There are many theories about these conditions, but a new perspective on them is given by so called “Darwinian Medicine” (R Lewin, New Scientist, 23 October 1993). According to Lewin, “twentieth century humans are Stone Agers displaced through time”. On a deep psychological level, the body knows that the food it is receiving is not suitable for it. In other words, IBD is in some way part of a protective and healing reponse. Proponents of this theory believe that the unconscious part of the brain governing the body’s bowel response can be reached through hypnotherapy.

Because the link between emotional and gastrointestinal problems is so well established, hypnotherapy is often used to treat both kinds of symptoms.

Psychotherapists have consistently reported an impressive success rate, but this has largely been ignored outside their own circles.

In the October 1993 issue of Inflammatory Bowel Disease, E E Taylor et al published a well designed study to determine whether psychological intervention can reduce both the physical and emotional problems associated with IBD. Participants were recruited from general hospitals into a 20 week programme consisting of relaxation hypnosis, cognitive therapy in tutorials, and hypnosis directed specifically at the gut.

The results showed that 90 per cent of subjects experienced a highly significant reduction in emotional symptoms, and 65 per cent reported a reduction in physical symptoms.

Gut directed hypnosis was most effective in relieving physical symptoms, while cognitive therapy was more effective in relieving emotional ones.

The published data strongly suggest that, regardless of the site, duration and severity of the disease, hypnotherapy (including auto hypnosis) can be effective for IBD sufferers and that it is certainly a safer first port of call than steroid treatment, with its well documented side effects.

Other research (Annals Int Med, 1985, 103: 291-293, and The Lancet 1983, ii: 589-92) found that biofeedback which measures changes in skin resistance and brain waves and psychotherapy, including hypnotherapy, enhanced the results of conservative treatment of IBS.

It goes without saying that none of these therapies should be initiated without the help of a practitioner who is adequately trained and experienced in the treatment of IBD.

Harald Gaier is a registered naturopath, osteopath and homoeopath.

But researchers from the Foundation Jean Dausset in Paris have advanced the argument with an interesting hypothesis. They argue that bacteria that can exist and grow at extremely cold temperatures as low as minus 10 centigrade may be responsible for the disease in susceptible people.

The spread of the disease certainly coincides with the use of refrigerators in the family home, and also the cold processing and freezing of food we buy in the shops.

The first case of Crohn’s was identified in 1913, while the first refrigerating machines were built in 1875 and started to appear in homes in the United States in the first part of the 20th century. But the rise of the refrigerator really occurred after the World War II, just as Crohn’s started becoming a more prevalent disease.

There are just a few bacteria that can thrive in extreme cold, and none has ever been studied as a possible cause of Crohn’s. Perhaps it’s time to start.

(Source: The Lancet, 2003; 362: 2012-15).

Earlier research had suggested that patients would suffer an immediate relapse if they came off the drugs azathioprine or 6-mercaptopurine, but researchers from the Hopital Saint-Louis in Paris found little difference between the two groups, although those who came off the drugs were more likely to suffer a relapse if they were aged 26 or younger, were male and the period of remission was less than four years.

Those who stay on the drugs run the risk of suffering side effects. About 10 per cent of people with inflammatory bowel disease report some adverse reaction. In the research group, 18 of the 157 taking the drugs suffered leukopenia, a severe reduction of white blood cells, four had liver abnormalities, four suffered infections, and four more suffered cancerous malignancies (The Lancet, January 27, 1996).

Anxiety and depression are common in patients with abdominal symptoms (Can J Psychi, 1993; 38: 475-9).Neuropsychiatric complications are evident in at least a third of Crohn’s sufferers, and more than half of these are thought to be the direct result of the disease. These can include headache, depression and eye problems (South Med J, 1997; 90: 606-10). Some Crohn’s sufferers are given tranquillizers as a matter of course, the use of which brings their own unwanted side effects. Though few conventional practitioners are equipped to work in this way, talking cures and effective stress management could be a more effective way of dealing with the emotional fallout of IBD.

Intestinal tuberculosis caused by bacterial disease. Symptoms are almost indistinguishable from IBD, but treatment is very different.Endometriosis of the bowel pieces of the endometrium (womb lining) can attach themselves to the intestine and cause many similar symptoms to Crohn’s.

