Ask The GI

IBD And COVID-19: Am I At A Higher Risk For Complications?

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Those with autoimmune disease are on heightened alert with the spread of COVID-19. The coronavirus not only poses a risk to our population as a whole, but especially to those with pre-existing conditions. At Gutbliss, we hold a special place for patients suffering from autoimmunity, and especially those with inflammatory bowel diseases (IBD – Crohn’s disease and ulcerative colitis). We’ve received lots of questions from our IBD friends and would like to address their concerns. Here are answers to the main questions we’ve received:

Is IBD considered an “underlying condition” that puts me at a higher risk of infection from the coronavirus?

First, just because you have an autoimmune disease doesn’t mean, by definition, that you have immune suppression. And while some individuals with autoimmune disease may be at a heightened risk of contracting the virus, others may not be. As a general rule of thumb though, because imbalanced gut bacteria often play a role in contributing to autoimmune conditions, and because the gut is instrumental in immune system function, those with poorly controlled autoimmune conditions may be at a higher risk of contracting infections, including COVID-19. But it’s important to know that just because you have an autoimmune disease doesn’t mean you can’t boost your immunity by living a healthy lifestyle that includes eating lots of indigestible plant fiber to help feed your gut bacteria, getting plenty of rest, and staying active. Doing so can significantly improve your immune function and help protect you against infection.

What about my medication? Does it put me at a higher risk of infection?

Some individuals with inflammatory bowel disease are on medications that suppress the immune system, which makes those individuals immune suppressed and at a potentially higher risk of contracting an infection. These medications include steroids and biologics. If you are on these medications, now is a good time to talk to your health care practitioner about what you can do to decrease your risk.

If I’m on steroids or biologics should I taper off of these drugs now because of COVID-19?  

Dr. Chutkan works closely with lots of IBD patients to help them taper off of immunosuppressive medications and replace them with lifestyle interventions, such as diet, exercise, and stress reduction, to treat their IBD. But she does that in a therapeutic setting, working closely with patients to make sure they don’t have a flare up, and recommending less toxic medications when appropriate.

If you’re considering tapering off immunosuppressive medications, it’s important to consider the following:

1) Your disease should be mild to moderate or in remission.

2) You must be someone who is willing to diligently implement and follow lifestyle changes, especially in the areas of diet and stress reduction.

3) We strongly encourage you to speak with your healthcare provider and work closely with them to implement lifestyle modifications and a medication tapering plan.

Most importantly, patients who are currently experiencing a flare, having obstructive symptoms, or who have had poorly controlled symptoms in the recent past may not be good candidates for medication tapering. Staying on your medical regimen at this time is recommended.

Lastly, while we encourage patients to pursue more natural avenues in treating their IBD, for those who are less comfortable with lifestyle changes or whose disease is not under control, drastically changing your medication regimen during a pandemic is not recommended. Waiting until COVID-19 is no longer a threat may be a better time for some patients to revisit implementing lifestyle changes and tapering their medications. And when the time is right, know that many, many IBD patients utilize lifestyle interventions alone to treat their disease. This is something that can be done and that works well for a lot of people.

If I’m taking these medications, should I take social distancing more seriously?

Yes. While this is challenging, social distancing, and the “stay home” policy is the best way to avoid contracting COVID-19. And this is especially true for those who are immune compromised. If you choose to stay on your meds, and even if you choose to taper, use this time to focus on living a lifestyle that optimizes microbial balance. For more information on this, check out our “dirt-sweat-veg” post below, as well as Dr. Chutkan’s book, The Microbiome Solution.

The Crohn’s and Colitis Foundation has released a COVID-19 guide for IBD patients. While we don’t support everything in this guide, it can be a helpful resource for those IBD patients looking for more information.

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