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Integrative Medicine Options for Patients With Inflammatory Bowel Disease: Diet, Dietary Supplements, and Acupuncture
S. Devi Rampertab, MD; Laura K. Turnbull, MSNc; Amy C. Brown, PhD, RD; Gerard E. Mullin, MD
Abstract Motivation: Studies demonstrate that more than one out of every two patients with inflammatory bowel disease (IBD) utilizes at least one form of complementary and alternative medicine (CAM). Problem Statement: Practitioners caring for patients with IBD need to be continually updated on the expanding evidence to support the incorporation of CAM modalities into the patient’s medical regimen. Approach: We present an overview of the published literature available in Medline and Ovid on CAM therapies for IBD. Results: Selected CAM modalities that appear to achieve benefit for IBD include a diet low in processed foods and meat and high in fruits and vegetables. For patients with Crohn’s disease (CD), foods that are high in fiber, including those that have skins and/or seeds, are best avoided during periods of active inflammation. Some patients may benefit by removing foods known to have a high potential provoke symptoms, such as dairy, wheat, and/or corn. A 2 to 4–week trial of an elimination diet may be utilized to determine if there is any benefit to the individual patient. Possible dietary supplementation consists of enteric-coated omega-3 fatty acids, prebiotics, and probiotics, as well as curcumin (Curcuma longa) for ulcerative colitis (UC) in particular. A promising yet not fully clinically tested herb is Boswellia (Boswellia serrata). There is no evidence for folate supplementation unless there is a deficiency; however, vitamin D status determination and subsequent supplementation if the patient is deficient is crucial. In general, the data for acupuncture in IBD have not been convincing. Conclusions: Certain patients with CD and UC use CAM modalities, and clinicians should become more familiar with the evidence supporting or refuting the use of diet, dietary supplements, and acupuncture for IBD.
S. Devi Rampertab, MD, is an assistant professor in the Department of Medicine-Division of Gastroenterology at the University of Medicine and Dentistry/Robert Wood Johnson Medical Center, New Jersey. She is the author of 17 peer-reviewed publications and 14 abstracts of original research presented at national meetings. Laura K. Turnbull, RN, MSNc, is a registered nurse and is enrolled in the nurse practitioner master’s program at the Johns Hopkins University School of Nursing in Baltimore, Maryland, with a career focus on integrative nutrition and autoimmunity. She is the author of 12 publications to date. Amy C. Brown, PhD, RD, is an associate professor of complementary and alternative medicine at the John A. Burns School of Medicine, University of Hawaii, Honolulu. She is the author of 29 peer-reviewed publications, 23 abstracts of original research presented at national meetings, and a textbook, Understanding Food (Cengage, 2011). Gerard E. Mullin, MD, is an associate professor of medicine and director of Integrative Gastrointestinal Nutrition Services at the Johns Hopkins Hospital in Baltimore, Maryland. He has had 75 peer-reviewed publications and 35 abstracts of original research presented at national and international meetings. Dr Mullin is also the author of Integrative Gastroenterology (Oxford University Press, 2011), which was the first book in its field; The Inside Tract: Your Good Gut Guide To Great Digestive Health (Rodale Press, 2011); and The Gastrointestinal and Liver Disease Nutrition Desk Reference (CRC Press, 2011).
