Explaining That Diet Does Help Severe “Stomach” Problems

baadsgaard-alfrida-ludovica-vi-opstilling-med-ananas-druer-ogImagine having diarrhea 15 times a day, every day. Add some blood to that. While you try to walk across a university campus. Or coach basketball.  Or serve on a Navy ship in the middle of the vast ocean. Or learn to add, subtract, and multiply.

This is life with Crohn’s disease or ulcerative colitis, collectively called inflammatory bowel disease (IBD). And when I was a medical student on general surgery, I swear it seems like we were digging around every day in some poor patient’s intestines due to his or her inflammatory bowel disease. Many emerged from surgery with bags to collect their liquid bowel movements.

I feel like I’ve heard it a thousand times. “My doctor says it doesn’t matter what I eat for my Crohn’s disease.” Have you heard that? Do you believe that? That’s 100% false. Research since the 1970s shows that patients can go into remission with special “nutritional shakes.” 

Patients are often convinced that food impacts their disease, but they can’t always pinpoint how or which foods. Medical studies weren’t very helpful in the past; they looked at things like fats, amino acids, and vitamin D, finding some correlations, but nothing to hang their hats on. So hard-working doctors just shrugged their shoulders and said, “It doesn’t really matter, dear patient. Just eat.” [Scram. I’ve got 8 patients waiting to see me. I don’t have time to listen to you speculate about whether or not milk gives you diarrhea.]

But fascinatingly, studies have shown for forty years now, plus or minus, that IBD can be controlled with nutrition! Well, more accurately put, researchers and patients controlled IBD with exclusive enteral nutrition. Exclusive enteral nutrition, EEN for short, is basically just a “nutrition” shake kind of like Ensure or PediaSure, only it tastes much worse. The ingredients in the shake have been pre-digested so they can be absorbed completely in the small intestine.

Studies have repeatedly and reproducibly shown great results for IBD patients and EEN, particularly Crohn’s disease. How great? Well how does upward of 100% sound to you for a remission rate? Would you even settle for a 70% rate? Yeah. That good. I’m cherry picking a little; some studies didn’t have such high success rates, but most did. And some studies that didn’t look all that good to begin with looked better after the study results were adjusted for patients who just couldn’t tolerate the special liquids (often quite a few). Also, results were consistently better for pediatric patients [who often heal more quickly and have to be compliant whether they like it or not—and sometimes choose to be compliant because they feel so much better!]. (Kansal, 2013)

But patients and doctors, I guess, weren’t having that. Too yucky. Too restrictive. (Just for interest, I notice that Nestle seems to make many of these nutritional EENs.)

What’s in that shake?

Great minds pontificated about what it was in the EEN drink which could cause these patients to do so well. They played around with the liquid formulas with good success, trying to make them less repulsive and less expensive. Then they pondered, “Well, can we let our patients eat [cake] and take some of this EEN stuff?”

So researchers let patients drink the liquid EEN formula and have free access to table food at the same time. Yum! With free access to table food, despite the nutritional “shake,” the remission rates weren’t as good as when a patient ate only EEN liquid—but they were better than the patients who received no EEN at all. Aha! So it’s starting to look like something in table food perpetuates increased inflammation in inflammatory bowel disease patients. (Triantafillidis, 2015)

Okay. All Mama’s good table food really threw a wrench in the great effects of the EEN shakes. What next?

Well, allowing table food was a step backward, and researchers thought, “We need another twist. What can we do? This is fun.”

So researchers gave patients nutritional “shakes” and they let them eat only certain allowed foods. (NO CAKE this time. Sorry.) Bingo. Success rates held at about 70% of patients showing improvement and or sustained remission. (I know a lot of doctors who made just 70% in class and are successfully practicing. Pass equals MD, baby. Seventy percent is pretty good.) That’s awesome. How happy would you be to be symptom-free and able to eat some real food?  (Sigall-Boneh, 2014)

It’s 2017. Can we ditch the EEN altogether and just eat real food?

Now, we have to cap it off. Could patients get off of the disgusting “shakes” altogether? (Good-bye, Nestle…) Well, the Journal of Clinical Gastroenterology is about to publish a study done by a Dr. Suskind (and his team, of course!) from Seattle Children’s Hospital. Ten pediatric patients followed a diet called the Specific Carbohydrate Diet for three months, and 80% of them had symptoms improve significantly and even resolve and lab markers normalize. Eighty-stinking-percent! Let me repeat: eighty percent success. WITH FOOD.

Way to go Dr. Suskind and team. Way to take medicine back to truly patient-centered, do-no-harm care! And most importantly: WAY TO GO PATIENTS AND PARENTS WHO PARTICIPATED IN THIS STUDY! Changing how you eat is hard work, and most people balk, standing in the corner cowering with too much fear to leave their pizza and bread behind. Not you. Not you. (Suskind, 2017)

[Click here for a readable summary of Suskind’s report and here for an abstract of it.]

