It's well documented that NSAIDs are bad news for those of us with MC. Virtually all the common over-the-counter painkillers, (and many prescription non-opoid type analgesics), are NSAIDs, except acetaminophen, of course, (Tylenol).
It's not that anti-inflammatories in general are bad, it's the way that NSAIDs work, that make them problematic for sufferers of Inflammatory Bowel Diseases. (IBDs).
The primary problem with NSAIDs, is the fact that they block the producton of virtually all prostaglandins.
In healthy people, the intestinal environment maintains a healthy balance, with anti-inflammatory proteins keeping pro-inflammatory components in check. In people with IBDs, however, the immune system can't calm the inflammatory response occurring in the gut. The result is damage to the intestinal lining, which causes an increase in the flow of intestinal contents, leading to diarrhea, and can also cause ulcers and and bleeding, in the case of crohn's and UC.
Although NSAIDs block prostaglandins, thereby reducing fever, pain, and swelling that prostaglandins cause, it’s not necessarily a good thing for the gastrointestinal (GI) tract. Prostaglandins play a useful role in the GI tract, where they have a protective effect on the mucosal lining of the gut. They can lessen the effects of cytokines, which are proteins released by the immune system, that produce inflammation. Therefore, although NSAIDs can ease joint pain, and possibly help in other components of various inflammatory activities, they can also cause damage to the mucosa in healthy people, or reactivate the symptoms of disease in IBD patients. This means that they can actually cause IBDs, and they can certainly cause someone with an IBD who is in remission, to relapse back into a state of full symptomatic autoimmune reaction.
IOW, the mucosa of our intestines is already highly vulnerable to attack by our immune systems, and for many or us, the reduction in prostaglandin production caused by NSAIDs, may be enough to allow an autoimmune reaction to proceed. The NSAIDs simply provide an increased opportunity for our overactive immune systems to wreak havoc with our guts.
Prostaglandins are hormone-like substances produced within the body, that regulate dilation of blood vessels, inflammatory response, and other critical processes. Certain natural anti-inflammatory agents, such as fish oil, are rich in Omega-3 fatty acids, which are needed for prostaglandin formation, while NSAIDs actually block the producton of prostaglandins.
Omega 3 fatty acids, which are essential fatty acids, make prostaglandins of the three series, which are anti-inflammatory and not constrictive. Prostaglandins can trigger pain and inflammation when they belong to the two series (arachidonic acid), however, the three series counteract that production and actually relieve pain and inflammation. Arachidonic acid dominates the average diet (meat and dairy), and without omega 3 fatty acids, such as fish oil, this balance tips in favor of inflammatory, pain-producing and vasoconstrive prostaglandins. This explains the seeming paradox of why the average person gets too much fat in their diet, and yet most people suffer from a fatty acid insufficiency (better termed a fatty acid imbalance). They actually don’t get enough of the “good” fatty acids.
Therefore, "natural" anti-inflammatory type foods/supplements, such as fish oil, (especially), do not have the same problem as NSAIDs, and therefore, do not pose a risk, for those of us with MC.
Here's a site which lists most of the common NSAIDs:
http://ibscrohns.about.com/cs/ibdfaqs/a/nsaidsibd.htm
Here is Some Information on Why We Must Avoid NSAIDs
Moderators: Rosie, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh, mbeezie
Here is Some Information on Why We Must Avoid NSAIDs
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Omega 3 & Anti-inflamatories
Thanks for this great explanation and this fantastic website. I have joined today and greatly appreciated the Newbie wrap up. I now have an explanation for what I have been experiencing for 20+ years. I knew I was intolerant to gluten and a few other things - but it is SO great to now understand why! Now that I have a 'label' it will easier to get a GI to take me seriously.
My question is that when you talk about NSAIDs being bad, I assume that mesalamine and sulpaslazine do not fall into this category even thought they are also anti-inflammatories? Do they work differently?
Also, I have struggled to tolerate fish oil in the past, possibly because I am amine intolerant. What is the most bio-available way to get the Omega 3 into the gut?
My question is that when you talk about NSAIDs being bad, I assume that mesalamine and sulpaslazine do not fall into this category even thought they are also anti-inflammatories? Do they work differently?