nflammatory bowel disease (IBD) is a group of inflammatory conditions of the small intestine and colon. The major types of IBD are Crohn’s disease (CD) and ulcerative colitis (UC). In CD, inflammation and/or ulcers can occur anywhere from the mouth to the anus, but usually the small intestine is most often involved. UC consists of inflammation and ulcers limited to the lining of the colon and rectum. Both diseases typically follow a relapsing and remitting clinical course resulting in some patients seeking solutions outside their conventional treatments. Botanicals (herbal products), dietary supplements including prebiotics and probiotics, and acupuncture are considered to be complementary and alternative medicine (CAM) modalities for IBD. Many other CAM modalities exist, and a recent US Centers for Disease Control and Prevention survey showed that almost 4 out of 10 American adults utilize CAM.1 It appears that CAM use may be higher in IBD patients due to the chronic aspect of the disease and the difficulty of controlling it with traditional medical therapy in some cases.2 The utilization of CAM has been well studied in patients with IBD, approximately 50% of whom are current or past users (Table).1-2
Integrative Medicine • Vol. 10, No. 6 • Dec 2011/Jan 2012
Rampertab et al—Inflammatory Bowel Disease
CAM. Nevertheless. there have not been any studies published evaluating such a diet in people with IBD. Many CAM therapies await further research to illustrate their mechanisms of action. CD. Utilizing actual diets to alleviate symptoms in patients with IBD requires further research.11 Use of Dietary Supplements Essential Fatty Acids Essential fatty acids (EFAs) are dietary constituents that cannot be synthesized endogenously and must be obtained via the diet for optimal health. it appears that overconsumption of a Westernized diet consisting of high contents of monounsaturated fats. F. while plant-based proteins with higher omega-3 fats may be protective. The authors also published a previous review summarizing all the clinical practice guidelines for IBD related to diet and dietary supplements. total polyunsaturated fatty acids (PUFAs). and spiritual aspects of individual’s lives”3 —as an approach to patient care that may yield better outcomes than treatments not incorporating CAM.9 Taken together. psychological. Integrative medicine combines conventional medical practice with CAM approaches that appear safe and effective. While these recommendations appear similar to the Mediterranean diet. those found in margarine) may be involved in the etiology of UC.8 More recently. social. please visit copyright. and animal protein were at increased risk for UC. F>M. To share or copy this article. and wild-caught salmon.12 A review by Bassaganya and Hontecillas (2010) summarized the current understanding of mechanisms of action underlying the antiinflammatory actions of conjugated linoleic acid and n-3 PUFAs in IBD. hemp seeds. sardines. fish. herring. A review of CD and diet by Brown et al (2010) revealed that patients with CD in the small intestine were most likely to experience symptoms related to diet. efficacy. It is our goal to provide familiarization with this very crucial area of medical practice—particularly since CAM therapies are continually expanding and more patients are utilizing them. investigators reported that individuals consuming higher amounts of total fats.1-2 Abbreviations: IBD. saturated fats.13 They reported recent research suggesting that IBD remission can be maintained by maintaining the n 3–to–n 6 ratio more than 0.This article is protected by copyright. omega-6 fatty acids. A dose of up to 3 g per day of eicosapentaenoic acid (EPA) combined with docosahexaenoic acid is a common dosage used in clinical trials and is considered safe for general consumption.5 Trans fats can be proinflammatory. To subscribe. female. fiber. some may benefit by removing symptom-provoking foods. UC. Because there are so many modalities currently in use and a wide variety of supplements employed. we will be selective in our discussion. and certain fruits and vegetables with skins and/or seeds. and omega-3 fatty acids and the subsequent development of CD in children. and deep-water fatty fish such as mackerel. ulceralive colitis. krill. Patient Impressions of Complimentary and Alternative Medicine Modalities for Inflammatory Bowel Disease CAM Probiotics Acupuncture Boswellia extract Homeopathy Satisfied Unsatisfied No Change 57% 49% 44% 9% 14% 21% 12% 24% 16% 20% 27% 35% Who is using it? • 21-68% of IBD participants in USA. They suggested the trial of a customized elimination diet for 2 to 4 weeks to determine if there is any benefit to the individual patient. wheat (gluten). eggs of hens on a diet rich in flaxseed. No. Partic- Rampertab et al—Inflammatory Bowel Disease Integrative Medicine • Vol. corn.com Table 1. increased refined sugar intake and high overall carbohydrate intake precede the development of CD. these data suggest that animal protein–rich diets with a high content of refined sugars appear to place individuals more at risk. such as dairy. Omega-3 EFAs are found in a wide variety of foods including flaxseed. M. male. benefits. 10.com. Use ISSN#10786791. Inflammatory Bowel Disease. the researchers determined that while not all patients respond equally to diet. Crohn's Disease. walnuts. and safety.65 via n-3 PUFA intervention.10 Overall. CD>UC Why are they using it? • Better control of disease • Good for stress Which forms of CAM are being used? • Homeopathy • Diet change and supplements • Probiotics 64% 63% 52-55% 22-45% 43% Data excerpted from patient surveys. this review aims to examine selected aspects of integrative therapy by briefly alluding to proposed mechanisms of action. visit imjournal. The most common source of EFAs is from fish oil that can be obtained from consuming fatty fish in the diet or through dietary supplements such as raw fish oil or enteric-coated capsules. and indications in regard to IBD. 6• Dec 2011/Jan 2012 23 . The Institute of Medicine regards integrative medicine—which “takes into account biological. complementary alternative medicine ularly.7 There is an inverse association between dietary intake of vegetables. fruits. Diet therapy There is evidence from a variety of investigators supporting the notion that diet plays a role in disease development. and omega-6 fatty acids and large amounts of refined sugars is a risk factor for UC and CD.6 Increased consumption of chemically modified fats (ie.4 Furthermore.
