At the Crossroads Making a Decision

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JLH
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Post by JLH »

That's what I was wondering, Polly.
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Joan
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Post by ant »

I agree,

That research looks good. How many people know about it I wonder?

Best, ant
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Post by Joefnh »

Thanks to Tex, Gloria, Ant, Polly, Joan, Zizzle, JoAnn, Linda and Memory and the others who contacted me on email, PM and facebook.

This has been a great response. First thanks again for the heartfelt responses and all of the incredible information. It does look like some of the options discussed here are steroids, TNF drugs, Acupuncture, supplements and this intriguing diet.

I thought that the paleo diet was a tough one :shock: But in the end if this diet works, I will certainly look into it.

Thanks again everybody for all the responses and good thoughts. This certainly adds to what I need to research this week and really does sound hopeful.

Polly my Vitamin D level last November was 2 yes two..., after 3 months taking 50k IU / week it went up to 38 (ng/nl units??) I have been taking 3k IU / day this summer and will have it measured again this month

I am certainly thankful for all the notes and welcome any additional thoughts or comments

--Joe
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tex
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Post by tex »

Polly wrote:My main question - the article date is 1984, so why hasn't this become more widely accepted during the ensuing 26 years?
Polly,

The date of that article caught my eye, also, but I just assumed that the answer to your question was basically the same reason why Dr. Fine's research has been largely ignored for the last 10 or 15 years - dietary treatments are simply off the radar of most GI docs. Their ties with the pharmaceutical industry are so strong that they are simply not interested in even considering diet as a treatment option. Apparently, as a group, they would rather see their patients continue to suffer, than to cave in and recommend a treatment regimen based strictly on diet control.

The only dietary treatment of any significance, to date, (the treatment of celiac disease), bothers them so much that they are working frantically to close that "loophole", by the development of all sorts of medical treatments involving either pills, vaccines, or desensitization treatments, so that once again, the pharmaceutical industry will totally dominate all disease treatment programs. I remain convinced that "the powers that be" are dead set on stamping out any and all forms of disease treatment based on diet changes, (that don't involve the use of prescription drugs).

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Tex
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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.
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Post by JLH »

Check out the web site of our "friends" at CCFA. Here's a link with some studies in the references.

http://www.ccfa.org/chapters/georgia/me ... 20Zhou.pdf
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Joan
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Post by Rosie »

My main question - the article date is 1984, so why hasn't this become more widely accepted during the ensuing 26 years? Of course, given what we know about the lack of info about MC and diet I guess it is not surprising.
Polly, I checked out PubMed, and there have been a number of studies over the years. But that makes it even more annoying that the importance of an enteral nutrition diet hasn't made the mainstream! And it sure looks like the diet can have a very significant effect on Crohn's Disease

Joe, here is a recent (2010) review article in which the entire text, not just the abstract, is available. The list of references will be a useful source of information for an inquiring mind like yours. It sure looks like diet is an important component of achieving and maintaing remission in Crohn's. I wonder if it will be similar to the way MC works for many of us.......a combination of food and diet.
http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed
Role of diet in the management of inflammatory bowel disease
Nirooshun Rajendran and Devinder Kumar 2010
Polly wrote:
I would opt for this treatment first, assuming that it is effective for jejunal Crohn's.
According to the review article, the diet seems to be more effective for small intestine Crohn's than for large intestine involvement, so that's good!
Esaki et al[31] have demonstrated in a trial of 145 patients with CD (mostly induced into remission with TPN) that, under maintenance with elemental/polymeric nutrition, the risk of recurrence was lower in those with small bowel rather than large bowel involvement.
How exciting! But darn it all, the enteral nutrition diet means giving up regular foods. Of course the hope is that the diet, or a combination of the diet and steroids, will bring about a remission that can be maintained with a less restricted diet. But the alternative is even grimmer.........

Rosie
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time………Thomas Edison
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Post by Gayle »

Well Joe, this certainly was not the report you were hoping for. On the other hand, knowing that the Entocort/diet approach has done nothing to deter the progression of the Crohns is well worth knowing at this point. (Information is power)

The questions to be discussed with the Physicians now revolve around options, --- what approach seems the best for limiting the progressive intestinal damage done by the Crohns disease, and why? What must be factored in is that once those tissues are Crohns damaged, the next level of drugs (Imuran and then Remicade) do not repair the damage, but can only hope to slow further disease destruction of more tissue.

I have a friend, -- for 33 years she was my next door neighbor, -- who has dealt with Crohns disease for most of the years we have known each other (and commiserated over the fence, or over tea/lunch). There has been a lot of ‘down’ time for her. In the long course of her disease she has had to have a section of small bowel resected. She was finally started on Imuran about 4 years ago. As a result, she has done, and felt, so much better with that drug, compared to all the other approaches (mostly steroids) over all those years. Because of the Imuran, she has even been able to travel Internationally with the DH, who’s job takes him to interesting foreign places. She wishes it (the Imuran) could have been offered to her sooner. Yes, the Imuran approach has potential downside and requires more monitoring. But I wanted you to hear that everyone’s experience with Imuran is NOT altogether bad. And yes, I realize that her story reflects only a 4 year history of treatment with Imuran.

