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Cytokine plays dual role in regulating IBD

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February 16, 2016
Original article on Science Today
Source:
Georgia State University
Summary:
Small proteins that affect communication between cells play an important role in regulating inflammation that occurs during inflammatory bowel disease, according to researchers.
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Small proteins that affect communication between cells play an important role in regulating inflammation that occurs during inflammatory bowel disease, according to researchers at Georgia State University, Emory University, the University of Michigan and Amgen, a biotechnology company.

The researchers compared immune cells in mice with and without intestinal inflammation and identified a new factor, a cytokine called IL-36, that is expressed in the inflamed intestine of mice. They explored the role of this cytokine to determine if it’s promoting disease, helping to protect against disease or simply associated with the disease. The findings are published inThe Journal of Immunology.

“What we found was quite striking,” said Tim Denning, lead author of the study and associate professor in the Institute for Biomedical Sciences at Georgia State. “If we block the effects of this cytokine, IL-36, in a mouse model of intestinal inflammation, the mice were better and had less disease early on, which suggested that this was a pro-inflammatory cytokine. However, when we assessed the ability of mice deficient in the receptor for IL-36 to heal, which is a vital part of resolving intestinal inflammation, they were completely unable to do so. The study highlights the important role of IL-36, not only in driving some of the inflammatory process, but also in helping to resolve the inflammation.”

Inflammatory bowel disease (IBD), chronic inflammation of all or part of the digestive tract, affects about 1.5 million Americans. The two main types, Crohn’s disease and ulcerative colitis, develop from uncontrolled inflammation in the intestine, which leads to severe diarrhea, pain, fatigue, weight loss and even death.

There are trillions of helpful bacteria inside human intestines, and the immune system is trained not to react aggressively. However, in people with IBD, the immune system doesn’t tolerate these bacteria and instead fights against them.

In this study, the researchers investigated the factors that may be regulating the immune system’s balance between tolerating these bacteria and reacting aggressively against them. They discovered the dual role of IL-36 in both promoting intestinal inflammation and resolving or healing that inflammation. The findings highlight the significance of understanding the timing and phase of disease, Denning said.

“Treatments that block certain factors, regardless of knowing the role it may be playing at a certain stage of disease, could lead to a poor outcome and may be the reason some clinical trials fail,” Denning said. “It is key to understand what phase of disease patients are in, what cytokines are expressed and the appropriate therapeutic targets during these distinct phases. Oftentimes, blocking a factor is not universally beneficial. Immune responses and inflammation, which are often viewed as deleterious, can be both good and bad depending on the context.”

For instance, blocking IL-36 may be beneficial in certain phases of the disease, but eliminating this factor could also make the body unable to recruit and activate cells necessary for healing and resolution of the disease. Therefore, it’s important to understand the pathways IL-36 affects because this cytokine could be valuable in other stages of the disease, he said.

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The above post is reprinted from materials provided by Georgia State University. Note: Materials may be edited for content and length.

A diet of worms to help IBD?

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Original article on The Gaurdian

For hundreds of thousands of years, worms have been infecting humans, burrowing into our bodies, setting up shop in our organs and generally making themselves at home. Until about 150 years ago, nearly everyone who ever lived was probably infected with some parasitic worm or other. Worms can cause intestinal problems, anaemia and, depending on the species, more severe problems, including seizures and paralysis. But, with modern sanitation, we have eradicated them from many parts of the world – a great public health success.

However, growing numbers of scientists have begun to argue that the loss of these parasites, known as helminths, has led to a spike in a range of illnesses, including autoimmune diseases, allergies and asthma, and even depression and other mental health problems. They say that worms, or drugs developed from them, could be potent treatments for these ailments, superior to current approaches, and with fewer side-effects.

“Our bodies, especially our immune systems, have evolved to expect input from these creatures,” says University of Iowa immunologist David Elliott, who has studied helminths for more than a decade. “Without this feedback, the immune system can get badly off track.”

Some immunologists claim our immune systems have evolved to expect input from parasites.

The first study of helminths as a treatment was 40 years ago, when JA Turton, a parasitologist in Surrey, dosed himself with hookworm and found that his chronic hay fever disappeared. In the past decade, helminth research has expanded significantly; so far, it has largely involved animal studies, which have mostly found positive results. “I can give a mouse multiple sclerosis, rheumatoid arthritis or colitis, and when I give it worms, the disease goes away,” says Elliott. “Can we do that in humans too? I don’t see why not.”

