Afleveringen
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This is my review of Zeposia (Ozanimod), a new once a day oral medication for moderate to severe ulcerative colitis. I go over the True North Study (https://www.nejm.org/doi/full/10.1056/NEJMoa2033617) in detail including efficacy and safety data. I have no conflicts of interest with any pharmaceutical companies. These are my opinions regarding Zeposia and other medications based on my personal/clinical experience and review of the literature.
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Dr. Shriram Jakate is Professor Emeritus in pathology at Rush University Medical Center. He has a particular expertise in GI and liver pathology and has been interpreting slides from patients with Crohn's and colitis for over several decades. I consider him to be the best GI pathologist I have encountered in my career and during this podcast we have a wide ranging discussion about interpretation of IBD pathology. We discuss the pathologic features of Crohn's and ulcerative in detail and also go over IBD mimickers (including NSAID induced inflammation), C diff, pouchitis and rethinking the classification of IBD subtypes.
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Zijn er afleveringen die ontbreken?
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This is a discussion with Dr. Assad Munis, third year gastroenterology fellow at Advocate Lutheran General Hospital, about his recent presentation "Initial Approach to Fistulizing Crohn's Disease" at our grand rounds.
We discuss pathophysiology, diagnosis, and primarily medical management. We also touch on topics of stem cell therapy, hyperbaric oxygen and exclusive enteral nutrition as potential treatments. -
I made this podcast for those who are newly diagnosed with Crohn's disease or ulcerative colitis.
Dr. Kâs Simplified Prescription to Treat IBD(itâs not that complicated to know what to do)
1.Start with appropriate and optimized medical therapy, preferably by an IBD specialist (like myself).
2.If this works, follow an IBD diet protocol that speaks to you and that you can realistically follow long term. Bottom line is to take out processed food and being plant based is probably helpful.
3.After at least 1 year, if in deep remission (feeling normal, normal colonoscopy, normal biopsies), continue meds if no side effects or consider de-escalation of medical therapy (ie stopping or reducing dose) and continue diet with careful monitoring strategy for recurrence. If there is disease recurrence, restart medical therapy at direction of IBD specialist and consider changing dietary protocol.
4.If you run out of medical therapies or are stuck on prednisone, surgery is a good option which can not only save your life but improve your quality of life.
5.Besides diet and medication, other complementary and alternative therapies (ie supplements, probiotics, etc) are unlikely to be the miracle you hope for.
That is all!
To schedule a phone conversation with me, go to:
https://calendly.com/samir3/against-the-grain -
This podcast is a deep dive into the recently published article "A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohnâs Disease."
(also known as the Dine Study) published by Lewis, et al.
Article link is here: https://pubmed.ncbi.nlm.nih.gov/34052278/
My guests are Dr. Meghana Doniparthi, gastroenterology fellow at Advocate Lutheran General Hospital and
Kim Beall, Pharm D.
Kim received her Doctor of Pharmacy from the Medical University of South Carolina (MUSC) and her BS in Pharmacy from Auburn University. She has experience in academics and industry, working at MUSC as part of an Internal Medicine team and serving as adjunct faculty at MUSC College of Pharmacy, then working in Health Sciences with Merck as an academic liaison for those publishing and researching in lipids, hypertension, and heart failure. She has been following research in IBD closely since 2013 with her teenage sonâs diagnosis of Crohnâs disease, and has become committed to the advancement of nutritional therapy as treatment.
Her website is http://www.ntforibd.org -
This is my second podcast with IBDCoach. We try to make sense of all the IBD diets, supplements and medications out there which can be so confusing! We also have a detailed discussion regarding Andrew's use of Ksharsutra (Ayurvedic Seton) to treat his fistula.
I am not officially endorsing or recommending this service or Ksharsutra. You must discuss using any adjunctive therapies with your gastroenterologist.
Andrew Kornfeld ([email protected]) holds degrees in Neuroscience and Psychology from UC Santa Cruz and is an award-winning educator, organizer, and published author. He has Crohnâs disease, and over the course of a decade and a half has developed a tailored and evidence-based protocol that allowed him to achieve robust, lasting clinical remission from his IBD. Andrew founded IBDCoach (www.ibd.coach) so others with Crohnâs disease and ulcerative colitis could benefit from the strategic lessons and research he has conducted in his personal pursuit of health.
