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

• “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]

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

• “Oral glutamine supplements, in the dose administered, do not seem to restore impaired permeability in patients with Crohn’s disease.”[1999]
• “Intestinal permeability and morphology improved significantly in both glutamine and ACG(Whey)”[2012]
• ” In the colon, however, which does not use glutamine as its principal energy source, immune enhancement of inflammatory cells by glutamine increases oxidative tissue injury.”[2006]
• “Oral supplementation with l-glutamine, for a short time, altered the composition of the gut microbiota in overweight and obese humans reducing the Firmicutes to Bacteroidetes ratio, which resembled weight loss programs already seen in the literature.” [2015]
• Glutamine and whey protein improve intestinal permeability and morphology in patients with Crohn‘s disease: a randomized controlled trial. [2012]
• Combined glutamine and arginine decrease proinflammatory cytokine production by biopsies fromCrohn‘s patients in association with changes in nuclear factor-kappaB and p38 mitogen-activated protein kinase pathways.[2008]
• Low intestinal glutamine level and low glutaminase activity in Crohn‘s disease: a rational forglutamine supplementation? [2006]

Bottom Line

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

During my 2nd period with CFS,  I found that I had a craving for Peanut Butter. The reason, in hind sight, was simple:

• Peanut contains most of the compounds needed to produce red blood cells. [Ref]

Why is this important? Typically CFS has hypocoagulation resulting in low delivery of oxygen. More red blood cells, means more oxygen delivery, the body logical response to lower oxygen levels.

• “Peanut consumption has been suspected of raising plasma very long chain fatty acid (VLCFA) levels in humans”[2012]

A recent article caused me to dig deeper into Peanuts

• “The high consumption of peanuts, walnuts, or almonds significantly reduced the risk for breast cancer by 2-3 times” [2015]
• “Total nut intake was related to lower overall and cause-specific mortality (cancer, diabetes, cardiovascular, respiratory, neurodegenerative diseases, other causes) in men and women.. Peanut butter was not related to mortality.” [2015]
  • i.e. eat peanuts and not peanut butter!!! The processing loose the health benefits.
• “Total nut consumption lowered [ systolic Blood Pressure] SBP in participants without type 2 diabetes. Pistachios seemed to have the strongest effect on reducing SBP and DBP. Mixed nuts also reduced DBP.” [2015]
• “Nut consumption was associated with decreased overall and cardiovascular disease mortality across different ethnic groups and among individuals from low SES groups. Consumption of nuts, particularly peanuts given their general affordability, may be considered a cost-effective measure to improve cardiovascular health” [2015]
• ” supplementing a usual diet with mixed nuts for 6 weeks had favorable effects on several lipid parameters in Korean women with metabolic syndrome. These findings present a possible mechanism for the cardioprotective effects of nutconsumption.” [2015]
• ” The findings suggest peanuts may be a preferred snack food to include in the diet for maintaining a healthy weight.” [2014]
• “Acute high-oleic peanut consumption leads to stronger moderation of postprandial glucose, insulin, and TNF-α concentrations than CVP and control meal intake.” [2014]
• “Tree nuts appear to have strong inverse association with obesity, and favorable though weaker association with MetS independent of demographic, lifestyle and dietary factors.” [2014]
• ” consumption of peanuts and/or peanut butter is associated with lower weight status, improved diet, and lipid levels among Mexican American children.” [2013]
• “frequent nut and peanut butter consumption is associated with a significantly lower [ cardiovascular disease ]CVD risk in women with type 2 diabetes.” [2009]

Most of the studies were done with 56 g (2 oz) of peanuts per day

• IBD and Crohn’s are 2.18 times more likely to have anxiety disorders [2015]. It is also the case for CFS[2015]
• People will allergies are 2x more likely to develop CFS [2015]
  • “More symptoms were experienced after the fatigue onset than prior to the fatigue onset; however, a considerable number of participants reported experiencing persisting symptoms prior to the onset of CFS. Particularly, rates of hay fever and asthma were higher prior to the illness” [2015]
• ” 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.
• “The clinical phenotype of the men with CFS (compared to women) was young, single, skilled worker, and infection as the main triggering agent. Men had less pain and less muscle and immune symptoms, fewer comorbid phenomena, and a better quality of life.”[2015]
• ” Cases of CFS had significantly elevated concentrations of transforming growth factor-beta (TGF-β) in five out of eight (63%) studies. No other cytokines were present in abnormal concentrations in the majority of studies, although insufficient data were available for some cytokines. Following physical exercise there were no differences in circulating cytokine levels between cases and controls and exercise made no difference to already elevated TGF-β concentrations. The finding of elevated TGF-β concentration, at biologically relevant levels, needs further exploration, but circulating cytokines do not seem to explain the core characteristic of post-exertional fatigue.” [2015]
• “Neuroimage may be an important key to unveil the central nervous system (CNS) mechanism in CFS. Although most of the studies found gray matter (GM) volumes reduced in some brain regions in CFS,”[2015]
  • ” It has been shown that the time it takes to process a complex cognitive task, rather than error rate, may be the critical variable underlying CFS patients’ cognitive complaints.”[2015]
• Chinese herbs: Cistanches Herba and Schisandrae Fructus suggested [2015]