Also, I have struggled to tolerate fish oil in the past, possibly because I am amine intolerant. What is the most bio-available way to get the Omega 3 into the gut?
Tracy
http://thepowerofpoo.blogspot.com/
"I have not failed. I've just found 10,000 ways that won't work." Thomas A. Edison
http://thepowerofpoo.blogspot.com/
"I have not failed. I've just found 10,000 ways that won't work." Thomas A. Edison
Hi Tracy,
Welcome to the board. Unfortunately, mesalamine is indeed chemically related to aspirin, so most people who are allergic to aspirin, or other salicylates, should not use medications in this group. Not only that, but this chemical similarity may extend to other attributes of NSAIDs. Even though in vitro studies have shown that mesalamine apparently inhibits the enzymes believed to be responsible for the production of both leukotrienes and prostaglandins, (known to be inflammatory mediators), case studies show that in certain individuals, it may promote the production of leukotrienes, similar to NSAIDs, resulting in diarrhea, and/or intestinal inflammation. That implies that the 5-ASA drugs may benefit some patients with MC, while increasing the inflammation in other cases.
If you'd like more information on this type of adverse reaction to mesalamione, I have posted a quote from a reference, (and a link to the reference), in the thread at the following link:
http://www.perskyfarms.com/phpBB2/viewtopic.php?t=14556
Here's an extensive list of foods, showing their total omega-3 fatty acid content, in descending order:
http://nutritiondata.self.com/foods-000 ... 00000.html
As you can see from the list, the highest concentration is in flax seed oil. But be careful with whole or ground flaxseed, because the hull is a laxative. Like many people on this board, I take a flax seed oil capsule, daily, especially since I don't eat fish very often.
Tex
Welcome to the board. Unfortunately, mesalamine is indeed chemically related to aspirin, so most people who are allergic to aspirin, or other salicylates, should not use medications in this group. Not only that, but this chemical similarity may extend to other attributes of NSAIDs. Even though in vitro studies have shown that mesalamine apparently inhibits the enzymes believed to be responsible for the production of both leukotrienes and prostaglandins, (known to be inflammatory mediators), case studies show that in certain individuals, it may promote the production of leukotrienes, similar to NSAIDs, resulting in diarrhea, and/or intestinal inflammation. That implies that the 5-ASA drugs may benefit some patients with MC, while increasing the inflammation in other cases.
If you'd like more information on this type of adverse reaction to mesalamione, I have posted a quote from a reference, (and a link to the reference), in the thread at the following link:
http://www.perskyfarms.com/phpBB2/viewtopic.php?t=14556
Here's an extensive list of foods, showing their total omega-3 fatty acid content, in descending order:
http://nutritiondata.self.com/foods-000 ... 00000.html
As you can see from the list, the highest concentration is in flax seed oil. But be careful with whole or ground flaxseed, because the hull is a laxative. Like many people on this board, I take a flax seed oil capsule, daily, especially since I don't eat fish very often.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Salycilate Intolerance & 5 ASAs
Thanks for the links. Does sulphasalazine have the same problem?
I have to take something as diet no longer controls it. I'm now living on rice & potatoes with a bit of butter and still experiencing torrents of diarreoh.
I have an appointment to see the doctor and need to form a view about my preferred course of action. I really wanted to avoid the cortisone but is seems I'm not going to have much choice if the 5 ASAs aren't an option.
I have to take something as diet no longer controls it. I'm now living on rice & potatoes with a bit of butter and still experiencing torrents of diarreoh.
I have an appointment to see the doctor and need to form a view about my preferred course of action. I really wanted to avoid the cortisone but is seems I'm not going to have much choice if the 5 ASAs aren't an option.
Tracy
http://thepowerofpoo.blogspot.com/
"I have not failed. I've just found 10,000 ways that won't work." Thomas A. Edison
http://thepowerofpoo.blogspot.com/
"I have not failed. I've just found 10,000 ways that won't work." Thomas A. Edison
Hi Tracy,
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine), in the treatment of IBDs. Mesalamine contains the active moiety of sulfasalazine, known as 5-aminosalicyclic acid. IOW, if someone reacts adversely to mesalamine, then they will also react adversely to sulfasalazine.
