Inflammatory Bowel Disease: Identification of the Causes and Approaches to Recovery; Part II of II

Inflammatory Bowel Disease: Identification of the Causes and Approaches to Recovery; Part II of II

IN PART ONE OF THIS SERIES (published in the July/August issue), we reviewed inflammatory bowel diseases (IBDs) as to diagnostic parameters, epidemiology, current modes of medical "therapies" and etiologic factors considered by allopathic medicine.

In part two of this series, we will explore etiologic factors that often play a role in inflammatory bowel diseases and hygienic measures with which to recover good health.

A successful approach to resolving any health problem starts by understanding its origins. This is especially true of the inflammatory bowel diseases.

Medical science has spent many millions of dollars seeking out a cure for inflammatory bowel disorders without success. Drugs (with potent side effects) have been developed to control symptoms, but none restore good health to the patient.

One of the greatest misunderstandings in determining the cause of these debilitating syndromes is the notion that there is a single cause for IBDs. Rather, there are a variety of factors that play a role. It is through a careful individual investigation, understanding each patient's biochemical individuality, that the best opportunity for recovery will occur.

THE ROLE OF REFINED CARBOHYDRATES

In part one, it was observed that inflammatory bowel diseases of non-infective origin are relatively rare in countries where the population follows a traditional diet of whole natural foods. This was observed by Weston Price, D.D.S., Denis Burkit, M.D., and other pioneering epidemiologists.

"Epidemiological studies have shown increasing westernization leads to a higher incidence of IBD....These emerging trends, as people of different races take up similar lifestyles" (and develop the same diseases, i.e., inflammatory bowel disease) "point convincingly to environmental causes."( 1)

A diet rich in refined carbohydrates is implicated as an etiologic factor in inflammatory bowel diseases. There may be a number of reasons for this. That muscle spasms are more likely to occur with diets low in fiber is one likely reason.( 2)

Alterations in gut flora result from the usage of refined carbohydrates. It is well recognized that the intestinal flora governing the internal environment of the bowel are largely determined by the diet of the individual. Diets rich in refined carbohydrates and poor in fiber tend to precipitate fermentation within the bowel, including abnormal flora/increased bacterial overgrowth, and an overabundance of yeast organisms, while simultaneously reducing the numbers of normal, beneficial lactobacilli and bifidobacter strains. This may lead to irritation of the mucus membranes of the gastrointestinal tract and increase G.I. permeability. Diets rich in refined carbohydrates also alter bile acids in the feces.

In an experimental study reported in Gastroenterology, subjects were placed on a two-week baseline diet, followed by a test diet of the same composition but with an added 120 grams of sugar.( 3) This additional sugar resulted in fecal bile acid concentrations increasing and the total transit time decreasing. Bacterial fermentation activity increased. These alterations in activity of the bowel are associated with elevated risk for inflammatory bowel disease.

In an observational study in Digestion, 120 patients with Crohn's disease, and 100 patients with ulcerative colitis and matched controls were interviewed by questionnaire.( 4) Crohn's patients ate significantly more sugar than either the controls or patients with ulcerative colitis, and their use of sugar had changed little since symptom-onset.

Since the use of refined carbohydrates may precipitate IBD in susceptible persons, likewise, altering the diet to remove refined carbohydrates is often of benefit.

In an experimental controlled study, 32 Crohn's patients were given a fiber-rich, unrefined, carbohydrate diet (in addition to conventional management), which they followed for four years. Their outcome was compared retrospectively with that of 32 matched patients who had received no dietary instruction.

Hospital admissions were significantly fewer and shorter in the diet-treated patients (111 days) than in the non-diet-treated patients (533 days). Five of the controls ultimately required surgery, while only one diet-treated patient required it. There were no cases of intestinal obstruction among the diet-treated patients.( 5)

It should be noted that the introduction of refined carbohydrates taking place in Western society is a recent phenomenon with the amounts used increasing dramatically over the past century. Medical dietitians have indeed historically promoted refined carbohydrate products, as evidenced by looking at the typical fare served in hospitals.