Amy Loftus ([email protected]) holds a B.A. in Biological Anthropology and an M.A. in Education from the University of California, Berkeley. She works alongside Andrew to run the operations arm of IBDCoach. Amy combines her decade of classroom teaching experience, her work as a software engineer at a Silicon Valley health tech startup, and her years as an IBD spouse to empower IBDCoach members with the resources they need to achieve their remission goals. -
There are many reasons why a whole food plant based diet may be helpful for Crohnâs disease and ulcerative colitis. Data suggest limiting omega-6 PUFAs (ie oils), saturated fats, animal protein, and food additives may be associated with a reduced risk of developing IBD. A whole food plant based diet seems to check all of those boxes. However, this doesnât change the fact that there are some out there who respond to the Specific Carbohydrate Diet (which is a monosaccharide diet) that does not restrict meat, cheese or cooking oils. Enthusiasm for a whole food plant based diet is gaining steam not just for IBD but also other health conditions like heart disease, obesity, diabetes and prevention of cancer. Itâs important to remember that there still is a lot of controversy regarding what is the optimal diet for human health if such a thing exists. Today I interviewed Shamiz and Shukul Kachwalla who are brothers who run High Carb Health and promote a whole food plant based diet. Shamiz has ulcerative colitis and has been maintaining drug free remission with a whole food plant based diet for over seven years. As a disclaimer, this podcast should not be interpreted as medical advice and is not an official endorsement of this diet for the treatment of inflammatory bowel disease especially without appropriate medical therapy.
Their website: https://www.highcarbhealth.com/
Crohn's Disease Remission with a Plant-Based Diet: A Case Report:
https://pubmed.ncbi.nlm.nih.gov/31226766/
Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet
https://pubmed.ncbi.nlm.nih.gov/20503448/ -
For all the mega Against the Grain fans out there, here is the full theme song, version #1 in all its glory. The part you are familiar with is in the middle of the track.
Produced and Written by Samir Kakodkar. Borrowed some parts from theme from the ABC reality TV show The Mole (that nobody watched).
Circa 2003 at Northwestern University, Foster Walker Complex, on a microKorg and Garage Band. -
For all the mega Against the Grain fans out there, here is the full theme song, version #2 in all its glory.
Produced and Written by Samir Kakodkar
Circa 2003 at Northwestern University, Foster Walker Complex, on a microKorg and Garage Band. -
There are many theories out there regarding what causes Crohnâs disease. Though ultimately most physicians and scientists acknowledge that we donât know the cause, there is a small subgroup that believe Crohnâs disease is caused by a specific bacteria called mycobacterium avium paratuberculosis which we will abbreviate as MAP. MAP mainly comes from infected cattle but is now ubiquitous in our environment and all of us are likely exposed to it on a regular basis.
The treatment paradigm for Crohnâs has mainly been the use of immunosuppressive medications which target a dysregulated immune system thought to be central to the pathophysiology of the disease. However, there are some that treat Crohnâs by targeting MAP with the use of antibiotics, fecal transplants and hyperbaric oxygen. There is even an anti-MAP vaccine in development. In my opinion, this is the biggest controversy in the IBD field right now. In fact, the Crohnâs Disease guidelines published by the American College of Gastroenterology in 2018 explicitly state that anti-MAP therapy has not been shown to be effective for induction or maintenance of remission or mucosal healing in patients with Crohnâs disease and should not be used as primary therapy. This led to subsequent letters being published in the American Journal of Gastroenterology both criticising and defending this statement.
Today I interviewed gastroenterologist Gaurav Agrawal and microbiologist John Aitken who are MAP experts and will give us a comprehensive overview of this topic.
As a disclaimer, I am not formally endorsing this therapy for Crohnâs disease as it has not been FDA approved for this purpose in the US. This podcast should not be interpreted as medical advice. This is an open discussion in order to encourage more research and awareness of this topic.