There have been just a handful of human studies: perhaps the most well-known is by Joel Weinstock, a gastroenterologist at Tufts University in Massachusetts, which examined the effect of worms on patients with inflammatory bowel disease. Almost 75% of those who ingested the worms were cured, especially noteworthy given that they had not been helped by more traditional treatments. But research with human subjects is difficult, largely because of regulatory obstacles; many worms are considered hazardous pathogens.

 

It is not clear exactly how helminths help their human hosts. They appear to have developed molecular strategies to hack into our immune system, reining in its response to alien cells. In allergy, asthma, autoimmune diseases, and probably many other illnesses as well, this inflammatory response is excessive, and ends up damaging the body. It makes sense that helminths would have found ways to calibrate our immunity; as long-term parasites, their survival depends on neutralising the host’s defences. “They can live in our bodies, and we can stay healthy and they can stay healthy,”’ says Weinstock.

He is among a group of researchers who are focusing on finding the particular molecules that allow worms to manipulate us. The aim is to develop these molecules – or analogues of them – into medicines. “By understanding what the worms do, we may be able to develop magic bullets,” he says. This approach has advantages over using the worms themselves: dosing would be more controlled, and patients wouldn’t be disgusted.

Others are sceptical, arguing that helminths are extremely complex and probably use multiple mechanisms to nullify our defences. “It’s hard to recreate complex biological interactions,” says William Parker, an immunologist at Duke University in North Carolina. “These organisms are their own living drug-delivery systems. They have so many effects on their hosts.”

The arrival of worms-in-a-pill, if it happens at all, is probably years away. But a handful of companies already offer live worms to consumers. Judy Chinitz and Marc Dellerba started their helminth supply company, Biome Restoration, in the UK three years ago, and have more than 1,200 regular customers. They ship microscopic larvae – which grow into worms after being swallowed – all over the world. Dellerba, who has a PhD in chemistry, oversees a rigorous manufacturing process.

Biome Restoration worked with the Medicines and Healthcare Products Regulatory Agency, which permits the company to sell the organism as a non-pharmaceutical product. But much of this commerce exists in a legal grey area, because many health regulatory agencies, including those in the UK and the US, deem most helminths to be pathogens that cannot be transported.

Some people are now taking the DIY route, raising helminths themselves. Parker estimates that 7,000 or so people worldwide have used worms as medicine in the past few years. There are several vibrant online communities where devotees discuss the best worm-raising regimens and the most effective dosing strategies.

One key question: which worm works best, for which ailment? Researchers, suppliers and consumers have identified a few promising species that fit the key conditions: they don’t cause serious health problems, don’t reproduce in humans, can’t spread from person to person, don’t migrate within the body, and can be eradicated with anti-worm medicines. Almost all of those who use worms ingest one of four different species: rat tapeworm, pig whipworm, human whipworm, or human hookworm.

Parker and his researchers have gathered data from hundreds of users and growers. “I’m convinced,” he says. “Based on the evidence I’ve seen, it is very effective,” he says. “It has a really good benefit-to-risk ratio, especially for serious autoimmune diseases such as multiple sclerosis and inflammatory bowel disorder.”

Not surprisingly, though, some scientists are suspicious of the current use of helminths, calling it unscientific, premature and possibly risky. Parker, too, recognises that more research is necessary: “It’s a slow process, but I think it’s inevitable that it will significantly change how we treat these diseases.”

Meditation may relieve IBD

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Original article on Harvard Gazzette

A pilot study has found that participating in a nine-week training program including elicitation of the relaxation response had a significant impact on clinical symptoms of the gastrointestinal disorders irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) and on the expression of genes related to inflammation and the body’s response to stress.

The report from investigators at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital (MGH) and at Beth Israel Deaconess Medical Center (BIDMC), both Harvard affiliates, is the first to study the use of the relaxation response in these disorders and the first to investigate the genomic effects of the relaxation response in individuals with any disorder. The report was published in the open-access journal PLOS ONE.

“Our results suggest exciting possibilities for further developing and implementing this treatment in a wider group of patients with gastrointestinal illness,” said Braden Kuo of the gastrointestinal unit in the MGH Department of Medicine, co-lead author of the report.

