Monthly Archives: August 2015

Unknown's avatar lassesen 7:45 pm on August 14, 2015  

Crohn’s Disease: Update on Recent Research 2015-08-14

There are interesting factoids from reviewing 2015 articles on PubMed for Crohn’s Disease

  • IBD and Crohn’s are 2.18 times more likely to have anxiety disorders [2015]. It likely also the case for CFS
  • ” Taken together, our results introduce cellulose as a novel physiological factor that impacts host-bacterial-environmental interactions and alters the proinflammatory potential of AIEC.” [2015]. Cellulose food includes:
    • Broccoli, Brussels Sprout, Cabbage, Collard Greens, Kale, Horseradish, Rutabaga, Turnip, Chinese Cabbage, Cauliflower, Broccoli Rabe, Daikon, Bok Choy, Radish, Kohlrabi [Ref]
  • Volatile organic compounds (VOCs) in breath has been found to be a good predictor of disease state with Crohn’s [2015]. It is likely similar results would be seen with CFS and IBS – but studies need to be done.
  • “The traditional management of Crohn’s disease, which is based on progressive, step-wise treatment intensification with re-evaluation of response according to symptoms, does not improve long-term outcomes of Crohn’s disease and places patients at risk for bowel damage.” [2015] This is likely also true for IBS and CFS.
  • ” A linear dose-response relationship was found between dietary fiber and CD risk, and the risk of CD decreased by 13% (P < .05) for every 10 g/d increment in fiber intake. The results from this meta-analysis indicated that the intake of dietary fiber was significantly associated with a decreased risk of inflammatory bowel disease.” [2015]
    • Source is important: ” By source of fiber, cereal and, to a lesser extent, vegetable fiber were significantly associated with lower total mortality, while fruit fiber showed no association.” [2014]
  • Impact of music on CD – no impact [2015]
  • Siblings of patients with Crohn‘s disease exhibit a biologically relevant dysbiosis in mucosal microbial metacommunities.[2015]. i.e. if you have CD, sibling will likely off gut bacteria that is off. i.e. Fecal Transplants from siblings may not be ideal.
  • “The risk of IBD is significantly increased in first -, second-, and third-degree relatives of IBD-affected cases, with up to 12% of all IBD cases being family cases. The risk is particularly pronounced in young individuals” [2015]
  • “These results indicate children with IBD have less adaptability to stress.” [2015]
  • Alopecia [Hair Loss] secondary to anti-tumor necrosis factor-alpha therapy.
  • “These results indicate children with IBD have less adaptability to stress.” [2015]
  • ” Conclusion In summary, this is the first study to prospectively establish that both CD and UC patients are more prone to neuromuscular diseases” [2015]
  • Vitamin D: “The present literature appears to suggest that 25(OH)D concentrations of ≥75 nmol/l may be required for non-skeletal effects; however, further research on optimal levels is required.” [2015]
  • High amount of dietary fiber not harmful but favorable for Crohn disease. [2015]
  • “The remission rate with combined infliximab and SVD[semivegetarian diet] for newly diagnosed CD patients was 100%. Maintenance of remission on SVD without scheduled maintenance therapy with biologic drugs was 92% at 2 years.” [2015]
    • “SVD was highly effective in preventing relapse in CD.” [2010]

SVD Food Pyramid See full text article for more details

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  • “The utility of antibiotics was beneficial for patients with CD. Nevertheless, subgroup analyses indicated that treatment with ciprofloxacin alone was significantly efficient for CD patients with perianal fistulas.” [2015]
  • ” Early treatment strategy with immunomodulators is effective for inducing remission but no controlled data are available regarding long-term outcome. Combination therapy (anti-TNFs agents and immunosuppressors) is more effective than single therapy but there is a lack of long-term data and an increased risk of malignancy. The effect of mesalazine, metronidazole and azathioprine in reducing postoperative recurrence is not clinically relevant; biologics are effective, but the duration of treatment is unknown. New drugs are under investigation in order to find exit strategy for patients who no longer respond to biologics. Combination therapy set on anti-TNF-α is until now the best option both to achieve fistula healing and avoid recurrence.”[2015]
Unknown's avatar lassesen 6:31 pm on August 14, 2015  

Crohn’s Disease: Glutamine/Whey

I’m on PTO and decided to finish a number of partially done posts.

Bottom Line

It appears the whey(high in Glutamine) and not just Glutamine is the approach to use.

Unknown's avatar lassesen 6:09 pm on August 14, 2015
Tags: , Crohns   

Crohn’s Disease: Supplements

This is a review of supplements and Crohn’s Disease[CD]. Some of the findings may apply to IBS and CFS.