Diverticultis an inflammation of one or more of the diverticula (pouches) in the wall of the large intestine.

Lymphoma cancer in the lymph nodes can result in liver enlargement. Gastrointestinal and bone problems can result.

Some drugs can cause IBD. For instance, NSAIDs cause ileal and colonic inflammation, sulphasalazine can cause symptoms which mimic Crohn’s. Gold salts used to treat rheumatoid arthritis have also been associated with Crohn-like symptoms.

Food allergy dairy, yeast and wheat can all cause varying degrees of bowel inflammation.

In an animal study, he found that at peak times of the year for stress, up to 25 per cent of cows tested showed positive for M paratuberculosis.Other research has shown that cows can be infected with the bacterium without being symptomatic so clearly the culling of symptomatic cows is not the answer. In one study of asymptomatic cows, 27 per cent were infected (J Clin Microbiol, 1992; 30: 166-7).

It is not only dairy products which are affected. M paratuberculosis can also get into the water supply via infected animal feces. The survival of M paratuberculosis and other infectious organisms in farm slurry is well documented (Nord Vet Med, 1977; 29: 67-70; J Dairy Sci, 1994; 77: 1999-2007; Commun Dis Rep CDR, 1994; 4: R50-1).

It is believed that the majority of the population can tolerate Mycobacterium, but those with Crohn’s or their close relatives who may be similarly genetically disposed may wish to switch to UHT milk which is less likely to be contaminated. Another theory is that the rise in Crohn’s seems to have paralleled the growing use of antibiotics in human and animals. Our overuse of antibiotics may be encouraging the growth of the bacteria in cattle and greater susceptibility in some individuals (Hepatogastroenterol, 1994; 112: 549-51).

He has linked the disease to a bacterium called M paratuberculosis which is found in cows’ milk. The organism, related to the bacteria that cause human and bovine tuberculosis, apparently survives the pasteurization process.

Mr John Hermon-Taylor, from St George’s Hospital in south London, has found minute traces of the organism in at least two thirds of tissues removed during surgery. He has also found the bacterium “intermittently. . . in supplies of whole pasteurized cows’ milk”, he says.

He believes the organism and, so, Crohn’s disease could be eradicated by improved animal husbandry and pasteurization techniques that can destroy it.

His claims have been rejected by the National Dairy Council, which says that low levels of M. paratuberculosis do not survive pasteurization. No other research has found the organism in the tissues of Crohn’s sufferers, the Council adds.

!AMedical Monitor, May 29, 1996.

The UK government is launching an immediate inquiry into the safety of the vaccine, which is currently given to nine out of 10 children. Eight million British schoolchildren were given the vaccine three years ago as a safeguard against a supposed measles epidemic.

The author of one of the five studies is Dr Andrew Wakefield of the Royal Free Hospital in North London, who believes the interaction of the various components of the vaccine could be responsible for causing autism and Crohn’s.

He said the results, based on research from the UK and other countries, “clearly confirm our suspicions and take them further”, he told the medical magazine Pulse.

Dr Wakefield said the number of children developing Crohn’s disease had escalated dramatically since the 1960s when the measles vaccination was introduced in the UK. Doctors are sending him up to six cases a week of children with Crohn’s or with autistic disturbances believed to be brought on by the MMR vaccine.

He suspects the vaccination could also be responsible for inflammatory bowel disease, although there is not enough evidence yet to confirm this.

Chickenpox and measles are more likely to be serious illnesses in adults than in children. A recent outbreak of measles in Greece resulted in 79 adults being admitted to hospital. Seventy six of those who contracted measles had been immunized with monovalent vaccine, which had been the standard preventative before the new generation of the MMR vaccine was introduced (BMJ 1997; 315: 262).

The Hib vaccine protects against Haemophilus influenzae type b, but doctors forget there are two other types of meningitis type d and f which are equally deadly.

The vaccines may open the door for other serotypes to emerge as new threats, two doctors at the Malmo University Hospital in Sweden have warned (Lancet, 1997; 350: 222).

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.