Consider revising your diet to eliminate dietary sources of sulphur-containing amino acids, such as:
eggs milk
cheese mineral water
whole milk sulphited drinks such as wine and cordials
ice cream nuts
mayonnaise cruciferous vegetables

Sulphur is also found in the food preservatives widely used in processed foods and in additives such as sulphites, sulphur dioxide and the thickener carrageenan, so avoid foods containing these as well. In addition, decrease your intake of red meat, and substitute chicken, fish and skimmed milk as protein sources. A combination of these dietary changes can effectively prevent relapses of UC in a large number of patients (Lancet, 1998; 351: 1555).

When my oldest child was 7 and had to have a shot to go back to school, he too underwent genital examination and was extremely uncomfortable. I asked the doctor if it was necessary. He said yes. I asked until what age it was necessary. He said until adulthood. Then he went on to say that oftentimes little girls are so uncomfortable that they have to transfer out to a female pediatrician. In the late 60s and early 70s, my mother found a pediatrician who also forced me to remove all my underclothes, lay on my back and spread my legs so that he could spread my vagina with his hands and get a “good look”. I never remember a visit forgoing this experience until I was well into my teens. No explanation was ever given to me, and my “panic attacks” prior to the visit were considered to be quite ridiculous. L B, Miami Springs, Florida…..Thank you for calling attention to this subject and for sending in photocopies from a medical textbook on physical examination of infants and children. It emphasizes that it isn’t essential that the child be completely undressed during the course of the examination only the part of the body being examined and that direct visualization of the vagina and cervix aren’t considered part of the ordinary physical examination.

Our advice would be for parents to avoid “well children” general examinations; to save doctor visits for times that something specific seems to be wrong, and then ask the doctor to only examine the relevant body part. If your child has something wrong with his plumbing requiring that his genitalia be examined, it would be wise for you to explain beforehand that the doctor is going to have a look at it and why, and perhaps for you to demonstrate it yourself so that your child is not taken by surprise. Of course make sure to always be present. If your child clearly doesn’t want it, never force or restrain him.

Since then, the drug has been reported 104 times in the UK to the Committee on Safety of Medicines, the drug monitoring body, for causing kidney and urinary tract reactions.

These included interstitial nephritis (kidney inflammation), which was reported 35 times, nephrotic syndrome (low blood protein and fluid in the tissues), and even kidney failure.

Even so, researchers at the Kent and Canterbury Hospitals fear that adverse reactions to the drug are being under reported by doctors.

They estimate that patients taking the drug are five times more likely to develop nephritis, but it may not occur until several months after starting treatment, which explains why doctors are not making the association. The longer diagnosis is delayed, the less chance there is of completely reversing the damage. They estimate that only one third of cases can be reversed if diagnosis is not made for 18 months.

Other reactions include headaches and gut problems such as nausea, abdominal pain and diarrhea, and it can even exacerbate colitis. Early reports also suggest it could cause a lowered blood cell count, pancreatitis and hepatitis.

When it was launched, it was marketed as the drug for colitis with fewer side effects. This was because the manufacturer, SmithKline Beecham, had used just mesalazine, supposedly the safer part of sulphasalazine used in other anti colitis drugs when preparing the new drug.

Perhaps a fresh look at the marketing stance may be in order.

An advisory panel to the Food and Drug Administration (FDA), the American drug regulator, is recommending the reintroduction of Lotronex (alosetron hydrochloride), manufactured by GlaxoSmithKline.

The panel says that there should be restrictions on who can prescribe it, and patients need to be carefully followed up. The FDA may not endorse the panel’s recommendations, but it is likely to do so.

Lotronex was withdrawn in November 2000 – just nine months after it received a licence – following reports of five deaths and 70 cases of serious adverse reactions. These reactions included ischaemic colitis (fever and gut pain caused by an insufficient blood supply) and severe constipation.

Peter Traber, chief medical officer of the drug company, described the panel’s recommendation as ‘a very positive step forward for patients who need this drug’. This view was countered by Sidney Wolfe, of Public Citizen’s Health Research Group, a medical watchdog group in the States, who said the decision would ‘lead to more cases of ischaemic colitis and more deaths’.

Lotronex was the first drug required to come with a full treatment guide under ‘patient-power’ regulation. The guide warned that the principal side-effect revealed in trials was constipation.

