The gastrointestinal tract provides the means by which we chew, digest, and obtain nourishment from food and eliminate indigestible fiber and wastes from the colon. Digestion starts in the mouth and continues in the stomach and small intestine. Most of the food’s nutrients and water are absorbed through the intestinal wall while it is passing through the twenty-six-foot-long small bowel. In the large bowel (colon), remaining water and nutrients are absorbed into the bloodstream, leaving undigested food, toxins, and wastes for elimination. The normal transit time for food to travel from ingestion to stool passage is twelve to eighteen hours.
Over one thousand species of normal bacteria are found in the gastrointestinal tract, and the number of individual bacteria is more than ten times greater than the number of cells in the body (there are 37.2 trillion human body cells). Amazingly enough, the extensive system of lymph channels in the walls of the small bowel is the largest reservoir of immune function in the body. The intake of nutrients here profoundly influences the balance of the intestinal bacteria, potentially favoring growth of harmful microorganisms and profoundly affecting lymphatic and immune system function. This can then promote inflammation throughout the body.
The gastrointestinal tract also houses the body’s “second brain,” known as the enteric nervous system, located in the linings of the esophagus, stomach, small intestine, and colon. Scientists consider it a single entity—brimming with neurotransmitter proteins, produced by cells identical to those found in the brain. This complex circuitry enables the “G-I brain” (the “belly brain”) to act independently, learn, remember, and produce gut feelings.
If the gut is imbalanced, it can profoundly affect your mood and energy. For example, the gut makes 90 percent of a neurotransmitter called serotonin—the “feel good” neurotransmitter. If the bacteria are imbalanced, then you are not able to properly manufacture serotonin, which could cause you to feel depressed, less resilient under stress, and more anxious, and cause you to have sleep problems.
Similarly, if you are feeling highly stressed for a prolonged period of time, it will have a significant impact on your belly brain and potentially create chronic digestive problems. This is especially true with irritable bowel syndrome, which not long ago was described by the medical community as a “temperamental bowel.”
IBS, also called spastic or mucous colitis, is said to afflict over 20 percent of the American population. Women with IBS outnumber men two to one. IBS is the most frequent diagnosis made by gastroenterologists.
The symptoms are a result of hyper-function and malfunction of the gastrointestinal tract, involving the stomach, small intestine, and large bowel. The neural circuitry within the brain is probably involved as well.
The symptoms of irritable bowel syndrome include a change from normal bowel function to periods of diarrhea and constipation, often alternating, with belching, bloating, abdominal pain, nausea, loss of appetite, flatulence, and a feeling after a bowel movement that the bowel has not completely emptied.
IBS patients can either have constipation-dominant IBS (IBS-C) or diarrhea-dominant IBS (IBS-D). IBS-C is characterized by harder, dryer stools and skipping days of bowel movements, usually indicating a sluggish bowel. IBS-D produces diarrhea that is sometimes urgent, explosive, and nearly uncontrollable, may involve liquid stools with white mucous, and may occur immediately after a meal or soon after awakening in the morning, with large meals tending to aggravate symptoms.
Symptoms in women also tend to increase during premenstrual and menstrual phases of the cycle. Physical symptoms are often accompanied by notable depression and/or anxiety, and there is often the preexistence of psychological symptoms, which may worsen with the onset of the physical symptoms. Making the diagnosis requires exclusion of other causes of diarrhea and constipation.
Anxiety is a major contributor to each of these GI conditions. As a result the focus of MMJ treatment is on reducing anxiety, in addition to relaxing the spasm in the smooth involuntary muscles controlling the peristaltic waves propelling food through the entire GI tract, and relieving the inflammation of the highly sensitive mucous membrane lining your gut.
Both indica and high-CBD products can address all three objectives quite well. Among my patients with these chronic GI problems, edibles, and especially juicing when possible (raw cannabis leaves are required) have been the preferred delivery methods. Direct contact with the mucosal lining seems to have a longer and stronger therapeutic effect than inhaling cannabis, although inhalation is also effective for relieving symptoms. Since cannabinoids can reduce motility of the bowel, some patients, especially those with IBS-C, find more effective relief when taking smaller “micro-doses” of the recommended products below.
For treating Crohn’s and ulcerative colitis, I also recommend THCa (a powerful anti-inflammatory) in either a tincture or a transdermal patch. The following is a list of MMJ products and delivery methods helpful for all three GI conditions:
• Juicing raw cannabis leaves—for those without access to fresh plants, THCa tincture, CBDa tincture, and CBD tincture are excellent alternatives.
