Inflammatory bowel disease mystery
? cause ? best treatment.

Paediatric Crohn's inflammatory bowel disease is increasing - progressively from the 1970's, and we don't know why.

The other one, ulcerative colitis, hasn't increased.

Genetic studies have put that contribution to the incidence of IBD as 17%, leaving 83% for environmental factors.

Crohn's disease may be the human equivalent of Johne’s disease.
This is a chronic, wasting disease of cattle caused by the bacterium Mycobacterium paratuberculosis.
The bacteria live in the animal’s intestines and cause thickening of the bowel wall which interferes with the normal absorption of food.

Treatment based on this proposition with a combination of three antibiotics (Rifabutin, clarithromycin, and clofazimine) had a clinical response of almost 95% in a Phase II clinical trial of human Crohn's disease.



Whatever the cause, the bowel damage definitely causes "leaky gut", which definitely aggravates the condition.

Testing intestinal permeability with lactulose and mannitol³, shows the leaky gut - damage allowing the passage of increased quantities of large molecules into the bowel wall. Healthy gut doesn't allow this.

This test predicted most of the recurrences in a group of people with quiescent Crohn's disease, in a trial reported in Lancet¹.

Those with increased permeability, were more likely to relapse.



Hypo-allergenic enteral feeding (eg. Emsogen, Vivonex) can give remission rates of 50% in adults, 50 to 80% in children.

This is a diet avoiding the normal foods, to which a person may be allergic or intolerant. It is called an elemental diet, consisting of foods broken down into their elements (components) of sugars, amino acids and short chain fatty acids.

As mentioned above, their leaky gut would otherwise allow greater passage of these foods, undigested or partly digested, into the bowel wall.
Aggravation of the Crohn's disease would follow from the immune reaction in the bowel wall.

Ed, the author of www.newtreatments.org, has a really interesting story, and his great response to Dr. Kwasniewski's "optimal diet" may well have an instance of avoiding food intolerances, or because it resulted in a healthy gut flora.

NewTreatments.org site

In my experience, emotional stress has been a major aggravating factor when people have trouble with their Crohn's.

This certainly fits with all immune problems - stress aggravates.

Endoscopy in Crohn"s inflammatory bowel disease

They often find histological granulomatous disease in areas which are macroscopically normal - less severe disease not visible to the naked eye, can be quite extensive.

You are likely to be advised to have endoscopy yearly. This is the best way to decide on treatment, as you can have active disease without causing much discomfort.

Regular blood tests

Nutrients and herbs as part of treatment

The anti-inflammatory bioflavonoid quercetin may have a role.

The tripeptide glutathione (GSH) Glu–Cys–Gly is absorbed to some degree, and is low in IBD², so may help your antioxidant defenses here.

One component of GSH is the amino acid glutamine. This may have a dual role, as it is a fuel for the cells lining our small intestine as well.

In animal experiments, glutamine has been shown to downregulate nuclear factor kappa B (NFkB) and tumor necrosis factor-alpha (TNF-alpha.) These are two key players in the inflammation.

Glutamine is not one of the 10 essential amino acids, but becomes "conditionally essential" during inflammatory states. Then a functional deficiency can result, as the increased requirement may not be available.

This lack of glutamine may result in deterioration of the intestinal barrier (leaky gut.)

Another glutathione precursor treatment is Immunocal (Immunotec, Montreal.)

From inflammatory bowel disease to home page.

References for inflammatory bowel disease.

2. Sido et al Impairment of intestinal glutathione synthesis in patients with inflammatory bowel disease Gut 1998;42: p.485-492
These researchers also found that abnormally low plasma cysteine and cystine levels were associated with inflammation in IBD.

3. Lactulose and mannitol are both are absorbed into our bloodstream by passive seepage through the wall of our small intestine. Lactulose is a bigger molocule so is only slightly absorbed here.

Once absorbed, neither is altered in our body, and both are passed out in our urine.

The ratio of lactulose to mannitol in the urine is increased if we have damaged "leaky" small intestine, as then more lactulose gets into our bloodstream.