“Several studies have found that stress management techniques and other psychological interventions can help patients with IBS, at least in the short term; and while the evidence for IBD is less apparent, some studies have suggested potential benefits. What is novel about our study is demonstration of the impact of a mind/body intervention on the genes controlling inflammatory factors that are known to play a major role in IBD and possibly in IBS,” said Kuo, who is also a Harvard Medical School assistant professor of medicine.

Both IBS and IBD are chronic conditions that produce related symptoms, including abdominal pain and changes in bowel function such as diarrhea. But while IBD — which includes Crohn’s disease and ulcerative colitis — is characterized by severe inflammation in all or part of the gastrointestinal tract, no inflammation or visible abnormality is present in IBS. Stress appears to exacerbate both conditions, and since the symptoms themselves can increase stress in patients, finding ways to break that vicious cycle could have significant clinical benefits.

The relaxation response — a physiologic state of deep rest induced by practices such as meditation, yoga, and prayer — was first described more than 40 years ago by Herbert Benson, director emeritus of the Benson-Henry Institute and a co-author of the current paper. Many studies have shown that regular practice of the relaxation response not only alleviates stress and anxiety but also directly affects physiologic factors such as blood pressure, heart rate, and oxygen consumption. In reports published in 2008 and 2013, Benson, along with Towia Libermann and Manoj Bhasin — both of the BIDMC Genomics, Proteomics, Bioinformatics and Systems Biology Center — described how elicitation of the relaxation response in healthy individuals affected the expression of genes in pathways involved with the body’s response to stress, inflammation, and energy metabolism. Libermann is co-senior author and Bhasin is co-lead author of the current study.

The current study was designed to investigate whether a relaxation-response-based intervention could improve the quality of life in patients with IBS or IBD and to analyze the intervention’s effects on inflammatory markers and gene expression. The study enrolled 48 adult participants — 19 of whom had been diagnosed with IBS and 29 with IBD — who participated in a nine-week group program focused on stress reduction, cognitive skills, and health-enhancing behaviors. Each of the weekly sessions included relaxation response training, and participants were asked to practice relaxation response elicitation at home for 15 to 20 minutes each day. Along with aspects featured in other group programs offered at the Benson-Henry Institute, this program included a session specifically focused on gastrointestinal health.

Study participants were assessed at the outset, midway through, and at the end of the program, and then three weeks later. The assessments used standardized tools for measuring symptoms common to both disorders, assessing anxiety and pain, and determining the effects of the disorders on participants’ quality of life. Blood samples were taken at baseline and a week after the study period’s conclusion for purposes of profiling gene expression and measuring known inflammatory factors.

Both in patients with IBS and those with IBD, participation in the mind/body program appeared to have significantly improved disease-related symptoms, anxiety, and overall quality of life, not only at the end of the study period but also three weeks later. While there were no significant changes in inflammatory markers for either group of participants, changes in expression were observed in almost 200 genes among participants with IBS and more than 1,000 genes in those with IBD. Many of the genes with altered expression are known to contribute to pathways involved with stress response and inflammation.

“In both IBS and IBD, the pathway controlled by a protein called NF-κB emerged as one of those most significantly affected by the relaxation response, which confirms the findings of our previous genomic studies,” said Libermann. “Indeed the relaxation response reduced the expression of a number of genes directly linked to the key inflammatory processes of IBD. While the mechanisms behind IBS are less well-defined, they most likely involve stress response, which also could be improved by relaxation response practice.”

Co-senior author John Denninger of the Benson-Henry Institute at MGH noted, “One interesting clinical impact was a decrease in both IBS and IBD patients in what is called pain catastrophizing — a negative cognitive and emotional response to pain or the anticipation of pain. In other words, participants became more resilient in the face of the pain they were experiencing. But before we can offer a program like this to patients with these disorders, we’ll need to conduct a longer, randomized trial with a control group and enough participants for statistically significant results.”

Vitamin D & IBD

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Original article on Vitamin D Council

Summary

Inflammatory bowel disease is a chronic disease that causes inflammation in all or part of the digestive tract. The two main types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis, which affect different parts of the digestive tract.

The cause of inflammatory bowel disease is not fully understood, but scientists think it is a combination of genetics, the environment, and your immune system.

Many studies have shown that there is a link between vitamin D and inflammatory bowel disease. People with inflammatory bowel disease are more likely to have low levels of vitamin D. In inflammatory bowel disease, vitamin D may help the immune system to reduce levels of inflammatory proteins that get overproduced.