• Indica and hybrid edibles—gluten-free, without sugar or dairy
• Indica—especially edibles and vaporizing—60:40 or 70:30/I:S, during daytime hours, and stronger indicas (above 70:30) in the evening
• Vaporizing (daytime)—high-CBD strains of flower, especially Harlequin (a 50:50/I:S hybrid), Cannatonic (a 50:50 hybrid), or other hybrids (either 50:50 or 60:40/I:S)
• Topicals—generalized (apply to wrist or ankle for rapid absorption)transdermal patches, especially THCa, 3:2/CBDa:THCa, or 1:1/CBD:THC
• High-CBD tinctures—2:1, 3:1, or 6:1/CBD:THC
• Ingesting high-CBD hash oil—3:1, 6:1, 12:1, or higher/CBD:THC
• High-CBD sativa strains and THC may provide some relief to those GI patients also suffering with some degree of depression
• If depression is not a factor, then I would recommend avoiding sativa and high-THC products
Most gastroenterologists believe the cause of irritable bowel syndrome is unknown. The following factors are thought by many holistic physicians to be contributory:
• Food sensitivity or allergy—most often, in order of frequency, milk and milk derivatives, wheat and gluten grains (barley, rye, oats, and spelt), coffee, chocolate, citrus fruits, corn, eggs, nuts, and potatoes
• Intolerance of sugars—fructose, sucrose, sorbitol, mannitol, and lactose (in milk).
• SIBO—Recently there have been several studies showing that some people who have been diagnosed with IBS may actually have a condition called SIBO: small intestinal bacterial overgrowth—especially if bloating is the dominant symptom. This is caused by an overgrowth of two of the predominant types of bacteria in the small intestine. They ferment certain carbohydrates in food, producing excess hydrogen or methane gas, which causes bloating.
• Bacterial infections—might be low-grade and require highly sensitive stool testing.
• Parasitic intestinal infestation—incidence estimate by some authorities as high as 30–50 percent in IBS.
• Candida (yeast) overgrowth—treatment with antifungal drugs and/or supplements shown to result in great improvement in IBS patients not responsive to food elimination diets.
• Pancreatic enzyme insufficiency—pancreatic enzymes are not secreted in sufficient amounts in response to food, creating more chance for food to ferment or putrefy, therefore affecting gas, bloating, and the motility of the intestine, which can then slow down the movement of food through the intestine.
• Psychological and social stress—creating accelerated motility of the colon in IBS patients experiencing it.
For more in-depth information on the causes of IBS, gas, and bloating, download the free report titled The 7 Causes of Gas and Bloating and What You Can Do About It, by Todd Nelson, naturopath, at www.tolwellness.com.
Successful treatment begins with a thorough investigation for possible causes and triggers of IBS:
• Careful search for bacterial and parasitic organisms, and a digestive stool analysis utilizing a Functional Medicine laboratory especially equipped for sensitive and comprehensive testing of stool specimens; specific treatment then follows for any abnormal organisms found on testing.
• Tracking of triggering foods and emotional stress factors you suspect might impact the waxing and waning pattern of IBS symptoms, done by diet/symptom journal-keeping, which includes recording foods you’ve eaten, bowel movement timing, consistency of stools, and how your gut feels, from which you will quickly learn what foods to avoid and what to include.
• Intestinal permeability functional testing for leaky gut syndrome. (There are several labs that do blood testing for this. See Resources.)
• Hydrogen/methane breath challenge test for small intestine bacterial overgrowth to determine if you have SIBO.
• Food sensitivity testing—blood testing from a highly specialized Functional Medicine lab (see Resources).
Besides the dietary guidelines in Chapter 5, dietary considerations in IBS include the following:
• For IBS-D, begin with the gradual addition of high fiber from primarily steamed vegetables and vegetable soups. Only add raw vegetables and fruit if you are sure they won’t loosen stools or increase bowel movement frequency. Only include beans and lentils if tolerated, adding one to two new foods per week, making careful observation of the tolerance of each.
• Unprocessed psyllium seed powder gradually increased from one rounded teaspoonful to two tablespoons daily tends to stabilize the loose bowel habit. Don’t use wheat or other cereal bran, as it may aggravate the problem if sensitivity to these grains is present. Brown rice may be the best grain, as it may slow down BMs and help form the stool.
• The intake of water should be six to eight glasses daily, sufficient to keep the urine very pale yellow most of the time.
