Another possible cause of Crohn's

I thought that this was worth putting out for you all. It suggests that a specific bacteria may be responsible for initiating Crohn's. The cascade of complications after the initiation has made it hard to sort out, I guess. It talks about this bacteria having enzymes that mimic several collagen types and thus antibodies for those enzymes attack collagen in the body. Have a look at Clinical Rheumatology

There are other ideas about specific bacteria that cause Crohn's, but the collagen mimicking of the enzymes is suspicious, considering the association of Crohn's with RA and AS as well as various rashes and tissue inflammation throughout the body. There are known examples of Salmonella, Shigella and Yersinia all initiating arthritic symptoms, so it is probably not quite so simple as the abstract above suggests.

Post Edited (Keeper) : 10/4/2008 3:03:54 PM (GMT-6)

so many things new in our everyday life in the last century, you could spend hours talking about what part of western lifestyles plays the part. Do a search, this topic comes up everyday at least once and everyone has a different theory. Sometimes i wonder if there is a company, government, etc that knows about what it is but are afraid to bring it out for fear of many lawsuits. I guess we have a lot of time to think don't we? lol

My understanding of the current model for the development of Crohn's is something like this:

- some initiating factor causes the mucous membrane of the gut to become more porous. There are a number of known causes - gut infection, stress, NSAIDs, alcohol and any number of inflammation producing events.

- the mucosa then leak. This results in bacteria or other pathogens entering the blood or immune cells entering the gut contents.

- this initiates an immune response with inflammation and further increases in gut permeability. This is the phase where diarrhea occurs and painful abscesses and fistulas form.

- the immune system fails to terminate the gut permeability and inflammation. This normally stops on its own, but some individuals' immune systems have a stronger reaction and a weaker terminating response.

There is the possibility that those people have adapted to a gut bacteria ecology that tempers and shuts down the immune response. There are many gut bacteria that perform those functions. The problem arises when that gut bacteria ecology is disrupted. This can occur several ways: antibiotics; diarrheal disease; impaired digestion which supplies more food to bacteria that push out the moderating bacteria; other drugs or digestive insults (like liquor, for example) which disrupt the population of the gut. The result is that the gut's immune response is not sufficiently diminished by the remaining bacteria and fairly normal challenges result in a hypersensitive response which is not self-limiting without the influence of the moderating bacteria.

If the previous assumptions are accurate, the use of probiotics becomes extremely important. Probiotics are not the whole answer though - they are a partial replacement for the bacteria that have been lost, but the probiotics that are available do not multiply well enough in the gut. If they are not continuously used, they are displaced by other, less friendly bacteria.

Lactobacillus bacteria have been shown to displace several undesirable gut bacteria and they have immune modulating action, reducing a range of inflammation vector molecules. They even have been shown to produce antibiotics that help them evict other bacteria. L. casei has been shown to displace E. coli from binding sites on the mucosa and reduce the production of TNF, thereby interrupting the cycle of inflammation.

Probiotics are a useful tool, but they do not replace the lost gut bacteria that normally maintain stasis. There are over 500 bacterial species in the gut and only about 100 of them have been studied. It will be a number if years before we can expect to have a solution based on restoring balance in the gut ecology. In the meantime, there are some things that we can try to moderate the problems caused by hyperactive immune response.

- gut permeability: known aids that reduce gut permeability are Lactobacillus based probiotics; glutamine (normally stored in large amounts for tissue repair, but depleted by inflammation); zinc (50 mg per day has been used to reduce gut permeability).

- infection/abscess/fistula: prescription solutions include cipro, flagyl, xifaxan. Of these, the only moderately safe one is xifaxan. Other possibilities include bee propolis and turmeric capsules (turmeric may cause rectal irritation if taken with active D).

- TNF reduction: Several Lactobacillus bacteria and a number of other gut bacteria reduce the production of TNF. I have seen a suggestion that a Lactobacillus bacteria be genetically engineered to enhance its TNF suppression abilities (and allow it to be patented). I would be very nervous about trying such a method given the delicate balance of gut bacteria ecology. There are several pharmaceuticals including Remicade, Humira, Imuran and others that do this. They all seem to have serious potential side effects and I wonder why the mechanism of action of the bacteria has not been discovered - it does not seem to cause side effects. Naturals include turmeric - others I do not have information on.

Yes, I think they've identified about 30 genes that are related specifically to crohn's, less genes are identified to UC.

:)

I think that the genetic component rules the intensity and the poor termination of the immune response. I am guessing that in the parts of the world where Crohn's is less abundant, the people there are not exposed to antibiotics and other drugs that alter the gut ecology. I think that it is possible to be healthy with the genes that are associated with Crohn's if you have a gut bacteria population that regulates the immune response and allows more normal termination of gut inflammation. There are certainly several bacteria that have been shown to regulate immune molecules like TNF, and since they have a working knowledge of only 20% of gut bacteria, I am sure that there are many more that are not well known. It would be ideal if they could modify the bacterial mix so that the bacteria could control the problem, but they don't know enough yet to do that. Some day, maybe........

