation.

Based on his and others’ work, he says that exposure to air pollution during childhood—not in utero or adulthood—is the greatest IBD risk. Staying away from heavily trafficked roads, especially on hot sunny days, is one way to avoid these risks. “The levels of these pollutants are highest within 50 meters”—about 160 feet—”of busy roads,” he says.

Lavigne has also looked at the impact of parks and other urban green spaces on the risks of air pollution. Their research found that children who grew up near green spaces had a lower risk for IBD. “Particles in the air can get trapped by the leaves of trees, and so environments with more trees and greener can actually create a buffer that reduces people’s exposure,” he explains.

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Food choices and dietary risks

The stuff you swallow can affect the composition of your microbiome, and therefore the health of your gut. And researchers have identified several dietary-related variables that play a role in IBD risk.

Some of the strongest actions involve the very first food that a newborn swallows. “Breastfeeding seems very important,” Kaplan says. Research has shown that babies who are breastfed, as opposed to formula milk, are more than 25% less likely to develop IBD. “As an infant, when you have breast milk, there are tangible benefits that support the development of a strong and diverse microbiome,” he explains.

Beyond infancy, there is evidence that consuming sugary drinks — especially soft drinks — increases a person’s risk of ulcerative colitis. The more soda a person consumes, the higher their risk. On the other hand, eating vegetables lowers rates of ulcerative colitis, while eating whole fruits or other fiber-rich foods lowers a person’s risk of Crohn’s disease.

“There’s also some really interesting research on preservatives that increase the shelf life of food,” says Kaplan. A 2021 study in the journal bmj found that higher intakes of ultra-processed foods—soft drinks, but also salty snack foods, processed meats and other packaged goods—were associated with a sharp increase in IBD. Compared with those who ate less than one serving of these foods per day, those who ate five or more servings had almost double the risk of IBD.

“Things like emulsifiers and additives and heavily processed food particles can actually lead to changes in the microbiome that may be associated with risk for IBD,” says Kaplan. “Choosing whole foods and staying away from processed or packaged foods can reduce your risk.”

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Early life hygiene and antibiotics

Antibiotics can save lives when someone has a bacterial infection. But these drugs kill indiscriminately – that is, they kill off good bacteria as well as bad ones. And there is evidence that, when taken early in life while a child’s microbiome is still forming, antibiotics can cause imbalances that promote IBD.

“Antibiotics may alter the composition of the human gut microbiota by reducing taxonomic richness and diversity,” wrote the authors of a 2019 research review in the journal Science. Gastroenterology. He cites work linking early-life use of broad-spectrum antibiotics—basically anything other than penicillin—to a more than 50% increase in IBD risk.

“If you have a bacterial infection, you need antibiotics,” Kaplan says. But very often, these drugs are prescribed when they are not really needed – for example, when a child has a respiratory tract infection that will likely get better on its own without antibiotics. Doctors are increasingly becoming aware of the risks posed by antibiotic overuse. But parents still need to be careful, he says.

Meanwhile, while cleanliness is generally considered to be a good thing – and not just a good thing but a safety measure that has saved countless lives – there is strong evidence that being very clean, especially in infancy and childhood. can, in fact, weaken the gut microbiome. The “hygiene hypothesis”, as it is called, argues that children who interact with siblings, farm animals, pets, dirt and other sources of germs have healthier and more resilient gut microbial ecosystems. happens, and research has linked all of these factors together. Lower rates of IBD (as well as allergies and autoimmune diseases).

“Early Life Risk” [to germs] There is an important programming role on the microbiome and the immune system,” says Dr. Emeran Meyer, founding director of the Microbiome Center at the University of California, Los Angeles. The theory is that when the developing microbiome encounters germs and bacteria, this exposure trains its sensitivity and reactivity in a way that lowers a person’s risk for IBD. And so exposing children to clean environments and other children, animals, or sources of germs can put their gut health as well as their immunity at risk. (Some experts have even speculated that COVID-19 safety measures, such as heavy use of hand sanitizer, may inadvertently lead to an increase in IBD in young people.)

a complex puzzle

While researchers have made great progress in the study of environmental risk factors for IBD, they say the relationship between a person’s gut health and these variables is extremely complex. “One’s risks can be completely different when in utero or in childhood or in adulthood,” Kaplan explains. He offers to smoke a cigarette as an example. It may be that smoking during adolescence, more so than in adulthood, is a greater risk factor for gut disorders. or vice versa. A person’s risk may depend on the amount they smoke as well as their genetic predisposition to GI disease. “There are so many variables that create so much diversity,” he says. “Saying that it’s a risk factor and doing so isn’t too difficult.”

With that caveat in mind, Kaplan says there are steps everyone can take to reduce their IBD risk. “These are often things that promote a healthier life in general,” he says. “Eating more whole foods, getting regular physical activity, and trying to reduce stress in my life are all on the checklists I go with patients.” For people who live in parts of the country where sunlight is scarce, he says taking a vitamin D supplement can be helpful. “If you look at people with IBD, you often see vitamin D deficiency,” he tells WebMD. It may just be a by-product of the situation—not the cause. Still, he says that taking a 1,000-IU daily supplement is a low-risk defense against stomach problems that may be related to a deficiency.

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The role of external factors such as diet, medications, and pollution in IBD is complex. But medical science is making great strides in considering the effects of environmental factors. “It’s very revolutionary the way the field is open,” Meyer says.

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