One thing that is puzzling to me is shouldn't we eradicate the underlying problems and in this case E coli and Klebsiella? Without the antibiotics, how can EN alone make sure that these bacteria don't cause problems anymore?The high starch diets in the Western world are troubling when we know Klebsiella is implicated in crohn's disease. Starch ends up as the undigsted energy source that fuels Klebsiella in the ileum and colon. EN works because it consists of glucose and MD, and unlike starch, it is fully absorbed in the upper GI tract.
Are they also very resilient then? I am assuming that you can't starve them out and by doing EN, they are sort of out of energy but will become active once solids are introduced.Klebsiella is usually antibiotic resistant. If you start using broad spectrum antibiotics, it will gain a fitness advantage. In the post-antibiotic period it will gain the upper hand and become a dominant species. It could explain why taking antibiotics is a precursor to developing crohn's disease.
But several studies are trialing phages for crohn's disease, both against invasive E coli and Klebsiella. You should be able to easily eliminate these bacteria with phages. Biofilms don't bother phages, they lyse right through them.
Klebsiella has always interested me, besides E coli, because people with crohn's disease usually have had aphthous ulcers at one point.
Haven't seen the video, but it is unlikely crohn's disease is related to a viral infection. The Rutgeerts and Harper studies from the 80s and 90s showed that filtering effluent from patients through ultrafiltration that eliminated bacteria and fungi, but not viruses, no longer evoked any immune response.Dr. Jeffrey apparently has identified some viral targets and wanted to create vaccines for them.
I don't remember you commenting on it before... can bone broth have the same efficacy as EN? Its nutritious, no burden on the GI as well.One of the reasons I am not a fan of fasting for crohn's, even though many experiments have tried this unsuccessfully, is the fact that the bacteria involved in crohn's disease happen to be excellent at sustaining themselves in harsh conditions like nutrient deprivation. Especially Klebsiella. By the time Klebsiella is affected by nutrient deprivation, you'll be in a lot more trouble than Klebsiella from fasting. The goal should be depriving Klebsiella of nutrients by depriving it of starches, but without depriving the small intestine of nutrients it needs. The small intestine requires daily nutrients, it is a much more complex organ than the colon. Paneth cells, peyer's patches, these are all exclusive to the small intestine and are very nutrient dependent.
The fecal stream in crohn's disease causes inflammation. This has been shown by Rutgeerts and Harper in the 80s and 90s.As for fecal transplants... why doesn't it make sense to replace the bad gut with a healthy donor's tissues?
Obviously Moderna wants to have a play in this so they brought Dr. Jeffrey out of academics and made her the head of this new division. Her findings esp the second part of the video are impressive. She was certain, backed up by all the patient data at her hospital and proposed to solve it using vaccines. She believes she is in a good position to carry this to the finish line since Moderna is experienced with trials and making vaccines. This, virome, is all very new compared to what we have been talking about for years.I watched the video up there.
I have my own experience and read many stories about people on this forum developing crohn's disease. It happens suddenly after an episode of gastroenteritis. People often throw up, develop fevers, night sweats etc.
This can be caused by an acute foodborne infection. Salmonella, E coli (closely related to salmonella), campylobacter, Yersinia.
But gastroenteritis can also be caused by a Norovirus.
A Norovirus would explain the clustering of crohn's disease, it would make crohn's disease a transmissible disease. We still don't know if crohn's disease is transmissible or not. The general consensus among doctors is that it is not transmissible, the truth is that we don't know at all.
OK, now I am in a knot. So if a person on medication achieves mucosal healing, are we saying that 1) the pathogen is successfully eliminated *and* 2) the immune system on overdrive is calmed to a normal level? I don't think so, right? It seems to me that the medication only does 2) and when the medicine is stopped, then the inflammation comes back and the patient relapses because 1) is never dealt with.Hm. Well a question that hasn't been answered yet is why crohn's disease patients relapse.
The inflammation in crohn's disease is deep and transmural, yet people can achieve full mucosal healing. But yet people relapse. The small intestine is densely packed with peyer's patches, paneth cells, TLR. If there's some kind of pathogen out there sticking to the intestinal wall, it knows. People in remission have somehow eliminated a great number of these bacteria, by modulating the microbiome, by starving them out, or because dendritic cells and macrophages removed them.
Something is causing people to relapse. A bacteria, fungi or a virus.
If they're not on immune suppressors, if they're on EN for example, and achieve remission, we see a large reduction in pathogenic bacteria.OK, now I am in a knot. So if a person on medication achieves mucosal healing, are we saying that 1) the pathogen is successfully eliminated
Right. And there's no straightforward explanation for this. Healthy controls harbour AIEC for example, they're less virulent and in smaller numbers, but some healthy controls harbour them.and when the medicine is stopped, then the inflammation comes back and the patient relapses because
I mean we can use the case of people who slowly add solids back into the diet once they achieve full remission using EEN. The inflammation comes back and it's very hard for me to think that solids bring on the problem especially if the gut is healed fully. However solid foods are an event for sure that kicks off a chain reaction, everytime.Right. And there's no straightforward explanation for this. Healthy controls harbour AIEC for example, they're less virulent and in smaller numbers, but some healthy controls harbour them.
There's no reason why someone with crohn's disease in clinical remission, should suddenly relapse if the intestinal wall has healed. Something is triggering a relapse in patients.
Right. Let me put it this way, these bacteria like AIEC and Klebsiella cause inflammation in crohn's disease. If these can be successfully removed through bacteriophages or disarmed through FimH blockers, there should be a large reduction in inflammation. Crohn's disease might become a much milder and more manageable disease like IBS.I mean we can use the case of people who slowly add solids back into the diet once they achieve full remission using EEN. The inflammation comes back and it's very hard for me to think that solids bring on the problem especially if the gut is healed fully. However solid foods are an event for sure that kicks off a chain reaction, everytime.
I am only aware of one such trial at Mt Sinai:Does anyone know how the phage trials are progressing? I think a lot of us are very ready for a positive leap forward with understanding and treating this wretched disease