Until recent years, the primary source of calories was carbohydrates, derived principally from starch. In the period of 1909 to 1913, starches were the source of 68 percent of dietary carbohydrates, whereas sugars were the source of only 32 percent. By 1976, a clear trend was obvious, with 53 percent of dietary carbohydrates coming from sugars and 47 percent from starches.( 6) This trend continues.

My observation, based on doing detailed computerized dietary analyses over the past 18 years, is that almost every patient I have seen with inflammatory bowel disease has consumed a large amount of refined carbohydrates for many years, including both refined flour and sugar. Since these items are prevalent in the American diet, counseling patients on avoidance of refined carbohydrates (and convincing them to do so) can be difficult.

I have found it better to advise patients on what types of foods should be ingested rather than attempt to list all the products and name brands that should be avoided. The reaction of most patients, after hearing the descriptions of foods containing refined carbohydrates, generally is: "What is left to eat?" This indicates how pervasive refined carbohydrates are in the American diet today, despite the fact that their introduction to the human species is a relatively recent phenomenon.

For the patient whose bowel is ulcerated and bloody, the mere introduction of whole grains, fruits, vegetables and other complex, fiber-rich carbohydrates may be contraindicated, however, until a period of digestive rest is allowed by a supervised fast or a carefully limited diet to permit the bowel the opportunity to begin the healing process. The IBD patient who enthusiastically introduces whole grains, including whole wheat breads and pastas, may find their condition worsened without a period of bowel rest. They also must consider the possibility that food allergy (grains are common allergens) may play a role in their disease.

FOOD ALLERGY

The function of the intestines is to serve as a conduit for the passage of food, allowing for its breakdown, absorption and elimination of waste products. It is surprising, therefore, that so little attention has been given by the health-care professions to the relationship between IBD and the intestines' poor reaction with the foods that pass through it daily. The medical gastroenterologist generally merely advises the patient to "eat a balanced diet" and assures the patient (while prescribing a myriad of pharmaceutical agents) that "diet" (the materials in contact with the G.I. tract constantly, and out of which his/her tissues are made) "has nothing to do with his/her disease."

A food allergy is an immune response to food. An allergy typically results in an inflammatory response, as is seen in IBD. The response may be an immediate one (within four hours), termed an IgE response, or a delayed one (taking as long as 72 hours to manifest), termed an IgG4 response. With IgG4 allergic responses, a patient might consume a food as little as two or three times per week, yet experience constant discomforts as the result.

Frieri, et al., reported on food allergy investigation in Crohn's patients, stating that the "interaction between food antigens and the immune system may play a role in the pathogenesis of inflammatory bowel disease."( 7)

Food allergies may be present at birth, or they may develop over the years. Their genesis may be associated with a number of factors, including the development of faulty digestion and poor intestinal membrane integrity.

In the presence of food allergy, it is to be expected that the intestines would seek to rid themselves of the offending agent as quickly as possible. The body produces intestinal spasms to eliminate the offending agent, pours water into the gut to wash out the offending agent, and secretes mucus to protect the gut lining from the irritating agent -- all typical symptoms of the patient with IBD! Ongoing exposure to the allergic food(s) is likely to create bowel inflammation as part of the allergic response.

While any food may be a causative agent in IBD, cow's milk, wheat and eggs are common offenders. My own observation in doing allergy testing (via the blood) on IBD patients is that milk allergy is extremely prevalent. Many patients are also lactose intolerant, which further aggravates the condition. Every patient, however, is different as to the allergies they have. Even usually benign foods may on occasion be a source of problem for an individual. One IBD patient I tested had a severe allergy to rice. Its removal resulted in significant improvement in the patient's condition, yet rice allergy is very uncommon. Every person is biochemically unique.

Allergy tests of choice are blood tests for IgE and IgG4 responses. These are rarely done by medical physicians, who characteristically utilize skin patch testing. The skin patch test, however, is notoriously inaccurate, resulting in many false positives and false negatives. It is limited as well in that it can only be utilized for immediate-type reactions (IgE responses), which are not as commonly involved with chronic diseases, such as IBD, as are the IgG4 (delayed) responses.

