Good news from Japan on CD front

[CHiZZoPs]

Just released in Japanese, and soon to be published in the Rockefeller Medical University Journal (or something like that?) is a study by Japanese researchers, headed by Dr. Nishimura on the cause of Crohn's. While the ultimate cause, probably the MAP bug, is very difficult to find in the body and eliminate because it lives deep in the tissue, their research found insight into the body's reaction in people with Crohn's disease.

They found the CD8T cells would proliferate in Crohn's patients, causing Antibody 17 to be produced in high number, causing inflammation. By injecting Antibody 6, they found that CD8T cell proliferation would be eliminated, thereby stopping the Antibody 17 from being produced and causing inflammation.

This could very well become a treatment and, dare I say, cure for Crohn's disease.

Very exciting!

Meanwhile, I suggest trying to find out more about the current Japanese treatment for CD. Since I have been here, I have not had a flare-up thanks to their treatment, which is solely diet-regulation-based. No fat whatsoever, as oils cause inflammation, save for fish oils and oil like flaxseed, which actually have the opposite effect, as well as the common-sense forgoance of spicey foods, fibrous foods, allergies, etc. Oils really seem to be the big thing, which means, of course, no fried foods, nor beef or pork. While this is easy to do in Japan, since the traditional Japanese diet is quite low in fat and oil, it would take a bit more effort in America to prepare meals yourself. Sure beats a bunch of drugs with side effects that rival CD, though.

Additionally, they give CD patients "Elental," which is an elemental powdered drink supplement first invented for nutrition in space because it has zero residue and thus produces no stool. It's is very easy to digest, already broken down to amino-acids and basic nutrients, and is high-calorie.

Hang in there, good things are coming!

 

[Mazen]

Great news. Could you give us more details on the diet: are you allowed to have dairy or wheat? Can you have olive oil etc........? Any supplements you take?

 

[CHiZZoPs]

Yes. I will talk to my wife and double-check the instructions, as they are all in Japanese, but first and foremost is the way they track our illness. I go in once a month for a checkup, and they generally take a blood sample to test my inflammation level. Based on this, it becomes evident from month-to-month on how I am doing. If I have inflammation, I know I need to be extra careful and rely more on Elental and the elemental diet to reduce the inflammation. If my blood test is normal, then I know I can probably get away with a few splurges now and then. Everything in moderation.

It's very easy to stick the diet here in Japan, as even at the convenience store you can buy rice balls and noodle bowls without any oil (but plenty of flavor!). When I visited back in the States last I was appalled when I went to a supermarket looking for something quick, easy and healthy to eat. There isn't anything! After circling the store, I found myself in the frozen food section looking for the least toxic-looking meal.

The convenience stores here (like 7-11) have fresh-made food brought in multiple times a day. You can literally survive on "conbini" food here.

Anyhow, the doctors I have been treated with use the inflammation level as a guide. If you are allergic to something (they give me allergy tests sometimes, too), they want you to avoid it, but otherwise, not eating fat and oil is the big thing. If your intestine is not scarred too narrowly or inflamed, even eating things like salad is fine, because they can show you have no inflammation through the tests. Obviously, cheese and milk contains the oil they frown upon. I use soy milk when I need it, and for cheese (when I cook my oil-free spaghetti for example), I try to get a nice, very well aged cheese (like a hard Italian Parmesan) and use it sparingly.

Living in a country that has a 100+ ways to prepare fish is a true blessing--and I never was a big fish eater before I came here. It's all about the souce! :ycool:

 

[AbstractDonut]

Hmmm, thats interesting. So wheat would not cause problems on your diet? So many diets cut it out. Rice and potatoes would be okay on your diet though.

 

[Mazen]

I guess the oils and fats they frown upon are saturated fats. But are monounsaturated fats like olive oil OK? Many studies say so, and they are also anti inflammatory. Also what about about fat free or low fat dairy, is it OK? Are the noodles made from wheat or rice in Japan?

Could you also tell us about the tests for inflammation they do. Is it CRP and ESR? Also what allergy tests are done (blood tests, skin tests ....)?

Sorry for all the questions, but it's interesting to see that in some countries they use a food based approach to treat this disease instead of life long medication with a huge list of side effects!!!!