• Thorough chewing and unhurried eating in a relaxed atmosphere are encouraged.
• Sugar is discouraged. Studies have shown that intestinal motility is prolonged by nearly two and one-half times over normal after introduction of a high load of sugar. This disruption of intestinal motility is one of the main problems in IBS. Sugar also encourages growth of candida (yeast), which has been implicated as an additional contributing factor in IBS.
• ProbioMax Plus DF (Xymogen): This powerful probiotic in individual premeasured servings contains different strains of highly researched acidophilus and bifidus, along with Saccharomyces boulardii and immunoglobulin proteins derived from colostrum. It is exceptional in helping reduce diarrhea and loose stools. Empty one packet in water and drink before bed. It may also be taken first thing in the morning. Once bowels are more stable, then switch to ProbioMax Daily (Xymogen): 1 capsule on an empty stomach before bed. If needed, you can also take 1 capsule in the morning.
• Glutagenics (Metagenics): This is a powdered combination of L-glutamine, DGL licorice, and freeze-dried aloe vera. The combination of these three ingredients helps soothe and repair the gut lining, and heal a leaky gut. Take 1 rounded teaspoon in water, morning and night, on an empty stomach, for two to six months.
• Other supplements need to be personalized depending on the Functional Medicine lab test results. For example, you may need herbs to kill infections, or pancreatic enzymes if you are found to be deficient in those.
• UltraFlora IB (Metagenics): 60 billion beneficial bacteria per capsule and highly effective for those suffering from constipation with IBS. Start with 1 capsule morning and night, on an empty stomach, for three weeks, then try reducing to 1 capsule before bed.
• Mag Citrate (Metagenics): The muscular action of the intestine (peristalsis) is dependent on magnesium, which acts as a gentle laxative. Start with 200–300 mg before dinner or at bedtime. You can gradually increase the dose until you experience a loose stool, then slowly reduce the dose until you are having more regular stools.
• Glutagenics (Metagenics): as described in the supplements for IBS-D.
• UltraGI Replenish (Metagenics): a medical food. The recommended dosage is two scoops one to two times daily; contraindicated if SIBO is present.
A food elimination and re-challenge trial should be undertaken if food sensitivity suspicion is high. You can also avoid extended food trials and simply try omitting the more highly suspect foods listed under “Risk Factors and Causes” earlier. Other less common offenders include tea and onions. Placed on a low-antigenic diet limited to a few foods, IBS patients commonly feel much improved within a week. Since food additives can occasionally be a problem, organically grown foods are desirable. Of those who follow a carefully planned exclusion diet, 75 percent experience substantial improvement.
If SIBO is diagnosed, you need to strictly avoid eating certain fermentable carbohydrates that will contribute to bloating, gas, and discomfort. You want to starve the offending bacteria, kill them with a strong professional herbal compound, and restore the bacterial balance. This should all be done under the supervision of a holistic doctor. A good educational website about SIBO is www.siboinfo.com.
Intesol (Metagenics)—enteric-coated capsules containing peppermint oil, chamomile extract, and lavender oil. A German study found clinical improvement and decrease in pain to be twice as great from peppermint oil compared to a placebo. This combination is antispasmodic and can help reduce gas. Take 1 capsule before each meal. Do NOT take if you have esophageal reflux (GERD)/heartburn, since peppermint oil can make it worse.
A mixture of twenty Chinese herbs, including Artemesiae capillaris, Codonopsis pilosula, Coicis lachyrma-jobi, Atractylodis macrocephalae, Schisandra, and others, was recently shown to be of substantial help with IBS symptoms. Herbal teas with antispasmodic properties (chamomile, peppermint, rosemary, and valerian) are soothing. Robert’s Formula is also helpful in treatment (see under “Crohn’s Disease” below).
IBS has been linked to the mental and emotional issues of gut-level fear, distrust, low self-confidence, personal honor, and self-care. There is a tendency for IBS patients to be highly invested in control and self-criticism, and an effort needs to be made to modify the attitudes behind these thoughts and behaviors. Dealing with and resolving the issues surrounding the early childhood origin of these traits is most beneficial. Working to improve the quality of sleep also reaps significant benefits in bringing symptoms under control. Irritable bowel syndrome patients are often worriers, with special concern about work and their disease. Fun, play, and laughter can be highly therapeutic.
