Ignoring diet in IBD also flies in the face of much evidence linking poor diets, especially those high in sugar and starches like bread and potatoes, to ulcerative colitis and Crohn's disease incidence. Historical documents date back to Greek and Roman times with references to detoxifying protocols that prompted remission in intestinal diseases.



Remission of Crohn's Disease may be maintained for long periods when foods to which patients are intolerant are identified and eliminated from the patient's diet, according to researchers from Cambridge, England, as reported in Drug Therapy (January 1986).



In their controlled study, seven of ten patients with remitted Crohn's Disease who excluded specific foods remained in remission for six months (Lancet 1985;2:177-180). In contrast, none of the ten similar patients who consumed an unrefined carbohydrate, fiber-rich diet were able to stay in remission for this length of time.



In a subsequent uncontrolled trial, the exclusion of certain foods enabled 51 of 77 patients to remain in remission for up to 51 months; the average annual relapse rate in these patients was less that 10%.



The investigators noted that this approach demanded a great deal of cooperation on the part of the patient. However, they added that most of their patients were so pleased with their improvement that they were willing to comply.



In my experience, the most significant breakthroughs for my patients with IBD have taken place with the "Specific Carbohydrate Diet" advocated by Elaine Gottschall in her book Breaking the Vicious Cycle (its foreword written by yours truly). Ms. Gottschall formulated the diet based on personal experience with her daughter, who at age 8 was stricken with debilitating ulcerative colitis. Faced with the imminent prospect of surgery to remove her daughter's colon, Gottschall, then a young biochemist, sought out the advice of an elderly physician trained in turn-of-the-century Germany. His approach hearkened back to an early naturopathic tradition that recognized "pathogenic fermentation" as the root cause of gastrointestinal ailments. Gottschall's use of diet cured her daughter's colitis and out of this experience was born the Specific Carbohydrate Diet (SCD).



The basic theory underlying the SCD is that disease-producing bacteria and fungus spread their toxic humors in the intestines when a natural balance has been disrupted. This can arise several ways:



~ inadequate breast-feeding

~ over-reliance on antacids

~ use of antibiotics

~ a diet high in sugar or starch

~ parasites or harmful bacteria or yeast from food or water

~ immunosuppression from disease, malnutrition or stress

~ toxic chemicals in food or water

~ natural aging of the GI tract

~ use of aspirin and aspirin-like pain-killer (NSAIDs) that inflame the intestinal lining.



In a "vicious cycle," harmful bugs proliferate, irritate the intestine, disrupt digestion, impair immunity, and foster fermentive degradation of certain hard-to-digest foods. The main dietary culprits: two-sugar and other enzymatically-resistant carbohydrates found in grains, certain starchy vegetables, certain fruits, table sugar, and lactose-rich dairy products.



Gottschall's Specific Carbohydrate Diet is a balanced, varied program consisting of meat, fish, eggs and poultry with most vegetables, nuts, and some fruits and sugars allowed. Lactose-free dairy products are permitted, as are certain ingeniously-formulated grain-free breads, cookies and pastries consisting of nut-meal. Beans are usually able to be reintroduced within three months.



Patients with IBD often note significant improvement in their symptoms within three weeks of starting the Gottschall diet. By twelve weeks, the majority are recovering definitively. One twenty-year-old patient of mine with ulcerative colitis took a full year to become symptom-free. She now maintains her remission with a modified version of the SCD that allows her occasional rice-based grain products. Another patient with ulcerative proctitis affecting the rectum had daily bloody diarrhea despite medications for years until initiating the Gottschall diet. After 18 months, he is completely symptom-free without the aid of medications. Elaine Gottschall herself is a frequent recipient of letters of gratitude from patients relieved of devastating symptoms.



While the SCD is the best-kept secret of IBD management, adjunctive therapies help speed resolution of symptoms and improve the margin of success. It has long been noted in the conventional management of IBD that antibiotics like Flagyl have value in ameliorating pain, diarrhea, and bleeding. For the same reason, herbs with natural antimicrobial effects are used to advantage in Crohn's Disease and ulcerative colitis. These include grapefruit seed extract, golden seal, artemisia, sanguinaria, gentian and garlic. These substances can be used to reduce proliferation of harmful intestinal bugs like Staph and Klebsiella and Proteus. Progress of therapy can be monitored with stool tests like the Comprehensive Digestive Stool Analysis from Great Smokies Diagnostic Laboratories.



Some studies suggest that IBD is a form of exaggerated allergic response to the presence of intestinal bugs that healthier individuals--or those less genetically susceptible--tolerate with ease. Innovative modern allergy desensitization techniques are being pioneered in colitis and Crohn's. They are aimed at rapidly reducing hyper-sensitivity to bad bugs and candida--an intestinal fungus that may wreak havoc in the GI tract.



