Conquering Crohn's disease

Judith Lipton, M.D.

(September 2005) — Most Western physicians believe that Crohn’s is an autoimmune disease, the result of an underlying genetic defect and some unknown environmental trigger.

Conventional medical treatment for Crohn’s consists of powerful medicines that suppress the immune system, from aspirin-like compounds that inhibit inflammation in the gut, to steroids, bone marrow-suppressing agents, and chemotherapy regimes that block the body’s inflammatory response. Some Crohn’s patients require surgeries, including removal of the colon.

On the other hand, naturopaths and other alternative medicine providers believe that Crohn’s is caused by diet, and there are many dietary regimes for Crohn’s. Specific carbohydrate restrictions, vegetarian programs, and food supplements such as probiotics to balance the flora of the gut have reasonable scientific validation.

As one might predict, Western doctors dismiss dietary “cures” for Crohn’s and alternative doctors reject the practice of immune suppression. Neither camp is getting very good results. What if they’re both partly right, but for the wrong reasons? What if there’s a definitive way not only to treat Crohn’s, but also to prevent it?

I was diagnosed with Crohn’s Disease in March 2004 and went to four gastroenterologists and two naturopaths over the next seven months without becoming medically stable. Even as an M.D. myself, I wasn’t getting the help I needed. I could barely eat, barely work, and barely get off the couch.

While lying in bed in October 2004 feeling useless and moribund, I happened to read an article by Dr. Saleh Naser in “Lancet,” the prestigious English medical journal, reporting that a bacterium similar to the pathogens that cause tuberculosis and leprosy had been cultured from patients with Crohn’s disease. This pathogen is called Mycobacterium avium subspecies paratuberculosis, or MAP for short.

“Lancet” had published a series of articles about MAP speculating that MAP might cause Crohn’s disease. I contacted one of the authors, Dr. Robert Greenstein, a researcher at the Bronx VA Hospital in New York, and he suggested I contact Professor Thomas Borody, a gastrointestinal (GI) and infectious disease specialist in Australia, for help.

Dr. Borody ran a double-blind clinical trial for Crohn’s disease using antibiotics to treat Crohn’s. He told me that 70 percent of the active patients went into remission. He also offered to help direct my treatment.

By December 2004, with much work, I convinced my local doctors to let me go on these antibiotics, per Dr. Borody’s protocol. Now, seven months later, I have no sign of Crohn’s. I have no sign of inflammation in my body. I can eat whatever I want, and my immune system is normal. I am not taking any immune-suppressing drugs. Because I’m on four antibiotics, I take vast amounts of probiotics. I’m going against the conventional treatment recommended by doctors, betting my life that Crohn’s is caused by MAP.

MAP is a bacterium that infects cows, sheep, goats and other mammals. In meat and dairy animals, it’s well established that MAP causes Johne’s disease, a diarrhea and wasting disease like Crohn’s. Roughly 20 percent of meat and dairy herds in the United States are estimated to be infected with MAP. Even animals raised to strict organic standards may have Johne’s disease. The U.S. Department of Agriculture (USDA) does not require slaughterhouses to inspect the gastrointestinal systems of meat animals, and Johne’s testing is not routine or mandatory.

It could be argued that small farmers using organic methods might be somewhat less likely to have animals with Johne’s disease, because they would be more intimately aware of each animal than a large agribusiness farm. However, most ruminants are not symptomatic before age two, so many would be slaughtered before symptoms develop.

There’s a simple blood test that costs about $40 per animal for MAP, but it’s not entirely reliable, especially in young animals. Johne’s tests are available at Washington State University and the University of Wisconsin.

Here lies the controversy: many scientists now think that Johne’s disease in animals may cause Crohn’s disease in people. MAP may cause both.

Not only is meat suspect, but dairy, too. Normal pasteurization (where milk is heated to 67º C for 15 seconds) was designed to kill the bacteria that cause tuberculosis, but it won’t kill MAP. Only ultrapasteurized milk, heated to 102º C for two seconds, kills MAP. MAP is found in many milk supplies and even in dry infant formula.

While the meat and dairy industry consider Johne’s disease to be a significant problem because it causes herd loss, there’s clearly a disincentive to link Crohn’s and Johne’s. The pharmaceutical industry has little incentive to investigate MAP, because anti-MAP antibiotics are old, mostly off patent, and nowhere near as profitable as newer immune-suppressing drugs.

In my opinion, MAP is a much bigger public health problem than mad cow disease. An estimated 500,000 Americans have the disease and up to 30 percent of all newly diagnosed cases are in children and teens under the age of 18.

For those of you who have suffered from Crohn’s disease, or know someone else who has, I wish I could recommend a local doctor. Unfortunately, I don’t know any GI doctors in the Northwest studying MAP. Dr. David Graham at Baylor University in Texas and Dr. Ira Shafran in Florida are doing studies, but not the quadruple antibiotic protocol that Dr. Borody recommends.

An empowered patient has to convince his or her doctor to read the literature, just as I had to convince my own doctors. Even today, when I talk to my GI physician, he is interested but skeptical.

All I can do is refer people to Dr. Tom Borody in Australia, www.cdd.com.au, to Dr. Shafran of shafran.net/crohn/ and to Web sites such as http://www.crohnscureforkids.com/.

You can read about Johne’s disease at paratuberculosis.org and the University of Wisconsin Johne’s Program, johnes.org. Search scholar.google.com for MAP and Crohn’s to find the original articles.

I believe that if the public becomes aware of MAP and demands testing and answers, the meat, dairy and medical industries will have no choice but to respond. Public health measures such as ultrapasteurization, animal vaccination and sanitation may prevent an increasing Crohn’s epidemic, and antibiotics and vaccination a definitive treatment.

Dr. Lipton is a psychiatrist at Providence Hospital in Seattle. She was the founder of the Washington Physicians for Social Responsibility, and she served on the PCC Board of Trustees. She may be contacted at 206-320-4404, or drlipton@gmail.com