Key proteins that cause Celiac disease discovered

Saw a few articles (ABC News, Geek System) about a study in Melbourne that identified several proteins that cause Celiac Disease. There are apparently three or four different protein fragments that can trigger the disease. Celiac is caused due to an allergic reaction to these proteins. The researchers hope to create an immunotherapy treatment where patients can build up immunity to those proteins. Very interesting development and certainly gives hope for the more than 2 million people in the US that suffer from the disease.

Here's an excerpt about the potential immunotherapy treatment:

Professor Anderson says the findings are being used to develop a new class of drugs, called peptide-based immunotherapy.

This involves injecting patients with a small amount of the toxic peptides to "desensitise" their body to them.

The researchers say the first phase of trials of the therapy to assess safety and tolerability were completed in June, and final results are expected in coming months.

Definitely great news.

Amy Proal on Viral and Bacterial Metagenome

Just watched a really interesting talk by Amy Proal about how the interaction and symbiosis (i.e. reinforcing relationship) between bacteria and viruses could lead to autoimmune disorders by interfering with Vitamin-D receptors (VDR's). I've embedded the video below, but here's a link to the post. It looks like she's working on some really interesting research.

The idea is that autoimmune disorders are caused by multiple bacteria and viruses working together to suppress the immune response. This causes a vicious cycle as it supports additional bacterial and viral infection. She suggests that traditional therapies like immunosuppression (which I have mentioned repeatedly seems counterintuitive) may actually prolong and worsen diseases in the long run. They have been working on alternative therapies that are meant to boost the innate immune response. Her blog seems pretty interesting as well, so worth a look as well: http://bacteriality.com/.

Combination Drug Therapy for Crohn's

Read a few articles (USNews, WebMD) about a new study that showed that a combination of azathioprine and biologics are more effective in treating Crohn's Disease than taking each individually in succession. Normally doctors treat Crohn's by prescribing steroids. If steroids don't work, doctors will move on to azathioprines and then finally biologics if the other two don't work.

Here's an excerpt:

Doctors now start treatment of Crohn's disease with steroids, Sandborn said. If the steroids do not provide relief from the abdominal pain, nausea, fever, weight loss, diarrhea and othersymptoms of the condition, the next step is to use azathioprine, which reduces immune system activity broadly. Only if that fails will they try biologics, newer treatments that include monoclonal antibodies such as infliximab (Remicade). These drugs target a specific part of the immune system.

The trial showed that the azathioprine-alone step should be skipped. "This study suggests that the therapy that follows steroids should include a biologic," Sandborn added.

Therapy with both azathioprine and infliximab appears to be the treatment of choice if steroids are not effective, Sandborn said.

"What this trial shows is that the most effective strategy is combination therapy," he said.

Definitely an interesting finding and good that doctors are finding a more optimal way to treat with traditional medicine.

Faces of Low Dose Naltrexone: New Book Explores Cutting-Edge Autoimmune Disease Treatment

I saw this blog post on About.com regarding an e-book that someone published summarizing many of the findings related to low-dose naltrexone (LDN). I haven't read through it yet, but just bookmarking it to review later.

This slide caught my eye while I was skimming through the document. It's a summary of the mechanism of how LDN works:

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?

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."

Entocort and Budesonide

I came across a good video describing how EntocortEC works. Entocort is a corticosteroid formulated to localize its effect on the ileum and ascending colon through a delayed release mechanism. Most Crohn's disease patients have the majority of inflammation in that area, hence it is meant to be a targeted drug. Because of the targeted delivery mechanism, it is mostly metabolized before it has a chance to reach the rest of the body, limiting the side-effects that many other cortiosteroid drugs (like prednisone, etc.) can cause.

The specific drug used in Entocort is budesonide. I was quite surprised to find that it is also used to treat rhinitis (nasal inflammation).

Stem Cell Treatment for Crohn's

In skimming through some of the forums on CCFA.org, I saw someone mention a treatment option involving stem cells. A quick Google search revealed this article. Researchers in Barcelona, Italy, and the US have treated a handful of patients with promising results - with 80% achieving remission after being followed for 6 years after their treatment. The basic idea is to "reset" your immune system by 1) destroying all of your leukocyte cells (i.e. immune-system cells) via chemotherapy so that you can then 2) replace them all via a stem cell transplant. The premise is that the leukocyte cells you currently have are not working properly - i.e. they are incorrectly attacking microflora in your gut causing inflammation - and hence you need to get rid of all of them and re-build all your immune cells from scratch.

From the article it sounds like they only try this on patients that don't respond to medication or surgery, so it's kind of a last resort. And from the sound of it, it really should be. Sounds extreme.

Dr. Whitaker on Natural Remedies

Just read through Dr. Whitaker's website and his page on digestive health. He has a page on treating diarrhea using natural remedies. Here is the abbreviated list of what he recommends:

• Drink plenty of water
• Add soluble fiber (the kind in fruits and legumes)
• Replenish the beneficial bactera (probiotics)
• Take digestive enzymes
• Eliminate foods you may have allergies to (perhaps via the Specific Carbohydrate Diet)
• Take the herb Una de gato (cat's claw)

One of the products offered on his website is PearlBiotics. It is a specially formulated probiotic supplement (in tablet form) that has a special coating (made in Japan) that allows the bacteria to survive the stomach so that they make it alive to the intestines.

Probiotics

I'm reading up on probiotics. Here are a collection of good articles on the topic with some interesting findings. There are numerous health benefits associated with probiotics (outlined in all of the articles below). But then again, the name itself means that the agent produces some benefit in the host, so by definition it must have health benefits.

Background and findings

• Wikipedia article "Probiotic" - includes a history of how probiotics were discovered and research and a list of strains
• NIH - "An Introduction to Probiotics" - covers much of the same stuff
• Life Extension Magazine - "Optimizing Digestive Health" - this is a fantastic article and highlights the benefits of BACILLUS COAGULANS. Although many people take probiotics supplements, much of the effort can often be wasted because those probiotics are not able to survive and colonize in your gut. Part of the reason is that natural food sources with live cultures (e.g. yogurt) are often on the shelf too long. With supplements, many bacteria are not able to make it through the manufacturing process. Dead bacteria, no matter how many make it to the intestines, don't really help. The goal is to have colonization in the gut. Bacillus coagulans is a probiotic bacteria that is able to survive through the harsh conditions of the stomach to make it to your intenstines. It then quickly multiples via spores to colonize the intestines. An additional benefit of the bacteria is that it produces lactic acid which aids in digestion and helps to kill off other pathogens. For those three reasons, it is a superior probiotic to other alternatives.

Natural Food Sources:

• eHow article - "Food Sources of Probiotics" -

From reading all this, it seems that the tablet form of Bacillus coagulans is worth a try, as is continued inclusion of natural forms of probiotics in the diet (yogurt, kimchi, etc.).

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.