Although inflammatory bowel disease is not curable, there are ways to manage the symptoms and keep the disease in remission. Having high vitamin D levels may be a way to help manage inflammatory bowel disease, as well as to reduce complications related to the disease, such as hospitalizations, surgeries, infections, and colon cancer.

More experiments need to be done to determine just how effective vitamin D might be for inflammatory bowel disease, if at all.  Research hasn’t been able to show yet that low vitamin D levels cause inflammatory bowel disease. Doctors don’t know yet whether taking a vitamin D supplement, or getting more sun exposure, can help to prevent inflammatory bowel disease.

If you have inflammatory bowel disease and want to take vitamin D, it is unlikely to make your IBD worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to treat your inflammatory bowel disease.

If you have inflammatory bowel disease, you shouldn’t take vitamin D in place of your treatment medications. Talk to your physician for more advice about taking supplements.

What is inflammatory bowel disease?

Inflammatory bowel disease, or IBD, is a chronic or recurring disease that causes inflammation in all or part of the digestive tract. There are different types of IBD. The main types are Crohn’s disease and ulcerative colitis.

Ulcerative colitis only causes inflammation in your colon (large intestine) or rectum, while Crohn’s disease can happen anywhere along your digestive tract. Crohn’s disease can also spread deep into the tissues of your digestive tract. Crohn’s disease is usually more severe and causes symptoms more frequently than ulcerative colitis.

It is common for people with IBD to have periods of flares, which is when you have worse symptoms, and periods of remission, when the symptoms are better or not there at all. When IBD symptoms are flaring up, the disease is called “active”1.

What are the symptoms of inflammatory bowel disease?

The symptoms for IBD vary by person, depending on where their inflammation is and how severe it is.  In general, symptoms for both Crohn’s disease and ulcerative colitis include1,2:

  • Diarrhea
  • Cramps and abdominal pain
  • Rectal bleeding or bloody stool
  • Fatigue
  • Bloating
  • Skin, joint, or eye inflammation

Some people who have severe cases also experience a loss of appetite, weight loss, and malnutrition from not getting enough nutrients. Ulcerative colitis symptoms usually come on gradually, whereas Crohn’s disease symptoms may come on suddenly.

People with Crohn’s disease are also more likely to get small sores or ulcers on the surface of their digestive tract. Sometimes these ulcers can become large and can occur inside the walls of the intestine.

How common is inflammatory bowel disease?

It is estimated that 1.4 million people in the United States have some form of IBD. Most people develop it between the age of 15 and 30, but it can occur at any age. There are some things that can increase your chances for developing IBD, including1,2:

  • Gender. Ulcerative colitis is more common in men, while Crohn’s disease is more common in women.
  • Ethnicity. IBD is more common in Caucasian and Ashkenazi Jewish people.
  • Family history. You have a higher risk of developing IBD if your parent or sibling has it.
  • Smoking.

What causes inflammatory bowel disease?

It is not fully understood what causes IBD or how it develops. Researchers think that IBD is caused by a combination of genetics, the environment, and your immune system.

It is not fully understood what causes IBD or how it develops. Researchers think that IBD is caused by a combination of genetics, the environment, and your immune system.

It is not fully understood what causes IBD or how it develops. Researchers think that IBD is caused by a combination of genetics, the environment, and your immune system.  Some researchers think that an invading germ in your digestive tract causes your body to become overly inflamed when your immune system is trying to fight it off.

There are things in the environment that might affect the chance of developing IBD, such as where you live, if you smoke, and your diet. People who live in urban areas, industrialized countries, or northern latitudes are more likely to have IBD3,4.

Other researchers think that it is an autoimmune disease, which means that your immune system has a hard time telling the difference between your own healthy cells and foreign things like germs, bacteria, or viruses. This causes your body to attack your healthy tissue, which can cause inflammation and pain.

Overall, there is some combination of genetics, the environment, and your immune system that causes IBD to develop1,2,5.

What is the link between vitamin D and inflammatory bowel disease?

Many studies have shown that there is a link between vitamin D and IBD. People with IBD are more likely to have low levels of vitamin D. Some researchers think that low vitamin D levels may be a consequence of having IBD because the symptoms may cause you to stay indoors more and eat less.

However, studies have found that even people who are newly diagnosed with IBD tend to have low vitamin D levels. This means that low vitamin D levels may be a risk factor for developing IBD3.