Hailed as ‘a promising aid for irritable bowel syndrome’ (Drug Infoline, December 1999), a 12-week trial of 370 IBS sufferers found that the drug was effective in women compared with a placebo.

As well as being a drug intended only for women, it was also only supposed to treat the diarrhoea form of IBS.

However, the trial didn’t pick up the serious adverse reactions with Lotronex that were soon reported to the FDA. These included cases of intestinal damage due to a reduced blood flow, and severely obstructed or ruptured bowels as a complication of severe constipation.

Within four months of its launch, six women needed hospital treatment and three of those underwent surgery after taking the drug.

By the time GlaxoWellcome agreed to withdraw it, 34 patients had been treated in hospital, 10 others had undergone surgery and three had died (Lancet, 2002; 359: 1491-2).

Specifically, this includes suicide, depression (in nearly a third of patients), aggressive behaviour, hallucinations, bipolar disorders and mania.

Otherwise, the drug may lead to a severe decrease in white blood cells and blood platelets, and may cause diabetes, low blood pressure, irregular heartbeats, angina and even a heart attack. Then there’s pneumonia and respiratory failure, colitis, pancreatitis, autoimmune disorders, loss of vision and retinopathy. And that’s just the one drug.

As for ribavirin (Rebetol is a Schering product), this can cause birth defects or death of an unborn child if you take it when pregnant. Some 10 per cent of those taking ribavirin develop haemolytic anaemia. In combination with PEG-Intron, it can cause blood, endocrine and liver abnormalities.

On its website FAQs For Patients, Schering cheerily notes: ‘Certain symptoms like severe stomach pain may mean that your internal organs are being damaged.’

All this and very little assurance that it works. According to Schering, only 24 per cent of patients respond to PEG-Intron, and far less if you are a particular viral genotype.

What he told me about the state of both human and canine bowels absolutely staggered me. For one thing, he said, he and his fellow vets were extremely disheartened about the amount of inflammatory bowel disease they now see among dogs.

Dogs are beginning to rival humans in the amount of drugs they consume for inflamed intestines, and forward-thinking vets put it down to the amount of worming that is now carried out in the name of keeping dogs and their owners free of parasites.

Back in the dark ages when I was a child, if you owned a dog, the only drug he got was the shot that put him to sleep if he had to be put down. Vaccines and worming pills were unheard of. You opened the back door, booted him out and, when he returned after a day of getting up to Lord knows what, he and his various microbes were embraced back into the bosom of the family.

But now, dogs, like their owners, are expected to be squeaky clean inside and out, and to live in a household free of dirt and parasites. Dog owners are given flea preparations not only for the dogs, but also for their houses. All of us, dogs and humans, are bombarded with antimicrobial agents, and our guts don’t like it one little bit.

This exchange set me off thinking about the current way that we deal with microbial enemies, human and otherwise. The current approach is to obliterate, but the evidence in our cover story this month is that the better route may be to familiarise, even integrate. Some of the most successful treatments of IBD concern methods of reintroducing a body to an array of potential invaders. Our vet’s favoured method of treating worms is not to wipe them out altogether, but just to keep their numbers down, using natural means such as raw garlic and Artemisia annua. That, and letting the dog stick its nose in dirt. A body can cope, it seems, if it lives with its enemy.

History should have taught us this lesson. When colonials like the Spanish arrived at a new territory, the most effective weapons against the natives were not guns, but new and usually benign diseases such as measles, which proved deadly to those to whom they were unheard of and threatening.

Another important lesson lies with our medical model, which has been adopted from the battlefield, of good battling evil. We’ve all been thoroughly indoctrinated with the importance of having more of the ‘good guy’ bacteria in the gut than the ‘bad guys’ and, to that end, we down vast quantities of acidophilus, as if our insides are the Third Reich and we’ve just unleashed the Allied invasion.

But the notion of a requisite bacterial victory is unhelpful and probably wrong. A human friend of this vet, who was suffering from dermatitis, finally isolated the cause. The problem was the acidophilus supplements he’d been taking. As soon as he stopped taking them, his skin condition vanished.

