Inflammatory Bowel Disease
By Joel Fuhrman, M.D. www.drfuhrman.com
Recovery Is Possible Through Aggressive Dietary Modifications.
Ulcerative colitis and Crohn’s disease are the two inflammatory bowel diseases. Inflammatory bowel diseases are autoimmune illnesses, where the lining of the digestive tract becomes the site of the autoimmune attack and becomes inflamed. Other autoimmune diseases are lupus, psoriasis, and rheumatoid arthritis—where the skin, kidney, or joints are the sites of autoimmune attack. Diarrhea, bloody stool, cramping, and pain are common symptoms of inflammatory bowel disease.
Ulcerative colitis primarily involves the distal colon, but when more severe, the entire colon can be involved. Crohn’s disease can involve both the small and large intestines. But unlike the inflammation associated with colitis, which tends to involve entire general areas, the inflammation associated with Crohn’s typically affects individual, discontinuous segments of the intestines.
Inflammatory bowel disease (IBD) is extremely traumatic and distressing to live with, and the therapies utilized are most often inadequate or toxic.
Hope For Recovery
This newsletter contains valuable and potentially lifesaving information about controlling, reversing, and removing IBD with nutritional interventions, while avoiding the highly toxic immune-modulating drugs used by physicians.
I will describe the aggressive dietary modifications I have used to help hundreds of patients, from those whose symptoms were relatively mild to those whose conditions were so severe that their doctors had recommended surgical removal of their colons.
Patients need to know that it is possible to improve and even eventually resolve inflammatory bowel disease (IBD). It takes time and commitment to dietary excellence, but the potential rewards are great.
Before I describe my methods, let’s take a look at conventional medical care for IBD as well as some other approaches.
Conventional Medical Care
Because IBDs are autoimmune diseases that involve recognition and attack by our own immune system’s T cells, standard therapy includes immune system suppressing drugs such as prednisone, Imuran and 6- MP, which have significant ,even life shortening side effects. Aminosalicylate derivatives, such as Asachol, Rowasa and Pentasa, are poorly absorbed anti-inflammatory drugs that have significantly fewer side effects and lower toxicity compared to the other medications, but they do not halt the autoimmune attack and, by themselves, are not sufficiently effective for the more serious cases. Remicade, a very effective newer drug, is one of the most toxic drugs in the medical arsenal and has a high risk of promoting cancer after years of use. Its use is reserved for the more severe, unresponsive cases of IBD, especially advanced Crohn’s. Many patients still require surgery to remove heavily diseased areas, and some patients who fail drug therapy require surgical removal of their entire colon.
Newer, more selective biologic agents such as monoclonal antibodies are in research trials, but these also are not without side effects.
The least toxic option and one of the most effective emerging therapies is the ingestion of whipworms. Data from pilot studies and now clinical trials in progress reveals that ingesting a solution containing thousands of eggs of Trichuris suis, the so-called “whipworm”(named for its whipping tail) commonly found in the intestines of pigs, has been effective. Each dose contained about 2,500 live whipworm eggs, harvested at a USDA laboratory.
This microscopic worm does not live very long in humans and does no harm. During the initial treatment and observation period, all of the patients showed evidence of improvement, defined as improved scores in a quality- of-life questionnaire and as a drop in- symptoms score. The researchers have yet to detect any side effects in any patient. Apparently, these types of worms have an immunosuppressive effect on the bowel and reside in the intestinal lumen without harm or symptoms in humans. I can envision using these worms, instead of more toxic drugs in the future, especially in those cases where nutritional intervention is not enough to induce remission.
An elemental diet is a hypoallergenic, protein-free, artificial diet consisting of essential amino acids, glucose, trace elements, and vitamins. Elemental diets have been used widely in the treatment of inflammatory bowel disease, especially with the management of Crohn’s disease. These diets attempt to provide essential nutrients and contain protein only in the form of free amino acids. They help because they contain no sensitizing food antigens or fibers, are lower in fat, are easily absorbed, and do not contain the residue that may irritate an inflamed bowel lining. However, because these diets are totally devoid of immune- supporting phytochemicals, they promote rather than relieve immune system dysfunction and patients invariably relapse once the therapy is halted.
Dietary Triggers Of IBD
A great many factors lead some to conclude that diet plays an important role in the etiology of IBD. Experts have observed an increased incidence of IBD in urban areas, and some believe that this may be due in part to the fact that urban diets have features that trigger an immune-mediated inflammatory response. Recent studies have implicated childhood diets low in fresh fruits and vegetables in the etiology of IBD.1
Studies have documented that IBD is related to increased free radical activity and a deficiency of antioxidants and phytochemicals (found most abundantly in fresh vegetables and fruit) in the cells of the bowel.2 Reestablishing a cell climate that is rich in protective nutrients through a high intake of green juices and green soups is a critical part of the nutritional care of all autoimmune diseases, and IBD is no exception.
