How to Prevent Inflammatory Bowel Disease

How is Inflammatory Bowel Disease Treated

Crohn's disease and ulcerative colitis, which doctors group under the heading of 'inflammatory bowel diseases', affect 8 people in every 10,000 in Western countries, and annually hospitalize over 100,000 people in the United States alone. However, doctors don't know their cause, and other than cutting out the diseased section of the bowel or giving powerful anti-inflammatory drugs, they don't know how to cure them, either. Why? The answer may be simple. Both cause and treatment could involve an area in which most doctors have little expertise — nutrition.

Crohn's disease

Doctors are so mystified by Crohn's disease (also called regional enteritis) that a textbook on digestive disorders states bleakly: 'The physician is powerless to prevent the progression of the disease' (Clinical Gastroenterology). That progression goes something like this:

At first, your symptoms are so mild that you ignore them: a bout of diarrhea every few months and occasional abdominal pain. But as the year's pass, the symptoms get worse. You have either diarrhea or constipation, and your stools are bloody. The fleeting abdominal pain turns into a chronic ache. You lose a lot of weight — 20 to 30 lb — and with it, your energy and ambition. You run a constant fever. But in a way, you're lucky. Most children who get Crohn's disease are even worse off. It stunts their growth and delays the start of puberty until they're 20.

Drugs, surgery, and the sugar connection

A study in the United States on the three drugs most commonly used to treat Crohn's disease showed that all three were 'useless'. Crohn's disease comes in 'flare-ups' — the symptoms go away for a while but suddenly hit again and researchers found that the drugs didn't help a patient stay better after a flare-up was over, nor did they prevent flare-ups.

Surgery, too, is of little use. The surgeon can cut out the diseased portion of the bowel, but he can't stop the disease. A study has shown that 89 percent of those operated on for Crohn's disease have a second operation, perhaps only a few months later. Some doctors even believe that surgery, while often necessary to prevent life-threatening complications, actually encourages the spread of Crohn's disease in the bowel.

Obviously, surgery and drugs don't get to the root of Crohn's disease. Nutrition does.

Crohn's disease was almost unknown before the 1930s but now hits millions of people in industrialized countries. The last 50 years have also seen a dramatic increase in the consumption of refined carbohydrates such as sugar and a decrease in the consumption of fiber. Such a diet, say some researchers, damages the bowel and may cause Crohn's disease. Studies help prove their point.

• A German study of patients with Crohn's disease showed that they 'consumed large quantities of refined carbohydrates' (British Medical Journal).
• A survey of the breakfast habits of Crohn's patients showed that many regularly ate refined cereals such as corn flakes (British Medical Journal).
• In a survey of sugar intake, researchers found that Crohn's patients ate the equivalent of an average of ten teaspoons a day, while people without Crohn's ate seven (British Medical Journal).
• Other researchers found that Crohn's patients added 26 per cent more sugar to tea and coffee and 13 percent more to cereals than people without Crohn's (British Medical Journal).

To test the theory that a cut in sugar intake might help Crohn's sufferers, doctors in West Germany divided 20 people with Crohn's disease into two groups. One group was put on a low-carbohydrate diet (with all refined sugar excluded), while the other group was given a diet high in carbohydrates (and high in refined sugar). Eighty percent of patients with the most severe cases of Crohn's disease found relief on the diet that restricted refined sugar. And their improvement lasted for the whole length of the study — 18 months. In contrast, 40 percent of the high-sugar group actually had to be taken off the diet because of increased flare-ups of symptoms (Z. Gastroenterology, vol. 19, 1981).

Symptoms point to nutritional deficiencies

No one can definitely say that a low-fibre diet in flames and toughens the lining of the bowel, but doctors can be very definitive about the nutritional deficiencies caused by that toughening, which blocks absorption. Crohn's patients, doctors have reported, have deficiencies of protein, iron, calcium, folic acid and vitamin B12. Recently, researchers turned up another deficiency: zinc. That deficiency does the most harm to them all.

Zinc controls sexual maturation and growth: children with Crohn's often have delayed puberty and stunted growth. Zinc controls the sense of taste; numb taste buds mean no appetite, and many Crohn's patients have anorexia, a lack of desire to eat. Zinc is necessary for healthy skin; some Crohn's patients have severe rashes. Normal eyesight needs zinc; some Crohn's patients have night blindness. Zinc is a must for wound healing; low zinc levels may be one of the reasons why Crohn's disease never heals.

To prove some of those connections, researchers measured the blood levels of zinc in patients with Crohn's and in healthy people. Children whose growth had been stunted by Crohn's disease had zinc levels 39 per cent lower than normal-sized children with Crohn's. Adults with Crohn's had zinc levels 15 percent lower than healthy people, and their sense of taste was 65 percent duller than the healthy group (Digestion).

But these cases are far from hopeless. A team of doctors at the University of Minnesota headed by Craig McClain (now director of gastroenterology at the University of Kentucky Medical Center), studied 50 patients with Crohn's disease who suffered from either delayed sexual maturation or eye problems. He then gave zinc supplements to those deficient in the mineral. In many cases, sexual maturation began to occur and eyesight became normal.

A vitamin C deficiency may also cause some of the symptoms of Crohn's disease. One study showed that a group of Crohn's patients had vitamin C levels 32 per cent lower than a group of healthy people. The researchers who conducted the study advised doctors 'to supplement the diet of all patients with regional enteritis with doses of ascorbic acid [vitamin C]' (Digestion).