Vitamin D receptors are found on the surface of a cell where they receive chemical signals. By attaching themselves to a receptor, these chemical signals direct a cell to do something, for example, to act in a certain way, or to divide or die. There are vitamin D receptors found on cells in the digestive tract and the immune system, and vitamin D can bind to these receptors.

In IBD, vitamin D works in the immune system by reducing levels of inflammatory proteins that get overproduced. One of the proteins that vitamin D can lower is called tumor-necrosis factor, or TNF.  One of the medications to manage IBD involves blocking TNF production. Therefore, researchers think that vitamin D may be a natural way to block TNF and help reduce inflammation in the digestive tract4,6.

While it is thought that there is a link between low vitamin D levels and IBD, more experiments need to be done to figure out whether or not taking vitamin D supplements can help to prevent or manage IBD.

What does the research say in general about vitamin D and inflammatory bowel disease?

Preventing inflammatory bowel disease

Not many studies have been done about preventing IBD. However, it has been shown that there is a difference in the risk of developing IBD based on where you live and the amount of sun exposure you get.

People who live in northern latitudes with less sunlight have an increased chance of developing IBD. Vitamin D is made in the skin from sunlight, so researchers think that low vitamin D levels may be a factor that increases IBD risk in these populations7.

Managing inflammatory bowel disease

Having high vitamin D levels may be a way to help manage IBD, as well as reduce complications related to IBD, such as hospitalizations, surgeries, infections, and colon cancer.

Having high vitamin D levels may be a way to help manage IBD, as well as reduce complications related to IBD, such as hospitalizations, surgeries, infections, and colon cancer.

Although IBD is not curable, there are ways to manage the symptoms and keep the disease in remission. Having high vitamin D levels may be a way to help manage IBD, as well as reduce complications related to IBD, such as hospitalizations, surgeries, infections, and colon cancer8. However, it is not known for sure yet that vitamin D can help to prevent these outcomes.

Some studies have found that people with IBD who have higher vitamin D levels tend to have lower disease activity, meaning their symptoms are less severe or they are in remission more9,10.

People with IBD are more likely to have low bone density, which increases the risk for osteoporosis and fractures. People with IBD tend to have lower bone density for different reasons, including long-term use of steroid medications, low nutrient intakes, and changes in bone formation from too much inflammation. Since vitamin D helps to strengthen bones, researchers think that low vitamin D levels may be one of the reasons why people with IBD tend to have low bone density11.

Although many studies have shown a link between low vitamin D levels and increased IBD severity and complications, most of the research has been observational, meaning that we can’t say for sure whether or not vitamin D can help to manage IBD.

What does the recent research say about vitamin D and inflammatory bowel disease?

An experiment published in 2013 looked at a small group of 18 adults in the United States with mild or moderate Crohn’s disease. All of the patients started with taking 1,000 IU of vitamin D every day for 2 weeks, and then they increased the dose every 2 weeks until it reached 5,000 IU per day. The total treatment time was 24 weeks. The researchers looked at their vitamin D levels, quality of life, and disease activity score throughout the study. They found that12:

  • Vitamin D levels increased greatly after 24 weeks. The people who started with the lowest vitamin D levels saw the biggest improvement.
  • All but 1 person had lower disease activity scores and higher quality of life after treatment.
  • Sixty-seven percent of the people went into remission.

The researchers conclude that 5,000 IU per day of vitamin D may help to lower disease activity and improve quality of life in people with Crohn’s disease, but more experiments need to be done to say for sure.

A 2010 experiment from Denmark looked at adults who were in remission from Crohn’s disease. The researchers gave them either 1,200 IU of vitamin D plus 1,200 mg calcium every day or a dummy pill and calcium. After one year, the researchers found that13:

  • People in the vitamin D group had fewer relapses into active Crohn’s disease compared to people in the dummy pill group.

The researchers conclude that vitamin D might help to keep people in remission from Crohn’s disease.

A study published in 2013 in the United States recruited a large group of people with IBD and looked at their vitamin D levels and various outcomes related to IBD. The researchers found that8,14:

  • People who had low levels of vitamin D were more likely to be hospitalized or have surgery related to IBD, compared to people with high levels of vitamin D.
  • People who had low levels of vitamin D were more likely to get cancer than people with higher levels.
  • For every 1 ng/mL increase in vitamin D levels, there was a 6% decrease in risk of colorectal cancer.