Working off the premise that CFS (and many auto-immune disease) is based on a stable dysfunctional shift in gut bacteria, I found the following PubMed article interesting:

Stool consistency is strongly associated with gut microbiota richness and composition, enterotypes and bacterial growth rates. Vandeputte D, Falony G, Vieira-Silva S, Tito RY, Joossens M, Raes J. Gut. 2015 Jun 11. pii: gutjnl-2015-309618. doi: 10.1136/gutjnl-2015-309618.

One of the premise of my treatment model is that any thing that produces an objective change of gut bacteria is a good change. One path has been selective probiotics, this is looking at another path.

Oh, what do I mean by objective change?

• Frequency
• “Floaters” vs “Sinkers”
• The  bouquet of the stools — who says that smellless stools are healthy???
• Consistency: pellets, loose, solid, diarrhea.

Another path may be to alter stool consistency by changing of diet. A diet high in roughage can often result in 3-5 stool movements a day, other’s may have it as an event that occurs every few days only.

“Results Stool consistency strongly correlates with all known major microbiome markers. It is negatively correlated with species richness, positively associated to the Bacteroidetes:Firmicutes ratio, and linked to Akkermansia and Methanobrevibacterabundance. Enterotypes are distinctly distributed over the BSS-scores. Based on the correlations between microbiota growth potential and stool consistency scores within both enterotypes, we hypothesise that accelerated transit contributes to colon ecosystem differentiation. While shorter transit times can be linked to increased abundance of fast growing species in Ruminococcaceae-Bacteroides samples, hinting to a washout avoidance strategy of faster replication, this trend is absent in Prevotella-enterotyped individuals. Within this enterotype adherence to host tissue therefore appears to be a more likely bacterial strategy to cope with washout.”

For clarity:  (low scores: firm stool and slow transit, high scores: loose stool and fast transit).

Remember where we are!!!

We have a stable dysfunction gut microbiome. We want to make it unstable and hopefully nudge towards  a functional one.

Food to consider (typically not in most Western diet – typically we eat only 1/2 of the recommended fiber intakes of 20-35 g/d,[1998])

• Bran – Rice, Wheat and Oat brans are different in their impact
  • ‘The apparent digestibility of plant-derived neutral sugars decreased significantly when wheat but not oat bran was consumed. The apparent digestibility of neutral sugars provided by wheat bran was 56%; the apparent digestibility of those provided by oat bran was 96%.” [1998]
  • Wheat bran extract alters colonic fermentation and microbial composition, but does not affect faecal water toxicity: a randomised controlled trial in healthy subjects.[2014]
  • “rice bran phytosteryl ferulates mediate anti-inflammatory effects by down-regulating the inflammatory transcription factor, nuclear factor κB (NF-κB), which in turn reduces expression of inflammatory enzymes such as COX-2 and iNOS, and proinflammatory cytokines such as IL-1β, IL-6 and TNF-α.” [2011]
  • “support that SRB[Heat-stabilized rice bran] consumption can affect gut microbial metabolism” [2015]
  • “As markers of CRC risk, , faecal water genotoxicity was determined using the comet assay and faecal water cytotoxicity using a colorimetric cell viability assay. Intake of WBE induced a shift from urinary to faecal 15N excretion, indicating a stimulation of colonic bacterial activity and/or growth. Microbial analysis revealed a selective stimulation of Bifidobacterium adolescentis.”[2014]
  • Suggestion: Have porridge for breakfast and add 1/4 cup of some form of bran to it.
    •  A bran muffin has typically 1/8 cup of bran in it, so the alternative would be two a day.
• A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs
  • A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. [2014]
  • Low FODMAP diet information
  • “Diets differing in FODMAP content have marked effects on gut microbiota composition. The implications of long-term reduction of intake of FODMAPs require elucidation.”[2015]
  • Suggestion: Take Prescript Assist and/or Align concurrent with this diet change, both have been shown effective for IBS.

Full Article.