Meh. Study needs to be bigger.

Now, I showed someone Suskind’s research summary, and she replied, “But there’s only ten patients. I wish it was bigger.”

Sigh. So do I. But it’s what we’ve got. And it’s so promising. I’m ebullient. Diet alone! Eighty percent remission! With real food. No diarrhea! No bleeding! No stomach cramps! Virtually 100% safe. No injections! No risk of white blood cell counts crashing. Why won’t people try this?

Reminds me of a verse I learned from a big book, although I’ve adapted it. “The fiddle plays and you won’t dance. The singer wails a mournful tune, and you will not cry.” We are hard to please. Impossible nearly. What do we want? A magic bullet pill with no side effects?

I must close now. But you will not want to miss my next post about the amazing stay-at-home mom who made it her life mission to show the world that inflammatory bowel disease can be controlled most of the times with real, whole food. And I’ll explain a little about the diet that saved her 8-year-old daughter’s life and which she spent her life studying and evangelizing.

Terri

Citations:

Kansal, S., et al. “Enteral nutrition in Crohn’s disease: an underused therapy.” Gastroenterology research and practice 2013 (2013).  https://www.hindawi.com/journals/grp/2013/482108/

Triantafillidis, John K., Costas Vagianos, and Apostolos E. Papalois. “The role of enteral nutrition in patients with inflammatory bowel disease: current aspects.” BioMed research international 2015 (2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352452/

Sigall-Boneh, Rotem, et al. “Partial enteral nutrition with a Crohn’s disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease.” Inflammatory bowel diseases 20.8 (2014): 1353-1360. https://www.researchgate.net/publication/263548102_Partial_Enteral_Nutrition_with_a_Crohn’s_Disease_Exclusion_Diet_Is_Effective_for_Induction_of_Remission_in_Children_and_Young_Adults_with_Crohn’s_Disease

Suskind, D. L., Cohen, S. A., Brittnacher, M. J., Wahbeh, G., Lee, D., Shaffer, M. L., … & Giefer, M. (2017). Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease. Journal of Clinical Gastroenterology. Abstract only: http://journals.lww.com/jcge/Abstract/publishahead/Clinical_and_Fecal_Microbial_Changes_With_Diet.98120.aspx

19 thoughts on “Explaining That Diet Does Help Severe “Stomach” Problems

  1. gabriella

    Ah yeah, you know, the Plant Based Diet Doctor Gurus, the ones with the sunken eyeballs, claim that the vegan diet is a cure all for everything that ails a human and prevents ailing in the future. Especially the no added oil, no added salt diet. The gurus claim that plant based diets solve all gut problems, even Crohn’s disease. There’s mixed reporting by individuals though. I did a brief google search to see if there’s any report out there of any one coming down with Crohn’s after years of eating a plant based diet. Nothing yet. I shall continue to venture forth into the belly of the Google beast. There must be someone lurking out there perhaps on the 60th page of ‘hits’. Or perhaps these poor people are shame facedly hiding in a dark corner somewhere avoiding castigation from The Dedicated Ones.

    Looking forward to your next installment, Terri.

    🙂

    Reply
    1. thehomeschoolingdoctor Post author

      Hey! My blog is on the 60th page of hits! (Hee! Haw!)

      No. Vegan does not seem physiologically compatible with life without modern supplements. To have a primary diet that requires supplements off the bat doesn’t seem right and defies my common sense. However, you know I do love plant matter to eat! Cooked, raw, heck, even flambeed. And I’m well aware that you like them cooked. Good by me.

      If you do find something, let me know. I’ve comprised a couple of eating plans for specific diseases, one being a kind of cancer, and none were vegan. Very plant-based, yes, but not vegan.

      Reply
      1. gabriella

        I cruised the Crohn’s forums. There was one person who claimed to have kept a vegetarian (not vegan) diet for 7 years prior to developing Crohn’s disease. But we don’t know, do what, how this person practiced a vegetarian diet. Some people tried vegan without success. Some people reported success and flare ups when they ‘cheated’.

        I agree with you totally. Vegan diets do not provide the nutrition required by human beings, namely vitamin B12 and probably zinc. Selenium is not required by plants so that is also a hit and miss. Saskatchewan lentils and probably other pulses are rich in selenium because it’s in the soil. Lentils more so because for some reason botanists don’t understand, the plant takes it up at a higher level than other pulses.

        I subscribe to plant based with some animal/ocean material. Doesn’t have to be huge amounts but focusing on kidney and liver which provide a concentrated source of vitamins and minerals means not needing to nosh on large quantities of animal ‘bits and pieces’. Also some seafoods like oysters and even sea urchin roe will provide valuable nutrition without concomitant ocean pollution.

