Crohn's disease and ulcerative colitis - inflammatory bowel disease responds well to the environmental approach

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[UPDATED SEPTEMBER 2022]

Introduction

My experience is that most gut problems, including inflammatory bowel disease, are caused either by allergy, or by gut dysbiosis (i.e. the wrong bugs in the gut), or poor digestion of foods. When things get complicated there is often an element of all three. In Crohn's disease almost always there is allergy - this was proven by Dr John Hunter at Addenbrooke's Hospital, Cambridge, who showed that patients responded as well to an elimination diet as to steroids. Nearly all are intolerant of grains. Usually with Crohn's there are just a few foods implicated. With ulcerative colitis (UC), allergy is also well documented, with reports of dairy products causing UC in the 1960s. I certainly do have a proportion of patients with UC who have responded well to the approach which aims at correcting all three areas, but I do not claim to be 100% effective in treating them all! There is quite a lot in the nutritional literature and what I have gleaned suggests that in inflammatory bowel disease there are several things which can go wrong.

Allergy

Allergy is a big player in inflammatory bowel disease. Allergies run very strongly in families and dairy allergy is the main suspect. Furthermore, the majority of sufferers of inflammatory bowel disease are intolerant of grains. The next commonest allergen is yeast and this can extend to yeast in the gut. So the first thing that needs to be done is a good Ketogenic diet - the practical details, which avoids the major allergens and is of low glycaemic index.

See also:

and my book on the "PK" diet

Of course, it is possible to be allergic to anything at all, and if certain foods are known to flare symptoms, they need to be avoided even if they are the "allowed food" in the diet. If it transpires that the sufferer is multiply allergic to foods, then one might try Nalcrom (an allergy blocker), which works in a few, or possibly Enzyme Potentiated Desensitisation (EPD) to switch off allergies. In a study by Dr McEwen, EPD was very effective in reducing reliance on medication and number of relapses.

Ulcerative colitis and phosphatidylcholine

The idea here is that the protective mucous layer between the lining of the gut and gut contents is damaged because it lacks the right oil. If this mucous layer is defective, stools come in contact with the gut wall to cause Ulcerative colitis and phosphatidylcholine (PC) in the gut

Gut Dysbiosis

The second thing that often arises in ulcerative colitis is gut dysbiosis, i.e. having the wrong bugs in the gut. Furthermore, it is possible to become allergic to the bugs in the gut. So, for example, inflammatory bowel disease (IBD) often has an arthritis associated with it as the allergy reaction to bacteria in the gut results in joint symptoms. The mechanism may be molecular mimicry, first described by Dr Alan Ebringer. The idea here is that the body makes antibodies against gut bacteria, which then cross-react with self - for some reason often with spinal ligaments - to cause back pain and typically early morning stiffness. (Please see The cross-tolerance hypothesis, HLA-B27 and ankylosing spondylitis. and Autoimmunity in Rheumatic Diseases Is Induced by Microbial Infections via Crossreactivity or Molecular Mimicry )

So, the treatment is to try to change the gut flora. There are many ways this can be done, but the gut flora depends largely on the diet. The first port of call is a PK diet, but some people find they just have to reduce their carbohydrate load to get a result. See SPECIFIC CARBOHYDRATE DIET - this handout is not available on website - contact the office for a copy.

It is quite possible that this explains the mechanism by which the drug Sulphasalazine works - it splits up in the gut to produce a sulphonamide, which is anti-bacterial, thereby changing the gut flora. It is possible to do tests for bacterial dysbiosis such as GI Effects Comprehensive Profile - stool, but these tests do not tell if one is allergic to bacteria or if there is molecular mimicry.

Bacterial allergy is a difficult diagnosis to make, but may well explain why some people respond clinically well to taking antibiotics or herbal anti-microbials, such as Artemisia, Berberis, Wormwood, Slippery Elm or the many other preparations on the market. However, there is no point experimenting with these until the basics are in place with respect to the PK diet, effective digestion of food and good levels of probiotics.