ACG Clinical Guideline: Management of Crohnâs Disease in Adults:
https://pubmed.ncbi.nlm.nih.gov/29610508/
Comment on 2018 ACG Clinical Guideline: Antibiotics in Crohn's Disease:
https://pubmed.ncbi.nlm.nih.gov/30333546/
Response to Chamberlin and Borody
https://pubmed.ncbi.nlm.nih.gov/30633034/
Two-year Combination Antibiotic Therapy With Clarithromycin, Rifabutin, and Clofazimine for Crohn's Disease:
https://pubmed.ncbi.nlm.nih.gov/17570206/
Targeted Combination Antibiotic Therapy Induces Remission in Treatment-NaĂŻve Crohn's Disease: A Case Series:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142403/
Combining infliximab, anti-MAP and hyperbaric oxygen therapy for resistant fistulizing Crohn's disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137971/
Profound Remission in Crohn's Disease Requiring No Further Treatment for 3-23 Years: A Case Series
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144342/
Website regarding Crohnâs Disease Vaccine:
http://www.crohnsmapvaccine.com
John Aitkenâs
Website:
https://otakaropathways.co.nz/about.php
Email:
[email protected] -
This is a show on some of my favorite ready-made food items. These would be considered processed foods to some degree, but definitely less processed than the types of things you would find at The Dollar Store or even a regular grocery store chain. Sometimes itâs nice to have food on hand that you donât always have to prepare. I understand there are diet purists out there that donât eat anything unless it is made from scratch. However, for those who are not able to dedicate a lot of time to cooking, these types of food products can help to reduce the time burden. Most of the products I mention would be compatible with the various diets used for inflammatory bowel disease including the Specific Carbohydrate Diet though there may be exceptions depending on the particular diet or stage you are in. Why are thes foods ok for IBD? Because they donât have the food additives, refined flours or sweeteners that may be detrimental (though I understand even making that statement is controversial). I donât receive any money or sponsorship from the companies that make these products so these are my unbiased opinions.
Iâm happy to announce that my clinic is now equipped for video and telephone visits. For those who would like more personalized attention, you can schedule an appointment with me. I only treat adults - those 18 years old or over. You can email me at [email protected] for more information about a virtual appointment if you are interested. -
This show will focus on the effect of stress on Crohnâs disease and ulcerative colitis. I will define stress as the feeling of being challenged by a threatening event or evolving situation. Everyone experiences some degree of stress in life, but when it becomes chronic and perceived as severe, it can have adverse health effects. Many patients attribute their initial diagnosis and subsequent flares to stressful life events. But does stress actually make the inflammation of inflammatory bowel disease worse? I review what the literature says and also present a case of a patient with Crohn's colitis who subsequently had a normal colonoscopy with normal biopsies after decreasing stress in his life. As a disclaimer, this is just an anecdote and does not constitute evidence. I am not recommending stress reduction as a primary treatment modality for IBD without adjunctive appropriate medical therapy.
References:
The Brain-Gut Axis and Stress in IBD by Bernstein: https://www.ncbi.nlm.nih.gov/pubmed/29173525
Manitoba Registry showing stress not associated with intestinal inflammation:
https://www.ncbi.nlm.nih.gov/pubmed/26077178
UC patients with more inflammation with more stress:
https://www.ncbi.nlm.nih.gov/pubmed/?term=10811330
Mindfulness Based Interventions in IBD by Hood et al : https://www.ncbi.nlm.nih.gov/pubmed/29173527
Wim Hof Method Paper: https://www.wimhofmethod.com/uploads/kcfinder/files/PNAS.pdf -
Today we are going to tackle Coronavirus, specifically SARS-CoV-2 which causes the disease COVID 19 in relation to gastrointestinal symptoms and disease. I will be interviewing Dr Kaushal Majmudar who is one of our great GI fellows at Advocate Lutheran General Hospital. He recently did a Grand Rounds for our GI department on this very topic and went over all the recent data regarding pathogenesis, treatment and also recommendations from various GI societies for specific clinical scenarios regarding liver disease, endoscopy and inflammatory bowel disease. This will be valuable information for clinicians in all specialties and definitely for those working in GI. Though at times this does become technical at certain points, it will be valuable information for the non-physician audience too. At the end I will give my own thoughts about COVID 19 and IBD with comments on the relevance of the hygiene hypothesis, infusion centers and specific risks of medications. As a disclaimer, we are not the CDC or members of committees creating the guidelines that will be discussed. Opinions are our own. This is an open discussion and should not be interpreted as medical advice.
