Ulcerative colitis

It is surprising how common ulcerative colitis is today, I used to see a case every two to three months in the late 1980’s, but now I see almost one case every fortnight. Could this be that more colitis patients seek help by way of natural medicine, or could it be that this condition has become much more prevalent?Ulcerative colitis (UC) is an auto-immune condition causing bowel disease in which the lining of your large intestine (colon) becomes inflamed. This inflammation can lead to the formation of raw sores, or ulcers, causing pain and bloody diarrhea. UC can begin at any age, but many people who get initially are in their early twenties, and for most, UC comes and goes for the rest of their lives. UC patients who experience flare-ups (if you have UC you will know what I mean) on very regular basis can experience a major improvement if they just follow a few simple rules which we will go into soon.

Some patients with UC I have seen over the years remain fairly stable, with only the occasional bowel flare-up occurring at the peak of stressful times. A sheep farmer I saw a few yrs back would only have a bowel flare-up annually during the hectic shearing season. An accountant with UC I know has major bowel issues when tax time comes around. It is so typical for stress to cause a flare up of an auto-immune condition, because stress causes the depletion of the adrenal hormone called cortisol, and cortisol is the hormone responsible for decreasing the body’s natural inflammatory response to a large degree.

Most people who develop UC recover from these flare-ups within a certain period of time. Some heal rapidly, but for others it may take ages for the bowel to restore. Most people are told by the doctor that they can “control the bowel attacks” by taking drugs and adjusting their diet. But for about one in four people with UC, surgery me be necessary at some stage. I firmly believe that if the UC sufferer could learn about stress and understand the significance of the connection between their stress levels, their immune system, their diet and lifestyle, that they would be in a much better position to expect a good clinical result and experience minimal flare ups. Doesn’t this make more sense than to take drugs daily for years to avoid flare ups? Examine your lifestyle. Have you been living under a low-grade stressful situation for some time? This could mean a high mortgage for some or a poor functioning personal relationship for others. For others it could be a low-grade infection “smoldering” away such as a root canal or dead tooth. Are you reading your body’s signals? Guys are especially bad at doing this, and soldier on regardless. A few years ago a UC patient in his 40’s consulted me who had a bowel which bled for over a year before he sought help. It was too late for him, he passed away with bowel cancer at 42yrs of age leaving a wife and two young children behind. I can still remember him telling me that “there was no pain, I didn’t think much of it”. But had he come in a week after the bleeding started (like a woman most likely would have done) I would have encouraged him to have an investigation from the gastroenterologist. It doesn’t take much to get a colonoscopy done, and it may well have saved his life.

Although the exact cause of ulcerative colitis remains unknown, this condition appears to be related to a combination of genetic and environmental factors. This article reviews the conventional and the unconventional treatments that may be considered in conjunction with conventional approaches or as part of a comprehensive alternative treatment protocol.

Signs and Symptoms

Some cases of UC – particularly during a flare-up phase may be accompanied by abdominal pain, bloody diarrhea, pus or mucous-containing stools – from mild to severe. Ulcers typically form in the inner lining of the colon which cause the abdominal pains. Diarrhoea is typically four times daily, although this can be much more frequent with a flare-up – with ten or more visits to the bathroom severely disrupting a person’s quality of life. Abdominal pains can vary from mild tenderness to severe abdominal cramping. Blood will be apparent in the stool depending on the severity. Fatigue will eventually come as iron levels become depleted, and low grade fever may present in severe cases. I have found that when a person is in a chronic situation where they go from one flare up to another, their appetite may be decreased and weight loss may occur.

Potential health problems long term

UC patients are at a higher risk of developing a number of secondary conditions, including

Bowel cancer – the inflammatory nature of the disease poses a higher risk, and it is now thought that the long-term use of anti-inflammatory drugs and immuno-suppressive therapy (steroids) may be partially responsible as well.

Osteoporosis – A higher incidence of low bone mineral density was seen in patients who regularly rely on corticosteroids. The hip was more frequently affected than the lumbar spine. Avoid steroidal drugs as much as possible.

Kidney stones – Patients who produce multiple loose motions daily are at a higher risk of producing a more concentrated urine, and hence are at a higher risk of being “stone formers”. Drink water!

