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Chris Longley
10-23-2007, 08:21 AM
Hi,

I have the mis-fortune of suffering from UC and despite my best efforts, it seems to be pretty persistent.

I was hoping that some of you might have some insight into this - I'd be particularly interested in Dr Garrett Smith's views.

I'm currently taking fish oil - approx 10g EPA/DHA, Probiotics (Udo's choice Super 8) and ZMA. This is in addition to the Pentasa prescribed by my Dr.
With regards to food, I aim for zone ratios with higher fat, but I'm not sure this is the best approach.

Any advice would be greatly appreciated.

Chris

JW Luckett
10-23-2007, 05:27 PM
My daughter was diagnosed with Crohn's Disease last year in August at the age of 18. She's on Pentasa and gets Remicade once every two months. Here in Japan they also have the patients sit down with a nutritionist, so diet also plays a very important role in managing the disease.

The approach here is to limit fat intake to 25-30 grams per day. That's not much. She is supposed to avoid fatty food, especially fatty meat like beef and pork. Fish is all good and she also takes an Omega-3 supplement. For some reason lamb seems to be OK, too (maybe cause it's grass-fed?). NG foods are things like all processed food, ramen noodles, cakes, ice cream, etc.

Her experience seems to support this approach. She was recently in Vietnam and had to just eat what was there, and that was mostly oily food. When she got back she was having a minor flare up. When she splurges and eats her favorite goodies, she gets abdominal pain and has to stop eating and just drink her nutritional supplement. I wish she would manage her diet better, but she's a 20-year-old college student away from home.

Anyway, you wrote that you go for zone ratios with higher fat, so I guess I'm saying you might want to experiment with that and really pay attention to the quality of the fat.

joe

Garrett Smith
10-24-2007, 05:49 AM
Chris,
You didn't mention much on diet at all. What do you strictly avoid?

If you wanted to go the cheapest route, my first advice would be to go on a STRICT gluten-free, nightshade-free, Paleo diet (no peas or green beans either) for a month and see how your symptoms fare. Also, you must get 9+ hours of sleep a night. I had a patient with suspected UC "fix" the problem simply by doing the above diet, getting more sleep, and taking my heavy-duty probiotics.

If you need to see proof in the form of tests, here we go:

First thing I'd say to do is the "Stool Test for Gluten Sensitivity" at www.enterolab.com . $100

Next, an Intestinal Permeability test through my office (a urine test).

If you were ever concerned or had hunches about parasites playing a role, get the stool test done through www.parasitetesting.com and list me as your physician (they won't do the test unless they have a doctor to send the results to, but you can order it). You can get my address and other info from my website for the forms.

Then, if nothing showed up yet, we'd talk about food allergy testing. Again, that won't be necessary if you really do the diet above. Make sure you are gluten-free, and I'd highly suggest the book from www.noarthritis.com on how to exactly avoid the nightshades (they are hidden in as many places as gluten).

Yes, it sounds like it will be tough. It is tough. So is UC.

Also, 10g total of EPA+DHA sounds like a bit much to me, but that's another story.

Greg Davis
10-24-2007, 06:26 AM
I don't know too much about the condition, but for what its worth I have an aunt who struggled for years with Chrohn's.. like really sick- in/out of hospital.

Finally she now eats a paleo diet and she's perfectly healthy (she does include nightshades, the odd tuber, some cheese/yogurt without problems). No more digestive problems, she's physically active, keeping a good bodyweight etc.

Funny thing is I stumbled on the same diet from reading pmenu, devany, etc. just to improve athletic performance. And she had to use trial and error for many years to come to the same conclusions about diet. When I stayed at her cottage this summer she was like "wow someone who actually eats the same way I do!".

So from what I know from her experience I wouldn't focus so much on the supplements, just don't deviate from paleo foods (absolutely no gluten or sugar- these are the number 1&2 no-no's for my aunt.)

Chris Longley
10-24-2007, 09:42 AM
Thanks for the replies so far.

My diet is by no means paleo, but is gluten free. I do eat nightshades - potatoes and tomato products ranking pretty highly.

So, is an elimination diet the most important factor in your opinion Dr Smith? How do macronutrient ratios factor in?

I'm in the UK so I would assume the tests suggested would be difficult to paticipate in...?

With regards to supplements - what doseages would seem sensible? The 10g EPA/DHA has come about through reading Dr Sears work. Also, what should I be looking for in a probiotic?