Imuran is a chemically structured drug so not a biologic in the true sense of the word -- it is yet another immunosuppressive drug. The biologic ‘immune modifiers’ such as Remicade and Humira are different, and interesting. They are derived from living organisms.

The DH at this house has MS, and has been on one of the MS “biologic immune modifiers” for several years. Again, yes, there are some issues, but the long and short of it is that the exacerbation’s have been few, less acute and further between, and the progression of the MS has been markedly slowed. He continues to be ambulatory long after folks who were untreated are confined to scooters, chairs ---- or worse. And yes, MS is another one of those conditions in which everyone is different (sound familiar?)

The higher level drug approaches come with risks ---- but also with potential for reward. I believe this is the reason that Imuran is not often seen suggested in the management of MC. Simply put - the 5ASA’s, Entocort, and diet, -- or a combination -- are by and large, very adequate to manage MC.

While the news was not good for you, this also allows you time, and an early opportunity to begin to think about, and evaluate, various options in an attempt to put the brakes on the Crohns Disease – options which my friend didn’t have 30, or 20, or even 10 years ago.

You have said here that Acupuncture treatments have helped you to feel better. Do consider continuing that while trying to figure your way through what the next step in managing the Crohns will be. Taking a multi-disciplinary approach to all our health issues – can only be a good thing.

And do make sure that your doggie understands that it is her Most Important Job to take you for a walk every day.

Best,
Gayle

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Post by tex »

Joe,

IMO, (and remember, I'm not a medical professional), you need to be taking at least 5,000 to 7,000 IU of vitamin D3 daily, because of your somewhat serious situation. I use the term "serious", rather than "critical", because your Crohn's disease is still at a stage where you hopefully do not yet have any stenoses, fistulas, etc. Obviously, as Polly suggested, it certainly behooves you to do whatever you can, (on a practical level), to prevent the disease from progressing to that level, because once it progresses to that stage, the damage is irreversible. Most of the damage done during the inflammation stage, (where you are now), should be reversible, I would think. 7,000 IU of vitamin D3 per day is the equivalent of 50,000 IU per week, of course, which is the dose that doctors typically use for someone who is vitamin D deficient. At 38 ng/mL, you are no longer deficient, but someone with your issues needs a 25(OH)D level at, or above, the top of the "normal recommended range", (using the new standards, not the obsolete ones), in order to optimize the capabilities of their immune system, so that it can function at it's best.

Again, I'm not a doctor, but there is no doubt in my mind that your incredibly low vitamin D level is clearly the reason why you have Crohn's disease, and it's also probably the reason why you have MC. If a severe vitamin D deficiency caused the onset of the disease, then that suggests to me that vitamin D might also be the key, (IOW, a vital component), of your requirements for achieving remission.

Tex
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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.
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Post by Joefnh »

You know there are times on this forum when you ask a question and its like drinking from a fire hose :grin: (in a good way) I have to say thanks to everyone once again for the ongoing information. I have spent the best part of today doing my weekly paleo cook-up, and researching Crohns websites and looking at the articles that have been posted in this thread.

Though Crohns is not even 'technically' covered by this boards topics, I feel like I am getting a crash course in the subject, which is great because yes 'Information is power'

In thinking about the liquid diet mentioned, the one question I keep coming back to is how to monitor it's success? While I absolutely agree that diet always trumps any meds, I am concerned that I could start this AMA (against medical advice) and have no way of knowing if I am making progress, and could be during that time allowing for additional damage to accumulate. I just do not have a feel for the time-frame of treatment with this disease.

With MC I would not mind at all as the MC does not appear have a permanently damaging mechanism, in that it allows us to experiment and test different treatments with little physical risk (I think).

I do believe no matter what path I choose to follow, I will be looking at this as a whole body - holistic approach. Meaning that I will still pursue diet which just makes sense. The goal should be to stop ingesting what irritates our systems, not try to take a pill to keep embarking on our bad dietary habits. So certainly the time in testing the diet was well worth it and should be continued.

In combination with diet the taking of supplements needs to be part of the plan, including as Tex has pointed out vitamin D and its importance in IBD and many other diseases. Tex & Polly, I will be getting my D level checked again in a couple of weeks. The acupuncturist I see is also a licensed nutritionist and seems very knowledgeable in this area, I plan on working with her to continue to take the right balance of supplements.

I guess what I am trying to say is that I plan on using all tools at my disposal to include conventional medicine, alternative treatments and nutrition to attack this problem. I believe where many people get into trouble is when they just want to take a pill and not address their lifestyles or diets.

The acupuncture has more than surprised me, as little as a year ago I would have written that off as a bit of 'hocus pocus', but certainly a member on this board has opened my eyes to a very beneficial treatment (thanks Gabes). Finally simple exercise which we all know the importance of.

