What does it involve?
The basic technique is to X-ray the lower colon. As the soft tissues in that area look similar in an X-ray, a liquid containing radiopaque barium sulphate is introduced into the colon via an anal enema. To maximise the reach of the barium liquid, the patient’s colon must be as empty as possible, so fasting and laxatives are prescribed for two days before the test.

The test itself has the patient lying on a X-ray table while the radiographer looks at a real-time X-ray (fluoroscope) of the colon, now clearly revealed by the barium liquid. Air is sometimes pumped into the colon along with the barium to improve the quality of the images (double-contrast technique).

The whole procedure takes about half an hour, during which you may be asked to shift position and hold your breath for still pictures to be taken. It is said to be not painful, but you will almost certainly feel bloating, cramping and possibly colonic muscle spasm. These can be partially relieved if peppermint oil is added to the barium liquid (Br J Radiol, 1995; 68: 841-3).

How accurate is the test?
Studies show that it’s about 80-90 per cent accurate in diagnosing colon cancer (Radiology, 1999; 211: 211-4), but it cannot detect tumours smaller than 1 cm. Other intestinal conditions have about the same rate of detection.

What are its dangers?
Barium may remain in the colon and harden, causing severe constipation. It can also produce so-called barium granulomas, where the colon wall is inflamed in reaction to the barium. More serious is perforation of the bowel. Under pressure from the barium or air, the colon may split open, spilling its contents into the abdomen. Those with a colon weakened by inflammatory bowel disease, ulcerative colitis, diverticulitis or Crohn’s are particularly at risk.

With the procedure, the radiation dose is relatively high compared with other tests. Radiologists try to play down the risks, pointing out that the radiation dose is equivalent to 16 months’ worth of normal background radiation. Nevertheless, they do acknowledge that the dose should ideally be reduced (Br J Radiol, 2002; 75: 652-6).

* Fish oil is anti-inflammatory. Supplements providing 2.6 g of EPA/DHA or 3.5-7 oz/day of oily fish can reduce the recurrence of Crohn’s disease.

* Minimise sugar intake to cut your risk of developing ulcerative colitis (UC).

* Diets high in animal fat, cholesterol or margarine significantly increase the risk of developing or aggravating UC.

* Cut out the junk. Evidence suggests that people who eat ‘fast food’ at least twice a week have nearly four times the risk of developing UC than those who do not (Epidemiology, 1992; 3: 47-52).

* Rule out allergies. Some people with Crohn’s also have food allergies, and have been reported to do better when they avoid certain foods. The most likely culprits are cereals, dairy and yeast.

* Vitamin D malabsorption is common in Crohn’s and can lead to a deficiency. Vitamin D supplements can help, but first have a practitioner determine your vitamin D status to find the right level for your individual needs.

* Other deficiencies common in Crohn’s include zinc, folic acid, vitamin B12 and iron. Zinc, folic acid and B12 are all needed to repair intestinal damage due to the disease. Some doctors recommend 25-50 mg of zinc (balanced with 2-4 mg of copper), 800 mcg of folic acid and 800 mcg of B12. Have your iron status evaluated before supplementing.

* Vitamin A is needed for the growth and repair of cells that line both the small and large intestines.

* Colostrum-derived supplements improve gut mucosa status and may encourage natural gut flora growth. They may also exert regulatory activity on the gut immune system.

* Probiotics help the gut immune response and defenses. Helpful strains include lactobacilli, bifidobacteria, Saccharomyces boulardii and non-disease-causing strains of Escherichia coli and streptococci.

* Live yoghurt and kefir may also encourage normal flora growth.

* Investigate homoeostatic soil organisms (HSOs), beneficial organisms found naturally in soil that would have been a regular part of our diets pre-1930. Supplementation can reduce intestinal inflammation. HSO supplements are available from The Nutri Centre (www.nutricentre.com), £35.99 for 90 capsules. Primal Defense supplements are available on the Net.

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.

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

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).

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.

Researchers at Johns Hopkins University in Baltimore followed up earlier studies that found that a cereal-free diet helped remission levels among schizophrenic patients.

They tested the theory on a group of 7,997 patients who were admitted to a Danish psychiatric unit for schizophrenia.

Even before beginning their tests, they found that four patients, five mothers of patients and three fathers of patients were already being treated for coeliac disease. They also tested for Crohn’s disease and ulcerative colitis, which have been linked to schizophrenia.

They discovered that those suffering from coeliac disease were over three times more likely to suffer schizophrenia than someone who didn’t have the disease, while the risk associated with Crohn’s is lower at 1.4 times, and lower still for ulcerative colitis.

(Source: British Medical Journal, 2004; 328: 438-9).