In addition to intestinal damage occurring by food allergens, the immune system may also be triggered by microbial antigens. Braegger and MacDonald, in reviewing the immune mechanisms in IBD, state that: "All these observations suggest that Crohn's disease may be caused by hyperreaction of the local cellular immune system to numerous microbial and nutritional (food) antigens, normally present in the intestine."( 8)

Saverymuttu, et al., state: "Much evidence suggests that the expression of immune responses in the gastrointestinal mucosa may be of importance, and evidence for sensitization of patients to a variety of gut-associated antigens, both intrinsic and extrinsic, has been reported."( 9)

GUT PERMEABILITY

Concurrent with food allergies, patients with IBD are generally found to have increased permeability of their intestines. This permits the entry of undigested proteins and microbial antigens into the blood. With the entry of these antigenic materials not only is the intestinal disease promoted, but there is also the production of a myriad of extraintestinal problems and symptoms. These symptoms include low back pain, rheumatism, skin disorders, fatigue, etc., and contribute to autoimmune disorders, such as rheumatoid arthritis, lupus and a host of other problems.

Many patients entering the chiropractor's office with IBD present with low back pain, sacroileitis, muscle pains, neck and shoulder problems, etc. These discomforts may be severe and are often directly related to allergic and microbial products entering the bloodstream and creating a host of inflammatory byproducts, resulting in muscle and joint inflammation. For the IBD patient with recurrent spinal subluxations, this may be an important consideration to address.( 10, 11)

Testing with a lactulose/manitol solution, I have found that most patients with IBD have increased intestinal permeability concomitant with their other complaints. Likewise, I have found that as the intestinal permeability decreases (as evidenced by retesting for gut permeability) that musculoskeletal complaints decrease accordingly.

Organic acid analysis of the urine may demonstrate the presence of a variety of antigens produced by excessive bacteria and yeast/fungi, often associated with a "leaky gut." The initiating factor leading to the abnormal compounds in the urine may often be traced to the usage of antibiotic preparations disturbing normal gut flora and contributing to inflammatory changes as in IBD. Lord and Brally report in a recent article that these changes in gut flora produced by antibiotic usage may be associated with autism and behavioral disorders as well.( 12) Clearly, one thing can lead to another.

It also seems likely that the increase in gut permeability may not only be the result of IBD, but may be an etiologic factor in its development.

Hollander, et al., stated: "Our data clearly supports the hypothesis that an intestinal permeability defect is an etiologic factor in Crohn's disease...Increased intestinal permeability in Crohn's disease may be the primary defect in producing both the local disease and systemic consequences."( 13)

Other gut-related factors that should be ruled out in patients with IBD include systemic candidiasis, parasites and upper G.I. tract maldigestion.

YEAST OVERGROWTH

Candidiasis has been increasingly recognized as part of the problem in a number of chronic disease conditions, including some cases of IBD. Its presence can be identified by both taking a blood candida titer and through stool cultures. The use of refined carbohydrates, alcohol, antibiotics and steroids; chronic emotional stress and lowered immunity, due to other factors such as lack of sleep and rest, allergies, overwork, etc., all contribute to the overgrowth of candida, which is in small amounts a normal intestinal inhabitant.

However, candidiasis needs to be addressed at its sources. While giving anti-yeast preparations (whether natural or drug-derived) can be of benefit in some cases, simply giving anti-yeast agents alone does not resolve the problem. Causal factors must be addressed so that overall immunity may be improved. Logically, this includes avoidance of refined carbohydrates (a low carbohydrate diet may be indicated for a time), alcohol, antibiotics and steroids; increased rest and sleep; allergen identification and removal; and other positive measures tailored for the individual to enhance overall body integrity.

PARASITES

While parasites are not a common reason for IBD, stool samples should be taken to assure their absence. It is important to take multiple samples and use a good laboratory for identification (typical parasitology stool exams are notorious for overlooking the presence of a parasite). It is also often wise to consider a stool microbiology to check for the presence of bacterial pathogens that may be playing a contributing role, realizing that their presence may be the result of the IBD rather than its cause.

