So you have colitis?

If you have ulcerative colitis or Crohn’s, then it’s a good time to wish you’d been born Chinese because gene markers have pretty much pinned both these inflammatory bowel diseases on those with Jewish and European ancestry (1;2). Apparently, your ancestors developed a phenotype with some kind of bad regulation of an immune mechanism (2). It’s kind of like an allergy, only the response causes a bunch of mucosal damage in your gut (2).

The cramping, diarrhea and fever is a pain (2). And colitis probably comes with blood in the stool, which could be serious since losing fluid and electrolytes, and blood loss, can put your body into shock (2). Most people (85 percent) only have mild-moderate symptoms, but 15 percent have severe cases of which 15 percent die (2). Worse yet is that colitis and Crohn’s can lead to other problems over time like inflamed joints, liver damage and even cancer (2). When you have colitis for a long time, cancer risk increases significantly (2). If you haven’t already, you might need a colonoscopy to determine how susceptible you might be to cancer (3). Getting treated early is key. You might need anti-inflammatories, immunosuppressives and antidiarrheal drugs (2). By keeping colitis in check, hopefully doctors won’t have to remove any part of your colon (2).

What else should you do? What about dietary therapy?

Well, you’ve got to think about nutrition. Fact is that mucosal damage from colitis impairs digestion leading to possible malabsorption and, thus, malnutrition (2). Poor nutrition means your increasing chances of other problems (like the cancer risk). You might, for example, take a consider taking digestive enzymes to help digest food correctly (making up for possible lack of pancreatic enzymes) and a multi-vitamin for extra nutrients (2).

You should consider probiotics/prebiotics. The long ancestral history of Europeans and Jews drinking fermented milk products might play a role in all of this. The genetic susceptibility to inflammatory bowel diseases is proving to be exacerbated by wrong bacteria in your gut, especially if there’s an overgrowth in the small intestine (where they should not be) (4-11). So, probiotics (such as lactobacilli in yogurt) and prebiotics (soluble fiber that helps grow probiotics) are showing great promise. The trick is to eradicate bad bacteria with antibiotics, then to populate and grow the good bacteria in your gut; the good bacteria protect mucosal cells and may even help regulate immune response by controlling pro-inflammatory cytokines; plus, they can help improve lactose absorption (4-11).

Changing the oils in your diet could offer long-term benefits in reduced inflammation. Basically you’d avoid the pro-inflammatory omega-6 oils from canola and soy, and instead use mono- and polyunsaturated fats from olive oil and fish oil (rich in EPA/DHA fatty acids). A few studies show that following that advice can help reduce inflammation in the gut and, along with antioxidants, guard against mucosal damage from reactive oxygen (12-15).

Because the mucosal damage occurs due to reactive oxygen, it makes sense to supplement with superoxide dismutase (SD) (16). The enzyme acts like an antioxidant by catalyzing reactive oxygen (superoxide anion) to regular hydrogen peroxide and oxygen (16). Problem is you can’t absorb oral SOD, but new research is showing that maybe you would be able to if it’s lecithinized (16). Other antioxidants to supplement that have shown clinical promise would be vitamin C, E, selenium and citrus bioflavonoids (14;15).

So here’s a summary on diet: start with taking a regular digestive enzymes supplement and multivitamin, talk to your doctor about antibiotics, then get your prebiotics (increase soluble fiber gradually) and probiotics, take a quality fish oil supplement, use olive oil and don’t use the pro-inflammatory oils with omega-6 like soy or canola oil. Lastly, get your antioxidants (from a supplement or from plenty of fruits and vegetables) and if you can find the lecithinized SOD, get that too. Do all this, try to avoid cancer and other terrible problems.

Reference List

1. Yun J, Xu CT, Pan BR. Epidemiology and gene markers of ulcerative colitis in the Chinese. World J Gastroenterol 2009;15:788-803.
2. Nowak TJ, Handford AG. Pathophysiology: Concepts and Applications for Health Professionals. New York: McGraw-Hill, 2004.
3. Korelitz BI. Crohn's colitis versus ulcerative colitis: should surveillance for dysplasia and cancer differ? Nat Clin Pract Gastroenterol Hepatol 2009;6:144-5.
4. Mitsuyama K, Sata M. Gut microflora: a new target for therapeutic approaches in inflammatory bowel disease. Expert Opin Ther Targets 2008;12:301-12.
5. Hedin C, Whelan K, Lindsay JO. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials. Proc Nutr Soc 2007;66:307-15.
6. Gionchetti P, Rizzello F, Campieri M. Probiotics and antibiotics in inflammatory bowel disease. Curr Opin Gastroenterol 2001;17:331-5.
7. Gionchetti P, Lammers KM, Rizzello F, Campieri M. Probiotics and barrier function in colitis. Gut 2005;54:898-900.
8. Lammers KM, Vergopoulos A, Babel N et al. Probiotic therapy in the prevention of pouchitis onset: decreased interleukin-1beta, interleukin-8, and interferon-gamma gene expression. Inflamm Bowel Dis 2005;11:447-54.
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11. Goossens D, Jonkers D, Stobberingh E, van den Bogaard A, Russel M, Stockbrugger R. Probiotics in gastroenterology: indications and future perspectives. Scand J Gastroenterol Suppl 2003;15-23.
12. Calder PC. Polyunsaturated fatty acids, inflammatory processes and inflammatory bowel diseases. Mol Nutr Food Res 2008;52:885-97.
13. Razack R, Seidner DL. Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol 2007;23:400-5.
14. Camuesco D, Comalada M, Concha A et al. Intestinal anti-inflammatory activity of combined quercitrin and dietary olive oil supplemented with fish oil, rich in EPA and DHA (n-3) polyunsaturated fatty acids, in rats with DSS-induced colitis. Clin Nutr 2006;25:466-76.
15. Seidner DL, Lashner BA, Brzezinski A et al. An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial. Clin Gastroenterol Hepatol 2005;3:358-69.
16. Ishihara T, Tanaka K, Tasaka Y et al. Therapeutic effect of lecithinized superoxide dismutase against colitis. J Pharmacol Exp Ther 2009;328:152-64.