Penn Study Linking Gut Microbe Type with Diet has Implications for Fighting GI Disorders

     Hats off to Penn Med.  I had my surgery (total colectomy with end ileo) there last year and they have the best doctors in the tri-state area.

Good to see studies like this one. I hope more will follow.

Wait... what was that towards the end of the article? Did they say "The next line of study will be to identify changes in microbial composition associated with successful dietary intervention for these diseases, then optimize ways of creating these changes for improved therapy"? Why, every GI I've ever seen has always made it clear that dietary changes really can't affect UC one way or the other.

imagardener2 said...
Thanks for posting. Very interesting and hope GI docs will start to believe that diet does have an effect on UC. It has on mine.

I have 2 GI doctors at different practices and both put me on a diet and supplements.

@subdued.

And what thing from your story excludes the genetic factor? Usually HLA-B27 antigen is involved in UC, but not for all people. There are other antigens possibily involved but i do not have the time to search for their codes.
The fact that genetics involvement in UC is not known so good at this time it does not mean there is no involvement at all.
If we've never seen a black swan with our own eyes does it mean black swans do not exist?

For example: I know a person who treats his Ankylosing Spondilitis with antibiotics protocol (this is another so called auto-immune disease). He does it more than 10 years already and uses some of the most powerfull antibiotics: flagyl and cipro.
Before this he used NSAID's the hard way and got into NSAID's induced colitis.
After starting antibiotic protoc is AS entered remission and his colitis dissapeared.

So, we have 2 persons: you and my friend, both using same enviromental trigger (antibiotics), but with oposable results: your UC was triggered, he uses antibiotics and they are beneficial for his immune dissorder. Considering this, does not genetics play a factor?

So we have an enviromental trigger - antibiotics - that changes gut flora for both of you, but only you get UC. Why? Most probably because the changes in your gut flora triggered immune response to it. Since there is the possibility that some of this gut flora has genetic resemblance (similar antigents) with your own colon cells, then your immune system woudl attack both. (you shoudl read more about molecular mimicity theory)

Why did you got remission from faecal transplant? Simple, your gut flora changed again, those bacterias with similar antigens reduced to a minimum and your immune system resolved because there is no more enviromental factor to trigger his response (a bad response since it seems it cannot make the difference between self and non'self).


Those are my 2 cents. I hope i've provided usefull information to you.

P.S. My IBD happened gradually too. I am HLA-B27 positive and did not used antibiotics more than trice in the past 10-12 years. But i was living a uncontrolled life, ate all the s-hits available and was also put into stressfull situations by the death of my both parents. But we arrived at the same spot - not because our different enviromental triggers, but because our simmilar genetics probably - our immune system got crazy.

subdued said...
Fecal transplantation put me in remission because it put back bacteria strains that I was missing due to abusing antibiotics. I'm having perfect poo.

Indeed. but can you explain why not all fecal transplants are successful ? Take for example the Borody's Clinic, they have high rates of success, developed a good protocol, but even so, their success rate is not overwhelming and their patients often relapse.
Also, consider the fact that you say that antibiotics were your colitis cause. Also the fact that you say your colon health was restored with fecal transplant. So do you consider yourself cured or in remission?

subdued said...
And what in my story includes a genetic factor?

Take for example the fructose intolerance you say you are suffering. Are you 100% sure it did not had any involvement in the development of your disease? By the way - off topic - i've asked you a long time ago but you did not answered. You are genetically fructose intolerant? Because there are tests that can attest if such intolerance is genetical. Or this intolerance appeared together with your colitis.

subdued said...
It also means that there is no proof that genetics has to be involved in everyone who has been diagnosed as having UC. Doctors will diagnose someone as having UC if they have no proof that it is some other form of colitis or chron's. They do not diagnose someone as having UC based on gene testing.

You are right, but there are some factors - genetical - that seem to be involved in most of UC cases:
1. race - whites are more prone to UC.
2. people with ancestors with so-called auto-immune disorders tend to have a higher rate of such diseases (there are significant statistical correlations between Ankylosing spondilitys / Iritis and / or UC history in the same family.)
Yes, there is no proof that genetics has to be involved in everyone, but i believe you must not dismiss this with such firm attitude.
Also there could be the fact that several diseases with similar manifestations might be included under the same umbrella of UC. This could explain the fact why we differ so much in our response to medication.

subdued said...
I did not have any forms of colitis until I was 44

Wrong. You were not diagnosed with any forms of colitis until 44. This does not mean that your colitis was not present, but mild enough not to make you take notice.

Regarding my friend and his antibiotic protocol, my argument was that his AS got under control with antibiotics, while your colitis got worse (or was triggered by them). So far i believe my argument still stands.

Alinus said...