UPPER G.I. TRACT INDIGESTION

Frequently in medical practice, the emphasis on IBD is put on the intestine, where the symptoms are, rather than on the source of the problem. IBD may be due to digestive problems in the upper gastrointestinal tract, including the following factors.

- decreased hydrochloric acid flow, resulting in poor breakdown of food proteins.

- impaired utilization of minerals.

- increased allergic responses.

- impaired secretion of sodium bicarbonate.

- bacterial overgrowth.

- impaired disaccharidase

secretion from the small intestine (maltase, lactase, sucrase). With decreased disaccharidase production, bacterial fermentation, which is highly irritating to the bowel, becomes a likelihood.

- poor utilization of proteins, resulting in amino acid deficiencies. Amino acid analysis through the blood plasma can make this identification. Amino acids are necessary for tissue repair, and they have potent anti-inflammatory effects.

- poor secretion of enzymes and/or bicarbonate from the pancreas, again resulting in poor utilization of nutrients, microbial overgrowth on undigested food products and bacterial fermentation and/or putrefaction.

CELIAC DISEASE

Celiac disease, a sensitivity to gluten, a protein found in most grains, should be checked for, since it results in significant bowel irritation and produces symptoms of IBD.

Patients identified with celiac disease must avoid all gluten-containing products. Doing so in patients with celiac disease will typically result in a complete resolution of IBD symptoms.

CHIROPRACTIC CARE

The relationship between the G.I. tract and the nervous system is an intimate one. The gastrointestinal tract is highly innervated, containing, it is said, as many neurons as the spinal cord. Every attempt should be made to improve and balance neurological function, including quality chiropractic care with specific adjusting techniques. No single area of the spine will require care in every case. Each case differs, and proper analysis is important.

Other measures to improve the nervous system that can be engaged in by the patient include meditation, Hatha Yoga and tai chi, along with various relaxation techniques.

"QUICK CURES"

As with other chronic, debilitating conditions, there is a ready marketplace for overnight remedies promising quick relief from the problems of IBD. Most of these fall in the category of so-called natural "bowel cleansing" products, and a host of so-called natural food and herbal supplements.

No amounts of colonics, enemas or "colon cleansers," composed of herbal derivatives, will prove of benefit to the IBD sufferer. Addressing "treatment" to the bowel itself rather than to the body as a whole is counterproductive. "Colon cleansers" do nothing to address the cause of the IBD and irritate the delicate lining of the bowel. The same is true of enemas and colonics. Both tend to further disturb the imbalanced bowel flora already present and further fatigue the patient.

If the first thing the doctor does with the IBD patient is suggest a host of herbal or other nutrient supplements, the patient would be well advised to seek out a different practitioner who is oriented toward looking for etiological factors. How often I have heard from patients that they went to Dr. A or Dr. B, who immediately recommended a new herbal product or other "natural supplement" upon hearing that the patient had IBD! The practitioner in such cases has not searched out causes of the patient's problem and is oriented toward symptom management at best. We do not acquire IBD due to a lack of any specific herbal or food supplement, and we are therefore not going to get well from such either.

Specific nutrient supplements for the patient's needs can prove helpful once causes have been identified, the bowel has had a chance to rest and a recuperative program is under way. Both patient and doctor must be aware, however, that they are of secondary importance relative to the other recuperative and hygienic steps that the patient must undertake.

FASTING

An irritated ulcerated intestine needs rest above all else. A properly supervised fast by a qualified, experienced, natural hygiene practitioner will frequently expedite the patient's recovery and in many cases is essential. During the fast, body functions are able to normalize; toxins and allergens are speedily removed; and the tissues have the opportunity to heal. The fast allows all the body tissues to rest and regain vitality.

Following the fast, the rested body is in a much better position to appropriate foodstuffs and build healthy tissues.