Another study showed that low vitamin C levels may be directly responsible for the formation of fistulas — abnormal passageways between two body surfaces — in Crohn's disease. In that study, researchers found that Crohn's patients with fistulas had 54 percent lower vitamin C levels than patients without fistulas (Gastroenterology).

Other vitamins have been found to be effective in treating Crohn's disease. At a hospital in Linkoping, Sweden, a 31-year-old woman suffering from Crohn's was given large amounts of vitamin A for her psoriasis. Psoriasis began to clear but, surprisingly, so did chronic diarrhea caused by the Crohn's disease. 'The most striking effect was a return to normal bowel function,' reported the Swedish doctors. 'Soon after starting the new treatment, the patient found she could eat any food, even plums, without ill effects and with no diarrhea' (Lancet, 5 April 1980).

This news from Sweden attracted the attention of Ann Dvorak, a research pathologist at Beth Israel Hospital in Boston, Massachusetts. She had taken electron microscope photographs showing intestinal epithelium damaged by Crohn's disease, and these offered a possible explanation for vitamin A's success with the woman in Sweden.

Crohn's patients, Dr. Dvorak says, have holes in their intestines. As a result, they might absorb bacteria and food impurities that are normally excreted, and they fail to absorb nutrients, including vitamin A, that they should absorb. When the holes become large enough, the damaged section of the bowel must be removed surgically. She thinks vitamin A might keep tiny holes from becoming big ones by bolstering the epithelium.

'In the past,' Dr. Dvorak said, 'we thought that the holes were always large enough to see on an X-ray. Now we're finding out that the large holes start as microscopic defects in the epithelium. I feel very strongly that if Crohn's patients took vitamin A after their first operation, they might not need so many operations later on. ' The Swedish doctors seem to agree.

It could be that vitamin A restored some previously impaired intestinal barrier function. If so, and if, as is suspected, the essential abnormality in Crohn's disease is the impaired function of the intestinal barrier, other Crohn's patients might benefit from vitamin A.

Keep an eye out for the results of John Hunter and his colleagues at Cambridge University. They have been very successful so far in treating Crohn's disease with, first, an exclusion diet to rule out any possible allergens; and, then, a high-fibre diet.

(See also IRRITABLE BOWEL SYNDROME.)

Ulcerative colitis

Like Crohn's disease, no one knows the cause of ulcerative colitis. Of the people it strikes (usually when they're in their teens or 20s), a small percentage have a family history of the disease, which suggests a genetic cause. Some researchers theorize that drugs — antibiotics, antihypertensives, anticoagulants, steroids — can bring on an attack. Other scientists believe it starts with an infection or an emotional upset.

Whatever the cause, something inflames the mucous lining of the colon until it bleeds. Ulcers can pit its surface. Small, worm-like stubs — pseudopolyps — grow in scattered clumps. During an attack of this inflammation (which can last for weeks and then not appear again for years), the colon is useless. It can't absorb water, and it can't stop the rush of liquid feces into the rectum.

The result, of course, is diarrhea. In mild ulcerative colitis, the diarrhea is bearable. In severe ulcerative colitis, it's not. You have to run to the lavatory. Immediately after defecating, you feel the urge to defecate again — and again, until the lavatory turns into a prison. You're weak and sickly. You run a high fever. Your painful abdominal cramps never let up. Anemic from loss of blood, your only desire is to stay in bed (standing up makes your diarrhea worse).

In a survey of 84 people with ulcerative colitis, 72 said that during a severe attack, social life was impossible because of fear of incontinence, the embarrassment of sudden trips to go to the toilet and tiredness. Many complained of irritability, marital problems, and a worsened sex life. Some had to change jobs so they'd be near a lavatory. Others had to get up early in the morning so that their frequent stops to go to the toilet during their journey didn't make them late for work. Half of the women said they did less housework and that shopping was difficult (Lancet).

However, many of those with ulcerative colitis could probably end their misery by making a simple change in their diet.

Food allergy

'I've found that in susceptible people, allergic reaction to commonly eaten foods 'is the direct cause of ulcerative colitis — and Crohn's disease too,' says Dr. Barbara Solomon of Baltimore. She tests all her patients for food allergies and finds that those with ulcerative colitis are always allergic to milk products and grains that contain gluten (wheat and rye). When she eliminates those foods (and sometimes other foods as well), the disease improves greatly. But not always.

'Food allergy isn't the only cause of ulcerative colitis and Crohn's disease,' she says. 'Sometimes a patient doesn't get well until I take him off tap water and have him drink only distilled water. Tap water is full of chemicals, and any one of them could be causing the problem. '

Robert J. Rogers, a Florida doctor also treats ulcerative colitis as a food allergy. The first patient he cured of the disease was himself. 'I developed ulcerative colitis early in my medical school career,' he says. 'I had bleeding from the bowel, a lot of profuse diarrhea and terrible cramps. It was very debilitating. I got books out and read about it, and the professors told me about it.

'But the only treatment was drugs. Drugs to slow down the fecal stream, drugs to take the cramps away, drugs to coat the bowel, drugs to tranquilize me. But while I was taking all these drugs, I was feeding the disease with the foods I was allergic to. Eventually, I discovered on my own that all forms of dairy products and chocolate and caffeinated beverages were my enemies. If I don't eat those foods, I don't have ulcerative colitis. '