Crohn's Disease - Using Alpha ENF
Jones and his associates in England demonstrated that specific foods exacerbated digestive tract symptoms and personalized food exclusion diets were successful in controlling the disease. The use of an Elemental Nutrient Formula (Alpha ENF) is effective in the management of Crohn's disease.
Remission of abdominal pain, diarrhea, and the associated generalized (food allergic) illness can be achieved by replacing food with an ENF with or without prednisone. Once the inflammation is controlled, a slow, careful re-feeding, using the Alpha Nutrition Program should maintain control of the disease. Many Crohn's patients in remission show increased tolerance to foods after a few months; some take advantage of this, eat carelessly and have another acute episode of inflammatory disease. All relapses are treated the same way.
The successful use of elemental nutrients formulas has been established:
Saverymuttu et al demonstrated in a controlled trial that patients placed on an elemental diet plus non-absorbable antibiotics (framycetin, colistin, nystatin) rapidly improved and were indistinguishable from a control group who improved on oral prednisolone (.5 mg/kg/day). Their rational : "The cause of Crohn's disease remains obscure, and treatment unsatisfactory. Much evidence suggests that the expression of immune responses in the gastrointestinal mucosa may be of importance, and evidence for sensitization of patients to a variety of gut associated antigens, both intrinsic and extrinsic has been reported."
Teahon et al reported on 10 years experience with an elemental diet (Vivonex) in Crohn's patients. They treated 113 patients with Vivonex and achieved successful diet remission in 85%. Patients with ilietis did better than those with colonic or perianal disease. They did not have a program for reintroducing foods to establish tolerance and did not attempt maintenance with food control. They noted a tendency to relapse when food was reintroduced.
Frieri et al reported on food allergic investigation in 11 Crohn's patients; Their premise was that "Interaction between food antigens and the immune system may play a role in part in the pathogenesis of inflammatory bowel disease. "
They found skin test reactivity in 7 patients to milk, wheat, and soya protein. 6 patients had increase sIgG4 levels to multiple food proteins. They suggested that increased IgG-secreting plasma cells in the gut mucosa may develop if increased concentrations of food antigens penetrated the mucosal barrier. They also demonstrated increased lymphocyte blastogenic response to egg, wheat and soya protein.
Jones et al showed that careful food reintroduction to patients with Crohn's disease, following remission by fasting was successful in 51 of 77 patients in an uncontrolled study and 7 of 10 patients in a controlled study on an "exclusion diet". The exclusion diet avoided high risk foods - milk and cereal grains - and foods thought to be unlikely to provoke symptoms were introduced one per day. Any food that provoked symptoms in a patient was eliminated from the patient's diet. I have used this protocol in patient management and created a reproducible algorithm for food re-introduction.
Jones stated "No current medical treatment is totally effective for Crohn's disease. Despite reports of Crohn's disease being related to intolerance of individual foods, specific dietary approaches to the management of this condition have been developed. Common dietary advice to these patients has been of a very general nature. Our findings suggest that dietary manipulation may be a practical strategy for the long-term management of the condition in many patients...Both TPN and an elemental diet are valuable in inducing remission in acute Crohn's disease."
Increase intestinal permeability in Crohn's disease may promote the local disease and provide the route for food antigen entry. Hollander et al demonstrated increased Crohn's disease patients and their relatives using polyethylene glycol 400 as a probe - this is a mixture of linear polymers with an average molecular weight of 414 daltons. They stated: "Our data clearly supports the hypothesis that an intestinal permeability defect is an etiologic factor in Crohn's disease. Increased permeability has been demonstrated in Crohn's patients in remission using the lactulose-mannitol test.; 37 of 72 patients showed increased permeability and 86% of this group relapsed within 1 year. Increased intestinal permeability in Crohn's disease may be the primary defect in producing both the local disease and systemic consequences.
Olaison reviewed oral absorption studies done to 1990. His conclusion; "... studies of intestinal permeability in Crohn's disease demonstrate a disturbed intestinal permeability in various parts of the intestine. The findings indicate a general leakiness of the intestinal mucosa, and the fact that this leakiness is not dependent on the presence of inflammation accords the possibility that increased intestinal permeability may be a primary expression of Crohn's disease and a possible pathogenic factor."