The length of the fast must be determined by the practitioner, usually lasting between three and 25 days. This is not something to be undertaken by any doctor who is not well versed and experienced in the art and science of fasting. Lengthy fasts, particularly with patients who are debilitated, should be conducted in house with the patient under the watchful eye of the professional. Monitoring the fast's progress through the blood and urine is supportive of good patient care.

For patients unwilling or unable to fast, liquid diets of different types suitable to the needs of the particular patient may, in some cases, be used to advantage, under careful experienced supervision, and I have done so with many patients over the years. It is my experience, however, that this is not as effective in allowing for recovery as a total fast (water is taken only) with complete bed rest in a hygienic setting, under supervision.

Breaking of the fast and the resumption of eating must be done carefully. Improper breaking of the fast (or even the liquid diet) may prove to be highly detrimental, even dangerous, to the patient. Again, the need for experienced supervision is very important.

HYGIENIC CARE

Getting well from IBD requires more than office care, laboratory testing, diet changes and chiropractic care. It also requires that the patient take these natural, hygienic steps:

- Sufficient rest and sleep. A daily nap is helpful.

- Chewing food very well and not overeating.

- Ingesting food only when there is emotional calm and real hunger present.

- Moderate exercise, avoiding exhaustion.

- Obtaining adequate sunshine and fresh air.

- Maintaining cordial relationships with friends and family.

- Having work that is rewarding.

- Avoidance of toxins such as coffee, tea, soft drinks, alcohol, etc.

How, patients may ask, are they to do all the above when they are feeling so ill? They must work toward improvement, realizing that making changes takes time and consistent effort. There are rarely any quick cures. Hard work and a change of habits on the patient's part are essential. There is nothing the doctor can do to equal the effort, or lack of effort, that the patient makes.

REGAINING GOOD HEALTH IS POSSIBLE!

IBD, whether termed colitis or Crohn's, need not lead to hopelessness and a life of misery. Most patients with proper effort, under natural hygienic care, can improve greatly and recover. Endless steroids and other drugs addressing symptoms while allowing the disease process to continue, colonoscopies, days of pain and fatigue, diarrhea, cramping, arthritic/rheumatic symptoms, a loss of vitality, eventual surgical removal of intestines, or the development of cancer, need not be the outcome with proper analysis, supervised hygienic care and a determined patient.

The following case studies from my own practice may help to illustrate some of the concepts addressed in the article.

CASE STUDY NO. 1

Patient Presentation: A 45-year-old male entered our office with a 15-year history of Crohn's disease. During this time, he had undergone a total of four intestinal reactions, each time having a segment of his inflamed small intestine removed. In between operations, he was kept on a variety of pharmaceuticals. Since nothing had been done to address causes, it was only a matter of a few years before another segment of intestine had to be removed. At the time the patient came to see me, his gastroenterologist had told him that while his intestines were badly inflamed again, there was nothing more that could be done surgically, since there was not enough small intestine left to be able to afford removing any more of it.

The patient was badly debilitated, underweight, weak, depressed and very pale. He had severe diarrhea on an ongoing basis. His diet was very poor and he had been told by his medical physician that his diet had nothing to do with his disease so that he could eat whatever he cared to. The patient tried to exercise, but found his efforts futile due to his profound weakness.

Analysis: The patient's diet was heavy in coffee and refined carbohydrates. His plasma amino acid levels were extremely low in eight of the 10 essentials, although his diet was rich in protein-containing foods. There was evidence of some abdominal bacterial overgrowth in the bowel, likely due to the massive doses of antibiotics and steroids he had been on over the years. The patient had extensive muscle spasm and tightness throughout the lower cervical and upper thoracic spine. The patient was modesty anemic, as evidenced through blood work. He was unhappy in his occupation as a salesman.

Care Plan/Outcome: The patient was initially taken off all refined carbohydrates, coffee and other irritative substances. He was other irritative substances. He was put on a light diet of easily digested natural foodstuffs with attention given to eating habits as well as types of foods eaten.