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Dr. Mitsuro Chiba is an MD, PhD is a gastroenterologist and researcher at Akita City Hospital, Kawamoto, Akita City, Japan.
He believes that inflammatory bowel disease is a lifestyle disease mediated mainly by a westernized diet, and has had many subsequent publications detailing his use of a plant based, semi-vegetarian diet.
He began to provide a plant-based diet for patients with inflammatory bowel disease at Nakadori General Hospital (Akita City, Japan) in 2003, and then continued to provide the diet at Akita City Hospital since 2013. We had a very detailed discussion regarding his well cited paper "Lifestyle-related disease in Crohnâs disease: Relapse prevention by a semi-vegetarian diet" published in 2010 which demonstrated the efficacy of using a plant based diet in combination with infliximab for induction of remission then maintenance with a plant based diet alone.
Though Dr. Chibaâs English is excellent, special thank you to Dr. Chibaâs daughter Kaeko who helped with translation at certain points of the interview.
This podcast should not be interpreted as medical advice as a plant based diet is not FDA approved for the treatment of inflammatory bowel disease.
Dr. Chiba's study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877178/
Lester Breslow's 1980 publication regarding healthy habits:
https://www.sciencedirect.com/science/article/pii/0091743580900420 -
This is my much anticipated interview with Judy Herod who has been on the Specific Carbohydrate Diet (which we will often abbreviate as SCD) for over 50 years for ulcerative colitis with rapid clinical response and sustained drug-free remission. Her mother is the late Elaine Gottschall, biochemist and author of Breaking the Vicious Cycle: Intestinal Health Through Diet which is the book that describes the SCD protocol in detail and started the food/ibd movement several decades ago. Judy has likely been using dietary therapy for her ulcerative colitis longer than anyone else in the world. There are many parents who have young children on the SCD. I thought it would be valuable to hear from someone who has been on this protocol for so long to perhaps get a sense of what life can be like using SCD as a treatment strategy long term. As a disclaimer, this podcast should not be interpreted as medical advice as the SCD is not as of yet an FDA approved treatment for Crohnâs or ulcerative colitis.
SCD Website: http://www.breakingtheviciouscycle.info/ -
Barbara Olendzki RD, MPH, LDN is Associate Professor of Medicine and the Nutrition Program Director of the Center for Applied Nutrition at the University of Massachusetts. She is passionate about research and clinical care of patients with inflammatory bowel disease (IBD), cardiac concerns, cancer, diabetes, obesity, and other inflammatory diseases. She has 20 years of experience in the nutrition field. She created the IBD-anti inflammatory diet (IBD-AID) which is based on the Specific Carbohydrate Diet but with an emphasis on pre and probiotics, healthy fats and textures of foods. It also includes certain carbohydrates like oatmeal and other foods that are otherwise forbidden on the SCD.
She published a case series in 2014 of 11 patients with IBD who went on her dietary protcol. Most of these patients had failed one or more medications, or medications had no effect or there was a loss of response. After using the IBD-AID, all patients were able to de-escalate medical therapy to some degree and all had symptoms reduced. Since that publication, she has updated the protocol and kindly shared her insights regarding implementing the IBD-AID clinically. As a disclaimer, this is not an endorsement or recommendation of this diet for the treatment of IBD as the IBD-AID has not been FDA approved for this purpose.
Barbara's website can be found here: https://www.umassmed.edu/nutrition/ -
Two guests for you today! The first is Andrew Kornfeld ([email protected] | https://www.facebook.com/andrew.kornfeld.18) who holds degrees in neuroscience and psychology from UCSC and has won awards for his work in science education. He has Crohnâs disease and has been able to achieve clinical drug free remission through a protocol he developed after doing his own extensive research with a lot of trial and error. Andrew is the founder of IBD Coach (http://www.ibd.coach) which offers consulting & educational services for IBD patients to develop their own personalized treatment protocol in coordination with their health and medical team.
My other guest is Lucy Mailing who has a PhD in Nutritional Sciences from the University of Illinois where her research focused on understanding how diet and exercise affect the composition and function of the gut microbiome in states of health and disease. She was recently named an Emerging Leader in Nutritional Sciences by the American Society for Nutrition and has authored several peer-reviewed journal articles related to the gut microbiome and health. Lucy is also a staff research associate for Kresser Institute and writes about evidence-based gut and skin health on her blog at NGmedicine.com. Lucy plans to continue her training and complete her MD at the University of Illinois in 2024.