I read most of your blog, and I believe I can tell you why your HPI treatment is not working as it should. Your donor needs to be someone living with you, if possible, because environment and diet determines the "demographic" profile of the gut flora and fauna. If you live alone, then the next best choice would be a relative who lives in the same area, and who eats a similar diet. The third best choice would be a friend who lives nearby, who eats basically the same diet, etc. Using strangers as donors is much, much less likely to provide a set of bacteria that will thrive under the conditions which exist in your gut, (IOW, your environment). That's one of the reasons why commercial probiotics are typically ineffective for people with IBDs - their bacteria profile isn't custom tailored to the needs of the individual consumer.
If you choose to use a corticosteroid, I trust that you are considering Entocort EC, (or one of the other meds that uses budesonide as the active ingredient), and not prednisone, or one of the other conventional corticosteroids. Prednisone works, but the side effects are Draconian, and trying to wean off the stuff can be a real nightmare. Entocort EC, (budesonide), does not have anywhere near the side effect risks of the other corticosteroids, so it's much, much safer to use, especially for long-term use.
Have you considered using diet to control your symptoms, the way that most of us here do? I've been in remission for 7 years now, by diet changes alone. Most people with autoimmune diseases and/or digestive system problems are sensitive to gluten and all dairy products, and over half are sensitive to soy. Some have additional sensitivities, as well. Eliminating those foods from the diet will often bring an amazing recovery from all sorts of symptoms.
Tex
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine), in the treatment of IBDs. Mesalamine contains the active moiety of sulfasalazine, known as 5-aminosalicyclic acid. IOW, if someone reacts adversely to mesalamine, then they will also react adversely to sulfasalazine.
I read most of your blog, and I believe I can tell you why your HPI treatment is not working as it should. Your donor needs to be someone living with you, if possible, because environment and diet determines the "demographic" profile of the gut flora and fauna. If you live alone, then the next best choice would be a relative who lives in the same area, and who eats a similar diet. The third best choice would be a friend who lives nearby, who eats basically the same diet, etc. Using strangers as donors is much, much less likely to provide a set of bacteria that will thrive under the conditions which exist in your gut, (IOW, your environment). That's one of the reasons why commercial probiotics are typically ineffective for people with IBDs - their bacteria profile isn't custom tailored to the needs of the individual consumer.
If you choose to use a corticosteroid, I trust that you are considering Entocort EC, (or one of the other meds that uses budesonide as the active ingredient), and not prednisone, or one of the other conventional corticosteroids. Prednisone works, but the side effects are Draconian, and trying to wean off the stuff can be a real nightmare. Entocort EC, (budesonide), does not have anywhere near the side effect risks of the other corticosteroids, so it's much, much safer to use, especially for long-term use.
Have you considered using diet to control your symptoms, the way that most of us here do? I've been in remission for 7 years now, by diet changes alone. Most people with autoimmune diseases and/or digestive system problems are sensitive to gluten and all dairy products, and over half are sensitive to soy. Some have additional sensitivities, as well. Eliminating those foods from the diet will often bring an amazing recovery from all sorts of symptoms.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Thanks for your in depth reply. Yes, I used diet for 20 years to control it. Back then there were no names for these diets - I discovered on my own that gluten, sugar, fruit & yeast were the culprits.
Avoiding these food groups kept things under control for many years until the anti-biotics recently wreaked havoc. Now the only things left I can tolerate are potatoes and rice. Up until two months ago I could tolerate a few vegetables as well.
The results from the HPI were very encouraging until I developed the colitis, so I haven't given up on it yet. Its too much to expect that new flora will grow while my gut is pouring torrents of water. I think I need to get the colitis under control first then start the HPI again. One thing at a time!
Avoiding these food groups kept things under control for many years until the anti-biotics recently wreaked havoc. Now the only things left I can tolerate are potatoes and rice. Up until two months ago I could tolerate a few vegetables as well.
The results from the HPI were very encouraging until I developed the colitis, so I haven't given up on it yet. Its too much to expect that new flora will grow while my gut is pouring torrents of water. I think I need to get the colitis under control first then start the HPI again. One thing at a time!