The patient was hesitant to undergo any chiropractic care, but consented once he saw that the care was gentle and that the fears he had heard expressed by other people about getting hurt by adjustments had no basis. A full-spine technique was administered, and the patient came to look forward to being adjusted.

After two weeks, the patient was placed on a fast that lasted nine days. The patient was concerned about losing yet more weight, but he understood that his weight loss had occurred due to his inability to digest and assimilate food properly and that the fast could help greatly in that regard. He completed the fast feeling very "clear-headed and refreshed," although the first two days had been uncomfortable, as is sometimes the case. The fast was carefully broken and the patient found that his cravings for coffee and junk foods had entirely disappeared. While he had lost eight pounds during the fast, this was quickly recovered, and within a month the patient had not only recovered all the weight lost during the fast, but gained an additional seven pounds for which he was delighted.

Specific amino acid supplements were given temporarily, based on the patient's blood studies, and the patient noted a rapid improvement in strength. He was able to commence an exercise program and made rapid gains.

I counseled the patient on the need to adjust better to his occupation or find a new one. The patient took the advice seriously and located another sales position, which proved to be much less stressful and more satisfying.

Three years later, the patient remains well. He takes excellent care of himself and has followed recommendations almost to the letter. Due to having had so much of his intestines previously removed, he still has some diarrhea, but reports it is very mild in comparison to what it had previously been. His need for ongoing chiropractic care has been minimal with his giving careful attention to diet, sleep, work, activity and other hygienic habits.

CASE STUDY NO. 2

Presentation/History: An 11-year-old male was brought to me by his mother, who was desperate for help and was seeing me as a "last resort," having been referred by another patient of mine. Nine months previously, the boy had begun to experience diarrhea, along with weight loss and accompanying fatigue.

His pediatrician sent him to a local hospital after a course of antibiotics failed to produce any results. A colonoscopy was performed, but was unrevealing. Due to the ongoing weight loss, the boy was transferred to a local, well-known Atlanta children's hospital, where he was given further testing and another colonoscopic examination. He stayed there for two weeks, undergoing extensive testing. The tests were unrevealing, and he continued to lose weight. He was transferred again to another children's hospital associated with a university. In addition to repeating most of the same tests, a careful search for malignancy was conducted, but was negative. An extensive psychiatric evaluation was also conducted.

After two weeks at this hospital, the patient was still continuing to have diarrhea and weight loss, leaving him with a "skin and bones" appearance. The university hospital sent him home with the following counsel to his mother.

The patient was in very serious condition, but there was nothing more that could be done at the hospital. Having ruled out any organic cause for the patient's problems, it was assumed to be the result of a psychological imbalance resulting from his parents' divorce and that he needed to receive psychiatric care.
The hospital's registered dietitian advised the mother to give the boy "regular feedings of ice cream and milk shakes to help maintain his weight, along with a balanced diet."
The child's lack of progress and continued weight loss indicated that he might not survive -- that re-hospitalization would likely be needed within the next few weeks to put the boy on intravenous feedings.
[Side note: At this point, the child's hospital and doctor bills totaled over $155,000.]

Analysis: The patient presented in a very weak state. Both he and his mother were very scared by his condition. I ran a battery of functional tests, including tests for food allergies and multiple stool parasitology samples. Test results showed the child to have the presence of a protozoa named giardia and a high sensitivity to cow's milk.

I immediately took the patient off of all the dairy products (including the milk and ice cream the registered dietitian wanted the mother to give him) and put him on a light diet of easily digested natural foods that he exhibited no allergic responses to, along with a few nutrient supplements, in light of his emaciated condition. Simultaneously, I referred him to a local medical doctor with the results of his parasitology test to receive appropriate medication to rid him of the parasite.

Outcome: The patient rapidly improved after the allergens were removed from his diet, and he was treated for giardia. Within the next two weeks, his weight increased along with his strength. His mood elevated (as did his mother's!). This was seven years ago. Since then, he has turned into a tall, well-built young man, who played football in high school and is currently enrolled in a university on an academic scholarship. He has had no recurrence of his illness.

