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Marz on Crohn's Disease


Crohn's disease
affects ilium and patchy parts of lg and small

SIGNS AND SYMPTOMS
intermittent bouts of D, low grade fever, and right lower quadrant pain
anorexia, wt loss, gas, malaise
general abdominal tenderness

DDX
ulcerative colitis: bloody C, lower cramps, rectal area involvement
IBS

ANDREW WAKEFIELD
the British gastroenteritis who made the link between the MMR vaccine and colitis
pretty impressive research
linear population incr in Crohns as MMR vaccine was introduced, Britain, US

ETIO
genetics
infx: bact, virus, fungal
amoeba, dientamoeba fragilis may or may not cause sx
parasites
EBV, CMV, chlamydia, pseudomonas, giardia
cryptosporidium
immune dysfx
polysystemic candidiasis
food allergies, sensitivity, lectin incompatibility
refined foods, lack of fiber
stress (esp UC but also Crohn's)
longterm cortison tx-->leaky gut

DIAGNOSIS
endomysial antibodies is #1 test
sigmoidoscopy and biopsy
intestinal permeability: mannitol and lactulose
stool analysis:
ova, parasites, bacterial culture (clostridium)
butyrate low?, inntestinal secretory IgA
blood type
gliadin Abs
HCl levels
urinary indican
SED rate
albumin low? correlates with trouble with food introduction

TREATMENT
give vitamin B12 shots immediately
no food
cautious with fiber: may exacerbate acute but is part of longterm cure
colitis is unheard of in communities where a high fiber diet is consumed
elemental diet is first food for acutes, stay on it for about a week
vibonex is what you can get at hospitals
not great tasting but you can make it tolerable by mixing with thin juice
tolerex is another product
alpha enf is what used to be n food
don't start with ultraclear sustain or whatever
at some point you have to reintroduce food
treat this like coming off a fast
fasting can sensitize you when adding foods so use elemental diet first
very low fiber intake at first, introduce soluble first
build up GI tract
give butyrate for LI, glutamine for SI
butyrate enemas help stabilize colitis

L- GLUTAMINE: dose them up, not just 500mg, 8-10grams a day of glutamine
glutamine protects vs wt loss in acute colitis
he uses a lot until their weight stabilizes
most elemental products contain it but not enough, add some
vital nutrients, other companies make powdered forms
arginine like glutamine involved in generating intestinal cells

vit A is well absorbed, 50-100,000 IU, reasonable dose, not if preg/possible preg
beta carotene less well absorbed
beta carotene pushes lipoxygenase enzyme, incr inflam, brings aa into inflam pathway
zinc: be careful, it can nauseate, give small amounts, 15-20mg
give a zinc losenge after a meal
give folate, 5-10mg this is a huge dose, he uses tetrahydro form activated, liquid
sulfasalazine depletes folate, he takes them off it
little bit at a time; this is an artsy project
great time to do IV nutrients: IV glutamine and all nutrients
Marz in hospital setting was unable to get gastroenterologist to add nutrients in the levels
that he would have used out of the hospital
each supp that you introduce, watch and wait for a few days
use quercetin 600mg tid to bring down inflam
he says B12 methylcobalamin up to 3g/shot
vit C, C mb irritating, use buffered form
selenium up to 800mcg/day
magnesium (in IV esp since oral causes D) if there is cramping or spasm
if using oral use sustained release in small amounts with gradual increase

n-acetylated glucosamino sugars
800mg tid
food for intestinal ECs

glycyrrhiza
anti-fungal and anti-inflam activity
you don't want DGL, these pts have adrenal exhaustion
you want the glycyrrhizin so solid extract would be a good choice
wise woman makes an extract

seacure
protein from white fish includes glutamine and arginine in hypoallergenic form
some practitioners swear by it
use it in middle stage tho some say use in acute

FOOD INTRODUCTION
albumin low? correlates with trouble with food introduction
use proteins, glutamine, elemental diet to get albumin up to 3.0-3.5 target
pancreatic enzymes when introducing foods
travacid = time release HCl
1st per marz: steamed greens cooked to mush
zucchini, yellow squash, yellow veg
white rice first, easy to digest and less antigenic: brown rice later
flax powder for the omega 3 fatty acids

FOODS TO BE CAUTIOUS WITH
dairy: not for at least a month
fats may cause diarrhea, wait until later
avoid allergens until moderate to high fiber intake

NUTRITION
vits A, C
EFAs get added late, a tsp mixed in with food

MONITOR
weight
albumin
hematocrit, hemoglobin, ferritin and % transferrin saturation
he says during acute ferritin will be elevated (acute phase reactant), saturation will be low
sed rate

PROTECTION FROM ULCERATION
cytotec, PGe1, mesoprostol
synthetic analog of prostaglandin E1
protects stomach mucosa vs ulceration
GLA supports same path
present in breast milk and some supps

TOOTHPASTE
some pts react to silicates in toothpaste
sodium lauryl sulfate in toothpaste can cause canker sores

MICROBES MATTER
BENNET AND BRINKMAN study 1989
case study doc himself has colitis for 7 years
physician gave self enema with someone else's fecal matter
had dramatic affect on intestinal tract
a week later he was better
6 mo doc was sx free 1st time in 11mo with no med
bx confirmed no inflam

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