We had a wide ranging discussion about several topics in IBD including the strengths and limitations of conventional medicines, potential to reform IBD care, health insurance, supplements, dietary therapy, mitochondrial function, candida, Genova testing amongst many other topics. As a disclaimer, I am not endorsing or recommending any of the supplements or protocols discussed in this podcast as they have not been FDA approved to treat Crohnâs or colitis. This is an open discussion and should not be interpreted as medical advice. -
Dr. Michael Briggs is a physicist who had ulcerative colitis which he claims to have "functionally cured" using a system he developed called The Briggs Protocol. He read every article on IBD he could get his hands on and wrote a document called "Understanding the Pathogenesis of Inflammatory Bowel Diseases, and moving towards a 'Functional Cure'" which has been circulating on internet forums. You will learn about his approach to inducing remission, healing the epithelial barrier to stop bacterial translocation and then maintaining the barrier to prevent relapse. We discussed things like bupropion, limitations of the SCD/paleo diet, resistant starch and fiber, butyrate, hydrogen sulfide, fecal transplant, supplements, lectins, wim hof and this is only a fraction of the topics covered. As a disclaimer, I am not endorsing or recommending this protocol for treatment for IBD as it has not been studied in the form of clinical trials and is not FDA approved.
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Dr. Jack Kruse is a practicing neurosurgeon and also a "theoretical quantum biologist." He specifically has an interest in our light environment, circadian rhythm and mitochondria in relation to health and disease.
In my opinion, these are topics that require more attention and research in the context of Crohnâs disease and ulcerative colitis.
This is one of the most high level podcasts I have ever recorded as Dr. Kruseâs knowledge base regarding these topics is unparalleled.
You will hear things in this interview that will make you rethink some of your assumptions about what you think you know about how the human body works. We overall need to do this more often for there to be progress in the treatment of IBD.
Resist the temptation to immediately believe or disbelieve anything that we discussed but actually go into the literature. See for yourself if Dr. Kruse is right. I did this myself on some of these topics..
As a disclaimer, nothing in this podcast should be interpreted as medical advice from my perspective. None of these interventions have been investigated in the context of clinical trials to determine if they affect actual clinical outcomes in IBD. Also increasing sun exposure with IBD, especially while on certain immunosuppressive medications and biologics, comes with the controversial but theoretical risk of skin cancer.
Dr. Kruse's website: https://jackkruse.com
Some referenced mentioned in podcast:
Sun exposure associated with decreased mortality
https://www.ncbi.nlm.nih.gov/pubmed/26992108
Red light therapy as a drug equivalent
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643261/
Cell phone radiation and cancer (NTP study)
https://ntp.niehs.nih.gov/results/areas/cellphones/
EMF as Risk for Disease
https://www.sciencedirect.com/science/article/pii/S0306987719300040 -
Although my training is in evidence based medicine (or what other alternative fields refer to as âallopathic medicineâ), I am fascinated by other disciplines that operate on a completely different understanding of the human body and disease. There is much mystery surrounding Ayurveda in the US, which is the most ancient form of medicine developed in India and still practiced today. There is an inherent paradox here - how can an ancient Indian system of medicine be used to treat Crohnâs and colitis which are diseases that have only been well described relatively recently? Today I spoke with Vikram Chauhan who is an Ayurvedic doctor who practices in India and also the founder of Planet Ayurveda (planetayurveda.com). He has a particular interest in treating inflammatory bowel disease and claims to have an 80-90% âcureâ rate. I obviously was skeptical so we had a detailed conversation about his protocol and experience. I did challenge some of his assertions but overall this was a respectful exchange of ideas. We specifically discuss the cause of inflammatory bowel disease according to Ayurveda and the herbs, diet and lifestyle modifications he recommends to treat it.
As a disclaimer, this is not an endorsement or recommendation of Ayurveda for IBD at this time since there is insufficient evidence published to show efficacy and it is not FDA approved. You must discuss any treatments you decide to use with your doctors. - Laat meer zien
