Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Monday, October 20th, 2008:
Natural Treatment for Ulcerative Colitis and Crohn's—Inflammatory Bowel Diseases
by Jacob Teitelbaum MD
Inflammatory Bowel Disease, most commonly manifesting as Ulcerative Colitis and Crohn's Disease, affects ~ 1 million Americans. It is one of over a hundred Autoimmune Illnesses, in which the body's defense forces (immune system) mistakenly attacks the body—in this case the small or large intestines.
Although standard medical therapies consist largely of steroids (prednisone), immune suppressants and modifiers (e.g., Remicade), salicylates (Asacol—a good treatment) and sometimes surgery to treat complications, the good news is that natural therapies can be very effective to both treat the cause of the inflammation and the inflammation itself.
Symptoms include persistent diarrhea, crampy abdominal pain, fever, and intermittent rectal bleeding. It is the latter 2 symptoms which distinguish inflammatory bowel disease from the more common (and more benign) spastic colon and irritable bowel syndrome. Most people with CFS & Fibromyalgia, and much of the population, has spastic colon, and this responds well to treating bowel infections such as candida, SIBO (bacterial), and parasitic bowel infections. Inflammatory bowel disease is not always limited to the intestines, and can also affect the joints, eyes, skin, and liver.
Although Crohn's disease most commonly affects the end of the small intestine (the ileum) and the beginning of the large intestine (the colon), it may involve any part of your intestines. In ulcerative colitis, on the other hand, bowel involvement is limited to the colon. In Crohn's disease, there can be normal healthy bowel in between patches of diseased bowel. Ulcerative colitis causes a more continuous inflammation which usually begins at the anus.
Most often your physician will diagnose the problem by doing a colonoscopy (looking up your bottom with a long flexible tube) and biopsies. Blood tests can also help distinguish between Crohn's and Ulcerative Colitis.
1. Treat for bowel infections. I consider it reasonable to simply treat for yeast infections with Diflucan 200 mg a day for 6 weeks (plus probiotics—consider the super high potency VSL#3® for a month, then Probiotic Pearls or Acidophilus Pearls 2 a day ongoing). I think this is reasonable for anyone with inflammatory bowel disease—no matter whether or not fungal cultures are positive. Do stool testing first at Genova labs or DiagnosTechs (by mail—do the bacterial and fungal cultures and sensitivities and parasite testing). If the parasite or bacterial pathogenic infection tests are positive, I would then treat these based on the results. If negative, a trial of Albenza may be reasonable. Doing stool cultures or parasite testing at most labs is a waste of time unless you are looking for an acute infection (e.g., salmonella food poisoning). Remember, that we don't have good testing for bowel infections does not mean they are not causing your problems!
2. Treat the nutritional deficiencies (which are widespread in Crohn's and Ulcerative Colitis). Low zinc (simply take it—labs are not reliable) has been associated with markedly increased complications from inflammatory bowel disease (called fistula where the inflammations drains to the skin or other organs). Take an extra 25-30 mg a day for 3 months and then at least 15 mg a day. A recent study showed vitamin D deficiency (which is associated with many autoimmune illnesses) plays a role in Crohn's (see article from American College of Gastroenterology). Take 2,000-4,000 units a day for at least 6 months. One can try the Energy Revitalization System powder, which supplies excellent overall nutritional support, but it may aggravate the loose stools. If this happens, substitute the product Natrol "My Favorite Multiple—Take One" which though nothing like the powder, gives excellent overall support for a single tablet each day.
3. The herb Boswellia 1,000 mg plus a day is VERY helpful for inflammatory bowel disease in general and I would definitely use it. It only costs a few cents a day, is very safe and well tolerated, and as or more effective for colitis than many of the medications. (See Boswellia for Colitis.)
4. Treat food allergies (I recommend NAET). Doing an elimination diet after the bowel infections and nutritional deficiencies are treated would be a good screen for the role of food allergies. See Multiple Food Elimination Diet for how to do this. Though the food allergies may not be causing the inflammation, the inflammation will result in "leaky gut" and secondary food allergies which may then cause more problems.
5. Fish oil is a good general anti inflammatory, so eat salmon or tuna 3-4 times a week (or more). The science supporting this is still early.
6. Though high dose prednisone (over 5 mg a day) is toxic over time, the bioidentical cortisol (Cortef by prescription) up to 20 mg a day (similar to 4 mg of prednisone but safer) can be used safely long term. Once your prednisone dose is lowered to 5 mg a day, ask your physician if you can switch to Cortef 20 mg each morning. Click here to read more about the safety of using up to 20 mg a day of Cortef.
Your doctor may recommend Asacol and occasionally antibiotics, which are good medications for these illnesses and not very expensive. They may also recommend "Biological Modifiers" like Remicade, which can cost over $2,000-$5,000 per injection (often netting a tidy profit for the doctor) and which only work for ~ 2 months and then need repeating. By 1 year it is only still effective in ~ 20% of cases. They are very heavily marketed to physicians because they are so profitable for both the company and the doctor. I recommend keeping these in reserve as "rescue therapies" to be saved for when all else fails (better than surgery). By using the treatments above, you may avoid the need for both the cost and toxicity of these medications—by staying healthy!
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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