SUMMARY: IBD CAM “Probiotics, Special Diets [SCD], and Complementary Therapies: We Know Patients Want Them, So What Do We Tell Them?“ was presented at the Dec. 2014 Advances in IBD conference, by Dr. Sandra Kim, MD, who noted, “SO CERTAINLY THERE IS SOME PROMISE IN AT LEAST THINKING ABOUT THIS.” Now that’s a first!!! At least one conventional doctor is encouraging her peers to seriously educate themselves about IBD CAM, LDN, probiotics, SCD… and Integrative Medicine and to ask their patients if they are interested in them, using them and if so, what do they use, and to actively seek funding for further study of them! And… Dr. Kim has disclosure of conflicting interests — Speaker: Nestle Nutrition, Abbott Laboratories and Consultant: AbbVie Pharmaceuticals!
IBD CAM, LDN, probiotics, SCD: “Probiotics, Special Diets, and Complementary Therapies: We Know Patients Want Them, So What Do We Tell Them?” (PowerPoint link)
That title (no joking) says it all now, doesn’t it? But no worries… the conference presentations have always questioned protocols such as the presentation: Should We Change How We Position Biologics in UC?
Dr. Kim is a pediatric gastroenterologist; her continuing medical education presentation was fifteen minutes. No time was left for questions; no surprise there.
Bottom line: there really is disease activity indices improvement and mucosal healing taking place with these modalities.
You can watch Dr. Kim’s Presentation in the below YouTube: “Probiotics, Special Diets, and Complementary Therapies: We Know Patients Want Them, So What Do We Tell Them?” Probiotics, Special Diets, and Complementary Therapies:
Dr. Kim addressed ten CAM and Integrative Medicine practices having anti-inflammatory impact and/or decreased disease activity indices on the gut function as it relates to IBD, although it should similarly relate to other gut dysbiosis and may be worth your time to Google research such.
Dr. Kim concluded saying she personally, with patients:
- Goes through the medications,
- Goes through the nutrition,
- Then she is open and up front asking patients if they are interested in different types of integrative medicine practices, or CAMs, and if so, what sorts of practices or supplements they are utilizing. She stressed to: LISTEN WITHOUT JUDGEMENT as there is a perception that physicians believe in only the Westernized medicine and judge, and for this reason, often she thinks the families are NOT upfront in the non-Western practices they are doing. She always says it is best to know what patients are thinking!!! I honestly don’t think they would like to know, at times, strictly my opinion.
- She thinks physicians should:
- Understand the literature or they are not credible.
- Know how the literature talks about the practice; is it used as primary or adjunct therapy.
- Know what the benefits and potential downsize is.
Treatments she discussed are:
- Artemisia or wormwood found to have a 65 to 80% improvement of disease activity indices; that was better than Remicade,
- HMPL found to have beneficial clinical response but not remission at 8 weeks; thought to exert anti=inflammatory effects due to TNF, IL-1β, and NF-kB pathways.
- Curcumin plus 5-ASA had 5% relapse versus 5-ASA alone which had a 21% relapse.
- Cannabis helped with symptoms but was a greater predictor of progression to surgery (OR 5.03).
- LDN improved disease activity indices for Crohn’s.
- Probiotics. The below images also include #7—Prebiotics and #8—SCD. Dr. Kim acknowledged FMT but decided to not discuss it in this presentation.
Probiotics: Potential butyrate producers. Some efficacy in pouchitis and UC but not Crohn’s. VSL#3 helped post operative surgery Crohn’s.
- But I am inserting a note: SCD, eaten for one month at about 80% compliance, was shown to increase F. prausnitzii for IBD Crohn’s; F. prausnitzii is a butyrate and antioxidant producer, and it is found to be reduced in IBD. See IBD CROHN’S: SCD INCREASED MICROBIOME DIVERSITY BUT LOW RESIDUAL DIET REDUCED DIVERSITY and the study at: Analysis of Gut Microbiome and Diet Modification in Patients with Crohn’s Disease, as well as the post, NICE, EATING SCD INCREASED F. PRAUSNITZII… HUGH?!? which explains the significance of F. prausnitzii in the microbiome.
