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Against the Grain
New ideas and controversies in inflammatory bowel disease (Crohn's disease and ulcerative colitis)
Category: Science & Medicine
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by Samir Kakodkar
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February 25, 2019 07:59 PM PST

If you have Crohn’s or colitis, I bet you have encountered someone either in person or on the internet who claims to be able to control his or her disease with the use of cannabis. Or maybe you are using medical marijuana already. This may seem appealing as an alternative to medications that can have a frightening side effect profile. The regulatory climate in the US makes marijuana difficult to study so we don’t have good, high quality information about it regarding its effect on IBD. The Crohn’s and Colitis Foundation commissioned a white paper on the topic.
Dr. Arun Swaminath is the first author on this publication.
He is the director of the Inflammatory Bowel Disease Program at Lenox Hill Hospital in New York also associate professor at Hofstra/Northwell.
His twitter page is located here: https://twitter.com/Swaminath_IBD
I hope we address any and all questions you may have about cannabis and IBD, both from the patient and clinician's perspective.
As a disclaimer, this podcast is not medical advice and I am not endorsing the use of cannabis for IBD as it has not been FDA approved for this purpose.

February 17, 2019 10:32 AM PST

After 10 years of researching the Specific Carbohydrate Diet (SCD) and implementing it along with other dietary therapies clinically, I wanted to share some of the insights I've gained along the way. I present the major findings of my research studies including brand new, exciting results from the SCD microbiome analysis. I also discuss my approach to co-managing diet along with medical therapy for Crohn's and colitis. For too long there have been two warring factions: 1) those that only believe in diet with a conspiratorial distrust of the pharmaceutical industry and 2) those that believe diet has nothing to do with IBD and think diet only influences symptoms. I believe there is value to using both diet and medication depending on a patient's unique circumstances. My wish is to finally bridge this gap with the goal of attaining optimal quality of life for my patients. I call this approach The Middle Path, a reference to the Buddhist teaching for attaining liberation.

My most recent review article on diet and IBD can be found at this link:
http://www.scdrecipe.com/scd-uploads/studies/kakodkar-2017.pdf

My case series on diet and IBD can be found here:
http://www.scdrecipe.com/scd-uploads/studies/kakodkar-scd-2015.pdf

December 17, 2018 08:21 AM PST

Fecal microbiota transplantation, otherwise known as FMT, is putting the stool from one person into the GI tract of another. This is an accepted treatment for recurrent clostridium dificil colitis which is a type of bacterial infection. Because we know that people with Crohn’s and colitis have a less biodiverse microbiome, some have hypothesized that a fecal transplant could theoretically be helpful for inflammatory bowel disease.

I interviewed Saffron Cassaday who is a documentary filmmaker based in Toronto and Los Angeles. Her films have been broadcast in over 40 countries including on PBS, Netflix, Hulu and CBC in North America.
Her current film, “Designer Shit”, is about Fecal Microbiota Transplant (FMT) for IBD. Saffron, who has suffered from ulcerative colitis for nearly a decade, sets off on a journey to determine if this form of treatment could potentially cure her of her disease. Through interviews with some of the top researchers in the field, Saffron is enlightened on the power “poo” has to affect our health, happiness and possibly even our physical appearance.
The film is set to be released in Spring of 2019.

As a disclaimer this is not an endorsement of FMT for treatment of inflammatory bowel disease. This is not FDA approved for this condition and at this point is still being actively researched.

Information on Designer Shit:
https://designershitdocumentary.com/

December 01, 2018 02:56 PM PST

I spoke with Raman Prasad who has been following the Specific Carbohydrate Diet for 20 years with sustained drug free remission of his colitis. He had a severe case of inflammatory bowel disease with possible primary sclerosing cholangitis and was facing surgery before discovering the SCD. He has published his experience in the book Colitis and Me: A Story of Recovery which I found personally inspiring and I highly recommend. He has also published two SCD cook books - Recipes for the Specific Carbohydrate Diet and Adventures in the Family Kitchen: Original Recipes Based on the Specific Carbohydrate Diet. He has been an advocate and spokesperson for the diet for almost two decades, and has worked alongside Elaine Gottschall in her efforts to promote the SCD to a wider audience.

