January 11, 2017 at 12:20 pm #1276Claire ClerkinParticipant
I would love some help with a female client suffering with long-term colitis. Here are the key details:
– 74 YO female
– diagnosed in 1991 with colitis
– she has been symptom free for 7 years using the drug Questran – her last scope indicated excess bile salts
– latest flare has been ongoing since May this year.
– diarrhoea c.15 times per day and this has increased incrementally since May and can be up to 20 times daily. It seems to be worse for eating a warm meal.
– awaiting results for coeliac disease
– always had issues digesting fatty meals (she reports since the first consult) and finds red meat difficult to digest.
– eliminated pulses, green veg, dairy, tomatoes, peppers, nuts, seeds, citrus and strains soup to avoid too much fibre. She doesn’t feel much better for it.
– terrible sleeper, waking several times a night (although not to go to the loo).
– ongoing sinus congestion – no better for cutting dairy.
– currently suffering from thrush
I searched similar posts in this group and on consideration advised her to incorporate stewed apple, increase anti-inflammatory foods, avoid carrageenan in some of the dairy free products and try a grain-free diet for one week. I suggested the following supplements:
– Cod liver oil
– Biocare Nutrisorb
– Vitamin D
– Saccharomyces Boulardii, working up to 4 caps per day
After a couple of weeks, the diarrhoea had not improved and she was feeling worse for taking the cod liver oil. I advised her to stop the oil and try some digestive enzymes. However, she is since experiencing more ‘turbulence and wind’.
Despite being up for trying anything, she is feeling poorly and continuing to lose weight and I am worried she will lose faith in this approach.
So, any advice on how to proceed when I see her next week would be welcomed. Thanks in advance.
Consider further testing for pathogenic bacteria, fungi and parasites if it hasn’t been done yet. I like GI-MAP from Diagnostic Solutions Laboratory because it’s DNA testing rather than antibody testing and quite extensive.
Posted By Clare Clerkin 1/11/17
March 18, 2019 at 12:23 pm #1277Christine BaileyModerator
Many thanks for your question regarding your client with ongoing symptoms linked to colitis. I suspect the reason for her reaction to the fish oil is linked to her gallbladder function as you have already mentioned bile salts. Therefore, your client is likely to benefit from reducing fat in her diet particularly saturated fats which can also be inflammatory. She is already taking Cholestyramine which is typically used in people with too much bile acid caused by a certain type of liver/bile duct disease (partial biliary obstruction).
It is also linked to gut dysfunction including coeliac disease, so I would strongly recommend removing all gluten from her diet. One of the issues with bile salt malabsorption is low levels of the fat-soluble nutrients – vitamin A, D, E and K. Do consider testing for these via a blood test e.g. Biolab. She may find that phosphatidyl choline could be helpful as well.
Looking at her ongoing symptoms I suspect there is an underlying gut infection and therefore I would consider a comprehensive stool test and include Helicobacter pylori as well. In view of her diarrhoea which may be linked to bile issues consider whether there is a need for electrolytes as well. It may also be the case that digestive function is compromised so consider use of either stomach acid support and / or digestive enzyme support. I would avoid dairy and anything that contains lactose and temporarily while you await for the tests results you may wish to consider a low FODMAP style of eating as it appears many of the high FODMAP foods already aggravate her.
As she is losing weight I suggest she eats every 2-3 hours and includes sufficient protein and slow releasing carbohydrates to support energy levels. She may actually benefit from a low allergen protein powder and / or inflammatory powder such as Wholly Immune. If she can tolerate some fermented foods like coconut kefir then she could try these but the fat content may be too high for her. Certainly, bone broth and collagen can be very useful and easy to tolerate.
Fish oil may be a useful therapeutic agent in the management of colitis. Studies on the use of dietary supplements of fish oil-derived fatty acids have indicated a beneficial effect in inflammatory bowel disease. Recent studies suggest that marine fish-oil supplements, which are rich in omega-3 fatty acids, may reduce the inflammation associated with ulcerative colitis. Fish oils may exert their anti-inflammatory effects by modulating tissue levels of certain immune factors that promote inflammation.