Tracy
http://thepowerofpoo.blogspot.com/
"I have not failed. I've just found 10,000 ways that won't work." Thomas A. Edison
http://thepowerofpoo.blogspot.com/
"I have not failed. I've just found 10,000 ways that won't work." Thomas A. Edison
Tracy,
Just a suggestion - you said you are eating a bit of butter. Many of us are just as intolerant to casein (dairy) as we are to gluten. I'm sure you don't want to give up one more food, but perhaps you could try using ghee, which is clarified butter, or butter with the casein removed. It actually tastes better than butter. It's fairly expensive when purchased ready-made, but it is fairly easy to make yourself. There is a recipe for making it in Dee's kitchen.
Gloria
Just a suggestion - you said you are eating a bit of butter. Many of us are just as intolerant to casein (dairy) as we are to gluten. I'm sure you don't want to give up one more food, but perhaps you could try using ghee, which is clarified butter, or butter with the casein removed. It actually tastes better than butter. It's fairly expensive when purchased ready-made, but it is fairly easy to make yourself. There is a recipe for making it in Dee's kitchen.
Gloria
You never know what you can do until you have to do it.
Tex,
Thanks for the explanation and link to the article about this. My MC was NSAID induced and in looking at the list I see several different NSAID's I've taken frequently over the years, but it was etodolac that pushed me over the edge. I was taking that for TMJ and I'm still hopeful that being GF will eventually help that condition, but thus far it's only gotten worse. Of course the fact that I crave crunchy things doesn't help any. I have learned to slice an apple almost paper thin but still like something like Nut Thins and peanut butter to snack on from time to time, or dry GF Chex cereal. Sorry....I digress! Back to the NSAID's: earlier in 2010 I had carpal tunnel surgery and took a lot of naproxen, then developed the TMJ and was put on etodolac. I remember hearing about stomach bleeding being a concern but it never dawned on me that the symptoms of MC could be caused by NSAID's. But one thing it taught me is to be very careful and cautious about taking any meds. Thanks for the ongoing medical education on this wonderful site!
Katie
Thanks for the explanation and link to the article about this. My MC was NSAID induced and in looking at the list I see several different NSAID's I've taken frequently over the years, but it was etodolac that pushed me over the edge. I was taking that for TMJ and I'm still hopeful that being GF will eventually help that condition, but thus far it's only gotten worse. Of course the fact that I crave crunchy things doesn't help any. I have learned to slice an apple almost paper thin but still like something like Nut Thins and peanut butter to snack on from time to time, or dry GF Chex cereal. Sorry....I digress! Back to the NSAID's: earlier in 2010 I had carpal tunnel surgery and took a lot of naproxen, then developed the TMJ and was put on etodolac. I remember hearing about stomach bleeding being a concern but it never dawned on me that the symptoms of MC could be caused by NSAID's. But one thing it taught me is to be very careful and cautious about taking any meds. Thanks for the ongoing medical education on this wonderful site!
Katie
Hi Katie,
I also had serious problems with TMJ back when I was reacting, but I was lucky, apparently, because my TMJ completely disappeared after I changed my diet, and so far, it has never returned.
You're most welcome,
Tex
I also had serious problems with TMJ back when I was reacting, but I was lucky, apparently, because my TMJ completely disappeared after I changed my diet, and so far, it has never returned.
You're most welcome,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Katie,
You might try almond butter instead of peanut butter, just in case you react to soy (as peanuts are legumes, and some people soy-intolerant people are also sensitive to other beans/legumes). Some of the Nut Thins flavor also contain soy, and some also contain dairy. (You can make your own nut crackers, or you might try rice crackers - Edward & Sons is one brand.)
Good luck,
Sara
You might try almond butter instead of peanut butter, just in case you react to soy (as peanuts are legumes, and some people soy-intolerant people are also sensitive to other beans/legumes). Some of the Nut Thins flavor also contain soy, and some also contain dairy. (You can make your own nut crackers, or you might try rice crackers - Edward & Sons is one brand.)
Good luck,
Sara