Gall stones and liver disease – A study of records of 113 UC patients revealed that 27% had elevated liver enzymes (ALT, AST, GGT) as wel as bilirubin. Additionally, gallstones were diagnosed in 4% of patients. Most UC patients benefit at some stage from the herb St Mary’s thistle.

Conventional Treatment of UC

While conventional treatments can be effective in maintaining remission and decreasing the length of active disease periods (flare ups), the treatments are not without side effects, and a significant number of people suffering from UC fail to respond to even the strongest drugs. What does the doctor generally prescribe the UC patient? The most common drug protocol includes a drug called an aminosalicylate (sulfasalazine) for maintaining remission, and corticosteroids (prednisolone) during the acute flare-ups. Pharmaceutical corticosteroids are a large group of drugs that are based on the chemical structure of hormones produced by your adrenal gland. Side effects of short-term steroid use include fluid retention, weight gain and mood swings. Long term use increases the risk of cataracts, osteoporosis, a multitude of health problems surrounding immune suppression and adrenal gland depletion leading to fatigue ranging from tiredness to complete exhaustion.

Pain killing drugs are also believed to be a causative factor. Non-steroidal anti-inflammatory drugs (NSAIDS) especially Ibuprofen, are believed to cause UC as well as exacerbate existing disease by increasing the permeability of the bowel (“leaky” bowel) and contribute towards bowel bleeds as well. I have seen a several patients over the years who have told me that they have developed UC since taking Brufen® for their arthritis. Please be very careful with Brufen, you will get nearly 4 million sites on Google when you type in: “Ibuprofen and side effects”. It is one of the most side-effect ridden drugs you are ever likely to take.

Antibiotics have been prescribed for UC; however, they have been largely ineffective according to a an American gastroenterology journal published in 2002. A relatively “new” immune drug called Cyclosporin, had been billed in 2003 as “the greatest treatment advance for UC in 10 years,” and seemed like a sensible choice for those UC patients for whom steroids were no longer effective. But like all drugs, the more potent the drug, the more devastating the side effects long term. Cyclosporin has significant potential toxicity, including high blood pressure, nausea, vomiting, headaches, seizures and kidney toxicity. I think I’d rather have the UC! Try to stay away from the “anti” drugs, especially antibiotics, they rarely help in most cases of auto-immune conditions. These drugs create more problems than they solve, particularly recurrent antibiotic therapy which allows other potentially pathogenic organisms like yeast and fungi to proliferate in the bowel.

Dietary Treatment

Food allergies have long been considered a causative factor in UC, with a lot of research focusing on allergies to cow’s milk. No consistent evidence to lactose intolerance (a sugar found in milk) has been found, but the jury is still out on beta casein (a protein). I generally tell all UC patients to avoid dairy products with the exception of butter. A small study involving 18 UC patients demonstrated that an elimination diet excluding all the known common allergenic foods resulted in fewer UC symptoms, particularly diarrhoea and bleeding. In addition to the decrease in symptoms, four patients in this study attained remission on the elimination diet and eight months later three were still symptom-free, despite returning to a “normal” diet. The highly allergenic foods include citrus (especially oranges), pork, pineapple and banana, spicy or curried foods, shellfish, grapes, tomatoes and particularly the high sulphur containing foods like eggs.

Eliminate the sulfur containing amino acid based foods

A study was conducted involving eight UC patients who were relying on sulfasalazine for maintenance and Prednisolone for flare ups. Patients were asked to eliminate dietary sources of sulfur-containing amino acid foods, including eggs, cheese, cow’s milk, ice cream, cream, mayonnaise, soy milk, mineral water, and sulfited drinks such as wine and cordials, nuts and the cruciferous vegetables such as broccoli, cabbage, Brussels sprouts, Chinese veges, mustard, cauliflower and canola oil. They were also asked to reduce their intake of red meats and substitute this with chicken and fish. Amazing things happened – during the twelve month follow-up, the UC patients experienced NO flare ups or acute attacks. The expected relapse rate on sulfasalazine was 22.6%. Additionally, their bowels showed a remarkable improvement on biopsy. The number of bowel motions reduced from an average of 6 per day down to 1.5 per day! Two patients stopped the diet, but quickly resumed it once the flare-ups occurred. And all this was achieved with a diet change folks. Now you can see how eliminating certain foods can have such a profound effect on ulcerative colitis, imagine what eating the right foods, and eliminating the “garbage” can do for your health in general.

