Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (119 page)

A 2004 study tested probiotic bacteria in mice. The exciting part of this study showed that sterilized probiotics worked as well as live probiotics in chemically induced ulcerative colitis. (The use of dead probiotics to modulate the immune system is discussed in
Chapter 6
.)

Although there is not much research on the yeast connection to IBD, clinicians have often found antifungal therapies to be useful. Friendly flora have been found to be dramatically out of balance in people with IBD, so use of probiotic supplements is highly recommended. Use of the comprehensive digestive stool analysis with parasitology screening and intestinal permeability tests will uncover many of these problems.

Medical treatment for IBD consists of anti-inflammatory drugs [e.g., sulfasalazine (Asulfadine), mesalamine (Asacol), olsalazine, balasalazide], steroids (e.g., prednisone), immune suppressors (e.g., azathioprine, cyclosporine, methotrexate), and sometimes antibiotics. While these medications can often relieve symptoms of IBD, they carry their own risks. Some specific drug side effects include bone loss and low cortisol levels due to use of steroid medications, and folic acid deficiency from use of sulfasalazine. Azathioprine (Imuran) has been associated with a small rise in the incidence of lymphoma.

Infliximab (Remecade) and Humira are new drugs that are being used for people who have Crohn’s disease and the fistulas caused by it. Research is ongoing for its use in ulcerative colitis too. A monoclonal antibody, infliximab has a high specificity for tumor necrosis factor (TNF-alpha). Humira also targets TNF-alpha. This is an entirely new approach that focuses on stimulating the immune system to stop inflammation in people with severe disease. Many people are able to stop taking steroid medications, and quality of life is increased. Yet, by suppressing immune function, you risk opening yourself up to other diseases.

Another drug called ecabet sodium works by helping to heal and soothe the mucosal lining. Most of the research on this medication focuses on its use in GERD and in treatment for H. pylori. Nonetheless, for people with IBD, it’s believed to help by targeting cell-signaling pathways to normalize kinas activation.

A very new approach to IBD is with the use of the Bowman-Birk protease inhibitor, called BBI; testing is in initial stages. BBI is derived from soybeans and is naturally found in all legumes. You’d need to eat huge amounts to get the same effects, but you might find them to be helpful. Remember that legumes are loaded with fiber, help lower serum cholesterol levels, and offer a vegetable protein of high quality.

Medications are often necessary, but use of complementary therapies can reduce the need for them, so that when you really need medication during a flare-up it works effectively. For example, repeated use of prednisone can lead to its failure as an available therapy.

The good news is that effective natural therapies address the underlying factors of the disease, reduce the need for prescription medications, and heal the bowel. Among the hundreds of patients with IBD that Drs. Jonathan Wright and Alan Gaby, two nutritionally oriented M.D.s, have seen, most have improved, many dramatically. The key to success appears to be getting people into remission as fast as possible. To do this effectively, a combination of medication and supplements may be
necessary. Once a flare-up has died down, natural therapies are highly successful in preventing a recurrence. It’s also really important to take care of yourself when you are well and to practice stress-management techniques to help reduce the number and severity of flare-ups.

One of the most promising new therapies is the use of phosphatidylcholine. People with ulcerative colitis have been seen to have low levels of phosphatidylcholine in their colonic mucus. Phospholipids are essential for the mucous barrier to protect us. When these levels are low, we are likely to have leakiness. Some people are able to stop steroid medications when taking sustained-release phosphatidylcholine at levels of 2 to 4 grams daily. There have been three studies on this therapy, all from the same research group, one of which holds a patent on this particular form of phosphatidylcholine. This gives a possible bias. Also, I wonder whether regular phosphatidylcholine might work as well.

No one diet will help all people with IBD, although an elemental diet, the Specific Carbohydrate Diet (details of the SCD program are discussed under “Healing Options”), and the Gut and Psychology Syndrome (GAPS) diet work especially well for people with Crohn’s disease. An elemental diet, which has resulted in a reduction of intestinal permeability as well as its symptoms, includes synthetic foods you drink or are given through a tube. It has been found to be as good as steroids in reducing inflammation in a flare-up of Crohn’s disease.

Up to 90 percent of people will get huge benefits from going on an elemental diet, which relies in part on medical foods. Medical foods are hypoallergenic foods that contain proteins, fats, and carbohydrates that have been broken down into single amino acids, fatty acids, and simple carbohydrates so that no digestion is necessary. This allows for inflammation to diminish and leaky gut to heal. But there are problems with use of an elemental diet. It is unpalatable to many people, and they won’t drink it. Newer products that are tastier are coming on the market.

Food sensitivities play a significant role in a subset of people with IBD. Many IBD patients report significant improvement with use of an elimination diet over a three-week period. After this, they gradually add foods back into their diet to see which ones provoke bloating, pain, diarrhea, bleeding, or other symptoms. One study found that 13 percent of children with IBD were allergic to cow’s milk during infancy. It is essential to check for food allergies and food sensitivities. Studies have shown reduction in symptoms and inflammation in people who adhere to a hypoallergenic diet because it reduces inflammation. People with bowel disease are especially sensitive to most grains. Chemicals from some foods are irritating to the
bowels. Truly, nearly any food can cause irritation and inflammation. In various studies, citrus, pineapple, dairy, coffee, tomatoes, cheese, bananas, sugar, additives, preservatives, spices, beverages other than water, and bread have all been implicated. You’ll need to be tested for both IgE and IgG antibodies to determine your food sensitivities. Testing of IgA and IgM antibodies is also useful.

