Natural Anti-diarrheals for IBD

Most natural diarrhea remedies you find on the web do not apply to folks with IBD. They assume your diarrhea is caused by something that 'will pass' with time. i.e., they assume if you can manage the symptoms, kill the infectious agent, and/or stay hydrated for a few days, then you'll be fine--Not so with IBD.

In IBD, your diarrhea is most likely due to one or a combination of the following:

Damaged Intestinal Wall- Damage to the intestinal epithelium impairs, for example, the ability of your large intestine to transport water and salts, causing fluid to accumulate in the colon. Damage caused by inflammation results in poor absorption and digestion of food, which increases transit time in the gut, adding to your diarrhea.

Food Intolerance- Although there are few actual food allergies, there are lots of food intolerances, especially in people with IBD. The only way to know if you have an intolerance to a specific food is to track your diet, and track your symptoms, to see which foods exacerbate your symptoms. (See my posts on diet tracking, and symptom tracking) Of course the first and best diet-related step you can do is to start the Specific Carbohydrate Diet (SCD).

Prescription Drug Use- Some of the drugs that allopathic doctors prescribe have diarrhea as a 'side effect'. Asacol is an example of one such drug. Curious that we take a medicine that gives us diarrhea to get rid of inflammation that causes diarrhea...

Natural Diarrhea Remedies
Most natural remedies just won't work for those of us with IBD. For example, a crushed clove of garlic may work for mild food poisoning in people with a normal gut, but for people with IBD, raw garlic can often cause massive D and exacerbate other symptoms. I've compiled the list below of IBD-friendly natural treatments for diarrhea. Keep in mind that the goal is to heal the root cause, not mask the symptoms, so while these treatments will decrease the severity of your diarrhea, they should be used in conjunction with a comprehensive natural IBD healing program such as the Specific Carbohydrate Diet, natural healing protocols from Listen to Your Gut, or treatments that your naturopathic physician has given you.

Below are a few natural treatments you can try that will help alleviate diarrhea. There are oodles of these out there, but I've only listed the remedies that I have either tried myself, or I've seen from multiple, trusted sources. I've labeled the remedies that are SCD friendly.

L-Glutamine- (SCD Friendly) L-Glutamine, on an empty stomach has a soothing and rebuilding effect on the inner lining of the intestine. Take anywhere from 1-5 grams of free-form L-Glutamine powder (no additives, no mixes, nothing but L-Glutamine) in divided doses throughout the day. This works best if you take the amino acid on an empty stomach. Start slowly (dosages are usu. 1/4 tsp) with one dose/day, and build from there until your diarrhea is under control.

Probiotics- (SCD Friendly) Probiotic therapy has been shown in placebo controlled, double-blind studies to be effective in alleviating the clinical manifestations of Colitis, and thus will decrease your diarrhea. The key with probiotics (and with any natural treatment for IBD, really) is to start slowly. While tracking your symptoms and diet, begin with 1/4 tsp/day, and slowly build to a therapeutic dose of 8-12 Billion CFU (Colony Forming Units). I"ve taken doses as high as 40 billion CFU. Keep increasing the dose until you notice your symptoms are improving.
You should use a probiotic that guarantees potency, is sealed in glass, and comes cold (to ensure that you are ingesting live bacteria). Avoid any product that doesn't list the serving size and CFU per serving on the label. See this post on probiotics, and this one on the probiotic retention enema. Jini Patel Thompson has some of the most detailed work on probiotics for IBD that I've seen. I highly recommend reading her book, Listen to Your Gut, for more information on probiotic (and other) treatments for IBD.

Bentonite Clay- (Not SCD Friendly) Bentonite clay is gray-ish colored and does not taste. It provides a 'filler' for the gut. By absorbing excess water and fluids, it is a good detoxification agent for the gut. The active ingredient is montmorillonite. Do not take Bentonite clay in conjunction with probiotics, as it also removes bacteria from the gut (i.e., the probiotics you just swallowed). Again, start small and note the effects. I'd start with 1/2 tsp/day and work up from there SLOWLY until you reach the desired effect.

Onward to Health.

Probiotic Retention Enema

Caution: When I first tried probiotics, 9 months ago, a small amount (10% of a therapeutic dose) caused me extreme D, fever, abdominal pain, chills, and uncontrollable shaking. TAKE IT SLOWLY. I suggest not trying probiotics until at least three months after you've started the SCD. I slowly increased my dosage over a 6 month period, 1/4 tsp every two weeks, sometimes less. It's very likely that probiotic therapy will work for you, but you have to introduce them slowly.

I've had the book Listen to your Gut, for 11 months now, and am slowly trying Jini Patel Thompson's suggestions (the one's that are SCD or mostly friendly) along with the SCD. Her book is reviewed on my reading list.

For the last two weeks I have been trying her Wild Oregano Protocol. Wild Oregano is a natural antibiotic and anti-fungal. Her protocol is a mix of natural antibiotic and probiotic therapies to rid your system of over infestations of yeast, and to shift the bacterial ecology of your gut.

