Colitis and Irritable Bowel

You have a garbage disposal in your kitchen. Most of the time, it probably works pretty well. Now, if only your digestive waste disposal system would work as well. But it seems like nothing's ever easy. If your stomach starts to ache after almost every meal, you have awful gas, and you either have diarrhea or are constipated, you might just have a bowel disease. Bowel diseases, including ulcerative colitis, Crohn's disease and irritable bowel syndrome (IBS), are responsible for nearly half the visits to digestive tract specialists.

Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is the term for a cluster of chronic disorders marked by inflammation or ulceration in the small and large intestines. Most cases of IBD are classified as Ulcerative Colitis or Crohn's Disease. These conditions are also sometimes referred to as colitis, enteritis, ileitis and proctitis, depending on the location of the symptoms. The term "colitis" simply means "inflammation of the colon", and is another term for IBD.

IBD affects over a million people in the US, and is the cause of over 700,000 physician office visits every year. Surprisingly, IBD is found mostly in developed countries- the higher the standard of living, the greater prevalence of the disease. For example, ulcerative colitis is almost non-existent in Sub-Saharan African black populations, who eat a largely traditional diet. The few recorded cases were urbanized people, eating a more typical western diet.[ 1] A 1998 Dutch study demonstrated that IBD, which has become more common since World War II, is highly correlated with "modern lifestyle."[ 2]

Ulcerative Colitis (UC)
Ulcerative colitis causes ulceration (open sores) and inflammation of the inner lining of the colon and rectum, provoking diarrhea. Ulcers then form in places where the inflammation has killed cells. The ulcers bleed, producing pus and mucus.

Ulcerative colitis most often afflicts people ages 15 to 40, but children and older people sometimes succumb. UC affects men and women equally. UC patients have abnormal immune systems, but researchers do not know why.

UC may also involve other issues, including arthritis, eye inflammation, liver disease, osteoporosis, skin rashes, anemia, and kidney stones. No one knows for certain why symptoms occur outside the colon, although some experts think these complications manifest when the immune system triggers inflammation in other body parts. Such symptoms are usually mild and clear up when the UC is treated. Colon cancer risk is greater than normal in patients with extensive ulcerative colitis. Studies have determined that UC patients who take folic acid supplements or who have high folic acid blood levels of have a reduced risk of colon cancer.[ 3][ 4][ 5] Interestingly, people who smoke tobacco have less UC.[ 6][ 7]

About 25 percent of ulcerative colitis patients eventually undergo surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer, usually after medical management has failed.

Conventional treatment for emergency UC is often vital. However, orthodox treatments for UC commonly offer only a partial resolution and frequently involve major side effects. Because of these limitations, many UC sufferers lean on natural medicine.

Crohn's Disease (CD)
Crohn's Disease is distinguished by inflammation that extends deeper into the layers of the intestinal tissue. CD most often affects the small intestine, typically the ileum. In any given case the colon may also be involved. The inflammation may also extend to the mouth, esophagus, stomach, duodenum, appendix or anus. It tends to produce sharp, severe pain in isolated areas of the gut.

CD is a chronic condition that often recurs at intervals during a lifetime. Patients can have long periods of remission, living symptom free, some for years, when they are free. There is no medically accepted way to predict when a remission may take place or when symptoms will come back.

CD affects males and females equally and seems to run in some families. About 20 percent of CD patients have a blood relative with some form of IBD. Smoking makes Crohn's worse.[ 6]

There is no medical cure for CD, although several medications are used to control symptoms. Corticosteroid drugs, which have very serious long-term side effects, including osteoporosis, have been the standard drugs used to treat CD flare-ups. Even though newer, safer medications are available, many doctors still rely on the steroids.

The standard goals of orthodox therapy are to correct nutritional deficiencies, control inflammation and relieve abdominal pain, diarrhea and rectal bleeding.

Treating IBD
If you develop frequent diarrhea, bloody stools, cramps and abdominal pain, see your physician, so the diagnosis can be confirmed. Colitis can mimic other bowel diseases, such as infectious conditions and irritable bowel syndrome. It's important that you receive a clear initial diagnosis.

