|Amino Acid / Protein||Not recommended:|
| ||Although glutamine is known to play a role in small intestine function, in Crohn's disease at least two studies have shown it to be mildly harnful. [J Parenter Enteral Nutr 24:196, 2000]|
Probiotics / Fermented Foods
| ||Use of a good probiotic product can help keep the bacterial flora in balance and reduce inflammation. Caution is advised with active inflammation, as bacteria may penetrate the gut wall and enter the blood stream.|
| ||See the link between Crohn's and Slippery Elm.|
Slippery Elm (Ulmus rubra)
| ||Slippery elm's soothing mucilage effect has been used for disorders of the gastrointestinal tract. It is part of the herbal combination called "Robert's Formula", which is widely prized by naturopathic physicians for such intestinal inflammations as gastritis, Crohn's disease, and ulcerative colitis. For digestive disorders, taking 500-1,000mg of powder tid is often recommended. It may be used in lozenge form as well.|
Chlorella / Algae Products
Dairy Products Avoidance
| ||Mycobacterium paratuberculosis (Para-T) RNA (a bacteria causing Johne’s disease in cows) was found in 100% of Crohn's disease patients, compared with 0% of controls.|
This bacteria becomes cultured in milk, and is not destroyed by normal pasteurization. Para-T crosses the species barrier to infect and cause disease in humans. Occasionally, the milk-borne bacteria will begin to grow in the human host, and irritable bowel syndrome and Crohn's disease results. The USDA estimates that 30% of America's dairy herds contain cows infected with Para-T.
| ||Fasting is an important element of treatment if a sustained remission is to be expected.|
| ||See the link between Crohn's and Sugar Avoidance / Reduction.|
Sugars Avoidance / Reduction
| ||Elaine Gottschall, author of Breaking the Vicious Cycle, has proposed that gut dysbiosis is a major cause of Crohn's disease, with small and large bowel fermentation being a key component. She has used a Specific Carbohydrate Diet (SCD) restricted in disaccharide sugars and devoid of cereal grains to alter gut flora. When digestion of carbohydrates such as starches and some sugars is impaired, these items are poorly absorbed. Yeast and bacteria can then overgrow in response to these newly available nutrients, increasing toxic by-products and mucus production, resulting in further injury to the small intestine and malabsorption. Digestion is worsened - thus "the vicious cycle". The purpose of the SCD is to deprive the microbial world in the small intestine of food it needs to overpopulate and irritate.|
Increased Fruit/Vegetable Consumption
| ||In one trial, patients (rather than doctors) were asked which foods aggravated Crohn’s disease symptoms. Those without an ileostomy said that raw fruit and tomatoes were among the most problematic foods, though responses varied from person to person, and other reports have come up with different lists. People with Crohn’s disease wishing to identify and avoid potential problem foods should consult a doctor.|
LDN - Low Dose Naltrexone
| ||As of September 2002, Dr. Bihari was following eight patients with Crohn's Disease on LDN. In all eight cases, within 14-21 days the signs and symptoms of disease activity stopped. All eight had remained stable since anywhere from 2 months to 36 months.|
Dr. Jill Smith’s original article, "Low-Dose Naltrexone Therapy Improves Active Crohn’s Disease," in the American Journal of Gastroenterology (2007;pp.102:1–9), officially presents LDN to the world of scientific medicine. Smith, Professor of Gastroenterology at Pennsylvania State University's College of Medicine, found that two-thirds of the patients in her pilot study went into remission and fully 89% of the group responded to treatment to some degree. She concluded that “LDN therapy appears effective and safe in subjects with active Crohn’s disease.”
The Promise Of Low Dose Naltrexone Therapy: Potential Benefits in Cancer, Autoimmune, Neurological and Infectious Disorders. By Elaine Moore, co-author SammyJo Wilkinson Foreword by Dr. Yash Agrawal, MD, PhD.
