Reduced Diversity of Faecal Microbiota in Crohn's Disease

Another research study (related to previous posts) found that:

... a reduced complexity of the bacterial phylum Firmicutes as a signature of the faecal microbiota in patients with CD. It also indicated the presence of new bacterial species.

The question is why is there less of that bacteria? Overgrowth from other bacteria? Lack of exposure to that bacteria? Hyper-immune response to that bacteria that result in immune imbalances due to the reduction in modulating or regulating effects of the bacteria?

Another interesting thing to follow-up on: small bowel bacterial overgrowth syndrome. Could there be a relationship with Crohns?

Localized Dysbiosis of lactobacilli and the Clostridium leptum Subgroup May Be Related to UC

This study (related to my previous post) highlights how there is localized dysbiosis (i.e. bacterial imbalances) in ulcerative colitis patients. Specifically, the lactobacilli and Clostridium leptum subgroups are lower than expected.

Also, the concentration of these bacteria were actually different within the same patient from site to site within their colon.

Here's the excerpt:

The data revealed that lactobacilli and the Clostridium leptum subgroup were significantly different between the ulcerated and the nonulcerated regions. It also was noted that for lactobacilli, the composition varied significantly between biopsy sites irrespective of the location of UC in the gut but that the composition of the Clostridium leptum subgroup showed significant differences between paired samples from UC in the rectum and not in the left colon. Localized dysbiosis of the mucosa-associated intestinal microflora, especially for lactobacilli and the Clostridium leptum subgroup, may be closely related to UC.

Lack of Faecalibacterium prausnitzii Bacteria May Contribute to Crohn's

Interesting research from last year.

Here's the text of the article:

Washington, Oct 21 (ANI): Lack of a specific bacterium in the gut may be a cause of Crohn’’s disease, an inflammatorygastrointestinal disorder, according to a team of French researchers.

Researchers from the Institut National de la Recherche Agronomique have highlighted the bug, Faecalibacterium prausnitzii, which they show secretes biochemicals that reduce inflammation.

The researchers have already shown that patients with Crohn’’s disease have a marked deficiency in bacteria from the Clostridium leptum group.

Now, their latest study shows that F. prausnitzii, a major component of this group, accounts for a large part of the deficit.

The researchers found that Crohn’’s patients who underwent bowel surgery were more likely to experience a recurrence of the condition if they had low levels of F. prausnitzii.

And in experiments on cultured cells, they showed that liquid in which F. prausnitzii had been grown provided an anti-inflammatory effect.

According to researchers, if the ongoing animal trials prove successful, human patients could benefit from a probiotic treatment with F. prausnitzii.

Dr Anton Emmanuel, medical director of the digestive disorders charity Core, agreed that the study raised the possibility of a therapeutic replacement therapy.

“It would be interesting to see how this finding relates to the emerging body of evidence looking at genetic changes in some patients with Crohn’’s disease, with the known abnormal gene being one that codes for the body’’s ability to recognise foreign bacteria,” BBC quoted Emmanuel, as saying.

The study appears in Proceedings of the National Academy of Sciences. (ANI)

Another quick article on the topic.

Some Interesting Blogs and Forums

Upon doing a Google search for "gaining weight on the Specific Carbohydrate Diet", I came across several pretty interesting blogs and forums. Here they are (short list):

• HealingWell.com Crohn's Disease Articles - array of articles on IBD and Crohn's
• HealingWell.com Crohn's Disease Forum - seems to be quite a bit of activity on there, including folks that are very well read up on the latest IBD research studies. I was pretty impressed by people's knowledge.
• Fanatical Adherence - blog from a young man on his attempt to have a "fanatical adherence" to the SCD diet. Interesting note, he regrets having taken himself off meds too soon as he developed a stricture in his colon as a result of excessive inflammation -- leading to a resection surgery. He continues his diet. He's 5'10" and at one point was as low as 115 lbs, but now a healthy 150 lbs. (Although, ominously, he hasn't posted anything in about a year).
• Living With Crohn's Disease - collection of blog postings via WordPress that cover a wide range of topics from the basics of the disease, to treatment options, to drug side-effects, to dealing with your doctor, etc.

