Understanding Microscopic Colitis

By Wayne Persky

This book is based on new and additional information that was not available when the first book about Microscopic Colitis was published, and in some situations it expands on information that was presented in the first book in order to provide new insight into successful treatment methods.  This edition looks at additional situations that mi

• Language: English
• Publisher: Persky Farms
• Release date: Feb 9, 2018
• ISBN: 9780985977290

Wayne Persky

Wayne Persky was born, grew up, and currently lives in Central Texas. He is a graduate of the University of Texas at Austin, College of Engineering, with postgraduate studies in mechanical engineering, mathematics, and computer science. He has teaching experience in engineering, and business experience in farming and agribusiness. He has 20 years of experience researching published medical research articles to discover novel ways to resolve health issues that are inadequately treated by mainstream medicine.Microscopic colitis (MC) is an inflammatory bowel disease more widespread than Chron's disease, yet the most popular medical treatment used by doctors results in an 85 % relapse rate. He promotes treating MC by diet changes, with a better than 95 % success rate. Over 15 years ago he founded and continues to administrate an online MC discussion and support board. In 2015 he founded the Microscopic Colitis Foundation, and he continues to serve as it's president and as a contributing author to the Foundation's Newsletter. He lives on a farm in Central Texas, where he continues to do research and write.

Book preview

Understanding Microscopic Colitis

Other books by this author

Microscopic Colitis (available in English and Spanish)

Vitamin D and Autoimmune Disease

Pancreatic Cancer

Understanding Microscopic Colitis

Wayne Persky

Persky Farms

United States

Published at Smashwords by:

Persky Farms, 19242 Darrs Creek Rd, Bartlett, TX 76511-4460. Tel.: [phone]; Fax: [phone]. www.perskyfarms.com

Copyright: This book is protected under the US Copyright Act of 1976, as amended, and all other applicable international, federal, state, and local laws. All rights reserved. No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of an audio recording, nor may it be transmitted or otherwise copied for public or private use, other than the fair use purposes allowed by copyright law, without prior written permission of the publisher.

Disclaimer and Legal Notice: The information contained in this book is intended solely for general educational purposes, and is not intended, nor implied, to be a substitute for professional medical advice relative to any specific medical condition or question. The advice of a physician or other health care provider should always be sought for any questions regarding any medical condition. Specific diagnoses and therapies can only be provided by the reader’s physician. The author and the publisher specifically disclaim any and all liability arising directly or indirectly from the use or application of any information contained in this book.

Please note that much of the information in this book is based on personal experience and anecdotal evidence. Although the author and publisher have made every reasonable attempt to achieve complete accuracy of the content, they assume no responsibility for errors or omissions. If you should choose to use any of this information, use it according to your best judgment, and at your own risk. Because your particular situation will not exactly match the examples upon which this information is based, you should adjust your use of the information and recommendations to fit your own personal situation.

This book does not recommend or endorse any specific tests, products, procedures, opinions, or other information that may be mentioned anywhere in the book. This information is provided for educational purposes, and reliance on any tests, products, procedures, or opinions mentioned in the book is solely at the reader’s own risk. Any trademarks, service marks, product names, or named features are assumed to be the property of their respective owners, and are used only for reference. There is no implied endorsement when these terms are used in this book.

Copyright © Wayne Persky, 2018. All rights reserved worldwide.

ISBN 978-0-9859772-9-0

Table of Contents

Introduction

Chapter 1

Why Do Treatment Programs Fail?

Chapter 2

Cross-Contamination and Other Dietary Issues

Chapter 3

Nutritional Deficiencies

Chapter 4

Methylenetetrahydrofolate Reductase (MTHFR) Gene Mutations

Chapter 5

Magnesium Deficiency, Histamine, Gut Bacteria, Inflammation

Chapter 6

BAM, SIBO, Low-Dose Naltrexone, GERD, Other Considerations

Chapter 7

Depression, Inflammation, and Stress Associated with MC

Chapter 8

Medical Diagnostic and Treatment Issues That Should Be Corrected

Chapter 9

Recent Research

About the Author

Contact Details:

Introduction

In the first edition of the book titled Microscopic Colitis (Persky, 2012) the history of the disease and diagnostic methods were discussed. All of the conventional treatment options that were commonly available at the time of publication were discussed. In addition, non-conventional treatment methods that have been found to be helpful by many patients who were unable to resolve their symptoms by using the treatment regimens prescribed by their physician, were also discussed. Non-conventional treatment methods also tend to be chosen by patients who prefer to treat the disease without the use of corticosteroids or other anti-inflammatory medications or immune system suppressants in order to avoid the side effects of those medications and the long-term health risks that are sometimes associated with them.