Stressful incidents and increased levels of self-imposed pressure are frequently associated with flare-ups of IBS. These recurrences can be modified by insight-oriented psychotherapy, particularly successful when augmented by relaxation training and practice with biofeedback. Some studies have documented 75 percent improvement in physical and psychological symptoms after several months of regular biofeedback practice. Hypnosis is also very effective with irritable bowel syndrome. After an initial series of treatments, the best results occur in patients who periodically—one to three times a year—return for a session of reinforcement. Self-affirmations are particularly effective, especially when repeated during relaxation, biofeedback, or meditation. An example: My intestine is healed and is serving me well.
John K. is a twenty-eight-year-old tech system administrator whose symptoms began at the age of twenty-one, shortly after he began commuting almost two hours round-trip to attend college. He describes this as a very stressful time in his life, both the pressure of the academics and the long commute. Driving long distances significantly increased his anxiety level, which was high to begin with. Associated with the commute, he was making more frequent stops at fast-food restaurants.
His early symptoms were moderate to severe abdominal pain, quickly followed by diarrhea. His visits to physicians were focused on ruling out more serious GI problems, before he was finally given the diagnosis of IBS. The medications he was given were largely ineffective, and he found his greatest relief with smoking marijuana.
This was 2009, the same year Colorado made medical marijuana legally available for sale. Having already experienced the medical benefit of marijuana in a state where it was illegal, he decided to move from Pennsylvania to Colorado.
He began using MMJ shortly after arriving in Boulder, and although it was quite effective for relieving his symptoms once they began, he was still having pain with diarrhea almost daily. Moving from home, he found himself feeling lonely and anxious, in a place where he knew no one. He also started a new job.
It took several years for him to recognize the triggers for his discomfort. When I saw him recently for the renewal of his MMJ license, he felt better and more in control of his GI dis-ease than at any time since it began seven years ago. He had identified several foods, especially red meat and greasy foods, that triggered his symptoms.
When I saw him a year ago, he was quite pleased with his improvement, primarily due to vaporizing or smoking indica strains after work. They helped him to relax and to reduce anxiety and the frequency and intensity of his pain. On his latest visit he reported even greater improvement than the year before. He had found a new MMJ product, the Stratos tablet (1:1/CBD:THC). This product is comparable to an edible in duration (six to eight hours), and John felt that the tablets were more effective than the strains of indica flower he’d been smoking previously.
Earlier this year, he also began seeing a psychotherapist on a weekly basis to help relieve his anxiety. The counseling, together with the MMJ tablets, modifying his diet to eliminate the trigger foods, and sleeping better, has made a huge difference in the quality of John’s life. He also feels as if he has a much greater sense of control, and he’s clearly a happier guy than when I first met him.
Crohn’s disease is a bowel disorder involving inflammation of the entire wall of the small and large intestine, but most impacted is the terminal ileum (the last one-third of the small bowel) as it empties into the colon.
Both Crohn’s disease and ulcerative colitis are considered inflammatory bowel disease (IBD). Crohn’s disease is an autoimmune condition, estimated to afflict more than one hundred thousand people in the United States. A slight majority are women. Age of onset is usually between fifteen and forty. Inflammatory bowel disease is more than twice as common in Caucasians than in non-Caucasians and four times as common in Jews than in non-Jews, and since the 1950s there has been a steady, remarkable increase in the incidence of Crohn’s disease in the United States.
The predominant symptom of Crohn’s is pain in the lower abdomen (usually the right side), often accompanied by episodes of diarrhea, mild fever, loss of appetite, weight loss, flatulence, and a general feeling of malaise or being unwell.
Crohn’s disease leads to a distorted pattern of assimilation of nutrients from the affected segments of the small bowel. The levels of pro-inflammatory prostaglandins, including the extremely potent leukotrienes, are greatly elevated in the wall of the affected bowel. Abnormal bacteria and yeast organisms often overgrow the small intestine, creating secondary problems. Protein is not properly absorbed, and this leads to weight loss in many cases. The complications of Crohn’s—liver, skin, spine, and joint problems, probably stem from the abnormal assimilation of proteins due to the disease itself. As a result of losses from diarrhea or poor assimilation through the inflamed mucosal lining, it is common in Crohn’s disease to have low levels of:
• Vitamins A, C, D, E, and K
• B-complex vitamins—B12 deficient 50 percent of the time; folic acid deficient 25–65 percent of the time
• Magnesium, potassium, calcium
• Iron—dropped levels due to bleeding from inflamed mucosal lesions
• Trace minerals—zinc deficient in 40 percent of Crohn’s patients
• Genetic predisposition (20–40 percent of patients)
• Immunological abnormalities
• Emotional stress
• Infection
• Dietary factors
• Ingestion of excess food allergens, hybridized wheat, and GMO foods sprayed with glyphosate (Roundup), a popular pesticide
The presence of antibodies to a bacterium, Klebsiella, is found in a high percentage of Crohn’s patients and patients who have rheumatoid spondylitis of the spine (a spinal arthritis). In fact, men with Crohn’s are more prone to develop spondylitis. Some physicians believe these facts favor an infectious cause of both diseases. Crohn’s is also associated with arthritis of other joints—wrists, knees, and ankles. Inflammatory skin nodules and canker sores are also more common in Crohn’s patients.
