Ulcerative colitis: merging traditional and alternative therapies

by Dr. Jacki Hart

Regular readers of this column probably realize by now that I am an advocate of an integrative approach to medical care, which means bringing together standard medical treatment and alternative medical care in a holistic and complementary way. Ulcerative colitis (UC), a type of inflammatory bowel disease (IBD), provides a good example of how the two different approaches can work together.

UC is a chronic condition; people with UC have relapses and remissions, which means that there are periods of time when the inflammation is active and periods of time when the disease process is quiet and inactive. An acute attack can cause bloody diarrhea, cramping abdominal pain, fever, and weight loss.

With UC very small ulcers occur throughout the first layer of the colon wall or mucosa. There are serious risks if the condition is not managed, including perforation of the bowel wall and a serious infection throughout the blood stream called sepsis.

The course of treatment is different for each person, with some people ultimately requiring surgery to remove the colon. People with UC are at greater risk for developing colon cancer.

Although there seems to be a genetic predisposition in people who develop UC, the exact cause of the disease is not known. Rates of IBD have been on the rise dramatically since World War II; many researchers hypothesize, therefore, about a relationship to environmental factors, including diet. Several different observational studies have suggested a possible association between UC and the following dietary components:

• Caffeine (particularly in chocolate and cola).
• Dairy foods.
• High-fat foods (particularly animal fat).
• Artificial sweeteners, such as saccharin and aspartame.

This possible association does not mean that eating these items causes UC or that if you avoid these items you will not get UC. I would recommend avoiding these foods, though, if you have a family history of IBD or already have the disease yourself. Given that it is healthful to avoid these particular foods in general, I think it is worth applying the discipline with the hope that the change may help reduce symptoms or avoid disease.

Food items that may have some protective effect include:

• Fruit, particularly citrus fruits (although fruit should be avoided during an acute flare-up of UC).
• Omega-3 fatty acids (see below).

The positive effects of citrus fruits may come from the vitamin C they contain. Therefore, if you cannot get the recommended five servings of fruit and vegetables per day (particularly if you already have IBD and these foods exacerbate your symptoms), I would recommend taking a vitamin C supplement (250 milligrams twice a day).

As with other chronic illnesses, research shows that UCmay be related to an imbalance of dietary omega-6 and omega-3 essential fatty acids. Americans consume far more omega-6 fatty acids than omega-3 fatty acids. The optimal balance should be about a 1:1 ratio, but the typical American diet contains 20:1.

Omega-6 fatty acids tend to promote inflammation (as well as other health problems), whereas omega-3 fatty acids protect against inflammation. Examples of omega-3 fatty acids include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both found in fish and fish oil, as well as alpha-linolenic acid (LNA), which is found in flaxseed, green leafy vegetables, and walnuts. LNA makes EPA and DHA in the human body. Although the studies are not absolutely definitive, flaxseed may be particular beneficial for people with UC, because it contains another substance, called lignan, which may help protect against cancer. I recommend 2 tablespoons of ground flaxseed per day. The flaxseed must be kept in the refrigerator and ground within 24 hours of use.

Selenium, an antioxidant mineral, may also be useful for UC. Two European studies published in 1998 (one from Italy and one from Copenhagen) showed that people with IBD tend to have low levels of selenium. Deficiency of selenium is more common with Crohns disease (another type of IBD) than with UC, but I recommend taking 200 micrograms per day for either of these two types of IBD.

Animal studies suggest that stress can activate inflammation in the bowel. Plus, one human study suggests a link between the development of IBD and a stressful life event (such as death of a family member, loss of a job, change in career, etc.) within one year.

To date, no specific pattern of emotional response or personality type has been clearly associated with IBD, although some psychiatrists suggest a possible connection to anxiety, anger or aggression, and a tendency to keep emotions inside. Many people who suffer from IBD say that they notice a worsening of their symptoms if they are under stress. In addition, many people react with strong feelings of depression to having IBD. Finally, developing good coping skills is necessary if you have IBD, with or without surgery.

For all of these reasons, I recommend psychotherapy, perhaps in combination with biofeedback and/or hypnotherapy (see below). While psychotherapy (individual or group) does not necessarily improve the course of the disease, the process often helps explore life situations and feelings that contribute to the disease, emotions and reactions from having the disease, and the ability to cope with living day to day with IBD.

Hypnotherapy and biofeedback are useful for improving symptoms of a variety of gastrointestinal disorders. More specifically, a recent study in the United States looked at treating children with biofeedback after surgery for UC to reduce incontinence (inability to control the bowels), which is a potential complication from ileoanal anastamosis

Practitioners of Ayurvedic and traditional Chinese medicine describe and approach the disease process that Westerners call UC in very different terms. In a report published last year, traditional Chinese medical doctors examined 57 people who had been diagnosed with UC. The problems of these 57 people were categorized by the Chinese practitioners in four ways: (1) stagnation of qi, or "life force," in the liver, (2) dampness and heat in the gastrointestinal tract, (3) cold in the spleen and stomach, (4) coexistence of cold and heat. A traditional Chinese doctor might treat someone with UC with a regimen of specific herbs and acupuncturetailored to that individual.

In the tradition of Ayurveda, astrology is quite important; Ayurvedic practitioners say that UC, a pitta or "fire" ailment, can be aggravated by Mars, the planet related to blood and to the liver. Particular yoga postures, called "the fish," "the boat," and "the bow," are recommended for UC. In addition, a traditional Ayurvedic herb called Boswellia serrata was compared to a Western medication commonly used for UC known as sulfasalazine. In this pilot study, the symptoms in each group improved equally, meaning that additional research should be done to confirm whether the two different treatment approaches are comparable.

In summary, I would recommend consideration of the following for managing UC in addition to the usual care of a primary care physician and gastroenterologist:

• Avoidance of caffeine, dairy, high-fat foods, and artificial sweeteners.
• Two tablespoons of ground flaxseed per day.
• Vitamin C 250 milligrams two times per day.
• Selenium 200 micrograms per day.
• Psychotherapy.
• Biofeedback or hypnotherapy to reduce symptoms and side effects from surgery.
• Stress reduction through meditation and yoga (using the postures mentioned above on a daily basis).
• Complementary treatment with an acupuncturist or Ayurvedic practitioner.