Omega-3 fatty acids, one type of essential fatty acids, are special fats that the body needs. Investigation found that the omega-3 fatty acids found in fish oil could lower triglycerides, "thin" the blood and decrease inflammation. Evidence indicates that fish oil, an anti-inflammatory remedy containing EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), benefits UC and can help prevent flare-ups of Crohn's disease.[ 8][ 9] A 1-year double-blind trial with 78 C D patients in remission who were at high relapse risk determined that fish oil supplements helped reduce flare-ups.[ 10] To match the dosage used in several major studies, many people take fish oil to supply 1,800 mg of EPA and 900 mg DHA daily.

Glutamine, an amino acid, participates in the functions of the digestive tract, immune system and muscle cells. It serves as a fuel for the cells of the intestinal lining. Infection and trauma can deplete glutamine reserves. Glutamine has also been suggested as a treatment for digestive disorders. Preliminary evidence suggests that glutamine supplements might reduce leakage through the intestinal walls. Along the same lines, glutamine has been suggested for people with other bowel diseases.

Animal studies show that the structure and function of the gut is preserved by glutamine. A small human study from 1993, published in Lancet, indicated that glutamine prevents deterioration of gut permeability and preserves mucosal structure.[ 11] More recent studies have been inconclusive, however.[ 12][ 13]

Glutamine can be taken in a total of 2 to 6 g daily, divided into several separate doses.

I have personally had great clinical success with a program of powdered marshmallow root or slippery elm bark (whichever is available or a mixture of the two) at a dose of 1-6 heaping Tbs. per day, and turmeric powder at a dose of 1-3 heaping Tbs. per day. This program is exceptional for quenching flare-ups, and for maintaining health at a lower dose as necessary.

No particular diet has been demonstrated to be effective for warding off or treating this disease. In some cases, symptoms worsen with milk, alcohol, hot spices or fiber. Each case must be approached individually. However, there is some evidence that dietary measures may be effective.

Use of alcohol, which promotes folic acid deficiency, has been connected to an elevated risk of colon cancer. Therefore, people with UC must minimize alcohol.[ 14]

Proponents of a link between food allergies and IBD recommend identifying and removing allergenic foods. This theory is debated, but advocates claim good success.[ 15]

Irritable Bowel Syndrome (IBS)
This disease is a common disorder of the intestines. In some people, IBS produces constipation; in others, diarrhea. Some people suffer from both. People with IBS may pass mucus with their bowel movements. Frequently the patient has cramps and an urge to move the bowels but cannot do so. Attacks of IBS diarrhea are frequently so unpredictable that patients fear to stray far from home.

IBS is known by many names — colitis, mucous colitis, spastic colon, spastic bowel and functional bowel disease. But none of these terms really describes IBS properly. IBS doesn't involve inflammation and should not be confused with ulcerative colitis.

There is no verified cause for IBS, and as yet there is no cure. Experts term IBS a functional disorder since there is no sign of disease in the colon upon examination. IBS provokes a stunning amount of discomfort and distress. However, it does not produce permanent injury to the intestines and does not bring about intestinal bleeding or a serious disease such as cancer. For some, IBS is a mild annoyance, and for others it is disabling. Though the disease creates the potential for trouble at any time, symptoms occur after a trigger takes place. Eating or distention from gas or food in the colon can cause the colon to overreact. Particular medicines or foods may trigger spasms. Frequent offenders include chocolate, milk products, fatty food or alcohol. Those with IBS are particularly likely to suffer loose stools from caffeine. Women with IBS have more symptoms during menstrual periods, implying that reproductive hormones may have a role in IBS. Many people have increased symptoms when they are under stress.

Over 5 million Americans have IBS, resulting in more than 3.5 million office visits per year.

Treating IBS
Lactobacillus acidophilus is a healthful strain of bacteria used to make yogurt and cheese. Soon after birth, acidophilus establishes itself in the intestines and helps prevent intestinal infections.

Acidophilus is one of several microbes known collectively as "probiotics." Others include the bacteria L. bulgaricus, L. reuteri, L. plantarum, L. casei, B. Bifidus, S. salivarius, and S. thermophilus and the yeast Saccharomyces boulardii. Acidophilus and related probiotics not only assist the digestive function, they also reduce the presence of negative organisms by competing with them for space. In fact, there are nine times as many bacteria in your intestines as there are cells in your entire body.

In a 4-week double-blind placebo-controlled trial of 60 individuals with IBS, probiotic treatment with Lactobacillus plantarum substantially reduced intestinal gas. And the benefits persisted for another year after treatment was completed.[ 16] A smaller double-blind trial using L. acidophilus also showed benefits.[ 17]

Friendly bacteria might also be helpful in UC. One 12-week double-blind study of 120 patients found that a friendly variety of E. coli helped prevent flare-ups as well as the drug mesalazine.