Negative outcomes like surgeries, hospitalization, and colon cancer are common for people with IBD. The researchers conclude that having higher levels of vitamin D may help to protect against these outcomes.

A study in 2013 in the United States looked at people with IBD who were on a specific treatment medication. The researchers wanted to know if vitamin D levels before treatment started would have an effect on how the treatment went. They found that15:

  • People who had low vitamin D levels before treatment started were 3 times more likely to stop treatment early compared to people with high vitamin D levels.
  • The people who stopped treatment early did so because they weren’t getting better or seeing a response.

The vitamin D status of people with IBD before starting treatment may affect how well someone responds to treatment. Having a high vitamin D level could make it more likely to see an improvement in symptoms once treatment is started.

Key points from the research

  • People who have IBD tend to have low levels of vitamin D.
  • In IBD, vitamin D may help the immune system in reducing levels of inflammatory proteins that get overproduced.
  • Having high vitamin D levels may be a way to help to manage IBD symptoms.
  • Vitamin D may help to reduce complications related to IBD, such as hospitalizations, surgeries, infections, and colon cancer.
  • Overall, more experiments need to be done to determine if taking vitamin D supplements can help to prevent or manage IBD.

What does this mean for me?

Research has shown that there is a link between vitamin D and IBD. People with IBD are more likely to have low levels of vitamin D and are more likely to experience worse outcomes, like hospitalizations, surgeries, more severe symptoms, and colon cancer.

Research shows that there is a link between vitamin D and IBD, but it is not known yet whether taking a vitamin D supplement, or getting more sun exposure, can help in prevention or management.

There is a link between vitamin D and IBD, but it is not known yet whether taking a vitamin D supplement, or getting more sun exposure, can help in prevention or management.

Some studies have shown that having high levels of vitamin D can help to lower the risk of these outcomes. However, more experiments need to be done to determine just how effective vitamin D might be for IBD, if at all.  Research hasn’t been able to show yet that low vitamin D levels cause IBD. Doctors don’t know yet whether taking a vitamin D supplement, or getting more sun exposure, can help to prevent IBD.

If you have IBD and want to take vitamin D, it is unlikely to make your IBD worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to treat your IBD.

If you have IBD, you shouldn’t take vitamin D in place of your treatment medications. Talk to your physician for more advice about taking supplements.

References

  1. Mayo Clinic. Inflammatory Bowel Disease (IBD). 2012. Web. Accessed at < http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/causes/con-20034908>.
  2. CDC. Inflammatory Bowel Disease (IBD). 2014. Web. Accessed at < http://www.cdc.gov/ibd/>.
  3. Ananthakrishnan AN. Environmental triggers for inflammatory bowel disease. Curr Gastroenterol Rep 2013;15(1):1-11.
  4. Cantorna  MT, McDaniel K, Bora S, et al. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease. Experimental Biology and Medicine 2014;0:1-7.
  5. WebMD. Inflammatory Bowel Disease. 2014. Web. Accessed at < http://www.webmd.com/ibd-crohns-disease/crohns-disease/inflammatory-bowel-syndrome>.
  6. Reich KM, Fedorak RN, Madsen K, et al. Vitamin D improves inflammatory bowel disease outcomes: basic science and clinical review. World Journal of Gastroenterology 2014;20(17):4934-47.
  7. Butcher RO & Limdi JK. Vitamin D status in inflammatory bowel disease: are clinicians seeing the light? Journal of Crohn’s and Colitis 2012;6:1039-1040.
  8. Ananthakrishnan AN, Cagan A, Gainer VS, et al. Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn’s disease. Inflamm Bowel Dis 2013;19:1921-27.
  9. Fu YN, Chatur N, Cheong-Lee C, et al. Hypovitaminosis D in adults with inflammatory bowel disease: potential role of ethnicity. Dig Dis Sci 2012;57:2144-48.
  10. Ham M, Longhi MS, Lahiff C, et al. Vitamin D levels in adults with Crohn’s disease are responsive to disease activity and treatment. Inflamm Bowel Dis 2014;20:856-860.
  11. Abraham BP, Prasad P & Malaty HM. Vitamin D deficiency and corticosteroid use are risk factors for low bone mineral density in inflammatory bowel disease patients. Dig Dis Sci 2014; doi:  10.1007/s10620-014-3102-x
  12. Yang L, Weaver V, Smith JP, et al. Therapeutic effect of vitamin D supplementation in a pilot study of Crohn’s patients. Clinical and Translational Gastroenterology 2013;4:1-8.
  13. Jorgensen SP, Agnholt J, Glerup H, et al. Clinical trial: vitamin D3 treatment in Crohn’s disease- a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 2010;32:377-383.
  14. Anathakrishnan AN, Cheng S, Cai T, et al. Association between reduced plasma 25-hydroxy vitamin D and increased risk of cancer in patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology 2014;12:821-827.
  15. Zatar ZA, Cantu SM, Konijeti GG, et al. Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor alpha therapy in inflammatory bowel diseases. JPEN 2014;38:385-392.