So we have an enviromental trigger - antibiotics - that changes gut flora for both of you, but only you get UC. Why? Most probably because the changes in your gut flora triggered immune response to it. Since there is the possibility that some of this gut flora has genetic resemblance (similar antigents) with your own colon cells, then your immune system woudl attack both. (you shoudl read more about molecular mimicity theory)

subdued said...

Alinus said...

But we arrived at the same spot - not because our different enviromental triggers, but because our simmilar genetics probably - our immune system got crazy.

What??

Yes, i believe that our UC is caused by a combination of genetical factors combined with an external factor (the change of our gut flora) in which your body mounts an immune response even though the external factor (the pathogen) is no longer present present.

Alinus said...
can you explain why not all fecal transplants are successful ?

I can only speculate. Perhaps, the colon is too damaged. Perhaps the poo isn't used quick enough. Perhaps the poo is mixed with something that kills the bacteria. Perhaps the poo is too hard, and the bacteria is stuck inside. Perhaps the donor is also missing some kinds of bacteria in his/her poo. Perhaps for most people the poo needs to go past the rectum and into the colon further for it to work. Perhaps it only works for those who have IBD due to an imbalance of fecal bacteria. I don't know. I can only tell you that in my case, it worked after only three syringe's worth of poo. And it worked immediately. I was pred dependent at the time. Each time I dropped to 25 mgs, the bleeding would come back in full. After the third infusion, the bleeding stopped immediately and my poo returned to normal. My goal then was to get off pred ASAP. I tapered too quickly. I got severe muscle pulls. My joints got inflamed. And yet my poo remained perfect the whole time. Absolutely, no sign of colon inflammation despite the fact that my cortisol production was so low that my joints got inflamed. BTW, this was the only time in my life that I ever had inflamed joints, and I'm the only one in my family who has ever had inflamed joints. I tell you it was horrible. I really feel for those who have arthritis. I had no idea how debilitating it could be.

Alinus said...
Take for example the Borody's Clinic, they have high rates of success, developed a good protocol, but even so, their success rate is not overwhelming and their patients often relapse.

Their success rate is overwhelming. Compare their success rate with 5-ASAs, pred, Immun, Remicade. Not only is their success rate overwhelming, it doesn't come with the dangerous side effects that many of the UC meds come with.

Alinus said...
Also, consider the fact that you say that antibiotics were your colitis cause. Also the fact that you say your colon health was restored with fecal transplant. So do you consider yourself cured or in remission?

I thought I was cured. But owing to the pred, I kept getting bladder infections. And I kept being prescribed antibiotics for those bladder infections. Each time I was prescribed a stronger antibiotic due to the bladder infection coming back. I got another flare after the third antibiotic. I took Asacol and within a week, I was in a full-blown flare. Telling myself that I would never take pred again, I took probiotics and changed my diet. My flare gradually subsided, but it took about a month and a half for it to do so. At the time, my granddaughter was in another state; otherwise, I would have done fecal transplantation. After that flare, I kept fighting off mini-flares. These were flares that lasted up to a week and went away with Canasa. So I did two more infusions of fecal transplantation when I got the opportunity to. I've been in remission since.

Alinus said...

subdued said...
And what in my story includes a genetic factor?

Take for example the fructose intolerance you say you are suffering. Are you 100% sure it did not had any involvement in the development of your disease? By the way - off topic - i've asked you a long time ago but you did not answered. You are genetically fructose intolerant? Because there are tests that can attest if such intolerance is genetical. Or this intolerance appeared together with your colitis.

No. I'm not genetically fructose intolerant. In technical terms, you would say I have fructose malabsorption. However, most people don't know what fructose malabsorption is, especially since it used to be called dietary fructose intolerance. My fructose intolerance (malabsorption) is due to having abused antibiotics and having consumed too many beverages containing HFCS. The antibiotics I took are known to be harmful to the liver. As for HFCS, studies are showing that it causes non-alcoholic fatty liver because unlike other sugars, fructose has to be digested entirely by the liver. I was drinking nothing but Vitamin Water and bubble teas. I was fooled into thinking they were healthy. All they did was give me massive diarrhea and bloating. And so I now get IBS from foods and beverages high in fructose. I figure after some 10 years of rest, my liver will be able to digest fructose again. Non-alcoholic fatty liver is curable if caught in time. As for whether or not it contributed to my IBD, I can not say. I do know that my body reacts immediately to fructose. I get massive diarrhea after consuming foods/beverages high in fructose. Within 24 hours, I'm all better. However, with antibiotics, my poo gets smaller and less well-formed. I do not get better.

Alinus said...

You are right, but there are some factors - genetical - that seem to be involved in most of UC cases:
1. race - whites are more prone to UC.
2. people with ancestors with so-called auto-immune disorders tend to have a higher rate of such diseases (there are significant statistical correlations between Ankylosing spondilitys / Iritis and / or UC history in the same family.)
Yes, there is no proof that genetics has to be involved in everyone, but i believe you must not dismiss this with such firm attitude.
Also there could be the fact that several diseases with similar manifestations might be included under the same umbrella of UC. This could explain the fact why we differ so much in our response to medication.