I have tested several UC patients by way of the IgE/IgG Elisa food allergy test and have found almost universally without exception that all UC people cannot handle eggs, and most have antibodies towards the cruciferous vegetables to varying degrees as well.

Eat the Right Fibre

Diets with a low fibre content have been associated with an increased risk of developing UC. The low fibre diets which are rich in refined carbs are thought to help promote the muscle spasms which are a common feature of the UC flare-up. Diets high in complex carbs help to promote optimal intestinal flora composition. Psyllium husk (avoid Metamucil® due to its content of Aspartame, a neurotoxin) is best taken in it’s natural form, and your health food shop should be able to help out here. Psyllium is great in UC – a double-blind placebo controlled trial of 29 UC patients demonstrated that 4gr of psyllium husk twice daily (or the placebo – a low fibre crushed crisp bread) for four months resulted in 69% of patients taking psyllium as compared to 24% taking placebo, gaining symptomatic improvement.

Butyric acid is the major fuel source (a fatty acid) for the cells that line the colon. Butyric acid may promote the proliferation of healthy cells in the colon and provides energy to these cells, as it is the preferred metabolic fuel for the colonic cells. Psyllium seed increases the production of butyric acid in the intestines, particularly in the colon. This effect occurs from beneficial bacteria in the intestines fermenting the carbohydrates content of psyllium seeds. Guess what food contains the highest amount of butyric acid? Butter. This is why I tell UC patients that it is ok to consume butter. Ghee, or clarified butter is even better.

What to take

Glutamine

Glutamine is an amino acid which is one of the main sources of “respiratory fuel” (energy) for the cells of your digestive system, especially the end part of the small intestine and the majority of your colon. It has been found that this amino acid in addition to the correct (low-allergy) diet promotes a more rapid healing of ulcers and lesions in the colon. A good quality bowel product should contain this, it is best taken as part of a bowel product three times daily. See you naturopath.

Essential Fatty Acids

Omega 3 fatty acids exert a beneficial effect in UC patients. It has been found through studies that UC patients who receive Omega 3 regularly achieved remissions earlier than those taking a placebo (olive oil capsules). Patients who took Omega 3 also noticed a significant reduction in steroid medication requirement over time. But not all studies found positive results, however. A long term study involving 63 UC patients taking EFAs for one whole year failed to prolong their remissions when compared to a group who were taking 500mg daily of sunflower seed oil., but in this study the dosages of Omega 3 may have been too low be of significance. Dosage: Omega 3 1000mg three times daily with meals, but also include a little sunflower oil or flaxseed oil in your diet daily. This way you are ensuring you receive a more balanced fatty acid approach to your diet.

Herbal Medicines

There are many types of herbs you could potentially try, but what do you take? A small but significant study done in Bulgaria in 1982 involved 24 UC patients taking a herbal combination of Dandelion, St John’s Wort, Lemon balm, Calendula and Fennel. By day 15, 23 out of 24 patients had a complete resolution of pain in the colon, diarrhoea had resolved and the fecal content had normalised. This is quite amazing. Why resort to drugs when studies have revealed a positive response in UC with herbal medicines? The herb Boswellia serrata has also shown beneficial results, particularly when the anti-inflammatory action of Boswellia and sulfasalazine were compared side by side. Your herbalist should be able to make you up a formula of the above herbs. Dosage of the above formula: 5mls three times daily in a little water before meals.

Probiotics

Beneficial bacteria are particularly beneficial when taken in supplement form by the UC patient, because these friendly bugs are responsible for the lactic acid production which favorably effects the inhibition of the putrefactive or harmful bugs. The other often overlooked problem is that opportunistic bacteria may gain a foothold in the bowel of the UC patient, creating all sorts of problems. I have done comprehensive stool analysis of several UC patients over the years and found this certainly to be the case. Sometimes an anti-parasite product may be called for, and I like using GSE (grapefruit seed extract) with UC patients with a good result in this regard. This is a hard to get product, but some health food shops still stock it. Dosage: 1.5 – 3 billion CFUs twice daily.