I really appreciate all the help on this.

Garrett Smith
10-25-2007, 08:16 AM
Chris,
I will be covering this topic more in depth in a future PMenu article, meanwhile, here's some info to look at:

Potato glycoalkaloids adversely affect intestinal permeability and aggravate inflammatory bowel disease. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12479649&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

CONCLUSION: Concentrations of glycoalkaloids normally available while eating potatoes can adversely affect the mammalian intestine and can aggravate IBD.

Pathology in hamsters administered Solanum plant species that contain steroidal alkaloids. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=2629175&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Syrian hamsters were orally administered ground plant material from either Solanum sarrachoides, S. melongena, S. eleagnifolium, or S. dulcamara. Six of eight hamsters administered S. eleagnifolium and eight of 10 hamsters administered S. dulcamara died following administration of plant material and had gastric glandular mucosal necrosis and small intestinal mucosal necrosis with little inflammation.

Mechanism of death in Syrian hamsters gavaged potato sprout material. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3194655&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

To determine the cause of death in animals ingesting potato sprout material, 40 Syrian hamsters were divided into 4 equal groups and gavaged once on day 0 either water, 300 mg of potato sprout material, 400 mg of potato sprout material, or 500 mg of potato sprout material. Tissues were examined grossly and microscopically at 72 hr post-gavaging and brain acetylcholinesterase activity of each hamster was measured. The 300-mg dose group had increased mean acetylcholinesterase activity compared with control hamster mean activity, and the 400-mg and 500-mg dose groups had 90% and 84% of the mean acetylcholinesterase activity of the control hamster mean activity. There was severe gastric and proximal small intestinal mucosal necrosis in those hamsters which died prior to euthanasia.

Lesions of potato sprout and extracted potato sprout alkaloid toxicity in Syrian hamsters. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3612898&ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Nine of 10 hamsters receiving dried potato sprout material and 3 of 5 hamsters receiving alkaloid extract had severe gastric and intestinal mucosal necrosis which was most severe in the glandular stomach, duodenum and proximal jejunum. All control hamsters gavaged with water and all hamsters gavaged with the potato sprout marc survived to the time of euthanasia and did not have gross or microscopic lesions.

Seriously, after seeing the documented evidence of GI lesions from multiple species of nightshades in both humans and animals, not eliminating them from the diet of someone with a GI disease is just plain wrong. I have to go, but take this seriously. I'm going to tell you that tomatoes do the same thing, potatoes are just MUCH worse for the GI tract.

Take them out of your diet completely. The evidence for induced pathology with peppers is even stronger, and eggplant contains the same alkaloids as potatoes do.

Sweet potatoes, yams, parsnips, and other root vegetables. It's an easy substitution.

Garrett Smith
10-25-2007, 10:12 AM
Didn't want to leave out tomato, since you said that was a large part of your diet:

Influence of saponins on gut permeability and active nutrient transport in vitro. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3794833&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Saponaria saponin and alpha-tomatine also reduced transmural potential difference, but soya saponins were much less effective. The results indicate that some saponins readily increase the permeability of the small intestinal mucosal cells, thereby inhibiting active nutrient transport, and facilitating the uptake of materials to which the gut would normally be impermeable.

I'm going to save the rest for my article, just wanted to give you a taste of the research showing that GI tracts don't like the nightshades at all...

Just wait for the article on peppers, that one will be brutal.

Robb Wolf
10-25-2007, 05:14 PM
2nd what Dr. G said. it may be a simple solution to a nasty situation.

Chris Longley
10-26-2007, 11:59 AM
Wow, thanks for the info. Consider nightshades gone. I'd pretty much subbed in potatoes for the grains i'd taken out out of my diet - no more though...

So are there any supplements that you'd recommend alongside the elimination diet or am I just wasting my money looking for a shortcut?

Thanks again everyone. :)

Garrett Smith
10-26-2007, 01:53 PM
Chris,
I think that one big imbalance the nightshades cause is a magnesium deficiency (and/or ratio of too much calcium to magnesium, causing calcium deposition).

As far as gut damage, the best thing you can do is avoid them completely. Read all your spices, avoid ingredient labels with "spices" or "natural flavors".

Glutamine may be of some help at this point.