- Another great read on F. prausnitzii and IBD is Among Trillions of Microbes in the Gut, a Few Are Special as it suggests perhaps F. prausnitzii, part of the clostridial clusters, that do the opposite of CDiff in a gut —they keep the gut barrier tight and healthy, and they soothe the immune system… In East Asian populations the gene variants associated with IBD differ from the gene variants in European populations. Yet the same bacterial species—F. prausnitzii—was reduced in the guts of those in whom the disease developed. This suggested that whereas different genetic vulnerabilities might underlie the disorder, the path to disease was similar: a loss of anti-inflammatory microbes from the gut. And although Sokol suspects that other good bacteria besides F. prausnitzii exist, this similarity hinted at a potential one-size-fits-all remedy for Crohn’s and possibly other inflammatory disorders: restoration of peacekeeping microbes.
- Prebiotics did not help significantly in changing typical probiotic strains like bifidobacteria or F. prausnitzii. But see above study for SCD study that did show this change for IBD-Crohn’s.
- SCD (1 year consumption, individual patients are charted):
- Stan Cohen, 2014 JPGN study: disease activity indices and endoscopic for mucosal healing showed improvement in PCDAI as well as Lewis Scores (measurement of mucosal healing when undergoing capsule endoscopy.)
- Also Suskind 2014 JPGN study from Seattle Childrens found significant improvement in multiple parameters including albumin and hemoglobins.
- Acupuncture in IBD: improved sense of well being.
- Hypnosis for IBD: one 50 minute session had mucosal and serum inflammation markers decrease.
While I am happy she included SCD, I am disappointed that she missed a lot of the studies.
Nutrition as Medicine in the past has been a holistic approach by those wanting to avoid medication side effects. Limited studies have been conducted and most are outside the US. There is a surprising overlap of IBD and IBS symptoms. The FODMAPS diet seriously helps over 70% of IBS and has decent research behind it. See the post, IBS: FODMAPS, STOMACH MICROBIOME & RIFAXIMIN ANTIBIOTIC TREATMENT, SERIOUSLY?!? Not surprising, many of the SCD type diets used for IBD have FODMAP overlaps. At times I think this is the concept that keeps diet management of IBD within reach, but it is hampered by the need for conventional physician’s to recant the knee jerk reaction, “Diet has nothing to do with it [IBD]” that patients hear again and again. And patients need to realize that as in Type 1 Diabetes control, diet management may not be a negotiable concept. What is sad is the lack of physician understanding that eating SCD is not that difficult, even on the road, once you learn and understand the rationale for its tenets and how to practically implement SCD.
Actually diet remission for IBD is not new considering enteral nutrition, and I’d be remiss to not mention it. “There is presently strong evidence supporting the use of EEN for induction of remission in pediatric CD. In 2006, both the European Society for Clinical Nutrition and Metabolism (8) and the working group of the Japanese Society for Pediatric Gastroenterology, Hepatology, and Nutrition (9) independently published guidelines recommending that EN be considered as the first-line induction therapy in children with CD, followed in 2010 by similar conclusions by the Inflammatory Bowel Disease (IBD) Working Group of the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition (10).” –Use of Enteral Nutrition for the Control of Intestinal Inflammation in Pediatric Crohn Disease
Stanford University, Jennifer Burgis, MD Clinical Assistant Professor Pediatric Gastroenterology, Hepatology and Nutrition Lucile Packard Children’s Hospital, (also point contact for the ongoing clinical trial, Specific Carbohydrate Diet as Maintenance Therapy in Crohn’s Disease) presented this PowerPoint, Nutrition in IBD: Enteral Nutrition and Alternative Diets. In summary, enteral Nutrition is formula feeding which has broad use world-wide for remission in Crohn’s [Western Europe (65%) and Canada (36%) whereas the US use rate is only 4%.] Enteral nutrition has up to 80% remission rates in children. Adult enteral nutrition is not as successful because it is thought there is less diet compliance and diagnosed cases are not “new” disease occurrence and by this, I surmise they mean more gut damage. It is thought the mechanism of action for enteral nutrition is:
- Nutritional repletion
- Correct intestinal permeability
- Monotony – minimize exposure
- Modification of intestinal bacteria
- Altered inflammatory cascade
- See Lionetti et al. JPEN 2005 and Critch et al. JPGN 2012 for details.