Uchiyama K, et al. N-3 polyunsaturated fatty acid diet therapy for patients with inflammatory bowel disease. Inflamm Bowel Dis. 2010 Oct;16(10):1696-707. http://tinyurl.com/yct39fw3
There is evidence to suggest that the metabolism of butyrate-the major fatty acid fuel source for the epithelial cells lining the colon-is impaired in ulcerative colitis. Studies on humans suggests that topical treatment using sodium butyrate may reverse symptoms in ulcerative colitis. Several reports on the use of butyrate enemas for the treatment of distal ulcerative colitis have appeared in the literature. One study showed a striking increase in colon cell mucin synthesis when butyrate was added to standard nutrient medium. The therapeutic effect of butyrate on colitis may be due to its ability to boost the rate of mucin synthesis and restore the colon’s mucous lining.
Assisi RF; GISDI Study Group. Combined butyric acid/mesalazine treatment in ulcerative colitis with mild-moderate activity. Results of a multicentre pilot study. Minerva Gastroenterol Dietol 2008;54(3):231-8. http://tinyurl.com/y8y5zwx7
Di Sabatino A, Morera R, et al. Oral butyrate for mildly to moderately active Crohn’s disease. Aliment Pharmacol Ther 2005;22(9):789-94. http://tinyurl.com/ycjmuv6f
Fibre is an important component of the diet. Dietary fibre contains soluble and insoluble substrates. Soluble fiber components are fermented by colonic micro flora, with the resultant production of short-chain fatty acids and gas. Short-chain fatty acids (such as butyric acid) are important fuels, not only for colonic mucosa, but also for the small intestine through secondary metabolism to glutamine and ketone bodies. Soluble fibres include apple pectin, guar gum and psyllium – these may also help with the diarrhoea. However please bear in mind that if she has significant bloating you need to address any potential gut infection first.
Colitis patients often suffer from multiple nutrient deficiencies. Supplementation with an all-around multi-nutrient formula may be helpful. I would also consider long term related issues such as osteoporosis especially if levels of vitamin D and K are compromised.
Clinical trials of probiotic use in IBD populations have indicated beneficial effects. Duration of trials and organisms employed has varied, but there have been several instances of positive results. A 2011 trial using a probiotic (Bifidobacterium breve) as well as a prebiotic (galacto-oligosaccharide) demonstrated a marked improvement in clinical status of people with ulcerative colitis
Ishikawa H, et al. Beneficial effects of probiotic bifidobacterium and galacto-oligosaccharide in patients with ulcerative colitis: a randomized controlled study. Digestion. 2011;84(2):128-33. Epub 2011 Apr 28. http://tinyurl.com/y92b82ng
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Wholly Immune (ARG): 1 scoop daily in 8oz liquid. http://tinyurl.com/33v5um9 Contains nutrients (B complex vitamins, vitamin C, vitamin A), botanicals, and mushroom extract to lower inflammation and support immune health
KappArest (BRC): take 2 tablets three times a day http://tinyurl.com/jms9v3n
Arthred Collagen Powder (ARG): take 1 tbsp three times daily http://tinyurl.com/j2arfe4
BioBifidoBact Powder (BRC): take 1 tsp daily
Fatty Acid formula
Super EPA (Small) (ARG): take 2 daily
Modified Citrus Pectin (ARG): take 1 tsp twice daily
Vitamin D3 Complete (ARG): take 1-2 daily based on vitamin D levels http://tinyurl.com/jqx3ttt
Support for Fat digestion
Phosphatidyl Choline (BRC): take 1-2 daily with meals – http://tinyurl.com/jq7923l
Full Spectrum Digest (ARG): take 1-2 with each meal
I hope this helps with your client
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