Mike ODonnell
10-29-2007, 01:53 PM
came across this at random today and it relates to this...interesting of course how it is a plan geared towards no meat or dairy...aka vegan...but what I took from it was more so the importance of enzymes from fruits and vegetables...perhaps an IF approach with digestive enzyme supplementation (on an empty stomach) would be of benefit? (disclaimer...not a dr...and nothing I say is or will ever be approved by the fda)

http://www.colitis-crohns.com/about.html

Garrett Smith
10-29-2007, 05:46 PM
MOD, I see your point. Just wanted to say that up front...

Ah yes, the raw food & enzyme vegan presentation.

Raw meat has enzymes too. I've also had to seriously repair folks who ate a nearly all raw fruit diet from systemic candidiasis that nearly killed them--but at least they were getting their enzymes!!!

Do I think that the best diet leans towards a majority of food taken raw or lightly cooked? Absolutely. Do I completely agree with the enzyme crowd, that enzymes will save the human race? Hardly.

I'd say there is a reason that guy is kneeling. If he stood up and turned sideways, it would probably be tough to see him. Same is true for another raw vegan guru, Dr. Gabriel Cousens.

Do I think a temporary meat-free diet could be of huge benefit? Absolutely. However, I also don't think it works for humans long-term.

Last thing on the enzymes--if there was such a huge deficiency from cooking our food and our lives have constantly been getting shorter due to a lack of enzymes, I'd have to think the human race would have petered out a LONG time ago.

Could proteolytic (in particular) enzymes help with improving health through reducing inflammation? Absolutely. Took me a while to get there, eh?

Mike ODonnell
10-29-2007, 08:22 PM
Ah yes, the raw food & enzyme vegan presentation.

Could proteolytic (in particular) enzymes help with improving health through reducing inflammation? Absolutely. Took me a while to get there, eh?

eh? Going Canadian on us Dr G? Ha.....yes was only looking at the health benefits of supplementing dig enzymes during periods of no digestion (IF) and the benefits for repair of tissues and other cellular functions...I was in no way trying to promote vegan lifestyle as I think it is a crock and I love my dead animal meat!! Go meat!! Might try some enzymes am and before bed.

Garrett Smith
10-29-2007, 09:10 PM
Yes MOD,

GO MEAT!!!

For those considering taking enzymes on an empty stomach, just make sure that they don't contain HCl, okay?

And from my understanding, the only enzymes really worth taking on an empty stomach are proteolytic and/or pancreatic. No need to take amylase or lipase, as far as I can tell.

Miguel Sanchez
09-26-2009, 10:55 PM
The Paleo diet seems to be the general recommendation for "stomach issues." My question is what happens if you don't digest vegetables very well like so many with digestive issues?

Chris Longley
10-03-2009, 05:15 AM
Veggies and fruits can be an issue, but you need to get them down.

The main problem is from eating them raw.

Here's some options to make them go down better...


Take digestive enzymes
Juice the veggies (but only the same amount you would actually eat at a normal meal if they were whole)
Use plenty of veggies in well cooked soups and stews.
Stew your fruits before eating (this works really well with berries for breakfast)


Cooking them breaks down the fiber and makes them much easier to digest. The enzymes will do the rest.

This has been working real well for me...

Steve Shafley
01-16-2010, 07:18 PM
This topic has become interesting to me since my oldest boy, 15, may have some form of colitis, and I am looking for what'd be considered a better diet for him to help control his issues.

I'm still waiting on his tests at this time.

His doctors recommendations in the mean time:

-no juice but white grape juice, may have gatorade
-more starches

Patrick Haskell
01-25-2010, 12:31 PM
Steve, there is very little peer-reviewed literature showing dietary recommendations for ulcerative colitis that work across the board. There is a low-residue diet that is recommended to ease the work of the digestive system when symptoms are flared-up, but that is not the same as a long-term dietary recommendation. From what I can tell of the anecdotal literature (i.e., the interweb), Dr. Garrett's recommendations (post #3 above) are as good a starting point as any.

People respond to food differently. What triggers the UC auto-immune response in one person may be different from another. The only way to really get a solid read on the dietary contributions to your son's UC is to do an elimination diet and see how he fares as the potential offenders are eliminated and then one-by-one reintroduced. When I say elimination and reintroduction, I'm talking weeks at a time to give time for symptoms to settled down and then more time for low-level inflammatory responses to manifest themselves as UC symptoms, if a given food is the cause of them.