Some relevant posts of yet other studies for SCD diet for IBD, Autism, and a very similar diet for RA, are:
- FOOD MANAGING IBD & AUTISM: THE STUDIES
- IBD CROHN’S: SCD INCREASED MICROBIOME DIVERSITY BUT LOW RESIDUAL DIET REDUCED DIVERSITY
- DR. ROB KNIGHT UPDATES: IBD MICROBIOME SKEW & SAN DIEGO MOVE
- MICROBIOME DIET MECHANISMS PREVENT OR MANAGE DISEASE (FOCUS: SCD & IBD)
- DIET AND OTHER THINGS DETERMINES OUR MICROBIOME
- SCD is used for autism and to that end, worth reading for the role probiotics plays in microbiome: 2 AUTISM STUDIES ARE SEEKING PARTICIPANTS: MICROBIOME & CONSTIP and FEED YOUR MICROBIOME TO MANAGE AUTISM
- CLA GRASSFED SCD YOGURT & CYTOKINE STUDIES: ERIVAN & WHOLE FOODS 365
- A diet similar to SCD is used for RA (now recognized to have microbiome dysbiosis): ARTHRITIS & GUT HEALTH: DIET & MICROBIOME
Bet you are at least as frustrated as me that Western physicians have no clue about the benefits of such CAM and Integrated Medicine practices
Nor do they promote them or even seem to be aware that such can help modulate the immune system especially given that the CDC reports that 42% of adults and 12% of children use them. In the pediatric IBD population, 40 to 56% of IBD patients use CAM:
I couldn’t wait to hear the “Probiotics, Special Diets, and Complementary Therapies: We Know Patients Want Them, So What Do We Tell Them?” (PowerPoint link) 2014 Advances in IBD conference presentation, and even though it was only 15 minutes, supposed to educate GI physicians on CAM and Integrative Medicine impact for IBD, it is a major step forward. Prior conferences had opposing panels addressing this type of information/data and for the longest time, had nothing at all. Microbiome talk only began a few short years ago which makes some sense as the literature only began to publish microbiome research a few years ago as understanding grew of the vast amount of direct health impact due to microbiome:
Factors beyond those Dr. Kim addressed that benefit the gut
In fact, it was only late last year that I saw the 180 degree turn around of a prominent GI doctor in a major teaching hospital (I had been pushing the string for about six years) finally acknowledge the microbiome and IBD connection. He connected me to OpenBiome (a 2012 launched company that is providing FMT CDiff clinical support of screened, filtered, and frozen feces), and that path eventually led me into the lab of Dr. Eric Alm and some insights into their current thoughts on diet and IBD. You may recall this lab from the post, MICROBIOME CHANGES FROM DIET & ENVIRO AFFECTING HEALTH; ALM. While I don’t want to go too far into those conversations, I do want to share that they’ll be embarking on a whole health type of overall evaluation of IBD, and I’m excited to see this occur.
I am a proponent that chronic disease, be it IBD or otherwise, is more than the food and substrate we feed our microbiome (albeit optimizing that is critically important), but it is other parameters, such as metabolism, sun, exercise, sleep and all the rest I speak of, that makes the whole of us tick, and optimizing any and all of these can turn around chronic disease.
I’m excited that the medical field is beginning to talk about CAM and Integrative Medicine relative to benefit for IBD publicly as evidenced by Dr. Kim’s talk. Even though it was only a 15 minute spill… it is evidence of a turning tide. Somewhat disturbing though, was her thoughts concerning the definition of Integrative Medicine which is: “Emphasizes healing of the whole person to achieve health goals:
- Spiritual, and
What disturbed me most was her thought (as a pediatric GI) that they are already now doing this, saying, “it is not just the medications or nutrition, or psycho and social, rather it is all coming together as a team… We currently do practice this; we just don’t call it Integrative Medicine.”
Sigh… still a long way to go… but a start. To that end, I ask that you forward this post to open the door for others to better understand how CAMs and Integrative Medicine, especially the SCD impact for chronic disease and prevention, is becoming a useful tool in health.
Updated for SEO optimization. Last updated: March 26, 2016 at 11:30 am
In health through awareness,