 

[OZGuts]

I'm also fascinated by your news and how they treat Crohn's differently over there. I've never had a test for inflammation that I know of... I wonder if you can get that Elentil elemental stuff elsewhere and not for too much expense? The IBD food replacement/supplements here tend to be with some parts of dairy and/or soy.

 

[CHiZZoPs]

Yes they use a CRP test mainly.

Allergenic foods such as wheat should be avoided only if you have an allergy to them, according to the Japanese doctors.
Over the years, my allergies have come and gone and changed as I have stopping eating foods. When I came here, I was allergic to a lot of stuff, but the allergies have gone away and I now eat those foods, but try not to eat too often. My guess is the allergies are caused during inflammatory episodes, so if your inflammation stays low then you have less of a chance to become allergic to something.

They say to avoid all oil, except for fish oil and oils such as flax seed that emulate fish oil (omega). It seems hard at first, especially considering the American diet, but with a good non-stick pan it's not even necessary to use. I always boil ground chicken when I use it. They said chicken should be fine this way, if you use very lean one (I think prolly ground turkey would be leaner perhaps, but I can't get that here).

They say "high calorie, low fat," such as rice. Also, rice is the least allergenic grain, according to the doctors, so they really push a high rice diet, while eating wheat more sparingly.
Because we should cut out the fats, we have to eat a diet high in calories, and that's why Elental is good for that, as one 500ml contains 300 calories, so you could essentially survive on it (which many people do). Some patients actually insert a thin IG tube through their nose to let it enter their stomach slowly while they sleep (not for me ).

Anyhow, next time I go for a checkup I'll see if I can get some documentation to get their exact guidelines, as I've been in quite good condition lately and have been able to push it a little from time to time. I really agree with the no-oil rule, and can't handle eating it anymore. It makes me sick. We Americans are really desensitized to how much oil is in our diet.

 

[AbstractDonut]

Well there may be come credence to this, alot of studies show that most fats that we eat are Omega 6s which increase inflammation. While Omega 3 decreases it. Or an unbalanced diet of ratio.

Anyway I'm going to try what you say, we have elemental diets you can get in the states. I'm going to supplement the elemental liquid with potatoes and chicken. Not fried.

 

[BWS1982]

Well I realize this is the groundwork for such a diet/theory, but I still follow strongly that in addition to Omega 3's and EPA's and DHA's (components of Omega 3's) I should ingest some Mono's from things like Olive Oil and Sunflower Oils, as they are also healthy, especially for the heart....sat fats do have their purpose in moderation (some of which for guys is testosterone related) but are not required. Trans fats are to be avoided like the plague imo.

 

[Mazen]

I guess I follow a similar plan; I got from the excellent book "The New Eating Right for a Bad Gut" by James Scala. In it he mentions we should increase our Omega 3 intake, eliminate saturated fat as much as possible, eat some mono fat like olive oil, and get only enough Omega 6 for your essential bodily functions. The aim is to have a 2:1 ratio of Omega 6 to Omega 3. He also mentions eliminating red meat, and only eating fish and lean white meat poultry.

In another book "The Omega diet", the author also discusses the same reasoning as above, and mentions that most of our fat should be mono with Omega 3 to Omega 6 added in the ratio above. She says that if we consume olive oil as our main fat resource, we also get some Omega 6 which we need for our essential bodily functions. All other high Omega 6 fats like corn, saflower, etc... oils should be cancelled from diet. Only use olive oil or canola oil for cooking. Then eat lots of oily fish, or take fish oil supplements.

The good thing about the above 2 books is that they are written by world leading scientists and nutritionists

http://www.amazon.com/New-Eating-Ri...bs_sr_1?ie=UTF8&s=books&qid=1211271872&sr=1-1
http://www.amazon.com/Omega-Diet-Li...bs_sr_1?ie=UTF8&s=books&qid=1211271921&sr=1-1

 

[Mazen]

CHIZZOPs. I also have another question. Do they use any maintenance medicine in Japan like Pentasa, Asacol, or Imuran etc....; or is it a strictly diet based approach??

 

[Mazen]

Crohn's Disease Linked To Increased Fat Intake.