Discussion: Between having giardia and food allergy (which the parasite worsened), the patient was unable to absorb nutrients, therefore the diarrhea and weight loss. One of the hospitals he had been in had tested him for parasites, but had done only two samples and claimed that both had proven negative. This points out the often false negative results that occur with hospital laboratory testing, particularly in regard to parasitology testing. A three-draw sample should always be conducted and, in severe cases such as this, repeated if the patient has not improved.

That the registered dietitian placed the boy on large amounts of dairy products (ice cream and milk shakes) reflects the indoctrination of dietitians by the food industry and Dairy Council in endorsing processed foods, sweets and dairy products. Despite the dietitian's exposure to basic concepts of food allergy in their training, few make such application of it in their hospital work. Dairy products are perhaps the most common food allergen there is in the American diet, a fact even many laypersons are aware of.

Postscript: A lawsuit against the hospitals, doctors and dietitian was pursued by the mother. She felt her son likely would have died had she not brought him to me for analysis. She was angry at the medical profession's oversights, the incompetence of the dietitian's advice to her, the guilt that had been laid at her feet for her son's illness being related to the divorce, and the enormous medical bills which had yielded only counterproductive results. One can imagine the chagrin of the medical professionals and dietetic staff when presented with the fact that this case they had misdiagnosed so badly had been resolved by a licensed doctor of chiropractic and professor of nutrition at a chiropractic college!

The above case studies help demonstrate the variety of stances under which IBD is developed. They also show the necessity for careful patient analysis, education and participation. Excellent results can be obtained when a constructive, hygienic approach is undertaken by a determined doctor and patient.

References
(1.) Hodgson, H.J.F., "Inflammatory Bowel Disease and Food Intolerance," JR Coll Physicians London 20(1):45-48, 1986.

(2.) Grimes, D.S., "Refined Carbohydrate, Smooth Muscle Spasm and Disease of the Colon," Lancet 1:395-397, 1976.

(3.) Kruis, W., et al., "Influence of Diets High and Low in Refined Sugar on Stool Qualities, Gastrointestinal Transit and Fecal Bile Acid Excretion" Gastroenterology 92:1483, 1987.

(4.) Mayberry, J.F., et al., "Increased Sugar Consumption in Crohn's Disease," Digestion 20:323-326, 1980.

(5.) Heaton, K.W., et al., "Treatment of Crohn's Disease With an Unrefined Carbohydrate, Fibre-Rich Diet," Br. Med. J 2:764-766, 1979.

(6.) Brewster, L., and Jacobson, M.F., The Changing American Diet, Washington, D.C.: Center for Science in the Public Interest, 1978.

(7.) Frieri, et al., "Preliminary Investigation on Humoral and Cellular Immune Response to Selected Food Proteins in Patients With Crohn's Disease," Ann Allergy 64:345-351, 1990.

(8.) Braegger, C.P., and MacDonald, T.T., "Immune Mechanisms in Chronic Inflammatory Bowel Disease," Ann Allergy 72:135-141, 1994.

(9.) Saverymuttu, S., Hodgson, H.J.F., Chadwick, V.S., in Gut, 26:994-998, 1984.

(10.) Katz, K.D., and Hjollander, D., "Intestinal Mucosal Permeability and Rheumatological Disease," Baillieres Clinic Rheumatol, (England), 3(2):371-284, Aug. 1989.

(11.) Smith, M.D., Gibson, R.A., and Brooks, M., "Abnormal Bowel Permeability in Ankylosing Spondylitis and Rheumatoid Arthritis," J. Rheumatol, (Canada), 12(2):299-305, April, 1985.

(12.) Bralley, A., and Lord, R., "Organics in Urine: Assessment of Gut Dysbiosis, Nutrient Deficiencies and Toxemia," Nutritional Perspectives, July, 1997.

(13.) Hollander, D., et al., "Increased Intestinal Permeability With Crohn's Disease and Their Relatives," Ann Int. Med. 105:883-885, 1986.

Life University.

~~~~~~~~

By Paul A. Goldberg

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