Crohn’s Disease: #2 – The Strategy

From Very Low E.Coli to Very High E.Coli

CFS and IBS have very low E.Coli level, while UC and Crohn’s has very high E.Coli levels — yet I believe that the first syndromes leads to the second syndrome often. Now? The answer is simple, with very low E.Coli, the gut is not able to keep bad E.Coli at bay and they eventually “get lucky” and take over. Where does the bad E.Coli come from? Like food that you eat. The bad E.Coli is not so bad that it makes you immediately sick, instead, it just jacks your system a bit.

What we know

In my last post I described what we know about the bacteria shift and how the degree of shift reflects the severity of Crohn’s Disease and UC. In this post I want to just describe the strategy and criteria to address the dysfunctional microbiome. Our starting point is the table below. Then we try to define what fits our model and what we know about Crohn’s Disease.

Low indicates either low count or low diversity or both compared to healthy controls

Species Change References
E.Coli Extremely High ..
Peptostreptococcus High ..
Bacteroides fragilis High ..
Enterobacteriaceae High [2014] [2014]
Pasteurellacaea Very High [2014] [2014]
 Veillonellaceae High [2014] [2014]
Fusobacteriaceae Very High [2014] [2014]
Firmicutes Low [2005]
Bifidobacteria Very Low [2014]
Faecalibacterium praunsitzii Low ..
Erysipelotrichales Low [2014] [2014]
Clostridiales Low [2014] [2014]
Bacteroidales Low [2014] [2014]
Neisseriaceas Very High [2014]
Gemellaceae High [2014]

Criteria for Selecting

Being trained in Operations Research, I am always inclined to develop models and work from there logically. Rather then tossing random medications, herbs and supplements at a condition, I want to define criteria that medications, herbs and supplements should fulfill (or if none can, then look for the best match at least). There can be some randomness — because what is important or not important can vary from MD to MD. These are my top concerns.

Criteria #1 Reduce the Very High without Hurting the Very Low

Given the large numbers of bacteria involved, it will be hard to find things that are perfect fits. Our worst case scenario will be something that reduces E.Coli but does not reduce Bifidobacteria.

Criteria #2 Anticoagulants are preferred over coagulants

This is also a carry over from the CFS  model that I thought should be checked. It appears  to apply to Crohn’s Disease. A few of many articles:

Criteria #3 Histamine reducers are preferred over histamine raisers

Because coagulation will result in signals to mast cells to release heparin stored there, it also risks releasing heparin. In this case, the literature states:

The results demonstrate highly elevated mucosal histamine levels of the large intestine in allergic enteropathy. In inflammatory bowel disease histamine content and secretion were found to be significantly increased particularly in affected mucosa of Crohn’s disease and ulcerative colitis than in unaffected tissue or in healthy controls. These findings give strong evidence that mast cell mediators like histamine play a role in the pathogenesis of these diseases. Mucosalhistamine is thus concluded to contribute to the immuno-inflammatory reactions of the intestine found in these disease states and to reflect the degree of colonic inflammation in Crohn’s disease and ulcerative colitis.” Mucosal histamine content and histamine secretion in Crohn’s disease, ulcerative colitis and allergic enteropathy. [1995]

This is actually important because E.Coli, especially those found in Crohn’s disease, are biofilm bacteria. Hence, we want to use EDTA and not NAC as a biofilm breaker.

Criteria #4 Preference for items that lowers TNF-Alpha

High TNF-alpha is associated with more severe Crohn’s disease and is a better indicator than C-Reactive Protein(a common inflammation marker) according to some studies

Criteria #5 No evidence of it being counter-indicated by actual studies

I tend to get picky when something is speculated to be harmful to a condition but there are no actual studies supporting the speculation. If there are actual studies — then it is a no-no, otherwise, all things should be considered.