Ulcerative colitis & Butyrate Dysfunction : IBD Series

ulcertative colitis natural treatments IBD herbal medicine IBD natural support inflammatory bowel disease herbal medicine natural herbs naturopathic support australia

Ulcerative colitis is a subtype of inflammatory bowel disease that I commonly see in my clinic. Often the patient is experiencing abdominal pain and blood, mucous or urgency with their bowel movements (or all three). Sometimes they have lost so much blood over time that they are iron deficient and anaemic. All in all, not in the best shape. 

Following on in our IBD series I wanted to cover one particular driver of ulcerative colitis that is being teased out in the research. An issue with butyrate usage in the large bowel (the site of active inflammation in ulcerative colitis) leading to an energy deficient state. 

Drivers of Ulcerative Colitis 

First off it is important to note that there is not one driver of ulcerative colitis. Keeping this in mind is helpful.

A whole range of factors including genetics, environmental factors, microbiome status and more can play a role in the initiation and progression of this condition. 

As a clinician it is my job working with my clients with IBD to explore these drivers and trial therapeutics that have a good history of helping. One surprisingly common driver is bacterial infections and overgrowths driving the inflammation.  

Image taken from: Hydrogen sulfide toxicity in the gut environment: Meta-analysis of sulfate-reducing and lactic acid bacteria in inflammatory processes

Butyrate Handling Issues Driving Ulcerative Colitis 

With such a complex and multifactorial condition it is next to impossible to pin down one root cause for every patient. 

A compromised ability to use butyrate by the cells that line the large bowel (colonocytes) may be one key factor in ulcerative colitis.

Butyrate has a number of important functions that make it the all-star fatty acid in the large bowel. Here it regulates (1)

  • Electrolyte exchange
  • Gut permeability (think leaky gut control)
  • Lipid synthesis
  • Mucin synthesis (the layer of mucus that protects the cells that line the gut)
  • Protein synthesis (a core aspect of human physiology)
  • Detoxification

From this short list you can quickly see how important butyrate is to the balance in the large bowel.    

Image taken from: Butyrate: A Double-Edged Sword for Health?

Let’s explore some connections between butyrate dysfunction and ulcerative colitis. 

  1. Excessive hydrogen sulphide production by bacterial overgrowths or infections in the gut appears to be a strong driver in some cases of ulcerative colitis. One action of excessive hydrogen sulphide gas is inhibiting the oxidation of butyrate (2).

Sounds like a lot of science talk, what is the relevance here?

  • Butyrate is the preferred fuel source for the cells that line the large bowel (the site of inflammation in ulcerative colitis) 
  • Butyrate usage by these cells is impaired in ulcerative colitis 
  • Excessive hydrogen sulphide production impairs butyrate usage (oxidation)

In this step wise explanation we can see mechanistic data – almost like looking under the hood. But often mechanistic data falls over when we try to apply it to real human beings with real health issues. 

Thankfully there is one human study that assessed butyrate oxidation in active ulcerative colitis patients showing it was significantly impaired (3).

We can see these results repeated in another study on humans too (4).

It can be easy to point the finger at hydrogen sulfide producers as the cause of ulcerative colitis. True, when testing IBD microbiomes I do frequently see a significant overgrowth in hydrogen sulfide bacteria (more here, here and here) but there are other causes of butyrate dysfunction.

  1. Inflammation reduces butyrate oxidation 

Tumor necrosis factor alpha (TNF-a), a major inflammatory messenger, was shown to downregulate butyrate oxidation in the colonic mucosa (5). 

I like to think of TNF-a as the master switch for inflammation. When this is in play it is safe to say that inflammation is happening.

With this reduced energy source the colonic mucosa becomes damaged. This is one theory helping to explain the continuous superficial lesions that are characteristic of ulcerative colitis. 

Side note – One of the most potent classes of pharmaceuticals in IBD are called biologics. Some of these inhibit TNF-a in a potent way. They can be very effective but come with the risk of turning off the inflammatory response too much. Remember, inflammation is your body’s natural and healthy response to a stressor. Too much is not great (treat the root cause) and not enough isn’t ideal either. Still, it is worth discussing this option with your doctor if you have failed all other treatments. 

Butyrate as a Natural treatment option for ulcerative colitis.

Taking this butyrate handling issue into account the treatment aims become quite straight-forward. 

  1. Deal with any infections or overgrowths that may be compromising butyrate handling.

I am always looking for hydrogen sulphide producers in inflammatory bowel disease clients. Other bacterial infections may be displacing or outcompeting butyrate producing beneficials. 

  1. Reduce inflammation to improve butyrate handling 

Anti-inflammatory herbs are key for many ulcerative colitis sufferers and lots of them. 

Often clients come to me already taking many of the herbs I would recommend. Rarely are they taking enough to get a handle on the inflammation that is raging in their digestive tract.  

  1. Increase local butyrate production by nourishing the microbiome 

Selectively feeding the beneficial bacteria that produce butyrate can be helpful. There can be issues with microbiome remodelling if there is an active ulcerative colitis flare happening. Sometimes I will test the waters gently and if there is a reaction I will shelf this approach and reinitiate it when the flare is under control. 

One study reflects this approach showing improvements in gut symptoms in patients with a history of ulcerative colitis now in remission while on a diet rich in butyrate boosting fibres (6).

This may also be why probiotics can be helpful in inflammatory bowel disease. In clinical experience I find them hit or miss in this condition and mainly use them to treat specific symptoms or infections found on stool testing. 

  1. Supplement butyrate orally and rectally

Butyrate supplementation can be helpful in ulcerative colitis. 

The results for oral supplementation are good but not great, with some studies showing improvements with butyrate and drugs compared to drugs alone but the improvements were not statistically significant (7).

With oral supplementation I prefer to use products that have good delivery systems to get the butyrate to the large bowel. 

It is a long way to go. 

With this thought in mind I did want to mention one therapeutic approach that I have been trialling in my IBD patients. 

With this thought in mind I did want to mention one therapeutic approach that I have been trialling in my IBD patients. 

Herbal Enemas For Ulcerative colitis

Retention enemas, using many of the same therapies that I use orally, have decent results in the research and it really makes sense to me. If we are trying to deliver the active herbs or nutrients to the large bowel it is a much shorter route starting from the end. 

This point makes particular sense when we are dealing with proctitis or left sided ulcerative colitis.   

Retention enemas deserve their own article so I will leave that thought there. Even though it is an unusual (and perhaps uncomfortable) thought, for most patients with active inflammatory bowel disease any therapy that is safe and effective is well considered. 

Now over to you. Have you experienced IBD flares? What helped get things under control in your experience? Share your thoughts below. 

References and Resources

  1. Tumor Necrosis Factor a Reduces Butyrate Oxidation In Vitro in Human Colonic Mucosa: A Link from Inflammatory Process to Mucosal Damage
  2. Hydrogen sulfide toxicity in the gut environment: Meta-analysis of sulfate-reducing and lactic acid bacteria in inflammatory processes
  3. Butyrate oxidation is impaired in the colonic mucosa of sufferers of quiescent ulcerative colitis
  4. Butyrate metabolism in the terminal ileal mucosa of patients with ulcerative colitis
  5. Tumor Necrosis Factor a Reduces Butyrate Oxidation In Vitro in Human Colonic Mucosa: A Link from Inflammatory Process to Mucosal Damage
  6. Increasing Fecal Butyrate in Ulcerative Colitis Patients by Diet: Controlled Pilot Study 
  7. Combined Oral Sodium Butyrate and Mesalazine Treatment Compared to Oral Mesalazine Alone in Ulcerative Colitis

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