Crohn's Disease and Colitis

Discussion

Inflammatory bowel disease is of two main types, sometimes occurring together; these are Crohn's disease and ulcerative colitis. The whole problem is extremely complex, and it is not known with certainty what the basic causes are. There is a difference between Crohn's disease and ulcerative colitis, in that Crohn's is characterised by inflammation through the entire thickness of the intestinal wall, whereas colitis affects mainly the surface. Crohn's disease occurs mainly in the small intestine, but can occur in the colon.

Symptoms

Crohn's Disease

¨ Weight loss, abdominal bloating and flatulence, anorexia, extreme fatigue, mild fever and intermittent diarrhoea, abdominal tenderness.

Ulcerative Colitis

¨ Abdominal cramps, mild abdominal tenderness, weight loss, fatigue, diarrhoea.

Causes

The causes are not known, but are generally thought to be:

¨ Infectious agents

¨ Immune dysfunction

¨ Dietary factors

¨ Recently, MMR (Measles, Mumps, Rubella) vaccinations have been heavily implicated.

Infections

Various infectious agents have been suggested; viruses, bacteria, fungi, and various parasites. A bacterium, Bacteroides Vulgaris, is particularly implicated in Crohn’s disease.

Immune dysfunction

There is much debate whether immune system disturbances are involved with inflammatory bowel disease, but we cannot see any doubt, considering that the immune system is involved in resistance to infection and allergic and inflammatory reaction. It seems to us that immune reactions are the major part of IBD.

Dietary factors

There is overwhelming evidence that dietary factors are a major cause of IBD. The problem is virtually non-existent in cultures consuming "primitive" diets, but is growing to epidemic proportions in the Western world. A majority of people with IBD have been found to have a high consumption of sugar and other refined carbohydrates and low consumption of fruit and vegetables. Anyone consuming such a diet will also consume large amounts of carrageenan (E407), used in most jellies, ice cream, salad cream, some sauces and some commercially prepared soups. This may be more important than the high-sugar diet.

Therapy

L-Glutamine

It is probable that the amino acid L-glutamine is the most important factor in treating IBD. The mucosal lining of the intestine is the most dynamic collection of cells in the body. The entire lining is replaced every 3-6 days, including the immune cells resident in it. L-glutamine is the main fuel. The huge replacement rate takes a lot of fuel, and if there is insufficient L-glutamine available, replacement falters, causing gaps in the mucosal barrier and in the intestinal walls themselves. The resultant condition is known as "leaky gut syndrome". The combination of incomplete mucosal barriers, weak intestinal walls and reduced numbers and activity of immune cells allows permeation of pathogens, and also allergy-causing particles, into surrounding tissues and into the bloodstream.

Crohn's patients often have to take all their nutrition intravenously, but in a 1992 study in Boston, using added L-glutamine, people were able to begin eating normally. Because of its tendency to cause constipation, L-glutamine will reduce diarrhoea.

Fatty acid balance

The modern diet is deficient in essential fatty acids, which help form the structure of all cell walls. Deficiency will therefore cause weak structures in all tissues. Another function of the essential fatty acids is the production of prostaglandins; hormone-like substances which control many bodily functions. There are two main groups; omega-3 and omega-6, which should be in balance. The omega-3 group lead to less inflammatory leukotrienes.

A particular fatty acid, arachidonic acid, is implicated in inflammatory processes. This is found mainly in meats, which should therefore be reduced.

Carageenan (E407)

This seaweed extract is an ideal growing medium for Bacteroides Vulgaris, a bacterium heavily implicated in Crohn's disease, and should therefore be avoided.

Nutrient deficiencies

Nutrient deficiencies almost invariably result from IBD. This is caused by two main factors:

¨ The pain, diarrhoea, nausea and general discomfort felt after a meal tends to reduce the amount eaten. This reduces calorie intake, with resultant erosion of tissues in order to make up the shortfall in fuel requirements. This particularly uses up L-glutamine.

¨ Malabsorption results from inflammation, particularly of the small intestine. Fat-soluble vitamins and minerals are particularly affected, fat-soluble vitamins because of poor bile secretion, and minerals because of the diarrhoea; zinc is particularly affected.

This creates a vicious circle; vitamin A and zinc are especially important in healing of surface tissues, and these are particularly depleted by the poor condition of the intestinal surfaces. Zinc deficiency also causes loss of appetite.

Treatment

Supplements

¨ Zinc picolinate; total of 40mg including that in multivitamin and multimineral.

¨ Calcium ascorbate or Ester-C 2x1000mg per day. (Non-acidic forms of vitamin C)

Phytonutrients

¨ Aloe Vera juice; according to instructions (strength varies). Aloe vera has powerful healing effects on skin surfaces, including those lining the intestinal walls.

¨ Oregon Grape: This herb has powerful effects against bacteria, fungi, parasites such as amoebae and to a lesser extent viruses.

¨ Celadrin: This recently developed supplement has strong anti-inflammatory effects and also aids the absorption of nutrients to rebuild cells. Will help the rebuilding effects of L-glutamine.

Diet

¨ Reduce animal proteins; particularly red meats, in order to reduce arachidonic acid consumption.

¨ Avoid common allergens; i.e. milk products, tomatoes, citrus fruits and juices and wheat products.