But as is sometimes the case with many diseases (and especially with inflammatory bowel diseases), complete resolution of symptoms does not always occur. Whether this is due to individual differences in response to treatments, diet cross-contamination, overlooked medications that can trigger microscopic colitis, overlooked food sensitivities in the diet, circumstances beyond their control, or some other issue, some patients are unable to attain satisfactory remission of all their symptoms. Or as so often happens when medications are prescribed as the sole form of treatment (in the absence of proper diet changes), remission may be only temporary.

And of course many patients prefer to avoid the need to take a medication for the rest of their life, since all medications have side effects that can lead to health issues in certain situations. Younger patients especially are reluctant to commit to using a medication for the rest of their life if an alternative treatment is available that has been shown to be both effective and free from undesirable side effects. In the long term, not only are the health risks of the extended use of medications a topic of concern, but so is the huge expense of long-term treatment with most of the medications prescribed to treat an inflammatory bowel disease.

Over five years have passed since the first edition of Microscopic Colitis was published. Progress has been made in understanding and treatment of the disease among medical professionals during that period of time, but many clinicians are still using outdated treatment methods. Out in the real world, where many thousands of patients have to live with this disease every day, the wheels of progress don't turn so slowly. Thanks to the Internet and improved communications, a lot of new information has become available to provide additional insight into how the disease develops, why some patients have more severe symptoms, and why some cases are more resistant to conventional treatment methods. In addition, much has been learned about improved methods for treating the disease.

So much additional understanding of microscopic colitis has happened since the first book was published, that it's time to update our knowledge base in the real world. In general, microscopic colitis patients who actively seek better methods for treating the disease continue to be far ahead of the medical community in their understanding of the debilitating social features of the disease and how to better treat the disease in the long run. This book is based on new and additional information that was not available when the first book was published, and in some situations it expands on information that was presented in the first book in order to provide new insight into successful treatment methods. This edition looks at additional situations that might lead to treatment failure in some cases, and it explores ways to overcome those obstacles.

Conventional medical thinking holds that the inflammation associated with microscopic colitis is due to an increased presence of lymphocytes in the epithelial lining of the colon. But in chapter five we shall see that a completely different mode of inflammation may also be involved, and it may be the reason why so many cases do not respond to conventional treatment programs. This association with the disease has previously been overlooked by the medical community. Ways to identify and resolve this problem are also discussed in chapter five.

And of course there have been numerous new medical research discoveries and this book examines how they relate to treatment programs followed by most major medical facilities, in order to provide an up-to-date perspective on the treatment protocols currently followed by most clinicians. In some parts of the world microscopic colitis is still seldom diagnosed. Because of that situation it may still be incorrectly considered to be a rare disease by medical professionals in those locations. This obviously implies that physicians in those locations are not likely to have the advantage of specific knowledge and experience that comes from dealing with the disease on a regular basis. This may limit their options when treating patients. In addition, this may reduce the likelihood that they will actively search for the disease in patients complaining of digestive symptoms typically associated with the disease. Since microscopic colitis can only be diagnosed by examining slides made from biopsy samples taken from the mucosal lining of the colon during a colonoscopy or sigmoidoscopy exam under a microscope, , a perception that the disease is rare will increase the odds that biopsy samples may not be collected, leading to a failure to diagnose the disease.

Accordingly, the basic information discussed in the first book is not included in this book. Only certain concepts from the first book for which additional insight is now available are discussed in this edition. It should be understood that before considering any of the treatment options discussed in this book, the reader should have a good understanding of the information presented in the first book. Without that background knowledge some of the information in this book may not seem complete, or parts of it may be difficult to understand. And obviously, without the treatment information discussed in the first book, this book does not offer a complete set of solutions. Together, the two books present a comprehensive and up-to-date (as of the dates of publication) coverage of microscopic colitis and treatment methods found to be effective not only by mainstream medical professionals, but also by patients who have looked beyond conventional treatment methods.

Because both the clinical symptoms and the treatments for collagenous colitis, lymphocytic colitis, and most of the other variations of the disease are the same or very similar, in this book the term microscopic colitis (MC) will be used to refer to all forms of the disease.

The human body is a very sophisticated and complex organism, and it is made up of numerous complex systems designed to work in harmony in order to nurture, protect, and preserve all parts of the body. Some of the discussions in this book involve medical terms (which are defined in the discussions), but because medical research by its very nature tends to involve somewhat complex scientific concepts, it's virtually impossible to completely avoid some level of complexity when describing the details of how various issues affect the body and its subsystems.

However, every effort has been made to describe any medical or scientific terms used in this book in a manner so that anyone can understand what is being discussed, without the need of a medical background. While reading this book, if you do not completely understand all of the details in some of the discussions, that should not prevent you from understanding the basic principles being discussed, nor should it prevent you from benefiting from the information presented here. Sometimes it may be helpful to reread some of the information in order to better understand it. At the end of each chapter there is a brief summary of the most important points, and that summary can be used to better understand the information presented in the chapter.