14 Numerous studies have evaluated the effects of fish oil on IBD.005) and higher Inflammatory Bowel Disease Questionnaire (IBDQ ) (179. The net results are as follows: 1) inhibition of both the cyclooxygenase (COX) pathway (primarily COX-2) and the 5-lipoxygenase pathway.29 Folic acid is a member of the B-complex family and is involved in many important body processes. but the methodology and endpoints have varied. including DNA synthesis. Seidner’s research group then conducted a clinical trial using this nutritional supplement in CD patients in which the supplement was renamed inflammatory bowel disease nutritional formula (IBDNF). P = .98. which is a transcription factor whose overexpression has been linked to inflammatory and autoimmune diseases. the treatment group required less prednisone to control clinical symptoms when compared to the placebo group. Clinical relapse was defined by using the gold standard of the Crohn’s Disease Activity Index (CDAI): a score of 150 points or greater.6 ± 35. the results showed that fish oils improve the clinical course of UC.20-23 The Cochrane Collaboration recently composed a report based on three studies concluding that an enteric-coated omega-3 EFA supplements reduced the 1-year relapse rate of CD by half. with an absolute risk reduction of 31% and a number-needed-to-treat of only 3. and the United States.17-19 A variety of studies have been performed exploring the roles of omega-3 EFA in the treatment of UC. Those with EPA levels >2% had significantly lower CDAI (116 ± 94.03). both the treated and control groups experienced similar relapse rates.25 Two randomized.com. Europe.22 Clinical and histologic parameters as well as medication usage were assessed over 6 months in the 86 patients who completed the study. double-blind. folic acid has been studied for its ability to circumvent dysplasia as a consequence of long-standing 24 Integrative Medicine • Vol.77.61 to 0. 6 • Dec 2011/Jan 2012 Rampertab et al—Inflammatory Bowel Disease . individuals afflicted with IBD utilize combinations of supplements that potentially synergize for clinical improvement. In both EPIC-1 and EPIC-2. Folate Multiple nutritional deficiencies are known to be problematic in IBD. please visit copyright. 95% confidence interval [CI]: 0.001) compared to those with EPA <2%.15. there were no significant differences in the CD relapse rate for placebo vs fish oils. and a prebiotic (fructooligopolysaccharide) on disease activity and medication use in patients with steroid-dependent mild to moderate UC.03) but not in UC (RR 1. In real life. Use ISSN#10786791. To share or copy this article. Omega-3 fatty acids should be provided to the 25% of patients with IBD experiencing EFA deficiency and perhaps to patients interested in exploring CAM modalities.28 Well-designed clinical trials are required to explore whether nutraceutical supplements can be used in conjunction with conventional therapies to optimize treatment of IBD.02.51 to 2. Seidner et al (2005) conducted a randomized.27 The investigators reported a clinical benefit over placebo with improved CD activity index and quality of life in those who received the IBDNF. Practitioners should be aware that fish oils have an anticoagulant effect. or initiation of treatment for active CD. However. with resultant downregulation of inflammatory processes.This article is protected by copyright. visit imjournal. Overall.6 vs 114. Thus rather than executing a single-supplement study. omega-3 fatty acids produced a favorable benefit (relative risk [RR] 0. antioxidants.26 The goal of these studies was to determine whether omega-3 fatty acids could sustain remission once it is achieved in CD. 10.16 and these findings were corroborated in small clinical trials. an increase of more than 70 points from the baseline CDAI value. P = . No. To subscribe. and the majority of IBD patients are deficient in folic acid. P < . Turner et al subsequently published two meta-analyses of nine studies of the influence of omega-3 fatty acids in IBD that included the EPIC-1 and EPIC-2 clinical trials. placebocontrolled trial to evaluate an oral supplement (called ulcerative colitis nutritional supplement) enriched with fish oil. placebo-controlled studies (Epanova Program in Crohn’s Studies 1 [EPIC-1] and 2 [EPIC-2]) were conducted between January 2003 and February 2007 at 98 centers in Canada. and 5) a decrease in the release of the proinflammatory cytokines interleukin-1β and tumor necrosis factor-α. Thus. Figure 1. Oral fish oil supplements led to improvement in IBD in animal models. both key pathways in the inflammatory cascade. Omega-3 Modulation of Arachidonic Acid Cascade Biochemical studies indicate that 25% of patients with IBD show evidence of EFA deficiency.9. 3) regulation of transcription factors such as peroxisome proliferator–activated receptors. 2) decreased production of proinflammatory leukotriene B4. 95% CI: 0.24 A similar Cochrane metaanalysis based on three studies found that nonenteric-coated capsules provided to patients with UC found no significant difference. Israel. Both groups (oral nutrition supplement and placebo) showed similar improvement in clinical and histologic indices.5 vs 261.5. The current research on IBD and omega-3 fatty acids shows sporadic positive results interspersed with studies showing no positive effect.12 These investigators reported that in six studies of CD. However.1 ± 26.com Omega-3 EFAs appear to work through many mechanisms (see Figure 1).8 ± 86. 4) inhibition of nuclear factor-κB (NF-κB).
