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Diet and Crohn's control

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Posted 8/3/2009 9:23 PM (GMT 0)
Despite the common statement by GI's that diet does not have an important role in Crohn's control, there are reports over twenty years old that support the use of diet. The reports are from allergists, so possibly the GI's do not respect the results?? Anyway, here's a quote from a letter dated 1983 from the British Madical Journal (Denman 286 (6372): 1164. (1983)):

Patients with Crohn's disease are known to respond to an
elemental diet but little is known about the manner in which
diet influences their risk of relapse once the elemental diet is
stopped. Dr J 0 Hunter (Addenbrooke's Hospital, Cam-
bridge) reported that dietary exclusion produced long term
remission in 20 out of 28 patients with histologically proved
Crohn's disease, in many of whom the disease had remained
active despite treatment with steroids or surgery. In addition
141 out of 205 patients with the irritable bowel syndrome also
responded to dietary exclusion. The foods most commonly
responsible were wheat, dairy products, corn, citrus fruit, tea,
and coffee. These clinical observations had been supported by
appropriately controlled challenge tests.

Why is this not the first line of attack for Crohn's??? It is much less dangerous than the drugs or surgery usually employed. I can only guess that GI's are reluctant to take on the cumbersome task of discovering each individual's dietary profile.
Posted 8/3/2009 10:11 PM (GMT 0)
here is the obvious (and cynical) answer:

doctors and drug companies cannot patent diet or food or anything found in nature. if you take an herbal remedy, the drug company does not get paid. the doc just gives a reference for an OTC brand. if one gets well from changing their diet, they do not need to keep coming back to the doctor's office and do not need monthly refills of prescriptions and do not need to have several prescriptions. if you treat the cause, the patient gets better. if you treat the symptoms, which is what most of western medicine does, then you have a patient for life, but more than that, you have residual income. that is how you get rich. just get them hooked and believe this is the only thing that will get them well and side effects are just a part of life and a sign of getting old, so get used to it.

yeah, i know, pretty cynical. sorry. get used to it.
Posted 8/3/2009 10:21 PM (GMT 0)
My understanding is that young British patients on the Modulen diet undergo exclusion testing when they start reintroducing "real" food into their diets again, so it is possible that this approach has not been completely "forgotten", but is simply not practised very much in the US, where you live.

Britain has a full NHS. Maybe they think it's worth investing that money in dietary therapy, as it may keep patients out of hospital - and thus save the NHS lots of money - in the long term.

In a country like the US where the health system is so privatised... *shrug*... maybe your insurance companies don't want to spend money on preventative interventions....

Ivy.
Posted 8/3/2009 10:22 PM (GMT 0)
ps. I could be wrong - just throwing that theory out for general discussion.
Posted 8/3/2009 10:24 PM (GMT 0)
I think it's worth a try. I have just started the SCD diet. I'm thinking of it as a person does with Diabetes. You may need meds, but the most important thing is diet and exercise. (even if you are Insulin dependent). At first my family thought I was crazy, they are starting to come around. What diet do you follow Keeper? By the way, my doctor thinks it's a waste of time too, but said if I wanted to what could it hurt???
Posted 8/3/2009 11:33 PM (GMT 0)
i noticed diet does help or not with mine if i eat most veg and friut im in agony....so i only eat waterbased veg..etc i find too much bread also doesnt help now ive started for past few yrs getting lot more bloating so trying work out whats not helping etc
Posted 8/4/2009 3:59 AM (GMT 0)
I've also read studies from the US in which they tested high fiber grains versus low fiber and they determined that there was no noticeable benefit. What a surprise! It is almost like they view diet as a drug which has to be tested by double blind controlled studies and the same diet must either work for everyone or it is a failure. There is little room for being different from the crowd, but that is one thing that is common in Crohn's - everyone's different. You certainly hear it here often enough. How come doctors can't handle this complexity?
Posted 8/4/2009 4:10 AM (GMT 0)
most tests are done with an agenda in mind and the outcome steered as much as possible to the outcome the researchers want. remember, a lot of research is funded by drug companies with a vested interest in making their stuff look good and the competition, even nature/diet, look bad. unfortunately the USDA is just as bad as big pharma in the US as they are in bed with one another.