        Recently I decided to try psyllium. Fabulous. Then I went without for a couple of weeks. Despite major ingestion of vegetables and pulses like lentils, (oodles of plant fibre) the Quality of product was not as good at all. So back on the two rounded teaspoons of psyllium per day. Less is more. The recommendation of 2 to 4 tablespoons per day is probably overdoing things and maybe even creating problems. I finally got the CD of the MRI of my back (from summer 2015… yeah I’m slow). There’s a herniated disc distorting the spinal cord at L4/L5. I already knew about the one at T10/11. The report stated ‘spinal stenosis’ but I didn’t really know what that meant. And now that I DO know, I’m not taking it lying down. If this has anything to do with lack of fecal propulsion in the rectal region, I’m not sure. Or if it has anything to do with a bit of lack of bladder control, again I do not know for sure. I do know that getting the muscles supporting the spine as strong as they can be is important. Way back many years ago I had sciatica but eventually it went away. When did all this happen? No idea. But I am getting the old back stronger and stronger and not giving up. Nice to see the picture though. Better to know than to not know.

      2. thehomeschoolingdoctor Post author

        Hi! Your comment got me thinking about selenium in South Dakota, as we’re really just there under Saskatchewan! Wondering if South Dakota would have pockets of high selenium! We do! But we don’t grow lentils. (I wonder if we could grow lentils…) Anyhow, not that you care much about SD, but I did find this.

        “The Western Plains of the Dakotas are underlaid by a geographic formation that contains high concentrations of Se (Rosenfeld and Beath, 1964). This geological formation results in high concentrations of Se in the soil of parts of North and South Dakota, and consequently, the beef raised in this region may contain high concentrations of Se.”

        Cool, eh!? I like geology a little bit. Not enough time to learn it.

        You should read Sarno’s book on the back. Interesting. Not meaning that a person should ever, ever ignore back pain and symptoms of constipation and bladder issues (I’ll toss in another ever, ever) and defer medical evaluation!!! But it’s definitely an interesting take. I think his theories could use some updating pathophysiology-wise, but a real winner none-the-less.

  2. Aviva

    Hello Terri,
    Haven’t read your posts for a while and my eyes just fell on this one about Dr. Suskind and Crohn’s remission, for a reason, I suppose. My daughter’s Crohn was very bad for a while and she did an enteral diet with Modulen (Nestle…). She did go on a remission and then went on with Gaps. To my disappointment, since being so sick before, on finishing the enteral diet, she submitted to the doctors’ recomendation and she receives the biological medicine Remicade I.V every two months. I am sure she could be well without the medication.
    Of course I was happy to see Dr. Suskind’s small study. Dr. Hunter from England got remission with enteral feeding for some years now and then a list of foods, kind of resemblins SCD.
    You have gone so far away from your Medical School knowledge. Chapeau!

    Reply
  3. Wilbur

    I wrote a long response that got deleted by my iPad. A reboot of my browser. I hope this one makes it through!

    Foremost, I cured myself of IBS-D. Lots of food intolerances. I knew all of the bathrooms on my route. My diet was geared to avoiding problems. It was awful. I was a C-section baby, bottle-fed, and took lots of antibiotics. I eat anything I want now.

    Regarding what you say about hypnotism. It has a bad rep because of what people see about theatrical stage hypnosis. Hypnosis as a general subject is nothing like that. I’m studying hypnosis. Pure and simple, hypnosis is benign, a concentration of mind. Focus. Hyper-awareness.

    What most do not realize is that we go through much of our day in a state of hypnosis. That we have a set of beliefs and we interpret normal everyday happenings to confirm our beliefs. Confirmation bias. The beliefs and confirmation bias provide a feedback loop that create our reality.

    So, one must create their own reality. Study after study shows that eating vegetables is good. It fixes lots of stuff, including IBS-D. I’m far from vegan, but I believe in vegetables. Cooked, raw, whatever. You know that; I know that. So reinterpret the rumblings and diarrhea and other things after eating vegetables as good things. A start to healing. A friend, not a foe. Yes, it looks the same as being IBS-D,but is it any worse? If it’s the same, what have you lost? You know vegetables are good. It must be better even if it feels the same.

    And damn, we see that, while not large, small improvements happen. We have an urgent poop, but it’s not as runny as before (a consequence of eating more veggies). And we concentrate on the small improvements. That’s positive hypnosis. Using minor and only slightly positive cues as triggers to produce larger positive behavior. The feedback loop done right.

    I also want to add that some of the IBS patients not helped by hypnosis seemed to have had surgeries that might have damaged nerves near their colons.

    Reply
    1. thehomeschoolingdoctor Post author

      Well, we’ll take the shortened version since the long one got lost in space. Thanks. That is a great point about the very small improvements being things to allow your mind to focus on rather than the feeling that this all isn’t working. “Using the minor and slightly positive cues as triggers to produce larger positive behavior.”