Further trials are warranted. In those individuals with high homocysteine levels.36 The major causes of bone loss in IBD.33.06. Jorgensen et al administered 1200 IU of vitamin D3 or placebo for 12 months to 108 patients with quiescent CD in a randomized doubleblind trial. The relapse rate was lower among patients treated with vitamin D3 (6/46 or 13%) than among patients treated with placebo (14/48 or 29%) or P = .com. vitamin D status is crucial to determine in patients with IBD given its impact upon bone health and autoimmunity.40 Of these. suspect the presence of a methylation defect and consider ordering methylenetetrahydrofolate reductase polymorphism analysis. 3) antimicrobial activity and suppression of pathogen growth. please visit copyright. There are many preparations available.43 to 1.5% of patients with IBD as compared to only 3. whereby probiotics compete with microbial pathogens for a limited number of receptors present on the surface epithelium. To share or copy this article.38 The clinical endpoint was relapse. may have many beneficial effects (see Figure 3). 2) immunomodulation and/or stimulation of an immune response of gut-associated lymphoid and epithelial cells.004) and older age at diagnosis (P = .35 Vitamin D deficiency was associated with older age (P = . and relapses occur more commonly in autumn and winter months when levels of sunlight are low. and 5) induction of T cell apoptosis in the mucosal immune compartment. A high homocysteine level may be due to a failure of folic acid being converted to the active methyl donor 5-methyl-tetrahydrofolate (5-MTHF).41. Though clinically insignificant. A dysbiosis may exist in some patients with IBD wherein an altered gut micoflora concentration results in increased pathogenic bacteria and decreased bifidobacteria and lactobacilli.07.41 Unfortunately.33) in CD but not UC (regression coefficient 0. a known inducer of a hypercoagulable state seen in 26. Clinical trials administering vitamin D with a therapeutic intention have been conducted in patients with IBD. are common in patients with CD and are related to malnutrition and lack of sun exposure.3% of controls. the major vitamin D metabolite.34 Ulitsky et al recently reported that 49. additional evidence is being acquired for probiotic use in patients with IBD. consistently listed as one of the top nutritional supplements used by patients with IBD. Low folate levels in IBD may be caused by medications (ie. Hyperhomocysteinemia. 95% CI: 0.10 to –0. recurrent Clostridium difficile– induced infections. Figure 2: Role of Vitamin D in Immune Regulation Probiotics Probiotics.91 to 3. Vitamin D deficiency was also associated with increased disease activity in CD (regression coefficient 1.31 is associated with a low serum folate level (as well as low B6 and B12) and can predispose patients to the development of deep venous thromboses. 4) enhancement of barrier function.com IBD with disappointing results. Vitamin D Vitamin D is now widely recognized as a regulator of the immune system (see Figure 2).9% having severe deficiency. Oral vitamin D3 treatment with 1200 IU daily increased serum 25-hydroxy vitamin D from mean 69 nmol/L (standard deviation [SD] 31 nmol/L) to mean 96 nmol/L (SD 27 nmol/L) after 3 months (P < . Use ISSN#10786791.30 There currently is no evidence to support supplement of IBD patients with folate unless they have a folate deficiency. Overall. 95% CI: –2. however. a trend towards improvement in maintenance of remission was observed. Vitamin D deficiency was associated with lower health-related quality of life scores (regression coefficient –2.This article is protected by copyright. 6• Dec 2011/Jan 2012 25 . Reduced blood levels of 25-OH cholecalciferol. No. To subscribe. and postoperative pouchitis.39 Several probiotic mechanisms of action related to inflammatory bowel disease have been elucidated: 1) competitive exclusion. Consider checking homocysteine levels in your IBD patients.001).8% of 504 individuals with IBD (403 CD and 101 UC) were deficient in vitamin D with 10. 10. modulation of the intestinal immune response is crucial to effective treatment of IBD.71). 95% CI: –4.03). sulfasalazine) that impair folic acid transport and malabsorption from loss of surface area due to underlying disease or surgery.21. visit imjournal. are the effects of inflammatory cytokines and glucocorticoid therapy. the quality of studies utilizing probiotics in UC and CD and the quality of the preparations (not all Rampertab et al—Inflammatory Bowel Disease Integrative Medicine • Vol.32 The incidence of both CD and UC is higher at northern latitudes. Deficiency of vitamin D may also be a risk factor for IBD. While level 1 evidence exists for the therapeutic use of probiotics in infectious diarrhea in children. The administration of vitamin D (1000 IU/d for 1 y) prevented bone loss in patients with active CD.73). Supplementation with 5-MTHF may help restore normalization of homocysteine levels and assist with cardioprotection in your IBD patients.37 not vitamin D status.