A low-sulfur diet may be of benefit in Crohn’s disease. Studies have shown an increase in sulfur-eating bacteria in people with bowel disease in comparison with other people. In a 1998 study by Dr. William Roediger, four people were advised to avoid high-sulfur foods, including eggs, cheese, whole milk, ice cream, mayonnaise, soy milk, mineral water, sulfited drinks (including wine), nuts, and cruciferous vegetables (broccoli, cabbage, cauliflower, Brussels sprouts, and so forth), and to reduce red meats. They were advised to get protein from fish and chicken. Dr. Roediger found significant changes—participants had no relapses or attacks while on the diet, and there were no adverse effects from the diet itself. The expected relapse rate had been 22.6 percent. Of the four people in the study, one was able to stop taking steroid medication and had been attack free for 18 months, compared to the four attacks experienced in the 18 months before the dietary changes. The other three showed microscopic improvement of inflammation. The average number of daily bowel movements in all four was reduced from six to one and one-half.

Diets that are low in fiber and high in animal fat and sugar have been implicated in the development of IBD. Cigarettes and fast foods have also been implicated in IBD. Oddly enough, eating fried potatoes has also been implicated in increased IBD. It’s believed that the glycoalkaloids (alpha-solanine and alpha-chaconine), which are concentrated when potatoes are fried, increase gut permeability.

Because of bleeding and continued irritation, malabsorption of nutrients is often found in people with IBD. These same nutrients are often vital for repair, so the cycle worsens. Low serum levels of zinc, an important nutrient for wound repair, are often found in people with IBD. Folic acid helps repair tissue and prevents diarrhea. Prolonged bleeding can cause deficiencies of copper, zinc, iron, folic acid, and vitamin B
₁₂
.

Studies have shown an increased need for antioxidant nutrients such as vitamins A, B
₃
(niacin), C, E, and K, selenium, calcium, phosphorus, copper, iron, zinc, glutathione, and superoxide dismutase (SOD). Many also have anemia, which is related to iron, B
₁₂
, copper, and/or folic acid deficiencies.

People with IBD have an increased level of inflammatory cytokines. Many natural substances can modulate these effects. Fish oils have been shown to be helpful for dampening this inflammation in Crohn’s disease, although the research isn’t entirely conclusive.

Several studies have shown bone loss in people with Crohn’s disease and ulcerative colitis. While incidence of loss in some studies is correlated with use of steroid medications, in others it appears to be independent. It is advisable to do at least a baseline bone density study to see if you are at risk. Also check vitamin D levels and try to keep them in the higher end of the normal range. If risk of bone loss is determined, increasing all bone nutrients would be advised. A study on low-impact exercise in people with Crohn’s disease found that bone density was significantly increased. So get out there and exercise regularly.

One unusual twist in the story is that nicotine appears to be protective for ulcerative colitis, while it makes Crohn’s disease worse. Although normally I wouldn’t recommend nicotine patches, the severity of the disease could warrant a try. Nicotene is certainly less toxic than the usual drugs that are used. The studies show positive results, using 15 to 25 mg patches over periods of four to six weeks along with mesalamine. Many people stayed in remission for up to three months after stopping the patch. One study gave people who were in relapse either nicotine or prednisone with mesalamine for five weeks. The relapse rate was much better in the nicotine group—only 20 percent in comparison to a 60 percent relapse rate for those on prednisone. In the long term, nicotine patches appear to help with flare-ups and maintenance when used with mesalamine.

There are many additional approaches for IBD. There have been several studies on the use of TSO whipworms to modulate the immune system and halt flare-ups in IBD. (See
Chapter 9
for more information on this.) One promising approach involves photopheresis, a process that exposes blood to light and many herbal therapies. Natural COX2 inhibitors, such as curcumin, green tea, and boswellia, also show promise.

You won’t believe this, but Dr. Thomas Borody, an Australian physician, took three men and three women with ulcerative colitis and gave them colonic enemas with the bowel movements of healthy people for five consecutive days. Four of the six had total remission of their symptoms within four months. One to 13 years later, they were still completely well and without use of any medications. They call this method fecal bacteriotherapy. Nonetheless, nearly all of his research since then has been on people with C. difficile. It’s been highly effective in people with C. difficile infection. I have one client who went to Australia to see Dr. Borody for her bowel issues who had great results. She’d love to have fecal bacteriotherapy done again. A
2010 paper by Faith Rohlke, Cristina Surawicz, and Neil Stollman reports that in 19 people with C. difficile, 18 went into remission after a single treatment and the last person after two treatments. All patients remained symptom free for periods spanning six months to four years.

Comprehensive digestive stool analysis with parasitology

Lactose breath test

Food and environmental sensitivity testing