getting a bit off topic in answering ivy6, i dont see socializing medicine being any better for the US, either with crohns or some other disease or not. from the preliminary stuff i've seen, they want to ration health care to such a degree that it makes HMO's seem better. a bureaucrat will be deciding what kind of treatment you get, if any, and it will be a continuation of what we have right now - a society of people hooked on pills cos that is what their doctors tell them to take. and good luck getting any care on the system if you're old. this all seems a way for the govt to put their hands in the insurance pot as there is a ton of money to be made in it. and once the govt puts their hands on anything, they create a monopoly and then we're stuck with a broken system that will never go away. i also really dont like having to pay for moochers, which is what socializing anything does. we'll see what happens....
Posted 8/4/2009 5:51 AM (GMT 0)
It looks a bit like diet is too much trouble for doctors to sort out. An exchange of letters in 1997 in the BMJ showed a reply to a review citing drug interventions as follows:

Wight and Scott surprisingly make no reference to the long term effectiveness of treatment. Elemental diet followed by the detection of food intolerances provides a strategy for maintaining longterm remission.2 In the East Anglian multicentre trial, diet resulted in a significantly superior remission rate at two years when compared with corticosteroids.3

The original author then replied in part as follows:

We are impressed with the tolerance of dietary treatment of Crohn's disease at King and colleagues' institution, but most gastroenterology units in Britain do not have the authors' level of experience and skill and their results will necessarily be considerably worse.

Experience and skill! In identifying food intolerances!! This is a skill that any decent naturopath can claim. Why would doctors not be capable of such a skill???
Posted 8/5/2009 12:10 AM (GMT 0)
Doctors are only educated in how to diagnose symptoms and write prescriptions to treat those symptoms,...no fault of theirs, I suppose. Not one doctor suggested probiotics or diet change (actually scoffed at the idea!) from 3 different states over a period of 8 years of UC misery. Yet, it is diet change (antifungal diet) and probiotics that have helped me claim my symptom-, and med-free life I enjoy today.

Posted 8/5/2009 12:19 AM (GMT 0)
When I was hospitalized a couple of years ago, I explained to the many doc's coming in to poke and prod on me that I had started the Maker's Diet approximately 18 months before this flare, but that at the time it had changed my life. I had only stayed strict with it for about 6 months, but then I kinda "fell off the wagon" and started eating and drinking some things I really shouldn't have. I sincerely believe this was the onset of my fistulas and abscess, but don't tell the GI doc's that! My mom and myself were trying to explain this to the doctors, and one said something to the effect that there are no scientific studies showing diet can have any effect on Crohn's Disease remission, etc. I just kept arguing with him, because he had no idea!! If he had been in my shoes and experienced going from a complete flare (going 5-6 times a day, pain, etc.) to complete remission (one fully formed stool every day or every other day, energetic, feeling wonderful), he would have been a believer!! What harm can come from suggesting a simple diet change? Here's to hoping the doctors wise up!
Posted 8/5/2009 2:26 AM (GMT 0)
On a positive note, MY doctor has always tried to keep me off most medication and on a diet that he recommended. It includes probiotics (through yogurt), fibre (when I can tolerate it) and as little processed foods as possible. Actually, during my most recent flare, I was the one pressuring him for more medication!!
Posted 8/5/2009 3:59 AM (GMT 0)
In my case, I honestly dont believe my diet has anything to do with my Crohns activity.  Im sure some foods dont *help* the situation, but I dont have any trigger foods.  I think my smoking cigarettes is a huge part of it, although Ive gone from a pack a day down to 2-5 a day and still have no relief.

Posted 8/5/2009 11:44 AM (GMT 0)
hmmm... My GI doctor has always said that diet can help or hurt. He suggested probiotics to me.
He is also the one that first told me about going on liquid elemental diets during flares as it can sometimes induce remission. Too bad this only helps me for small flares. Though it did keep me going for 2 1/2 months this past year.