Crohn’s disease and ulcerative colitis are extremely rare in primitive societies not consuming calorie-dense, highly refined, Westernized diets. This dietary influence is significant. The diets of people who subsequently develop Crohn’s disease have been documented to contain substantially less fruit, vegetables, and fiber and to include far more sugar and refined flour foods compared to those who remain healthy. One study found that the amount of sugar consumed by those who later got Crohn’s disease was twice that of healthy matched controls.
Review the anti-inflammatory diet in Chapter 5.
Since the predisposing low-fiber, highly refined carbohydrate intake is considered a significant risk factor for developing Crohn’s, the diet of choice removes sugar and refined flour, gluten (especially hybridized wheat), and GMO foods such as corn and soy, and adds fiber from vegetables, fruits, and gluten-free whole grains such as rice, quinoa, millet, and buckwheat. If you are having frequent loose stools, most vegetables should be steamed or in soups. If you cannot tolerate raw fruits, then try applesauce, bananas, and pears. You should greatly reduce or eliminate meat and dairy products to diminish levels of leukotrienes and inflammation, especially if the meat is commercially raised with antibiotics and other additives. Eat only chemical-free, organic meats. If you continue to eat beef, make sure it’s from grass-fed cows, not cows that are ingesting GMO corn. Increase intake of ocean fish (for example, salmon, sole, cod, halibut, and mackerel), with two to four servings each week.
• UltraInflamX Plus 360 (Metagenics): I strongly recommend drinking this medical food powder. It has been highly effective in patients with inflammatory bowel disease. This should only be done under the supervision of a holistic practitioner.
• Multivitamin/mineral/antioxidant/phytonutrient formula: Take an easy-to-absorb one, such as PhytoMulti from Metagenics: 1 tablet with meals, two times daily.
• Vitamin A: Take 50,000 IU daily during the acute phase or reactivation of the disease. This should be monitored by a practitioner.
• Vitamin C: Take 1–2 gm daily; magnesium, potassium, and calcium ascorbate in Ester-C forms are often less irritating to the bowel.
• Vitamin D3: Make sure your blood level of vitamin D is optimized at 70–80 ng/ml. Until you have a blood test, you can take a maintenance dose of 5,000 IU of D3 daily with food.
• E Complex-1:1 (Metagenics): Take 2 softgels with one meal daily.
• Quercetin: Take 0.5–1 gm three to four times daily.
• Methyl Protect (Xymogen): This provides exceptional methylated forms of folate and B12 that are easily absorbed. Take 1 tablet two to three times daily with food.
• Zinc A. G. (Metagenics): Take 1 pill twice daily with a meal.
• Mag Glycinate (Metagenics): This is a well-tolerated bowel product. Take 1 tablet at breakfast and 2 with dinner.
• Glutagenics (Metagenics): For restoring gut lining health, take 1 rounded teaspoon two to three times daily in water between meals.
• Fish oil (OmegaGenics EPA-DHA 2400 from Metagenics): This reduces the frequency of relapses by 40–50 percent. OmegaGenics is a very strong, economical, pleasant-tasting liquid fish oil. Take 1 teaspoon two times daily with a meal.
• OmegaGenics SPM Active (Metagenics): A fish-oil derivative that accelerates the resolution of inflammation. Begin with a loading dose of 2 capsules three times a day with food for one to two weeks. Then reduce to 2 capsules twice a day for three weeks, followed by a maintenance dose of 1–4 capsules a day.
• Flaxseed oil: Contains ALA omega 3 oil. Take one tablespoonful daily.
• Adequate protein: This is conveniently supplied in amino acid supplements that are derived from foods unlikely to be offending (milk and wheat) and require no digestion before assimilation. Pea and rice protein concentrate will meet this need with a very low chance of allergic reaction (UltraGI Replenish from Metagenics).
• Gamma oryzanol: Take 100 mg three to four times daily (derived from rice bran oil). This is readily available in health food stores.
