Fungi and Inflammatory Bowel Disease

Inflammatory Bowel Disease Common and Debilitating

Inflammatory Bowel Disease (IBD) consists of Crohn’s Disease and Ulcerative Colitis.  IBD causes severe discomfort including chronic pain, persistent or intermittent diarrhea, bloody stools, weight loss, and chronic fatigue.  For reasons not completely understood- rates of both forms of IBD have been increasingly steadily over the past 60 years in most developed nations ¹. About 1.3 million people have IBD in the USA alone ¹.  Risk factors possibility implicated in increased risk of Crohn’s and/ or ulcerative colitis include smoking, oral contraceptives, diets high in sugars and fats and low in fruits and vegetableS, frequent use of antibiotics, urban environment, and prior gastroenteritis ².

Common Intestinal Fungi

Recent research has suggested that digestive tract fungi such as Candida and Malassezia may be involved in the development of IBD ³. The most common fungal genera found in in the intestines of healthy humans are Candida, Saccharomyces, and Cladosporium; with other common intestinal fungi being Debaryomyces, Malassezia, Sporobolmyces, Trichosporon, and Wallemia  ³. Fungal composition in stools and intestines tend to be more variable and fluctuating than bacteria ³.

Changes in Fungi Seen in Inflammatory Bowel Disease (IBD)

 A number of significant alterations in the number of gut fungi have been reported in humans and laboratory mice with inflammatory bowel disease (IBD). Significantly higher levels of 3 Candida species- Candida alibicans, tropicialis and glabrata have been reported in the stools for Crohn’s Disease patients ³. Higher gut levels of Malassezia have been found in Crohn’s patients and  higher Malassezia levels have been associated with inflammation and colitis symptoms ³. Significantly lower levels of Saccharomyces cerevisiae have been seen in IBD patients, and higher levels of  Saccharomyces cerevisiae have been associated with remissions of IBD symptoms ³. Other studies have reported increased intestinal mucosaL concentrations of Dioszegia, Leptosphaeria, and Xylariales in the intestinal mucosa of IBD patients.

Mouse studies have reported that increasing levels of 3 gut fungi Aspergillus amstelodami, Epicoccum nigrum, and Wallemia sebi are associated with significantly increase risk of both colitis and GI symptoms and respiratory allergy and asthma ³.

Diet Influences Gut Fungi

Some recent animal and human studies report that diets high in refined carbohydrate, high in animal fat, and low in fiber, low in fruits vegetables and low in vitamin D and omega 3 fats are associated with increased risk of IBD ⁴. Other human and animal studies have reported that diets high in refined carbohydrate, high in saturated fats, low in fiber, and low in short chain fatty acids (such as found in coconut oil) are associated with significantly higher levels of Candida in stools ³.

Oral Probiotic Bifidobacterium and Saccharomyces Yeast May Be Helpful For IBD Symptoms

A meta-analysis of 6 published studies of Ulcerative Colitis involving 214 treated patients and 210 controls has reported that the use of probiotics containing Bifidobacterium is associated with significantly increased change of remission (Odds Ratio 1,73, 95% CI 1.23-2.43, p=0.002) as compared to placebo ⁵. Another review reported that the use of oral Saccaromyces boulardii was associated with significant improved versus placebo in 2 out of 3 studies involving Crohn’s Disease patients ⁶.

Research and References

1. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46-54 e42; quiz e30.

2. Molodecky NA, Kaplan GG. Environmental risk factors for inflammatory bowel disease. Gastroenterology & hepatology. 2010;6(5):339-346.

3. Lam S, Zuo T, Ho M, Chan FKL, Chan PKS, Ng SC. Review article: fungal alterations in inflammatory bowel diseases. Aliment Pharmacol Ther. 2019.

4. Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology. 2017;152(2):398-414.e396.

5. Asto E, Mendez I, Audivert S, Farran-Codina A, Espadaler J. The Efficacy of Probiotics, Prebiotic Inulin-Type Fructans, and Synbiotics in Human Ulcerative Colitis: A Systematic Review and Meta-Analysis. Nutrients. 2019;11(2).

6. Sivananthan K, Petersen AM. Review of Saccharomyces boulardii as a treatment option in IBD. Immunopharmacol Immunotoxicol. 2018;40(6):465-475.