Extensive work has been done looking at the effects of probiotics on inflammatory bowel disease and the bacterium which is particularly helpful in IBD is lactobacillus plantarum. There are others and indeed a package has been put together which is now available on NHS prescription called VSL3.

Another way to use probiotics is to grow them yourself on culture. The one I particularly like to use is Kefir because it is so easy to grow and this makes it inexpensive. It does not contain lactobacillus plantarum, but it does contain many other lactobacilli species, which may be equally effective. So this is another possibility to consider. Also see Probiotics - we should all be taking these all the time and double the dose following antibiotics and gastroenteritis.

It may well be that the inflammatory bowel conditions described by Dr Andrew Wakefield following MMR vaccination have to do with bacterial allergy since in clinical practice I see allergies following viral infections.

Dr Thomas Borody gets excellent results with ulcerative colitis using Faecal bacteriotherapy.

Also see Fermentation in the gut and CFS

Chronic Bacterial Infection

Work done by Prof John Hermon-Taylor at St George's Hospital has demonstrated that some early cases of Crohn's can be completely cured by antibiotics. (Please see Two-year-outcomes analysis of Crohn's disease treated with rifabutin and macrolide antibiotics. This stems from work which has shown the presence of a tuberculosis-like organism called Mycobacterium avium subsp. paratuberculosis, present in the gut of Crohn's patients.(Please see Mycobacterium avium subspecies paratuberculosis, Crohn's disease ) This is the same bacterium that causes Johne's disease in cattle and is thought to be acquired by humans through drinking milk. The pasteurisation of milk does not kill this bacterium, which Prof. Hermon-Taylor has shown to be present in about 10% of all milk samples. That is to say, we are all exposed to this bacteria, but some people get infected with it.

Digestion of Foods

Food first has to be chewed. Longer chewing results in more efficient digestion. Gandhi said we should chew our drinks and drink our solids! Don't gobble!

It then requires an acid environment for bacteria and yeasts to be killed and proteins digested. This makes sense - it prevents inoculation of the gut with unwanted bacteria. Therefore, being hypochlorhydric (having insufficient stomach acidity) may well be a risk factor for gaining a bacterial dysbiosis and this could be exacerbated by the use of antibiotics. A simple test for hypochlorhydria is now available, i.e. a salivary VEGF. If the results indicate deficiency of the stomach acid, this can be easily corrected. See Hypochlorhydria

Low levels of enzymes may also slow digestion of foods - consider a faecal elastase, which is a measure of pancreatic exocrine function. Low results suggest impaired production of pancreatic enzymes. CDSA also looks at ability to digest and absorb as well as other factors.

Anti-inflammatory interventions

This is the mainstay of conventional drug therapy and there is no doubt that on occasions this is essential! It seems that some inflammatory processes have a momentum of their own -inflammation damages cells, which release free radicals, which stimulate further inflammation. Again, anti-oxidants and vitamin D are very helpful for the same reasons as above. There are also anti-inflammatory preparations worth trying, such as curcumin (turmeric extract). See Inflammation. Smoking is a risk factor for Crohn's, probably because of its pro-inflammatory effects.

Worms

There is evidence to suggest that worms have a useful anti-inflammatory effect on the gut. Indeed, this illustrates the "hygiene hypothesis". The immune system needs exposure to bacteria and parasites for it to be correctly programmed. Modern life means the gut no longer gets this essential programming and the immune system starts to react inappropriately. In this case to foods and gut flora (bacteria and possibly yeast).

Antioxidant status

Finally, it may be that in people with ulcerative colitis the immune system is just up-regulated and this would be made worse by poor antioxidant status. This can be checked by measuring levels of Co-enzyme Q10, glutathione peroxidase and superoxide dismutase (SODase). High dose vitamin D might be extremely helpful and I would suggest say 10,000iu a day. I know this sounds like a high dose, but there has been no documented cases of hypocalcaemia or any such problem in the medical literature. 10,000iu daily of vitamin D is equivalent to an hour of daily sunshine. See Antioxidants

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