Yesterday, I tried her probiotic retention enema, after a particularly bad gut day (I must have eaten something that really irritated my system). I took the enema at 1:30p after a BM (so my system was cleared out), but didn't bother with the warm water enemas she suggests (given the amount of liquid D I had, my system was pretty clean already) as they most likely just cleanse the lower colon. I had no trouble retaining the mixture for the full 2 hours, but experienced one bout of liquid D that evening (some Herxhimer reaction, no doubt), and my mood darkened significantly. I became tired and irritable.

This morning I woke up and didn't have the urge to go. That was enjoyable. My mood today has been light and fun. This afternoon, 24 hours after the enema, I had my first completely normal, formed, slow and pleasurable poo in 19 months*. --Thanks Jini. Read another probiotic retention enema success story from the Crohn's Boy blog here.

The probiotics I take from Natren are not SCD friendly, per se. My theory is that the probiotic bacteria will use the non-SCD friendly medium you ingest as food. They should consume it all, so that it won't interfere with the SCD. The Healing Crow (great SCD learning on that site) confirmed this for me with an email from Elaine Gottschall, herself--read it here. That said, the benefits of proven, probiotic therapy in conjunction with the SCD likely outweigh the small amount of non-SCD legal substance in the growing medium.

*The SCD has made a dramatic improvement in my health. It has taken me down from 8-24 trips to the bathroom to 1-2 trips per day. I've regained my energy and stamina, but my system is still, after almost a year on the SCD, not totally normal. My stools are loose, and my colon is still sensitive, indicating that I still have some inflammation. Some people, like me, will need to combine therapies with the SCD to reach full healing.

Onward to Health.

SCD and Probiotics, Interesting Experience

Short Post:

I noticed a difference in my symptoms only 4 days after starting the SCD. I don't know what the typical healing time is for people, though I gather some from blogs, chats, etc. From the start, my symptoms got better and better for about 4 months. Then they seemed to level off at a normal 1-2 trips to the bathroom per day, but the stool was not solid, and I was still gurgly. My doctor considered this full remission. I was unsatisfied. It could be something I'm doing wrong on the diet, something wrong for my body, but I'm (still) at a loss to figure it out. So, after 4 months of SCD, (2 months of unchanging, 90% healing) I started probiotics. For the past 6 months, I've been taking 36 Billion CFU per day of a mix of bacteria. Still at 90% with a few days here and there at 100%. Colonoscopy at 8 months on the diet showed little change in intestinal inflammation, though I felt great. Hmmm? Then I started taking B. Infantis and my world changed. I transitioned to 100% in about 48 hours. Hmm again? Curiosity being my only real gift, I quit probiotics for a week to see if they had been helping or not. Indeed, 2 days into my 7 day trial, my stools loosened and filled with mucus. Oops! After the week trial, I went immediately up to 48 B CFU, a mix of B. Infantis and L. Bulgaricus. Back to normal. Lesson learned.

Bottom Line Learing: The SCD induced remission for me, but progress stagnated after 4 months. The combination of SCD and Probiotics has put me over the hump. We'll know for sure at my next scope, Feb, 2011.

Probiotics and Insurance

Will insurance pay for my probiotic treatment?

It's not standard for insurance companies to pay for non-traditional (read: non-pharmaceutical, non-interventionist) treatments, so lots of folks don't try. The industry is changing however, complementary and non-traditional methods are beginning to become main stream. Preventative care is a good example of that. More and more plans are making allowances for preventative care. Mine even allows for massage, and acupuncture. Heck, in the future maybe they'll pay for part of my gym membership, or buy me some running shoes.

Seriously-- If you have Crohn's or Colitis, your doctor can prescribe probiotics as a proven treatment. VSL#3 has been proven in statistically significant, placebo-controlled, double blind studies to reduce inflammation in the large intestine. (I don't provide those links to promote VSL #3, but to demonstrate that by becoming an expert, and showing your Dr. the studies--you can gain a lot of treatment latitute and respect from your GI)

The elemental diet has been proven (also statistically significant) to induce remission at least as effectively as Prednisone (read: Steroids). So if Probiotic treatment is appropriate for you, then ask your Dr. to 'prescribe' it as an essential treatment. There will likely be a letter of medical necessity you will need, and you'll spend a lot of time on the phone, but...We'll let's put it this way: A therapeutic dose (10+ B CFU) of probiotics can cost almost $400/mo. Ouch!

My insurance would not cover probiotics per se, but my flexible spending account (tax-free set aside for medical expenses) covers them. All they needed was a letter of medical necessity from my Dr.

Wish they'd cover the cost increase in my grocery budget since I started the SCD.

Onward to Health.

Short-Shorts: Probiotics, Recipes, Traveling

These short-shorts are my way of pacifying blogging ADD.