Dosages of acidophilus are expressed not in grams or milligrams, but in billions of organisms. A typical daily dose should supply about 3 to 5 billion live organisms. Other probiotic bacteria are used similarly.

Enteric-coated peppermint oil works well to relieve the symptoms of IBS. Peppermint oil is a relaxant for the muscles of the intestinal wall. Enteric coating the capsule delays the effect until the remedy is further down in the digestive tract, as well as reducing peppermint-tasting burps. In one double blind trial from Taiwan, four out of every five IBS victims experienced reduced symptoms when given enteric-coated peppermint oil.[ 19]

Caraway oil has similar properties, relaxing the gut wall and reducing diarrhea episodes (gastrointestinal motility). In 1999, a study from Germany used peppermint and caraway oils to test 223 IBS patients. The combination brought about a significant reduction in pain.[ 20] A German study from February 2000 again confirmed that a combination of peppermint and caraway oils effectively reduced the speed of intestinal movement.[ 21]

Psyllium seed, a common bulk fiber laxative, balances bowel function and relieves pain in IBS. Psyllium's capacity to absorb fluids means that it is useful for treating diarrhea, a common IBS symptom. As it travels through the gut, the mucilage in psyllium creates a soothing benefit, which may relieve cramping. An English study revealed that constipation significantly improved in patients taking psyllium. Eighty-two percent of the subjects had IBS symptom relief.[ 23] A study to determine the optimum dose recommended 20 grams per day.[ 24]

For some, eating a restricted diet reduces IBS symptoms. The diet must be individualized, depending on the individual triggers. Fiber usually helps. Clinicians usually recommend just enough fiber so that you have soft, easily passed, and painless bowel movements. More frequent, smaller meals usually work better.

The scientific evidence is accumulating. There is help for bowel diseases. These natural medicines will help. Give them a try and get your life back.

Other Options to Quell the Fire
Drink water- prevent diarrhea from dehydration
Eat a very nourishing diet- reduce the
malnutrition from diarrhea

Add a supplemental multivitamin — replace lost nutrients
Use apples- they contain pectin, a very colon friendly fiber
Keep a food diary- record reactions to avoid offending foods
Folic acid- add 400 mcg. per day if taking azulfidine, which depletes this vitamin
Stress reduction- yoga, meditation, exercise, breathing
Reduce milk- many colitis patients are somewhat lactose intolerant
Cook vegetable until very tender to reduce symptoms
Be cautious with nonsteroidal anti-inflammatory drugs (ibuprofen, aspirin)- they erode the digestive wall
Cut the fat- stimulates colon contractions
Don't fill up the gas tank- avoid beans, cabbage, brussels sprouts, broccoli, cauliflower, onions.
Coffee… not!
Beer and wine- off the list- ingredients tend to cause colon grief.
During an attack:
Eat sparingly- with cramps, limit food and eat plainly- apple sauce, cooked carrots, etc.
Reduce fiber- limit high fiber foods. Stick to the bland ones (Jello).
Reduce seeds, nuts, popcorn.
Be cautious with spicy or acid foods.
Base your diet on rice, sweet potatoes, bananas, well-steamed green and yellow vegetables.
Try a hot water bottle on that bum tummy.
Bowel Diseases- What's the Difference?
Legend for Chart:
A - Disease
B - Symptoms
C - Drug treatments
A: Ulcerative colitis (inflammatory)
B: Softening of the Stools
Urgency to Move Bowels
Blood in the Stool
Abdominal Pain
Anemia
Weight Loss
Joint Pain
Eye and Skin Ailments Fatigue
Loss of Appetite
Loss of Body Fluids and Nutrients
C: Sulfasalazine (inflammation in the colon)
Steroids
Antibiotics
A: Crohn's Disease (inflammatory)
B: Abdominal pain, often in the lower right area Diarrhea.
Rectal Bleeding
Weight Loss
Fever
Anemia
Delayed development (children)
C: Sulfasalazine (inflammation in the colon)
Steroids
Antibiotics
A: Irritable Bowel Syndrome (IBS) (non-inflammatory)
B: Cramping pain
Gas
Bloating
Changes in bowels habits (constipation or diarrhea)
C: Fiber products (Metamucil)
Laxatives
Colon anti-spasmodics
Tranquilizers
Digestive slowing agents
REFERENCECS
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2 Russel MG, Engels LG, Muris JW, Limonard CB, Volovics A, Brummer RJ, Stockbrugger RW Modern life' in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors. Eur J Gastroenterol Hepatol 1998 Mar;10(3):243-9

3 Lashner BA, Heidnreich PA, Su GL, et al. Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. Gastroenterol 1989;97:255-59.