He is a believer in low residue diets and has not mentioned SCD or anything. But then again I seem to respond to low residue (or atleast I used to). But he has always seemed to be open to alternative methods.

Many doctors that I have come across are open to using methods other than drugs. It really comes down to the doctor, I think.
Possibly it is different in countries where doctors do not get paid by the drug companies and nothing is privatized.
Posted 8/5/2009 1:14 PM (GMT 0)
My GI has been fab, he referred me to a dietician (without me asking) and she has placed me on a strict low residue diet and I'm being monitored. I think it is helping. Although it is difficult to tell because of all of the meds that have come beforehand. But he has ben very proactive for exploring all potential treatments.
The dietician is a firm believer in elemental diets over steroids, she says that as well as helping with the inflammation it aids mucosal healing, where as the steroids only deal with the inflammation, especially in the case of severe flares.
I think I have an element of IBS aswell and I'm hoping she'll be able to help with that.
From what I've read on here things are approached very differently in the UK, Having worked in the NHS for 8 years now, I think generally it work pretty well when you need it for big issues, (not so hot with more minor ailments).
Posted 8/10/2009 5:48 AM (GMT 0)
I work for a GI and I have Crohn's too. At our office we have a registered dietician that works with our patients on their diets. Food doesn't cause flares but it can exasperate it. In other words our gut might be inflammed and we aren't feeling any symptoms but then we eat something and whammo it makes the flare even worse! We have many patients who stop their medicine to go on diets such as the makers diet. These patients tend to come back in worse shape. If you are looking to England's approach they are now setting up a nation wide standard to treat IBD (Crohn's and Colitis) and the approach you mentioned is not one of the treatment options used to induce remission. Plus keep in mind the IBS is at totally different disease and is treated differently too.

Treatments change over time-Just think in the 1950's one of the treatments or ulcerative colitis was have a lobotomy! The link below is to an article that appeared in JAMA:

http://jama.ama-assn.org/cgi/content/abstract/160/15/1277

So you might consider that the reason why doctors don't use diet to control Crohn's or UC is because it was determined it didn't work.
Posted 8/10/2009 5:57 AM (GMT 0)
Researchers for crohn's and colitis in canada have not yet ruled out food/diet as a possible trigger for IBD

http://www.ccfc.ca/English/research/todaysresearch.html

....also,

There is evidence from studies performed on rats, guinea pigs and monkeys which indicates that degraded carrageenan (poligeenan) may cause ulcerations in the gastro-intestinal tract and gastro-intestinal cancer.[14] Poligeenan is produced from carrageenan subjected to high temperatures and acidity. The average carrageenan molecule weighs over 100,000 Da while poligeenans have a molecular weight of less than 50,000 Da. A scientific committee working on behalf of the European Commission has recommended that the amount of degraded carrageenan be limited to a maximum of 5% (which is the limit of detection) of total carrageenan mass. Upon testing samples of foods containing high molecular weight carrageens, researchers found no poligeenan.[15]

A recent publication[16] indicates that carrageenan induces inflammation in human intestinal epithelial cells in tissue culture through a BCL10-mediated pathway that leads to activation of NFkappaB and IL-8. Carrageenan may be immunogenic due to its unusual alpha-1,3-galactosidic link that is part of its disaccharide unit structure. Consumption of carrageenan may have a role in intestinal inflammation and possibly inflammatory bowel disease, since BCL10 resembles NOD2, mutations of which are associated with genetic proclivity to Crohn's Disease.

Foods/diet may not only exacerbate symptoms of IBD but they could very possibly be triggers so one cannot say one way or another that diet/food has no impact on IBD, it's certainly does with IBS so it wouldn't surprise me if ispecific foods/diet is strongly linked to IBD as well....also, because IBD is so individualistic triggers for each patient could likely vary.