Mindfulness & IBD

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Original article on Science Daily

Training in meditation and other mindfulness-based techniques brings lasting improvements in mental health and quality of life for patients with inflammatory bowel diseases (IBD), according to a study in Inflammatory Bowel Diseases, official journal of the Crohn’s & Colitis Foundation of America (CCFA). The journal is published by Wolters Kluwer.

“Our study provides support for the feasibility, acceptability, and effectiveness of a tailored mindfulness-based group intervention for patients with IBD,” concludes the research report by Dr. David Castle, a psychiatrist at St. Vincent’s Hospital, Melbourne, Australia, and colleagues. More research is needed to demonstrate the clinical benefits of mindfulness techniques–including whether they can help to reduce IBD symptoms and relapses.

Mindfulness Reduces Anxiety and Depression in IBD Patients

The researchers evaluated a mindfulness-based stress reduction (MBSR) program tailored for patients with IBD. The study included 60 adults with IBD: Crohn’s disease or ulcerative colitis. The patients’ average age was 36 years, and average duration of IBD 11 years. Twenty-four patients had active disease at the time of the study.

The MBSR intervention consisted of eight weekly group sessions plus a daylong intensive session, led by an experienced instructor. The program included guided meditations, exercises designed to enhance mindfulness in daily life, and group discussions of challenges and experiences. Participants were also encouraged to perform daily “mindfulness meditation” at home.

Thirty-three patients agreed to participate in the MBSR intervention, 27 of whom completed the program. Ratings of mental health, quality of life, and mindfulness were compared to those of the 27 patients who chose not to participate (mainly because of travel time).

The MBSR participants had greater reductions in anxiety and depression scores, as well as improvement in physical and psychological quality of life. They also had higher scores on a questionnaire measuring various aspects of mindfulness–for example, awareness of inner and outer experiences.

Six months later, MBSR participants still had significant reduction in depression and improvement in quality of life, with a trend toward reduced anxiety. The patients were highly satisfied with the mindfulness intervention.

Anxiety, depression, and decreased quality of life are common in patients with IBD. Psychological distress may lead to increased IBD symptoms and play a role in triggering disease flare-ups. Previous studies have shown benefits of MBSR for patients with a wide range of physical illnesses, but there is limited evidence on mindfulness-based interventions for patients with IBD.

The new results show that the MBSR approach is feasible and well-accepted by patients with IBD. The study also suggests that training patients in mindfulness practices to follow in daily life can lead to significant and lasting benefits, including reduced psychological distress and improved quality of life. Dr. Castle comments, “This work reinforces the interaction between physical and mental aspects of functioning, and underscores the importance of addressing both aspects in all our patients.”

The researchers point out some important limitations of their study–including the fact that patients weren’t randomly assigned to MBSR and control groups. They also note that the study didn’t assess the impact on measures of disease activity, including IBD flares. Dr. Castle and colleagues conclude, “A larger adequately powered, randomised study with an active control arm is warranted to evaluate the effectiveness of a mindfulness group program for patients with IBD in a definitive manner.”

Turmeric & Crohn’s disease

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Original article posted on Turmeric for health

Along with ulcerative colitis, Crohn’s disease is also clubbed as an inflammatory bowel disease that causes inflammation of the intestines. Unlike ulcerative colitis that is found mostly in the colon and rectum, Crohn’s occurs in any part of the intestine. It could form in patches with healthy tissue surrounding it and thenspread deeper inside the tissues. People can suffer from fistulas, ulcers, anal fissure and malnutrition because of Crohn’s disease. Symptoms include watery or bloody diarrhea, fever, abdominal pain, loss of appetite and weight loss since the intestine does not absorb all the required nutrients.