Similarly, in a recent tiny study of six patients with ulcerative colitis, all six were given enemas of healthy faecal flora from donors every day for six days. All six fully recovered in a week; during periodic follow-ups, they were still healthy, even as long as 13 years later (J Clin Gastroenterol, 2003; 37: 42-7).

All these patients apparently needed was a population of the usual mix of good and bad guys, happily living in a sort of standoff.

Perhaps the moral here is that, all of us, even the tiniest of organisms that compose us, need to adopt a position of détente with our enemies to function at our peak.

Lynne McTaggart

I have been prescribed prednisolone and mesalazine daily. I am feeling the side effects of these drugs and wish to reduce and withdraw from them as soon as possible.

I would be grateful for any information about the alternative control for colitis and Crohn’s disease and about the known side effects of these particular drugs. J H, Rochester, Kent…..

A:Colitis and Crohn’s disease remain a mystery to most doctors. In fact, in a recent editorial, the British Medical Journal admitted as much (BMJ, 6 August 1994).

One likely cause still unrecognized by most gastroenterologists (and ignored by the above editorial) is the link between non steroidal anti inflammatory drugs (NSAIDs) and the development of these diseases, even though NSAIDs are well known to injure the mucosa of the colon and cause ulcers.

A number of researchers from the Departments of Gastroenterology and Histopathology at the General Hospital in Jersey recently reported that of the 60 new cases of inflammatory bowel disease (IBD) seen between March 1991 and June 1994, 23 (or 38 per cent) had developed while the patient was taking an NSAID. None of those 23 patients had a pre existing IBD that could have been exacerbated by taking NSAIDs.

After taking highly detailed histories of drug use among these patients, the researchers found that while a large number of NSAIDs were implicated, diclofenac (Voltarol, Voltaren in the US) and mefanamic acid (Ponstan, Ponstel in the US) were the most frequent culprits, with 12 and five cases, respectively. “The NSAID had usually been taken orally but colitis was seen after rectal and intramuscular administration and could occur within a few days of therapy,” they wrote. Although the symptoms varied, in some instances the drugs caused full blown ulcerative colitis.

With the milder cases, the patient rapidly improved on withdrawal of the drug and the use of suphasalazine or mesalazine. But some of the severe cases required systemic and topical steroids, and one patient needed to have his colon surgically removed after developing toxic megacolon ((life threatening massive widening of the colon) in the wake of intramuscular doses of diclofenac.

“NSAIDS associated colitis seems to be an underrecognized but common form of colonic disease,” concluded the Jersey researchers. “We suggest taking a thorough drug history in every new cases of colitis” (The Lancet, 8 October 1994).

Another vastly underreported cause may be measles vaccination.

Researchers in the inflammatory bowel disease study group at the Royal Free Hospital in London have made links between a rise in Crohn’s disease and ulcerative colitis and the measles jab. They believe that the measle virus, both in the wild form and used in the vaccine, may damage blood vessels supplying blood to the intestines, casuing inflammation and ulceration of the gastrointestinal tract and severe abdominal pain and diarrhea.

This link was also made by Swedish researchers, who found that people with Crohn’s disease were more likely to be born during measles epidemics, and so exposed to the virus in the womb or shortly afterward (The Lancet, 22 October 1994).

However, it is the vaccine which may be responsible for the massive rise is cases of IBD in children, says Andrew Wakefield, director of the Royal Free study group. Mr Wakefield said studies in Scotland had discovered that over the last 20 years cases in children had risen by more than seven times, from four per million to 29 per million. During that time, although cases of live measles dropped drastically, the measles vaccine was introduced and widely used.

Medicine usually first attempts to treat each illness with mesalazine (mesalamine in the States), an antiinflammatory, or sulphasalazine (sulfasazaline), a drug with two halves containing mesalazine and a sulphur drug chemically akin to aspirin. As the latter is the more dangerous drug, which can lead to acute intolerance syndrome, causing bloody diarrhea, cramping and great pain, some doctors prefer preparations with only the mesalazine portion left in.

As we described in WDDTY vol 5 no 6 (Drug of the Month), mesalazine has a number of its own problems. These include a surprising number of gastrointestinal problems in a drug supposed to be used for that purpose: nausea, abdominal pain, diarrhea, and even causing a worsening of the colitis. It has also been known to cause hepatitis, lowered blood cell count, pancreatitis and kidney failure. This is particularly worrisome for those patients on long term “maintenance” therapy.

