Ulcerative colitis (UC) is inflammatory bowel disease that is limited to the
colon. The lining of the large intestine and rectum become inflamed and
superficial ulcers develop. Ulcerative colitis is not always distinct from
Crohn's disease. The deeper inflammatory process of CD sometimes involves the
colon and rectum and can be confused with UC. Ulcerative colitis affects all age
groups but tends to be more common in young people. It affects males and females
equally and appears to run in some families. The main symptoms are abdominal
cramps, bowel movement urgency, fever, malaise, weight loss, fatigue,
mucosal ulcers, rectal bleeding and diarrhea.
The cause is listed as unknown, but I am going to persevere with the approach that it is food-related
disease until proven otherwise. Foods associated with the occurrence of UC are
milk, wheat, meat, sweets,d sugar/confectionery, fast foods.
Jowett et al. reported that dietary factors, such as a high meat or alcoholic beverage intake
were associated with an increased likelihood of relapse for UC patients.[i]
Hydrogen sulfide, which is a bacterially-derived cell poison, is produced in the
large intestine from animal meat and milk.
There is an obvious interaction between environmental, genetic, immunological factors, and infection. The colon
is full of pathogenic bacteria and any break in the surface automatically is
infected. Ulcers in the mouth form by contact with an antigenic food. Ulcers in
colon also probably develop on contact with antigenic material in the colon. The
colon, of course, is a septic tank full of smelly food residues and massive
amounts of microorganisms. From an immune network point-of view, the colon is
populated with microbial antigens in chaotic profusion. The symptoms of
ulcerative colitis are abdominal pain and diarrhea. Loose to watery stools that
contain blood and mucus strongly suggest the diagnosis. When the disease is
chronic other symptoms become obvious, such as fatigue, weight loss, loss of
appetite and malnutrition. Prolonged bleeding leads to anemia. Other systemic
symptoms occur that suggest delayed pattern food allergy; these are mouth
ulcers, skin eruptions, joint and back pain, inflammation of the eyes, and
hepatitis. The diagnosis is made by looking at the lining of the bowel with an
endoscope A biopsy is usually
Aminosalicylates are first-line
therapy for induction and maintenance of remission in active, mild-to-moderate
disease; corticosteroids are prescribed when symptoms of active colitis do not
respond to aminosalicylates. Immunosuppressants and biologics are used in
moderate-to-severe UC. Most patients with mild or moderate disease are first
treated with Sulfasalazine. People with severe disease and those who do not
respond are treated with prednisone orally and topical hydrocortisone applied by
the administration of enemas. Biological therapies may improve the care of
patients with UC. Infliximab was the first biologic approved for
moderate-to-severe disease; then, 2 more tumour necrosis factor (TNF)
antagonists, adalimumab and golimumab, and 1 anti-α4β7 antibody, vedolizumab,
received regulatory approval. They have shown good efficacy and safety profiles.
Recently, tofacitinib, an oral small-molecule Janus kinase inhibitor, was shown
to be more effective than placebo for induction and maintenance of remission in
adults with moderate-to-severe UC.
In the USA, 25 to 40% of ulcerative
colitis patients have their colons removed because of bleeding, severe illness,
rupture of the colon, or risk of cancer. The most common surgery is a
proctocolectomy with ileostomy; the colon is removed and the surgeon creates a
small opening in the abdomen and attaches the end of the small intestine. A
pouch is worn over the opening to collect waste, and the patient empties the
pouch as needed.
About 5 percent of people with ulcerative colitis develop
colon cancer. The risk of cancer increases with the duration and the extent of
involvement of the colon. Screening for colon cancer is recommended to patients
who have had generalized UC for more than 8 years; they should have a
colonoscopy every 1 to 2 years to check for cell dysplasia.
Since the colon is such a terrible place to have a wound (ulcerated lining), effective measures
are required to promote healing. The best idea, in my opinion is a long food
holiday, using Alpha ENF. Early research on elemental formulas showed a dramatic
decrease in the microorganism population. With Alpha ENF feeding, the colon
becomes almost empty and rests. How long should the food holiday last? The best
idea is until the colon heals, but this may be weeks and many people are not
that patient. A reasonable compromise would be an initial food holiday for 1-2
weeks, followed by careful and slow re-feeding. You would stay on cooked Phase 1
foods with some Alpha ENF for at least another 4 weeks. When the colon is
healed, you can slowly and carefully add some phase 2 foods, but not go too far
beyond phase 1 for many months. The use of prednisone for several weeks is
often required – hopefully, at a low dose such as 10 mg per day or less.
[i] Jowett SL, Seal CJ, Pearce MS et al. Influence
of dietary factors on the clinical course of ulcerative colitis: a prospective
cohort study. Gut 2004; 53: 1479–84.