In regard to race:

"The prevalence of IBD is higher in Jews than in non-Jews, although there is variation according to geographic location. Incidence in the Jewish population in some regions parallels that of the general population.2588 This observation supports both a genetic and environmental etiology for the disease. Early epidemiologic studies identified IBD to be more common among Caucasians, although more recent data have revealed similar incidence among other racial and ethnic groups."

I am a white, non-Jew.

I have no blood relatives who have or had any auto-immune diseases.

Alinus said...

subdued said...
I did not have any forms of colitis until I was 44

Wrong. You were not diagnosed with any forms of colitis until 44. This does not mean that your colitis was not present, but mild enough not to make you take notice.

Actually, I was diagnosed when I was 45. I had my first flare a year prior to that when I was 44. I've asked my GI about this. Whether or not I could have had IBD even earlier than that. He said, "No," and wrote down that my first flare was when I was 44.

Alinus said...

Regarding my friend and his antibiotic protocol, my argument was that his AS got under control with antibiotics, while your colitis got worse (or was triggered by them). So far i believe my argument still stands.

The antibiotics we took are different. He took flagyl and cipro. These antibiotics kill bad bacteria. I took antibiotics that kill good bacteria. Dr. Borody, himself, prescribes antibiotics that kill bad bacteria before doing the fecal transplantations.

Alinus said...

Yes, i believe that our UC is caused by a combination of genetical factors combined with an external factor (the change of our gut flora) in which your body mounts an immune response even though the external factor (the pathogen) is no longer present present.

And for you, that is probably true. I won't tell you that you are wrong just because my experiences with IBD differ. I understand that we all don't have the same experiences when it comes to IBD, especially since IBD is diagnosed based on a condition--the colon is inflamed--and not a cause.

Just wanted to add a simple question to a very in depth thread. Do you guys ever contemplate if UC could be caught from a public toilet? I think they say the frequency of UC is 1 in 100,000, but when I think back over my life, while I never verified diagnosis half the time, I feel I've known probably 5 or 6 people with UC or Crohns. There are several people in my office with UC.

I read something once that UC can start as proctitis and spread everywhere (don't know if that's true or not). If so, why couldn't toilet bowl "backsplash" colonize the rectum?

I read something once that UC can start as proctitis and spread everywhere (don't know if that's true or not). If so, why couldn't toilet bowl "backsplash" colonize the rectum?

I think if UC were "contagious" it would take more than joint toilet use to get UC. The TV show "Myth Busters" did a piece about toilet germs and discovered that there are more germs on your kitchen floor than there are in your toilet. That was reassuring...I think.

A good discussion about genetics and triggers. Kudos to all participants for providing a civil examination of views.

I do think that folks tend to think about genetics incorrectly, to give it too much weight. For example to assume that to admit a genetic component is to imply that there is no environmental causation (e.g., antibiotics). But, the very fact that not ALL people treated long term with antibiotics get colitis is evidence that the "individual version" (i.e., genetic design) of the immune system is involved. It does not mean that UC was genetically inevitable, or that enough environmental triggers might not take down the immune system of even the most genetically least likely to get UC person.

Ah. But there are so many different strains of bacteria that could be involved. Perhaps in something like 99% of the cases it's not contagious. But in that 1%...

And then just because something is contagious, doesn't mean others will get it. It depends on how contagious it is. My mom has Hepatitis C, which can be passed through blood. She contracted it when I was born and at the time no one knew what it was. They just knew she got bad blood from a transfusion. Three people got the bad blood. Two of them died. My mom was very sick, but she pulled through. Anyway, unknown to us, we weren't supposed to share toothpaste, nail cutters, ... We did, and none of us got Hepatitis C from her.

Anyway, the question has to do with backsplash. The UC would have to be caused by bad bacteria. The poo would probably have to be something like diarrhea. And it would probably have to be present in the backsplash. And the backsplash would probably have to hit the rectum. That doesn't happen very often if at all. I think it's happened to me only once or twice after I got UC. But then I never used to flush the toilet when I was sitting on it when I went putty outside. In fact, I never poo'd outside until I got IBD. And the toilet at home never backsplashes.

     I was hit by a triple whammy....paternal grandmother died from cancer of rectum in 1952 (family members said it was from untreated hemmies but I found out she had the same symptoms I developed at age 52...she died at age 65.  I had ulcerative proctitis.)  Whammy #2.....family doctor I had for YEARS prescribed antibiotics for anything from a hangnail to pneumonia, therefore, overuse of antibiotics.  Whammy #3.....I was on that darn Atkins diet for two weeks and BAM...mucus in stools which escalated rapidly into a deteriorating condition.  I suppose it was much, TOO MUCH, of red meat.

     Guess I was doomed from the start.