Commonly used herbs include marshmallow root, wild indigo, ginger, goldenseal, and slippery elm. These are often combined in a traditional naturopathic formulation, Robert’s Formula, that you can get from a naturopath or holistic doctor. It is advisable to consult a health professional for a balanced program before using these botanicals.
Stress plays a major role with Crohn’s disease, just as it does with nearly every one of the most common chronic pain conditions. The issues in the tissues contributing heavily to Crohn’s are very similar to those associated with IBS (see above). All inflammatory conditions and immune responses improve with the reduction of stress that follows consistent practice of relaxation skills, biofeedback, and meditation. It cannot be overemphasized: the mind is infinitely more powerful than we can imagine.
Coltyn T. is a very mature and articulate sixteen-year-old high school sophomore who has had Crohn’s disease since the age of nine. By eleven, he was incapacitated and in a wheelchair. Surgery to remove most of his ileum was recommended, but he declined. As a result of a highly aggressive pharmaceutical treatment regimen, including high-dose steroids and extremely painful injections of Humira, he developed rheumatoid arthritis and lupus.
At his suggestion, his family moved from Illinois to Colorado in order to gain access to medical marijuana (prior to its legalization in Illinois). After seven months on cannabis, taking capsules of hash oil (containing 15 mg THC plus 15 mg CBD) four times a day, Coltyn was in complete remission. He has remained on that regimen for the past two years and “feels great,” with almost no symptoms of Crohn’s, RA, or lupus. He has also become a passionate proponent for MMJ.
• • •
Alyssa C. is a twenty-six-year-old mental health worker who had been in excellent health until one and a half years before when she was initially diagnosed with Crohn’s disease. Only a few months later she developed rheumatoid arthritis, and began treatment with Humira, two (very painful) injections every two weeks; plus prednisone (a corticosteroid) at a dosage of 60 mg daily, which she was to gradually taper over twelve months. Within several weeks of beginning this treatment regimen, she developed adrenal failure from the prednisone, and decided to stop both medications. She currently takes no prescription drugs.
Her MMJ daily regimen consists of the following:
• CBD capsules—25 mg two times a day
• Stratos Relax (hybrid) tablets—one or two times a day
• THCa tincture—once daily
• Vaporizing—either a hybrid or an indica in the evening
She has modified her diet to strict vegetarian and gluten-free, with no oils except olive and coconut. She takes the following supplements on a daily basis: vitamins A, C, and D; calcium, magnesium glycinate, activated charcoal, amino acids, ginger, and turmeric; an essential oil blend consisting of peppermint, tarragon, and ginger; and Glutagenics (Metagenics).
She has been essentially symptom-free (from Crohn’s and RA) for much of the past year on her current MMJ/holistic regimen. The day before seeing me for the renewal of her MMJ license, she had a colonoscopy performed by her gastroenterologist (the first one had been done at the time her diagnosis was made, a year and a half earlier). The result: “He was blown away by what he saw. There was no inflammation!”
Ulcerative colitis is a chronic inflammatory disease of the large bowel (colon), occasionally affecting the lower part of the small bowel. The inflammation of the bowel wall is so intense that ulcer-like erosions of the tissue lining the bowel are created.
Upward of four hundred thousand people in the United States are thought to have ulcerative colitis. Onset is typically between the ages of fifteen and thirty-five. It strikes women more often than men, Caucasians more often than blacks, and those of Jewish descent more often than others. Like Crohn’s, it is rarely seen in indigenous peoples.
The most frequent symptoms of ulcerative colitis are bloody diarrhea, low abdominal cramps, loss of appetite, and sometimes fever. Malaise and weight loss are common. The highly inflamed and ulcerated surface bleeds extremely easily. A common pattern ensues in which phases of partial healing are interrupted by acute relapses.
Conventional medical treatment of both ulcerative colitis and Crohn’s disease typically includes a sulfa antibiotic, Azulfidine (sulfasalazine), and often large doses of corticosteroids (prednisone) to suppress the inflammation in more severe cases. The dosages of prednisone or other potent synthetic cortisone derivatives are then slowly tapered off to avoid the long-term serious consequences of steroids in the body. These side effects include:
• Suppression of the immune system
• Overgrowth of yeast organisms in the intestine
• Osteoporosis
• Weight gain that spares the limbs
• Moon-faced appearance
• Development of prominent blood vessels in the skin
• Wasting of muscle protein
• Promotion of diabetes
• Loss of neuronal connections in areas of the brain
Rarely, all medical measures fail, and surgical removal of the colon or diseased portions of it becomes a necessary life-saving measure. Patients who have relapsing ulcerative colitis for fifteen to twenty years are at a higher risk for the development of cancer of the bowel and rectum and need regular assessment because of this.