Microparticles Found In Processed Foods
Microparticles (such as titanium dioxide and aluminosilicates) used in processed foods such as baked goods, desserts, and pancake mixes are known excitatory triggers for inflammatory bowel disease. Microparticles combine with bacterial components in the intestine and form antigenic particles.3 Microparticles also have been associated with other disease processes such as asthma, and it has been shown that a microparticle-free diet is helpful in IBD and decreases inflammation and disease activity.4
Sucrose, Fructose, Fats And Oils
Sucrose, commonly found in table sugar, may adversely effect those with IBD. It is critical that patients with IBD avoid sugar and concentrated sweeteners. Studies that have compared the eating habits of those with IBD and those without it have shown that affected persons consume a higher amount of sucrose and refined carbohydrates. Interestingly, a high intake of fructose (commonly found in fruits) was not associated with IBD. Complex carbohydrates (starches) show no association with IBD in scientific studies; however, there is a subset of people with fructose intolerance and a subset of people sensitive to grains, including corn, rice, and all gluten containing grains.
It is important to note that “fructose intolerance” is a general term that describes two possible conditions:
Hereditary fructose intolerance is a rare genetic disorder. People with hereditary fructose intolerance lack an enzyme that breaks down fructose. This is a serious disorder that can lead to liver and kidney damage if not detected early in life.
Fructose malabsorption is a digestive disorder. People with fructose malabsorption have difficulty digesting fructose. This is a less serious disorder because it doesn’t result in liver or kidney damage, but it can cause abdominal pain, nausea, bloating, and diarrhea.
Besides flours and sugar, studies also have shown that diets high in animal fat and oil predispose susceptible individuals to IBD.5 Fried foods are particularly risky for IBD patients, and epidemiologic research also has linked IBD to the consumption of fast foods where recycled cooking oil is often used.6 Alcohol, burgers, and soft drinks have been shown to be linked to heightened disease activity in colitis patients, and red meat and processed meats have been implicated again and again.7
Dietary fat and especially long chain triglycerides that are not well absorbed have been found to worsen IBD. Lots of long-chain triglycerides are found in meat and in safflower and soybean oil. Processed oils promote inflammation of the bowel. Studies have shown that low fat diets with supplemental omega-3 fats are superior to higher-fat diets in the induction and maintenance of remission.8
Fried potatoes may be particularly harmful as studies have indicated that the prevalence of IBD correlates well with the consumption of fried white potato products. White potatoes have a high concentration of glycoalkaloids. These molecules can injure cell membranes in genetically sensitive individuals, altering the intestinal epithelial barrier. These glycoalkaloids are concentrated when potatoes are fried, and the heated oils synergistically aid in the damage by creating increased intestinal permeability. The sensitivity to glycoalkaloids in potatoes is not present in all IBD patients and is genetically determined.9
1. Amre DK, D’Souza S, Morgan K, et al. Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children. Am J Gastroenterol 2007;102(9):2016-2025.
2. D’Odorico A, Bortolan S, Cardin R, et al. Reduced plasma antioxidant concentrations and increased oxidative DNA damage in inflammatory bowel disease. Scand J Gastroenterol 2001; 36(12):1289-94.
3. Mahmud N, Weir DG. The urban diet and Crohn’s disease: Is there a relationship? Eur J Gastroenterol Hepatol 2001;13:93-95.
4. Lomer MCE, Harvey RSJ, Evans SM, et al. Efficacy and tolerability of a low microparticle diet in a double blind, randomized, pilot study in Crohn’s disease. Eur J Gastroenterol Hepatol 2001;13:101-106.
5. Sakamoto N, Kono S, Wakai K, et al. Dietary risk factors for inflammatory bowel disease: a multicenter case-control study in Japan. Inflamm Bowel Dis 2005;11(2):154-63.
6. Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case-control study. Epidemiology 1992;3(1):47-52.
7. Magee EA, Edmond LM, Tasker SM, et al. Associations between diet and disease activity in ulcerative colitis patients using a novel method of data analysis. Nutr J 2005;4:7.
8. Cabre E, Gassull MA. Nutritional and metabolic issues in inflammatory bowel disease. Curr Opin Clin Nutr Metab Care 2003;6:569-576. Bamba T, Shimoyama T, Sasaki M, et al. Dietary fat attenuates the benefits of an elemental diet in active Crohn’s disease: a randomized controlled trial. Eur J Gastroenterol Hepatol 2003;15:151-157.
9. Patel B, Schutte R, Sporns P, et al. Potato glycoalkaloids adversely affect intestinal permeability and aggravate inflammatory bowel disease. Inflamm Bowel Dis 2002;8:340-346.