TOKYO, Japan. Crohn's disease was almost totally unknown in Japan prior to 1965 but has been increasing rapidly since. The increase in the incidence of the disease parallels a drastic, six-fold increase in the intake of dietary fat between 1945 and 1985.

Now researchers a the International Medical Center report that they have found statistically significant links between the increase in fat and animal protein consumption and the rise in Crohn's disease. Their data is based on a comprehensive dietary survey carried out by the Japanese Ministry of Health and Welfare during the period 1985 to 1996. The researchers found strong correlations between intake of total fat, animal fat, n-6 polyunsaturated fatty acids (linoleic acid), animal and milk protein and the incidence of Crohn's disease. The intake of fish protein showed no correlation with disease incidence and a high intake of vegetable protein was found to have a protective effect. The ratio of n-6 to n-3 polyunsaturated fatty acids was also found to be significant with a high ration corresponding to a high incidence of Crohn's disease.

The researchers concluded that the increase in Crohn's disease observed in Japan correlates closely with an increase in the consumption of dietary fats and animal proteins and a decrease in the intake of n-3 fatty acids (linolenci acid) which has been found to have an anti-inflammatory effect.

Shoda, Ryosuke, et al. Epidemiologic analysis of Crohn's Disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn's disease in Japan. American Journal of Clinical Nutrition, vol. 63, No. 5 May 1996, pp. 741-45

 

[BWS1982]

Mazen I hope they are stating an apparent "correlation" and not a "cause", that would be foolish to be honest, to say that correlation equals causation in anything scientific. I just pet my dog, then had to run to the bathroom, would that directly indicate that petting my dog makes my bowels spasm wildly? Just an anology to remind us all.

 

[Kev]

No, they are calling it a correlation... and the numbers seem inarguable.. And lets face it.. I don't think anyone could make a 'good' argument for 'bad' fatty foods.

A shame to see another 'Western' influenced country is paying for the "privilege"

 

[katiesue1506]

I can argue that most fatty foods are GOOD

 

[Kev]

No, you mean they taste good... or as Tony the Tiger might say'' They're GREEAT!

 

[AbstractDonut]

Yet I don't think corn flakes with sugar are high in fat? This idea is interesting though it does not implicate sugar.

It does make sense though I was looking at the omega3 to omega6 content of some oils and even the ones that have some omega3s like almonds have more omega6s. Its just there are lots of food with only omega6s.

 

[Kev]

Well, I think (but could be wrong) the issue with sugar is that it is a great food for the bad biotics that flourish in our GI tract.. not that it is inducive to getting IBD.

The only thing I don't understand... well, the aboriginal people of the far north of North America.. Indian, Inuit, Eskimo.. for the past 13 thousand years or more.. have ... well, not subsisted, not existed.. but 'flourished' on a very fatty diet. yet they show no advanced disposition or incurrence of digestive issues.
And their ancestry is traceable back to Asia N eastern Europe. The study has the numbers to back up the correlation between adopting a hi fat, Westernized diet... and the increased risk/presence of IBD... but I think there must be some piece of the puzzle that is being overlooked. As to what that might be, I don't have a clue. In the meantime, unless one is of aboriginal descent, it might be best to start watching your fat intake... And, I doubt if this is the first time fat has been associated with IBD. I was placed on a low fat diet, despite my tests showing my chloresterol (sp) was perfect. HDL, LDL N Triglycerides (sp? again).

 

[AbstractDonut]

That is interesting, I would figure that an Eskimo diet probably had a better amount of omega3s in their diet. Even though it was high in fat. And people of old didn't fry their foods in fats causing high omega6 concentrations.