Hi Osprey - Yeah, I think that there are results from SIBO that mess up the gut ecology and that results in the symptoms. My take on it is that the carbs are not being digested (enzyme insufficiency or actual damage to the gut from infection or food allergy and the like) and this results in unusual amounts of carbs reaching the colon where certain types of bacteria that are well adapted to digesting carbs then flourish. With an excess of those bacteria, they then begin to displace other bacteria from the gut by sheer numbers. This results in the loss of beneficial bacteria that regulate the gut's immune response. That's my story anyway.....

The long course of antibiotics just suppresses the overabundant bacteria and does not restore the balance of gut bacteria. The immune regulating bacteria need to be added back somehow.

Bacteria happily eat starches and fiber. If this were not the case, everyone would have a large population of yeasts in their guts since less than 80% of starches are digested at best.

Well, I don't know about you guys, but be it MAP, Klebsiella microbes, candida (yeast), E. coli, or whatever, I'm thankful that a carb controlled diet and beneficial bacteria like Lactobacillus can make a big difference!

It is true that fungi will do the same thing as bacteria in the gut, but there are a couple of difficulties with assigning them the role of villain. First, if you starve yeasts like candida and it is actively infecting the gut, it will grow through the gut wall looking for sugars from the blood. That would mean that enteral diets and the SCD plan would make the disease worse before it became better. Similarly, several people report great improvement using antibiotics like cipro and xifaxan. This would not touch fungi and would make the problem worse, not better, since antibiotics would remove bacteria that competed with fungi for food. Third, there are reports in the journals that several of the antibodies in the blood have been identified as being caused by different gut bacteria. If it were fungi that were penetrating the gut wall, you would expect that the antibodies would be targeting fungi.

I am sure that there are individual cases where fungi are involved in the disease - there are so many different experiences that it would almost be certain that someone has had a fungus involved and that may be why the usual solutions don't work for everyone. I am only trying to understand the causes of this DD so that I can make better choices for myself and offer good advice. I too have had good results from the SCD plan and probiotics. That is an excellent starting point, but can we improve on that? I think so, but a good understanding of the causes would be desirable.

The addition of fructo-oligosaccherides to probiotic supplements would imply that Lactobacillus bacteria digest it, since it is intended as a source of food for them. Given the variety of bacteria in the gut and the number of unknown species, I would not like to say that there are none that can compete with fungi in digesting complex sugars. On the other hand, a high sugar consumption is often associated with Candida infections, so it works both ways - fungi and bacteria compete for the same food. The simple sugars are preferred by both bacteria and fungi and different bacteria and fungi are specialized in digesting different complex polysaccherides. Since the population of fungi is normally small in the gut, it would seem that gut bacteria out-compete the fungi for the undigested complex starches in our diets. After all, we absorb simple sugars ourselves and not much of that reaches the gut, so gut bacteria must consume complex sugars.

Hi ivy's mom... you mentioned you are willing to try anything. You don't say how old your daughter is, but is SHE willing to try anything? If she is, I would definitely recommend reading the book "Breaking the Vicious Cycle" by Elaine Gottschall and starting the Specific Carbohydrate Diet (SCD). Since you mentioned she's not happy with her weight, a great side benefit for her is that she can lose weight on the diet (my son has to eat frequent meals so as to NOT lose weight). Does she take a high quality probiotic? That would also be a great idea!

When you ask "how do I get her doctor to give her the antibiotics?", for what are you wanting the antibiotics? (i'm not familiar with n&v) For the micro-organisms we've been discussing? If so, keep in mind that that treatment, as I understand, has its own set of pitfalls. Taking a triple or quadruple antibiotic therapy for 2 to 4 years should not be entered into lightly--at least that's what a GI doctor here in the US told me when I was questioning him at length. That doctor is one of the very, very few in this country who uses the anti-MAP therapy, but prefers to use it as a last-ditch effort, when all else has failed. He also prefers to use it on "worse case scenario" patients, of which my son isn't.

And as Osprey101 pointed out, there is a large percentage of folks who undergo this treatment who end up back in the same boat. This suggests to me that we just don't have the right drugs for the job yet. It can't be emphasized enough *how very difficult MAP is to kill.* It's not a typical, run of the mill pathogen.

So is the problem MAP? I dunno. It could be fungal, Klebsiella, E. coli, or as our GI recently told us "a massive gut flora imbalance. Something that's supposed to be there, run amuk". Shoot, it could be ALL of those! Bottom line is, they just don't know.

So for us, until there is a real, true light on the horizon, we'll continue the SCD and probiotics.

Ivy's Mom> I would recommend reading "Life Without Bread." There are multiple copies on eBay, probably on Half.com and Bookfinder.com as well. There is an excellent section in there on management of Crohn's using diet alone, and it has certain implications for managing weight as well.

Good luck!