• I recently started taking B. Infantis. After 8 months on the SCD, I still didn't have well formed stools, though everything else seemed normal. I added this probiotic, and WHAMO!, formed stools literally overnight. Read about the benefits of B. Infantis here and here. One note: There's a lot out there about probiotics and IBD (read: Crohn's/Colitis). It's important to understand that no one really knows for sure which strains or strain combinations help and which hurt in IBD writ large (and more importantly why). For example, Bifidobacterium have been shown to cause bacterial overgrowth in the large intestine, and may cause harm in IBD patients. But--note that B. Infantis is a bifidobacterium. So are some of the other strains shown to help (see below). Hmm?
• More on Probiotics. Benefits of B. Longum. Note the apparent conflict between the two articles on B. Infantis, B Longum and Elaine's research on Bifidus causing overgrowth in the large intestine. Who's right? (Both may be correct!) Which helps, which hurts? Things that make you go, Hmmmm?
• Recipies online. Also here.
• SCD cookbooks from Lucy's Kitchen Shop.
• Check out the FAQ on SCDdiet.org. There's lots to learn there when you're first starting. Lots of the topics I cover are mentioned there too. The reason I write on them is that I think their coverage of some of these topics is pat and short. When I first read their posts, walked away still hungry for more details. This Q&A on traveling on the SCD is good.

Onward to Health.

How I handle cravings, Peanut Butter Brownies (recipe)

Even after almost a year on the SCD, I still get cravings for non-SCD food--Beer and Bread mostly. In other posts, I've alluded to the fact that I handle these cravings with gluttonous indulgement. I indulge in SCD-friendly desert. I eat as much of it as I want. Of course I exercise a lot, so weight has never been a concern for me. Also, the SCD is leaner and healthier than most any diet you've probably ever been on, so if you're doing the SCD healthily, then you should naturally lose some weight.

If weight is a concern for you however, then I still suggest you indulge in something SCD friendly that fills the craving. Here's why: Crohn's and Colitis will decrease your quality of life much more than an 10 extra pounds. These conditions will kill you faster than those extra pounds. If you deprive yourself of food satisfaction on the SCD, then you will fall off the wagon, fast. Elaine is clear that the diet won't work unless you follow it strictly. Thus, the consequences of falling off the SCD wagon will likely be much more dire than gaining weight. So, if you want to lose weight, or are worried about gaining, exercise. There's no way around it. Research, history, and intuition all say, exercise. It does your body good.

Here's my staple snack/desert/breakfast treat (you get the picture). They're fast and easy. I almost always have a pan of these Peanut Butter Brownies sitting around, and I eat them by the row, not by the square. Be careful though, excessive gluttony, even on the SCD, can throw your system into a flare.

This recipe is a modification of the one in Breaking the Vicious Cycle.

Peanut Butter Brownies
Ingredients:
- 1 jar natural, unsweetened, SCD friendly Peanut Butter (Smuckers all natural is my favorite)
- 1 cup honey
- 2 eggs
- 1 tsp baking soda
- 1/4 tsp vanilla
- pinch of salt (optional)
- 1 very ripe bananna, mashed (also optional, but awesome in the brownies)

Instructions:
Combine ingredients in a bowl. Mix thuroughly. Bake in large glass baking dish at 350 for 18-25 min. CAREFUL! if you burn these, they're just aweful. Better to leave them gooey than too brown.

Time Commitment:
Mix ingredients: 5 min
Bake: 18-25 min

Probiotics Part 1

"What about Probiotics? Can I take them on the SCD?"

I have two initial thoughts for this post, and I welcome input. This issue is far from resolved...
1. The SCD does include probiotic suplementation, per se, in the yogurt. It's slow, and gentle. But here's the rub, you can't get a therapeutic dose of probiotics by eating yogurt (unless you want to measure your daily consumption in litres of yogurt, yuck!).

2. Therapeutic doses of probiotics (8-10+ Billion CFU) have been shown in credible studies to provide clinical relief of symptoms, and to help induce 'remission'. If the underlying premise of the SCD is to shift, or change the digestive flora to a more healthy balance, then wouldn't probiotic supplementation make sense with the SCD. The short answer is, yes...But. But there are no SCD friendly probiotics on the market, which means, if you are going to take them, you are necessarily going to have to ingest 'illegal' (for the SCD) substances, such as whey, garbanzo bean extract, milk, cellulose, etc. By far the most SCD-friendly way to take probiotics is to take a single species, Lactobacillus, in a dairy form. When you consume the bugs, they will in turn consume any lactose in the milk medium. I use Natren probiotics. So, what to do, what to do...


It's a cost benefit, deciding to take supplemental probiotics or not. If you take 10 Billion CFU/Day, you might ingest 5 grams of milk powder, or whey, for example. So the question becomes, Will those 5 grams of illegal substance hurt me more than the Probiotic will help me? Probiotics come in a medium. That is, the lab sends the little bacteria in a medium (such as potato powder) that the bacteria can use as food. Likeliness is that those bacteria, when activated in the gut will consume the majority of the powder medium on their way to health and freedom, but it's unclear to me how much of the ingested medium is consumed by the probiotic bacteria, or how much would be left to the 'bad' bacteria in the gut. That's the issue. The best way to take probiotics and stay SCD is to take SCD-legal species in a dairy medium.

Bottom Line: I take probiotics. In my mind, 5g of milk powder is nothing compared to the benefits of the bacteria. Only time will tell I guess.

More on Probiotics to come.

Onward to Health.