Gut Buddies

The treatment of Crohn’s disease usually involves the use of anti-inflammatory drugs, but these are frequently only partially effective and are also associated with serious side effects. Many patients eventually require surgery in spite of the use of these medicines.

The serious risks associated with Crohn’s medications have again been highlighted recently by a study which found that the immunosuppressant thiopurine drugs – one of the cornerstones of Crohn’s treatment – can increase the risk of cancers linked to viral infections.

Patients receiving thiopurines – such as azathioprine and Imuran – were found to have a more than five-fold increase in the risk of lymphoma compared with those who had never received these drugs. Older male patients with a longer history of inflammatory bowel disease also have an increased risk of lymphoma.

Another recent study indicated that patients with inflammatory bowel disease, especially those receiving thiopurine medications, may also be at increased risk of developing non-melanoma skin cancers.

Only in the last few days, a new warning has been issued about the drug Tysabri (Natalizumab), the multiple sclerosis medication that was approved for use in moderate to severe Crohn’s disease in early 2008.

Tysabri, which had previously been linked with a rare but deadly brain disease called progressive multifocal leukoencephalopathy (PML), has now been confirmed to increase the risk of this disease. Whilst there have been no reports of PML in patients taking Tysabri for less than 12 months, the rate in patients who use the drug for two to three years is estimated to be one case per 1,000 patients.

The search for a better treatment alternative continues with a new multi-centre trial, funded to the tune of $4.7 million, which is about to compare the use of the conventional management strategy featuring gradual escalation of drug therapy with a newer approach combining immunosuppression with a tumor necrosis factor alpha blocking drug and an anti-metabolite.

Turning to studies that are already bearing fruit, potential sources of relief for Crohn’s are being revealed by research looking at the effects of certain nutrients on the activity of this disease. For example, it appears that it may be advantageous for Crohn’s patients to vary the types of fat that they consume, especially to increase the amount of Omega-3 fatty acids and decrease the Omega-6 fats that are now found in extremely high quantities in the average Western diet.

Several studies have suggested that Omega-3 fats – available from oily fish, and fish oil supplements – exert a protective effect by modulating intestinal inflammation, and a new study has found that a high intake of total, saturated and monounsaturated fats, and a higher ratio of Omega-6 to Omega-3 polyunsaturated fatty acids, is associated with higher disease activity.

Another new study has identified a further novel treatment avenue for people with Crohn’s or other inflammatory bowel diseases, in the readily available vitamin D. The study shows, for the first time, that vitamin D deficiency can contribute to Crohn’s disease, and that supplementing with this nutrient can counter the effects of the disease.

Vitamin D impacts the immune system, specifically the innate immune system that acts as the body’s first defense against microbial invaders, and it appears that the inflammatory response, which is thought to underlie autoimmune conditions, is probably the result of a defect in the handling of intestinal bacteria by the innate immune system.

Another potentially hopeful recent study, has found that two compounds extracted from cannabis – the cannabinoids THC and cannabidiol – appear to be able to restore the gut membrane barrier by allowing epithelial cells to form tighter bonds.

Studies being carried out at Nottingham into the use of live hookworm as a therapeutic agent in Crohn’s and other autoimmune diseases is still a very long way from demonstrating efficacy, mainly due to the low numbers of worms having been used in these trials to date, and the inadequately short period that the worms have been left in place.

Nevertheless, existing research, already suggests a high degree of success from the use of hookworm, and the efficacy of this treatment is regularly confirmed by patients who have chosen not to wait for further trials, and have obtained a supply of helminths elsewhere.

Helminthic therapy is therefore arguably the current treatment of choice for Crohn’s disease, especially as it provides freedom from the long-term side effects associated with so many of the available drug treatments. Unfortunately, the FDA has recently banned the supply of helminths to anyone within the US, so American citizens who are too ill to travel are now effectively denied access to this treatment, which is available everywhere else in the world, via the internet, from Autoimmune Therapies.