This is perhaps the first, and so far only book on LDN, and as such represents a milestone in the effort to bring LDN into mainstream use. Written by Elaine Moore, a high level science writer with a portfolio of previous accomplishments, her LDN book is perhaps somewhat technical and may be difficult for the untrained non-professional to follow. It delves into the sophisticated jargon of the medical research world. For example, in Chapter 5 on LDN and Cancer, there is a discussion of Zagon's work on Cyclin dependent kinases, P53 and protein 21 and how this relates to inhibition of cancer by LDN.
However, in addition to the esoteric technical sections of the book, there are also chapters devoted to the lay reader interested in learning how LDN can help them on a practical level. A listing of dispensing practitioners was included which I found contained my own office address and phone number.
The book is highly recommended for other health care practitioners who wish to get quickly up to speed in this new area of medicine which is destined to become the medical paradigm of the 21st century, casting a giant shadow over the rest of mainstream medicine.[ Comments on the LDN book by Jeffrey Dach MD]
Conventional Drugs / Information
| ||Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into two products: 5-aminosalicylic acid (5ASA), and sulfapyridine. There is some controversy as to which of these two products are responsible for the activity of azulfidine. Whereas it is known that 5ASA has therapeutic benefit, it is not clear whether sulfapyridine adds any further benefit. In the colon, the products created by the breakdown of sulfasalazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulfasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immune-suppressant effect as well. Following oral administration, 33% of the sulfasalazine is absorbed, all of the sulfapyridine is absorbed, and about 33% of the 5ASA is absorbed. Sulfasalazine was approved by the FDA in 1950.|
Crohn's disease (CD) and ulcerative colitis (UC) are chronic-relapsing diseases, the clinical courses of which are characterized by periods of remission and periods of acute flare up, determining clinical symptoms which have a strong impact on the quality of life for patients. For many years, corticosteroids have represented the cornerstone of therapy for induction of remission in Inflammatory Bowel Disease (IBD); however, the side-effects emerging with long-term use exceeded the clinical benefits. Recently, Infliximab (IFX) has become an alternative choice in the treatment strategies for CD and UC. Some safety issues are associated with IFX use, mostly related to the development of adverse events (e.g. opportunistic infections, autoimmune disorders and infusion reactions). Major concerns are related to the reactivation of latent tuberculosis and development of malignancy, even if there is no clear evidence the use of IFX increases the incidence of solid cancers. The research published in issue 39 of World Journal of Gastroenterology and led by Renato Caviglia at University Campus Biomedico in Italy aimed to retrospectively evaluate the safety and efficacy of long-term therapy with IFX, reviewing the medical charts of 41 IBD patients who received, after a loading dose of 3 IFX infusions, scheduled retreatment every 8 weeks as maintenance protocol.
Centocor, Inc., Schering-Plough Corporation, and Mitsubishi Tanabe Pharma Corporation have announced that an estimated one million patients have now been treated with REMICADE® (infliximab), the leading anti-tumor necrosis factor (TNF)-alpha therapy worldwide. In fact, REMICADE has been used to treat more patients worldwide than all other anti-TNF-alpha agents combined. REMICADE was the first anti-TNF-alpha treatment approved by the U.S. Food and Drug Administration (FDA), when it was indicated for the treatment of acute moderate to severe Crohn's disease in 1998. The indication for Crohn's disease was quickly followed by additional indications, such as rheumatoid arthritis.
REMICADE has been studied in more than 37 clinical trials, evaluating its use in a wide variety of diseases of the immune system and is approved for use in 88 countries.