There is no specific cause of Crohn’s disease although a faulty immune system usually triggers it. Genetics, consuming diets high in saturated fat and sugar and low in vegetables and fruits, cigarette smoking and people of European or Jewish descent are more vulnerable to contracting Crohn’s. There is no cure for Crohn’s, but it can be controlled and can go into remission with medication, surgery, better diet, alternative remedies etc.

Turmeric & Crohn’s Disease

Turmeric is said to have anti-inflammatory properties that can benefit those with Crohn’s. But as with most herbal / natural remedies further research is required to prove it with scientific rigor.

Inflammatory bowel disease (IBD) can be chronic and lead to cancer depending on how long the condition lasts. Since surgery and drugs rarely provide any cure, most doctors try to manage it with dietary therapy. This is especially effective in those suffering from Crohn’s disease. Curcumin has anti-cancer and anti-inflammatory properties and its effects were studied in those with IBD. Mucosal biopsies of those with Crohn’s were cultured and treated with curcumin. There were signs that curcumin suppressed inflammatory mediators in both adults and children, therefore offering hope for those with IBD like Crohn’s disease.

In a study of 207 suitable volunteers with symptoms of IBD, 1 or 2 standardized turmeric extract tablets were given daily for a total of 8 weeks. After this period, it was found that there was a significant improvement in symptoms in both 1 and 2 tablet groups. There was a reduction of 22% (1 tablet) and 25% (2 tablets) in pain and discomfort also. There was improvement in bowel pattern and 2/3rds of all subjects treated said their symptoms were better after treatment. This shows that turmeric could reduce symptoms of IBD like Crohn’s and more placebo-controlled studies are required.  Crohn's Disease and turmeric

In a study of 4-5 patients with Crohn’s, it was found that when given curcumin of 360mg, 3 times daily for a month and then 360mg, 4 times daily for 2 months, there was improvement in their condition. Patients are advised to refer to the instructions on the label when taking turmeric supplements for Crohn’s.

Turmeric has a volatile oil fraction that has anti-inflammatory benefits. This is even stronger in curcumin that is the main pharmacological agent of turmeric. Studies have found that curcumin’s anti-inflammatory benefits are on par with corticosteroids and phenylbutazone and other anti-inflammatory drugs. Since it does not produce side effects like reduced blood count, ulcers or intestinal bleeding like these drugs, it could be used as a safe alternative in treating IBD.

In a study on mice induced with colitis, it was found that they were protected when pre-treated with curcumin 5 days beforehand. What is more, the mice given curcumin lost less weight and there were reduced signs of colitis like thickened intestinal walls, mucosal ulcers and inflammatory cells in the intestines. Researchers think the benefits offered by curcumin could be because it inhibits NF kappa-B a cell inflammatory agent and also has antioxidant properties. Another great advantage is that those with IBD like Crohn’s need not take high doses of turmeric. Even small doses like 0.25% offer significant benefits. This amount can easily be got by including turmeric in our daily diets.

IBD is characterized by oxidative stress, presence of pro-inflammatory cytokines etc. In a study on mice, they were given 50mg / kg body weight of curcumin for 10 days and they suffered less from colon disruption and diarrhea. Higher doses of 100 or 300mg / kg had similar effects. There was decrease in lipid peroxidatin and reduced serine protease activity also. These findings suggest curcumin could be an excellent treatment option for IBD like Crohn’s.

In two studies involving 99 patients, a combination of mainstream therapy of mesalamine, corticosteroids or sulfasalazine were given with curcumin. There was significant improvement in symptoms. Some patients could reduce their corticosteroid dosage and others stopped taking it altogether. This shows that turmeric may be a safe and less expensive alternative therapy for IBD like UC and Crohn’s.

Dosage

Turmeric supplements are available as tablets, capsules, tincture, powdered root or liquid extracts. The dosage depends on the specific medical condition. It is not recommended for children. 1-2g of turmeric a day could benefit those with Crohn’s disease according to some studies.

Precautions

Turmeric is safe when consumed within the recommended dosage and when eaten as a spice in food. Those who are scheduled for surgery must avoid turmeric for at least 2 weeks before the date since it can slow down blood clotting. Do not take turmeric supplements if you have gall bladder diseases or are pregnant or breastfeeding. Those who are taking turmeric must be careful for it can interact with anti-platelet drugs, drugs for stomach acid, analgesics and diabetic medications.  Always consult your doctor before including turmeric or other herbal supplements in your diet.