Bromelain

Bromelain is an enzyme found in the pineapple which is proteolytic, which means it can aid in the digestion of protein (meat). Bromelain is also a potent anti-inflammatory and two studies have revealed that it may well be of benefit in reducing diarrhoea, decrease the number of bowel movements and reduce the appearance of blood in the stool. In both studies, endoscopy performed after the supplementation of Bromelain revealed a healed intestinal mucosa. Dosage: 0.5 – 1gr twice daily.

Quercetin and Rutin

These bioflavonoids have shown that they can assist in reducing bowel adhesions and colonic surface damage significantly. They have a protective anti-inflammatory effect on the colonic mucosal wall, and are possibly a good adjunct therapy. Try a supplement with both these bioflavonoids, you may find them in combination with a good Vitamin C supplement. Take a small amount daily in water. Dosage: 500mg two to three times daily.

Butyrate enema

I have read many positive American studies involving the use of butyrate retention enemas in the acute flare up phase of UC. In a large trial involving 51 UC patients, which involved receiving the enemas twice daily for several weeks, the patients were then assessed by way of endoscopy, laboratory data, stool frequency and consistency and other UC symptoms. It was found that the administration of the butyrate enemas was significantly more effective than saline (placebo) enemas in achieving disease improvement or remission. These enemas are not readily available in NZ unfortunately at this stage, but I am sure if you find a doctor with a big interest in complementary meeicine you should be able to have access here. A pharmacist may be able to make them up for you perhaps. You will have more chances in Auckland or Wellington, and it is a matter of making enquiries with your GP regarding this. Take a look online, a Google search revealed over 27,000 sites.

Wheatgrass

According to a new double-blind study published in the Scandinavian Journal of Gastroenterology, people taking wheat grass juice experienced a significant improvement of their ulcerative colitis symptoms on a scale that measured overall disease activity, compared with people taking a placebo. Wheat grass juice also significantly reduced the severity of rectal bleeding and abdominal pain.

The use of wheat grass juice for therapeutic purposes was pioneered by the late Dr. Ann Wigmore. In 1956. Although this “green drink” has been promoted for over 50 years as a treatment for a wide range of health conditions (including cancer), until 2002 it had not been tested in clinical trials. Researchers studied 23 people (average age, 35 years) with clinically active UC who were randomly assigned to consume wheat grass juice or a placebo for one month. The initial amount, 20 ml per day, was increased over a period of several days to a maximum of 100 ml per day. In addition to the positive results mentioned above, an examination of the colon (sigmoidoscopy) showed improvement in 78% of the people receiving wheat grass juice, compared with only 30% of those receiving placebo. No serious side effects were seen. Although nausea was reported by 33% of the participants receiving wheat grass juice, and 41% also noted an increase in vitality while taking the supplement.

Wheat grass is produced by sprouting and planting the seeds of the common wheat plant (Triticum aestivum). The difference between wheat grass and what most of us recognise as edible wheat is that the former is harvested much earlier in its life cycle. The wheat grass juice used in the new study was prepared fresh each day and consumed within an hour of extraction. Wheat grass juice has long been sold at many health food stores and juice bars in NZ. Some people grow wheat grass at home from the seeds. Talk to your local health food shop, they should be able to put you in touch with a wheat grass supplier.

Conclusion

I have found in the clinic in most UC cases that once the diet and lifestyle has been changed and the UC patient becomes less reliant on sulfasalazine therapy that the bowel can heal over a period of time to the point where flare ups rarely occur. There are rare exceptions of course, and not every chronic UC patient responds as well as expected, but most do and aren’t they grateful once they can trust their bowel to do it’s job ! Ask your natural health care professional if they have much experience with UC, and many have, particularly the ones who have been in practice for ten years or more. Your best results will come when you make the right changes, because staying on pharmaceutical drugs to treat a condition like ulcerative colitis is not the best choice long term.