  • “A diet high in protein, particular animal protein, may be associated with increased risk of inflammatory bowel disease and relapses” [2012]
  • ” Micronutrient intakes were suboptimal most notably for folate, vitamins C, E, and calcium.” [2007]
  • Trace Elements
    • The recommendation of the supplementation of these trace elements [Zinc, Selenium, Copper] in IBD is further supported by the findings of this study'[2002]
    • Copper[Cu]
      • No studies on supplementation on humans with CD found
    • Selenium [Se]
      • “Selenium deficiency is common in patients with severe gastrointestinal disorders. The deficiency is mainly related to malabsorption, and a low selenium level was almost invariably present in patients” [1998]
      • “This data, particularly from animal experiments, hold promise that adequate dietary Se supply may counteract chronic intestinal inflammation in humans.” [2014]
      • “New Zealand has one of the highest incidence rates of Crohn’s Disease (CD), whilst the serum selenium status of New Zealanders is amongst the lowest in the world.”[2012]
      • “Selenoprotein-P is a selenium-rich serum protein that carries more than 50% of serum selenium.. the serum selenoprotein-P level is decreased in patients with CD “[2005]
      • ” Supplementation of selenium (100 microg/day) and zinc (10 mg/day) for 2 months significantly improved the trace element status in CD patients.” [2007]
    • Zinc [Zn]
      • “[At onset]  serum zinc levels are significantly lower compared with children without IBD” [2011]
      • [AI found low Zinc level dominantly produced] 94% correct classification of CD and healthy subjects. [2014]
      • Zinc supplementation tightens leaky gut in Crohn’s disease.[2012]
        • “oral zinc sulfate supplements (110 mg three times a day) for 8 weeks”  [2001]
      • ” adolescents with CD have significantly reduced zinc absorption” [2004]
      • “Serum zinc levels correlated with plasma vitamin A in acute colitis”[1990]
  • Vitamin A Supplement – should supplement, but no impact on symptoms expected
  • Vitamin C [ascorbic acid] – do not supplement (contradictory results)
    • “Caution should be exerted regarding surplus ascorbic acid intake for patients with chronic inflammatory diseases.” [2003]
    • “The results indicate that ascorbic acid absorption is normal in patients with both fistulizing and nonfistulizing Crohn’s disease.”[1989]
  • Vitamin D supplement — big plus
    • “We found statistically significant inverse associations between vitamin D status and development of any autoimmune disease and thyrotoxicosis in particular.” [2015]
      • translation: low vitamin D level means higher risk of ALL autoimmune diseases
    • “Short-term treatment with 2000 IU/day vitD significantly increased 25(OH)D levels in CD patients in remission and it was associated with increased LL-37 concentrations and maintenance of IP. Achieving 25(OH)D ≥ 75 nmol/l was accompanied by higher circulating LL-37, higher QoL scores and reduced CRP.” [2015]
    • “vitamin D doses between 1800–10,000 international units/day are probably necessary.” [2015]
    • “an association between vitamin D deficiency/insufficiency and disease activity in IBD patients” [2015]
    • “Replication of phagocytosed E. coli was substantially decreased by [hydroxychloroquine] HCQ and vitamin D” [2015]
    • “Increased UV exposure is associated with a reduced risk of inpatient surgery among patients with CD. Further studies of vitamin D‘s role in CD are necessary.”[2015]
    • “Greater inflammation was associated with lower PTH and 1,25(OH)2D concentrations.” [2014]
  • Whey

Probiotics – recent articles

  • “The highly concentrated probiotic mixture VSL#3 has been shown to be effective in prevention of pouchitis onset and in maintaining antibiotic-induced remission.” [2015]
  • Detail analysis in The role of probiotic lactic acid bacteria and bifidobacteria in the prevention and treatment of inflammatory bowel disease and other related diseases: a systematic review of randomized human clinical trials. 2015 is worth reading. Note that many of the trials were done taking 5-ASA with it.
    • “The current scientific evidences are more significant in UC than in CD. However, more detailed mechanistic studies on the effectiveness of probiotics in IBD are necessary to determine their potential beneficial effects.”
  • Bifidobacterium longum subsp. infantis BB-02 attenuates acute murine experimental model of inflammatory bowel disease.[2015]
  • “Escherichia coli Nissle 1917 has comparable effects to low doses of mesalamine in maintaining remission in UC. VSL#3, a combination of 8 microbes, has been shown to have an effect in inducing remission in UC and preventing pouchitis. Prebiotics have yet to be shown to have an effect in any form of IBD, but to date controlled trials have been small” [2014]
  • “E. coli Nissle 1917 seems promising in maintaining remission and it could be considered an alternative in patients intolerant or resistant to 5-ASA preparations. in pouchitis, small controlled trials suggest a benefit from VSL no. 3 in the primary and secondary prevention of pouchitis;” [2013]
  • “support the promising results for E. coli Nissle in inactive UC and the multispecies product VSL#3 in active UC and inactive pouch patients.”[2012]
  • “Patients with CD in remission present alterations in the integrity of the intestinal mucosal barrier according to lactulose/mannitol ratio. S. boulardii added to baseline therapy improved intestinal permeability in these patients, even though complete normalization was not achieved.”[2008]