Life Extension Foundation Research on IBD

I just read through this excellent article from Life Extension Foundation on inflammatory bowel disease, including Crohn's disease and ulcerative colitis. Citing the latest research, they provide background on each to the diseases, complications associated with each, treatment options, and then outline recommendations on how to manage them.

They summarize their recommendations at the end of the post:

Life Extension Foundation Recommendations

First-line therapy for inflammatory bowel disease involves lifestyle changes and supplementation with valuable nutrients. A strong multivitamin is recommended to provide the basic nutrition needed. It is important to reinoculate the intestine with beneficial bacteria. Also, patients should be aware that many people with inflammatory bowel disease are anemic to some degree and should carefully monitor their iron levels. If iron levels are low, supplementation with iron is recommended. A standard dose is 15 mg/day of elemental iron. Inflammatory bowel disease is also strongly associated with elevated homocysteine levels. Blood testing is recommended to make sure homocysteine levels remain in safe ranges. For more information, see the chapter Homocysteine.

People who have Crohn's disease may respond to the 4-R Program:

1. Remove all suspicious and proinflammatory foods, including processed foods and refined sugar. Also, foods high in saturated fat and trans fat should be removed. Instead, focus on intake of healthier fats, such as olive oil.
2. Replace any missing nutrients with a high-potency multivitamin (and other nutrients as needed).
3. Reinoculate the intestine with beneficial bacteria by taking L acidophilus and L bulgaricus with fructose oligosaccharides.
4. Repair the inner wall of the damaged intestine with supplements that have been shown to support the integrity of the intestinal wall itself, including glutamine, zinc, vitamin C, and fructose oligosaccharides.

Specific supplements that have been shown to help reduce the symptoms associated with inflammatory bowel disease include:

• Glutamine—1000 to 3000 milligrams (mg)/day
• Probiotics—300 mg, three times daily, of Life Flora, or 900 mg, three times daily, of Primal Defense. Both products contain beneficial bacteria. It's suggested to start with a single dose and gradually add more.
• Zinc—30 mg/day
• Vitamin C—1000 to 3000 mg/day
• Vitamin E—400 International Units (IU)/day with at least 200 mg of gamma-tocopherol
• Vitamin K—10 mg/day
• Vitamin B complex—A complete B-complex vitamin that includes high potencies of all the essential B vitamins including B1, B3, B6, and B12
• Selenium—200 micrograms (mcg)/day
• Arginine—1800 to 5400 mg/day
• Butyrate enemas—Two enemas a day are suggested for patients who have ulcerative colitis or Crohn’s disease that affects their lower colon.
• EPA/DHA—At least 1400 mg/day of EPA and 1000 mg/day of DHA
• Gamma Linolenic acid (GLA)—900 to 1800 mg/day
• Ginger extract—250 mg/day
• Soluble fiber—5 to 15 grams (g)/day during remission periods
• DHEA—Start with 15 to 75 mg (in 3 to 6 weeks have blood tested to make sure optimal blood levels are maintained)
• Folic acid—800 micrograms (mcg)/day (in addition to the folic acid that is in the B-complex vitamin)

Because of the association between inflammatory bowel disease and osteoporosis, people with inflammatory bowel disease are encouraged to carefully monitor their bone density. For more information on supplements that can help prevent osteoporosis, see the chapter Osteoporosis.

Also, based on the association between colitis and colon cancer, patients are encouraged to closely monitor their colon health through regular screening. For more information on colon cancer screening and prevention, see the chapter Colon Cancer. Supplementation with folic acid and vitamin B12 (800 mcg of folic acid and 300 mcg of vitamin B12) has been shown to reduce the risk of colon cancer.

I thought the 4-R program was particularly useful. They expand on that in the body of the article:

The 4-R Program for Crohn’s Disease

The following steps are recommended to help patients with Crohn's disease first reduce their symptoms and then begin long-term repair of the damage caused by their disease:

• Remove. Remove all suspicious foods from the patient's diet that precipitate inflammation. The following are the most likely to be troublesome: dairy, eggs, nuts, fruit, tomatoes, corn, wheat (or gluten), and red meat. All refined carbohydrates should be removed. All fats except for essential fatty acids should be eliminated, because hard or trans fats are detrimental to people with Crohn's disease (Heckers H et al 1988; Lorenz-Meyer H et al 1996). Products such as Vivonex®, UltraMaintain®, or UltraClear® can be used at the outset. UltraClear® is preferable because it contains sufficient fiber to maintain regular bowel evacuation. Removal of gastrointestinal parasites, undesirable bacteria, or fungal elements is important.
• Replace. The diets of most patients who have inflammatory bowel disease are nutritionally imbalanced. Replacement of vital nutrients consists of a good multivitamin, together with minerals that are lacking. The vitamins that most patients with inflammatory bowel disease lack are the B-complex vitamins such as folic acid and vitamin B6, and particularly vitamin B12 (Rogler G et al 2004). Iron and calcium deficiencies are frequently found in patients with Crohn's disease (Capurso G et al 2002; Lomer MC et al 2004; Siffledeen JS et al 2003), as well as deficiencies in zinc, protein, vitamin D, and folic acid (Rath HC et al 1998; Siffledeen JS et al 2003). Patients with Crohn’s disease are usually under increased oxidative stress and have lower levels of antioxidant vitamins. Supplementation with vitamins C and E reduces oxidative stress (Aghdassi E et al 2003). Long-term use of corticosteroids warrants the inclusion of supplemental calcium and vitamin D to prevent corticosteroid-induced osteoporosis.
• Reinoculate. A normal healthy intestine contains 5 to 7 pounds of friendly bacteria, the good bacteria that are responsible for manufacturing some vitamins and cell food in the intestine. In a diseased intestine, these bacteria are not present in adequate amounts or are absent, having been replaced by pathogenic organisms or yeast overgrowth. Reinoculation consists of taking mixtures of the friendly bacteria Lactobacillus acidophilus andLactobacillus bulgaricus along with fructose oligosaccharides to promote continued repopulation with these beneficial bacteria (Fedorak RN et al 2004). Inhibition of pathogens by lactobacilli follows the lowering of pH through liberation of acids, resulting in an antimicrobial action. Stool samples provide information regarding these overgrowth factors, pH, and the balance of fatty acids.
• Repair. Frequently the lining of the small intestine becomes permeable, allowing antigens and other incompletely digested products to pass through the bowel wall. Repair of the protective layer consists of adding nutrients such as pantothenic acid (vitamin B5), zinc (Cario E et al 2000; Kapp A et al 1991; Weimann BI et al 1999), fructose oligosaccharides, and vitamin C to build up the integrity of the intestinal wall itself.

Great article. I'll likelly be summarizing other aspects of this article in future posts.