 

[Kev]

I dunno.. know my greatgrandmother (on fathers side) fried food in cast iron frying pan using animal lard. Did all her baking with lard. Never heard of teflon, or light oil, or low fat anything.. drank whole milk, not 1% or skim.. never heard of decaf tea.
I recall seeing how she'd make breakfast... thick rashers of bacon, cut from the rind.. fry that up.. toss eggs in the hot fat from that... serve it with toast made from her homemade bread... eggs, flour, lard, salt, baking powder.. smothered in butter... home fried potatoes... not deep fried.. but made in same cast iron pan using more animal fat.. Yet she never got IBD, and lived to be 103. none of her children got it. none of her childrens children got it.. most lived till their 80's or 90's.. Now, I've got it.. When I became an (ha ha) adult.. living on my own, I decided to get away from the 'ancestral' cooking methods.. lite oils, or teflon coated pans, spray on cooking oil to reduce fat, lean cuts only... broiled/grilled to avoid 'frying'.. 3 decades after putting my ancestral methods behind me, I go and get IBD.. I dunno, I really dunno. sometimes it all makes my head spin

 

[chizzops]

Well I seriously consider the work by Dr. Taylor, amongst others, to be rather compelling, pointing the MAP bacterium to be the cause of Crohn's. Looking at the epidemiology of the illness alongside the spread of infected livestock from Europe to America and other counties, it seems completely feasible. Of course, killing off this bacteria seems close to impossible. Its spread seems to be another byproduct of our industrialization.

Assuming that is causing the immune system to freak out in those of us with a susceptibility to do so, following a diet like the Japanese doctors recommend makes sense to keep inflammation down. We go through cycles of feeling good to bad, and by using that diet when we know we are flaring up, we can quickly get it back under control so we can eat that occasional greasy thing we have been craving:ymad:

If you haven't read much on that, you should do so. Here is a good multi-part lecture he did in South America. Quite informative, and when you put the pieces together, it makes more and more sense. Of course with a huge industry whose interests are quite against exposing their equestrian practices as the vector for the disease, it's no surprise that it hasn't been getting more attention. He explains the difficulty in culturing the bacteria. They actually have to test for its DNA to find it. Worth a watch:
http://www.youtube.com/watch?v=5pYuf5rnnQo


I tried to get in to see my doctor last week, but of course he wasn't there. I should have called first. Had to transfer twice, to get there, to. Bah. He'll be in this week, though. I'll try and get an information sheet with the diet written more clearly. Any other questions I should ask him? My wife and I are moving back to the States (and the worry of health insurance is a whole other can of worms...), and I'm going to talk to him about importing Elental, so if pass on any useful information for that, as well.

I'm not so sure that Elental is the same as "elemental diet" supplements in the States. It was invented for space travel back before they had bathrooms. It produces zero residue, that is to say. The good thing about this stuff is you can completely replace food with it if you are really sick. When you are in tip top shape you don't need to take it, or maybe just a bit extra for nutrition, but when you are flaring up, then you can cut way down on food intake, but still use this to get your calories so you don't lose a bunch of weight.

 

[Mazen]

I have talked to my GI about the MAP theory, and he sais it has been proven wrong and no study could prove it is the cause of Crohn's.... He said there was a large study in Australia about it and it didn't have good results... Has anyone else discussed this with their GI?

 

[Mazen]

Also here is a study in which does not support a role for water or dairy products potentially contaminated with MAP in the etiology of Crohn's disease.

Logistic regression showed no significant association with measures of potential contamination of water sources with MAP, water intake, or water treatment. Multivariate analysis showed that consumption of pasteurized milk (per kg/month: odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.69, 0.97) was associated with a reduced risk of Crohn's disease. Meat intake (per kg/month: OR = 1.40, 95% CI: 1.17, 1.67) was associated with a significantly increased risk of Crohn's disease, whereas fruit consumption (per kg/month: OR = 0.78, 95% CI: 0.67, 0.92) was associated with reduced risk

http://aje.oxfordjournals.org/cgi/content/full/165/7/776

 

[Kev]

Mazen, I don't recall the specific studies.. but my 'gut' (pardon the phrase) feel is that 1st MAP was a hot topic in UK N Australia... then a major study indicated that MAP couldn't be shown to have a role in the development of IBD.. which seemed to cool the ardour for MAP for a while.. Then the last study (linked somewhere in here from the CCFA - I think) I looked at said that a new theory about MAP looked promising AND seemed to explain the issues raised by prior study.. I may be wrong, but in this see saw battle, at last count I thought MAP was once again being looked at anew. But it's so hard to keep track of which theory is in favour at any particular moment... What we really need is like a MAP vs Not MAP scoreboard, like in baseball