Patient Perspectives on Demystifying Environmental Triggers in IBD

Reviewed by Madhura Balasubramaniam, MA

Medically reviewed by Drs. Manasi Agrawal, Ashwin Ananthakrishnan, and Parakkal Deepak

In November, I had the privilege to listen to SAIA’s livestream discussion on Demystifying Environmental Triggers in IBD, a much-requested topic among our IBDesis Community.

As someone living with Ulcerative Colitis, I have long wondered, “how did I develop this condition as a young person with no known family history of IBD? Is there something environmental that triggered it?”

I remember learning that there may be an association between PFAS (“forever chemicals” found in non-stick cookware and waterproof fabrics, for example) and chronic health conditions (such as IBD), in an Environmental Health class while earning my MPH degree. I thought, “could this be a clue to the puzzle?”

It’s hard to know without any definitive evidence. I remember my gastroenterologist once explaining that IBD is a complex condition – Crohn’s and UC are immune-mediated inflammatory diseases (IMIDs) that we develop due to a complicated interplay of genetic and environmental factors that researchers are working to better understand.

With the incidence of IBD and other chronic IMIDs rising rapidly across the world, it is imperative to understand the different environmental factors, including industrialization, increased consumption of ultra-processed foods, and increased exposure to pollutants, and the role that they may play in driving this growing number of cases.

The scientific community is actively working towards figuring out the role of the environment in IBD, and it was great to hear Drs. Manasi Agrawal, Ashwin Ananthakrishnan, and Parakkal Deepak discuss the current state of this research with IBD patient advocates Tina Aswani-Omprakash and Chandershekhar Shori. The panel reviewed the growing body of research on different environmental factors and their relationship with IBD.

Here’s what we learned:

Among the general population, some environmental factors that have been associated with the development of IBD include the following:

• Diet & Lifestyle
• Researchers are studying the role of diets high in ultra-processed food (such as packaged food with GMOs, additives, artificial colors and flavors, and preservatives) and have found that UFPs are associated with a risk of developing IBD, particularly Crohn’s Disease.
• Mental health factors, including bidirectional pathways between depression/ anxiety and IBD, can contribute to the development of IBD.
• Poor quality and insufficient sleep may also play a role in developing IBD.

• Chemicals

An important domain of research on the environment and IBD has focused on the risk that exposure to various man-made chemicals presents in the development of IBD. Such chemicals may include:

• PFAS (as mentioned previously)
• Pesticides
• Air pollutants
• Microplastics (e.g., from the breakdown of plastic bottles/containers or polyester fabric)

• Medications & Substances

Another key factor that may be associated with the development of IBD is extensive exposure to medications such as antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs such as aspirin, etc.), and smoking. While we may occasionally need antibiotics and NSAIDs for our health, using these medications rationally and only as prescribed by our doctors is important.

It is important to remember that we still have A LOT to learn about the complex interactions between environmental factors and the development of IBD. Some of this is experimental data and the results are still mixed. More observation and research are needed to better understand how these environmental factors impact IBD.

It is also important to remember that this research indicates association and not causation (i.e., the research does not suggest that just because you have been exposed to these chemicals, substances, medications or diet/lifestyle factors, that you will without a shadow of doubt develop IBD).

Having discussed factors that may be associated with developing IBD, let’s turn our attention to environmental factors that may be protective against IBD. These include:

• Having a pet at home
• Following a diet that is high in diverse fruit and vegetables, and provides plenty of dietary fiber
• Regular access and exposure to green space/nature
• Regular physical activity

Finally, in addition to discussing environmental factors that may be associated with developing IBD and factors that might be protective against IBD, the talk also covered some factors with no evidence of a link to the development of IBD:

• Mode of delivery (C-section vs vaginal birth) has not been associated with the development of IBD
• Vaccinations are NOT associated with the development of IBD

So, how should we as patients feel empowered to utilize this information?

Most importantly, we want to stress to all patients that the association between these environmental factors and the development of IBD does not mean IBD is something we did to ourselves. These exposures are the reality of life in our modern and rapidly industrializing world.

Even armed with the knowledge that these factors may be contributing to the rise of chronic inflammatory diseases around the globe, there is only so much we can do. It is impossible to avoid it all, and it’s important that we don’t beat ourselves up over what we can’t control.

Avoiding these factors will not cure IBD, nor will it guarantee the prevention of IBD or any other chronic inflammatory illnesses. However, realistic efforts to avoid these exposures and prioritize our health can be empowering while improving our overall well-being and quality of life. While further research and observation are needed to better understand these environmental factors, the talk brought to our attention practices that we can incorporate in our everyday lives for overall well-being.

As an example, this image from the International Organization for Study of Inflammatory Bowel Disease (IOIBD) summarizes some evidence-based lifestyle, behavior, and environmental modifications that we can consider as also suggested by the physicians on the SAIA livestream:

Consensus recommendations for patients with IBD
Notes: BMI = body-mass index. IBD = inflammatory bowel disease. NSAIDs = non-steroidal anti-inflammatory drugs.

As next steps, there are some things we can try to incorporate into our daily lives if possible:

• Prioritize sleep and management of any anxiety and depression
• Avoid smoking and air pollution where possible (e.g., wear a mask)
• Prioritize fruits, vegetables, legumes, and lean meats in our diets and limit ultra-processed foods where possible
• Engage in regular physical activity and spend more time in nature
• Decrease plastic use in daily life (i.e., use reusable stainless steel or glass water bottles) where possible
• Avoid heating or storing hot food in plastic containers when possible
• Use metal or cast iron instead of non-stick cookware if possible

Please remember that managing these environmental exposures is not a substitute for the role of medication in IBD. These are simply good practices to adhere to for overall well-being.

Be well, SAIA family! If you missed it, be sure to check out the full livestream here. And if you’re interested in learning more about how environment and lifestyle might affect IBD, check out the resources below.

Also, check out Dr. Manasi Agrawal’s study which is now recruiting participants who are pregnant or looking to get pregnant to understand the role of microplastics in intestinal inflammation and the development of Crohn’s disease.

This blog post was based on SAIA’s livestream titled “Demystifying Environmental Triggers in IBD,” sponsored by Johnson & Johnson, AbbVie, Merck, and Genentech-Roche.

References

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Agrawal M, Vianello A, Picker M, Simon-Sánchez L, Chen R, Estevinho MM, Weinstein K, Lykkemark J, Jess T, Peter I, Colombel JF, Allin KH, Vollertsen J. Micro- and nano-plastics, intestinal inflammation, and inflammatory bowel disease: A review of the literature. Sci Total Environ. 2024 Nov 25;953:176228. doi: 10.1016/j.scitotenv.2024.176228. Epub 2024 Sep 11. PMID: 39270875; PMCID: PMC11424240.

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Keefer L, Kane SV. Considering the Bidirectional Pathways Between Depression and IBD: Recommendations for Comprehensive IBD Care. Gastroenterol Hepatol (NY). 2017 Mar;13(3):164-169. PMID: 28539843; PMCID: PMC5439135.

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