The material in this book is a combination of medically-proven facts (backed up by references) and insight based on my own experiences and the experiences of many microscopic colitis patients who have been kind enough to share their experiences of living with the disease on an Internet discussion and support forum for over twelve years. Most of the material is based on medically-proven, peer-reviewed, published research, although other types of reference information is available where applicable. References are available as live links within the text in this digital edition. Whenever an opinion or conjecture is included, it is clearly identified as an opinion, unsupported by medical research. The goal of this book is to bring the reader up to speed on the information and recently-published research that appears to matter in regard to understanding microscopic colitis and how to effectively treat the disease.

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Chapter 1

Why Do Treatment Programs Sometimes Fail?

MC can affect our mind almost as much as it can affect our body . . . maybe that's the worst part of the disease, but we may not even realize that until after we've lived with the disease for a while.

As anyone who has the disease is well aware, in some cases microscopic colitis is a complex and difficult-to-control disease. In a small percentage of cases, despite hard work to carefully apply treatment programs that work well for others, nothing seems to bring remission. When medical treatments are prescribed, the medications may fail to bring the expected therapeutic response. And when treatments based on diet changes designed to avoid inflammatory foods are used, the diet changes don't always bring remission — at least not as promptly as anticipated. The lack of treatment success may be due to undetected sensitivities to certain foods, supplements, medications, or environmental issues. Or perhaps there are problems with cross-contamination in the diet. But for whatever reason, the treatments don't bring remission. And with any type of treatment, or with a combination of both medical and dietary treatments, there can be vitamin or mineral deficiencies that can limit the effectiveness of the treatment by compromising the natural healing ability of the body.

And to further complicate the issue there can be sensitivities to items such as cosmetic products, hormone replacement therapy treatments, contraceptives, certain chemical odors, heat, high humidity, mold, pollen, and possibly other environmental influences. Certainly not all patients are significantly affected by all of these potential problems, but any of them can prevent remission in many cases. Obviously, avoiding or at least minimizing all of the potential pitfalls in cases where they are a factor can require hard work, constant vigilance, and dedication. But it is certainly doable if the right procedures are followed.

Food sensitivities are closely associated with microscopic colitis.

Many different environmental conditions have been shown to predispose to the development of microscopic colitis, and those conditions are discussed in the first edition. But in order to fully understand the disease, it's necessary to understand why the inflammation associated with the disease is so persistent and how it is actually perpetuated.

In a nutshell, regardless of the health issues that initially trigger MC (and there are numerous known triggers), the inflammation that perpetuates the disease appears to be due to either certain medications or food sensitivities in virtually every case. And even in the cases where medications are the initial cause of the ongoing inflammation, in most cases food sensitivities soon develop. The presence of these food sensitivities can be easily verified by stool tests to detect IgA antibodies to specific foods. They can also be verified by IgA antibody testing of biopsy samples taken from the intestines. IgA antibodies appear to be responsible for the immune system responses that result in the classic inflammation pattern associated with MC.

Few people are born with food sensitivities, although genetics predispose a relatively high percentage of the population to the potential development of food sensitivities. Most food sensitivities seem to develop as a result of digestive issues caused by side effects of medications, infections, parasites, or some other issue that disrupts normal digestion by causing intestinal inflammation. There are two basic types of food sensitivities, and they are distinguished by the type of immune system response they provoke.

Foods that provoke IgE-based reactions are known as food allergies, and foods that provoke IgA-based reactions are considered to be food intolerances.

The term food sensitivities includes both food allergies and food intolerances. The differences between food allergies and food intolerances were discussed in detail in chapter 7 of the first edition of Microscopic Colitis (Persky, 2012).Reference 1 Basically, IgE-based reactions occur within minutes or even seconds after exposure, and they typically result in classic upper respiratory or skin allergy symptoms. Severe IgE-based reactions involve anaphylactic reactions that can be life-threatening.

IgA-based reactions typically begin several hours after exposure (following ingestion of the food associated with the reaction) and they result in gastrointestinal symptoms such as gas, bloating, nausea, cramps, and diarrhea. With microscopic colitis, we are primarily concerned with food intolerances, so that will be our main focus here.

To understand how food intolerances develop, it's necessary to understand at least some of the basic details of how the digestive system normally functions. The digestive system must supply the body with all of the basic materials needed to repair and replace damaged cells, and cells that have been marked for replacement because of their age. And it has to supply the energy required to accomplish that, in addition to all of the other energy demands by the body. It also has to provide an adequate amount of certain vitamins and minerals that are required in order to facilitate the many chemical and neurological processes that are necessary for normal functioning of various organs and systems.

