Sue appeared in discomfort as we began our discussion. She had been experiencing bloody diarrhea for the past four weeks. At a dinner engagement the previous week she had to leave early because she was spending much of the event running to the bathroom. Normally a high achieving professional that is always on the go, her stomach has felt painful since the onset and she has felt feverish. Sue was hoping this was a stomach infection or maybe a hemorrhoid. What she feared was that she was experiencing Ulcerative Colitis that her Aunt complained about.
Ulcerative Colitis (UC) is considered an Inflammatory Bowel Disease that involves the gastrointestinal tracts whose cause is largely unknown. It normally occurs between ages 15 and 30 years old or between 60 and 80 years old, but can occur at any age. Theories exist regarding the cause being due to immune cells attacking the body. In addition, some researches think it is due to a virus or bacteria.
So what goes wrong UC? A healthy colon has several layers of lining that provides protection against inflammation and infection and aids in absorption. In UC, this system is disrupted and there are ulcers, wounds, and inflammation in the colon wall causing a breakdown in this protective barrier. Sometimes this process will extend up into the small intestine .
Severe cases of UC can cause major weight loss, decreased immune function, and changes in the blood function (i.e. Anemia). In some, surgical removal of the diseased colon in recommended. People with UC have an increased risk of Colon Cancer related to time duration of having UC. The cumulative likelihood of cancer is about 3% at 15 yr, 5% at 20 yr, and 9% at 25 yr, representing an annual risk of about 0.5 to 1% after the 10th yr. There is also an increased risk of Osteoporosis in UC. Other complications exist in UC including joint pain in 25% of sufferers.
During the visit I began my investigation of the root cause of her symptoms. After completing a physical exam, I ordered a complete blood test and chemistry panel. I also ordered an antibody test called P-ANCA (p-antineutrophil cytoplasmic antibodies) which appears in about 70% of people with Inflammatory Bowel Disease. Once the P-ANCA came back positive, I referred Sue to a Gastroenterologist for a more through exam of her colon through a sigmoidoscopy. The exam confirmed that Sue indeed had UC and her Gastroenterologist prescribed Asacol, which is an anti-inflammatory medication specific to the colon. Medications commonly employed including corticosteroids and Sulfasalazine were discussed as future options. Other options were presented to her such as surgical removal of the diseased part of the colon if her condition worsened .Sue began taking Asacol and scheduled frequent follow-up visits with her Gastroenterologist.
Sue returned to my office inquiring if any natural medicines would be helpful. I explained that one strategy in managing UC is following a diet that reduces inflammation in the gut. Sue learned about and initiated the specific carbohydrate diet invented by Elaine Gottschall. This diet chooses specific sugars and starches that are easier to digest. Specifically, the diet strictly eliminates grains, lactose and sucrose from every meal.
With UC, Sue may be at risk for certain nutrient deficiencies. Therefore, she started a quality Multivitamin. Some of the common deficiencies in UC include Vitamin E, Vitamin D, Magnesium, Zinc, and Vitamin B12.
We discussed that un-managed stress may be a trigger in the exasperation of UC. And, employing certain mind-body therapies such as visualization, Tai Chi, yoga, Buteyko© breathing, meditation, or progressive relaxation may be of great benefit. She chose to take up Yoga at her local health club to help manage stress.
Sue also started a probiotic supplement which is becoming a staple in UC. A probiotic includes strains of healthy bacteria taken in pill to aid in digestion and immune defense. Some specialized manufacturers offer dairy-free probiotic strains (contact me for a list of these manufactures). Other important supplements in UC that may be beneficial are antiflammatory herbal extracts like Curcumin which acts on some similar pathways as many of NSAIDS and appears to work well with Asacol.
There are other aids that may become helpful for Sue such as Butyrate Enemas, and Fish Oil supplementation, but for now her plan seems to be helping. Sue currently maintains remission. It is comforting to her to have regular follow-ups with her Gastroenterologist, for long-term medication management.
UC is serious condition effecting people worldwide. Fortunately, there are ways that conventional medication and Naturopathic Medicine can integrate to reduce the severity of the disease.
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