lactulose. their use should be restricted in such settings and always administered under supervision. Compared with the nonprobiotics group.42 A recent meta-analysis has helped clarify the potential beneficial role of probiotics in UC.54 In a pilot study involving open-label 26 Integrative Medicine • Vol. Botanicals In traditional Chinese medicine and Ayurveda. and oligosaccharides consisting of short-chain complexes of sucrose. probiotics were more effective than placebo for the maintenance of remission but not induction of UC.96).43 Seven studies evaluated the remission rate. which may be antiinflammatory and may reduce intestinal permeability. please visit copyright. galactose. Use ISSN#10786791. There are reports of fungemia and bacteremia in critically ill or immunocompromised patients given probiotics. Compared with the nonprobiotics group. herbal extracts are the mainstay of treatment for IBD and appear to be effective when used by trained practitioners.07 to 1. probiotics should be in the toolbox of clinicians who manage patients with UC and CD. No. or xylose. are believed to play a biologically active role and have been shown to be potentially immune modulating (see Figure 4). The group who received Bifidobacterium bifidum treatment had a recurrence rate of 0.com probiotic strains have the same efficiency) are highly variable.35 to 2. studies have demonstrated that curcumin is an inhibitor of NF-β and leads to downstream regulation and inhibition of proinflammatory genes and cytokines.52 Administration of curcumin has also been reported to modulate a host of other cytokines and signaling pathways. Examples include bran.12 to 0. potential risks need to be appreciated. glucose. Figure 3.73).51).01). They are Turmeric (Curcuma longa). maltose.00 (95% CI: 1. has been used in Ayurvedic medicine since ancient times. Mechanisms of Probiotic Action in Inflammatory Bowel Disease nondigestible dietary carbohydrates that preferentially encourage growth and modify activity of beneficial intestinal bacteria. Botanical Modulation of Arachidonic Acid Cascade As with any therapy.12 to 0. given the promising results for IBD.25 (95% CI: 0.47 Other prebiotics that have shown promise in placebocontrolled trials include wheatgrass juice48 and inulin. found in food substances produced from plants. prebiotics appear to be beneficial as a standalone therapy for UC and should be considered as an adjunctive treatment option. there are far more data showing benefit in UC than in CD.50) compared with the nonprobiotics group. Thus.This article is protected by copyright. resistant (high amylose) starch. To share or copy this article. the most prominent of which is curcumin. the recurrence rate was 0. the recurrence rate of UC patients who received probiotics was 0. visit imjournal.53 Seven studies involving curcumin administration to animal colitis models showed clinical and histopathological improvement and decreased inflammatory cytokine production where measured.25 (95% CI: 0. Prebiotics Prebiotics are probably less well known and therefore utilized less frequently compared to probiotics. Recently. the remission rate for UC patients who received probiotics was 1. Future studies on the combination of preand probiotics in managing IBD are encouraged.44 Therefore.36 (95% CI: 1. two studies evaluated both remission and recurrence rates. In the mild to moderate group who received probiotics compared to the group who did not receive probiotics. Bacterial fermentation of prebiotics yields short-chain fatty acids such as butyrate. Polyphenols. 10. fructose. the remission rate of UC was 1. and eight studies estimated the recurrence rate.35 (95% CI: 0.69 (95% CI: 2. the major spice in curry. the remission rate of UC patients who received probiotics was 2. During the course of treatment in patients who received probiotics for less than 12 months compared with the group treated by nonprobiotics. To subscribe. 6 • Dec 2011/Jan 2012 Rampertab et al—Inflammatory Bowel Disease . Sang et al analyzed 13 randomized controlled high-quality studies that met their selection criteria.45 Overall.49 Overall. Compared with the placebo group.com. psyllium husk. Thus far. The major chemical constituents of turmeric are curcuminoids. inulin.85).98 to 1.46 An unblinded study of germinated barley foodstuff has shown an increased remission rate in UC patients over 12 months.51 Figure 4.50 There is clinical evidence in humans for use of two polyphenols in IBD: curcumin and Boswellia (Boswellia spp).47 to 1.