Dr. Hoffman on Crohn's Disease and Ulcerative Colitis

I came across several great articles from Dr. Hoffman on the topic of IBD, specifically Crohn's and Ulcerative Colitis. Hoffman runs a center that combines both modern and natural medicines in treating illnesses. I'm still reading these articles, but they are so helpful I thought I would forward them on. I found the first article off of the scdiet.org website, which is also great. Not a coincidence that Hoffman wrote the foreword on the Breaking the Vicious Cycle book.

Here are links to a few articles:

• Crohn's Disease and Ulcerative Colitis - great article from 1995 that highlights the Specific Carbohydrate Diet and even new therapies like low-dose naltrexone
• Addressing inflammatory bowel disease - includes a very long list of treatment options with discussion of each
• Candida - discussion of candida overgrowth / infections and its link to IBS. This is why I am currently drinking Chamamille tea (as it is an anti-fungal).
• Inflammatory bowel disease update - similar to the first article listed above, but also includes a few success stories that are quite interesting (all involving IV treatment which I had not thought of)
• How Does Dr. Hoffman Treat Crohn's and Ulcerative Colitis? - discussion of treatment approach that Dr. Homman might take (excerpt included below)

And here's a sample of a treatment program:

An example of our treatment program is described below.

TESTING:
IgG RAST food panel, Candida antibodies, anti-gliadin antibodies, Vitamin D, B12, folic acid, homocysteine, zinc, iron, ferritin, testosterone (healing in men), and DHEA (healing in both sexes)

DIET:
Specific Carbohydrate Diet (tailored to reflect results of IgG RAST)

SUPPLEMENTS:
SCD-Compliant Probiotics, Vitamin D, Enteric-coated Fish Oil, EGCG, Curcumin, Zinc, L-glutamine, Methylcobalamin, Methylfolate, DHEA

OTHER THERAPIES:
Low-dose Naltrexone, Chrohn's/Colitis intravenous "drips", antifungal medication (Nystatin, Diflucan, etc.), bio-identical testosterone

There was a very long list of potential therapies and supplements in the above articles that I will likely be investigating more and experimenting with myself. His services don't seem too expensive, but he doesn't accept any forms of insurance, so its all out of pocket. They appear to have offices in Manhattan (New York) only.

Dr. Whitaker on Crohn's Treatment Options

I mentioned that Dr. Whitaker recently commented in his newsletter on the latest treatment options for Crohn's. I thought I would post that here:

A reader wrote in and asked:

Would you supply me with whatever information you have on dealing with Crohn's disease? I have had it for 36 years and they want to do surgery and remove my large bowel. I don't want to go that route. Any nutritional information you can give me would be helpful. --Pastor David, NE

Dr Whitaker wrote back:

The first thing I would recommend isn't a nutrient but a safe, effective drug that your doctor probably doesn't know about: LOW-DOSE NALTREXONE (LDN). In a recent pilot study, Jill Smith, MD, of the Pennsylvania State College of Medicine treated patients with Crohn's disease with 4.5 MG of LDN at bedtime for 12 weeks, and then followed them for an additonal month. Eighty-nine percent of the participants responded to LDN, and 67 percent went into remission. Dr Smith is now conducting a large phase II placebo-controlled trial of LDN involving children with Crohn's. To learn more vist lowdosenaltrexone.org

Diet modifications are also helpful. But now, you likely know what foods exacerbate your symptoms. If you aren't sure, try eliminating common problematic items such as milk, gluten, citrus, tomatoes, additives, preservatives, sugars, and starches.

Crohn's is associated with poor nutritional status, which means a good daily multivitamin is essential. Correcting vitamin D deficiencies alleviates symptoms in some patients, so make sure you get adequate sun exposure and talk to your doctor about testing your blood level of vitamin D (25(OH)D). If its below 50 ng/mL, take enough supplemental vitamin D to bring it into the optimal range.

Other supplements with proven benefits for Crohn's disease include aloe vera (I've heard good things about AMP Floracel and Digestinol), the amino acid glutamine, fish oil, curcumin extract (10% of tumeric is curcumin and 90% something else), and probiotics. Look for these supplements in your health food store or call (800) 810-6655 to order.