The digestive system is able to efficiently regulate all of these complex processes because it has its own automatic control system, known as the enteric nervous system. And the enteric nervous system coordinates its operation with the brain, through the central nervous system.

The building blocks used to create new cells in the body are known as amino acids. When proteins are digested, the molecules are broken down into individual amino acids or short strings of amino acids (short peptides). When carbohydrates are digested, they are broken down into simple sugars. Fats are broken down into tiny globules by bile so that they can be digested by lipase enzyme produced by the pancreas.

All food sensitivities (with one exception) are caused by certain proteins.

Therefore it's the digestion of proteins that is of interest here. However there is one exception to this rule. That exception is mammalian meat allergy, which is caused by sensitivity to a sugar found in all mammals except humans, old world monkeys, and the great apes (van Hage, et al., 2013, Nunen, 2015, Allergy Researchers, n.d.).Reference 2,Reference 3,Reference 4 The sugar is known as galactose-alpha-1,3-galactose, or simply alpha gal, or alpha-Gal. The sensitivity is caused by a tick bite, and if a tick bite triggers the condition, the victim becomes allergic to alpha-gal, which implies an allergy to all mammal meat (excluding the 3 exceptions previously noted). And this allergy extends to dairy products, in some cases. But other than this single exception, all food sensitivities are caused by proteins.

In order to be absorbed into the bloodstream, nutrients must be allowed to pass through the inner lining of the intestine.

This lining consists of a single layer of columnar (tall and relatively narrow) cells known as the epithelium. Both the small and large intestine contain an epithelial layer. The epithelium is actually the top of several layers of the intestinal lining known as the mucosa. The second layer is known as the lamina propria, and the third layer is known as the muscularis mucosae. The lamina propria and the muscularis mucosae provide support and resources for the epithelium. For example, the lamina propria contains numerous lymphocytes provided by the immune system to help prevent pathogens from entering the bloodstream. Normally, the density of lymphocytes is less than 10 or 15 per 100 enterocytes. When inflammation is present, that area of the intestine will usually contain over 20 lymphocytes per 100 enterocytes, and this is a diagnostic criterion for lymphocytic colitis.

The epithelium is the critical link in the interface between the food flowing through the digestive system and the rest of the body (via the bloodstream). It's vitally important that the integrity of the epithelial barrier must be maintained because this is where nutrients are allowed to pass into the bloodstream, and this must be done while blocking the passage of pathogens, incompletely digested food, and other foreign items that could cause serious harm if allowed into the bloodstream. The junctions between these epithelial cells are known as the tight junctions and they normally remain tightly closed. As food is digested, and nutrients become available for absorption, the tight junctions open wide enough to allow the passage of nutrients such as amino acids, without allowing undigested molecules or longer chains of amino acids (peptides) to pass through. Peptides are the result of incomplete digestion. They are partially-digested segments of protein molecules, consisting of medium-length or longer strings of amino acids.

But if the tight junctions open too widely, or stay open too long, these peptides and other inappropriate contents of the intestine can pass through. This condition is known as increased intestinal permeability. It's also called leaky gut, and leaky gut is bad news for health in general because it can lead to many miserable symptoms. When leaky gut allows peptides and other foreign matter into the bloodstream, they tend to be transported to various organs and dumped. When they end up in joints, they can cause arthritic-like inflammation and pain. When they end up in various organs they can cause inflammation that interferes with the proper functioning of those organs.

Gluten is a primary cause of leaky gut.

While food allergies can have other origins, the most common cause of food intolerances can be traced to the fact that gluten causes increased intestinal permeability — for everyone, not just for celiacs (Drago et al., 2006).Reference 5 But people who have genes that predispose them to gluten sensitivity tend to experience a greater intestinal permeability problem when exposed to gluten, so they are more likely to develop clinical symptoms, and they are more likely to develop symptoms earlier in life.

Research shows that the opening of the tight junctions is controlled by a protein in the blood known as zonulin, and certain peptides resulting from the incomplete digestion of gluten and glutelin proteins in wheat, rye, and barley promote the production of zonulin (Fasano, 2012).Reference 6 Normally closed, the tight junctions open wider whenever food is digested, so that nutrients in the intestines can be absorbed into the bloodstream to be transported to the cells where they are needed. It is zonulin's job to regulate when and how much the tight junctions open. And it is zonulin's responsibility to ensure that the tight junctions remain closed then they do not need to be open. But repeated exposures to these reactive peptides leads to increased production of zonulin. And as the process is repeated over and over again with virtually every meal, the tight junctions tend to open wider and stay open longer, allowing larger particles and an increasing amount of inappropriate material to enter the bloodstream.

And this problem (increased intestinal permeability) generally exists not only for gluten sensitivity associated with celiac genes, but it's also present with non-celiac gluten sensitivity