The elimination of nightshades was revelatory - less with respect to my UC symptoms, but more that the arthritic symptoms that I had always associated with UC flare-ups were simply gone. I think I had some luck with elimination of grains and sugar, but a few months of high-stress living showed that that wasn't a panacea. That being said, I have yet to go whole hog in hopes of demedicating myself by eliminating dairy and legumes as well (which are logical targets for me given my son's dairy and peanut allergies). If there is a history of food allergies in your family, that may help provide a good starting point for your son, as UC is largely (entirely?) an auto-immune response.

Certainly, diet is a big contributor to digestive health, but for UC, the most important thing for me has been making sure I get enough sleep and otherwise control my stress levels. This much seems to be a pretty common thread for others I know with UC. Maybe a super-strict diet would allow me to dine on stress without concern, but I haven't been able to test that one out yet. If your son can tweak his diet without undue stress, then he's in a good place. Good luck.

Matt Lawson
02-24-2010, 05:27 AM
I was diagnosed with Crohn's disease in '01. Because of Crohn's, I've been on some nasty nasty nasty drugs. Pentasa, happily, has the shortest book on side effects. From there they may bump you to immunosuppressants like Imuran (azathioprine) or even Remicade (infliximab). I would never tell you not to take these, but please do your own research on them. Talk to other GI docs, talk to pharmacists, talk to whoever would know. They are rough. One Pharmacists described my options as, "between a rock and the deep blue sea". anyway...

I've given a solid chance to just about all the different ways of eating there are minus the obviously unhealthy. My experience thus far:

Prior to finding PM and Xfit, I ate diets I found in "Power Eating" by, Susan Kleiner or the latest issue of Men's Health. (keep flames to moderate heat please, I have repented). I had regular flareups starting as soon as 3 months after my first surgery (i had roughly 2 feet of guts around my ilium removed). Later, i started to find eating changes that seemed to ease the symptoms of Crohn's and keep me out of the hospital. Here's what happened:

• I went gluten free. This was my first step in the right direction. I noticed a significant amount of joint pain went away, so did a significant amount of abdominal pain.

• Later I started zone ratios while staying gluten free. This was another good step, and was the first time my skin color returned to a no-pasty look. I did notice that all the raw leafy greens and raw fruit caused me to have, at times, significant discomfort. This has since lessoned to a very manageable level and no longer makes me worried that I'm having a flareup.

• Dropping any significant alcohol intake (i'll still have the occasional glass of wine or beer) was another step in the right direction.

• Going “primal” at least in the sense that I did all that I could to eliminate processed foods.

• From time to time, such as if I felt I was starting to slip towards a flareup, I would remove nightshades all together and slowly re-introduce them when I felt I was ok.

• From time to time I'll cold turkey the dairy as well. Minus of course kefir and/or greek yogurt.

I've found that significant spikes in insulin make me feel like crap. They make my joints hurt, they sour my stomach and generally make me feel like awful. Granted, eating gluten free, and avoiding processed foods of any sort generally keeps me from being able to spike my insulin.

I regularly have high amounts of fat in my diet. I've not noticed any pain associated with the fat intake; generally it's brought on by fiber, I believe, and I've gone so far as to take shots of olive oil. I will say that 12 trips to the bathroom are normal when fat starts hitting the 60% of total caloric intake mark. This usually makes it a necessity to drink copious amounts of water. Diarrhea is something of a constant regardless of what diet I've been on. I'm told it is as much because of the segment of intestines they removed as it is Crohn's itself.

Stress, as MOD would say, is a killer. I had my first operable Crohn's flare up about a month after my grandfather (who i had been taking care of daily for six years) died.

With regards to “self medication” I've been taking BCAA powder, glutamine, glucosamine, fish oils, a multi, and probiotics. I drink tons of slippery elm tea, but that is probably as much a comfort thing as it is anything else. You made the right choice in seeking out Dr. G. His suggestions have made me the healthiest I've been since 2001.

Please feel free to PM me whenever you would like. UC and Crohn's support groups are great, but they can be tear fests. That may work for a lot of folks, but for me it has been mentally healthier to hit the ground running with a “f*ck it, I'm alive” attitude.

Garrett Smith
02-24-2010, 06:10 AM
Matt, are you doing any enzymes? That might help to speed your digestion/absorption so that you aren't having loose bowels all the time.

