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Can Circadian Rhythms Influence Crohn’s and Colitis?

People living with chronic digestive disorders often worry about the impact that their conditions might have on their sleep. Pain, persistent diarrhea, and bloating from Crohn’s and colitis can make it hard to fall—or stay—asleep.

However, the digestive system—like the sleeping process—is regulated by circadian rhythms. When those rhythms fall out of sync, poor sleep and disease flares are both common outcomes.

What are circadian rhythms?

It was once thought that the circadian system was guided singlehandedly by a main “body clock” called the suprachiasmatic nucleus (SCN) and that it only served the body’s sleep-wake cycles.
This “body clock” uses cues based on time, light, and activity—including mealtime—to prepare the body for sleep or wakefulness.

Research has since shown that all of our systems, organs, even cells, have their own unique circadian systems which synchronize with the SCN to keep everything in working balance.1

This includes the digestive system. While it doesn’t require light to maintain healthy rhythms, research shows that it works in tandem with sleep-wake rhythms to regulate metabolism, appetite, and the absorption of nutrients.

Knowing this, it should make sense that when these circadian rhythms fall out of sync, the function and regulation of the gastrointestinal tract may be equally affected.

How do disrupted circadian rhythms impact digestive disorders?

There are parallels to trace between disruptions of sleep-wake rhythms and digestive rhythms. Generally speaking, research shows that people with IBD—including both ulcerative colitis (UC) and Crohn’s disease (CD)—tend to experience poor sleep quality, such as delayed sleep onset, problems with fragmented sleep, daytime sleepiness, and a higher rate of reliance on sleep aids.1 Circadian disruptions caused by shift work (working the late or overnight shift) or common jet lag also affect immune function in ways that could possibly trigger the “leaky gut” inflammatory responses commonly tied to IBD.1

In fact, other research points to the problematic likelihood that disturbed sleep and IBD flares “could form a self-perpetuating feedback loop, with the chronic inflammation of IBD worsening sleep and decreased sleep exacerbating the production of inflammatory cytokines and the inflammatory milieu.”2

Also worth noting: Poor sleep has been shown to increase the risk for disease relapse in IBD.3 Researchers recently published insights into these connections between circadian rhythms and IBD in an article in Translational Research4:
“Disruption of the circadian system can increase the activity of the gut immune system and the release of inflammatory factors. The link between …circadian rhythm impairment and IBD demonstrated by experimental and clinical studies illustrates the potential impact of circadian rhythms on the treatment of these diseases.”

In other words, the better we understand circadian influences over the disease course of IBD, the more able we will be to design more effective treatment strategies that support both the digestive and circadian systems.

How to maintain a healthy circadian system

Currently, there aren’t any circadian-specific treatments (chronotherapies) that can help ease IBD.
However, there are several circadian “best practices” we can pursue to keep our circadian rhythms in balance. In doing so, we also support our digestive and immune systems.

  • Keep a strict bedtime/rise time schedule.
  • Stick to a strict mealtime schedule, and avoid eating at least 2 hours before bedtime.
  • Get a good dose of light exposure (at least 20 minutes) first thing in the morning. The best source is the sun. However, northern seasonal darkness may prevent this; try phototherapy devices like “happy lights” to get your morning dose of light.
  • Exercise, especially in the morning, is a powerful tool for achieving a circadian reset.

Can melatonin help?

Possibly. The substance known as melatonin is an important circadian regulator that our bodies generate naturally. It is secreted at night as part of the sleep-wake transition. While most melatonin is generated by the pineal gland in the brain, the gastrointestinal tract contains levels of melatonin at about 400 times the rate of the pineal gland.

One of melatonin’s circadian-stabilizing jobs is to slow down activity in the digestive tract. Melatonin also improves the quality of the lining of the gut, reduces stomach acid, and increases the circulation of blood throughout the digestive system.5

Research suggests that melatonin supplementation may improve symptoms in people with IBD, but more specific studies are needed to confirm its value as a formal treatment for IBD.1 Talk to your doctor if you’re interested in using melatonin to improve your sleep and reduce your IBD symptoms.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The InflammatoryBowelDisease.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Swanson, G. R., Burgess, H. J., & Keshavarzian, A. (2011). Sleep disturbances and inflammatory bowel disease: a potential trigger for disease flare? Expert Review of Clinical Immunology, 7(1), 29–36. doi: 10.1586/eci.10.83
  2. Codoñer-Franch, P., & Gombert, M. (2018). Circadian rhythms in the pathogenesis of gastrointestinal diseases. World Journal of Gastroenterology, 24(38), 4297–4303. doi: 10.3748/wjg.v24.i38.4297
  3. Ananthakrishnan, A. N., Long, M. D., Martin, C. F., Sandler, R. S., & Kappelman, M. D. (2013). Sleep Disturbance and Risk of Active Disease in Patients With Crohns Disease and Ulcerative Colitis. Clinical Gastroenterology and Hepatology, 11(8), 965–971. doi: 10.1016/j.cgh.2013.01.021
  4. Gombert, M., Carrasco-Luna, J., Pin-Arboledas, G., & Codoñer-Franch, P. (2019). The connection of circadian rhythm to inflammatory bowel disease. Translational Research, 206, 107–118. doi: 10.1016/j.trsl.2018.12.001
  5. (n.d.). Peristalsis and Sleep: How both work in tandem with circadian rhythms. Retrieved from https://www.soundsleephealth.com/blog/peristalsis-and-sleep-how-both-work-in-tandem-with-circadian-rhythms

Comments

  • Kelly C (#purpleproject) moderator
    2 months ago

    I’m a real believer that sleep directly affects Inflammatory Bowel Disease. It’s a cirlce, really. If you don’t get enough sleep.. symptoms. If your symptoms are bad, no way you’re sleeping well.

    I think more research needs to be done with sleep hygiene, for sure. I would really like my GI to be asking how well I’m sleeping, as that’s a pretty good indicator of how my disease activity has been.

    Thank you for all of this!
    Kelly, IBD Team Member

  • Amanda Osowski moderator
    3 months ago

    Super helpful post! I became a new mom in May, and when my sleep schedule was thrown out the window I had to be so careful about my IBD symptoms. I think this is so important for patients and caregivers to be aware of!

    Warmly,
    Amanda (team member)

  • TamaraSellmanRPSGT-CCSH
    2 months ago

    Thanks, Amanda! Congrats on becoming a new mom! Yes, your sleep schedule may fall in and out of bedlam for the next few years but you are exactly right: prioritizing it will definitely help you with your IBD. Good luck and enjoy this new chapter of your life!
    Tamara

  • Julie Marie Palumbo moderator
    3 months ago

    Wonderful and informative article, TK. It is worth considering getting ourselves in a normal circadian rhythm, whether or not we have IBD, even more so if we do.

    I like the idea of keeping a set routine (especially working out in the morning!) so thank you for sharing these great ideas with us!

    –Julie (Team Member)

  • TamaraSellmanRPSGT-CCSH
    2 months ago

    Thanks Julie!

    I totally agree… our circadian rhythms are a critical influence over all of our systems.

    Even our individual cells have clocks timed to the main body clock, which establishes our rhythms.

    When they go out of synch, so much of our body can fall out of balance, even if we are healthy.

    Set routines (especially for sleeping, eating, and exercising) are some easier ways we can do ourselves the kindness of minding our rhythms.

    Happy to contribute to the IBD community… I have a special passion, as a sleep technologist and sleep educator, for circadian issues and am happy to share what I know with whoever will listen 🙂

    Tamara

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