      Hypnosis for select things seems to have some good results. It’s on the reading list here.

      Reply
      1. Pat

        Thank you Terri, and to everyone else who has replied to my post.

        I have been thinking about a number of comments that were made. It does appear to me that I am able to eat certain foods sometimes, but not other times. Reading through what you were saying, it occurs to me that perhaps sometimes I’m eating too much of those foods at one time, and I am not able to digest them due to overload. Sometimes I will have black beans with a meal of salmon and vegetables. Afterword, I will feel so good as if I have received some nutrient that I really needed. I thought that might be the black beans (fiber?). Although to be honest salmon does settle very well with me. However other times I will have soup with black beans and really have a digestive upset. So I wonder is it combinations? Is it that I was already in “the mode” and sensitive to almost anything I would eat, or some other reason. After reading your posts, I think I will try small portions of those healthy foods that can cause problems and cook the vegetables to make them less fibrous. The question is why do we want to starve the microbiome with EEN? Are we starving out the bad bacteria.before replacing it with good?

        The other problem is just that sometimes I narrow down my list of things I can eat to a degree that I’m starving and I just eat something that I know is not the right thing. At that point, I’m definitely my worst enemy. The idea of eating small portions of well cooked food may help me from getting into that state.

        As far as hypnosis goes, I actually think that is very very successful. I have a lot of headaches that I think are linked to the food in tolerances. I use hypnosis tapes, meditation and other forms of mind over body techniques for the headaches as well as sleep problems. I also jog. It came to me one time that I was having a very difficult time jogging, my legs felt like lead, I was breathing hard, etc. I’m 60, so I have to admit things are getting a little tougher out there on the pavement. But when I start thinking about something else, I completely forget the physical discomfort and find myself further down the road. Essentially, my brain is sipping a piña colada on the beach while my body is jogging. A brain expert I once read said that the brain is not capable of thinking of two things at one time. So if I think about the pain in my big toe, it becomes impossible for me to think about the pain in my head–or gut. I have been trying that technique during meditation, creating a distance between the symptom as if the symptom is a separate entity from me. At the end of the sessions both my gut and my headache are better, although not necessarily gone. Of course that works well for symptoms that are not so painful that it would be extremely hard to block them. It has helped reduce my symptoms and giving me an attitude adjustment. 🙂 Sometimes that’s half the battle.

      2. thehomeschoolingdoctor Post author

        Food sensitivities are weird, and everyone has to admit, even allergists, that they are so shifting and unpredictable! Even true allergies can be so shifting!

        That is the million dollar question. Do we want to starve the microbiota? For how long? I look at it as not necessarily starving the microbiota, but more as allowing restoration of the proper environment for the microbiota. Yes, you are taking away their external food source but by doing so the body can probably restore itself without dealing with digestion. EEN will be nearly completely absorbed before it hits the distal small intestine. When starches, fats, and proteins make it to the ileum (the last part) of the small intestine, changes are put in place that shouldn’t be. For example, if these nutrients reach the ileum, then it feeds back to the pancreas and shuts off production of pancreatic enzymes. So a person with malabsoprtion, who needs those enzymes, may not be getting them the way they should.

        Another change that occurs would be the change in pH of the small intestine and intestine with unabsorbed sugars, starches, proteins, and fats. Proper pH is VERY important for the action of our enzymes and also for certain bacteria to grow (or to keep other ones from growing) or to keep bacteria from growing in wrong spots! So by using EEN or a diet which alleviates some of the delivery of nutrients more distally than it should be, the distal small intestine, cecum, and colon may be allowed rest. Give the body a rest, and it can restore. It can do a better job at eliminating damaged cells and new cells aren’t being inflicted with digestive turmoil. I’ve often wondered if a long water fast could cure many GI issues. PLEASE NO ONE TRY THIS. DUH! We are finding out a lot currently about fasting, which is so very interesting and insightful. Maybe feeding overgrown, negative quality bacteria is worse than starving good ones. I’ve read the good ones dig down deep in the crypts and so even though we think we’ve killed them off, there are still colonies deep in there. So get the environment (pH, mucous layer, motility) back the way it should be, and the beneficial bacteria can get back to living well again.

        Also, I do want to point out that changes in the cecum that occur with bacterial overgrowth and delivery of nutrients also feeds back and slows peristalsis. So that’s another change that occurs in all this which makes things worse.

        So my thought with the EEN and the SCD is that less makes it down to the ileum and cecum, which isn’t necessarily a bad thing. But if the studies keep working, I’ll be super excited for lots of medical minds to think on it and finally give us their final conclusion!

        I liked your information on hypnsosis. It was very interesting. Thanks!

        Have a great weekend! May all be well!

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