Matt Lawson
02-24-2010, 06:45 AM
Negative. Brand suggestions?

Garrett Smith
02-24-2010, 07:40 AM
Progressive Labs Digestin. You can get it online or contact my office.

Matt Lawson
02-25-2010, 04:31 AM
OP, one other thought I neglected in my novella length post was IF. Intermittent fasting, originally brought to my attention by Mike O'donnell, has been a huge help to me. Looking back, the writing should have been on the wall. Regardless of their intent, doctors take me off food as soon as I'm admitted to the hospital. Now, if I feel like I'm having a flareup, I begin a 12 hour waking fast. In other words, the clock is only running while I'm awake.

Sometimes, your guts just need a break.

Patrick Haskell
02-27-2010, 04:40 AM
OP, one other thought I neglected in my novella length post was IF. Intermittent fasting, originally brought to my attention by Mike O'donnell, has been a huge help to me. Looking back, the writing should have been on the wall. Regardless of their intent, doctors take me off food as soon as I'm admitted to the hospital. Now, if I feel like I'm having a flareup, I begin a 12 hour waking fast. In other words, the clock is only running while I'm awake.

Sometimes, your guts just need a break.

I hadn't thought about this as therapy, but I'll have to second this in retrospect. Might be time to reintroduce IF to my routine.

Chris Tracy
04-12-2010, 04:52 PM
I had my first real flare last November that I couldn't shake for about 3 months. Patrick and others have hit on many of the most important points, sorry for repeating some of them.

Here's what's worked for me:
1. Learn everything you can and apply what makes sense. Take an active role in your healthcare choices.
2. Only take antibiotics when absolutely necessary, ask how any antibiotic will affect your disease and ask a second opinion if necessary prior to starting a course of a new antibiotic. Avoid Augmentin like the plague. Maybe an injectable rather than oral form????
3. Find people/Doctors that feel they can help you live well. My GI Doctor is good for what he’s trained in, but, that isn’t enough. I had to find others that I felt could help me in ways my GI Doctor couldn’t or wouldn’t.
A. Dr. G helped me figure out that I was suffering from Adrenal Fatigue, how it could affect/contribute to my condition and wrote a treatment plan to fix the issue. Most Doctors would not have figured it out or would have written this off as the “alternative diagnosis of the month”- yet I feel better.
B. Amy Kubal helped me dial in a strict (no dairy, nightshades, legumes, grains of any sort) Paleo diet with flare and maintenance menus. As said here before, your diet needs to be different for the different stages of disease. Very different diet than what the dietician my GI referred me to had to say and…. I feel better.
C. Are your hormones in check? Find a Doctor that knows what he or she is doing. This was huge for me. If you research the different hormones and various autoimmune diseases you will find some interesting trends, D3 and DHEA being 2 of them.
4. Take probiotics as many times a day and in as large of dose as you can afford. More seems to be better for me. I've found that VSL#3-DS works very well and costs an arm and a leg.
5. Add a non-irritating fiber to your diet when you're in the maintenance phase of your diet.
6. IF works when in a flare, no doubt in my mind. Just make sure you are getting enough calories. (Coconut milk has lots of MCT's that are great for the gut lining, blended sweet potato, and yes, the dreaded banana)
7. Check to see if you insurance will pay for Levaza (prescription fish oil), if they do find a Doctor that will write you a prescription, I only pay $15.month for 4grams/day. Limit your omega 6’s to get the best bang for your buck.
8. ChiGong has helped me "cool my jets" and start to get my nervous system out of the "fight or flight" mode, find a way to decrease your stress level and improve how you respond to stress.
9. Live as clean as you can.

I know this will cause a S*&T storm, but please keep an open mind. If you have a severe case, are cancer free, have truly given the diet and lifestyle changes 100% and your Doctors want you to take drugs that has significant side effects or worse, do some research on GH. Very limited research has been done with GH and Chron's, some with Lupus, RA and the other well known autoimmune diseases with what seems to be a high level of sucess. What they fail to metion is that the second job you'll need to be able to pay for the GH could kill you.

Chris dePaola
10-30-2012, 08:17 PM
Great Posts! I'm a Chron's patient of about 10 years and have also gotten a kidney transplant approximately 5 years ago. Just recently started getting into and enjoying the olympic lifts which led me here.

Very interested in all the information presented so far and look forward to more reading!