To read more about Crohn's, visit the Subscriber Center at drwhitaker.com. I truly hope these suggestions will improve your condition. Give them a try and let me know how you're doing. -- JW

To list those out:

• Low Dose Naltrexone
• Diet modifications
• Daily multivitamin
• Vitamin D
• Aloe vera
• Glutamine
• Fish oil
• Curcumin extract
• Probiotics

Low Dose Naltrexone (LDN) Could Help in Treating Crohn's

In a recent Dr. Whitaker newsletter, Whitaker discussed some of the natural or alternative treatment options for Crohn's sufferers. The one that caught my eye was Low Dose Naltrexone (LDN). Naltrexone is an FDA approved drug from 1984 that has been used to help people overcome their addiction to herion and opium addictions. For that use, the drug is given in 50mg doses and helps to block the effects of the drugs. Researchers have been experimenting with lower dose uses (e.g. 3 - 5mg) of the drug to treat a variety of immune disorders from cancer to Crohn's with very promising results.

The drug works by boosting the immune system. Specifically, LDN increases the body's production of endorphins and enkephalin. These opiods apparently have some regulating effect on the immune system (although the exact effect appears to be unknown). From what I've gathered, there are other immune therapies, such as acupuncture, that may have a similar effect. Acupuncture, for instance, likely triggers the release of endorphins as well.

The recent study conducted at Pennsylvania State University to use LDN for Crohn's therapy used 4.5mg at night before bedtime and had great results. The positive results prompted additional NIH funding to proceed with clinical trials.

Another source of info (in addition to Wikipedia) is this website: http://lowdosenaltrexone.org/. It includes information on how and where to get low-dose naltrexone. Naltrexone is already widely available, but you need to get it altered to put it in low-dose form. There are a limited number of pharmacies that do this.

Another thought that this treatment prompts is that this treatment works in direct opposition to most traditional therapies. While most prescription drugs are meant to stop the immune system (i.e. immunosuppressants like Entocort or Prednisone), this treatment is meant to boost the immune system. Which way is right?

Low-carb, high protein diet

I came across this via another web search. It's off of a ministry website. Perhaps the pastor is really into health? Here's the link to the diet. I only skimmed it, so will have to read it in more detail another time. There is a lot of content. Unclear how much of it is opinion vs. real research.

Glutamine helps heal stomach ulcers

I came across a short article in Life Extension titled "Glutamine helps heal stomach ulcers" and thought it might be useful for dealing with Crohn's inflammation as well. Might be a stretch, but worth a try to add L-Glutamine (perhaps 500-mg per day) to see if there is any benefit.

Here is the text of the article:

In the May, 2009 of the Journal of Nutrition, researchers from Beth Israel Deaconess Medical Center and the Massachusetts Institute of Technology report that the amino acid glutamine could help heal the damage caused by H. pylori, the bacteria that causes stomach ulcers and many cases of stomach cancer.

In earlier research, Susan Hagen, PhD and her colleagues discovered that glutamine prevented the death of cultured stomach cells from H. pylori-produced ammonia. For the current experiment, they divided 105 mice to receive standard diets or diets in which L-glutamine replaced 5 percent of total calories. After two weeks, some of the mice in each group were infected with H. pylori. The animals were followed for 20 weeks, during which blood samples were analyzed for antibodies to immune cells that mediate the body’s response to H. Pylori. Additionally, tissue samples were obtained from the stomach and examined for damage, cancer progression and inflammation.

At the end of the 20 week period, infected animals that received L-glutamine had less inflammation than those that received the control diet. "Because many of the stomach pathologies during H. pylori infection are linked to high levels of inflammation, this result provides us with preliminary evidence that glutamine supplementation may be an alternative therapy for reducing the severity of infection," Dr Hagen explained.

"H. pylori bacteria infect more than half of the world's population and were recently identified as a Group 1 carcinogen by the World Health Organization," Dr Hagen added. "Approximately 5.5 percent of the entire global cancer burden is attributed to H. pylori infection and, worldwide, over 900,000 new cases of gastric cancer develop each year. The possibility that an inexpensive, easy-to-use treatment could be used to modify the damaging effects of H. pylori infection warrants further study in clinical trials."