Plant Sterols / Sterolins (Phytosterols)
| ||Although clinical studies have not been conducted using sterols and sterolins, based on existing research for other conditions, it is foreseeable that taking sterols and sterolins in cases of IBD will result in controlling the immune onslaught taking place on the mucosal surface. Sterols and sterolins will decrease the release of the inflammatory factors, get the good T cells to secrete the good factors, and induce a state of balance in the immune response. By so doing, it will allow repair mechanisms to kick in and recovery from such chronic conditions to take place.|
| ||A study of 474 smokers with Crohn's disease found that patients who stopped smoking for more than 1 year had similar rates of flare-ups as patients who never smoked, and both groups had fewer problems than current smokers. Quitters, for example, had a 65% lower risk of flare-up than patients who were still smoking [Gastroenterology, April 2001]. Furthermore, smoking significantly increases the likelihood for Crohn's disease symptoms after surgery, particularly in women and heavy smokers.|
Test for Helicobacter Pylori Infection
| ||Drug therapies used to fight the ulcer-causing bacteria Helicobacter Pylori may help treat Crohn's disease. Researchers recently reported that "after treatment [with antibiotics against H. Pylori], clinical remission [of Crohn's disease] was achieved in all patients", regardless of the type of therapy received. At the same time, H. Pylori infection was eradicated in 28 of the 30 infected patients.|
"What this shows is that by eradicating H. Pylori infection... we achieved a remission of Crohn's disease," Dr. Mantzaris explained. The authors stress that their findings do not mean that H. Pylori causes Crohn's disease. But it does raise the issue of "whether regimens aimed at eradicating H. Pylori in infected patients with Crohn's disease may also achieve remission of Crohn's disease."
Test for Food Allergies
| ||Finding out which foods may be triggering the inflammatory reaction is an important part of treating this disease. Often wheat, corn, dairy, and eggs are involved as in ulcerative colitis.|
Hydrochloric Acid (Trial)
Test CBC (Complete Blood Count)
Test for Occult Blood
| ||Tissue damaged by Crohn's disease has an enhanced recovery rate with adequate zinc.|
| ||One study took a look at a drug called etidronate to see if it would help protect the bones of people with Crohn's disease. The bad news: It didn't. The good news: The vitamin D and calcium supplements that were taken in the control group were highly effective all on their own.|
MSM (Methyl Sulfonyl Methane)
| ||Please see the link between Crohn's and LDN.|
| ||A study from France demonstrated the use of an antioxidant called superoxide dismutase and desferoxamine (an iron chelating drug) which allowed 82% of severe Crohn's patients to go into remission.|
Essential Fatty Acids
| ||A study by Japanese researcher Kuroki found that, compared with control subjects, Crohn's patients had lower concentrations of Omega-3 essential fats and higher concentrations of the monounsaturated fatty acids Omega-7 and Omega-9. These results indicate EFA deficiency. Among the fatty acids that correlated with the Crohn's disease activity index, EPA and total Omega-3 polyunsaturated fatty acids showed the most significant negative correlations. The less of these fatty acids present, the worse the disease. [Digestive Diseases and Sciences; 1997; 42(6): pp.1137-1141, Fatty Acid Patterns in Patients with Chronic Intestinal Disease, Metabolism 1996; 45(1): pp.12-23]|
Fish oil, the only current means of getting EPA without equal amounts of DHA, may delay relapses in Crohn's disease due to its anti-inflammatory effect. Dr Belluzzi, MD tried a new way of delivering the fish oil to the intestine by putting it in a capsule that would not dissolve in the stomach for at least 30 minutes. As a result, the overall dose of fish oil could be reduced by a third and the unpleasant taste of the oil was avoided. 78 Crohn's patients took part in a trial for one year; 39 were given the fish oil and the other 39 were given a placebo in an identical capsule.
At the end of the year the doctors checked which patients were still in remission and which had experienced a flare-up of symptoms. 59% of the patients who took the fish oil were still in remission, compared with only 26% of those who were given the placebo.
About 10% of the patients who were given the fish oil dropped out of the trial because of increased diarrhea, but Dr Belluzzi believes that the coated fish oil capsules could offer an effective way to prolong remission for Crohn's patients. The patients involved in the trial had some evidence of mild inflammation before starting the trial and that the fish oil may have helped by treating this rather than by preventing inflammation from actually starting. He estimates that about 30-40% of Crohn's patients are likely to have a mild level of inflammation similar to those people involved in the trial.
| ||Dr. Antonio J. DeLiz treated an advanced case of Crohn's disease with remarkable results using 16,000IU of vitamin E daily. Dr. Wilfred Shute, too, was able to bring relief to several individuals with Crohn’s disease who telephoned or wrote him after a particular lecture in Australia.|
| ||See the link between Autoimmune Tendency and Vitamin D.|| |