Crohn's/Colitis *not* auto-immune!!??

But, if that is true, then why do immunosuppressive drugs of all kinds work?

Dr. Myhill said...


Crohn's disease and ulcerative colitis - inflammatory bowel disease responds well to the environmental approach

My experience is that most gut problems, including inflammatory bowel disease, are caused either by allergy, or by gut dysbiosis (i.e. the wrong bugs in the gut), or poor digestion of foods.

When things get complicated there is often an element of all three.

In Crohn's disease almost always there is allergy - this was proven by Dr John Hunter at Addenbrooke's Hospital, Cambridge, who showed that patients responded as well to an elimination diet as to steroids. Nearly all are intolerant of grains. Usually with Crohn's there are just a few foods implicated. With ulcerative colitis (UC), allergy is also well documented, with reports of dairy products causing UC in the 1960s. I certainly do have a proportion of patients with UC who have responded well to the approach which aims at correcting all three areas, but I do not claim to be 100% effective in treating them all! There is quite a lot in the nutritional literature and what I have gleaned suggests that in inflammatory bowel disease there are several things which can go wrong.

www.drmyhill.co.uk/wiki/Crohn's_disease_and_ulcerative_colitis_-_inflammatory_bowel_disease_responds_well_to_the_environmental_approach

garylouisville said...
But, if that is true, then why do immunosuppressive drugs of all kinds work?

TNF causes inflammation.
There are increased levels of TNF in IBD.
Anti-TNFs decrease levels of inflammation.

Absolutely no autoimmune requirement necessary.

It could be some combination of (and there is evidence of this):

• inappropriate/ineffective response to some real trigger (caused by leaky gut?), and people with IBD tend to have high concentrations of known pathogenic bacteria that can cause ulcers, like MAP and fusobacteria
  
• faulty immune system regulation where the immune reaction does not shut off when it should

The immune system supressors take care of the second one, but if the first issue remains you would just re-flare once you come off the suppressors. Also the flora in our colon is part of our immune system, so if it is out of whack, that could cause the inflammation to become chronic because healthy flora helps in regulation and immune system response, as well as keeping aggressive, disease causing species at bay.

Now, nobody claims to know the cause one way or the other, but to me UC being a real auto-immune disease seems unlikely given the known facts.

I don't think it is fair to say that just because immunosuppressants work for some patients, that this is indicative of the cause of IBD. As seen many times on these forums and through limited research being done, FTs, LDN and restricted diets also show success. Why would these show success if the problem was purely an over reactive immune system?

People may justify this by saying the treatments kill off benign bacteria in the colon, but this is simply a theory. I could equally theorize that FTs and restricted diets kill off a yet unknown bad bacteria that is producing toxins (with the former actually replacing the killed off bacteria). LDN can possibly be explained by enhancing the immune system to wrestle the bad bacteria (but not kill its spores).

Immunosupression may just be a band-aid, stopping the body's reaction to the pathogen that has yet to be found.

My theory has holes and that is to be expected when the disease is not fully understood. Again, I don't think one explanation fits all cases.

..but there is a beginning change of the autoimmune paradigm