November 11, 2018 08:47 AM PST

Today I had the pleasure of interviewing Joshua Bradley who overcame a severe case of fistulizing Crohn’s disease using a combination of conventional methods, ketogenic diet, endurance exercise and supplements which were guided by a biohacking -- that is he used objective data from testing to help determine what was working for him. I found our discussion regarding how foods affected his microbiome analysis to be particularly interesting. As a disclaimer, this is not an endorsement or recommendation of any of the methods discussed in this podcast and this is not medical advice. The particular tests mentioned in this interview are not FDA approved and are lacking in evidence to support clinical validity - that is the ability to measure or detect a clinical condition or predict a health outcome.

November 11, 2018 08:23 AM PST

Today I spoke with Stephanie Colo Manning who is chef and owner of Colo Kitchen which offers consulting and cooking lessons for people who want to transition to a nutrient dense, whole foods diet. She also had colitis and is someone who had a relatively rapid response to the Specific Carbohydrate Diet (SCD) and was able to maintain her remission without the use of medications with confirmed healing by colonoscopy. We also have a very detailed discussion about implementing the SCD which I imagine would be very helpful to both those who are thinking about starting it and also to those who are SCD veterans.
As a disclaimer, it is advisable that you discuss any dietary therapies with your physicians first. I have done many of the research studies regarding SCD for IBD and so far the evidence is still considered weak (in the form of case reports/case series); however, randomized controlled trials are being conducted now at other centers so I am hopeful in the future we will have stronger evidence to determine more details regarding the efficacy of the diet.

Website: http://www.colokitchen.com

October 18, 2018 02:22 PM PDT

The answer is we don’t know yet but there may be a mechanism to explain how it theoretically could be anti-inflammatory and possibly helpful for autoimmune disease. Today I spoke with Dr. Paul O’Connor who recently published some very interesting work on anti-inflammatory effects of baking soda -- something that you probably have in your fridge right now. However, as a disclaimer, this is not an endorsement or recommendation to use baking soda for IBD as it has not been FDA approved and has not been studied in the form of a randomized controlled trial (which admittedly would be a lot easier to do than some of the other treatments discussed in other episode so I am optimistic that it will eventually be done).

October 18, 2018 02:02 PM PDT

Fasting is becoming more and more popular nowadays and is being promoted for everything from obesity, diabetes, cancer and now diseases of immune dysregulation. There are many forms including prolonged water fasts, fasting mimicking diets, intermittent fasting and time restricted eating. There is no strong research I know of supporting the use of fasting as a treatment modality for IBD and can in fact be dangerous in someone who is malnourished and underweight. By chance I discovered a thread on a forum where a man named Vit Smilauer from the Czech Republic claimed to have cured his Crohn’s disease by fasting for 38 days. Yes you heard that right, 38 days! I contacted him and he kindly shared his experience which is truly remarkable and a compelling story. As a disclaimer, this is not an endorsement or recommendation to try fasting for inflammatory bowel disease as I think this can be very dangerous depending on your personal circumstances and health. This also has not been rigorously tested in a clinical trial to confirm safety and efficacy so at this point this is simply an anecdotal success story. I would not recommend anyone try this but hopefully this can open the scientific community’s eyes so that the appropriate research can be done.
His protocol can be found here:
http://mech.fsv.cvut.cz/~smilauer/Crohn_Smilauer_fasting_en.pdf

August 01, 2018 07:31 PM PDT

Today we are talking about hyperbaric oxygen therapy for inflammatory bowel disease. This is a hot topic with some studies suggesting efficacy in both Crohn’s disease and ulcerative colitis. Recently there has been interest in using it for hospitalized patients with severe ulcerative colitis. We speak with Dr. Scott Sherr who is a physician with training in internal medicine and also practices health optimization medicine. He has a subspecialization in utilizing hyperbaric oxygen for various conditions and today shares his insights and experience using it off-label for inflammatory bowel disease.
As a disclaimer - this is not an endorsement of this therapy for inflammatory bowel disease since it is still being studied and efficacy has not been established. It is not FDA approved to treat IBD at this time. You must discuss all treatment decisions with your physicians.

April 29, 2018 02:12 PM PDT

We venture into the realm of complementary and alternative medicine(AKA CAM) for Crohn’s and ulcerative colitis. These include various diets, supplements, and other lifestyle interventions that are not part of the standard of care.
Today we speak to Reid Kimball who has made a documentary called Wanted: Crohn’s End which is one of the most comprehensive investigations into complementary and alternative treatments for IBD that I have seen.
His documentary can be found at http://crohnsend.com/

As a disclaimer - this is a frank conversation about what he has learned and his personal experience. This is by no means a recommendation of any of these therapies for you. Any CAM treatment you decide to try should be discussed with your treating gastroenterologist first.

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