Indeed, the yeast connection is an important one in IBD. Some studies have shown increased sensitivity to Brewer's and Baker's yeast in colitis and Crohn's sufferers. Avoidance of yeast and sugars with the Candida Diet, as well as the use of anti-fungal herbs and medications, often speeds resolution of IBD.



Certain herbs and nutrients have anti-inflammatory effects in the intestines. Ginkgo biloba, known for its circulatory-enhancing effects, has demonstrated anti-disease activity in some studies of IBD. Herbs like licorice and the bioflavonoid quercitin have soothing effects on the intestinal wall. Aloe vera can help to heal ulceration. Chinese herb formulations containing, among other things, extract of cinnamon and angelica, relieve spasm and inflammation and dissipate pathological heat.



The amino acid L-Glutamine has been shown to possess healing affects on gastrointestinal mucosa. Fish oil, containing the vital Omega 3 polyunsaturated fatty acid EPA, can help break the inflammatory cycle in colitis as it does in rheumatoid arthritis and psoriasis. Shark cartilage too has been touted in IBD. Some studies support the use of bromelin as an anti-inflammatory, and surprisingly, certain properties of red-hot capsacin from cayenne peppers have led to research in its application to IBD. Certain short-chain fatty acids, especially butyrate, work well in colitis when administered orally or via enema.



Many vitamins and minerals play a supportive role in GI tissue repair, but since IBD impairs digestion and absorption, a vicious cycle of nutritional decline can easily perpetuate itself. A very high percentage of IBD sufferers are malnourished. Statistics show many to be protein-calorie deficient. Many have fat-intolerance which results in essential fatty acid and fat-soluble vitamin deficiency. Many suffer from bleeding which leaves them iron-deficient. Diarrhea promotes depletion of water-soluble vitamins and essential minerals like zinc and magnesium.



Table 1:

Percentage Of IBD Sufferers Deficient In Key Nutrients

Crohn's Disease Ulcerative Colitis

Folic Acid 54-67% 36%

B12 48% 5%

Iron 39% 81%

D 75% N/A

Zinc 50% N/A



Research shows that some of the damage in IBD is caused by free radicals. Antioxidants can offer protection, but studies show many IBD sufferers to be deficient in critical free-radical scavengers like beta-carotene, C, E, zinc, and selenium.



Folic acid poses a particular problem in IBD because drugs commonly used to treat the disease like Azulfidine deplete folate. This is of particular concern since folic acid helps regenerate tissue and prevents transformation of chronically inflamed tissue to cancer. As many as 10% of ulcerative colitis sufferers ultimately develop colon cancer. High-dose folate can act as a preventative.



Difficulties arise, too, from overzealous supplementation even though patients may be lacking critical nutrients. High doses of C and minerals like zinc and magnesium can irritate the intestines and worsen diarrhea. Iron is often poorly tolerated, and its direct introduction into the intestines may paradoxically worsen disease by promoting free radicals locally.



The solution is slow, gradual repletion of nutrients by mouth, sometimes with a boost from intravenous "drips" of C, magnesium, B vitamins, zinc, selenium, and glutathione. Energy can thus be rapidly restored and healing can be facilitated by bypassing impaired intestinal absorption.



Putting "good" bacteria back into the intestines can also enhance recovery. Supplements of acidophilus, bifidus and sacchromyces boulardi (a digestive flora frequently used in Europe) can restore bowel function to normal. Experimental work is now underway with medically-administered specific "inoculations" of beneficial flora via enema.



In conjunction with traditional Chinese herbs, acupuncture is sometimes administered for intestinal diseases. Some of my patients report this is most helpful for alleviating symptoms of exhaustion, pain, and spasm and marshalling the body's own healing forces.



External treatments like castor oil packs were often advocated by Edgar Cayce in his readings on Crohn's Disease and ulcerative colitis. Castor oil is also known as palma Christi, or literally, "the hand of Christ," because of its superb healing properties.



Many patients with IBD are adrenally-suppressed due to frequent treatments with prednisone, with the result that they are chronically fatigued and vulnerable to stress, infection and allergy. Partial alleviation can be accomplished with a prescription of DHEA, an adrenal hormone often found to be deficient in IBS sufferers.



Recent research indicates that regeneration of damaged intestinal mucosa can be hastened with a substance called epithelial-derived growth factor (EDGF).Bioengineered EDGF may eventually be prescribed for Crohn's Disease and ulcerative colitis, but present-day sufferers may gain access to its benefits in natural form with over-the-counter "glandulars" rich in duodenal extract from animal sources.

on September 21 2002 01:00:32 · 5 Comments · 4255 Reads ·

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