Gayle Nestle certainly knows how to tell me when she wants to go out and play or go for a walk, she will often drops a ball in my lap when it's time to go play catch or stand by the door and 'talk to me' until we go for a walk. This is different than when its time for her to do her 'business', we live in the woods, so I can just let her go out back to her area for that. Walk time is different and a very serious subject for her :dogrun:

Thanks again for all the comments and excellent information, it really has helped me feel that I can deal with this in a positive way. I guess I am not really between a 'rock and a hard place' after-all, just at a crossroads.... That's not so bad, it's just an issue of going left, right or straight ahead.


--Joe
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Post by Polly »

Hi again Joe,

I love your change to the word "crossroads", which seems to put a more positive spin on the issue, as well as to allow for more choice. This positivity should definitely help you along the path to healing. :thumbsup:

I've been thinking all day about how to monitor success with regard to trying the elemental diet. Here's what I think I would do if I were in your shoes. First, I would make a copy of Joan's (and others' articles) to take to your next doc visit. Since your doc seems disinclined to prescribe steroids over a long period of time (and good for him!) discuss your interest in this diet with him - especially the fact that it is as good as (or even preferable to) steroid treatment. Then, ask him if he would be willing to support you in a trial of the elemental diet for 4 weeks (or maybe 8 weeks at the most, although the article reported success in only 4 weeks). To determine outcome, ask him if it would be possible to do another camera test after the trial period. If he is reluctant to order it so soon after the last one, perhaps you could offer to pay for the repeat test out-of-pocket - YIKES - I have no idea what it costs, but perhaps it wouldn't be too costly. This way you would know for sure the outcome of diet, and I don't believe that 4-8 weeks would be too dangerous with regard to the progression of the Crohn's. No way to know this for sure, of course, but if the diet really does work, then you should actually be improving. I am assuming that your Crohn's progressed 25% in 4 mo. (is that correct?), so a one or two mo. trial seems reasonable. Of course, you may need to sign a disclaimer, an AMA statement, but who cares if you are getting what you want? Perhaps you can appeal to his scientific curiosity by requesting him to join you in a specially-designed experiment.

Just my 2 cents worth............

Love and a :bigbighug:

Polly

P.S. How about some more Nestle photos? I am missing my boy so much and would love to see more of her.
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Post by Joefnh »

Polly thanks for thinking of this and your inputs. I was going to bring the documents with me as well as any additional research that I might dig up. As far as costs go, I wouldn't mind paying for another pill cam dpending on what $$ are involved. My guess the doc might not mind, but even with pretty good PPO insurance, they can be fussy about paying for they type of test 8 weeks apart.

Beyond that you are right this diet really is worth pursuing. From what I can tell, it would be about $225.00 a week but certainly avoiding the big gun medications makes it worth the costs.

I can certainly post some more photos of 'Nurse' Nestle. She does love the camera and knows when shes getting that type of attention. She just finished here now weekly lamb shank bone and is sound asleep at the foot of the bed having some fun dream or another. Her paws are twitching and she is barking in her sleep.

Thanks again Polly for all of your great advice. This has been a bit of a roller coaster weekend emotionally and yours and the other help on this site has been incredible.

Take Care

--Joe
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tex
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Post by tex »

Polly and Joe,

That plan sounds good to me, too. There's also a chance that the GI doc might be able to suggest additional ways to measure your progress, that he would support, especially if he is interested in the research aspect.

Tex
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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.
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Post by Bifcus16 »

Hi Joe,

Everyone seems to have come up with some really good ideas here. If your doc will support you to do a trial of the diet that would be brilliant. He could justify the rapid retest that you had such rapid changes over the past four months that he needed to confirm the results - or make some other change (like your entocort dosage) and tell them he wants to see if it has worked before prescribing the big drugs. The extra Vit D sounds like a good idea too.

The other bit that caught my eye was Tex' comments about MAP infections. These are a real possibility. Antibiotics don't make me happy though. I am just starting a second round myself, for a cold and all the warnings to look out for C Diff (though they don't name it as such) and fungals is a bit of a worry. I hate to think what a dose of C Diff would do to you. There are other options - though if you find acupuncture a stretch, things like homeopathics or energy meds are probably a step too far at this point. Maybe discuss the infection option with the doc anyway, and see what he says.

And don't forget if you spend all that money on the ent diet, you don't have to buy normal food as well, so there is some cost offset.

Do hope you come up with an approach you like, and are able to convince the doc to support you. He sounds willing to consider things at least.


Lyn
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Post by Linda in BC »

Joan, from what she says in her video on how to mix it, yes, it is used for children (with a straw.) My take on this re: snake oil?, from what I have read , is that the treatment (Elemental diet therapy) is legitimate and has been around for a long time for Crohn's. And IMO her product info indicates a well researched, high quality product, but I am sure there are many others on the market, available with or without a prescription. My only concern about this product is an issue that arose about about shipping costs with the company that retails the product. I was going to order a sample package of three flavours form them, but they were going to add the shipping costs to my credit card after I ordered, so have held off. I have emailed for a quote on shipping. I like to know what is going on my credit card BEFORE I order!
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Post by JLH »

OK, good, thanks.

I certainly don't blame you for wanting to know the shipping cost, too.
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