The cause of ulcerative colitis is currently unknown; the following are possible contributors:
• Genetic factors
• Infectious agents—numerous theories implicate viruses or bacteria as a cause.
• Nutritional factors—inflammatory bowel diseases are seen scarcely, if at all, in indigenous cultures on whole food diets.
• Food allergies and food sensitivity—although this is not usually mentioned in conventional textbooks, the consistent substantial improvement with treatment by elimination and exclusion diets, or parenteral feedings (intravenous nutrition only, with nothing by mouth), lends strong support to this possibility.
• Disorders of the gut microbiome and imbalances in bowel bacteria may be a contributor.
• Immunity—the immune theory classifies ulcerative colitis as an autoimmune disease similar to rheumatoid arthritis and lupus erythematosus. Anti-colon antibodies have been demonstrated in some studies, lending support to this view.
• Psychological and emotional factors appear to play a significant contributory role in this disease.
Carrageenan, a commonly used food stabilizer in the nutrition industry, induces ulcerative colitis in guinea pigs. It may exert its damage when combined with the presence of a specific bacterium, Bacteroides vulgatus. The latter is six times more common in ulcerative colitis patients compared to normal healthy controls. Carrageenan should be avoided in ulcerative colitis patients until further research information on this question emerges.
Comprehensive testing is recommended for the functional status of the intestine and bowel. If pathogenic organisms (bacteria or parasites) are identified, specific treatment is as follows.
Bowel rest is recommended in the acute phase of the disease. With severe symptoms, nutrition needs to be supplied by products that yield low fiber residual, reducing the stimulation and work required by the diseased bowel, such as UltraGI Replenish by Metagenics, or MediPro by Thorne Research (Dover, Idaho). In more severe cases of acute onset, intravenous feedings with nothing by mouth for a few days is necessary to sufficiently rest the bowel.
Caloric malnutrition often occurs because of poor assimilation of nutrients and declining appetite. This is more common when diarrhea is severe; optimum treatment makes use of a higher fiber diet without utilizing wheat bran.
A food elimination protocol is recommended to confirm or rule out food sensitivity as a possible cause of ulcerative colitis. When food sensitivity is found to be the central issue, as it is in some colitis patients, appropriate exclusions from the diet bring great and long-lasting improvement. Occasionally, the elimination of offending foods is permanently curative. In general, elimination of dairy products, sugar, and wheat is a likely place to start. Other more commonly found offenders are eggs, corn, cocoa, peanuts, oranges, soy, pork, beef, and chicken. Coffee, although it is a non-food, belongs on the list as well. Following a food elimination program is time and effort well spent.
High amounts of micronutrient support are necessary in the acute and chronic phases of this disease. A potent, daily, megadose multi-vitamin-mineral combination needs to include high amounts of antioxidant vitamins C, D, E, K, and B12 and folic acid. I recommend PhytoMulti from Metagenics and a dosage of 1 tablet twice daily with food. Azulfidine, if used long-term, hastens the loss of folic acid, and extra intake is necessary. PABA (para-aminobenzoic acid), a B-complex vitamin manifesting anti-inflammatory and anti-fibrotic effects, is effective in doses of 2 gm four times daily.
Mineral deficiencies are common in inflammatory bowel disease of all kinds; anemia and iron deficiency are common because of persistent bleeding; extra losses of calcium, magnesium, potassium, and zinc occur with diarrhea. The PhytoMulti mentioned above should provide basic, broad-spectrum nutrients that are easily absorbed. In addition, you might want to consider adding:
• Vitamin B12: Take 1,000 mcg of methylcobalamin in a sublingual lozenge.
• Vitamin C or magnesium-potassium-calcium ascorbate: Take 1–2 gm daily.
• Vitamin D3: Take 5,000 IU daily. (Have your vitamin D level checked periodically with a blood test.)
• Vitamin E: Take 800 IU daily.
• OmegaGenics SPM Active (Metagenics): Same dosage recommendations as for Crohn’s.
• Folate: 3–5 mg daily. (I recommend 5-MTHF [Xymogen] 1,000 mcg one to five times per day.)
• Quercetin: 1/2–1 gm three to four times daily.