For more severe cases, doctors often turn to today’s catch all therapy for all inflammation: steroids. Although prednisone or prednisolone are the usual drugs of choice, medicine has been tinkering with a new type of steroid called budesonide. Although it has potent topical anti inflammatory activity (that is, at the site where the drug actually makes contact with your body), it supposedly doesn’t much effect the rest of your body because it is largely inactivated once it hits your liver. In order to deliver budesonide straight to the intestine, medicine has developed a controlled release preparation, which supposedly doesn’t start working until it reaches your gut.

One study found that patients taking the highest doses of budesonide had higher remission rates than patients taking a placebo over eight weeks. Although budesonide didn’t cause the usual significant side effects associated with steroids moon face, thinning skin, osteoporosis, permanent adrenal disease, eye damage, such as glaucoma it was shown to suppress your body’s own natural supply of steroids in the blood. Furthermore, in another study comparing budesonide against prednisolone, the older drug worked better (66 per cent remission rate against 53 per cent at four weeks), but had worse side effects (N Engl J Med, 29 Sept 1994).

Once again medicine appears to be blind to the suggestion that food allergy or intolerance may cause or exacerbate the condition. According to several Birmingham and Scottish doctors, at least two controlled trials demonstrated that avoiding foods found not to be tolerated significantly prolonged the time before the disease returned. Numerous patients expected to undergo colectomies managed to avoid the operations by having their allergies fully investigated and keeping away from the offending foods. “Patients remained well for years unless they inadvertently ate one of the foods that they could not tolerate,” the group said in a letter to the British Medical Journal (22 October 1994). Besides avoidance, in some cases the patients underwent enzyme potentiated desensitization (EPD), a method of desensitizing patients to the offending allergen by finding a “neutralizing dose”, which switches off symptoms, and giving it to them periodically by injection or under the tongue.

According to these researchers, Dr Len McEwen, who introduced EPD to this country, demonstrated that using them even without a exclusion diet worked better than placebo in patients suffering from IBD. (Bear in mind that WDDTY is concerned about the lack of data of the long term effects of EPD.)

Besides food allergy treatment, IBD has been proven to respond well to hypnosis, psychotherapy and biofeedback (see our Alternatives column, WDDTY vol 4 no 9).

There are also many good reports of herbal success. Several herbalists say their patients are cured or controlled with formulas containing liquorice, slippery elm and golden seal root, all herbs long demonstrated to have healing and anti inflammatory properties.

A:Ulcerative colitis is an inflammation of the bowel, either just affecting the rectum or the part or all of the colon. It causes loose, blood filled diarrhea containing mucus and pus; other symptoms include weight loss, anemia, abdominal cramps, fatigue, weakness, and fever.

We don’t know what causes the condition, although many nutritional doctors see a definite link with food allergy or intolerance, possibly to cows’ milk or, in some cases, salicylates (apples, berries, a number of vegetables, fruit juices, etc). There is also a tendency to develop a zinc deficiency. Furthermore, people with Crohn’s disease, a similar condition, tend to have higher intake of sugar and refined carbohydrate. This disease most commonly strikes young people between 20 and 40. It used to be rare in children, affecting perhaps four per million, although that incidence has increased sevenfold in the last 20 years.

One possible cause may have been the measles vaccine, if your son received the measles, mumps, rubella vaccine at 15 months (he appears to developed the condition soon after). Andrew Wakefield, director of the inflammatory bowel disease study group at the Royal Free Hospital in London, says that there is evidence of the measles virus causing a blockage of tiny vessels controlling the blood flow to the intestines. Although it is possible that patients contracted the virus naturally, the vaccine could also be responsible, says Wakefield.

Steroids are highly dangerous in young children. The most common worry is that it can suppress a child’s growth. Paradoxically, children often require higher doses than adults for the drug to work; and these higher doses often leave the child virtually without an immune system. Any opportunistic infection, particularly chicken pox, can be fatal (see our Case Study, vol 4 no 8).

Mesalazine is also given for the treatment of ulcerative colitis. The Data Sheet Compendium has no dosage recommendations for children (leading us to suspect that it is not usually given to them); it also warns that it should not be given to children under two. This drug can also cause gastrointestinal problems like nausea, diarrhea, abdominal pain (the very symptoms you’re trying to treat) and even exacerbate the symptoms of colitis. It can also cause problems with bone marrow function, hepatitis, other liver and kidney disorders, and possibly even kidney failure.