57 During a small 6-week trial. skins.63 In the Western literature.62.40(6):754-760. Vilaseca J. Use ISSN#10786791. Thomson AB. Farbstein M. Familiarity with these modalities by health care practitioners and continued investigations allow us to optimize medical management of IBD. double-blind study from Germany. References 1. 55 In a larger randomized. Gut. Porcino A.56 Given its excellent safety profile as well as the results above. Commissioned for the IOM Summit on Integrative Medicine and the Health of the Public February. 1996. 6. 1991. Turner D. Dietary conjugated linoleic acid and n-3 polyunsaturated fatty acids in inflammatory bowel disease. 2007. 2011 4. Supplementation with n-3 fatty acids from fish oil in chronic inflammatory bowel disease—a randomized. 350 mg three times daily of Boswellia gum resin was as effective as sulfasalazine (1000 mg 3x/d) in reducing symptoms or laboratory abnormalities of patients with active UC. Studies from the Chinese and Western literature suggest that these therapies may regulate gastrointestinal motor activity and secretion through opioid and other neural pathways. Dorrell L.com administration of a curcumin preparation to five patients with UC and five patients with CD. 2011. With regards to CAM modalities for IBD.19(2):166-171. claim excellent results. one modality that appears to achieve benefit for IBD is a diet low in processed foods and meat and high in fruits and vegetables (except those high in fiber.com. Four of the five patients with UC were able to decrease or eliminate their medications. Guarner F. Can J Physiol Pharmacol. parallel study performed in 22 German centers. 14. inhibits leukotriene biosynthesis by noncompetitive inhibition of 5-lipoxygenase. Expert Rev Gastroenterol Hepatol. D’Souza S. Hilsden RJ. 2. randomized. Bloom B. Smith CL. Fedorak RN. El-Serag H. Accessed May 20. Zlotkin S. placebo-controlled. 400mg each or 2400 mg/day) or placebo for 52 weeks.3(1):47-52. 108 outpatients with CD in clinical remission were randomized to Boswellia (2 capsules given 3 times a day. In all. Conversely. double-blind. Prevalence of essential fatty acid deficiency in patients with chronic gastrointestinal disorders. Inflamm Bowel Dis. Clandinin MT. vegetables.731:225-232. Weber PC. Some patients may benefit by removing symptom-provoking foods like dairy. One herb of interest that needs further scientific support is Boswellia. To share or copy this article. prebiotics. however. Roy M. Health effects of trans-fatty acids: experimental and observational evidence. Brown AC. It is an exciting. Nahin RL. Loeschke K.31(5):539-544. 3. a proprietary Boswellia extract was found to be as effective as mesalamine in improving symptoms of active CD. Summit on integrative medicine & the health of the public: issue background & overview. To subscribe. http://www. as well as those comparing these modalities against standard Western treatments. Salas A. Hallak A. Barnes PM. 5. et al. the data for acupuncture in IBD has not been convincing. 2009. 10.17(2):655-662. Curr Opin Clin Nutr Metab Care. Weisfeld V. Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan. Possible dietary supplementation consists of enteric-coated omega-3 fatty acids. 6• Dec 2011/Jan 2012 27 . Lerman RH. Eur J Clin Nutr. Incorporation of fatty acids from fish oil and olive Rampertab et al—Inflammatory Bowel Disease Integrative Medicine • Vol. Metabolism. Abraham B. 2010. vitamin D status determination and subsequent supplementation if the patient is deficient is crucial. In general. Verhoef MJ.5(3):411-425. rates of response to Western treatments seem smaller than would be expected. Am J Gastroenterol. multicenter trial involving 89 patients with quiescent UC. Rampertab SD. Empey LR.45(1):12-23. Rodriguez R. Klein I. visit imjournal.59 Patients taking the extract had an average reduction of 90 CDAI points vs 53 points in those provided mesalamine. Diet and inflammatory bowel disease: a case-control study. Pre-illness dietary factors in inflammatory bowel disease. Lubin F.edu/~/media/Files/Activity%20Files/ Quality/IntegrativeMed/IM20Summit20Background20Paper20Weisfeld2022309. Jewell LD. Hellers G. Use of complementary and alternative medicine by patients with inflammatory bowel disease. Morgan K. and/or corn in a 2 to 4–week trial to determine if there is any benefit to the individual patient. 