• Glutagenics (Metagenics): 1 teaspoon three times daily for two months, then reduced to twice daily for another three months. (This will help to heal the gut lining.)
• Hemagenics (Metagenics): 1 tablet two to three times daily with food if iron is low and you are anemic.
• OSAplex (Xymogen): Take 1 packet two times daily with food for easily digested forms of calcium, magnesium, vitamin D3, and vitamin K for bone health.
• Zinc A. G. (Metagenics): 50 mg twice daily with food.
• Potassium: 500–700 mg daily.
• Gamma oryzanol: 100 mg three times daily for four to six weeks.
• Dehydroepiandrosterone (DHEA): If levels are low, modest replacement doses are helpful, usually 10–20 mg daily for women and 15–25 mg daily for men.
Herbal remedies not yet subjected to controlled studies but long in common use to treat ulcerative colitis include goldenseal (2–3 capsules four times a day in the acute phase) and Robert’s Formula, or its modification Bastyr Formula, from Eclectic Institute or NF Formulas.
In healthy people, the mucous blanket that protects the intestinal surface contains mucins that have been found to be distinctly abnormal in active phases of ulcerative colitis yet normal in remission. Herbs that are helpful in promoting mucus secretion are deglycyrrhizinated licorice-DGL (found in Glutagenics, mentioned above), slippery elm, and marshmallow root.
Stress. Physicians familiar with many cases of ulcerative colitis see a consistent pattern, with onset often associated with some acutely stressful life event. Large studies have linked recurrences to the stopping of smoking. Why would smoking deter the recurrence of this illness? If the stress theory is accepted, one can theorize that smoking might be an outlet for the expression of tension and anxiety; when that outlet is no longer available, the stress-generated responses find their way to expression in the body.
The answer lies in the incorporation of the excellent techniques that are helpful in nearly all disease: the relaxed state achieved through the practice of biofeedback, meditation, imagery, quiet contemplation, autogenics, or progressive relaxation. Hypnotherapy too, particularly in conjunction with other methods, can be of enormous assistance.
Extensive early studies of ulcerative colitis patients showed that the conversations of subjects, especially at times of recurrences, were often sprinkled with statements expressing a desire to get rid of their stressful troubles. Ulcerative colitis and diarrhea have been found in numerous studies and clinical experience to be related to high levels of anger, particularly when the patient possesses no socially acceptable skill for the expression of his or her hostility. If you have ulcerative colitis, even the chance to talk about your feelings, without acting them out, may be a novel experience for you.
The attitude most often underlying the emotional experience of anger is hostility; indeed, ulcerative colitis patients are found to have tendencies toward hostility, conformity, and rigidity more often than comparison subjects without ulcerative colitis. Ulcerative colitis is also one of the diseases in which the initial episode is often associated with the loss of an important relationship. Appropriate counseling and personal work to help alter the psychological dynamics, attitudes, and worldview under which you are functioning can have an enormous payoff, with lessening of symptoms and normalization of bowel function. Clearly, ulcerative colitis is one of the many gastrointestinal dysfunctions that are more than organ-specific problems. These dysfunctions are only local manifestations of a systemic or generalized problem, which has many aspects—mental, emotional, nutritional, hereditary, allergic, neurological, and hormonal. To approach anything resembling a cure frequently requires a comprehensive, holistic approach.
Michele B. is a sixty-two-year-old self-employed small-business owner (computer repair/website building), with a sixteen-year history of ulcerative colitis. After being diagnosed in 2001 (at the time, she had just completed several courses of antibiotics for a dental infection, and was also experiencing lots of stress), she was prescribed Asacol and prednisone. The prednisone “made me crazy, with bizarre behavior and major mood swings. I had to stop taking it.” The other recommended medications were Humira and methotrexate, which she said were “horrible.”
Following the diagnosis, she stopped smoking cigarettes and began investigating more natural treatments, such as diet and supplements. However, she continued having colitis attacks, with severe diarrhea, bleeding, gas, and bloating that could last for months. Since MMJ became available in Colorado in 2009, she’s been using it daily and her attacks have gradually become much less severe (no bleeding or pain) and less frequent, occurring approximately two to three times a year. And they last no longer than one to two weeks.
She currently ingests hybrid or indica edibles on a daily basis, and occasionally smokes or vaporizes hybrids for pain. In July 2016 she experienced a shamanic long-distance energy healing, and was in complete remission for over four months before having a mild attack triggered by stress. She’s aware that her diet has a significant impact on the severity of the attacks but “it’s definitely stress that triggers them.”