We urge you to continue to refuse azathioprine (see Drug of the Month, p 7, for a full rundown), to get your little boy off this potentially lethal cocktail, to keep him isolated from infection until he is safely off steroids, and to work with a highly experienced nutritional doctor investigating diet and food allergy as possible culprits in his condition. (And see our Alternatives column for a different approach.)

The article gives a fair description of the neutralizing technique, but this has nothing whatever to do with EPD. Most patients with complex illnesses who are treated by EPD remain in contact with their doctors at least once a year for many years. In addition, several hundred of the patients treated more than 10 years ago are members of the National Society for Research into Allergy and have remained in contact with that organization. As a result it is probably true to say that there are very few forms of medical intervention which have been so well followed up for a period of between 10 and 20 years.

At the present time the doctors in America who use EPD have a computerized system of audit which has received the blessing of an FDA inspected investigational review board. In this country, a similar scheme is just off the ground now.

My chief concern is that while your newsletter is prepared to damn a rather useful and very safe treatment on the basis of a totally inaccurate account, it fails to be equally concerned about the long term follow-up and harmful effects of herbal treatment. In the same issue is the suggestion that tincture of berberis is a safe alternative to antibiotics. I have recently dealt with a patient treated with berberin for supposed candida by a herbalist, during which time he developed symptoms of neuropathy in his legs with absent ankle jerks. One of my own patients had a nasty reaction when I prescribed berberin for a resistant blastocystis infection. Once berberin was stopped, both patients recovered. Dr Len M McEwen, Henley-on-Thames….

Thank you for pointing out our confusion in lumping together neutralization and EPD desensitization, which you pioneered in 1966. Although both aim to desensitize the allergic patient in a similar way, the technique for each is very different. In neutralization, which we described, the individual’s allergies are located. He is then tested with different potencies of the allergy until the potency is found that “switches off” allergic symptoms. This potency is given to him for some months either by injection or under the tongue until he becomes “immune” to his allergy.

The EPD method, on the other hand, is less individually tailored and perhaps more comprehensive. A weakened and highly purified mixture of a wide selection of the most common allergic inhalants and foods is mixed together with an enzyme called beta- glucuronidase, found in the human body. This is administered either by injection in the skin, or through the skin, by scraping a small area of the thigh or forearm and administering the EPD “vaccine” by holding a cup over the scraped surface for 24 hours.

Thank you also for the two papers, showing the treatment’s success in treating hyperactivity (The Lancet, March 9, 1985) and ulcerative colitis (Clinical Ecology, 1988; 5 (2): 47-51). Both definitively show that EPD can work for those conditions. According to our Alternatives columnist Harald Gaier, most reports demonstrate that EPD works well with inhaled allergies such as dustmites and hayfever, but is less definitive with food or contact allergies.

EPD and neutralization are undoubtedly lifesaving for many people crippled by multiple allergies. However, the problem is that we have no scientific data on the effect of these “vaccines” over the very long term. I’m sure you will agree that although the anecdotal evidence you cite is encouraging, no patients have been followed over time in a scientific way. According to Dr Sybil Birtwistle, The British Society for Allergy and Environmental Medicine is attempting to address this problem with a strict follow-up on all new cases.

We agree that alternative medicine has the potential to be as toxic as conventional medication. For an entire year WDDTY’s editor suffered side effects from Chinese herbs containing 11 different estrogens-the equivalent of a very strong birth control pill (we later found out through the Poison Control Unit, which analyzed them).

Berberis and most herbs are being subjected to safety studies in countries like Germany. According to Pizzorno and Murray’s Textbook of Natural Medicine, berberine and berberin-containing plants are “generally nontoxic”. In studies on animals, large intravenous doses produced no lethal or gross toxic effects. That does not mean that some patients will not react to the herb or that we should treat it any more cavalierly than we would a prescription drug.

Our policy at WDDTY is to regard all treatments with a degree of suspicion until they have been proven safe. Our Alternatives column attempts to apply that principle to alternative treatments: even the most seemingly benign and encouraging medicines are guilty until proven innocent (and effective).