9. and probiotics to treat IBD in general and curcumin to treat UC in particular. 12. an Ayurvedic herb also known as Indian frankincense. Mullin GE.58 In a randomized. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Szimnau P.106(4):563573. 10. double-blind cross-over trial. 2010. wheat (gluten). 2008. Reif S. A case-control study in Japan. the data for acupuncture in IBD has not been convincing. and/or seeds during inflammation). Complementary and alternative medicine use among adults and children: United States. Strasser T. There is no evidence folate supplementation helps unless the patient is deficient.61 Uncontrolled studies from China. Inflamm Bowel Dis. Fish oilenriched diet is mucosal protective against acetic acid-induced colitis in rats. Lorenz R. 2007. 13. 2011. Hontecillas R. however. Hillier K. Gilat T. placebo-controlled.102(9):2016-2025. Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): a systematic review and meta-analyses.pdf. Integrative medicine is best practiced with continued open communication between patients and providers in an attempt to render the best care possible. Griffiths AM. Persson PG. 1992. 16.17(1):336-345. No. Heldwein W.60 Acupuncture Acupuncture and moxibustion (using herbs on acupuncture points through burning or needling) are commonly employed in traditional Chinese medicine for treatment of UC. 2011. please visit copyright.iom. 15. Epidemiology. DeBruyn JC.69(4):480-487. and fruits are associated with risk for Crohn’s disease in children. curcumin is poised to have a prominent role in the future management of IBD.65 In general. Natl Health Stat Report. Am J Gastroenterol. 11. 8. Rasmussen H. Ahlbom A. nine out of 10 patients reported improvement at the conclusion of the 2-month study. Existing dietary guidelines for Crohn's disease and ulcerative colitis. 1997. 7.13(5):569-573. 2011. Aro A.64 These results were echoed in a study of UC patients with similar design. Bassaganya-Riera J. Martinez M.(12):1-23.63 Suppl 2:S5-S21. Dietary and other risk factors of ulcerative colitis. Brown AC. Jewell R. cONclUSION Integrative medicine is the artistic blending of CAM modalities into a patient’s medical regimen. Holtmeier and colleagues (2011) found no significant differences in CDAI or IBDQ scores in a double-blind. Dietary fish oil reduces progression of chronic inflammatory lesions in a rat model of granulomatous colitis. 1994. Siguel EN. Mechanisms by which acupuncture and moxibustion modulate the immune system are not entirely clear. Shah PS.1990. J Intern Med Suppl. Malagelada JR. administration of 1 g curcumin twice daily resulted in both clinical improvement and a statistically significant decrease in the rate of relapse. No authors listed. Garg ML. 18. J Clin Gastroenterol. Mozaffarian D. a randomized. Willett WC. Amre DK. controlled study of acupuncture and moxibustion as treatment for active CD showed no significant difference in CDAI score and quality of life between the treatment group and the placebo group undergoing sham acupuncture. Steinhart AH.This article is protected by copyright. 2009. dynamic field that holds much promise and often has centu- ries of experiential evidence and numerous published studies to support its use in the prevention and treatment of human disease. Does evidence exist to include dietary therapy in the treatment of Crohn's disease? Expert Rev Gastroenterol Hepatol.1989. Boswellia serrata. Gut. Hou JK. Imbalances in dietary consumption of fatty acids. 17.4(2):191-215.
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