:)

Posted 8/10/2009 6:43 AM (GMT 0)
If you bowel is already inflammed it can not help having foods that are partially digested scrapping past it, I'm still on the low residue diet for the time being.
It's a very strict version intended to reduce frequency and stool volume. It wouldn't be of any use if you had a wheat or dairy intolerence. In my case it definately seems to be helping and I'm hoping I'll be able to start adding in foods soon.
The dietician views it as an aid to achieveing remission in conjuction with meds. It's resting the gut and giving a better chance to heal without resorting to a liquid or predigested diet.
She certainly does not advocate stopping meds.
The approach my GI is using for my meds is as outlined in the NHS guidlines for the UK, but he is also considering other alternative options, it's a shame that more medics can't be a little less restricted by the meds and guidelines. I do feel like I have been very lucky.
Posted 8/15/2009 6:38 PM (GMT 0)
I have had really good success using Wolfgang Lutz's Diet from the book Life Without Bread. For 3 years I never achieved remission, but after sticking to this diet for some time I would say I'm in remission. I also use the drug LDN, but I think the diet plays a bigger role.
Posted 8/15/2009 11:54 PM (GMT 0)
A common condition associated with Crohn's disease is SIBO (Small Intestine Bacteria Overgrowth). It results from reduced peristalsis, allowing bacteria to overgrow in the small intestine. The symptoms are as follows:
The symptoms of SIBO include:

* excess gas,
* abdominal bloating and distension,
* diarrhea, and
* abdominal pain.

A small number of patients with SIBO have chronic constipation rather than diarrhea. When the overgrowth is severe and prolonged, the bacteria may interfere with the digestion and/or absorption of food and deficiencies of vitamins and minerals may develop. Weight loss also may occur. Patients with SIBO sometimes also report symptoms that are unrelated to the gastrointestinal tract, symptoms such as body aches or fatigue. The symptoms of SIBO tend to be chronic. A typical patient with SIBO can experience symptoms that fluctuate in intensity over months, years, or even decades before the diagnosis is made.

Taken from MedicineNet.com
In looking for causes of reduced peristalsis, apart from partial blockage and intestinal pain or pain meds, I discovered a book that spells out the impact of undigested foods (Clinical nutrition in Gastrointestinal Disease). It seems that undigested food will cause reduced peristalsis presumably to allow for proper digestion and absorption of the food. Reduced peristalsis results in SIBO. Food intolerances are probably universal in Crohn's - just ask anyone here what foods they avoid. Foods that are not tolerated cause inflammation and this interferes with digestion of that food - resulting in reduced peristalsis, which causes SIBO. It looks like a smoking gun to me.
Posted 8/16/2009 12:04 AM (GMT 0)
How does a doctor diagnose SIBO, Keeper?
Posted 8/16/2009 3:37 AM (GMT 0)
The only tests so far are a breath test for hydrogen (which is not a 100% certain test) and a sample test which is rarely done except in research settings because it is expensive and requires a skillful operator. The breath test along with symptoms is the only diagnostic tool so far.
Posted 8/16/2009 3:44 AM (GMT 0)
That's crazy. A lot of the diagnostic tools used to measure the extent and severity of disease activity, look for exactly the same symptoms as are displayed by patients with SIBO??! I'm thinking of things like abdo pain and d and weight loss (in the CDAI) and gas and bloating (in that quality of life questionnaire that they often make us do).

That MATTERS. To stay on Humira, I have to keep a CDAI diary and stay at or below a certain score... but they don't do SIBO tests to rule out whether our symptoms are being caused by disease or bacterial overgrowth?

Grrr.
Posted 8/16/2009 4:37 AM (GMT 0)
Well, it sort of fits... Someone here (CrazyHarry?) said once that Remicade was first developed to treat toxic shock syndrome. Anti-TNF drugs can limit the body's immune response to bacterial overgrowth, so it would limit the more severe immune reactions to SIBO.
Posted 8/16/2009 1:35 PM (GMT 0)
I am currently being treated for SIBO. I did no tests but the doctor believes that is what has been going on with me. My symptoms were ALOT of gas and bloating all of a sudden. I had it about 2 weeks when I finally called my doc. He put me on Cipro and had me change to a better probiotic and I feel much better already. I can eat better now without the gas and bloating afterwards. I am still fatigued but I really think that is because of other health issues in combination with the Crohns. JMHO
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