4 Lashner BA. Red blood cell folate is associated with the development of dysplasia and cancer in ulcerative colitis. J Cancer Res Clin Oncol 1993;119:549-54.

5 Lashner BA, Provencher KS, Seidner DL, et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterol 1997;112:29-32.

6 Andus T, Gross V Etiology and pathophysiology of inflammatory bowel disease — environmental factors. Hepatogastroenterology 2000 Jan-Feb;47(31):29-43

7 Sandborn WJ Nicotine therapy for ulcerative colitis: a review of rationale, mechanisms, pharmacology, and clinical results. Am J Gastroenterol 1999 May;94(5):1161-71

8 Almallah YZ, Ewen SW, El-Tahir A, Mowat NA, Brunt PW, Sinclair TS, Heys SD, Eremin O Distal proctocolitis and n-3 polyunsaturated fatty acids (n-3 PUFAs): the mucosal effect in situ. J Clin Immunol 2000 Jan;20(1):68-76

9 Dichi I, Frenhane P, Dichi JB, Correa CR, Angeleli AY, Bicudo MH, Rodrigues MA, Victoria CR, Burini RC Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition 2000 Feb;16(2):87-90

10 Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med 1996 Jun 13;334(24):1557-60

11 van der Hulst RR, van Kreel BK, von Meyenfeldt MF, Brummer RJ, Arends JW, Deutz NE, Soeters PB Glutamine and the preservation of gut integrity. Lancet 1993 May 29;341(8857):1363-5

12 Den Hond E, Hiele M, Peeters M, Ghoos Y, Rutgeerts P Effect of longterm oral glutamine supplements on small intestinal permeability in patients with Crohn's disease. JPEN J Parenter Enteral Nutr 1999 Jan-Feb;23(1):7-11

13 Akobeng AK, Miller V, Stanton J, Elbadri AM, Thomas AG Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr 2000 Jan;30(1):78-84

14 Klatsky AL, Armstrong MA, Friedman GD, Hiatt RA The relations of alcoholic beverage use to colon and rectal cancer. Am J Epidemiol 1988 Nov;128(5):1007-15

15 Candy S, Borok G, Wright JP, Boniface V, Goodman R The value of an elimination diet in the management of patients with ulcerative colitis. S Afr Med J 1995 Nov;85(11):1176-9

16 Nobaek S, Johansson ML, Molin G, Ahrne S, Jeppsson B Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol 2000 May;95(5):1231-8

17 Halpern GM, Prindiville T, Blankenburg M, Hsia T, Gershwin ME Treatment of irritable bowel syndrome with Lacteol Fort: a randomized, double-blind, cross-over trial. Am J Gastroenterol 1996 Aug;91(8):1579-85

18 Kruis W, Schutz E, Fric P, Fixa B, Judmaier G, Stolte M Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997 Oct;11(5):853-8

19 Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997 Dec;32(6):765-8

20 Freise J, Kohler S [Peppermint oil-caraway oil fixed combination in non-ulcer dyspepsia — comparison of the effects of enteric preparations]. Pharmazie 1999 Mar;54(3):210-5

21 Micklefield GH, Greving I, May B Effects of peppermint oil and caraway oil on gastroduodenal motility. Phytother Res 2000 Feb;14(1):20-3

22 Hotz J, Plein K[Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation]. Med Klin 1994 Dec 15;89(12):645-51

23 Prior A, Whorwell PJ Double blind study of ispaghula in irritable bowel syndrome. Gut 1987 Nov;28(11):1510-3

24 Kumar A, Kumar N, Vij JC, Sarin SK, Anand BS Optimum dosage of ispaghula husk in patients with irritable bowel syndrome: correlation of symptom relief with whole gut transit time and stool weight. Gut 1987 Feb;28(2):150-5

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By Karta Purkh Singh Khalsa, CD-N, AHG

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